IBEW- Effective July 1, 2010
IBEW- Effective July 1, 2010
Dear Flexible Benefits Plan Participant,
This Summary Plan Description (SPD), along with other documentation provided by carriers, provides detailed information about the health and welfare benefits provided by Vought
Aircraft Industries, Inc. to its employees. We encourage you to utilize these documents to help you understand the provisions of the plans offered by Vought Aircraft, in particular, those plans which you and your dependents may be enrolled. Please keep this SPD and other documentation handy for future reference.
As you read through this SPD you will see that is it broken into sections related to a particular plan option, such as medical or dental, for easy reference. Each section describes the benefit options available under a plan, eligible and in-eligible expenses, and contact information for each provider or carrier. At the back is a glossary of commonly used terms.
By reading this SPD Vought hopes that you can become a more informed health care consumer. This will enable you to be better prepared to make cost effective decisions regarding services you and your dependents utilize under each plan. Health and welfare plans represent a significant cost to the organization. Your support in helping us to control costs as much as possible is appreciated.
At the back of this document you will find information about Continuation of Coverage Rights
(COBRA), your rights under the Employment Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). Each of these laws provides protection to you regarding your benefits. Vought Aircraft encourages you to read these sections.
If you have a question regarding your benefits we encourage you use this SPD along with documents provided by providers, such as an Evidence of Coverage or Certificate of
Insurance, to determine the answer. The Vought Benefits Center is available Monday through Friday from 8 a.m. to 4:30 p.m. Central time if you have further questions. The contact number for the Vought Benefits Center is 866-689-5999.
Sincerely,
DarabDenise_Sig.doc
Denise Darab
Manager, Benefits
IBEW- Effective July 1, 2010
Aircraft Industries, Inc. (“the Company”) and any employee. Nothing in this booklet prevents the Company from terminating or changing the terms of any employee’s employment. The
Flexible Benefits Plan is expected to be continued indefinitely. However, the Company reserves the right to amend, suspend, or terminate the Plan at any time. T
The self-insured health and welfare benefits provided under the Flexible Benefits Plan are described in detail in this document. The insured benefits provided under the Plan are described in detail in the Certificates of Coverage, Evidence of Coverage booklets or subscriber contracts through which those benefits are provided. Those separate documents are considered part of and must be read together with this Summary Plan Description, which contains the Plan rules regarding eligibility, participation, costs, and administration and other important information regarding the Plan that applies to the benefits described in those certificates and contracts.
IBEW- Effective July 1, 2010
IBEW- Effective July 1, 2010
IBEW- Effective July 1, 2010
This document describes the benefits, terms and conditions of the Flexible Benefits Plan (“the Plan”), which is offered to eligible non-represented employees of Vought Aircraft Industries, Inc. There may be other documents that are part of the official Plan documents and which legally govern the operation of the Plan. If there is any conflict between the official Plan documents and other documents relating to health and welfare benefits, the Plan documents will govern.
The Plan Administrator has the sole and absolute discretion to interpret and construe the terms of the
Plan and to resolve any ambiguities in the Plan. The Plan Administrator can act through a delegate.
During normal working hours, you can review the annual report of the Plan’s operations and the Plan documents under which the Plan is established or operated. These documents are available from the
Plan Administrator. You can also write to the Plan Administrator and ask for copies of any or all of these documents. They will be furnished at a reasonable charge within 30 days of receipt of the written request.
Benefits under the Plan are an important part of your total compensation at Vought, adding significant value to your compensation package. Our benefits program is designed to be competitive in our industry and in our job markets – part of the corporate strategy to create a work environment that establishes us as a Best Place to Work. Our benefits program has numerous options with choices to help meet your personal and family needs.
Our ability to offer competitive health and welfare benefits is a cooperative effort between you and the company. Because of Vought’s purchasing power, we are able to negotiate cost-effective coverage for you and your family. Although the company pays the major portion of the cost of your benefits, you pay a part of the total cost of your coverage. However, your cost to participate in the Vought Aircraft
Plan is generally significantly less than you would pay for comparable individual coverage.
In addition to this summary, you have two other excellent resources for benefit information:
The Vought Benefits Center. You can reach the Benefits Center; toll free, at 1-866-689-5999
Monday through Friday from 8 a.m. to 4:30 p.m. Central time. When you call, you may use your touch-tone phone to select from a menu of choices. One of your choices is to speak with a benefits representative, a Vought Aircraft employee trained and dedicated to providing you with prompt, accurate benefit information and services.
The Vought Benefits Web Site: Vought Aircraft's Intranet/Internet site provides quick access to information and benefit forms. The Web address is http://benefits.voughtaircraft.com.
IBEW- Effective July 1, 2010 1
You are eligible for the benefits described in this plan summary if you are a full-time employee of
Vought Aircraft Industries, Inc. who is covered by the bargaining agreement between the Company and the IBEW Local 20 and you are a United States citizen or legal resident.
If you are eligible for the Vought Aircraft Industries, Inc. Flexible Benefits Plan, you may also cover your eligible dependents under the program.
Eligible dependents include:
Your legally recognized spouse
— This definition includes your common-law spouse if your state of residence recognizes commonlaw marriage and you provide a Declaration of Informal Marriage or a common-law affidavit to the company.
— This definition does not include your spouse if you are legally separated or divorced, even if the separation agreement or divorce decree states that health coverage must be provided. If the court orders you to provide coverage for your legally separated or divorced spouse, you must arrange for coverage on your own.
Your children, including:
— Your natural and adopted children, regardless of where they live.
— Stepchildren who live with you in a regular parent-child relationship.
— Children who are placed with you for adoption under age 18.
— Children for whom you have legal guardianship issued by a court of law.
— A minor child who qualifies as a dependent under the Internal Revenue Code.
— Children who are unmarried and under age 19, or under age 25 and a fulltime student.
Your child is considered a fulltime student if he or she is enrolled in 12 or more hours of a regular curriculum that leads to a diploma or degree at an accredited high school, technical school, college or university.
A temporary reduction in credit hours after the semester starts does not result in a change in status unless your child is no longer enrolled in a qualified program as described here. Your child is considered a fulltime student if he or she was enrolled for the prior semester, unless your child secures a fulltime permanent job, gets married, does not enroll when school resumes or is no longer supported by you.
NOTE: Eligible dependents do not include anyone who is a member of the armed forces of any country, including the United States Armed Services.
Age requirements for qualified children can be waived if your child is disabled. Normally a child between the ages of 19 and 25 must be a full time student in order to be covered under the Plan.
Disabled children may not be required to meet these requirements if all of the following provisions are met:
The child was covered or was eligible for coverage under the Plan while under age 19
The disability occurred before age 19 or the disability occurred between age 19 and 25 and the child was a full-time student as described above
The child is unmarried and unable to earn a living because of the disability
You are able to claim the child as a dependent on your Federal income tax return in accordance with IRS regulations.
A disabled dependent may not be eligible for coverage unless all the above provisions are met.
IBEW- Effective July 1, 2010 2
If both you and your spouse work at Vought Aircraft Industries, Inc. or certain of its subsidiaries, you have the following options regarding health coverage:
One employee may elect coverage for their spouse and qualified dependents. o The other employee waives coverage. The employee who waived medical and/or dental coverage is not eligible for weekly Opt Out Dollars.
Both employees may elect coverage for themselves and qualified dependents o Qualified dependents may only be covered by ONE employee’s medical or dental plan option. Dependents cannot be covered by both employee’s medical or dental plan option.
Both employees may elect to waive medical and/or dental coverage. o Both employees will be eligible for weekly Opt Out Dollars.
In many instances, the spouse of a Vought Aircraft employee has the opportunity to enroll for group medical coverage through his or her employer. If your spouse's employer pays 50% or more of the cost of medical coverage, Vought Aircraft requires your spouse to enroll in their employer’s coverage. This rule applies even if your spouse's employer offers only one option, such as a health maintenance organization.
After your spouse is enrolled in their employer’s plan, you may also elect to enroll your spouse in
Vought’s plans and pay the associated weekly premium contribution. If you elect to enroll your working spouse in Vought Aircraft Industries, Inc.’s medical plan, you must annually certify your spouse’s eligibility under the terms of the Plan.
If you elect to enroll your spouse in Vought’s plans in addition to their employer’s plan, your spouse will have dual coverage. With dual coverage, your spouse’s medical plan is primary and will pay for benefits in accordance with their plan’s provisions, and then Vought Aircraft’s plan will pay secondary for remaining expenses in accordance with our plan’s provisions.
The claim for your spouse’s medical care must first be submitted to his or her employer’s plan as the primary payer. Once you receive an explanation of benefits (EOB) from your spouse's plan (reflecting either the amount of payment or a denial), you can submit the EOB along with your claim to your
Vought Aircraft benefit claims administrator for reimbursement as a secondary payer.
For example, if your spouse's plan is an HMO but your spouse goes to a non-HMO doctor, in most cases the HMO would deny the claim. However, you can submit both the claim and the EOB to your Vought
Aircraft Industries, Inc. medical plan provider for reimbursement under the terms of the Plan.
Please see the Non-Duplication of Benefits section for more information on dual coverage and Primary vs. Secondary coverage.
In such a case, you have three options for covering your retired spouse:
While you are an active employee, your spouse may be covered as your dependent under your medical and dental plan options in the Flexible Benefits Plan.
You can waive coverage and your spouse can cover you as a dependent under one of the retiree health care plans, if available.
You can be covered under the active medical and dental plan options and your spouse can be covered under his or her retiree medical plan option.
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You and your retired spouse may only be covered by one Vought Aircraft Industries, Inc. plan. If both you and your spouse are eligible to enroll for optional benefits and one of you covers the other as a dependent, you are not eligible for weekly Opt Out Dollars.
As a retiree of another company your spouse may be eligible for health benefits from their previous employer. In addition to benefits from their previous employer, you may elect to enroll your retired spouse into Vought’s plan. Depending on their age, your retired spouse may have coverage under
Vought’s plan, their previous employer, and Medicare. The chart below illustrates how payment of your spouse's benefits will be coordinated depending upon their age:
If your spouse is... Vought’s active medical plan pays
Your spouse’s retiree medical plan option pays...
Under age 65 First Second
Medicare pays...
Not applicable
Second Over age 65 or
Medicare eligible
First Third
If, after termination, you are rehired or recalled and return to Vought Aircraft Industries, Inc. employment within the same benefit plan year, your previous benefit elections for the benefit plan year will be reinstated (subject to eligibility rules and any intervening qualified life status changes) effective on your rehire or recall date. You will also be credited with the amount you paid toward your deductibles prior to separation if you return in the same benefit plan year.
If you are rehired or recalled and return to employment in a new benefit plan year, you will be given an opportunity to re-enroll for benefits as through you were a new hire, and your deductibles will start over. Any amounts the Plan has paid toward your annual or lifetime maximums before your Vought
Aircraft Industries, Inc. employment ended will count toward those limits.
When your domestic or foreign country assignment begins, call the Vought Benefits Center at 1-866-
689-5999. A representative will research your situation and give you information on how your benefits are affected and how to submit claims.
If you transfer jobs and move out of your plan provider’s service area, you will receive a benefit package based on your new ZIP code. You and your family may then select new health care benefits based on your new address of record within 31 days of the transfer. When you move, it is important that you change your address in the company Human Resources system of record.
You might have eligible dependents living away from home, such as a child who is away at college.
Here are the rules for coverage of those dependents:
EPO – If you participate in an exclusive provider organization (EPO), your dependent must participate in the national provider network. Your dependent will not be covered if they
receive treatment from a provider outside of the EPO network. However, in cases of an emergency, your dependent will be covered until they are stable and can be moved to a network provider nearby.
IBEW- Effective July 1, 2010 4
PPO – If you elect one of the preferred provider organization (PPO) options, your dependents can visit a physician in the PPO network anywhere in the nation and receive reimbursement at the higher in-network benefit level. If your dependents receive care from an out-of-network provider, reimbursement will be paid at the out-of-network level.
While you are on leave from the company, you are required to contribute for certain benefits. Your contributions will continue through automatic payroll deductions as long as you are receiving a paycheck. If you are receiving a disability check under this Plan during your leave, the disability claims administrator will deduct and remit your benefit premiums on your behalf. If you have waived medical and/or dental insurance, you will also still receive the opt-out credit in your paycheck.
If you are not receiving a paycheck or disability check while on leave, to ensure continued coverage you must pay for your share of benefits costs. In general, this is done by writing a personal check to
Vought Aircraft Industries, Inc.
Send it to:
Attn: Payroll Department, M/S 220-24
Vought Aircraft Industries, Inc.
P.O. Box 655907
Dallas, TX 75265-5907
Failure to make these payments in a timely manner may result in loss of coverage. In some circumstances, the Company may make other arrangements, including creating arrears that can be repaid when your paychecks resume. It is your responsibility to discuss with your leave administrator or a benefits representative payment arrangements to avoid loss of coverage during your leave.
During an approved leave of absence, your benefits generally will continue as long as you comply with the requirements of the leave and continue paying your benefits contributions, subject to applicable company rules regarding maximum time on leave (check with your leave administrator to find out the applicable rules). You may elect changes to your benefits during open enrollment while on leave; however, some changes, such as increases in life insurance benefits, will not take effect until you have returned to active work. If benefits are discontinued during your leave, they will be reinstated when you return to work, assuming you continue to meet eligibility requirements for coverage. If benefits are discontinued during a leave you may be eligible to purchase coverage at your own cost under
COBRA. If a new plan year has begun, you will need to select new benefit options upon your return if you did not participate in open enrollment.
The Vought Aircraft Flexible Benefits program includes two types of benefits – basic benefits provided at no cost to you, and optional benefits for which you must enroll yourself and any eligible dependents you wish to cover.
Basic benefits apply only to you and you are enrolled in them automatically. The following are the company-provided basic benefits:
Basic life insurance
Basic accidental death and dismemberment (AD&D)
Employee assistance program (EAP)
Business travel accident insurance
Your benefit program also allows you to purchase – through weekly payroll deductions – other benefits for yourself and your family. These are called optional benefits, and you and Vought Aircraft Industries,
Inc. share the cost of these benefits. You must make an election to receive optional benefits. If you do not make a positive election for these benefits during New Hire Enrollment, within the required time period, coverage will automatically default to waive and you will not be eligible for benefits under the
Plan for you or your eligible dependents.
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For most benefits there are two enrollment periods when you can elect coverage: the first is when you are hired and the other is during the Annual Open Enrollment period. The following paragraphs describe what you must do to enroll for benefits in each situation.
As a new employee, you will receive information about your benefit options as part of the New Hire
Orientation process. Your enrollment materials will describe the benefits available to you and your family and the cost of those options. You must enroll yourself and any eligible dependents in the benefit options within 31 calendar days of your hire date. Your benefit elections will then be effective retroactive to your hire date for both you and your enrolled dependents. You must provide the required documents to substantiate your dependents’ eligibility for coverage within the 31 day enrollment period
If you do not enroll within the 31 day new hire enrollment period, you will be covered by basic benefits only. If the required documentation substantiating dependent eligibility is not received during the 31 day new hire enrollment period, dependents will not be eligible to enroll in optional benefits.
If you waive coverage or do not enroll during the new hire enrollment period, you may be eligible to enroll for benefits during the next Annual Open Enrollment. You may be required to provide evidence of insurability for certain benefits for you and your dependents that is may not be required if you had enrolled during the New Hire enrollment period.
If you do not enroll for optional benefits, for example medical, dental, or optional life insurance, during the New Hire enrollment period, your coverage will default to Waive and neither you nor your dependents will be enrolled in optional coverage for that plan year. The next opportunity you will have to enroll in optional benefits will be during the next Annual Open Enrollment.
Each year you have a specific period of time when you have an opportunity to reassess your benefit choices and make changes. This period is called Annual Open Enrollment. Any changes you make take effect on July 1 st , the start of the benefit plan year.
Prior to Annual Open Enrollment, Vought Aircraft makes information available about enrolling for optional benefits and your share of the costs for the new plan year. Benefit options and your share of the cost may change from year to year, so it is important to review your Annual Enrollment materials each year and act promptly if you want to make changes in your coverage.
If you do not want to make any changes to your current elections, you do not need to do anything.
You will stay enrolled in your current elections for the next plan year. You cannot make any benefit changes unless you experience a qualified change in status. Please see the “Changing Your Coverage
During the Plan Year” section in this document for more information.
When you elect your optional benefits, you also elect your coverage category and specifying the dependents you want to cover. You can choose from the following categories:
Employee only
Employee + child(ren)
Employee + spouse
Employee + family (employee, child[ren], and spouse)
Waive Coverage.
IBEW- Effective July 1, 2010 6
Each benefit option has a cost associated with it: a cost shared by you and the company. Your share of the cost of the benefit is deducted from your pay each pay period.
Generally, the higher the level of coverage you choose, the higher the cost. Your share of the cost for coverage varies, based on your coverage category.
There are certain benefits the Internal Revenue Service allows you to purchase on a before-tax basis and others you must purchase on an after-tax basis.
Before-tax contributions pay for medical and dental coverage, optional AD&D insurance, Health Care and Dependent Care Flexible Spending Accounts. After-tax contributions pays for optional life insurance for yourself, optional life insurance for your spouse, optional life insurance for your child(ren), and group legal.
When you purchase benefits with before-tax dollars, you pay for your coverage before federal and
Social Security taxes are deducted from your paycheck – and, at some locations, before state and local taxes are withheld. In other words, you pay for these benefits with tax-free money. This tax-free payment method can lower your taxable income, which then lowers your tax liability and increases your take-home pay. However, the tax savings also mean you may pay less into Social Security, and your
Social Security benefit could be slightly reduced.
Under IRS rules, a qualified change in status allows you to make changes in benefit elections that you purchase with before-tax dollars. These include medical, dental, optional AD&D insurance, and Flexible
Spending Accounts. Any changes to your benefits elections must be consistent with the type of status change you experience.
For your benefit elections that are paid for with after-tax dollars such as optional life insurance for you, your spouse, or child(ren), or group legal coverage, you may add or change your election coverage at anytime. You may, however, be subject to evidence of insurability requirements according to the rules of each policy.
To make changes to your coverage for medical, dental, optional AD&D insurance, Health Care and
Dependent Care Flexible Spending Accounts, you will need to logon to the enrollment system and use the Life Event Transactions Tool. This tool will automatically update your coverage, inform insurance carriers of the change and provide a confirmation of the change. After you have completed the tool, you may need to provide copies of documents that substantiate the change in life status to the Vought
Benefits Center or your local benefits representative. Some of the examples include:
Final court orders
Birth certificate
Marriage License
Adoption Papers
Current registration to a College or University for a dependent age 19 to age 25
Mail copies of applicable documents, internally, to Benefits, Dallas, M/S 2-52 or, externally, to:
Vought Aircraft Industries, Inc.
Benefits, M/S 2-52
P.O. Box 655907
Dallas, TX 75265-5907
Do not send original documents. They will not be returned.
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Should you have any questions regarding the required forms or how to use the online tool, please contact the Vought Benefits Call Center or see your local benefits representative.
The Plan Administrator assesses your situation and determines if your change is a qualified change in status as defined by the Internal Revenue Service. Qualified changes in status apply to your before-tax benefits only (medical, dental, Flexible Spending Accounts, and optional Accidental Death &
Dismemberment insurance).
To make changes in your before-tax benefit options, all three of the following must occur:
You experience a qualified change in status as defined by the IRS (see the following list for common examples)
Your change in status causes a gain or loss of eligibility in Vought Aircraft Industries, Inc. Flexible
Benefits Plan, your spouse’s plan option, or the plan of your dependent’s employer
Your new election corresponds to the gain or loss of coverage (for example, if you have a baby or get married, you can change your coverage category to add your new dependent).
The following are qualified changes in status:
Marriage, divorce or annulment;
Birth, adoption or placement for adoption of a dependent child;
Death of your spouse or dependent child;
A change in the employment status of you, your spouse or a dependent, including commencement or termination of employment, a strike or lockout, the commencement of or return from an unpaid leave of absence or a change in worksite;
A change in the employment status of you, your spouse or a dependent such that the affected individual becomes or ceases to be eligible under Vought’s program or another employer’s benefit plan;
A change in eligibility, such as your spouse’s enrolling in their employer’s plan during annual enrollment or when a dependent ceases to satisfy the requirements for coverage due to attainment of age, change in employment status, fulltime student status change, or similar event;
You or your dependent move out of the geographical coverage area for your current medical plan option;
Significant changes in cost or coverage options, as determined by the Plan Administrator;
Eligibility/ineligibility for Medicare or Medicaid/MediCal of you or a dependent;
Entry/expiration of a judgment, decree or order that requires you to cover a child under one or more options under the Vought Aircraft Flexible Benefits Plan. (The child will be added to your coverage and your contributions will be automatically increased as necessary to provide that coverage. If medical or dental coverage is ordered to be provided for your child under another group health plan pursuant to a judgment or court order, you may revoke your election of coverage for that child only if the child actually becomes covered under the other group health plan);
A change in the number of qualifying dependents for the purposes of increasing or decreasing the contribution amount for the dependent care flexible spending account.
Any other changes allowed by IRS regulations.
In addition, “HIPAA” (the Health Insurance Portability and Accountability Act of 1996), a federal law, allows you to enroll yourself and new dependents in optional benefits when you acquire a new dependent if you have previously waived coverage or when you or your dependents experience a loss of other group health coverage under certain circumstances. For more information about HIPAA special enrollment rights, please see the section entitled Special HIPAA Enrollment Period in this Summary Plan
Description.
If you experience one of these events, you may change or revoke one or more of your elections under the Plan for the remaining portion of the year by contacting the Vought Benefits Center. Any changes in your benefit elections must be made within 31 calendar days of the event and the benefit election
IBEW- Effective July 1, 2010 8
must be consistent with that change. A change in benefit elections is consistent with a status change if the change affects eligibility for coverage under the Vought plan or under a similar plan in which your spouse or dependent participates. Further, if you have a new dependent as a result of a marriage, birth, adoption or placement for adoption, enrollment is available for yourself and all of your family members (not only for the new dependent). For family status changes as a result of birth, adoption or placement for adoption, coverage will be effective retroactive to the date of birth, adoption or placement for adoption if you submit your enrollment request within the allotted time. For family status changes as a result of marriage, coverage will be effective retroactive to your marriage date if you submit your enrollment request within the allotted time.
If the cost of a coverage option significantly increases or decreases, you may be able to change your elections for the remainder of the year. Permitted changes include enrolling in a benefit option if the cost of that option decreases during the year. If costs increase, you may revoke your election for a benefit option and elect another option that provides similar coverage, or you may drop coverage if no option is available. If coverage under a plan option ceases or is significantly curtailed during the year, you may be allowed to make a new coverage election for the remainder of the year, but you will not be able to change the number of dependents covered under the original election unless there is also a change in status. Similarly, if a plan option is added or benefits under an existing option are significantly improved during the year, you may elect the new or improved option for the remainder of the year. The cost and coverage changes described in this paragraph do not apply to the Health Care
Flexible Spending Account.
In regards to the Dependent Day Care Flexible Spending Account, a significant increase or decrease in expenses eligible for reimbursement is a qualified status change allowing you to increase or decrease your weekly election.
Soon after you enroll in the Vought Aircraft Industries, Inc. medical plan, you will receive an identification card from Blue Cross Blue Shield or Cigna HealthCare for your medical coverage. You may receive a separate card from Caremark for prescription drug coverage.
If you enroll in the Vought Aircraft Industries, Inc. dental plan option with Delta Dental or CIGNA
Dental Health you will receive an identification card shortly after enrollment.
Typically, you receive a card for each of your enrolled family members. However, your name – not your covered dependents’ – may appear on all cards. Your dependent(s) should present the card to providers and pharmacies. If you need additional cards, call the customer service department at Blue
Cross Blue Shield, Cigna HealthCare, Caremark, Delta Dental or CIGNA Dental Health. The telephone numbers are available on the benefits Web site under “Service Providers” or you may call the Vought
Benefits Center and select your provider from the telephone menu.
Your medical, dental and drug plan identification cards contain your group number and other administrative information for you and your health care providers to use in accessing services and filing claims. Present your card to your doctor, dentist or other health care provider when you seek health care.
The card provides information about your eligibility, and the claims administrator's address for submitting claims. If you have recently changed medical or dental plans and have not received a new card or don’t have lost your card, you may have to pay for services and submit a claim for reimbursement. In an emergency, seek immediate care. At the earliest opportunity, but within 72 hours, call the customer service number of the provider or ask someone to call on your behalf.
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You may select medical coverage within 31 calendar days after the date you are hired, during the
Annual Enrollment period, or within 31 calendar days of a qualified change in status.
The following choices for health care coverage are available to covered employees as of July
1, 2010 (except as noted below):
The Healthcare Essentials (PPO) option provided by Blue Cross Blue Shield of Illinois
The BlueEdge HSA (PPO) option provided by Blue Cross Blue Shield of Illinois
The Healthcare Solutions (PPO) option provided by Blue Cross Blue Shield of Illinois
The Open Access Plus (EPO) plan provided by Cigna HealthCare
No coverage, if you waive the Vought Aircraft Industries, Inc. medical plan or fail to make an election as noted under the section entitled ”New Hire Enrollment”.
The Plan may make changes, additions or deletions to the available options from time to time. Affected participants will be notified of these changes if they are made.
The following pages describe features of the PPO and EPO options.
If you do not want medical coverage or you have coverage from another source, you may choose to waive the Vought Aircraft medical plan options altogether. If you make that choice, neither you nor your eligible dependents will have medical, prescription drug, vision, hearing or mental health and substance abuse benefits through Vought Aircraft optional benefits. However, you may still receive benefits under the employee assistance program (EAP). You may be eligible for Opt Out Dollars (see the section entitled “Coverage for Working Spouses” for exceptions).
Blue Cross Blue Shield of Illinois is the Claims Administrator for the Healthcare Essentials,
HealthcareSolutions PPO, BlueEdge HSA PPO, Premium PPO, and BlueEdge HRA PPO plans. These plans feature a network called a Preferred Provider Organization (PPO). The network is a group of physicians, hospitals, labs and other health care providers who agree to treat plan participants at a specified discounted rate and meet the quality standards of the claims administrator. Each provider agrees to:
Undergo an extensive quality screening process
Comply with Blue Cross Blue Shield's quality measures and protocols
Provide care at discounted rates.
The PPO network includes providers in all states. PPO networks may also be available outside the
United States. To determine if a provider is in-network contact Blue Cross Blue Shield at 1-888-979-
4514. After you pay the benefit plan year deductible, Vought’s PPO plans typically pay 80% - 90% of your in-network eligible medical expenses.
There are important differences among the PPO plans. The main differences are the following:
Office visit co-pays are required under the Healthcare Essentials PPO, Healthcare Solutions PPO, and Premium PPO
The deductible amounts and out-of-pocket maximums may vary under each plan option. These amounts are established annually and communicated during open enrollment.
The BlueEdge HSA PPO option is a high deductible health plan option coupled with a Health Savings
Account. Under the BlueEdge HSA PPO option, you will have:
A Health Savings Account (see the section entitled “Health Savings Account”)
A significantly higher deductible
More out-of-pocket costs
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The BlueEdge HRA PPO option is a high deductible health plan option coupled with a Health
Reimbursement Account (HRA). This option features a significantly higher deductible as well as an HRA from which you can receive reimbursement for qualifying expenses.
Cigna HealthCare is the Claims Administrator for the Open Access Plus plan, which is an Exclusive
Provider Organization (EPO). The Open Access Plus plan contains a network of physicians, hospitals, and other health care providers who meet Cigna HealthCare’s quality standards. Cigna Healthcare providers agree to:
Undergo an extensive quality screening process
Comply with Cigna HealthCare’s quality measures and protocols
Provide care at discounted rates.
The Open Access Plus network includes providers in all states. Providers may also be available outside the United States. To determine if a provider is available, contact Cigna HealthCare at 1-800-244-6224.
The Open Access Plus EPO plan comprises of a schedule of various co-payments relating to various network eligible medical expenses.
What are some of the differences in the EPO plan options versus the PPO plan options?
The main differences are that under the EPO plan options:
There are no deductibles.
Co-pays are required, but there is no co-insurance.
You do not have access to out-of-network providers.
Under the PPO plan options there are two levels of benefits: in-network and out-of-network. Each time you or an enrolled family member needs medical care, you can decide whether to use a health care provider who is part of Blue Cross Blue Shield's network (from an in-network provider) and receive in-
network benefits. The PPO plan options pay a higher level of benefits when you receive services from an in-network provider. The Cigna Open Access Plus EPO plan option does not have coverage outside of the network; therefore, the provider must be in-network except in emergency situations.
Under the PPO plan options, you may visit any doctor, hospital or ancillary provider for lab or X-ray services outside the network and receive out-of-network benefits. That means you pay a higher deductible and co-insurance, and you may be responsible for expenses above the usual, reasonable and customary charge. When you receive care from an out-of-network provider, these medical plan options pay a lower percentage of eligible expenses, which is a lower percentage of usual, reasonable and customary charges after you have met the deductible.
These are the Plan networks:
Medical
— Blue Cross Blue Shield PPO
— Cigna HealthCare Open Access Plus EPO
Prescription drugs
— Caremark participating pharmacies
— Prime Therapeutics participating pharmacies (if enrolled in BlueEdge PPO or BlueEdge HSA)
Mental health and substance abuse treatment
— Value Options
— Cigna HealthCare (if enrolled in the Open Access Plus plan)
— Blue Cross Blue Shield (if enrolled in BlueEdge HSA)
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The PPO and EPO plan options allow you to visit Blue Cross Blue Shield PPO or Cigna EPO network providers in other states and receive in-network coverage. If you do not visit a PPO network provider, you receive out-of-network benefits, which are subject to usual, reasonable and customary limits on charges. If you visit a provider outside of the EPO network you will not be covered. Please see the
Access to In-Network Benefits section or the EPO Plans section for more details on the EPO network.
The final decision on all medical care always remains with you, your family and your physician. If you and/or your physician do not agree with the claims administrator’s adjudication, you may continue your course of treatment (or any other treatment you choose). However, your medical plan option may limit or deny payment of your medical expenses and you may pay more of the cost.
Each time you need medical care, if you are enrolled in a Vought Aircraft Industries, Inc. medical plan option administered by Blue Cross Blue Shield, you decide whether to use an in-network or an out-ofnetwork provider. Because Blue Cross Blue Shield administers a large network of providers, you should be able to locate an in-network provider if you want to receive in-network care. An in-network provider
(such as a physician, hospital, or laboratory) is a health care provider that enters into a contract with an insurance carrier or claims administrator to provide care at a specified discounted rate.
You will receive out-of-network benefits when you visit an out-of-network provider. Out-of-network benefits are benefits you receive when you use a health care provider who is not an in-network provider. Typically, you pay more out-of-pocket when you use an out-of-network provider. If there are no network providers within 50 miles of your location you will receive benefits at the in-network benefit level, including costs that exceed the Usual, Reasonable, and Customary (URC) limits.
However, coordination with the Blue Cross Blue Shield Customer Service unit must be contacted prior to your visit. You can contact Blue Cross Blue Shield at 1-888-979-4514. If you live outside the United
States, call Blue Cross Blue Shield at 1-888-979-4514.
Under the PPO plan options, you receive in-network benefits whenever you visit a network provider. Visit the Blue Cross Blue Shield Web site for more information. The Internet address is www.bcbsil.com.
You are not limited to Blue Cross Blue Shield network providers in your state, and you can receive care from any Blue Cross Blue Shield network provider in any state in the United States.
You can visit any network physician, specialist or facility of your choice and receive in-network benefits. However, it is your responsibility to ensure that network providers treat you. Do not
assume that your physician referred you to a network provider.
There is no out-of-network benefit for the Open Access EPO plan through Cigna. All services must be obtained from an in-network provider in order to be eligible for coverage by the
Plan.
Usual, reasonable, and customary (URC) charges are the "going rate" for services in your geographic area. The Vought Aircraft Industries, Inc. claims administrator determines the URC charge for all services covered under the Vought Aircraft medical plan options. As long as you use an in-network provider you do not need to worry about charges over the URC charge. You will not be billed for any expenses above URC if you use an in-network provider. This is not the case if you use an out-ofnetwork provider. When your expenses exceed the URC charge with an out-of-network provider, your medical plan pays eligible expenses based on the URC charge. You are responsible for paying 100% of the fees over the URC charge.
A deductible is the amount of money you pay before your medical plan option begins to pay any of your eligible medical expenses, unless otherwise stated. All of our PPO plan options with Blue Cross
IBEW- Effective July 1, 2010 12
Blue Shield have a deductible. The EPO plan option with Cigna Healthcare does not have any deductibles. At the beginning of each benefit plan year, a new annual deductible begins. Expenses credited to your deductible in one year do not carry over to the next. A benefit plan year runs from
July 1 st to June 30 th and includes all expenses incurred.
There is no deductible for the following expenses under any of the Vought Aircraft Industries, Inc. medical plan options:
Hearing care
Vision care
The cost of wigs to the extent covered by the Plan if prescribed by a physician for medical reasons
Preventive care
These expenses do not count toward your benefit plan year deductible under the Healthcare Essentials
PPO, Healthcare Solutions PPO, BlueEdge HSA PPO, and Premium PPO plan options:
Co-payments for Office Visits, Prescription Drugs, and/or Wellness
Expenses that exceed the URC charge, as determined by the claims administrator
Any pre-certification penalties you incur
Penalties for out-of-network hospital visits
Charges for prescription drugs through Caremark, Prime Therapeutics, or Medco
Charges that exceed any benefit plan year maximum
Charges for mental health and substance abuse treatment (except for BlueEdge HSA)
Ineligible expenses, such as cosmetic or experimental procedures
A family deductible is the deductible that is satisfied by the combined expenses of all enrolled family members. You can combine eligible expenses of any two or more enrolled family members during a benefit plan year toward meeting the annual family deductible. However, the most you can count from any one family member is the maximum annual deductible for one person under your medical plan
(except for BlueEdge HSA, in which a single family member’s expenses can satisfy the entire family member deductible).
When an in-network provider charges you for an office visit, you make a co-payment directly to the provider (except for BlueEdge HSA and BlueEdge PPO, which do not have co-payments). A co-payment is a fixed dollar amount depending on the type of service provided.
The amount of the co-payment varies. You will generally make lower co-payments to primary care providers, such as:
Family Practitioner
General Practitioner
Internal Medicine Specialist
Pediatrician
Obstetrician/Gynecologist (OB/GYN)
Chiropractor
You will pay a higher co-payment when you see a specialist (except as noted for a specific plan option).
You pay a co-payment every time you visit a provider, regardless of the number of times in a benefit plan year you may visit. Co-payments do not apply to your deductible or out-of-pocket maximum
(except as noted for a specific plan option).
After you meet the benefit plan year deductible, the PPO plan options pay a percentage of your eligible expenses after the co-payment is deducted; you pay the remaining share of that amount. The amount
YOU pay is called "co-insurance," because you share the cost of eligible expenses with the Plan. Coinsurance amounts apply to your out-of-pocket maximum.
IBEW- Effective July 1, 2010 13
After you meet your annual deductible, PPO plan options pay 80-90% of eligible expenses in-network; you pay 10-20% in addition to any co-payments.
After you meet your annual deductible, PPO plan options pay 50-60% of the URC charge for eligible expenses out-of-network. You pay 40-50%, plus any charges that exceed the usual, reasonable and customary charges as determined by the claims administrator in addition to any co-payments.
Note: If you live outside the United States, a provider network may not be available to you. If no network provider is available, your benefit will be paid as in-network, but you will be responsible amounts in excess of the allowed amount.
The out-of-pocket maximum is the most you pay during a benefit plan year. It is the sum of the amounts you pay towards the deductible, co-payments and/or co-insurance. After you reach your outof-pocket maximum, your medical plan option pays 100% of eligible expenses for the rest of the benefit plan year. Expenses credited toward your out-of-pocket maximum do not carry over from one benefit plan year to the next.
Under the PPO plan options , there are separate out-of-pocket maximums for in- and out-of-network care. In-network expenses count only toward the in-network maximum. Out-of-network expenses count only toward the out-of-network maximum. That means, if you receive both in- and out-ofnetwork care under the PPO options, you may need to meet two out-of-pocket maximums before the option pays 100% of your eligible expenses.
These expenses do not apply toward your out-of-pocket maximum:
Co-payments (Excluding the Open Access Plus EPO with Cigna HealthCare)
Charges that exceed any benefit plan year maximum
Ineligible expenses, such as the cost of cosmetic or experimental procedures
Charges for prescription drugs through Caremark or Medco
Any pre-certification penalties you incur
Penalties for out-of-network hospital visits
Expenses that exceed the URC charge, as determined by the Plan Administrator
Charges for mental health and substance abuse treatment (except for the BCBS BlueEdge HSA,
BCBS BlueEdge PPO and the Open Access Plus EPO with Cigna HealthCare)
The lifetime maximum is the total amount the medical plan option pays for each enrolled individual. If the medical plan option you choose has a lifetime maximum, every dollar the medical plan option pays toward your medical expenses reduces your lifetime maximum by the same amount.
The lifetime maximum applies to benefit payments paid on your behalf under all of the Vought Aircraft
Industries, Inc. health care plans in which you have had coverage throughout your employment. The lifetime maximum includes medical, prescription drug, mental health and substance abuse, and vision and hearing benefits provided under the Plan.
The lifetime maximum benefit is five million dollars ($5,000,000) per person for all medical plan options.
At the start of each benefit plan year, the PPO and EPO plan options restore all or a portion of your lifetime maximum, if you have reached the lifetime maximum. The amount restored equals the amount paid by the carrier during the previous benefit plan year – up to a maximum restoration of $25,000 per year.
Other lifetime maximums may also apply to specific services and expenses (see section entitled
“Eligible Medical Expenses”).
IBEW- Effective July 1, 2010 14
The medical plan options pay benefits only for eligible expenses that are considered medically necessary by the claims administrator. The claims administrator considers a treatment, service, or supply as medically necessary if it is:
Ordered and approved by a licensed physician;
Reasonably required for the diagnosis or treatment of a medical symptom or condition;
A treatment that is economical, safe, and provided in a manner and setting consistent with generally accepted United States medical standards;
Not primarily for the convenience of the patient or the health care provider;
The most appropriate level of treatment, service, or supply that can be safely provided;
Not educational, vocational, experimental, or investigational in nature (except for individuals with diabetes - the Plan provides for education about diabetes); and
Not specifically excluded by the Plan.
When you are hospitalized, your provider and the claims administrator determine how long your hospital stay is medically necessary. Even though your physician or other health care provider prescribes, orders, recommends, or approves a service or supply, it is not automatically
considered medically necessary or an eligible expense. This rule applies even if the service or supply is not listed in this guide as an ineligible expense. Consequently, you should obtain precertification of expenses to determine eligibility for benefits.
With respect to hospitalization, acute care as an inpatient is judged to be necessary based on the type of services the patient is receiving or the severity of the patient's condition. It also means that safe and adequate care cannot be received as an outpatient or in a less intense medical setting.
Preventative care, such as: adult physicals, newborn baby care and childhood immunizations that you receive from a network provider are considered medically necessary. Maternity hospital stays for mothers and newborn children are considered medically necessary for at least 48 hours following a normal vaginal delivery or 96 hours following a cesarean birth.
Out-of-network services and supplies provided to a newborn child are considered medically necessary if they:
Meet all the requirements listed in the Eligible Medical Expenses section.
Are provided to treat a diagnosed sickness or injury (including a congenital defect or birth abnormality).
For mental health and substance abuse treatment to be considered medically necessary by the claims administrator, the treatment must be:
Adequate and essential for the condition; and
Expected to improve the patient's condition or level of functioning.
If you need emergency care:
Go immediately to the nearest hospital emergency room.
When you arrive, show your Blue Cross Blue Shield identification card or Cigna HealthCare card.
If you enrolled in any of the Blue Cross Blue Shield plans, you need to call Blue Cross Blue Shield at
1-800-571-1041 within 72 hours of receiving emergency treatment and you will receive in-network benefits. If you are unable to call, arrange to have someone - a friend, relative, physician or member of the hospital staff - call for you. If you are admitted to the hospital and fail to notify Blue
Cross Blue Shield, you will be responsible for an additional $500 toward the cost of your treatment.
If you are enrolled in the Cigna HealthCare Open Access Plus plan, you need to call Cigna within 72 hours of admission to the emergency room and you will receive in-network benefits. If you do not notify them or pre-certify, Cigna may not approve the services and you will be responsible for
100% of the costs. If you are at a hospital outside of the Cigna HealthCare network, Cigna will transfer you to an in-network hospital once you are stable.
IBEW- Effective July 1, 2010 15
All the medical plan options cover ambulance service for emergency transportation to the nearest hospital; for instance, if you have a heart attack. Afterwards, if necessary, you may be transferred to another hospital that has a cardiac care unit or is in-network for the health plan option that you are enrolled in. As long as the transfer is necessary and not for patient convenience, the cost of the second ambulance would be processed at the appropriate benefit level provided by your plan.
If you are enrolled in any of the PPO plan options, you must obtain pre-certification from Blue
Cross Blue Shield before you are admitted to a hospital except in an emergency. Pre-certification is the advance review and approval of proposed hospital stays and specific health care services and is required for all non-emergency inpatient procedures. If you are enrolled in the Cigna Open Access Plus
EPO plan option the provider is required to pre-certify the admission in accordance with the rules setup as a managed care provider.
Pre-certification is the claims administrator’s advance review of proposed hospital stays or other predetermined services. If you are enrolled in a Blue Cross Blue Shield plan option and you do not precertify, you will be responsible for an additional $500 toward the cost of your treatment or the services may not be covered at all. (See process for pre-certification later in this document.) The penalty is in addition to your benefit plan year deductible or out-of-pocket maximum.
If you are admitted to an out-of-network hospital in a non-emergency, you pay a $500 penalty in addition to your benefit plan year deductible. The penalty does not apply when you use an out-ofnetwork hospital for emergency room treatment, outpatient treatment or laboratory services.
Before you are admitted to a hospital or when you are scheduled for inpatient surgery, you must obtain pre-certification. Call Blue Cross Blue Shield at 1-800-571-1041 (also listed on the back of your ID card). This rule applies to all the previously described procedures and care, whether they are in- or out-of-network, except in an emergency.
Mandatory pre-certification helps manage medical costs by confirming the need for the following situations:
A non-emergency hospital stay
Extension of a pre-certified hospital stay (When you pre-certify a hospital stay, the claims administrator will authorize a specific number of days in the hospital. If you need to extend your stay in the hospital, the claims administrator must be contacted to certify the extension. This rule includes extended maternity stays beyond those described in the Eligible Medical Expenses section.)
Skilled nursing facility care
Private duty nursing
Home health care
Hospice care
Inpatient surgery
Complex Imaging, such as PET Scans or MRI Scans (only if enrolled in the BCBS Healthcare
Solutions or BCBS BlueEdge HSA)
To pre-certify a non-emergency hospital stay or other medical service requiring pre-certification, follow these steps for each separate stay or service (even if related to the same condition):
Call Blue Cross Blue Shield at least 72 hours before the scheduled hospital admission or medical service, or as soon as your physician suggests the hospitalization or treatment. The telephone number to call for pre-certification is on the back of your ID card.
For hospitalization, obtain authorization from your physician for the recommended number of inpatient hospital days based on your specific diagnosis. If your physician recommends additional days, Blue Cross Blue Shield reviews the recommendation with your physician and, if appropriate, authorizes the additional days.
IBEW- Effective July 1, 2010 16
For mental health or substance abuse pre-certifications, Value Options is the provider for those services if you are enrolled in a Blue Cross Blue Shield plan option (except BCBS BlueEdge HSA and
BCBS BlueEdge PPO). You need to contact them at 1-866-269-5800 for pre-certification.
Remember: pre-certification is your responsibility.
Case management is a process in which a registered nurse is assigned to an individual patient to assess, coordinate, monitor and evaluate the options and services required to meet the patient's health care needs. Case managers access all available resources to promote quality and cost-effective outcomes. This is an additional resource that helps coordinate and ensure the quality of health care.
The Claims Administrator’s case management program is designed to help if you or an enrolled family member needs intensive medical care for an extended period of time. Case management assigns nurses and physicians representing all clinical specialties who work with the patient and the physician to meet the patient’s long-term medical needs.
Blue Cross Blue Shield or Cigna HealthCare, depending on which plan option you are enrolled in, will refer you or your enrolled family members to the case management program, depending on the severity of the diagnosis or expected length of hospital stay. If you are referred, your case management team reviews your medical records and considers your medical needs. The attending physician and hospital staff may be consulted about your course of treatment.
Your case management team explores treatment alternatives that may be available to you. Sometimes, these alternatives include treatment whose cost typically is considered ineligible for reimbursement.
The claims administrator reviews these situations case-by-case and may approve payment.
The final decision on all medical care always remains with you, your family, and your physician. If you and/or your physician do not agree with the claims administrator's recommendations, you may continue your original course of treatment (or any other medical treatment you choose). However, in these cases, your medical plan option may limit or deny payment of your expenses and, as a result, you may pay more.
Urgent care facilities provide urgently needed, routine treatment at times when your regular physician is unavailable, such as evenings and weekends. In a few states, urgent care facilities provide care only for conditions that will deteriorate if not treated immediately. At these facilities, your treatment is subject to the provisions of your medical plan option. Call Blue Cross Blue Shield at 1-888-979-4514 or
Cigna HealthCare at 1-800-244-6224 to determine how urgent care is handled in your state.
The Plan pays expenses that are considered eligible, medically necessary, and within the URC limits as determined by the claims administrator. You pay any deductibles, co-payments, co-insurance and penalties associated with eligible expenses. You also pay any expenses that are not eligible and all amounts that exceed URC limits.
When medically necessary and within URC limits, the Plan pays benefits for eligible services and supplies for enrolled employees and eligible enrolled dependents, unless specifically excluded elsewhere in this SPD. Subject to these limitations and any applicable pre-certification requirements, eligible medical expenses include, but are not necessarily limited to:
Pursuant to the Women’s Health & Cancer Rights Act, restoration of breasts in connection with a mastectomy, specifically:
— Reconstruction of the breast on which the mastectomy was performed
— Surgery and reconstruction of the other breast to produce a symmetrical appearance
— Prostheses and treatment of physical complications for all stages of mastectomy, including lymph edemas (swelling associated with the removal of lymph nodes)
IBEW- Effective July 1, 2010 17
The plan will determine the manner of coverage in consultation with the patient and the attending doctor. Coverage for breast reconstruction and related services will be subject to deductibles and co-insurance amounts consistent with those that apply to other benefits under the Plan.
Allergy Serum
Ambulance service to a local facility for a life-threatening condition or a condition that could cause serious harm to your body. The medical plan options also cover air ambulance service to the nearest appropriate facility when this service is medically necessary. There is no coverage under any of the medical plan options for ambulance use when there is no emergency.
Anesthesia and its administration
Abortion services (limitations may apply under some plan options)
Treatment of attention deficit disorder (ADD), as defined by the American Psychiatric Association, including physician visits and related therapy
Autologous chondrocyte (ACO) implantation surgery (joint replacement therapy)
Biological serum (such as vaccines and medicines, and other injectables)
Birth control: diaphragms (device and fitting), IUDs and Norplant (when procedure is performed in the doctor's office)
Blood and blood plasma (except charges for the storage of your own blood)
Cardiac rehabilitation phases 1 and 2, when received as a hospital outpatient within three months after your discharge from the hospital for a heart-related condition
Chiropractic services performed by a doctor of chiropractic (D.C.).
Christian Science practitioner services
Cosmetic/reconstructive surgery and resulting implants to:
— Restore a bodily function
— Correct functionally significant congenital deformities
— Correct conditions resulting from accidental injuries
— Correct conditions resulting from scars, tumors, disease, or previous therapeutic processes
Medically necessary surgery that results from a previous cosmetic surgery (Cosmetic surgery performed mainly to change a person's appearance is not an eligible expense.)
Covered prescription drugs (see section on Prescription Drugs)
Dental services to treat injuries to natural, rooted teeth (excluding damage to dental implants such as dentures, crowns, and bridges) resulting from an accident, including services provided by a physician, dentist, or dental surgeon (This benefit includes replacement of the teeth and any related X-rays.)
— For your expenses to be eligible, you must receive treatment within 12 months of the injury and you must remain enrolled in one of the medical plan options
Diagnostic tests rendered for the diagnosis of your symptoms and which are directed toward evaluation or progress of a condition, disease or injury. Such tests include, but are not limited to, x-rays, pathology services, clinical laboratory tests, pulmonary function studies, electrocardiograms, electroencephalograms, radioisotope tests and electromograms.
— Pre-determination is required, if you are enrolled in the BCBS Healthcare Solutions or BCBS
BlueEdge HSA and any out-patient non-emergency imaging tests that require that medical policy criteria is met. If no pre-determination is performed and the claim meets medical policy, then the claims administrator will apply a $250 penalty.
Pap smears and mammograms when medically necessary or necessary to support a diagnosis; otherwise, they are covered as preventive benefits
Dietary formulas for participants whose esophagus does not function and who require processed food with a feeding device, such as a feeding tube (Expenses for dietary formulas are also eligible for those with a diagnosis of phenylketonuria [PK-U] or a similar disease.)
Durable medical equipment, including rental of equipment, such as a wheelchair, hospital bed, or oxygen equipment. To help save money, the claims administrator may authorize the purchase of
IBEW- Effective July 1, 2010 18
equipment that you need for an extended period of time. The medical plan options also cover the repair and necessary maintenance of equipment if not provided under a manufacturer's warranty or a purchase agreement.
Educational expenses related to diabetes, when medically necessary and prescribed by a physician and approved by the claims administrator.
Emergency room services for the treatment of emergencies (When your ER visit is for an emergency, you always receive in-network benefits. However, if your visit is not for an emergency, your benefits are determined by the medical plan option in which you are enrolled.)
— For in- and out-of-network care, the co-payment is waived if you are admitted to the hospital in conjunction with the emergency room visit (except for BlueEdge options).
Hearing care
Hemodialysis
Heart pacemakers
Home health care services, including medical and nursing care (but not Custodial Care)
Hospice care for terminally ill patients
Hospital or surgical center expenses, including inpatient and outpatient charges for:
— Semiprivate room and board
— Services and supplies for inpatient and outpatient services furnished by the hospital or surgical center for medical care, including:
Drugs and medicines administered in the hospital
Electrocardiograms and basal metabolism tests
Medical equipment
Newborn care
Operating rooms
Oxygen and anesthesia materials
Recovery rooms
Treatment rooms
Use of blood transfusion and physiotherapy equipment
X-rays and laboratory tests.
For plan options other than CIGNA Open Access Plus EPO: Except in a life-threatening emergency, you pay a penalty if you are admitted to an out-of-network hospital. The penalty applies only to out-of-network hospital admissions. It does not apply to emergency room treatment, outpatient treatment or laboratory services. Services from a professional (such as a physician, therapist or specialized nurse) are generally billed to you separately; they are not considered hospital charges and are not subject to the penalty.
CIGNA will not pay benefits for non-emergency hospitalization at an out-of-network facility.
Human organ and tissue transplants only when approved by the claims administrator and when performed at an approved facility.
— If enrolled in a Blue Cross Blue Shield plan option, the medical plan options also cover the donor's charges and coordinate payment with the donor's own plan.
— If enrolled in Cigna Healthcare, procurement expenses for the organ would be covered and would coordinate with the donor’s own plan. The transplant level benefit is only payable for the recipient not the donor.
Infertility services, including diagnostic services to determine the cause of infertility, and medical procedures required to correct a physical condition causing infertility (excluding CIGNA, BlueEdge
HSA, and Healthcare Solutions plan options, which do not cover infertility services)
— The medical plan options that cover infertility services also cover impregnation procedures such as in vitro fertilization, artificial insemination, and gamete intrafallopian transfers (GIFT), as well as related services such as hormone therapy, ultrasound, and lab work.
IBEW- Effective July 1, 2010 19
— The medical plan options that cover infertility services pay in-network benefits for fertility medications when prescribed for an infertility condition. In some cases, your physician may prescribe fertility medication for a condition unrelated to infertility. If so, the prescription drug benefit administrator covers the fertility medication. Benefits for infertility treatment are subject to a $20,000 lifetime maximum for in-network and out-of-network services combined.
After you reach the $20,000 lifetime maximum, your infertility coverage ends under the Vought
Aircraft Industries, Inc. medical plan. The lifetime maximum includes reproductive technology, such as in vitro fertilization, and prescriptions to treat an infertility condition. (The lifetime maximum does not include fertility medications that are reimbursed through the prescription drug benefit administrator.)
Inhalation therapy
Mammography services
Maternity care, including expenses for you or your enrolled spouse or child pursuant to the
Newborns’ and Mothers’ Health Protection Act. This Federal law provides that hospital stays for services for the mother and newborn child cannot be less than 48 hours following a normal vaginal delivery or 96 hours following a caesarean birth, unless the attending physician, after consulting with the mother, discharges the mother or newborn child earlier. The physician is not required to pre-certify the maternity hospital stay if it falls within these limits.
— Expenses for a newborn baby of a dependent child are eligible only if the newborn becomes an eligible dependent under the Vought Aircraft Industries, Inc. medical plan.
— Expenses for midwives are eligible only when services are pre-certified by the claims administrator. The Blue Cross Blue Shield medical plan options pay out-of-network benefits for midwife services. The Cigna Open Access Plus EPO plan option pays 100% with no co-payment.
Medical and surgical supplies, such as:
— Blood and blood plasma
— Casts and splints
— Ostomy supplies (available from medical supply stores)
— Oxygen and rental of equipment for its administration – up to the purchase price
— Surgical dressings
— Trusses, braces, and crutches
Occupational therapy when medically necessary and provided by a licensed occupational therapist
Physical and physiotherapy services, except maintenance physical therapy, as determined by the claims administrator. Eligible expenses include therapeutic treatment by a registered physiotherapist, when prescribed by a physician.
Physicians' services, including physicians' fees for medical care or treatment, such as visits in the hospital, at home or in the physician's office
Physician assistant services, if accepted medical practice in your state. To determine if services provided by physician assistants are eligible in your state, call Blue Cross Blue Shield at 1-888-979-
4514 or Cigna Healthcare at 1-800-244-6224.
Podiatry care (but not routine foot care)
Preventive care, including immunizations, routine office visits, routine lab tests, and annual physical and well-woman exams (The medical plan options cover Pap smears, mammograms, colorectal screens and X-rays as preventive care, unless they are performed to support a diagnosis, in which case they are covered as a diagnostic service.)
— Shots, pills, and vaccinations in preparation for travel outside the U.S. are considered preventive care and are subject to the benefit plan year maximum under your medical plan option. You pay all costs above the benefit plan year maximum.
— The medical plan options cover adults for preventive care, with no deductible, subject to an annual maximum that varies by plan option. Children through age 5 are covered without limit.
Private duty nursing services, including care provided by a nurse (R.N., L.P.N., or L.V.N.). The Plan limits benefits to $1,000 per month. Pre-certification and case management is required.
IBEW- Effective July 1, 2010 20
Prosthetics and orthotics, e.g., artificial limbs, eyes and larynx.
Radiotherapy and chemotherapy services, including charges for treatment and related materials, equipment and facilities.
Skilled nursing facilities, including charges for room, board, and miscellaneous expenses related to the stay (Your physician must recommend your admission. The medical plan options pay benefits based on eligible expenses for a semiprivate hospital room and limit each stay to 60 days per condition. Pre-certification and case management are required.)
Speech therapy, including therapy by a qualified speech therapist, to:
— Restore speech after a loss or impairment of a demonstrated previous ability to speak (except speech loss or impairment caused by a mental, psychoneurotic, or personality disorder).
— Develop or improve speech after surgery to correct a defect that existed at birth and impaired, or would have impaired, the ability to speak.
Sterilization, including voluntary sterilization procedures such as tubal ligation and vasectomy
Surgery and surgical procedures, including:
— Charges by a physician for performing a surgical procedure and for the physician's preoperative and post-operative exams
— Assistant surgeon's and/or anesthesiologist's charges for services required for the surgery
— Charges for cutting, suturing, and treating burns, correcting fractures, reducing dislocation, and manipulating joints under general anesthesia
— Charges for performing electrocauterization, tapping (paracentesis), applying plaster casts, performing voluntary sterilization, performing endoscopy, or injecting sclerosing solution
Temporomandibular joint (TMJ) syndrome, including medically necessary initial surgical consultation and surgical treatment of dysfunction of the temporomandibular joint. (The medical plan options do not cover therapy [before or after surgery], appliances or the shortening or lengthening of the maxilla or mandible for cosmetic purposes or for correction of malocclusion.)
Urgent care facility services
Vision care
Well-child care, including charges for routine checkups and immunizations at the physician's office for children through age 5
Weight loss prescriptions through prescription drug benefits, but only with a diagnosis of morbid obesity.
Weight loss surgery is only eligible under Blue Cross Blue Shield Premium and Essentials PPO plan options.
— Approval of specific surgical methods for weight loss require individual consideration by the claims administrator.
Wigs, including the cost of a patient's initial wig, covered at 100% with no deductible (up to a lifetime maximum of $500) if:
— The hair loss is a result of alopecia, chemotherapy or radiation treatment, or other, similar conditions, and
— The wig is recommended or prescribed by the patient's attending physician.
The Plan limits or excludes some medical treatments, services, supplies, and expenses. The following list provides some examples of items that are not eligible for reimbursement; however, this list does not include all ineligible expenses.
If you do not find an expense listed under the Eligible Medical Expenses section, call Blue Cross Blue
Shield at 1-888-979-4514 or Cigna HealthCare at 1-800-244-6224 to determine if it is eligible under your medical plan option. Ineligible treatments, services, and supplies include:
The cost of acupuncture and acupressure treatment
The cost of ambulance service for non-emergencies or patient convenience
IBEW- Effective July 1, 2010 21
Expenses related to artificial organs - other than limbs, larynx, and eyes - including surgery and related expenses for any type of artificial organ transplant
The cost of care or treatment for caffeine addiction, including prescription and nonprescription drugs
Charges above the usual, reasonable, and customary (URC) limits
Charges for a sickness or injury due to war or any act of war, or that occurs during military service
Charges for an injury that occurs while the covered individual is committing a crime
Charges for services or supplies that are not medically necessary
Charges for services that are not ordered by a physician for the diagnosis, care, or treatment of an illness or injury, except preventive or well-child care
Charges that you are not legally required or obligated to pay, or charges that would not have been billed, such as free immunizations provided at a local clinic or drugstore
The cost of comfort or convenience equipment or supplies, such as exercise and bathroom equipment, seat-lift chairs, air conditioners, humidifiers, dehumidifiers and purifiers, shoes or related corrective devices, spas, or computer "story boards" or "light talkers"
Expenses related to cosmetic/reconstructive surgery, except if required:
— Because of an accidental injury
— To treat a condition that impairs the function of a body organ, including a congenital organ malformation of a child enrolled in the medical plan option
— To reconstruct a breast after a mastectomy
Expenses related to court-ordered treatment, unless certified as medically or psychologically necessary
Expenses related to Custodial Care or maintenance therapy, including care for conditions not typically responsive to treatment
The cost of dental services, except those described under eligible expenses (This exclusion encompasses shortening or lengthening the maxilla or mandible for cosmetic purposes or correction of malocclusion.)
Expenses related to educational programs for mental impairment or for developmental disorders such as cluttering and stuttering
Expenses related to experimental or investigational services or supplies. Any of the following criteria may result in classification as experimental or investigational:
— Requiring federal or other governmental body approval, such as drugs and devices that do not have unrestricted market approval from the Food and Drug Administration (FDA) or final approval from any other governmental body for use in treatment of a specified condition. (Any approval that is granted as an interim step in the regulatory process is not a substitute for final or unrestricted market approval.)
— Insufficient or inconclusive scientific evidence in peer-reviewed medical literature to permit the claims administrator's evaluation of the therapeutic value of the service or supply
— Inconclusive evidence that the service or supply has a beneficial effect on health outcomes
— Evidence that the service or supply is not as beneficial as any established alternatives
— Insufficient information or inconclusive scientific evidence that, when used in a noninvestigational setting, the service or supply has a beneficial effect on health outcomes and is as beneficial as any established alternatives
The cost of foot treatment for:
— Weak, strained, flat, unstable, or unbalanced feet, metatarsalgia, or bunions (except opencutting operations)
— Corns, calluses, or toenails, except the removal of nail roots and necessary services prescribed by a physician (M.D. or D.O.) to treat metabolic or peripheral-vascular disease
The cost of homeopathic or related treatment
IBEW- Effective July 1, 2010 22
The cost of treating any illness or injury related to employment that is covered under workers' compensation or similar laws
Expenses related to infertility administration fees that are not medically necessary, such as egg and sperm costs and donor search fees
Charges for massage therapy
The cost of care for the newborn child of an enrolled child, unless the newborn becomes an eligible dependent under the Vought Aircraft Industries Flexible Benefits Plan
The cost of over-the-counter medication or dietary supplements that do not require a prescription by law
Expenses related to penalties under the medical plan options for failure to comply with the Plan’s pre-certification procedures or for an out-of-network hospital stay
Expenses related to periodontal or periapical disease, or any condition other than a malignant tumor involving teeth, surrounding tissue or structure, except as described in eligible expenses
(If you select dental coverage, these expenses may be eligible under your dental plan option.
Refer to the Dental section of this guide for more information.)
Personal non-medical expenses, such as telephone and television charges while in a hospital
Expenses related to physical, occupational or speech therapy for maintenance purposes, as determined by the claims administrator
Fees for physician assistant services, if not accepted medical practice in your state. To determine if the services of physician assistants are eligible in your state, call Blue Cross Blue Shield at 1-888-
979-4514 or Cigna HealthCare at 1-800-244-6224.
Physician charges for duplicating records or completing forms
Physician charges for appointment no-show or late fees
The cost of radial keratotomy (RK), photo refractive keratectomy (PRK), astigmatic keratectomy
(AK), LASIK, or other similar surgical procedures to improve or correct vision problems
Expenses related to the reversal of voluntary sterilization
The cost of services furnished by a hospital or facility operated by the U.S. government or any authorized agency of the U.S. government or furnished at the expense of such government or agency unless payment is legally required
The cost of services or supplies that any school system provides as required by law
The cost of services or supplies provided by the Vought Aircraft Industries, Inc. (or subsidiary)
Medical Department or onsite health unit
Charges related to services or treatment rendered by you, your spouse or your child, or by your parent, parent-in-law, brother, sister, brother-in-law or sister-in-law
The cost of services received before coverage begins or after coverage ends
Expenses related to speech therapy to correct pre-speech deficiencies or to improve speech skills not fully developed, such as stuttering and developmental delay
Expenses related to transsexual surgery (sex-change operations), including counseling or therapy before or after the surgery
Expenses related to weight reduction treatment, unless medically necessary and otherwise eligible under the participant’s medical plan option
IBEW- Effective July 1, 2010 23
When you select health care coverage under the PPO or EPO plan options, you receive the Vought
Aircraft Industries, Inc. vision and hearing benefits.
Blue Cross Blue Shield administers these benefits for their plan options. There is no deductible for these benefits and no network of providers. You can choose any licensed provider. You pay for the cost of services and glasses or hearing aids and submit receipts for reimbursement up to the maximum for each plan year.
If you are enrolled in the Cigna Open Access Plus plan, Cigna will administer the vision and hearing coverage.
Your vision benefit is a maximum of $250 per year per covered person with no deductible for both Blue
Cross Blue Shield and Cigna HealthCare participants. If you are enrolled in the Cigna Open Access Plus
EPO plan option and you see an out-of-network provider, Cigna provides a maximum of $160 per year per covered person. These annual vision benefits can be used for the following:
One vision exam per person each benefit plan year; $45 co-payment out-of-network coverage with
Cigna
Lenses (including contact lenses) and eyeglass frames, or up to a one-year supply of disposable contact lenses each benefit plan year
Sunglasses prescribed by a physician that are medically necessary and are not otherwise available without a prescription.
If you receive routine vision care from an optometrist or ophthalmologist, your care is covered by the vision benefit and your expenses are applied to the $250 annual maximum. The medical plan options cover eligible expenses for care from an ophthalmologist to treat a disease or injury of the eye.
Depending on the option in which you enroll, a co-payment, deductible, and/or co-insurance may be required. In these cases, your expenses will not count towards the $250 annual maximum.
When you visit an optometrist, ophthalmologist or eyeglasses manufacturer for a vision exam, lenses or frames, you pay the provider at the time you receive the services. Then, you file a claim with Blue
Cross Blue Shield or Cigna for reimbursement of eligible expenses. Use the standard BCBS claim form or Cigna HealthCare claim form available online at http://benefits.voughtaircraft.com
or from your local site benefits office. When you file your claim, include your receipt and keep a copy for your files.
Participants enrolled in the BCBS BlueEdge HSA medical plan option have separate insurance coverage for vision benefits provided by BCBS. This coverage provides the same benefit, but it is not subject to the BlueEdge HSA deductible.
If you are enrolled in a medical plan with BCBS or Cigna HealthCare, Vought provides the hearing benefit for you at no additional cost.
With BCBS, the hearing benefit pays up to $500 per ear each benefit plan year for eligible expenses for each covered individual. Cigna provides a $1000 benefit per plan year, which does not include a “per ear” exclusion. The annual benefit can be used for the following:
One annual hearing exam per covered person per year.
One hearing aid repair or a new hearing aid every three benefit plan years.
If you are enrolled in Cigna, they will allow 2 hearing aids every 3 years with no “per ear” exclusion. (For example, you will be covered if you need to purchase 2 hearing aids for the same ear in the same 3 year period.)
Hearing aid batteries are not covered.
When you visit a hearing care professional, you pay the provider when you receive the services. Then, you file a claim with Blue Cross Blue Shield for reimbursement of eligible expenses. If you are enrolled
IBEW- Effective July 1, 2010 24
in the Open Access Plus EPO with Cigna Healthcare, you must see an in-network Audiologist and no reimbursement will be necessary.
The standard BCBS claim form and the Cigna HealthCare claim form is available on the Download
Forms page of the Vought Benefits Web site at http://benefits.voughtaircraft.com
.
Blue Cross Blue Shield’s Member Services and Cigna HealthCare’s Customer Care is a critical link between you and their respective networks. Trained representatives answer the customer service lines.
BCBS Member Services can be reached at 1-888-979-4514. Cigna HealthCare’s Customer Care can be reached at 1-800-244-6224. Both customer service centers can help you with:
Obtain current provider information, including a provider's address, or whether a provider accepts new patients
Find out if there are Blue Cross Blue Shield or Cigna HealthCare network providers in a particular location
Check on features and procedures under the medical plan options
Provide comments or feedback regarding a provider's performance
Ask questions about claims or reimbursements
Ask about eligibility or pre-certification requirements for planned services
Request claim forms
Ask for assistance in filing out-of-network claims (if you are not using a network provider)
Report lost ID cards and request new ones.
In most cases, you do not need to file a claim for health care reimbursements. However, in some cases you may be required to file a claim. For example, you are responsible for completing and submitting claim forms when you:
Use an out-of-network provider (for BCBS plan options)
Incur vision or hearing expenses (except as noted in Vision and Hearing sections).
You must submit claims that you incur during the benefit plan year within 12 months after the benefit plan year ends. If you need a claim form or have questions about filing claims, call your claims administrator at the toll-free telephone number listed on the back of your medical ID card. The standard claim forms are also available on the Download Forms page of the Vought Benefits web site at http://benefits.voughtaircraft.com
.
If the provider does not file your claim, you need to do the following:
Complete a claim form and submit it to the address printed on the form
Attach the appropriate paperwork or itemized receipts (The claims administrator cannot accept canceled checks as a receipt.)
Attach an explanation of benefits (EOB) if you receive reimbursement from another plan, such as your spouse's plan
Write the group number and your plan identification number on each claim form – even if the claim is for an enrolled family member (the numbers are listed on your ID card.)
Indicate whether payment should be made to you or directly to your provider
Keep a copy of everything you send to the claims administrator
IBEW- Effective July 1, 2010 25
Vought Aircraft Industries, Inc. offers a managed drug program that helps you get the most out of your prescription drug dollars. The Healthcare Essentials PPO, Healthcare Solutions PPO, Premium PPO, and
Cigna Open Access Plus EPO options provide coverage through Caremark for covered prescription drugs. The BlueEdge plan options provide covered prescription drug coverage through Prime
Therapeutics.
The Plan Administrator for each prescription drug option carefully selects the drugs it covers and determines whether they are allowed as an eligible expense under the Plan. “Covered drugs” are those prescription drugs that are medically necessary – that is, necessary for the treatment of a disease or illness and widely accepted as effective, appropriate, and essential, based on the recognized standards of the medical community and approved by the claims administrator for reimbursement. In addition, the drug therapy must be prescribed by a licensed physician and must be in accordance with type, frequency, and duration-of-treatment guidelines of national medical, research, and governmental agencies.
The medical plan options allow you to purchase covered drugs from:
Any Caremark participating pharmacy
The Caremark Mail Service Program
Prime Therapeutics network (if you are enrolled in either the BlueEdge PPO or BlueEdge HSA)
Prime Mail (if you are enrolled in either the BlueEdge PPO or BlueEdge HSA)
Your prescription drug benefit is based on where you purchase your prescriptions, whether you purchase generic, specialty, or brand name drugs, and whether you purchase preferred or nonpreferred brand name drugs. Prescription drug expenses count toward your medical plan’s lifetime maximum but do not count toward your deductible or out-of-pocket maximum. Call your pharmacy and ask if it is a participating pharmacy, or call your prescription drug provider at the number on the back of your prescription drug ID card.
A Brand Name drug is a drug that is protected by patent and is marketed under a specific name. A generic drug is a drug for which the patent has expired and can be manufactured by any drug manufacturer. If a generic drug is available it is equivalent to the brand name drug. Not all drugs have generic equivalents. Generic drugs usually cost less than name brand drugs.
Preferred vs. Non-Preferred Drugs
A preferred brand name drug is a drug that has been proven by claim administrator’s independent team of doctors and pharmacists to be less costly than other brand name drugs, but just as safe and effective. Non-preferred brand name drugs are also chosen by an independent team of doctors and pharmacists, but have a higher co-insurance than the preferred brand-name medicines.
Specialty Drugs
Specialty Drugs are high-cost oral, injectable, infused or inhaled medications that can be either selfadministered or administered by a healthcare provider, and have special shipping and storage requirements. Specialty medications are generally prescribed for people with complex or ongoing medical conditions such as multiple sclerosis, hemophilia, hepatitis, and rheumatoid arthritis.
Retail prescriptions are drugs that are purchased at local pharmacies. You can purchase up to a 30-day supply of prescription drugs at a local pharmacy for the retail pharmacy co-pay amount. To receive the highest benefit for retail prescriptions, purchase your prescription at a participating pharmacy under your prescription drug provider.
For eligible participants residing in the United States, the mail order program provides long-term and maintenance medications at a reduced price. Maintenance medications are drugs taken on a regular
IBEW- Effective July 1, 2010 26
basis for chronic conditions such as high blood pressure and diabetes. Mail order prescriptions are typically more financially advantageous. You do need to allow sufficient time for medications to be received when ordering by mail. If you are currently taking a maintenance medication and you cannot wait the 14 days for the mail order prescription, ask your physician for two prescriptions: one for a 30day supply to fill immediately at a local participating pharmacy and one for a 90-day supply to send to the mail order program you are enrolled in.
If your drug benefit is provided by Caremark, the prescription drug benefit includes a special provision for diabetic kits. You pay a $40 co-payment for a kit of supplies if:
Your physician lists all your diabetic supply requirements on one prescription, and
You order all the supplies at the same time through the Caremark Mail Service Program.
Each time you refill all or part of the kit, you pay another co-payment. The kit includes these supplies:
— Insulin
— Alcohol wipes
— Diagnostic strips
— Lancets and syringes
There is no special drug benefit for diabetic supplies if you are enrolled in either the BlueEdge PPO or
BlueEdge HSA medical plan option. The drug benefit will follow the same benefit level as your prescription coverage.
The Plan may make changes, additions or deletions to the available options from time to time. Affected participants will be notified of these changes.
IBEW- Effective July 1, 2010 27
If you are enrolled in a plan administered by Blue Cross Blue Shield, other than the BlueEdge HSA PPO,
Value Options is the claims administrator for the mental health and substance abuse benefits. The
Value Options provider network is separate from the Blue Cross Blue Shield network.
If you are in the Open Access Plus EPO provided by Cigna HealthCare, Cigna provides the mental health and substance abuse benefit. Similar to the medical provisions with Cigna, you must see an in-network provider to receive benefits.
The Vought Aircraft Industries, Inc. mental health and substance abuse program pays for eligible medically necessary and appropriate mental health and substance abuse services and treatment. For benefits to be considered medically necessary by the claims administrator, the service or treatment must be:
Adequate and essential for your condition
Expected to improve your condition or level of functioning
The fact that your physician prescribes, orders, recommends, or approves a service or supply does not make it medically necessary. The claims administrator makes that determination.
Pre-approval is the advance review and approval of proposed mental health and/or substance abuse care. Without pre-approval, the Plan pays no benefits for mental health and substance abuse services and treatment. You must contact your claims administrator for approval before treatment begins. If no in-network provider is available, Value Options, Blue Cross Blue Shield, or Cigna can refer you to an out-of-network provider and the mental health and substance abuse program pays in-network benefits.
When you need mental health or substance abuse treatment, your mental health and substance abuse provider must be contacted for approval – even if you do not plan to use a network provider. The following list is the phone numbers for each of the providers:
Value Options = 1-866-269-5800
Blue Cross Blue Shield = 1-800-851-7498
Cigna HealthCare = 1-800-244-6224
Your call is confidential. No one at Vought Aircraft Industries, Inc. or its subsidiaries will be told about your call or about any treatment you receive, unless you authorize the disclosure or the law requires disclosure.
If you do not contact your claims administrator for pre-approval of in- or out-of-network care, the mental health and substance abuse program pays no benefits except in an emergency.
On-call case managers are available 24 hours a day, seven days a week. However, if you or an enrolled family member must be hospitalized because of a mental health emergency and are unable to pre-certify the admission, a family member, physician or friend should call Value Options within 72 hours, Blue Cross Blue Shield within 48 hours, or Cigna within 48 hours after the admission.
Once the hospitalized person becomes stable, your claims administrator may advise a transfer to a network hospital to receive the highest level of benefit reimbursement.
Note: Treatment of medical emergencies related to alcoholism or substance abuse, such as overdose, coma, shock, or a heart attack, are covered by your Medical Plan claims administrator.
The Vought Aircraft Industries, Inc. mental health and substance abuse program pays for a range of inpatient and outpatient services. The following mental health/substance abuse expenses and services are covered, if medically necessary:
IBEW- Effective July 1, 2010 28
Charges for licensed local ambulance service to or from the nearest hospital or approved qualified mental health/substance abuse treatment facility where the needed mental health treatment or evaluation can be provided, as authorized by the claims administrator.
Outpatient charges at a hospital or approved qualified mental health/substance abuse treatment facility
Semiprivate room and board charges, and inpatient services and supplies at a hospital or qualified mental health/substance abuse treatment facility approved by the claims administrator.
The claims administrator establishes who the qualified mental health/substance abuse treatment providers are, within the lawful scope of the practice of:
Psychiatrists
Licensed or registered psychologists
Licensed or registered psychotherapists
Licensed or registered psychiatric social workers
Some mental health and substance abuse services, treatments, and expenses are not eligible for payment of benefits, including but not limited to:
Aversion therapy
Services or treatment rendered by you, your spouse or your child, or by your parent, parent-in-law, brother, sister, brother-in-law or sister-in-law
Conditions resulting from:
— Act of war (declared or undeclared)
— Insurrection
— Atomic explosion
— Other release of nuclear energy under any conditions (except when used solely as a medical treatment)
Counseling/therapy related to a sex change
Couples therapy, except when certified as a medically necessary part of the treatment plan of a spouse with a Diagnostic and Statistical Manual of Mental Disorders mental disorder that is covered under the mental health and substance abuse program
Court-ordered psychiatric or substance abuse treatment, except when certified by Value Options or
Cigna Healthcare as medically necessary
Custodial Care
Educational rehabilitation or treatment of learning disabilities, regardless of the setting in which services are provided
Evaluations, consultations, or therapy for educational or professional training or for investigational purposes relating to employment
Experimental or investigational services or supplies. Any of the following criteria may be cause for classification as experimental or investigational:
— Lack of federal or other governmental body approval, such as drugs and devices that do not have unrestricted market approval from the Food and Drug Administration (FDA) or final approval from any other governmental body for use in treatment of a specified condition. Any approval that is granted as an interim step in the regulatory process is not a substitute for final or unrestricted market approval
— Insufficient or inconclusive scientific evidence in peer-reviewed medical literature to permit the
Plan's evaluation of the therapeutic value of the service or supply
— Inconclusive evidence that the service or supply has a beneficial effect on health outcomes
— Evidence that the service or supply is not as beneficial as any established alternatives
— Insufficient information or inconclusive scientific evidence that the service or supply, when used in a non-investigational setting, has a beneficial effect on health outcomes and is as beneficial as any established alternatives
IBEW- Effective July 1, 2010 29
Injuries or illnesses caused by the conduct or omission of a third party for which you have a claim for damages or relief, unless you provide the claims administrator with a lien against any recovery for such claim for damages or relief
Marriage counseling except through your EAP
More than two inpatient admissions for substance abuse treatment at an in- or out-of-network facility
Non-abstinence-based or nutritionally based treatment for substance abuse
Prescription drugs; however, your prescription may be eligible under the Vought Aircraft prescription drug plan
Private duty nursing, except when pre-approved by the claims administrator as medically necessary
Psychological testing, except when pre-approved by the claims administrator as medically necessary
— Remedial education beyond evaluation and diagnosis of learning disabilities, education rehabilitation, academic education, and educational therapy for learning disabilities
Services, supplies or treatment covered under the Vought Aircraft medical plan options
Any testing, therapy, service, supply, or treatment for conditions that are identified by the DSM-IV as not being attributable to a mental disorder but are additional conditions that may be a focus of clinical attention (i.e. certain V-Codes). The DSM-IV is a manual published by the American
Psychiatric Association which covers all mental health disorders.
Services, treatment or supplies provided as a result of any workers' compensation law or similar legislation
Services, treatment or supplies obtained through, or required by, any governmental agency or program, whether federal, state, or any subdivision thereof (exclusive of Medicaid/Medi-Cal)
Sex therapy programs
Therapies that do not meet national standards for mental health professional practice, including – but not limited to – Erhard/The Forum, primal therapy, Rolfing, sensitivity training, bio-energetic therapy, and crystal healing therapy
Treatment by any providers not pre-approved by the claims administrator
Treatment for caffeine or nicotine addiction withdrawal or dependence
Treatment for co-dependency
Treatment for personal or professional growth, development, training, or professional certification
Treatment of congenital and/or organic disorders (e.g., autism, mental retardation) except for initial diagnostic evaluations, associated treatable, and acute behavioral manifestations
Treatment or consultations provided by telephone
The Employee Assistance Program is a professional and confidential counseling service and referral program that is available to you and your immediate family members – free of charge. The EAP is administered by Value Options. You can use the EAP services even if you are not enrolled in a Vought
Aircraft Industries, Inc. medical plan option.
EAP counselors are licensed mental health professionals who specialize in conducting comprehensive assessments and short-term problem-solving. They also have extensive knowledge of community resources in your area.
Counselors are available to help you and your family members resolve personal issues or problems before they affect your health, family, relationships, or job performance. No one at Vought Aircraft
Industries, Inc. is told of your call or about any treatment you receive unless you authorize it or unless the law requires it.
IBEW- Effective July 1, 2010 30
The EAP can help you deal with:
Death of a loved one
Depression
Family problems
Financial matters through referrals
Legal matters through referrals
Relationship issues
Stress
Substance abuse
Work-related issues
There are two ways you can receive care through the EAP:
Contact Value Options
— Call Value Options at 1-866-269-5800, toll free, 24 hours a day, seven days a week
— Identify yourself as a Vought Aircraft Industries, Inc. employee, the spouse of an employee, or other eligible family member; you may need to provide the employee’s Social Security number when you call
Discuss your concerns with the EAP counselor. The counselor helps you assess your situation, clarify the problem, and develop a plan of action. The plan of action could include:
— Follow-up discussions with the EAP counselor (there is no limit to the number of telephone contacts you can make)
— Referrals to a Value Options EAP affiliate in your community up to five in-person sessions for you and each of your eligible family members per benefit plan year
— When needed, direct referrals to a resource available under your medical plan option
Visit an on-site counselor at a Vought Aircraft Industries, Inc. worksite
— Some Vought Aircraft Industries, Inc. sites have EAP counselors on site - licensed therapists who can assist you with personal concerns, especially those that interfere with work performance.
— All meetings are confidential. For information regarding locations and appointments contact your worksite EAP representative through your Human Resources office.
There is never any cost to you for services provided directly by the EAP. However, there may be costs for additional services recommended by the EAP.
IBEW- Effective July 1, 2010 31
You or your dependents may be covered by more than one group health plan, such as the Vought
Aircraft Industries, Inc. Flexible Benefits Plan and your spouse's employer's plan. In such an event, the
Plan uses a non-duplication of benefits provision, or coordination of benefits (COB), to coordinate payments with the other plan to avoid double payment of a claim for health expenses. However, nonduplication of benefits does not apply to any private personal insurance, TRICARE or school policies that you or an enrolled family member may have.
When the Plan is the secondary payer, the Plan makes up the difference between the amount the other plan pays and the benefit that otherwise would be payable under the Plan option.
This provision ensures that payments from the other plan, plus payments from the Plan, do not exceed the amount the Plan would have paid if there were no other coverage.
To calculate non-duplication of benefits, it is necessary to determine which plan is the primary plan and which is the secondary plan. The primary plan pays benefits first. The secondary plan pays benefits after the primary plan has paid.
If you are divorced, legally separated, or not married to your child's other parent and your child is enrolled in the Vought Aircraft Industries, Inc. plan and the other parent's employer's plan, the Plans pay in this order.
First, the plan of the parent awarded financial responsibility for the child's medical expenses by a court decree
Then, the plan of the parent with custody of the child
Then, the plan of the stepparent whose spouse has custody of the child
Then, the plan of the parent who does not have custody of the child.
If none of these rules determines the order of payment, the parent’s plan that has covered the child the longest is the primary plan.
The following chart summarizes how the non-duplication benefits provision works:
NON-DUPLICATION OF HEALTH BENEFITS IF YOUR SPOUSE HAS COVERAGE
If health expenses are for: The Plan pays:
You (the employee) Primary
Your child who has coverage under the Vought plan and under your
spouse’s employer’s plan
Primary if your birthday falls earlier in the year than the other parent’s birthday (If you and the other parents have the same birthday, the plan covering the parent longer pays benefits first.)
Or, secondary if, based on the "birthday rule" described above, the other parent's plan is primary
You or enrolled family members who have COBRA coverage under another
group health plan
Primary if you and/or they have COBRA coverage under another group medical plan
Secondary if the other plan does not have a coordination-of-benefits provision
Your spouse who is covered by another employer’s plan as an active
or former employee
Secondary
Your spouse who is a Vought retiree Primary
IBEW- Effective July 1, 2010 32
If you or your dependent (the covered person) suffers an injury or illness caused by a wrongful or negligent act of another person or entity giving rise to a claim of legal liability, and if benefits are paid under this Plan due to such injury or illness, the Plan shall have the right to recover such payments to the extent of the value of the benefits provided by the Plan. The following provisions govern the Plan’s right of recovery (subrogation):
The right extends to third parties and to the covered person's insurer and any other insurer that covers injuries sustained by the covered person;
The Plan may utilize all possible remedies, both legal and equitable, including subrogation, restitution, constructive trust, and equitable lien, to recover funds;
The Plan may offset future benefits to the extent required to provide for full recovery;
Recovery may be made from any funds paid and from any and all sources, including judgment, settlement, and insurance;
The Plan will have the right of first recovery, and recovery may be sought from any full or partial recovery, notwithstanding the fact that the covered person has not been made whole; and
Attorney’s fees and all other litigation expenses are the sole responsibility of the covered person.
The Plan is not obligated to pay any benefits until the covered person has agreed and acknowledged, in writing, that the Plan has a right of recovery with respect to any amounts that the covered person receives. As a further condition precedent to the Plan's obligation to pay any benefits, the covered person agrees to do the following:
Agree in writing to reimburse the Plan from any award or settlement the covered person receives;
Promptly provide the claims administrator agent with all pertinent information regarding the cause of the injury or illness including whether there is any person or entity who may be legally liable;
Include the full amount of any payments by the Plan in any claim the covered person asserts for compensation and promptly notify the Plan of any such claim;
Do nothing to prejudice the Plan’s rights under this provision, either before or after the need for services of benefits under the Plan;
Provide the Plan with a lien to the extent of benefits paid. The lien may be filed with the persons whose act caused the injuries, his/her attorney, the covered person's attorney, or a court having jurisdiction of the covered person's liability claim; and
Cooperate fully with the Plan in asserting its subrogation and/or reimbursement rights against any person or entity, including supplying the information and executing any instrument or agreement reasonably necessary for that purpose.
The failure of the Plan to insist upon any of the above requirements or the payment of benefits by the
Plan before receiving any such information or documents described above shall not be deemed a waiver of the Plan's right to recover benefits paid. The covered person agrees to a credit against payments to be made under the Plan in the future equal to the amount of any damages collected against a third party or under no fault automobile insurance, whether by legal judgment, settlement or otherwise.
If you or your dependents have coverage with Vought Aircraft Industries, Inc. because you are an active employee, and you or the dependent are also enrolled in Medicare, the Vought Aircraft
Industries, Inc. medical plan pays primary to Medicare. That means Vought Aircraft Industries, Inc. pays benefits first in accordance with plan option provisions, and then Medicare pays benefits as the secondary payer.
Medicare coverage is available on the first day of the month in which you:
Complete 25 months of disability and are determined to be disabled by the Social Security
Administration
Complete 31 months of end-stage renal disease
Become age 65, whether you are retired or still working
IBEW- Effective July 1, 2010 33
If you plan to work past age 65, you can:
Apply for Medicare when you become age 65, or
Wait until you retire to apply for Medicare if you are enrolled in one of the Vought Aircraft
Industries, Inc. medical plan options. You are not obligated to enroll in Medicare while you are an active employee.
Please visit www.medicare.gov
for complete rules and regulations on enrolling in Medicare coverage.
If you or a dependent are enrolled in Medicare because of end-stage renal disease, the Vought Aircraft
Industries, Inc. plan option that you are enrolled in pays primary for the first 30 months of the disease.
Thereafter, the Vought Aircraft Industries, Inc. plan option pays secondary to Medicare. After 30 months, if you are still an active employee, Vought Aircraft Industries, Inc. will reimburse you the cost of the Medicare Part B premium. Reimbursement will not be made for a dependent’s Medicare Part B premium.
If you or a covered dependent has been diagnosed with end stage renal disease and becomes eligible for Medicare Part B, please notify the Vought Benefits Center.
If you or your dependents are considered disabled by the Social Security Administration, your Vought
Aircraft Industries, Inc. medical plan option will pay secondary to Medicare if one of the following applies:
You are no longer an employee; or
You are enrolled in another group health plan as an active employee
Otherwise, the Plan will pay benefits primary to Medicare.
A Qualified Medical Child Support Order (QMCSO) is an order or judgment from a state court or administrative agency directing the Vought Aircraft Industries, Inc Plan and the Plan Administrator to cover a child for benefits under a health care plan.
If you are subject to such an order, Vought Aircraft Industries, Inc. notifies you and each affected child
(or the child's representative) about the procedures that determine the validity of the order and how it will be implemented.
Federal law provides that a medical child support order must meet certain form and content requirements in order to be a QMCSO. After Vought Aircraft Industries, Inc. verifies that an order is a
QMCSO, Vought Aircraft Industries, Inc. enrolls the child according to the terms of the order.
Medical coverage ends when any of these events occurs:
You and/or your dependents are no longer eligible to participate in the Vought Aircraft medical plan
— Benefit coverage will end at midnight on your last day of employment according to the payroll records of Vought Aircraft Industries, Inc.
— If you are retiring, your active Vought Aircraft Industries, Inc. coverage ends on the last day of employment according to the payroll records of Vought Aircraft. If you are eligible for and elect retiree medical benefits, those benefits begin on the first day of your retirement.
— You fail to pay required contributions to the Plan.
Vought Aircraft Industries, Inc. terminates the Vought Aircraft medical plan options
You and/or your dependents may be able to continue medical coverage under certain circumstances when coverage would otherwise end, as described in the Plan Administration section under COBRA, or under a retiree medical plan option, if you are eligible for retiree health coverage when you retire from active service.
IBEW- Effective July 1, 2010 34
The information below is a summary of what happens to your medical benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions to continue coverage. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Personal or Educational – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Family Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month. Vought Aircraft Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the Uniformed
Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues. However, if your current option is not available at your new location, you must elect a new option within 31 days.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date. You may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
Retire – Coverage stops at midnight on your termination date. Certain employees may be eligible for a retiree medical plan. Otherwise, you may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
Layoff/Reduction In Force - Coverage stops on your termination date. You may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
Employee’s Death – Dependent Coverage continues to the end of the month from the date of death, plus 12 additional months from the date of death, at no charge to your eligible survivor(s).
Dependents may then elect retiree coverage, if eligible or COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
IBEW- Effective July 1, 2010 35
Dental plan options available in your area may include:
Preventive PPO provided by Delta Dental
Dental Care PPO (excludes orthodontia benefits) provided by Delta Dental
Dental Care Plus PPO (includes orthodontia benefits) provided by Delta Dental
CIGNA Dental Care DHMO (includes orthodontia benefits) provided by Cigna Dental Health
No coverage, if you waive the Vought Aircraft Industries, Inc. dental plan. (Note: This is the
default option if you do not make any coverage election)
Delta Dental administers three of your dental plan options – Preventative, Dental Care, and Dental Care
Plus. These options pay some level of benefits for eligible expenses regardless of the dentist you choose. Call Delta Dental at 1-800-336-8264 for availability of in-network providers in your area.
Your other dental plan option is a managed dental plan offered by CIGNA Dental Health. To receive benefits under this option, except in an emergency, you must receive care from general dentists and specialists in the CIGNA dental network. The network is available in most, but not all, locations. Call
CIGNA Dental Health at 1-800-367-1037 for availability of network providers in your area. There is no out-of-network benefit under the CIGNA dental plan option.
You may enroll for dental coverage within 31 days of your hire date or during Annual Enrollment. The dental plan option that you select for yourself and your family stays the same for the full benefit plan year unless you have a qualifying change in status, For more information on qualified status changes, please see the “Changing Your Coverage During the Plan Year” section.
The dental plan options offer the same coverage categories as the Vought Aircraft Industries, Inc. medical plan options:
Employee only
Employee + child(ren)
Employee + spouse
Employee + family (employee, child[ren], and spouse)
No coverage. (Note: This is the default option if you do not make any coverage election)
You may choose a different coverage category for dental than you choose for medical. For example, you can cover only yourself in the medical plan while covering yourself, your spouse, and your children in the dental plan. If you select no dental coverage, you may be eligible to receive weekly Opt Out dollars.
Delta Dental plan options pay benefits for treatment necessary for good dental health care that is within the Plan limits. The plan options do not pay benefits for cosmetic dentistry or for any treatment more costly or more extensive than needed. If two or more dental services are appropriate for a treatment, the dental plan options pay benefits on the basis of the least expensive service expected to produce a professionally satisfactory result, for example, amalgam (metal) vs. gold fillings.
Delta Dental negotiates fees with their network dentists and the network dentists agree to charge their patients their lowest fees; these are called the “allowed amounts”. Delta Dental pays their network dentists directly, which means you do not have to pay the bill and wait for reimbursement. There is no balance billing, so Delta dentists charge only the amount that
Delta Dental and the dentist have agreed upon. Additionally, if you choose to use Delta Dental dentists you will not have to file claims because the dentist will submit them directly to Delta
Dental.
You can receive treatment from any dentist in the country, no matter where you live. Even if your dependent child attends school in a different state, benefits for you and your enrolled
IBEW- Effective July 1, 2010 36
family members are the same. Delta Dental offers a network of member dentists who agree to charge fees that they have negotiated with Delta. These dentists are called "Delta dentists."
Call Delta's toll-free directory service at 1-800-4-AREA-DR (1-800-427-3237) for a list of Delta dentists in your area and to network dentist information, or visit Delta's Web site at www.deltadentalins.com and select the Dentist Directory. From that page, select the Premier
Program for your location.
Under the options administered by Delta Dental, average fees apply only when you use a dentist who does not participate in the Delta Dental network. Delta dentists charge Delta patients only the allowed amounts. For example, when you use a Delta dentist, you pay only the applicable deductible and coinsurance for eligible expenses. If you use an non-Delta dentist, Delta will pay only the average fee to the dentist for services provided. You are responsible for payment of all expenses above and beyond the average fee in addition to deductibles and co-pays, if applicable.
Dental Care, Dental Care Plus, and Preventive provide the same levels of preventive and diagnostic care. However, they vary in the amount of the benefit plan year deductible, other eligible dental expenses, and annual maximums.
When a dentist signs a contract to join the Delta Dental network, he or she promises to provide care that meets professional quality standards. If you experience a problem that your dentist cannot correct, call Delta Dental at 1-800-336-8264. Delta Dental often can resolve problems quickly.
If you decide not to use “Delta dentists” you may be responsible for the dentist’s fee, which could be higher than those approved by Delta Dental. You may also have to complete and submit your own claim forms, pay a service fee, or pay the entire amount out of pocket and wait for reimbursement from Delta
Dental.
The following rules apply when you select the Delta Dental plan:
Your dentist must be practicing within the scope of his or her profession and furnishing services for which he or she is licensed. Dental charges must either be negotiated with Delta or be based on average fees for dentists in your area, as determined by Delta.
If you do not use a Delta network dentist, you are responsible for any charges that exceed the allowed amounts as determined by Delta Dental.
When you visit a Delta dentist, charges are always within the allowed amounts with Delta. Delta will pay all expenses, up to the annual maximum, less your deductible and co-insurance amounts directly to the Delta dentist.
You do not file a claim form when you use a Delta dentist. Your dentist files your claims for you.
A deductible is the amount of money you pay before your Delta Dental plan option begins to pay your eligible expenses. There is a deductible under the Dental Care and Delta Care Plus plan option. At the beginning of each benefit plan year, a new annual deductible begins. The benefit plan year is from July
1 st to June 30 th each year. Expenses credited to your deductible in one year do not carry over to the next.
You can satisfy the family deductible with any combination of eligible expenses you and at least one other family member incur during the benefit plan year. However, the maximum you can count for any one family member is the amount of the dental plan’s individual deductible.
Once you meet your benefit plan year deductible, the Plan pays a percentage of negotiated fees up to an annual maximum. You are responsible for paying the rest. Your share of the cost is called "coinsurance."
IBEW- Effective July 1, 2010 37
See the following sections for how each of the three dental plan options administered by Delta Dental pays benefits.
This option covers only preventive care – such as cleanings, exams, and X-rays. No other services are covered by this plan. If additional services, such as fillings or crowns, are provided by the dentist
100% of the cost for these services is your responsibility to pay.
There is no deductible under this plan option. The option pays 100% of either Delta’s allowed amount or the average fee when visiting an out-of-network dentist up to a maximum per person benefit each benefit plan year. Fees charged by an out-of-network above the average fee are your responsibility for payment.
This option pays 100% of the allowed amount for diagnostic and preventive services from Delta dentists. These services include up to two cleanings and bite-wing X-rays each benefit plan year. You pay no deductible or co-insurance for these services.
For dental services other than diagnostic and preventive, you are responsible for paying 100% of the cost up to the benefit plan year deductible amount. After you pay the benefit plan year deductible you will pay a co-insurance amount based on the allowed amount for other dental services, such as fillings, extractions, crowns and bridges. Usually the co-insurance amount you pay is higher for major dental services, such as crowns and bridges.
You also pay 100% of any expenses that exceed the average fee for dentists in your area when you use a dentist who is not in the Delta Dental network.
Annual maximum: The Delta Dental Care plan option pays up to an annual maximum during the benefit plan year per covered individual. If you receive services that exceed the annual maximum, you will be responsible for 100% of the charges that exceed that amount.
The Delta Dental Care Plus plan option provides the same benefit levels as the Delta Dental Care plan option; however, there are two important differences:
The Delta Dental Care Plus plan option also covers orthodontic care. You will pay a co-insurance amount based on either Delta’s allowed amount or the average fee when visiting an out-of-network dentist for orthodontic care, up to an individual lifetime maximum. (This amount is in addition annual benefit plan year maximum.)
The Delta Dental Care Plus plan option deductible is higher than the Delta Dental Care plan option.
The Preventive option covers only diagnostic and preventive care. The Dental Care option and the
Dental Care Plus option include coverage for diagnostic and preventive care, basic services, and major care. Only the Dental Care Plus option includes orthodontic services. The following is a description of each of these eligible expenses.
Biopsy tissue examination
X-rays
— Bitewing X-rays – Includes one set every six months for children to age 18, and one set every benefit plan year for adults age 18 and older
— Full mouth X-ray – one set every three years unless a special need is shown
Note: Benefits will not be paid for a full-mouth X-ray and bitewing X-rays for an adult in the same benefit plan year.
Emergency treatment – Includes relief of dental pain when the dental plan option pays no other benefit other than X-rays
IBEW- Effective July 1, 2010 38
Fluoride treatment – Includes up to two treatments in a benefit plan year for children under age
14.
Office visits and specialist consultations – Only the first two oral examinations, including office visits for observation and specialist consultations, or combination thereof, are covered benefits during a plan year while you are eligible under any Delta program
Space maintainers for children under age 12, once every five years
Teeth cleaning (prophylaxis) – Includes up to two in a benefit plan year
Anesthesia – general anesthesia, nitrous oxide or IV sedation given by a dentist for covered oral surgery, periodontics, fractures, and dislocations
Crowns, jackets, and cast restorations – limited to once every five years per tooth
The dental plan option covers this treatment for cavities that cannot be restored with amalgam, synthetic, plastic, or resin fillings. A broken tooth is also covered. A tooth worn down by day-to-day wear is not covered.
Drugs - includes antibiotic injections and other drugs administered or ordered by a dentist. If your dentist writes a prescription for you, take the prescription to your pharmacy and fill it as you would any other health care prescription, using your prescription drug coverage.
Endodontics - includes treatment of tooth pulp, such as root canals and other endodontic treatments
Oral surgery - includes extractions of one or more teeth, cutting procedures in the mouth, and treatment of fractures and dislocations of the jaw
Periodontics - includes deep cleaning and scaling, treatment of disease of the gums, mouth tissue, and bones supporting teeth. Periodontal root planing (limited to one quadrant per 24-month period). Gingevectomy, gingeval curretage, muco gingeval surgery, osseous surgery and osseous grafts as part of osseous surgery (limited to once every 36 months)
Restorative (fillings) - includes amalgam, synthetic, plastic, or resin fillings for treatment of cavities
(decay). Direct composite (resin) restorations are the only benefits available on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services and Delta's payment is limited to the cost of the equivalent amalgam restorations
Sealants - limited to once every three benefit plan years for children under age 14. Includes topically applied acrylic, plastics, or composite material applied to permanent posterior molars to seal teeth and prevent decay
Prosthodontics - limited to once every five years. Construction or repair of fixed bridges, partial dentures, and complete dentures if provided to replace missing natural teeth
Bands
Braces
Correction of malocclusion
Orthodontic appliances
Services for strengthening teeth
IBEW- Effective July 1, 2010 39
The Delta Dental plan options each have a maximum benefit per person, which is subject to change.
As of the date of this SPD, the maximum benefits are listed below and vary per plan option.
The Dental Care option and the Dental Care Plus option benefit plan year annual maximum benefit is $2,000 per person.
The Preventive option benefit plan year annual maximum is $500 per person.
The Dental Care Plus option lifetime maximum for orthodontic care is $2,000 per person.
For dental treatments likely to cost more than $300, your dentist should request a pre-determination of benefits before beginning treatment. A pre-determination of benefits is an application for approval of dental treatment and an estimate of eligible expenses before treatment is received. To make this request, your dentist should complete a regular Delta Dental claim form with a diagnosis of the condition, the proposed course of treatment with itemized services, and the charges for each procedure. Dates of service do not need to be included with the request for approval.
Delta Dental will review the proposed treatment for appropriateness and cost effectiveness and send the dentist a predetermination of benefits, stating the Delta Dental approved costs for the procedures recommended.
If less costly treatments are available, Delta Dental will inform you and your dentist in writing of benefits that the dental plan option will pay. You and your dentist can then pursue any treatment plan, with the understanding that Delta will pay only for the least expensive but equally effective procedure.
If you do not obtain a predetermination of benefits for any treatment costing more than $300, your claim is reviewed after treatment and reimbursement may be less than you expect.
If your dental coverage ends, you may extend your Delta Dental coverage for 30 days for the following dental services, provided your dental plan option would otherwise have paid benefits:
For an appliance – or modification of an appliance – for which an impression was taken before your coverage ended
For a crown, bridge, or gold restoration for which the tooth was prepared before your coverage ended
For root canal therapy, provided the pulp chamber was opened before your coverage ended.
In addition, you and/or your dependents may be able to continue dental coverage under certain circumstances when coverage would otherwise end, as described in the Plan Administration section under COBRA.
Ineligible services, supplies and expenses include but are not limited to:
Charges by any hospital or other surgical or treatment facility and any additional fees charged by the dentist for treatment in any such facility
Crowns, jackets, and cast restorations used to treat cavities that could be restored with amalgam, synthetic, plastic, or resin fillings
Crowns, jackets, and cast restorations to replace a tooth more than once every five years.
Diagnostic photos
Full-mouth X-rays for adults within the same benefit plan year as bite wing X-rays
Applications of fluoride or other anti-cavity substance to adult teeth
Experimental procedures, techniques, or materials that are used by some dentists but have not received the full approval of government, scientific, or dental committees. Procedures remain experimental until studies are completed under scientific conditions and published in scientific literature and until they become part of what is known as "generally accepted dental practice"
IBEW- Effective July 1, 2010 40
Grafting of tissue from outside the mouth to tissue inside the mouth (extraoral grafts)
Implants (material implanted into bones or soft tissue) or the removal of implants. If implants are provided with a covered prosthodontic appliance, Delta Dental allows the cost of a standard partial or complete denture toward the cost of the implants and the prosthodontic appliances
Oral examinations when a dentist usually does not charge for this procedure and does not have a fee on file with Delta Dental for this procedure
Orthodontic services, unless you are enrolled in the Dental Care Plus option
Pulp vitality test
Postoperative examinations, the removal of stitches, or any other procedure included in the cost of surgery
Repair or replacement of a sealant on any tooth within three years of its application
Replacement of prosthodontic appliances more than once every five years – unless Delta determines extensive loss of the remaining teeth (or a change in supporting tissues) made the existing appliance unsatisfactory
Services for any disturbance of the jaw joints (temporomandibular joint or "TMJ" disorders) or associated muscles, nerves, or tissues. These services may be covered under your Vought Aircraft
Industries, Inc. medical plan option.
Services for cosmetic purposes or for conditions that are a result of heredity or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth, and teeth that are discolored or lacking enamel
Services for injuries covered by workers' compensation or employer's liability laws, or services paid for by a federal, state, or local government agency – except Medi-Cal or Medicaid benefits
Services performed by someone other than a dentist, except where performed by a qualified technician under the direction of a dentist
Services that are usually furnished without cost when there is no dental coverage
Services started before the participant became covered by the Vought Aircraft Industries, Inc. dental plan
Specialized techniques involving precision attachments, personalization or characterization, and additional charges for adjustments within six months of the installation of prosthetic appliances
Temporary dentures, if billed as a separate item
Treatment that restores worn tooth structure, rebuilds or maintains chewing surfaces that are damaged because teeth are out of alignment or occlusion, or stabilizes the teeth, such as equilibration and periodontal splinting
You and your dependents may be covered by more than one group dental plan, such as the Vought
Aircraft Industries, Inc. dental plan and your spouse's employer's plan. In such instances, the benefits you receive under your Vought Aircraft Industries, Inc. dental plan option will be coordinated with benefits you receive from other plans. When the Vought Aircraft Industries, Inc. dental plan option is the secondary payer, the benefits from other plans are taken into account and you can receive payment up to 100% of your eligible expenses from both plans combined. This provision prevents double payments of benefits.
For example, assume you receive dental services to fill a cavity, and your eligible expenses total $100.
Also assume the primary plan pays 80% (or $80) of eligible expenses for this service and your Vought
Aircraft Industries, Inc. dental plan option - the secondary plan - typically pays 80% of eligible expenses. In that case, since payment cannot exceed 100% of the fees charged, your Vought Aircraft
Industries, Inc. dental plan option pays only the remaining $20 and you pay nothing.
Remember to inform your dentist of all programs under which you have dental coverage and have him or her complete the dual coverage portion of the Attending Dentist's Statement. This process helps ensure that you receive all the benefits to which you are entitled. For more information, contact the
Delta Dental Customer and Member Service Department at 1-800-336-8264.
IBEW- Effective July 1, 2010 41
If your dental coverage ends, you may extend your Delta Dental coverage for 30 days for the following dental services, provided your dental plan option would otherwise have paid benefits:
For an appliance – or modification of an appliance – for which an impression was taken before your coverage ended
For a crown, bridge, or gold restoration for which the tooth was prepared before your coverage ended
For root canal therapy, provided the pulp chamber was opened before your coverage ended.
In addition, you and/or your dependents may be able to continue dental coverage under certain circumstances when coverage would otherwise end, as described in the Plan Administration section under COBRA.
Delta dentists file your claims for you. When visiting your dentist, show your identification card and verify that the provider files the claim with Delta Dental.
If you use a out-of-network Delta dentist, you must file a claim form with Delta Dental. Claims must be submitted with receipts, bills, or an explanation of benefits (EOB) for the expense.
The address for sending claims is:
Delta Dental Insurance Company
P.O. Box 1809
Alpharetta, GA 30023-1809
You must submit claims that occur during the benefit plan year within six months after the benefit plan year ends. Dental claim forms are available from your local Vought Aircraft Industries, Inc. Benefits
Services office or the Vought Benefits Center, or you can download the forms from the Download Forms section on the Vought Benefits Web site at http://benefits.voughtaircraft.com
.
CIGNA Dental Health administers a managed dental plan option, or dental health maintenance organization (DHMO), available in most, but not all, locations where Vought Aircraft employees work.
The following is a brief discussion of benefits in the CIGNA plan and includes a partial list of eligible and ineligible expenses. However, the list is not intended to be all-inclusive. For a detailed description of eligible and ineligible expenses, contact CIGNA at 1-800-367-1037 and request a copy of the enrollment literature. If you select the CIGNA Dental Health plan option, you will receive specific information describing your DHMO dental benefits under the Plan. The DHMO Certificate of Coverage will control in the event of any conflict with this Summary Plan Description. In the event of a conflict between this summary and the Certificate of Coverage, the terms of the Certificate of Coverage will govern the benefit.
If you select the CIGNA Dental Health option, to receive benefits you must receive care from one of the general dentists or specialists in the CIGNA dental network except in an emergency. CIGNA also requires you to select a dental office for you and each of your enrolled dependents from a list of CIGNA providers. With the CIGNA Dental Health option, you save on out-of-pocket expenses for dental care because there are:
No deductibles
No maximum benefits
No claim forms
You pay only a co-payment for services – if any – according to CIGNA’s co-payment schedule.
You must choose a network dentist or specialist. However, you and each of your enrolled dependents may choose a different network dentist. Any office you choose is a private dental practice operated by
IBEW- Effective July 1, 2010 42
a licensed, independent dentist and a qualified dental health team of hygienists, dental assistants, and technicians. Each network dentist contracts with CIGNA to provide care for members who enroll in this option.
At the time of enrollment you will be requested to make a first and second choice for you dentist. If your first or second choice of dentist is not accepting new patients, you will be assigned to a network dental office nearest your home. Call CIGNA at 1-800-367-1037 to request information about network dentists. Or search the CIGNA Dental Directory Service Providers section of the Vought Benefits Web site at http://benefits.voughtaircraft.com
.
If you decide to change your dental provider, simply call CIGNA at 1-800-367-1037. There is no charge to transfer to another dental office. However, your current dentist must be paid in full before your transfer can be processed.
Transfers are effective the first day of the month after your request is processed. Unless you have a dental emergency, you may be unable to schedule an appointment at the new dental office until your transfer is effective.
When you visit a CIGNA network dental office, you pay the amount shown on your co-payment schedule. For example, you may pay nothing for a filling or a small co-payment for more extensive care.
If your network dentist determines you need specialized dental care, your dentist refers you to a specialist. Simply follow your dentist's instructions. Care from a network specialist is covered when
CIGNA Dental Health authorizes payment. If you receive specialty care that is not authorized by
CIGNA, you are responsible for 100% of the charges.
If you have a dental emergency, contact your network dentist immediately. You will pay an additional charge for emergency care provided after office hours. If you are more than 50 miles away from home or are unable to contact your network dentist, seek care immediately at the nearest dental office. You may have to pay for emergency dental services when you receive them. CIGNA reimburses you up to
$50 per emergency for diagnosis and pain relief only, less any co-payments that apply. To receive reimbursement, submit your dental reports and X-rays to CIGNA Dental Health.
The CIGNA Dental Health option does not set a benefit plan year maximum for dental services or a lifetime maximum for orthodontic services.
With CIGNA Dental Health, you file no claim forms. Your provider takes care of that for you.
Call 1-800-367-1037 and speak to a customer service representative who will provide you with the mailing address for your area.
Dental coverage ends when either of these events occurs:
You and/or your dependents are no longer eligible to participate in the Vought Aircraft dental plan
— Benefit coverage would end at midnight on your last day of employment according to the payroll records of Vought Aircraft Industries, Inc.
— If you are retiring, your Vought Aircraft Industries, Inc. coverage ends on the date of your retirement.
— If you fail to pay required contributions to the Plan, your coverage may be discontinued.
IBEW- Effective July 1, 2010 43
— Vought Aircraft Industries, Inc. terminates the Vought Aircraft dental plan options
You and/or your dependents may be able to continue dental coverage under certain circumstances when coverage would otherwise end, as described in the Plan Administration section under COBRA.
The information below is a summary of what happens to your dental benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Personal or Educational – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Family Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month. Vought Aircraft
Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues. However, if your current option is not available at your new location, you must elect a new option within 31 days.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date. You may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
Retire – Coverage stops at midnight on your termination date. Certain employees may be eligible for a retiree medical plan. Otherwise, you may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of a qualifying event.
Layoff/Reduction in Force- Coverage stops on your termination date. You may elect COBRA continuation coverage within 60 days from receiving notice from the COBRA administrator of the qualifying event.
Employees’ Death – Dependent coverage continues to the end of the month from the date of death, plus 12 additional months from the date of date at no additional charge to your eligible survivor(s).
Dependents may then elect retiree coverage, if eligible, or COBRA continuation coverage within 60 days from receiving notice form the COBRA administrator of a qualifying event.
IBEW- Effective July 1, 2010 44
Through payroll deductions, you can set aside money – before taxes are withheld - to cover eligible health care and dependent care expenses in a Flexible Spending Account (FSA). Your money is deposited in a special account from which you withdraw money to reimburse yourself for eligible expenses. (These accounts do not pay you interest on your deposits.)
You have two Flexible Spending Account (FSA) options:
The Health Care Flexible Spending Account helps you save money on your out-of-pocket medical, prescription, dental, vision and hearing expenses
The Dependent Day Care Flexible Spending Account helps you save money on the cost of your dependent care expenses.
You can enroll in one or both accounts within 31 days after you are hired, within 31 days of a qualified change in status, or during the Annual Enrollment period. You also can choose not to participate.
You can contribute as little as $1 each week ($52 each benefit plan year) to one or both Flexible
Spending Accounts. Once your contributions are deposited, they remain in your account until you file a claim for reimbursement or the benefit plan year expires. The most you can contribute to each account is the smallest of the following:
$96 each week ($4,992 each year)
Half your base wage
The amount of your annual taxable income, if less than $4,992 per year
Additional limits may apply to the Dependent Care FSA if you are married.
When you enroll in the middle of the benefit plan year, your maximum contribution is the weekly maximum ($96) multiplied by the number of weekly pay periods left in the benefit plan year. For example, you have a qualified change in status effective February 1 and you elect to enroll in the
Health Care FSA. Your participation in the account will continue for five months (21 weeks) until June
30. Your maximum contribution for this benefit plan year to each account is $96 each week for 21 weeks, for a total of $2,016.
If you choose to participate, you must decide how much money to set aside in each account for the benefit plan year The benefit plan year runs from July 1 st to June 30th. Planning how much to contribute to each account is very important. If you do not incur expenses for all the money in your account by the end of the benefit plan year (June 30), any unused money cannot be rolled over to the next plan year and you cannot receive a refund of the unused funds. The benefit plan year ends June 30 and you have until September 30 to file claims for reimbursement for amounts spent during the benefit plan year. The IRS requires you to forfeit any amounts remaining in your account after the deadline for filing claims for the current benefit plan year.
The amount you select is deducted automatically from your paycheck each week. The money is then credited to an account in your name. When you enroll, you should carefully estimate your expenses for the upcoming benefit plan year, July 1 to June 30. According to IRS rules, you:
Cannot transfer money from one FSA to another (i.e. Health Care FSA to Dependent Care FSA).
Cannot transfer money from your FSA to a health savings account (HSA).
Cannot change the set amounts you choose to contribute during the benefit plan year, unless you have a qualified change in status.
Will forfeit your unused account balances at the end of the run-out period following the benefit plan year.
Will forfeit your unused account balances if you leave Vought Aircraft in midyear for any reason, unless you elect to continue coverage through COBRA for the Health Care FSA. (However, you will
IBEW- Effective July 1, 2010 45
be able to submit a claim through the end of the 90-day period following the end of the benefit plan year for reimbursement of expenses that you incur before leaving the Plan.)
Cannot file for an income tax deduction or tax credit for expenses reimbursed through the FSAs.
If you participate in the BlueEdge HSA PPO option, your Health Care FSA will be limited to dental and vision expenses ONLY. Any medical expenses will be reimbursed through your Health Savings Account
(see section entitled “Heath Savings Accounts” in this document).
If you participate in the BlueEdge PPO option (Nashville only) and elect to participate in the Health Care
FSA, your eligible expenses will be deducted from the Health Reimbursement Account (HRA) first.
When your HRA is depleted, health care expenses can then be reimbursed from the Health Care FSA.
Your funds in the Health Care FSA can be used to satisfy the remaining portion of your deductible, or co-insurance payments after the deductible is met, or non-covered eligible charges. See the section entitled “Health Reimbursement Accounts” in this document.
You can use the money in your flexible spending accounts to either pay for qualified expenses at time of purchase through the debit card or receive reimbursement after making a qualified purchase via submission of a claim form.
If you or your dependents are enrolled in more than one health plan (such as your plan and your spouse's plan or Medicare), you first have to submit your expenses to those plans. After you receive reimbursement from all your health plans, you can submit the balance of your eligible expenses for reimbursement under the Health Care Flexible Spending Account. Please include the EOB from both plans with your claim.
The Flexible Spending Account debit card allows you to use pre-tax dollars from your flexible spending account to pay for qualified out-of-pocket health care expenses and dependent day care expenses and avoid filing a claim for reimbursement.
The FSA debit card, available through PayFlex, automates the process of paying for eligible expenses to selected providers that accept MasterCard and are compliant with Internal Revenue Service regulations.
You can use the card for qualifying purchases at health-care related merchants as well as certain nonhealthcare related merchants, drug stores, and retail pharmacies that have implemented an IRSapproved inventory information approval system. Call PayFlex at 1-800-284-4885 or log on to their web site at www.mypayflex.com
to determine at which establishments you can use your debit card.
You must retain your receipts for all eligible expenses. Payflex will, at times, request documentation of an expense and you must submit this to Payflex on request. If you are unable to submit receipts in support of your eligible charges, then the charges will be denied and you must reimburse the Plan for all unsupported charges.
There may be times when you are unable to use your debit card issued by Payflex to pay for a qualified expense. This might be when you are paying your child’s day care provider or you’re purchasing items such as groceries and don’t want to pay for the qualified expense such as contact supplies in a separate transaction. In such instances you’ll need to pay for the qualified expense up front and then request reimbursement from your account after the fact.
You’ll need to complete a paper claim form and send it, along with supporting documents (via online, mail, or fax) to the claims administrator, PayFlex Systems USA, Inc (Payflex). Forms are available from the Download Forms page on the Vought Benefits Web site or the Vought Benefits Center at 1-866-
689-5999.
When you submit a paper claim, you should receive your reimbursement check and a statement of your account balance within six weeks. If you want your reimbursements deposited in your bank account through electronic funds transfer, you may request that service from PayFlex.
IBEW- Effective July 1, 2010 46
By mail, submit your claims to:
PayFlex Systems, USA, Inc.
Flex Dept.
P.O. Box 3039
Omaha, NE 68103-3039
By fax to
(402) 231-4310 (no cover page is required, but on the first page, indicate how many pages you are sending)
If your family status changes during the benefit plan year, you can enroll in the Flexible Spending
Accounts or change the amounts you contribute. That is the only time you can make a change except during Annual Enrollment. See “Changing Your Coverage During the Plan Year” for examples of a qualified change in status.
You have 31 days after a qualified change in status to enroll or to change your existing selection. The change you make must relate directly to your change in status, and you will have to submit documentation of the event. For example, if you marry and wish to increase your contribution to the
Plan, you must submit a copy of your marriage license along with your election form.
At the time of a qualified change in status, you may have a negative balance in your health care
Flexible Spending Account. A negative balance occurs when you contribute less money to your account than you receive in reimbursements. In that case, any changes you make to your contributions must allow you to repay the negative balance by the end of the benefit plan year.
You can use the Health Care FSA for health care expenses that are considered eligible deductions on your federal income tax return (with the exception of insurance premiums) but are not reimbursed by another health plan. Eligible expenses may include your share of the cost of medical, dental, vision, and hearing care for you or a dependent.
Health care expenses can be for:
Yourself
Your spouse
Qualified dependents
Note: You, your spouse, or your dependents do not have to be enrolled in the Vought medical plans to be eligible for the Health Care Flexible Spending Account
If your dependent is your tax dependent for federal income tax purposes, their expenses may be eligible.
Under the health care FSA the full amount that you elect to contribute for the benefit plan year is available for reimbursement on the first day of the Plan year. You can submit health care expenses and receive reimbursement for up to the total you will contribute for the entire year, less any reimbursements that already have been paid. Your future contributions will pay off the deficit in your account.
The Health Care FSA reimburses you for these eligible expenses, according to IRS regulations:
Medical and dental plan co-payments, deductibles and co-insurance
Charges above the medical and dental plans' usual, reasonable and customary limits
Other Eligible medical and dental expenses not paid (or not fully paid) by your medical, dental, or vision option.
IBEW- Effective July 1, 2010 47
For a complete list and more information on eligible and non-eligible expenses, please go to www.payflex.com
.
The Health Care FSA will not reimburse for certain expenses, such as the following items (even if they are recommended by your doctor):
Cosmetic treatment (unless the treatment corrects a deformity arising from or directly related to a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease), Cosmetic treatment includes, but is not limited to, teeth bleaching, laser peels, chemical peels, hair transplants and treatment for male pattern baldness
Drugs prescribed for cosmetic purposes (such as Rogaine, a drug prescribed for hair-loss treatment)
Dance or swimming lessons
Electrolysis
Expenses reimbursed through any health insurance policy or plan, such as your spouse's health plan or Medicare
Expenses you or a family member incurred before the effective date of your Health Care Flexible
Spending election, or change of your Health Care FSA election
Expenses you or a family member incurs after the end of the benefit plan year (June 30)
Health club dues, YMCA dues and related expenses
Household help
Liposuction
Marriage or family counseling
Maternity clothes, diaper service, and related expenses
Nonprescription drugs or vitamins (unless prescribed by a physician as periodically necessary to treat a specific disease or condition)
Custodial nursing home care
Premiums for automobile insurance, including premiums to insure medical care for persons injured by or in your car
Premiums for life or accidental death and dismemberment (AD&D) insurance
Premiums for medical, dental and vision insurance, including COBRA premiums
Transportation to and from work (even if your condition requires special means of transportation)
Trips or vacations taken for relief of a condition, change in environment, improvement of morale, or general health purposes
Tuition for a child with disciplinary problems who is enrolled in a special school
Uniforms
Weight-loss programs (unless prescribed by a doctor as medically necessary for the treatment of a specific disease or condition)
Any other expenses that are not deductible on a federal income tax return (see IRS Publication
502)
For a complete list and more information on eligible and non-eligible expenses, please go to www.payflex.com
.
IBEW- Effective July 1, 2010 48
The information below is a summary of what happens to your health care flexible spending account when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid medical leave, you must continue to make contributions to be eligible to be reimbursed for eligible expenses. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. If you are receiving a paycheck from the company during your leave of absence, your contributions will continue and you can continue to be reimbursed for eligible expenses.
Personal or Educational – Coverage continues for the duration of your approved leave. You must continue to make contributions to be eligible to be reimbursed for eligible expenses. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions.
Claims you incur after your participation ends are not eligible for reimbursement.
Family Leave – If you are on an unpaid leave, you must continue to make contributions to be eligible to be reimbursed for eligible expenses. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. If you are receiving a paycheck from the company during your leave, your contributions will continue and you can continue to be reimbursed for eligible expenses.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions to be eligible to be reimbursed for eligible expenses. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Vought Aircraft Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Your contributions stop with your final paycheck. If you want to continue participation in your FSA until the end of the benefit year, you can make contributions to the COBRA administrator. If you stop making contributions under COBRA, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Retire – Your contributions stop with your final paycheck. If you want to continue participation in your
FSA until the end of the benefit year, you can make contributions to the COBRA administrator. If you stop making contributions under COBRA, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims incur after your participation ends are not eligible for reimbursement. You have
90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Layoff/Reduction In Force - Your contributions stop with your final paycheck. If you want to continue participation in your FSA until the end of the benefit year, you can make contributions to the COBRA administrator. If you stop making contributions under COBRA, you can only be reimbursed for
IBEW- Effective July 1, 2010 49
expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Employee’s Death – Contributions stop on the date of death. Your dependents have 90 days from the end of the benefit plan year to file claims for expenses incurred before your date of death. Your dependents may continue participation in your FSA until the end of the benefit year by making contributions to the COBRA administrator. If your dependents stop making contributions under COBRA, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims they incur after their participation ends are not eligible for reimbursement.
The Dependent Day Care Flexible Spending Account may be used for eligible expenses for the care of your eligible dependents as defined by IRS regulations.
If you are married, to be eligible to use a Dependent Day Care FSA, your spouse also must work (or actively be searching for work). The only exception is if he or she is disabled or a fulltime student.
If you are divorced or legally separated, you can use the Dependent Day Care FSA if you have custody of your child for a longer period of the year than does your child's other parent. In addition, your child must be your tax dependent for federal tax purposes.
Who is a qualified caregiver?
Your day care provider can be a caregiver if his or her services enable you and your spouse to work, look for work or attend school, but CANNOT BE any of the following:
Your spouse
Your child's other parent
Your child who is under age 19 at the end of the benefit plan year
A person whom you or your spouse claims as a dependent for income tax purposes.
Dependent Day Care FSA
You can be reimbursed for eligible expenses up to the balance in your dependent day care account at the time you use your FSA debit card or your claim is processed. If you have enough money in your account, you can pay with your FSA debit card if your day care center accepts MasterCard. If your balance is insufficient, your debit card transaction will be rejected.
For paper claims, you will receive reimbursement for expenses up to the amount in your dependent day care balance at the time the claim is processed. If you do not have enough funds in your account at the time the claim is processed, the remainder of the claim will be processed the next time you have made sufficient payroll contributions to your account.
To file a paper claim, submit your completed dependent day care FSA claim form to PayFlex. Include a bill that shows your provider's Social Security or tax identification number. Internal Revenue Service
(IRS) rules will not allow your expenses to be reimbursed if you do not provide the number.
For reimbursement of the cost of day care provided by your child's school, day care must be shown as a separate item on the tuition bill. Tuition for children in kindergarten or above is not an eligible expense.
Day care expenses that can be reimbursed through the Dependent Day Care FSA, according to IRS regulations, include day care for:
Children under age 13 whom you claim as exemptions on your federal income tax return
A spouse who is mentally or physically incapable of caring for him- or herself
IBEW- Effective July 1, 2010 50
Parents, grandparents, children age 13 or older, or other relatives or members of your household who:
— Are claimed as a dependent on your federal income tax return
— Spend at least eight hours each day in your home
— Receive more than half of their support from you, and
— Are physically or mentally incapable of caring for themselves
If your spouse is incapable of caring for him- or herself, the expenses you incur for his or her care must enable you to be gainfully employed, and your spouse must:
Have a physical or mental condition that does not allow him or her to take care of personal, hygienic or nutritional needs, or
Require fulltime attention for safety reasons
The fact that your spouse is unable to engage in substantial gainful activity or perform his or her normal functions is not necessarily sufficient for day care expenses to be reimbursed under the Plan.
Expenses eligible for reimbursement, according to IRS regulations, include:
The cost of day care provided in or out of your home (including Social Security taxes you pay on behalf of your provider) by an eligible babysitter, for example
The cost of day care provided at a licensed day care center or kindergarten that cares for at least six people and complies with applicable state and local regulations (but not services from a facility that charges no fee)
The cost of day care provided at a day camp (but not tuition and other fees unrelated to day care and not at an overnight camp)
The cost of day care provided at a private school (but not tuition and other fees unrelated to day care if the child is in kindergarten or above)
Any nonrefundable fees to secure your dependent's place in a day care center
Any other expenses that would be considered eligible for a dependent care credit for federal income tax purposes.
For a complete list of these expenses, see IRS Publication 503, available from your local IRS office, or order a copy from the IRS by calling 1-800-829-3676.
The following expenses are not eligible for reimbursement under the Dependent Day Care FSA. There may be other ineligible expenses. Please reference IRS Publication 503 or contact the Claims
Administrator.
Child support payments
Clothing, entertainment or food expenses
Day care costs for hours when you or your spouse is not working or is working as a volunteer
Expenses for day care while you or your spouse is away from work because of vacation, illness, or leave of absence
Expenses you or a family member incurred before the effective date of, or a change in, your
Dependent Day Care FSA election
Expenses that are reimbursed by another plan, such as your spouse’s or a government plan
Expenses that occurred before you enroll in the Dependent Day Care FSA or after your participation ends
Expenses that occur during any time you cannot claim your dependent as an exemption on your federal income tax return
Day care costs after the benefit plan year ends (June 30)
Finder's fees for placement of an au pair or nanny
IBEW- Effective July 1, 2010 51
Fulltime convalescent or nursing home expenses (except care for a mentally disabled child under age 13)
Overnight camp expenses
Transportation expenses for your caregiver or your dependent
Tuition for kindergarten or beyond
Any other expenses not eligible as a dependent care credit for federal income tax purposes (see
IRS Publication 503 from your local IRS office)
For a complete list of these ineligible expenses, see IRS Publication 503, available from your local IRS office, or order a copy from the IRS by calling 1-800-829-3676.
Each benefit plan year, you can set aside up to $96 per week ($4,992 per year) in your Dependent Day
Care Flexible Spending Account. However, special limits apply if you are married, as shown in the following table:
The information below is a summary of what happens to you dependent care flexible spending account when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage does not continue for the duration of your approved leave, unless you are hospitalized and your spouse has to work. If you are hospitalized and your spouse has to work, you must continue to make the required contributions. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Personal or Educational – Coverage does not continue for the duration of your approved leave, unless you are hospitalized and your spouse has to work. If you are hospitalized and your spouse has to work, you must continue to make the required contributions. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your
IBEW- Effective July 1, 2010 52
participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Family Leave – Coverage does not continue for the duration of your approved leave, unless you are hospitalized and your spouse has to work. If you are hospitalized and your spouse has to work, you must continue to make the required contributions. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions and your spouse has to work. If you are on a paid leave, your contributions will continue via payroll deductions. If you are on an unpaid leave, you must continue to make contributions by remitting payments directly to the Company. If you stop making contributions, you can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Any claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date. Vought Aircraft Industries,
Inc. military leave coverage will comply with all applicable federal and state military leave laws including the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Your contributions stop on your last paycheck. You can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Retire – Your contributions stop on your last paycheck. You can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Layoff/Reduction In Force - Your contributions stop on your last paycheck. You can only be reimbursed for expenses up to the amount of your account balance and only for expenses incurred during the period in which you were making contributions. Claims you incur after your participation ends are not eligible for reimbursement. You have 90 days from the end of the benefit plan year to file claims for expenses acquired before your termination date.
Employee’s Death – Contributions stop on the date of death. Expenses up to the amount of your account balance and for expenses incurred during the period in which you were making contributions are eligible for reimbursement. Claims for expenses acquired before your date of death must be filed no later than 90 days from the end of the benefit plan year.
Your contributions to an FSA could affect the amount of your future Social Security benefits, because your Social Security benefits are based on your average annual taxable income – up to the Social
Security annual wage base – over your entire career. Your FSA contributions lower the amount of your taxable income, so your Social Security benefits at retirement or disability may be slightly less.
Even though the Health Care FSA reimbursements can save you money on taxes, the federal income tax deduction can provide greater tax savings for some employees. To claim such a deduction, your
IBEW- Effective July 1, 2010 53
out-of-pocket health care expenses must exceed 7.5% of your adjusted gross income. Ask your tax adviser which method is best for your personal situation.
Another way to reduce federal income taxes with dependent care expenses is to claim the childcare credit on your tax return, which is a federal tax credit for eligible dependent care expenses. The combination of FSA reimbursements and tax credits that provides the greatest tax saving for you depends on your household income, the number of your eligible dependents, and your income tax filing status.
You have the option to use both the Dependent Day Care FSA and the tax credit. However, the IRS does not allow you to claim a tax credit for any expenses reimbursed under the FSA. In other words, you cannot "double deduct" these expenses to receive a tax saving twice. You should consult your tax adviser about how to utilize both the Dependent Day Care FSA and tax credit.
Note: You are responsible for ensuring that the expenses are valid IRS deductions. The claims administrator and Vought Aircraft Industries, Inc. are not responsible for verifying that your claims are valid tax deductions. You should consult your tax adviser with any questions regarding your income tax obligations.
Your participation in the FSAs end and your contributions stop when the first of these events occurs:
You or your dependents are no longer eligible under the plan; or
You elect to change your contribution to zero dollars during annual enrollment or as a result of a qualified life status event; or
The plan terminates.
You can submit claims that you incur before your participation in the FSAs end. The deadline to submit claims is September 30, ninety days after the benefit plan year ends.
Claims that you incur after your participation ends are not eligible for reimbursement, and you lose any money left in your accounts. However, under certain circumstances, when your coverage otherwise would end, you may continue participating in the Health Care FSA by making contributions through
COBRA.
A Health Savings Account is a special account owned by the participant, not the employer, used to pay for current and future medical expenses including expenses occurred in retirement. The Health Savings
Account is used in conjunction with the Blue Cross Blue Shield BlueEdge HSA. This plan is an IRS qualified High Deductible Health Plan.
An IRS qualified High Deductible Health Plan is a health plan with a defined minimum annual deductible and a defined out-of-pocket maximum limit for medical expenses. With the exception of preventative care, all expenses must apply to the deductible, including prescription drugs and mental health and substance abuse.
The Health Savings Account can be funded by the employer, employee, or both up to the annual indexed maximum as set by the Internal Revenue Service, which are subject to change year-to-year.
The maximum contribution limit in 2010 is $ 3,150 for an individual and $6,150 for any other coverage level. Contributions to the Health Savings Account can only be made as long as you are enrolled in a qualified High Deductible Health Plan. If you choose to waive coverage, enroll in a plan that does not meet the minimum deductible and out-of-pocket maximum limit, or leave the Plan, contributions can not be made to the Health Savings Account. However, distributions can still be made to pay for qualified medical expenses.
IBEW- Effective July 1, 2010 54
Employer contributions are subject to change on a year to year basis, including the frequency of distribution of such contributions. For the benefit plan year beginning July 1, 2009, the Company will make an annual contribution of $250 for single coverage or $500 for family coverage (employee + spouse, employee + child(ren), or employee + family) to a health savings account established by the employee. If the Company chooses to continue with the employer contribution in future plan years, the contributions will be made to the account by the last pay period of the first month of the new benefit plan year. For new hires, the employer contribution will be made within 30 days after a health savings account is opened with the Health Savings Account Administrator. Funds contributed by the Company are available for use once they are deposited into the health savings account. Employer contributions will not be made if the employee is receiving medical coverage through COBRA.
THE PARTICIPANT IS RESPONSIBLE FOR MANAGING THE AMOUNT OF ANNUAL
CONTRIBUTIONS GOING INTO THEIR HEALTH SAVINGS ACCOUNT AND ENSURING THEY ARE
COMPLIANT WITH APPLICABLE HEALTH SAVINGS ACCOUNT AND TAX REGULATIONS.
Employees may elect to contribute pre-tax funds via payroll deduction if they choose to open a Health
Savings Account with the Plan’s Health Savings Account Administrator. If an employee decides to open a Health Savings Account using a different Health Savings Account provider other than the Company’s
Health Savings Account Administrator, the Company will not submit contributions to that account via payroll deduction. Employees can change the amount of their contributions at any time during the benefit plan year without the requirement of a qualified life status change. Contributions can also be made to the Health Savings Account on an after-tax basis via manual deposit into the employee’s account.
If contributions into a health savings account exceed the maximum allowable deposit, a withdrawal of the excess amount and any earnings on the excess amount can be made prior to April 15 th of the following year without the employee incurring any tax penalty. However, the employee must pay income tax on the amount of the excess contributions and any earnings of the excess contribution. For more information on tax implications, please visit the IRS online at www.irs.gov
. If the participant does not withdraw the excess contribution to the health savings account prior to April 15 th of the following year, the participant must also pay an excise tax (6% in 2009) on the excess contribution, and on any earnings of the excess contribution.
Health savings accounts are subject to audits by the IRS. The IRS will directly contact the owner of the account (the employee) for such requests. Participants should maintain all receipts for distributions made for eligible expenses. The IRS can impose a penalty if distributions were used for non-qualified expenses.
If a distribution from your health savings account is used for purposes other than a qualified expense as defined in IRS Publication 502, then the amount withdrawn is subject to both income tax and a 10% penalty, unless the person who makes such a withdrawal from their health savings account is over the age of 65 or disabled. If the participant is 65 years old or older or disabled, the amount withdrawn for non-qualified purposes is subject to normal income tax, but is not subject to the 10% penalty.
The participant should name a beneficiary upon enrolling in the account. The Health Savings Account
Administrator will keep a record of the beneficiary. Unless otherwise designated by the account owner
(employee), the participant’s spouse will inherit the health savings account. If at the time of death the account owner (participant) does not have a spouse and a beneficiary has not been named, any funds in the account shall no longer be treated as a health savings account, but part of the individual’s estate and will be subject to estate taxes.
If the participant experiences a qualified life status change and increases their level of coverage from employee only to employee + child(ren), employee + spouse, or employee + family, Vought will make a pro-rated employer contribution into the employee’s health savings account based on the number of full months the participant was enrolled in the previous level of coverage. The participant can also make a contribution into their Health Savings Account up to a pro-rated maximum.
IBEW- Effective July 1, 2010 55
If the participant encounters a qualified life status change, such as a divorce or if a dependent loses eligibility, and decreases their level of coverage the participant’s contribution limit will be decreased on a pro-rated basis. This limit will be calculated based on the number of full months the participant was enrolled in the previous level of coverage.
The following items are a summary of rules and regulations set forth by the IRS for the administration of Health Savings Accounts. For a complete listing, please visit www.irs.gov
and www.treas.gov
.
Employees cannot be enrolled in Medicare or Medicaid/MediCal and must be covered by a qualified, high deductible health plan to open a health savings account.
Employees who have received any Veterans Administration health benefits in the last three months cannot have a Health Savings Account.
If the employee is no longer in a Health Savings Account-qualified High Deductible Health Plan, they can no longer contribute to the health savings account, but can still spend the funds in the
Health Savings Account on qualified expenses.
Health Savings Account balances roll over from year-to-year.
Distributions from a health savings account used to pay for qualified expenses as defined by IRS
Publication 502 are tax-free. Qualified expenses for health savings account purposes are only expenses incurred after the Health Savings Account is established.
Health savings accounts are portable, meaning that the employee can move the balance from plan to plan (e.g. Vought’s Flexible Benefits Plan to another employer’s benefits plan, subject to their plan rules), use it in retirement, or move it between banks.
Health Savings Account balances may be invested through the investment options of the Health
Savings Account Administrator. Any earnings are tax-deferred. If the earnings are transferred back to the participant’s health savings account to be used for qualified expenses the earnings will be tax-free.
Account holders can make a one-time IRA rollover to the Health Savings Account.
“Catch-Up” contributions can be made to your health savings account for individuals who are age
55 and older. If you were not enrolled in the BlueEdge HSA plan option the full calendar year, you must pro-rate your “catch-up” contribution for the number of months you were eligible for the High
Deductible Health Plan option (BlueEdge HSA).
For a list of allowable and non-allowable expenses, please visit the IRS website at www.irs.gov
.
Special Note for BlueEdge HSA Plan
Coordination of benefits (COB) will apply to the high deductible health plan. Please see the Non-
Duplication of Benefits section for more information. Please note that usually COB will not apply because the member who has the health savings account cannot be covered by other health insurance unless it’s another high deductible health plan. However, there are circumstances where COB may apply such as:
The member is covered under two high deductible health plans (i.e., a husband and wife both have family coverage under separate high deductible health plans)
The family has one spouse covered under a high deductible health plan/ health savings account with family coverage and the other spouse covered her or himself and dependents only under a non-high deductible health plan through his/her employer
Please Note: In the above circumstances, the husband and wife who both have family coverage under separate high deductible health plans cannot contribute more than the annual maximum allowed for a family in that calendar year ($6,150 in 2010). However, both may make “catch-up” contributions if they are age 55 or older.
If you have an HSA and you elect to enroll in a health care flexible spending account (FSA), you must enroll in a limited purpose Flexible Spending Account. A limited purpose Flexible Spending Account restricts reimbursements to certain permitted benefits such as vision and dental expenses. Rollovers from an FSA into a Health Savings Account are not permitted.
The information below is a summary of what happens to your health savings account when you encounter a change to your employment status.
IBEW- Effective July 1, 2010 56
Leaves of Absence
Medical Leave – If you are on a paid leave, your contributions to your account will continue via weekly payroll deductions. Otherwise, your contributions will stop. You may continue to make contributions via deposit into the bank account as long as your coverage continues in the Plan. You may also continue to withdraw funds for eligible expenses.
Personal or Educational – If you are on a paid leave, your contributions to your account will continue via weekly payroll deductions. Otherwise, your contributions will stop. You may continue to make contributions via deposit into the bank account as long as your coverage continues in the Plan. You may also continue to withdraw funds for eligible expenses.
Family Leave – If you are on a paid leave, your contributions to your account will continue via weekly payroll deductions. Otherwise, your contributions will stop. You may continue to make contributions via deposit into the bank account as long as your coverage continues in the Plan. You may also continue to withdraw funds for eligible expenses.
Military Leave – If you are on a paid leave, your contributions to your account will continue via weekly payroll deductions. Otherwise, your contributions will stop. You may continue to make contributions via deposit into the bank account as long as your coverage continues in the Plan. You may also continue to withdraw funds for eligible expenses. Vought Aircraft Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the Uniformed
Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Your payroll contributions will stop on your last paycheck and the Company will make no further contributions to your account. In order for you to continue to make contributions to the
Health Savings Account, IRS regulations require you to be enrolled in a qualified High Deductible Health
Plan. Unless you elect COBRA continuation coverage within 60 days from the end of coverage, you will not be eligible to continue contributions. However, you may continue to withdraw funds for eligible expenses.
Retire – Your payroll contributions will stop on your last paycheck and the Company will make no further contributions to your account. In order for you to continue to make contributions to the Health
Savings Account, IRS regulations require you to be enrolled in a qualified High Deductible Health Plan.
Unless you elect COBRA continuation coverage within 60 days from the end of coverage, you will not be eligible to continue contributions. However, you may continue to withdraw funds for eligible expenses.
Layoff/Reduction In Force - Your payroll contributions will stop on your last paycheck and the Company will make no further contributions to your account. In order for you to continue to make contributions to the Health Savings Account, IRS regulations require you to be enrolled in a qualified High Deductible
Health Plan. Unless you elect COBRA continuation coverage within 60 days from the end of coverage, you will not be eligible to continue contributions. However, you may continue to withdraw funds for eligible expenses.
Employee’s Death – Participation ends on the date of death. Unless the employee designates a different beneficiary, the spouse will inherit the funds in the account. If the employee does not have a spouse or a designated beneficiary at the time of death, the funds in the account will be treated as part of the employee’s estate and subject to estate taxes.
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Vought Aircraft Industries, Inc. provides you with a basic level of life, accidental death and dismemberment (AD&D), and business travel accident insurance. In addition, the company offers you the opportunity to purchase optional coverage for yourself and your eligible family members. You can enroll in optional supplemental coverage within 31 days after you are hired, 31 days of a qualified change in life status, or during the Annual Enrollment period.
After enrollment, you will receive a Certificate of Coverage, which will describe all the requirements of the policy including eligibility, Evidence of Insurability (EOI) requirements, and conversion rules. The information below provides a summary of the information. For complete information, you will need to reference the Certificate of Coverage. In the event of a conflict between this summary and the
Certificate of Coverage, the terms of the Certificate of Coverage will govern.
Your basic and optional life insurance pays benefits to your beneficiary in the event of your death.
Optional life insurance for your spouse or children pays a benefit to you in the event an enrolled dependent dies.
Both the basic and optional life insurance plans are known as "term insurance." Unlike whole life insurance, term insurance policies do not build up a cash value. Term insurance pays benefits in a lump sum only if you or your enrolled dependents die while covered.
As a Vought Aircraft Industries, Inc. employee, you have these basic and optional supplemental benefits available under the Plan.
Vought Aircraft Industries, Inc. provides $50,000 of basic term life insurance for you at the Company’s expense. You are automatically covered if you are an eligible employee. You do not have to complete an enrollment form. However, you need to complete a beneficiary designation form, available from the
Vought Benefits Center or on the Vought Benefits Web site at http://benefits.voughtaircraft.com
. Select
Employee from the menu at the left side of the screen. Then select Beneficiary Review or Change and follow the instructions on the form. After enrollment, you will receive a Certificate of Coverage providing the terms and conditions, including eligibility, evidence of insurability (EOI) requirements, and conversion regulations. The information below provides a summary of the information. For complete information, you will need to refer to the Certificate of Coverage.
The following is a summary of the Vought Aircraft Industries, Inc. optional term life insurance plan options for you, your spouse, and your eligible children. You pay the full cost of optional life insurance through payroll deductions. You will receive a Certificate of Coverage providing the terms and conditions, including eligibility, evidence of insurability (EOI) requirements, and conversion regulations.
The information below provides a summary of the information. For complete information, you will need to reference the Certificate of Coverage.
You may purchase optional life insurance for yourself in an amount equal to one to eight times your annual base salary, up to a maximum of $1,500,000. If your annual base salary is not an even $1,000 multiple, the amount of your coverage is rounded up to the next higher thousand-dollar amount.
You may purchase optional life insurance for your spouse in the following amounts:
$10,000
$25,000
$50,000
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If both you and your spouse work for Vought Aircraft, you can select optional life insurance for one another.
You also may purchase optional life insurance for your children in one of the following amounts:
$5,000 per child
$10,000 per child
This coverage is available for children from live birth to 19 years old. Children who are fulltime students are eligible until they reach age 25.
If both you and your spouse work for Vought Aircraft, you each may purchase optional life insurance for your children.
You may enroll in optional life insurance for yourself and/or your eligible dependents without evidence of insurability within 31 days after you are hired, at Annual Open Enrollment, or within 31 days of the date you or they become newly eligible for coverage.
You can enroll in optional life insurance at any other time if you provide satisfactory evidence of insurability (EOI) to the insurance company. You will need to refer to your Certificate of Coverage to review EOI requirements.
Evidence of insurability (EOI) is specific documents and/or procedures that confirm whether you and/or your dependents are or are not in good health at the time you enroll in the optional life insurance plan.
If you enroll when you are first eligible or at Annual Open Enrollment, you do not have to provide EOI, unless you exceed the non-medical limit. If you decide to enroll at a later date or your election exceeds the non-medical limit, you must provide satisfactory evidence of insurability to the insurance company. You may be required to provide EOI if you increase the amount of your insurance coverage.
Please refer to your Certificate of Coverage for EOI requirements.
If you are required to provide EOI, you need to contact your local benefits representative or call the
Vought Benefits Center at 1-866-689-5999 and ask for an EOI form. Complete the form and mail it to the life insurance administrator, as soon as possible, at the address shown on the form. On the basis of the information you provide, the insurance company reviews the form and determines your eligibility to enroll in the optional plan. In addition, the life insurance administrator may ask you to schedule a physical exam with a physician of its choice. You pay the full cost of the exam. The life insurance administrator will inform you and the Vought Benefits Center if you are approved or denied. If your coverage is approved, the life insurance administrator will tell you when the coverage is in effect. The current life insurance administrator and address information is found in the Administrative Facts section.
IMPORTANT: For your optional life insurance coverage to take effect, you must be an active employee and not on a leave of absence. If you are on a leave of absence and you decide to increase your coverage, the coverage increase will not be effective unless and until you return to work – even if you satisfied the EOI requirement.
For your dependent's coverage to take effect, he or she must not be confined for medical care or treatment – either in a medical treatment facility or at home – on the effective date of the coverage. If your dependent is confined, coverage begins when he or she is released from confinement.
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To receive benefits as a result of a loss, you or your beneficiary must report the death of the enrolled person to your local benefits representative or call the Vought Benefits Call Center at 1-866-689-5999.
The company will notify the insurance carrier, gather the necessary information, and provide you or your beneficiary with information about the payment of life insurance benefits.
You or your beneficiary will be asked to provide certified copies of the death certificate, birth certificate, and marriage certificate, if applicable, of the deceased. Photocopied certificates are not valid. Once the claim is filed and the appropriate documents are received, the insurance company will typically pay the benefit to the designated beneficiary within 7-10 business days.
The Vought Aircraft Industries, Inc. basic and optional life insurance coverage includes a special feature that helps you financially if you or your spouse is terminally ill. Under the Living Benefit Option, if you or your spouse is expected to live for six months or less, you may receive 50% of the total life insurance amount, up to $200,000.
To receive this benefit, you must provide medical documentation of the insured’s condition and proof pf the terminally ill status. After your request is approved, the life insurance administrator will issue payment of the benefit. After the insured dies, the remaining life insurance benefits are paid to the beneficiary. However, the benefit may be reduced if, within 6 months after the date the life insurance administrator receives such proof, a reduction on account of age would have applied to the amount of your coverage. In that case, the amount of the benefit may not exceed the amount of such insurance after applying the reduction.
Your insurance beneficiary is the person or persons you choose to receive your insurance benefits when you die. You also may choose your estate or living trust as the beneficiary of your life insurance benefits. If the beneficiary is under age 18, the insurance company requires that benefits be paid to a legal guardian on behalf of the minor. If you do not name a beneficiary, your benefits are distributed to your estate according to the laws of your state.
If you elect optional life insurance for your spouse or your children, you are automatically the beneficiary of that coverage.
You can change your beneficiary(s) at any time. If you need to change your beneficiary(s), you may do so on-line via the Vought Benefits Web site at http://benefits.voughtaircraft.com
. Select Employee, then Beneficiary Review or Change, and follow the instructions.
Life insurance coverage ends when the first of these events occurs:
You or your dependents are no longer eligible to participate in the Plan;
You fail to make a contribution or authorize a payroll deduction for coverage; or
The plan terminates.
Your life insurance coverage and any optional coverage for your spouse and/or children end on the date of your termination. The conversion privilege allows you to convert all or a portion of your life insurance coverage to an individual whole life insurance policy within 31 days of your termination. The policy becomes effective at the end of the 31 days.
If you die within that period, the life insurance company pays benefits to your beneficiary for your basic life insurance as well as any optional life insurance as if you had converted the policy, whether or not you had actually started that process.
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The life insurance company issues the individual whole life insurance conversion policy. You can contact any licensed representative of the insurance company and choose the amount and type of individual policy that suit your needs. There may be several types of policies from which you can select.
You do not have to provide evidence of insurability. The cost is based on your age and the amount and kind of life insurance you select. To request a conversion policy, you must request a form from the
Vought Benefits Center at 1-866-689-5999 within 31 days of your termination.
The Vought Benefits Center fills out the form and mails it to you. You, then, take the form to any agent of the life insurance company within the 31-day conversion period. From then on, you pay premiums directly to the life insurance company.
Term Life Coverage under the Portability Plan
A Portability Plan is an alternative to the life insurance conversion as described above. You have the right to apply for coverage under the Portability Plan during the Portability Application Period, which is
31 days after your Optional Employee Term Life Coverage ends. The Portability Plan only applies to
Optional Employee Term Life coverage under the Group Contract with Vought Aircraft Industries, Inc.
Evidence of Insurability is not required to become insured.
The Portability Plan is different from the conversion privilege because it continues your term life insurance as opposed to a whole life policy when it is converted.
You have the right to apply for term life coverage under the Portability Plan if you meet all of the following tests:
1.
Your Optional Employee Term Life Coverage ends for any reason other than: a.
your failure to pay, when due, any contribution required for it; or b.
the end of your employment on account of your retirement; or c.
the end of the Coverage for all Employees when such Coverage is replaced by group life insurance from any carrier for which you are or become eligible within the next 31 days.
2.
You must be an active employee and not on a leave of absence on the day your insurance ends.
3.
You are less than age 80.
4.
Your amount of insurance is at least $20,000 under the Optional Employee Term Life Coverage on the day your insurance ends.
The amount of your insurance under the Portability Plan will not be more than your amount of insurance under the Optional Employee Term Life Coverage when insurance ends, but not less than
$20,000. The maximum amount of term life insurance under the Portability Plan is the lesser of 5 times your annual earnings or $1,000,000. The life insurance administrator will bill you directly for the premiums.
The information below is a summary of what happens to your life insurance benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Personal or Educational – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Family Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you
IBEW- Effective July 1, 2010 61
stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month. Vought Aircraft Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the Uniformed
Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date. After termination, you have 31 days to convert your policy to a whole life policy or apply for the Portability plan.
Retire – Coverage stops at midnight on your termination date. Certain employees may be eligible for a retiree life insurance plan option. After termination, you have 31 days to convert your policy to a whole life policy.
Layoff/Reduction In Force - Coverage stops at midnight on your termination date. After termination, you have 31 days to convert your policy to a whole life policy or apply for the Portability plan.
Employee’s Death – Your beneficiary receives the amount of your basic and optional life insurance benefit.
Accidental death and dismemberment (AD&D) insurance pays benefits within 365 days of an accident if, as a result of the accident, you die, lose a limb or limbs, sight, speech, or hearing. The amount the
Plan pays depends on the type of loss. In addition to basic AD&D, you may purchase optional AD&D insurance to supplement your basic coverage. You also may purchase optional AD&D insurance for your spouse and/or children. You will receive a Certificate of Coverage providing the terms and conditions, including eligibility, evidence of insurability (EOI) requirements, definition of loss, and conversion regulations.
Vought Aircraft Industries, Inc. provides you with basic accidental death and dismemberment insurance of $25,000 (Principal Sum) at no cost to you. You are automatically covered by this insurance; you do not have to enroll in the Plan.
You must complete a beneficiary designation form on the Vought Benefits Web site at http://benefits.voughtaircraft.com
. If you die, the Plan pays benefits to the beneficiary or beneficiaries you choose. If you lose a limb or your sight, speech or hearing as a result of an accident, the Plan pays a portion of your AD&D benefits to you. Please refer to the Certificate of Coverage for the percentage of AD&D coverage for each type of loss and injury. In the event of a conflict between this summary and the Certificate of Coverage, the terms of the Certificate of Coverage will govern the benefit.
The AD&D Administrator also pays additional benefits to your basic AD&D benefits if you suffer a loss or injury. Please refer to the Certificate of Coverage for more information on each specific benefit including the provisions and exclusions associated with each. The following is a list of the available additional benefits as of July 1, 2009:
Rehabilitation Benefit
Coma Benefit
Survivor’s Benefit
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Custodial Care Benefit
Adaptive Home and Vehicle Benefit
Surgical Reattachment Benefit
War or act of war
Terrorism and Terrorist Acts
Aircraft Accident
Criminal Assault Accident Protection
Private Passenger Seatbelt or Airbag Accident Protection
Sky-Jacking or Air Piracy
The information below is a summary of what happens to your accidental death and dismemberment benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave.
Personal or Educational – Coverage continues for the duration of your approved leave.
Family Leave – Coverage continues for the duration of your approved leave.
Military Leave – Coverage stops as of the date your leave begins. Vought Aircraft Industries, Inc. military leave coverage will comply with all applicable federal and state military leave laws including the
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date.
Retire – Coverage stops at midnight on your termination date.
Layoff/Reduction In Force - Coverage stops at midnight on your termination date.
Employee’s Death – If you die as a result of an accident, your beneficiary receives the amount of your basic and optional AD&D insurance benefit.
Optional accidental death and dismemberment insurance pays benefits, based on the employee’s base earnings, for the same types of losses as those covered by basic AD&D insurance. You may purchase optional AD&D, on a pre-tax basis, for yourself to supplement your basic AD&D. You may also purchase optional AD&D, on a pre-tax basis for your spouse and/or children. In the event of a conflict between this summary and the Certificate of Coverage, the terms of the Certificate of Coverage will govern the benefit.
You may purchase optional AD&D insurance coverage for yourself, equal to one to ten times your annual base salary, or a maximum of $1 million.
You may purchase optional AD&D insurance coverage for your family, equal to a percentage of your total basic and optional AD&D insurance, based on the number of family members you are covering for life insurance. Please see the chart below entitled “Optional AD&D Insurance Coverage Amounts” or
IBEW- Effective July 1, 2010 63
contact the Vought Benefits Center for more information. Optional AD&D also has an enhanced benefit provision for Dependent Children. Please refer to the Certificate of Coverage for more information on the enhanced benefit.
Enrolled Family
Members
Amount of Coverage
(Based on % of Employee’s AD&D Insurance Amount)
Spouse only 75%
Spouse and children Spouse: 60%
Children: 15% per child (up to $100,000)
Children only 25% per child (up to $100,000)
Remember that you are automatically the beneficiary if your spouse or one of your dependents dies.
The plan pays benefits to you after you report the death and provide the necessary documents to the
Vought Benefits Center.
The AD&D Administrator also pays additional benefits to your optional AD&D benefits if you suffer a loss or injury. Please refer to the Certificate of Coverage for more information on each specific benefit including eligibility, termination of coverage, definitions, conversion information, and general provisions. The following is a list of the available additional benefits as of July 1, 2009:
Rehabilitation Benefit
Common Disaster Benefit
Coma Benefit
Survivor’s Benefit
College education benefit
Spouse Training Benefit
Child Care Center Benefit
Private Passenger Seatbelt or Airbag Accident Protection
Criminal Assault Accident Protection
War Risk Benefit
Accidental Permanent Disfigurement Benefit
COBRA Benefit
Custodial Care Benefit
Therapeutic Counseling Benefit
Adaptive Home and Vehicle Benefit
Funeral Expense Benefit
Surgical Reattachment Benefit
The following is a summary of the general exclusions for the Basic and Optional AD&D benefits. For a complete list of exclusions, please refer to the Certificate of Coverage for each benefit.
Losses as a result of voluntarily taking any drug, chemical or controlled substance unless taken as prescribed by a licensed physician
Losses while committing or attempting to commit a felony
Losses while operating a vehicle with a blood alcohol level greater than the legal limit
Losses that occur more than 365 days after an accident
Losses that result from suicide, attempted suicide, bodily infirmity, or disease
Losses that result from an infection other than an accidental cut or wound that becomes infected
Medical or surgical treatment, except surgical treatment required by the accident
Injuries that you sustain while in any of the armed forces (land, sea or air) of any country or international authority, unless you are on temporary domestic duty with the National Guard or
Reserve for less than 30 days.
IBEW- Effective July 1, 2010 64
Accidental death and dismemberment insurance coverage ends when the first of these events occurs:
You or your dependents are no longer eligible to participate in the plan
You fail to make a contribution or authorize a payroll deduction for coverage
The plan terminates
Your accidental death and dismemberment insurance coverage and any optional coverage for your spouse and/or children end on the date of your termination. The conversion privilege allows you to convert your optional accidental death and dismemberment insurance coverage to an individual insurance policy within 31 days of your termination. The policy becomes effective at the end of the 31 days. (If you suffer a covered loss within that period, the insurance company pays benefits to your beneficiary for your optional insurance as if you had converted the policy, whether or not you had actually started that process.)
The insurance company issues the individual insurance conversion policy. You can contact any licensed representative of the insurance company and choose the amount and type of individual policy that suit your needs. There may be several types of policies from which you can select. You do not have to provide evidence of insurability. The cost is based on your age and the amount and kind of life insurance you select. To request a conversion policy, you must request a form from the Vought
Benefits Center at 1-866-689-5999. The Vought Benefits Center will mail it to your address on file and provide instructions to complete. You must submit an application for conversion within 31 days from the date your insurance terminates under the Group Voluntary AD& D policy. From then on, you pay premiums directly to the insurance company for the conversion of optional AD&D benefits.
The information below is a summary of what happens to your optional accidental death and dismemberment benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Personal or Educational – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Family Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Military Leave – Coverage stops as of the date your leave of absence begins for the employee.
However, coverage for dependents will continue for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your dependent’s benefit will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date. After termination, you and your dependents have 31 days to apply for a conversion policy.
IBEW- Effective July 1, 2010 65
Retire – Coverage stops at midnight on your termination date. After termination, you and your dependents have 31 days to apply for a conversion policy.
Layoff/Reduction In Force - Coverage stops on your termination date. After termination, you and your dependents have 31 days to apply for a conversion policy.
Employee’s Death – If you die in as a result of an accident and meet the qualifications of the policy, your beneficiary receives the amount of your basic and optional AD&D benefit. At that time, your dependents have 31 days to apply for a conversion policy for your family coverage.
Vought Aircraft Industries, Inc. offers a business travel accident insurance plan at no cost to you. You will receive a Certificate of Coverage providing the terms and conditions. The information below provides a summary of the information. For complete information, you will need to refer to the
Certificate of Coverage. In the event of a conflict between this summary and the Certificate of
Coverage, the terms of the Certificate of Coverage will govern the benefit.
The claims administrator will pay benefits if you or one or more of your covered dependents die or lose a limb, sight, speech, or hearing within 365 days of and as a result of an accident. The accident must occur while you are traveling on company business. If your dependents accompany you on company business, they are eligible for benefits only if Vought Aircraft Industries, Inc. pays their travel expenses.
You are considered to be traveling on business when you are traveling to advance Vought Aircraft's business. Accidents are not covered that occur during your normal course of travel to and from work or while you are on leave of absence or vacation. The covered losses and benefit percentages paid under business travel accident insurance are identical to those for optional AD&D insurance. The maximum amount the Plan pays for all types of losses that result from a single accident is the full amount of your insurance coverage.
The amount of insurance coverage is based on your or your dependent(s)’ category, shown in the following chart:
Category Description Amount of Insurance
I All full-time employees scheduled to work
20 hours or more;
4 times annual base salary up to
$500,000 maximum
II A All eligible dependent spouses for whom
Vought Aircraft Industries, Inc. agreed in advance to pay transportation expenses
$50,000
II B All eligible dependent children for whom
Vought Aircraft Industries, Inc. agreed in
$5,000 advance to pay transportation expenses
The business travel accident insurance plan provides a benefit if a loss occurs under certain hazardous conditions. For example, the Plan pays benefits if you die or are injured as a result of:
A war, an act of war, terrorism or a terrorist act
Sky-jacking or air piracy
An aircraft accident
In an aircraft accident in which several Vought Aircraft Industries, Inc. employees die or are injured, the Plan pays a maximum benefit for all losses of $10 million. If the total loss exceeds $10 million, you or your beneficiary receives a proportionate share of the $10 million based on your salary as determined by the insurance company.
IBEW- Effective July 1, 2010 66
The plan pays business travel accident insurance benefits to you in the event of accidental loss of limb(s), hearing, speech, or sight. If you die in a covered accident, the Plan pays benefits in the following order:
to the beneficiary or beneficiaries designated by you in writing, otherwise;
to the beneficiary or beneficiaries of your life insurance benefits, otherwise;
to your surviving spouse, otherwise;
to your surviving child or children, in equal shares, otherwise;
to your parents, in equal shares, or to the surviving parent, otherwise;
to your surviving brothers and sisters, in equal shares, or their beneficiaries, otherwise;
to your estate.
If your covered dependent dies, the Plan pays benefits to you.
Your business travel accident insurance coverage ends when the first of these events occurs:
You or your dependents are no longer eligible to participate in the Plan; or
The plan terminates.
You may not convert your business travel accident insurance coverage into an individual policy.
The information below is a summary of what happens when to your business travel accident insurance benefits you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage stops on the date your leave of absence begins.
Personal or Educational – Coverage stops on the date your leave of absence begins.
Family Leave – Coverage stops on the date your leave of absence begins.
Military Leave – Coverage stops on the date your leave of absence begins.
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Coverage stops on your termination date.
Retire – Coverage stops on your termination date.
Layoff/Reduction In Force - Coverage stops on your termination date.
Employee’s Death – If you die in an accident while traveling on business and meet the qualifications of the policy, your beneficiary receives the amount of your business travel accident insurance benefit.
Otherwise, your coverage stops on your date of death.
IBEW- Effective July 1, 2010 67
Disability benefits can help protect you against a loss of income if you are ill or injured and cannot work.
To receive short-term or long-term disability income, you must be disabled. You are considered disabled for purposes of this benefit if:
You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
You are under the regular care of a doctor; and
You have a 20% or more loss in weekly earnings due to the same sickness or injury; and
Your disability is documented by current medical evidence.
After 24 months of meeting the above conditions for disability (12 months STD + 12 months LTD), to be considered disabled you must also, in addition to meeting those conditions, be unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.
During your disability you must remain in the regular care of a qualified physician, participate in appropriate courses of treatment prescribed by your physician, provide required medical information to the company, and cooperate in the evaluation of your disability. Your benefit cannot continue if you fail or refuse to abide by any of these requirements.
The definition of a doctor or physician is: a person who is performing tasks that are within the limits of his or her medical license; and
is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or
has a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or
is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction.
There are two disability income benefits, described below. One begins where another leaves off so that you have a continuous flow of cash in the event of a lengthy absence because of a disability.
Short-term disability income
Long-term disability income
Short-term disability income begins on the fourth calendar day of disability and continues through the
52nd week of a disability. Your weekly benefits are determined based on the schedule of benefits contained in the collective bargaining agreement. Please refer the latest collective bargaining agreement for your applicable benefits.
Participants with less than sixteen years of seniority as of December 31, 2007 and/or were newly hired on or after 1/1/2009 are eligible for a long-term disability benefit. You will receive a Certificate of
Coverage providing the terms, eligibility, and definitions. The information below provides a summary of the information. For complete information, you will need to refer to the certificate of coverage.
Long-Term disability benefits begin with the 53rd week of disability after you meet the elimination period of 52 weeks. An elimination period is the period of time during short-term disability when you must be continuously disabled. Weekly benefits are equal to 50 percent of your base pay at the time your disability began.
The disability benefit is subject to a monthly maximum and a maximum period of benefits.
IBEW- Effective July 1, 2010 68
To ensure that you receive the extended disability benefit payments for which you are eligible, and to avoid a lapse in benefit payments, follow these steps:
After 39 weeks of permanent disability, the Company will send to your address of record all the necessary forms and instructions to apply for Social Security and extended disability benefits. You must file your applications within 90 days after receiving them. Note: You must also apply for
Social Security disability benefits and appeal a first denial.
Periodically, the disability administrator may request verification from your physician of your continued disability. This verification enables your benefit payments to continue, so be sure to provide it.
After you have been disabled for 24 months, the definition of "disability" changes (see accompanying definition). If you do not meet the more restrictive definition of disability, your extended disability benefit payments end.
Your disability benefit payments will be reduced by any other disability income that you receive, as follows:
The benefit payments you receive under the disability plans are offset dollar for dollar by "other disability income benefits" that you receive - or are entitled to receive - for the same disability.
Under the disability plans, your disability income from all sources – including your disability benefits,
Social Security, Workers’ Compensation and Company earnings - is limited to 50% of your monthly base earnings.
How the Offset Works
Your disability benefit amount $1,950
Income from Social Security and a Vought Aircraft Industries, Inc. retirement plan
- 1,200
Adjusted monthly disability benefit payment $ 750
These types of benefit payments will be subtracted from your disability benefit payments:
Workers' compensation, occupational disease, or similar insurance benefit payments that you receive or are eligible to receive
Other Vought Aircraft Industries, Inc. group insurance benefit payments
Disability and/or retirement benefit payments you receive under a Vought Aircraft Industries, Inc. retirement plan
Benefit payments under the United States Social Security Act, or any similar plan or act, including:
Social Security disability benefit payments for which you are eligible because of your age or disability. However, any cost-of-living adjustments to the Social Security benefit amount are not subtracted from your disability benefit payments
Benefit payments from any other plan, fund, or other arrangement to which Vought Aircraft
Industries, Inc. contributes or makes a payroll deduction
Extended disability benefits end when the first of the following conditions occurs:
The participant no longer has an extended disability
The participant is no longer under the care of a physician for treatment of the cause of the disability
The participant refuses to have a medical examination at Vought’s expense
The participant has received extended disability benefits for the length of participant’s seniority as defined by the collective bargaining agreement
Five years from the date the participant became disabled if the disability occurs upon or after reaching age 60, but before reaching age 65
IBEW- Effective July 1, 2010 69
The date the participant reaches age 70 if the disability occurs upon or after reaching age 65 but before reaching 69
One year from the date the participant incurred the disability if on or after participant’s 69th birthday
The participant dies.
Employees who become disabled retain health care coverage according to the following schedule:
Seniority on Last
Day Worked
90 days to 3 years
3 years to 5 years
Health Care
Eligibility
1 year
1 ½ years
5 years or more 2 years
Contributions for employee and dependent coverage will be waived while an employee is on approved disability leave that is not job-related.
Your disability income plan is designed to help you return to work. It provides financial assistance so you can concentrate on your recovery. Please notify the Vought Benefits Center and your supervisor as soon as you can return to work. If you are absent for four days or more, you must report to the company medical department before returning to your work assignment.
The participant, by accepting payment of benefits from the plan, assigns all rights of recovery to the
Plan that the participant may have against any person, company, organization for any negligent or any willful act or omission resulting in the disability.
Your coverage under the disability plans ends on the date:
Your employment ends (unless you are receiving disability benefit payments when your employment ends)
You no longer are an eligible employee
Vought Aircraft Industries, Inc. terminates this plan.
The information below is a summary of what happens to your long-term disability benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave.
Personal or Educational – Coverage continues for the duration of your approved leave.
Family Leave – Coverage continues for the duration of your approved leave.
Military Leave – Coverage stops as of the date your leave of absence begins.
Transfers (To a position with the same eligibility as this Plan)
Coverage continues. If you are transferring to California, you will be enrolled in the state disability benefits program.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date.
IBEW- Effective July 1, 2010 70
Retire – Coverage stops at midnight on your termination date.
Layoff/Reduction In Force - Coverage stops on your termination date.
Employee’s Death – Coverage stops on the date of death.
IBEW- Effective July 1, 2010 71
The group legal benefit is an optional benefit provided by Signature Agency called Signature LegalCare.
Signature LegalCare is paid through weekly post-tax deductions out of your paycheck. Signature
LegalCare offers access to legal assistance to you and your eligible dependents for common legal problems. You can receive assistance over the phone by calling 1-800-848-2012 between 5 a.m. and
11 p.m. Eastern Time Monday through Saturday and 5 a.m. to 4 p.m. Eastern Time on Sundays. The plan also may provide benefits when you meet with an attorney in person. You will receive a
Certificate of Coverage providing the complete schedule of fees, terms and conditions, eligibility, and extension of benefits. The information below provides a summary of the information. For complete information, you will need to refer to the Certificate of Coverage. In the event of a conflict between this summary and the Certificate of Coverage, the terms of the Certificate of Coverage will govern the benefit.
When you need legal services, call 1-800-848-2012 to reach the Signature LegalCare Service Center.
The Signature LegalCare Service Center is your access to the Plan’s legal services. It is staffed with customer service representatives who can answer your questions about legal services and help you determine what type of legal help you may need. You have three options each time you need legal assistance:
You can speak with an attorney over the phone
You can request a directory of participating attorneys and meet with an attorney who is a member of the Signature LegalCare network
You can choose an attorney who is outside the network.
If you choose a face-to-face meeting with an attorney, you have two options:
1.
You can use an attorney in the network and receive full coverage for many services, or;
2.
You can choose your own attorney and be reimbursed a set dollar amount.
The level of benefit you receive depends on the option you choose. When you use an attorney who belongs to the Signature LegalCare network, many of your legal services are covered in full; others are covered up to a maximum amount.
For your privacy, Vought Aircraft Industries, Inc. will not be notified when you use your group legal benefits. There are only two ways individuals at Vought Aircraft Industries, Inc. can learn anything about your use of the Plan:
If you tell someone at Vought Aircraft, or
If you authorize the Signature LegalCare Service Center to discuss the legal matter with your employer. This situation might occur if you have an unusual claim or problem and you request assistance from the company. Even then, the Signature LegalCare Service Center will do everything possible to avoid sharing the nature of the case with the company.
If you were involved in a legal matter prior to the effective date of the coverage, the services of a lawyer before the effective date of your coverage are not covered.
There are no deductibles to be met for any of the legal services. You can also choose to pay the attorney directly and be reimbursed by Signature LegalCare or have Signature LegalCare pay the attorney directly. If you elect to be reimbursed, fill out a claim form and mail it to:
Signature LegalCare
P.O. Box 968004
Schaumburg, IL 60196
If you choose an attorney who belongs to the network, many legal services are covered in full. Other services are covered up to a maximum amount (see accompanying chart). If you use an attorney who is not in the network, you are responsible for any fees that exceed the scheduled benefit amount. The chart shows the amount the Plan covers for some of the services provided by network attorneys and attorneys outside the network. Moreover, not all participating attorneys provide each legal service. You
IBEW- Effective July 1, 2010 72
may call the Signature LegalCare Service Center at 1-800-848-2012 or the attorney directly to determine which services, if any, are not provided. When you use an attorney outside the network, the
Plan covers a portion of your legal fees.
If you are traveling out of the country and you need to speak with an attorney about a legal matter that took place in the United States, you can call 1-502-253-3228 and ask to be connected to an attorney. There are no attorneys available outside the United States. Any legal matters that occur outside the United States are not covered by the Plan.
You can view plan information (including an attorney directory) through a link on the Vought Benefits
Web site under Service Providers, or directly through the Internet at www.legalcareplan.com. Once on the legal plan’s web site, select Vought Aircraft Industries, Inc. and enter the password 43178.
The following chart shows types of services and benefits for each that the Plan provides:
Legal Service
Uncontested agency adoption
(limited to one per benefit plan year per family)
Coverage Level
Full
Full Simple will
(limited to one per benefit plan year per family)
Attorney office work
(limited to four hours per benefit plan year per family)
Full
Maximum benefit for a non-network attorney
Up to $490
Up to $75
$17.50 for each quarter hour up to a maximum of four hours
Up to $700 Real estate sale and purchase
(limited to one per benefit plan year per family)
Estate administration and closing
(limited to two per benefit plan year per family)
Uncontested Matrimonial matters with property
settlement or separation agreement
(limited to one per five benefit plan years per family)
Consumer protection by court judgment after
court appearance
(limited to two per benefit plan year per family
Full
Up to $240
Full
Full
Up to $240
Up to $840
Up to $1400
Juvenile court
(limited to one per benefit plan year per family)
Full Up to $700
Note: The information in this chart refers to benefit plan year 2009-2010. There may be changes from year to year.
If you are involved in one or more legal actions resulting from a single event, you receive one benefit to cover all services. For example, if you are receiving legal assistance to purchase your home, you may need legal assistance with both the mortgage preparation and the deed preparation. However, because these tasks relate to the same transaction, both the mortgage preparation and the deed preparation are covered under one benefit.
The list below are the legal Services available to a covered person. Refer to the Certificate of Coverage for more information and exclusions related to each benefit.
Administrative Hearings (limited to two per benefit plan year per family unit)
Adoptions (limited to one per benefit plan year per family unit)
Attorney Office Work (limited to four hours per benefit plan year per family unit)
Consumer Protection (limited to two per benefit plan year per family unit)
IBEW- Effective July 1, 2010 73
Criminal Trial Defense (limited to one per five benefit plan years per family unit)
Debt Collection Defense (limited to two per benefit plan year per family unit)
Defendant Civil Action (limited to one per benefit plan year per family unit)
Document Review and Preparation (may not be used to supplement benefits available under any other legal services covered by the Plan)
Driver's License Suspension (limited to one per benefit plan year per family unit)
Estate Administration and Estate Closing (limited to two per benefit plan year per family unit)
Guardianship/Conservatorship (limited to one per benefit plan year per family unit)
Juvenile Court Proceeding (limited to one per benefit plan year per family unit)
Matters of Marriage or Divorce (limited to one per five benefit plan years per family unit as the petitioner or the non-petitioner, but not both)
Modification/Enforcement of Divorce or Separation (limited to one per benefit plan year per family unit)
Name Change (limited to one per benefit plan year per family unit)
Preliminary Criminal Defense (limited to one per five benefit plan years per family unit)
Real Estate Matters (limited to one per benefit plan year per family unit)
Tax Advice and Counseling
Wills and Trusts
Any services or charges in connection with any of the following:
The participation in any business venture, including, but not limited to: proprietorships, partnerships, corporations, commercial endeavors, rental property, patents, copyrights or trademarks A business venture is defined as any activity which produces or is contemplated to produce revenue.
Preparing or filing income tax returns.
Estate planning matters, including, but not limited to: complex wills or trusts, living trusts, or revocable/irrevocable trusts.
Workers Compensation Law, Unemployment matters, Admiralty; Federal Employers Liability Act.
Judicial appeal proceedings, group or class actions, intervention, and amicus curiae filings.
A Civil Action pursued in court where the Covered Person is a plaintiff. This applies only if the monetary amount of the suit would fall within the jurisdiction of a small claims court or its equivalent. The Preventive LegalCare Office will give advice to a Covered Person on how to pursue a claim in such a court.
Consultations, civil, or criminal legal actions, any part of which: (a) involve the Contract Holder, or any included employer, or the labor organization or union, if any, which collectively bargained for this coverage; or (b) relate to your employment would exclude the entire action.
Legal actions involving Vought Aircraft Industries, Inc. or any of its parents or affiliated companies, agents, administrators, subcontractors, or which involve disputes about the insurance.
Legal proceedings for which the Covered Person had consulted or retained an attorney prior to becoming covered under this insurance.
Legal proceedings in which both the plaintiff and the defendant are persons in the same Family
Unit. This does not apply to Legal Services listed as Matrimonial Matters in the List of Legal
Services.
Defense of criminal charges against a Covered Person if any of the following has contributed to the cost of this insurance on behalf of that Covered Person: (i) the victim of the crime; (ii) someone who is in the same Family Unit as the victim.
Fines, title insurance costs, court costs, court appointed attorneys, filing fees, subpoenas, assessments, penalties, expert witness fees and other related expenses (e.g., facsimile, copy expense, postage, long distance phone charges, mileage, etc.).
Services where the attorney’s fee is provided by statute from a fund subjudice or paid by contingent fee (e.g., personal injury).
Services performed by an attorney who is related to the Covered Person by blood or marriage.
Services not performed by an attorney. Services performed by a paralegal under the direct supervision of an attorney will be treated as if performed by the attorney.
Services provided outside the United States.
IBEW- Effective July 1, 2010 74
Any legal proceeding in which the Covered Person is entitled to legal representation or reimbursement for the costs thereof from any source other than this policy (subject to Coordination of Benefits provisions).
Your coverage under this plan ends if:
Your employment ends;
You no longer are eligible for coverage;
The plan terminates; or
You fail to make any payments required to participate in the Plan.
The information below is a summary of what happens to your group legal benefits when you encounter a change to your employment status.
Leaves of Absence
Medical Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Personal or Educational – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Family Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Military Leave – Coverage continues for the duration of your approved leave, provided you make any required contributions. If you are on an unpaid leave, you must continue to make contributions on an after-tax basis. If you stop making contributions, your benefits will end at the beginning of the next pay period or at the end of the month if you have paid for the entire month.
Transfers (To a position with the same eligibility as this Plan)
Coverage continues.
Terminate Employment
Quit/Discharge – Coverage stops at midnight on your termination date.
Retire – Coverage stops at midnight on your termination date.
Layoff/Reduction In Force - Coverage stops at midnight on your termination date.
Employee’s Death – Coverage stops on the date of death.
IBEW- Effective July 1, 2010 75
LiveWell@Vought is the name of the Company’s employee wellness program, which is available to
Vought employees, participants in the Flexible Benefits Plan, and their spouses and dependents. It is designed to advance the health and well-being of eligible participants by providing education about health and wellness and offering support programs to help individuals improve their health.
Program offerings include health risk appraisals, web-based and live education programs, health screenings, onsite fitness facilities and advice, condition management, health fairs, and wellness programs to address tobacco use, stress, cholesterol, and high blood pressure and to encourage exercise, good diet and nutrition.
More detailed information about the benefits offered under this program is available in the program materials distributed when benefits are made available, as well as on the web site www.livewellatvought.com
. Those descriptive materials are considered part of this Summary Plan
Description.
IBEW- Effective July 1, 2010 76
This section contains information about the administration of the Plan, as well as your rights as a participant under the Employee Retirement Income Security Act of 1974 (ERISA). If you have any questions about the Plan, contact your site Benefits Representative or the Vought Benefits Center at 1-
866-689-5999. If you have any questions about your rights under ERISA or about this statement outlining your rights, you should contact the nearest regional office of the Employee Benefits Security
Administration, U.S. Department of Labor, listed in your telephone directory. You may also contact the
Division of Technical Assistance and Inquiries, Employee Benefits Security Administration (EBSA) U.S.
Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.
This table includes administrative information, including plan names, Plan Administrators, and plan funding, as well as contacts you may need in certain situations.
Employer
Vought Aircraft Industries. Inc.
P.O. Box 655907
Dallas, TX 75265-5907
Employer Identification Number
(EIN) 75-2884072
Type of Plan
Welfare benefit plan
Plan Administrator
Administrative Committee for the Benefit Plans of
Vought Aircraft Industries. Inc.
P.O. Box 655907
M/S 49L-01
Dallas, TX 75265-5907
1-866-689-5999
Agent for Service of Legal Process
CT Corporation
350 North St. Paul, Suite 2900
Dallas, TX 75201
Benefit Plan Year
July 1 to June 30
Plan Number
501
Plan Option Plan Option is insured by:
Inc. self-insures the Plans that are administered by
BCBS and CIGNA
Mental Health and
Substance Abuse
Treatment
Value Options
340 Golden Shore
Long Beach, CA 90202
1-866-269-5800
Claims Administrator: Plan Option is funded by:
Blue Cross Blue Shield of
Illinois
PO. Box 122
Chicago, IL 60690
1-888-979-4514
Vought Aircraft Industries, Inc. and participant contributions
CIGNA HealthCare
P.O. Box 182223
Chattanooga, TN 37422-7223
1-800-244-6224
Value Options
340 Golden Shore
Long Beach, CA 90202
1-866-269-5800
Vought Aircraft Industries, Inc. and participant contributions
Prescription Drug Vought Aircraft Industries,
Inc. self-insures the plan that is administered by Caremark
Caremark
P.O. Box 686005
San Antonio, TX 78268-6005
1-866-623-1395
Vought Aircraft Industries, Inc. and participant contributions
IBEW- Effective July 1, 2010 77
PO Box 453099
Sunrise, FL 33345-3099
1-800-244-6224
Vought Aircraft Industries,
Inc. self- insures the Plans that are administered by
Delta Dental
Long-Term
Disability
The Prudential Life Insurance
Company
P.O. Box 1215
Newark, NJ 07101
1-800-524-0542
Life Insurance
(including Optional
Life)
The Prudential Life Insurance
Company
P.O. Box 1215
Newark, NJ 07101
1-800-524-0542
Accidental
Death &
Dismemberment
Insurance
(including Optional
AD&D)
Gerber Life Insurance
Business Group
Travel Accident
Gerber Life Insurance
Health Care and
Dependent Care
Flexible Spending
Account
N/A
CIGNA Dental
PO Box 453099
Sunrise, FL 33345-3099
1-800-244-6224
Delta Dental Insurance
Company
PO. Box 1809
Alpharetta, GA 30023-1809
1-800-336-8264
The Prudential Life Insurance
Company
P.O. Box 1215
Newark, NJ 07101
1-800-524-0542
The Prudential Life Insurance
Company
P.O. Box 1215
Newark, NJ 07101
1-800-524-0542
A.C. Newman & Co.
Insurance Correspondents,
Inc.
4969 East McKinley Avenue,
Suite 105
Fresno, CA 93727-1968
1-559-252-2525
A.C. Newman & Co.
Insurance Correspondents,
Inc.
4969 East McKinley Avenue,
Suite 105
Fresno, CA 93727-1968
1-559-252-2525
PayFlex Systems USA, Inc.
302 S. 36th Street
Suite 700
Omaha, NE 68131
1-800-284-4885
Vought Aircraft Industries, Inc. and participant contributions
Vought Aircraft Industries, Inc. and participant contributions
Vought Aircraft Industries, Inc. and participant contributions
Vought Aircraft Industries, Inc. and participant contributions
Vought Aircraft Industries,
Inc. contributions
Participant contributions
Group Legal
Insurance
Heritage Casualty Insurance
Co.
51 W. Higgins Rd
South Barrington, IL 60010
Signature Agency
51 W. Higgins Rd
South Barrington, IL 60010
Participant contributions
Note: The information in this table refers to benefit plan year 2010-2011. There will be changes from time to time, which will be communicated to participants.
Coverage under the Vought Aircraft Industries, Inc. Flexible Benefits Plan is offered through a variety of options. Some of these options are self-insured and other options are fully insured. Under the selfinsured options, Vought contracts with third-party administrators (the “Claims Administrators”) to administer the Plan provisions. Vought has delegated to these Claims Administrators the final, discretionary authority to determine if an Urgent Care Claim, a Concurrent Care Claim, a Pre-Service
Claim, Post-Service Claim or a Disability Claim is payable under the terms of the respective plans. If an option is fully-insured, for example an life insurance option, the insurance carrier has sole, final authority and discretion to interpret insurance contract terms, including eligibility. Vought does not guarantee payment of insured benefits. The details of filing an appeal are provided in the Certificate of
Coverage or Evidence of Coverage for each option.
IBEW- Effective July 1, 2010 78
Claims that are not Urgent Care Claims, Concurrent Care Claims, Pre-Service Claims, Post-Service
Claims or Disability Claims are considered “Administrative Claims.”
The Claims Administrators under the Plans, the contact information for each Claims Administrator, and whether the Plan option is insured or self-insured are indicated under Administrative Facts section above. Please contact the Vought Benefits Center at 1-866-689-5999 if you have any questions.
The timeframes for benefit determination for medical and disability benefits vary depending on the Plan and the type of claim. For purposes of this section, “Medical” includes medical, prescription drug, dental, vision, mental health and substance abuse, and health care FSA claims.
Type of Claim
Initial
Deadline for Claims
Review
Time for You to
Provide
Additional
Information
Extensions for Claims
Review, if Necessary
Medical: Urgent 72 hours
Medical: Urgent, concurrent care
24 hours*
Medical: Pre-Service 15 days
Medical: Post-Service 30 days
Disability 45 days
48 hours
45 days
45 days
45 days
45 days
None
None
15 days
15 days
Two 30-day Extensions
*Applies only when claim is submitted at least 24 hours before end of approved treatment.
Medical Urgent claims: Medical care is "urgent" if a longer time could seriously jeopardize the participant's life, health, or ability to regain maximum function. Also, care may be urgent if, in a doctor's opinion, it would subject the participant to severe pain if care or treatment were not provided.
If you have an urgent medical situation, the Claims Administrator must respond to your initial request for benefits within 72 hours, and no extensions are permitted. If the Claims Administrator needs more information from you to make a determination, you will have 48 hours from the time you are notified to supply that information. The time period during which you are gathering that additional information does not count toward the time limits that apply to the Claims Administrator.
Medical Concurrent care decisions: These are decisions involving an ongoing course of treatment over a period of time or a number of treatments. If you or your dependent is undergoing a course of treatment, or is nearing the end of a prescribed number of treatments, you may request extended treatment or benefits. If the course of treatment involves urgent care and your request is made at least
24 hours before the expiration of the authorized treatments, the Claims Administrator will respond to your claim within 24 hours. If you reach the end of a pre-approved course of treatment before requesting additional benefits, the normal "pre-service" or "post-service" time limits will apply, as described below.
Pre-service determinations: A "pre-service" determination requires the receipt of approval of those benefits in advance of obtaining the medical care. If you request a review for pre-service benefits, but do not submit enough information for the Claims Administrator to make a determination, the Claims
Administrator will notify you within 15 days. You have 45 days after that to supply any additional information. Until you supply this information, the time limits that apply to the Claims Administrator are suspended (or “tolled”). Once your claim is complete, the Claims Administrator will notify you of its decision within 15 days (or 30 days if more time to process your claim is required).
Medical Post-service claims: A "post-service" determination is made for benefits after you have already received care or treatment. A "post-service" determination does not require advance approval of benefits. If you request a review for post-service benefits, but do not submit enough information for the Claims Administrator to make a determination, the Claims Administrator will notify you within 30 days. You have 45 days after that to supply any additional information. Until you supply this
IBEW- Effective July 1, 2010 79
information, the time limits that apply to the Claims Administrator are suspended (or “tolled”). Once your claim is complete, the Claims Administrator will notify you of its decision within 30 days (or 45 days if more time to process your claim is required).
Disability claims: A "disability" determination is required in order for you to receive disability benefits under the Plan. You have 45 days after the determination to supply any additional information. Until you supply this information, the time limits that apply to the Claims Administrator are suspended (or
“tolled”). Once your claim is complete, the Claims Administrator will notify you of its decision within 45 days (or longer if an extension is necessary).
For insured life, accidental death and dismemberment, and business travel accident benefit claims, check your Certificate of Coverage for information on how to file a claim for benefits and the deadlines for doing so.
If your claim for benefits is denied (either in whole or in part), the Claims Administrator will send you a written explanation of why the claim was denied. In the case of an urgent claim, this can include oral notification, as long as you are provided with a written notice within three days.
This explanation will contain the following information:
The specific reason for the denial
Specific references to plan provisions on which the denial is based
A description of additional material or information that you may need to revise the claim and an explanation of why such material or information is necessary
A specific description of the Plan's review procedures and applicable time limits, including a statement of your rights to bring a civil action in federal court following a denial of your appeal.
Depending on the type of claim, the explanation will also contain the following information:
If the denial is based on an internal rule, guideline, or protocol, the denial will say so and state that you can obtain a copy of the guideline or protocol, free of charge upon request
If the denial is based on an exclusion for medical necessity or experimental treatment, the denial must explain the scientific or clinical judgment for determination, applying the terms of the Plan to the medical circumstances, or state that such an explanation will be provided upon request, free of charge
If the denial involves urgent care, you will be provided an explanation of the expedited review procedures applicable to urgent claims.
If your claim for benefits is denied, you have the right to make an appeal.
First, you may call the Claims Administrator and ask why your claim was denied. You may discover that a simple error was made. If so, you may be able to correct the problem right over the telephone.
Then, if you cannot correct the problem by phone or you choose not to call the Claims
Administrator, you have a right to file a Level 1 appeal by writing directly to the Claims
Administrator for that benefit (see Administrative Facts, above). Be sure to explain in your letter why you think your claim should be paid and provide all relevant details.
If your claim is denied by the Level 1 Appeals Review Committee (and not an Urgent claim), ask the Claims Administrator to submit your claim to the appropriate Level 2 Appeals Review
Committee, if available for that benefit.
Administrative Claims
Claims that are not a claim for a specific benefit, such as eligibility questions or questions about employee contribution amounts, are called “Administrative Claims.” Administrative claims must be submitted to the Plan Administrator within 90 days from the date you know or should have known that there is an issue, dispute, or problem with respect to the Plan. If the administrative claim involves a plan change or amendment, you are considered to know about such a claim when the change or amendment is first communicated to participants, regardless of whether the change has become effective by that date.
IBEW- Effective July 1, 2010 80
If you do not file a claim by the applicable deadline and in the proper manner, your claim will expire and be automatically denied if subsequently filed. You will not be able to file a lawsuit based on that claim.
If you file a claim for benefits and the Claims Administrator denies that claim, you have the right to appeal the denial. The appeal procedures must be exhausted before you can enforce your rights under
ERISA (see Employee Retirement Income Security Act of 1974 for details).
Below are the timeframes that apply when you file an appeal:
Time to Appeal
From Date Claim
Is Denied
Time for Decision
On Appeal
Extensions for Claims
Administrator,
If Necessary
Medical: Urgent claims
180 days
Medical: Pre-Service claims
Medical: Post-Service claims
180 days for each level of appeal
180 days for each level of appeal
72 hours None
Two levels of appeal:
15 days from the receipt of the appeal for each level
None
Two levels of appeal:
30 days from the receipt of the appeal for each level
None
Disability claims 180 days for each level of appeal
45 days at each level of appeal
Administrative Claims 90 days to appeal 90 days for each appeal
45 days at each level of appeal
90 days
Urgent Claims.
If your claim involves an Urgent Care Claim, an expedited appeal may be initiated by a telephone call to the telephone number on your ID Card or by contacting the Claims Administrator at the number provided under the “Administrative Facts” section. You or your physician may appeal
Urgent Care Claim denials either orally or in writing. All necessary information, including the appeal decision, will be communicated between you or your physician and the Plan by telephone, facsimile
(fax) or other similar method. If the appeal decision is communicated to you or your physician orally, you will receive a written determination within three days following the oral determination. You will be notified of the decision no later than 72 hours after the appeal is received, with no extensions.
Pre-Service Claims.
There are two levels of appeal.
Level 1 appeal: You may file a Level 1 appeal with the Claims Administrator within 180 days if your initial claim for benefits is denied and you would like to appeal that denial. Your appeal must be considered within 15 days, with no extensions.
Level 2 appeal: If your first appeal is denied by the Claims Administrator, you may file a Level 2 appeal with the Claims Administrator within 180 days, and your appeal must be considered within an additional 15 days, with no extensions.
Post-Service Claims .
There are two levels of appeal.
Level 1 appeal: You may file a Level 1 appeal with the Claims Administrator within 180 days if your initial claim for benefits is denied and you would like to appeal that denial. Your appeal must be considered within 30 days, with no extensions.
Level 2 appeal: If your first appeal is denied by the Claims Administrator, you may file a Level 2 appeal with the claims administrator within 180 days, and your appeal must be considered within an additional 30 days, with no extensions.
IBEW- Effective July 1, 2010 81
Disability Claims .
There are two levels of appeal.
Level 1 appeal: If your initial claim for disability benefits was denied, you may appeal that denial within 180 days, and your appeal will be considered within 45 days, with a 45-day extension permitted if necessary.
Level 2 appeal: If your first appeal is denied by the Claims Administrator, you may file a Level 2 appeal within 180 days, and your appeal must be considered within an additional 45 days, with a
45-day extension permitted if necessary.
Administrative Claims. There is one level of appeal.
You may file an appeal with the Plan Administrator within 90 days if your initial administrative claim is denied and you would like to appeal that denial. Your appeal must be considered within 90 days, with a 90-day extension permitted if necessary.
In filing an appeal, you have the opportunity to:
Submit written comments, documents, records and other information relating to your claim for benefits
Have reasonable access to and review, upon request and free of charge, copies of all documents, records and other information relevant to your claim
Have all relevant information considered on appeal, even if it wasn't submitted or considered in your initial claim.
If benefits are still denied on appeal, the notice that you receive from the final review level (usually the
Level 2 review) will provide:
The specific reasons for the denial
Reference to the Plan provisions on which the decision was based
A statement that you may receive, upon request and free of charge, reasonable access to, and copies of all documents, records, and other information relevant to your claim
A statement that the individual who reviewed your appeal is not the same individual who initially denied your claim
A statement describing any additional appeal procedures and a statement of your rights to bring a civil action in federal court under ERISA.
Depending on the type of claim, the notice that you receive from the final review level will also contain the following information:
If the denial is based on an internal rule, guideline, or protocol, the denial will say so and state that you can obtain a copy of the rule, etc., free of charge upon request
If the denial is based on exclusion for medical necessity or experimental treatment, the denial will explain the scientific or clinical judgment for determination, applying the terms of the Plan to the medical circumstances, or state that such an explanation will be provided upon request, free of charge.
At both the initial claim level, and on appeal, you may have an authorized representative submit your claim for you. In this case, the administrator may require you to certify that the representative has permission to act for you. The representative may be a health care or other professional. However, even at the appeal level, neither you nor your representative has a right to appear in person before the claims administrator or the review panel.
You may also have the right to other voluntary alternative dispute resolution options such as mediation instead of filing suit in federal court. One way to find out what may be available is to contact your local
U.S. Department of Labor Office and/or your State insurance regulatory agency for details.
If you or your beneficiary apply or file a claim for benefits under any plan other than those discussed above (i.e., employee or dependent life insurance, business travel accident benefits (if eligible), or dependent day care flexible spending account benefits, and your application for benefits is denied, the
IBEW- Effective July 1, 2010 82
appropriate Claims Administrator will notify you of such denial in writing within 90 days, or within 180 days if the Claims Administrator notifies you in writing that special circumstances require additional time for processing the claim. The Claims Administrators under these benefit plans and their contact information is indicated under “Administrative Facts.”
The rules in the “If Your Claim is Denied” and “Appealing a Denied Medical or Disability Claim” sections of this SPD also apply to such claims for other benefits.
Limits on Legal Actions
Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action on your claim. If your claim for benefits or administrative claim is denied on the final level of appeal, you generally may file a lawsuit under ERISA regarding your claim, provided you comply with the deadlines described in this section. If you wish to file a lawsuit, you must do so by the earlier of the date that is 12 months after the date your claim was denied on appeal or the date that is 12 months from the date a cause of action accrued. A cause of action “accrues” when you know or should know that the claims administrator or Vought Aircraft Industries, Inc., as Plan sponsor, has clearly denied or repudiated your claim.
Your contributions for coverage under the Plan will change from time to time. Vought Aircraft
Industries, Inc. will notify you if your contributions change.
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In 1974, Congress passed the Employee Retirement Income Security Act (ERISA) to safeguard the interests of participants and beneficiaries under employee benefit plans. As a participant of the Plan, you have certain rights and protections under ERISA, as outlined in the following statement adapted from regulations of the U.S. Department of Labor.
ERISA provides that all plan participants are entitled to:
Examine, without charge, at the Plan Administrator's office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the
Employee Benefits Security Administration.
Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated Summary Plan Description. The administrator may make a reasonable charge for the copies.
Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.
Continue health care coverage for yourself, your spouse, or your dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review COBRA and the documents governing the Plan for the rules governing your COBRA continuation of coverage rights.
Receive a reduction or elimination of the exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a Certificate of Creditable Coverage free of charge, from your group health plan or health insurer when you lose coverage under the Plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.
In addition to creating rights for participants ERISA imposes duties upon the people who are responsible for the operation of the Plan. These people may include employees who make certain discretionary decisions about the management or administration of the Plans or may also include outside investment advisors and trustees. These people who operate the Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA.
If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal
IBEW- Effective July 1, 2010 84
court. In addition, if you disagree with the decision or lack thereof concerning the qualified status of a domestic relations order, you may file suit in federal court. If it should happen that plan fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
If you have any questions about your plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits
Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of
Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of
Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the
Employee Benefits Security Administration.
IBEW- Effective July 1, 2010 85
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that places limits on exclusions a health care plan can place on an individual for pre-existing conditions, among other previsions. HIPAA can help you and your family obtain new medical coverage if your coverage ends under the Vought Aircraft Industries, Inc. medical plan (e.g., if you terminate employment).
If you change jobs, for example, you most likely would request coverage under your new employer's health care plan.
If you or your dependents have a pre-existing condition, your new health care plan would not be required to cover any expenses related to the pre-existing condition for the first 12 months. On the other hand, if you and your dependents previously were enrolled in the Vought Aircraft Industries, Inc. medical plan for 12 months or more, your new plan would be required to cover any pre-existing conditions immediately. However, if you had no health care coverage for a period of 63 days or more before your next coverage begins, your previous coverage does not count as "creditable coverage" and cannot be applied against a pre-existing condition exclusion.
By law under HIPAA, Vought Aircraft Industries, Inc. must provide you with a Certificate of Creditable
Coverage when you or your dependents stop participating in a Vought Aircraft Industries, Inc. health care plan. A Certificate of Creditable Coverage is a document that provides proof of your previous medical coverage. The certificate is sent to you within 45 days of the date Vought Aircraft Industries,
Inc. is notified of your termination of coverage.
You can present your Certificate of Creditable Coverage to a new health care plan to prove that you previously had coverage. This certificate can reduce the length of time pre-existing conditions delay your new coverage.
Your Certificate of Creditable Coverage states:
The date the certificate was issued
The name of the Vought Aircraft Industries, Inc. medical plan option you or your dependents are leaving
The period of time you or your dependents were enrolled in the medical plan option
The name, address, and telephone number of the issuer of the certificate
The person to contact for further information.
Certificates of Creditable Coverage are issued to you:
Automatically, when your coverage under the Plan ends – whether or not you elect COBRA
Automatically, when your COBRA coverage ends, if you elected COBRA coverage.
On request within 24 months of the date your coverage ends.
If you need to request a Certificate of Creditable Coverage, or if you are interested in more information about HIPAA, call the Vought Benefits Center at 1-866-689-5999.
After you become covered or eligible for coverage under the medical, prescription drug, dental, or vision options, you may enroll a new dependent acquired through marriage, birth, adoption or placement for adoption within 31 days of acquiring the new dependent. If you are not already enrolled when you acquire a new dependent, you will be able to enroll yourself within the same 31-day period after acquiring the new dependent. If you acquire a new dependent through birth or adoption and your spouse is also eligible for coverage, you may enroll your spouse as a dependent within the same 31day period.
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For new dependents acquired by birth, adoption or placement for adoption, coverage will be effective retroactive to the date of birth, adoption or placement for adoption. For new dependents acquired by marriage, coverage will be effective on the date of your marriage, provided the Plan timely receives your enrollment request.
Enrollment requests received more than 31 days after the date you acquire a new dependent will not be accepted, and you will have to wait until the next annual enrollment period to enroll them.
If you or an eligible dependent did not enroll in the medical, prescription drug, dental, or vision plan options when first eligible because you or your dependent had other similar group coverage, you or your dependents may be eligible to enroll in the benefit plan or make a change to your election in the
Health Care Flexible Spending Account when that other coverage ends. To be eligible for this special enrollment right, you or your dependent must have lost coverage because:
The maximum available period of COBRA continuation coverage was exhausted; or
Eligibility for the coverage was lost (including due to legal separation, divorce, death, termination of employment or reduction in hours), or employer contributions toward the group health coverage were terminated.
Voluntarily declining group health coverage, including the failure to pay required premiums, does not qualify as a loss of coverage that entitles you or a dependent to a special enrollment right.
You must request this special enrollment no later than 31 days after the date your coverage ends under the other group health plan. If you enroll in this plan within this 31-day period, there will be no interruption of your coverage. Special enrollment requests received later than 31 days after the date your coverage ends under the other group health plan will not be accepted. You will have an opportunity to enroll for coverage during the next annual enrollment period or earlier if you have a change in status. See the section entitled “Changing Your Coverage During the Plan Year” for more details regarding changes in status or contact the Vought Benefits Center at 1-866-689-5999.
Title II of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information, known as protected health information, includes virtually all individually identifiable health information held by the Plan - whether received in writing, in an electronic medium, or as an oral communication.
Title II of HIPAA imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information, known as protected health information, includes virtually all individually identifiable health information held by the plan - whether received in writing, in an electronic medium, or as an oral communication.
The Plan, or its claims administrator, or health insurer, may disclose your health information without your written authorization to Vought for purposes related to the administration of the Plan. Vought agrees not to use or disclose your health information other than as permitted or required by the plan documents and by law. The only Vought employees who will have access to your health information will be those necessary to carry out the proper administration of the Plan, including those in the following organizations:
Benefits Administration
Benefits Design
Benefits Accounting
Legal
Here's how additional information may be shared between the Plan and Vought, as allowed under the
HIPAA rules:
The Plan, or its claims administrator, or health insurer, may disclose "summary health information" to Vought if requested, for purposes of obtaining premium bids to provide coverage under the Plan,
IBEW- Effective July 1, 2010 87
or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants' claims information, but from which names and other identifying information has been removed.
The Plan, or its claims administrator, or health insurer, may disclose to Vought information on whether an individual is participating in the Plan, or has enrolled or disenrolled in an insurance option offered by the Plan.
In addition, you should know that Vought cannot and will not use health information obtained from the
Plan for any employment-related actions. However, health information collected by Vought from other sources, for example under the Family and Medical Leave Act, Americans with Disabilities Act, disability income programs, or workers' compensation is not protected under HIPAA (although this type of information may be protected under other federal or state laws).
The Plan may disclose your health information, without your authorization, to third parties that assist the Plan in its operations, to government and law enforcement agencies, to your family members in limited instances, and to certain other persons.
In certain cases, your health information can be disclosed without authorization to a family member, close friend, or other person you identify who is involved in your care or payment for your care.
Information describing your location, general condition, or death may be provided to a similar person
(or to a public or private entity authorized to assist in disaster relief efforts). You'll generally be given the opportunity to agree or object to these disclosures (although exceptions may be made: for example if you're not present or if you're incapacitated). In addition, your health information may be disclosed without authorization to your legal representative.
Except as described in the Plan’s privacy notice ("Privacy Notice"), other uses and disclosures will be made only with your written authorization. You may revoke your authorization as allowed under the
HIPAA rules. However, you cannot revoke your authorization if the Plan has taken action in reliance upon it.
You have the right to request restrictions on certain uses and disclosures of your health information and the Plan's right to refuse.
You have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or health care operations, except for uses or disclosures required by law. In addition, you have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death
- or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing.
The plan is not required to agree to a requested restriction. However, if the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the
Plan (including an oral agreement), or unilaterally by the Plan for health information created or received after you're notified that the Plan has removed the restrictions. The plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.
You have the right to receive confidential communications of your health information:
If you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accommodate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.
If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.
You have the right to inspect and copy your health information:
— With certain exceptions, you have the right to inspect or obtain a copy of your health information in a "Designated Record Set." This may include medical and billing records maintained for a health care provider; enrollment, payment, claims adjudication, and case or medical management record systems maintained by a plan; or a group of records the Plan uses
IBEW- Effective July 1, 2010 88
to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. In addition, the Plan may deny your right to access, although in certain circumstances you may request a review of the denial.
— If you want to exercise this right, your request to the Plan must be in writing.
You have the right to amend your health information that is inaccurate or incomplete:
— With certain exceptions, you have a right to request that the Plan amend your health information in a Designated Record Set. The plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the Designated Record Set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal, or administrative proceedings).
If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment.
You have the right to receive an accounting of disclosures of your health information:
— You have the right to a list of certain disclosures the Plan has made of your health information.
This is often referred to as an "accounting of disclosures." You generally may receive an accounting of disclosures if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the Privacy Notice.
— If you want to exercise this right, your request to the Plan must be in writing.
If you believe your privacy rights have been violated, you may file a complaint with the Secretary of
Health and Human Services and or with the Plan. You will not be retaliated against if you file a complaint. To file a complaint with respect to a violation of your privacy rights, please contact the
Privacy Official or its designee.
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The Consolidated Omnibus Budget Reconsolidation Act (COBRA) of 1985, as amended, is a federal law, ensures that you and your covered dependents have a right to temporarily continue group medical, dental, mental health, prescription drug and vision coverage, at your own cost, if any of the following qualifying events result in the loss of plan coverage:
You terminate employment with Vought for any reason, including retirement but excluding termination for gross misconduct;
Your regularly scheduled work hours are reduced so that you or your covered dependents become ineligible for coverage; or
Your employment ends (for a reason other than gross misconduct) following an FMLA leave, in which case the qualifying event will occur on the earlier of the date you indicated you were not returning to work or the last day of the FMLA leave.
In addition, your covered dependents will become eligible for COBRA continuation coverage after any of the following qualifying events occur and cause a loss of plan coverage:
Your death;
Your divorce or legal separation;
You first become entitled to Medicare after your loss of coverage due to termination of employment
(for a reason other than gross misconduct) or reduction in hours; or
Your dependent child no longer qualifies as a dependent under the Plan.
A child who is born to or placed for adoption with a covered former employee during the continuation coverage period has the same continuation coverage rights as a dependent child described above.
Keep in mind that continued prescription drug, mental health and vision coverage is generally available only if you decide to continue your medical coverage. Similarly, you must continue your coverage under the BlueEdge PPO option in order to continue your participation in the HCA. If you purchase continued coverage, it will be the same as the coverage offered to similarly situated non-COBRA participants. If the Plan covering such participants changes, those changes will also apply to your continued coverage.
You also have a right to continue participating in the Health Care Flexible Spending Account Plan if a qualifying event occurs. If you choose to do so, you will participate in the account only until the end of the year in which the initial qualifying event occurs. However, your contributions will be made on an after-tax basis, because payroll deductions will no longer be possible.
If you are enrolled in the Blue Cross Blue Shield BlueEdge HSA plan option and elect COBRA continuation coverage, Vought will not contribute to your Health Savings Account at the beginning of the next benefit plan year. If you would still like to contribute funds to your Health Savings Account,
IRS regulations require you to be enrolled in a High-Deductible plan. This means you will need to elect
COBRA continuation coverage in the BCBS BlueEdge HSA plan option. If you choose not to elect
COBRA continuation coverage, HSA regulations still allow you to use the existing funds in your account for qualified expenses.
If you elect continued coverage, it will begin on the day you lose your coverage as a result of one of the events mentioned above. How long this continued coverage lasts depends on the event.
18-Month Continuation – You or your covered dependents can purchase continued coverage for up to
18 months if:
Coverage ended due to a reduction in your work hours or termination of your employment.
36-Month Continuation – Your covered dependents can purchase continued coverage for up to 36 months if your dependents lose eligibility for medical coverage due to:
Your death;
Your divorce or legal separation;
Your entitlement to Medicare after your termination of employment or reduction in hours; or
IBEW- Effective July 1, 2010 90
Your dependent child ceases to qualify as a dependent under the Plan.
29-Month Continuation – If you lose coverage due to a termination of employment or reduction in hours and the Social Security Administration determines that you or a covered dependent is disabled, as defined by Title II or Title XVI of the Social Security Act, before or within 60 days of electing COBRA continuation coverage, you can continue coverage for up to 29 months from the date of the original qualifying event. In this case, you may continue coverage for an additional 11 months after the original
18-month period either for the disabled person only or for one or all of your covered family members.
To be eligible for extended coverage due to Social Security disability, you must notify Vought of the disability determination before the end of the initial 18 months of COBRA continuation coverage and within 60 days after the later of:
The date you or a covered dependent is determined to be disabled by the Social Security
Administration;
The date of the qualifying event;
The date on which you or your covered dependent loses (or would lose) coverage under the Plan as a result of the qualifying event; and
The date on which you or your covered dependent is informed of the obligation to provide the disability notice (which includes receipt of this Summary Plan Description)
If the disabled individual should no longer be considered to be disabled by the Social Security
Administration, you must notify Vought within 30 days following the end of the disability. Coverage that has exceeded the original 18-month continuation period will end on the first day of the month that is more than 30 days after a final determination by the Social Security Administration that the individual is no longer disabled.
An extension of the maximum continuation coverage period may be available to your covered dependents that have purchased continued coverage after a reduction in your work hours or your termination of employment. If, during the 18-month period (or, in the case of a disability extension, the 29-month period) of continued coverage, your covered dependents experience a second qualifying event, your covered dependents will be able to purchase continued coverage for a maximum period of up to 36 months measured from the date of the initial qualifying event. A second qualifying event includes:
Your death;
Your divorce or legal separation;
Your entitlement to Medicare after your termination of employment or reduction in hours; or
Your dependent child ceasing to qualify as a dependent under the Plan.
A second qualifying event will result in an extension of the maximum continuation coverage period only if the second qualifying event would have resulted in a loss of coverage for your covered spouse or dependents under the Plan had the initial qualifying event not occurred.
If you become entitled to Medicare and lose health care coverage as a result of your termination of employment or reduction in hours within 18 months of your Medicare entitlement, your spouse and/or dependents will be able to elect COBRA for up to the later of:
36 months from the date of your Medicare entitlement; or
18 months from the date of your termination of employment or reduction in hours.
If more than one qualifying event occurs, no more than 36 months total of COBRA continuation coverage will be available. The COBRA beneficiary must experience the second qualifying event during the first 18 months of COBRA continuation, and must provide notice to Vought within the required time period (see Notification below). COBRA continuation coverage will end sooner if the Plan terminates and
Vought does not provide replacement medical coverage, or if a person covered under COBRA:
Fails to make required contributions when due;
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Becomes entitled to Medicare benefits after electing COBRA continuation coverage;
Vought Aircraft Industries, Inc. ceases to provide health care benefits to any employee;
Is extending the 18-month coverage period because of disability and is no longer disabled as defined by the Social Security Act; or
Becomes covered under another group health plan after electing COBRA continuation coverage, unless the new group coverage is limited due to a pre-existing condition exclusion; the Vought plan will be primary for the pre-existing condition and secondary for all other eligible health care expenses, provided that contributions for COBRA coverage continue to be paid. Coverage may only continue for the remainder of the original COBRA period.
The cost of your continuing coverage is based on the total cost Vought determines is applicable for the same medical and dental coverage for active employees. Your cost for the duration of COBRA continuation coverage includes Vought’s cost plus any contributions employees are normally required to make, plus 2% for administrative expenses.
If you or your dependent is Social Security disabled and you choose to continue coverage for up to 29 months, your cost will increase from 102% to 150% of the group rate during the 19th through the 29th months of coverage.
The cost for continued coverage may be adjusted periodically to reflect changes in Vought’s cost for providing this coverage.
Vought Aircraft Industries, Inc. has 30 days to notify the COBRA Administrator of a COBRA qualifying event. The plan’s COBRA Administrator then has 14 days to send an election notice to notifying you and your covered dependents that a qualifying event has occurred and explaining your right to purchase continued coverage and to continue participating in the Health Care Flexible Spending
Account.
If there is a change in status because you divorce (or legally separate from your spouse), or a dependent becomes ineligible for coverage, you or your covered dependent must notify the Vought
Benefits Center that a qualifying event has occurred. This notification must be received by the Vought
Benefits Center within 60 days after the change in status (or the date on which you or your eligible dependent would lose coverage on account of such event, if later). Failure to promptly notify the
Vought Benefits Center of these events will result in loss of the right to continue coverage for you and your dependents. After receiving this notice, you will receive an election notice within 44 days.
See 29 Month Continuation section above for your notification requirements related to disability extensions.
If you are participating in COBRA continuation coverage and there is a second qualifying event
(described in Extension of maximum continuation coverage period – second qualifying events above), you must notify the Vought Benefits Center within 60 days of the event. Failure to promptly notify the
Vought Benefits Center will result in the loss of your right to extend your COBRA continuation coverage past the original 18-month period.
If you or your dependents wish to elect continuation coverage, the election form must be returned to the COBRA Administrator within 60 days from the later of the date you receive the form, or the date your coverage ends due to the qualifying event. You cannot enroll for continued coverage once the 60day election period ends.
When you return the election form to the COBRA Administrator, you are not required to submit evidence of good health. Your first premium payment is due no later than 45 days after the date of your election, and it must cover the period of time back to the first day of your COBRA continuation coverage. After that, you are required to make monthly payments in advance.
IBEW- Effective July 1, 2010 92
The following chart illustrates the COBRA continuation period under certain circumstances:
Qualifying Event Maximum Continuation Period
Employee Spouse Child
You lose coverage because you reduce your work hours or take unpaid leave
18 months
You terminate employment for any reason (except gross misconduct)
18 months
You or your dependent is disabled (as defined by Title
11 or XVI of the Social
Security Act) during the first
60 days of COBRA coverage
29 months
You die N/A
18 months
18 months
29 months
36 months
18 months
18 months
29 months
36 months
You and your spouse legally separate or divorce
N/A
You are already on COBRA and become disabled and entitled to Medicare, which causes your dependents to lose coverage
N/A
Your child no longer qualifies as a dependent
N/A
36 months
36 months
N/A
36 months
36 months
36 months
Under the Family and Medical Leave Act of 1993 (FMLA), you may be entitled to up to 12 weeks of unpaid, job-protected leave during each calendar year for the following:
The birth of your child, to care for your newborn child, or for placement of a child in your home for adoption or foster care;
To care for your spouse, child or parent with a serious health condition;
For your own serious health condition; or
To take care of any urgent matters for your spouse, child or parent who is on active duty or who has been notified of an impending call or order to active duty in the U.S. Armed Forces.
Additionally, you may be entitled to up to 26 weeks of unpaid, job-protected leave during each calendar year to care for your spouse, child, parent or next of kin who incurs a serious injury or serious health condition during active military service in the U.S. Armed Forces. You may take this 26-week leave period intermittently or on a reduced schedule basis. To be eligible for FMLA leave, you must have at least one year of service and have worked at least 1,250 hours over the previous 12 months
(these are your regular scheduled working hours).
If your FMLA leave is unpaid, you may continue coverage while on FMLA leave and you will be required to pay your contributions directly to Vought until you return to active pay status. Your coverage is the same as that of an active employee and subject to changes as modifications is made to the Plan for active employees. Vought will bill you for any contributions required for coverage while on FMLA leave.
Contributions are made on an after-tax basis.
If your FMLA leave is a paid leave, your pay will be reduced by your before-tax contributions as usual for the coverage level in effect on the date your FMLA leave begins.
IBEW- Effective July 1, 2010 93
If you notify the Vought Benefits Center that you are terminating employment during your FMLA leave, your coverage will end on the date of your notification. If you do not return to work on your expected
FMLA return date, and you had not notified the Vought Benefits Center of your intent to terminate your employment or to extend the period of leave, your coverage will end on the date you were expected to return.
You may not change your plan elections until you return from your FMLA leave unless you experience a family status change or a HIPAA Special Enrollment event during your period of leave. Please refer to the ‘Changing Your Coverage During The Plan Year’ section for more information about events that may permit a mid-year election change and the extent to which you may make changes as a result.
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This booklet serves as a Summary Plan Description of the Vought Aircraft Industries, Inc. Flexible
Benefits Plan. The information in this SPD is subject to the provisions of the policies, contracts, and/or plan documents that legally govern the operation of the Plan (“official plan documents”). If there is any conflict between the information in this SPD and the policies, contracts, or plan documents, the official plan documents will govern.
The Plan Administrator is generally responsible for determining whether someone is eligible for the Plan and for deciding appeals of denied claims involving questions of eligibility to participate in the Plan or changes in coverage elections such as the addition or deletion of dependents. In carrying out these functions, the Plan Administrator has full discretionary authority to interpret and construe the terms of the Plan, to decide questions regarding eligibility for the Plan, and to make any related findings of fact.
The Plan Administrator can act through a delegate.
The Claims Administrator for the particular benefit is responsible for determining whether benefits are payable under the Plan, determining the amount of benefits payable, if any, and deciding appeals of denied claims. In carrying out these functions, including reviewing denied claims, the Claims
Administrator and, when applicable, the Plan Administrator has the full discretionary authority to interpret and construe terms of the Plan, to decide questions related to the payment of benefits, and to make any related findings of fact. The decision of the Claims Administrator (or Plan Administrator, as applicable) shall be final and binding to the full extent permitted by law.
Fraudulent Claims
Vought takes fraudulent benefit claims very seriously. If you make a claim you know is based on or contains false, incomplete, or misleading information, with the intent to pursue or obtain benefits you are not entitled to (for yourself or others), the Plan may terminate your eligibility for benefits and/or demand that you repay the benefits or offset future benefits. You may also be subject to prosecution under state and federal law.
The Board of Directors of Vought Aircraft Industries, Inc. has the absolute right, by written resolution, to amend, suspend, or terminate the Plan, in whole or in part, at any time. The Plan Administrator may amend the Plan to maintain its compliance with or legal, administrative or procedural changes or requirements or other reasons.
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Acute care Treatment for an immediate and severe episode of an illness, an injury related to an accident or other trauma or recovery from surgery. Typically, acute care is provided in a hospital.
Unlike chronic care, acute care often is needed for only a short time.
After-tax contributions Contributions for certain benefits that are deducted from your paycheck after federal, state and local taxes are withheld.
Annual maximum The maximum number of treatments or services or amount of benefits that you or your enrolled dependents can receive each benefit plan year. Annual maximums vary by benefit plan option.
Annual restoration A certain amount that is restored to your lifetime maximum benefit each benefit plan year.
Automatic payroll deductions Costs that are deducted from your paycheck before your net amount is calculated.
Base Pay Your gross straight-time pay for regularly scheduled hours each week. This amount does not include bonuses, overtime, incentive compensation allowances or other forms of special compensation.
Benefit plan options The various options available to you and your family within the Vought Flexible
Benefits Program.
Benefit plan year A 12–month period from July 1 through June 30 where your flexible spending amounts, deductible, out-of-pocket maximum and annual maximums start over and tracked throughout the period.
Benefits representatives The Vought staff who can assist you with your benefit questions.
Carrier A company that underwrites or administers a range of health benefit programs. May refer to an insurance company or a managed health plan.
Claim Any charge for services submitted for payment to the claims administrator by either you or a service provider.
Claims Administrator The outside firm with which Vought Aircraft Industries, Inc. contracts to administer benefits under the guidelines of the Plan and generally accepted insurance practices. The claims administrator may collect premiums, pay claims and/or provide administration services. See the section on Administration Information for a list of claims administrators for each benefit plan option.
Contract employee An individual who is not on the Vought Aircraft Industries, Inc. payroll, but instead works for a company that was retained by Vought Aircraft Industries, Inc. or its affiliates to provide a specific service.
Contributions The amount you pay toward the cost of the benefits in which you enroll. Typically, contributions are deducted from your paychecks.
Coverage categories The number of family members, such as employee only or employee and family, which you enroll in the benefit plans. Coverage categories vary under the Vought Aircraft Industries,
Inc. benefit plans.
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Covered loss The loss of limb(s), sight, speech or hearing for which you are eligible to receive full or partial benefits under the AD&D insurance plan.
Custodial Care Personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include care that most people do themselves, like using eye drops.
Diagnosis Identification of a condition by examination, testing and/or analysis.
Diagnostic and Statistical Manual of Mental Disorders (DSM HI-R/IV) A code book of mental disorder symptoms and illnesses.
Diagnostic tests Tests conducted in order to make a diagnosis.
Emergency A sudden serious medical condition for which failure to receive immediate care could place your life in danger or cause serious impairment of bodily functions.
Employer contribution The amount Vought Aircraft Industries, Inc. contributes toward the premium cost of your benefits or towards your health savings account.
Estate The assets and liabilities left by you when you die.
Experimental A procedure, service or supply that does not conform to accepted medical practice, is not approved by the appropriate governing body, such as the Food and Drug Administration, or has not completed scientific testing or whose effectiveness has not been established. Typically, experimental procedures, services or supplies are not covered under the medical or dental plan options.
Explanation of benefits (EOB) A statement from a claims administrator or insurance company that describes services or treatments performed, dollar amounts paid by the Plan, benefit limits and denials.
It is important to keep a copy of your EOBs in your personal files for reference.
Flexible Benefits The health and welfare benefits program Vought Aircraft Industries, Inc. offers certain eligible employees and their dependents. Eligible employees are able to select a benefits package suited to their and their dependents’ needs.
Funding The amount of revenue required to finance a benefit program.
Group The employer, union, trust, association or organization through which you and your dependents are entitled to benefit coverage. In this case, the group is Vought Aircraft.
Group rates The discounted insurance rates offered to an employer, union, trust, association or organization.
Home health care Care provided in your home by an agency licensed by the state in which you live.
The claims administrator must preauthorize home health care. Benefits may be approved for individuals who are homebound for medical reasons, physically unable to obtain necessary medical care as an outpatient, or under the care of a physician.
Hospice care Medical care provided to a terminally ill patient and emotional support for family members during the last months of a patient's life. Medical care emphasizes controlling the patient's
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pain and other symptoms rather than attempting to find a cure or prolong life. A licensed agency provides hospice care to the patient, either as an inpatient in a licensed hospice center or a privateduty nursing facility or at home as an outpatient.
Hospital admission Entry for an overnight (or longer) stay in a hospital facility.
Identification card A card issued to each enrolled person by an insurance company, health plan or claims administrator. The card identifies the person as eligible for reimbursement of eligible expenses under the benefit plan option. Keep your identification card with you at all times.
Individual policy Insurance for individuals and their dependents that is separate from a group insurance plan. Also see conversion policy.
Inpatient A patient admitted to the hospital for an overnight stay.
Investigational See Experimental.
Job Shopper See Contract Employee.
Leased employee An individual who is not on the Vought Aircraft Industries, Inc. payroll but who provides services to Vought Aircraft Industries, Inc. or its affiliates as specified in an agreement between the individual’s employer and Vought Aircraft Industries, Inc. and who qualifies as a leased employee under Section 414(n) of the Internal Revenue Code.
Legal guardian A person designated by the court to be legally responsible for a minor child(ren) in place of a parent.
Licensed day care facility Any state-licensed facility, other than a family day care home, that provides non-medical supervision for children. The care must be in a group setting and for less than 24 hours a day.
Licensed physician A person who is legally qualified to practice medicine.
Lump sum Payment of your benefit in its entirety at one time.
Managed care A structured system of health care delivery that offers patients access to quality, costeffective health care by assessing the utilization and cost of services and measuring provider performance. All the Vought Aircraft Industries, Inc. health care plans are managed care plans.
Medicaid/Medi-Cal A government program administered and operated individually by participating state and territorial governments that provides medical benefits to eligible low-income individuals.
Federal and state governments share the cost of the program.
Medical leave of absence An absence from work due to illness or injury for more than 7 consecutive calendar days.
Medicare A federally administered, nationwide health insurance program that covers the cost of health care for individuals who are eligible for Social Security benefits. As a Vought Aircraft Industries, Inc. employee, you and the company pay a premium each pay period for your future Medicare benefits.
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Network specialist A specialist who enters into a contract with the health plan to provide care at a specified, discounted rate. Typically, the Plan options pay more when you receive treatment from a network specialist. See Specialist.
Non-participating pharmacy A pharmacy that has not entered into a contract with the claims administrator to dispense prescription drugs at a specified, discounted rate.
Obstetrician/gynecologist (OB/GYN) A physician who specializes in women's health, including pregnancy and child birth.
Out-of-pocket costs The amount of your health care expenses not covered by the benefit plan option that you pay. Out-of-pocket costs typically include co-payments, deductibles, co-insurance and ineligible expenses.
Outpatient care Health care you receive from a clinic, emergency room or other health facility without being admitted as an overnight patient.
Participating pharmacy A pharmacy that is a member of the claims administrator’s network of pharmacies and agrees to dispense prescription drugs to you according to the provisions of the Plan.
Physician A person who is legally qualified to practice medicine.
Plan administrator The person or group of persons designated by the legal plan document as responsible for most day-to-day activities of the Plan. These activities include determining eligibility for benefits, processing claims and appeals regarding claims, maintaining plan records, and distributing information about the Plan to participants
.
The Administrative Committee for the Benefit Plans of
Vought Aircraft Industries. Inc. is the Plan Administrator.
Plan document The legal document that contains all the provisions, conditions and terms of operation of a pension, savings or health and welfare plan. It may be written in technical terms. This differs from a Summary Plan Description (SPD), which must be written in a way that an average participant of the
Plan can understand.
Plan year Vought Aircraft's benefit plan year is July 1 through June 30. See “Benefit Plan Year.”
Pre-existing condition Any physical or mental condition that you or a dependent had within a specific period of time immediately before enrolling in a health plan.
Premium The contribution you make for certain benefit plans. The health plans have one premium rate for you only and another, separate premium rate or rates for you with dependents. Premiums may change periodically.
Provider A hospital, skilled nursing facility, ambulatory surgical facility, physician, practitioner, laboratory or other individual or organization that is licensed to provide health care services, supplies and/or accommodations.
Provider directory A list of all health care providers that are members of a health plan's network. You can find provider directories through the Vought Benefits Web site or, to request a copy, call the
Vought Benefits Center and select your health care provider through the phone menu.
Recalled When you are rehired after being terminated for lack of work or a reduction in workforce.
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Referral An arrangement, usually made by your primary care physician, under which you can be evaluated and treated by another provider, typically a specialist.
Rehired A Vought Aircraft Industries, Inc. employee hired again after terminating employment.
Secondary plan If you are enrolled in more than one medical or dental plan, the Plan that pays benefits after the primary plan.
Service area (network area) The geographic area, usually based on ZIP code, in which you must live to be eligible to participate in a plan.
Skilled nursing facility A specially qualified facility that has the staff and equipment to provide skilled nursing care, or rehabilitation and related health services. Care at the facility is provided by, or under the supervision of, licensed nursing personnel. Skilled rehabilitation services may include such services as physical therapy performed by or under the supervision of a professional therapist.
Specialist A physician who, based on education and qualifications, concentrates on a particular specialty of medicine.
Summary Plan Description (SPD) A written statement required by ERISA that describes a plan in easy-to-read language. It includes a statement of eligibility, coverage, employee rights and claims appeal procedures. This guide is the Summary Plan Description for your Vought Flexible benefits
Program.
Temporary employee An employee on the payroll who is scheduled to be employed for less than six months.
Usual, reasonable and customary (URC) fee The "going rate" for medical and dental services in your geographic area, as determined by the claims administrator. The medical and dental plans pay benefits up to the usual, reasonable and customary fee. Expenses that exceed URC limits do not apply to out-of-pocket maximums. You pay 100% of expenses over the URC fee. When you receive care from a network provider, expenses never exceed the URC limit.
Waive coverage The decision to elect no coverage for yourself and your family.
Whole life insurance An insurance policy that builds up a cash value as premium payments accrue.
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