American Airlines, Inc. Group Life and Health Benefits

388 Pages·2015·1.71 MB·English

by  Kelley, Kim

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

Employee Benefits Guide for Ground Employees

Effective January 1, 2015

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2015 Employee Benefits Guide for Ground Employees
American Airlines, Inc. (the “Company”) provides you with a comprehensive benefits
package designed to help you meet the health and insurance needs of you and your eligible
family members.
To help you make the most of those benefits, this Guide, which serves as both the legal plan
document and the summary plan description, describes the provisions of the American
Airlines, Inc. Group Life and Health Benefits Plan, the American Airlines, Inc. Long-Term
Disability Plan, and the American Airlines, Inc. Long-Term Care Insurance Plan (collectively,
the “Plans”) effective January 1, 2015 for ground employees.

Additional Important Information
In addition to the descriptions of the benefits provided and how each Plan
works, this Summary Plan Description also provides general and plan specific
information in the:
About this Guide section
General Eligibility section
General Enrollment section
Life Events section
Additional Health Benefit Rules section
Plan Administration section
Reference Information section, including a Contacts list, the Glossary, and the
Archives of older versions of the Guide.

About This Guide
This Employee Benefits Guide (“Guide”) is for the eligible employees, as described in
“Employee Eligibility” section, in the following groups (collectively referred to as “Ground
Employees”):
• Agents/Representatives/Planners (ARP); including Home-Based Representatives
or Level 84 Premium Services Representatives (HBR) employed by the Company
• Officers, Management/Specialists, Support Staff (OMSS) employed by the
Company and US Airways, Inc.
• Transport Workers Union-represented employees (TWU) employed by the
Company
• Communication Workers of America (CWA), International Association of
Machinists and Aerospace Workers (IAM) and Transport Workers Union (TWU)
represented employees employed by US Airways, Inc1

This Guide describes separate health and welfare benefit plans sponsored by American
Airlines, Inc. and established under and operated pursuant to the Employee Retirement
Income Security Act (ERISA) and other applicable federal laws. These health and welfare

1 This guide serves as the Legal Plan Document and Summary Plan Description for CWA, IAM and TWU represented
employees employed by US Airways, Inc. who are eligible for and/or enroll in the CORE medical option.
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benefit plans are provided through a §125 cafeteria plan arrangement, as described and
controlled by Internal Revenue Code, and US Treasury regulations. US Airways, Inc. is a
participating employer of the plans.
This Guide serves as the legal plan documents and the summary plan description (SPD) for
the following benefit program (collectively the “Plans”):
• American Airlines Inc. Group Life and Health Benefits Plan (the “Group Life and
Health Plan”)
• American Airlines, Inc. Long-Term Disability Plan
• American Airlines, Inc. Long-Term Care Plan

The Company, or its authorized delegate, reserves the right to modify, amend or terminate
any of the Plans, any program described in this Guide, or any part thereof, at its sole
discretion. Changes to the Plans generally will not affect claims for services or supplies
incurred before the change.
From time to time, you may receive updated information concerning changes to the Plans.
Neither this Guide nor updated materials are contracts or assurances of compensation,
continued employment or benefits of any kind.
The Company believes that certain HMO Medical Options under the Group Life and Health
Plan are grandfathered health plan(s), under the Patient Protection and Affordable Care Act
(PPACA). The following chart specifies which medical benefit options in this plan are
grandfathered, and which are not:
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Medical Option Grandfathered or Non-Grandfathered
STANDARD Medical Option Non-Grandfathered
CORE Medical Option Non-Grandfathered
VALUE Medical Option Non-Grandfathered
Out-of-Area Medical Option Non-Grandfathered
HMO Medical Options May be either, depending upon the HMO; contact
your specific HMO for this information
As permitted by the PPACA, a grandfathered health plan can preserve certain basic health
coverage that was already in effect when the law was enacted. Being a grandfathered health
plan means that your plan or policy might not include certain consumer protections of
PPACA that apply to other plans, for example, the requirement for the provision of
preventive health services without any cost sharing. However, grandfathered health plans
must comply with certain other consumer protections in the Affordable Care Act, for
example, the elimination of lifetime limits on benefits.
Questions about non-grandfathered Medical Options can be addressed to:
American Airlines, Inc.
PO Box 619616
Mail Drop 5134, HDQ1
Dallas-Fort Worth Airport, TX 75261-9616
You may also contact the Employee Benefits Security Administration, U.S. Department of
Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table
summarizing which protections apply to non-grandfathered health plans.
Voluntary Offerings Provided by American Benefits Consulting (ABC)
The Company makes accessible for employees the opportunity to enroll in: Hyatt
Legal, Group Homeowners’ and Automobile Insurance, Veterinary Pet Insurance,
LifeLock, Group Accident and Critical Illness Insurance at a discounted rate. At the
request of the employee, the Company facilitates the post-tax payroll deductions to
pay for these voluntary offerings. The Company does not assume any plan
sponsorship for the Voluntary Offerings provided by American Benefits Consulting
(ABC). The details of these offerings are not included in or governed by this Guide.
Please go to www.AAaddedbenefits.com or call 1-855-550-0706 to contact ABC
directly for information about these benefits.

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Contents
About This Guide 2
How do I determine my eligibility? 12
Employee Eligibility 12
Ineligibility 13
Benefits Effective Date for New Hires 14
Proof of Eligibility 14
Eligibility During Leaves of Absence and Disability 15
Family Medical Leave of Absence (FMLA) or Military Leave 15
Eligibility After Age 65 16
Dependent Eligibility by Benefit 16
Medical Coverage 16
Dental and Vision Coverage 17
Child Life Insurance and Child Accidental Death and Dismemberment (AD&D) Insurance
17
Spouse Life Insurance and Spouse Accidental Death and Dismemberment (AD&D)
Insurance 18
Dependent Eligibility Requirements - Generally (All Benefits) 18
Determining a Child’s Eligibility 18
Dependents of Deceased Employees 19
Determining a Spouse (SP), Domestic Partner (DP) or Common Law Spouse Eligibility
(CLSP) 19
Employees Married to Other Employees 21
Other Information Related to Married Employees 22
Medical Benefit Options Overview 24
Medical Benefit Options 25
Medical Benefit Options Comparison 26
Covered Expenses 44
Excluded Expenses 54
Network/Claim Administrator 57
Mid-Year Medical Benefit Option Change: Impact on Deductibles and Out-of-Pocket
Maximums 58
Filing Claims 59
Claims Filing Deadline 60
CheckFirst (Predetermination of Benefits) 60
QuickReview (Pre-Authorization) 61
Mental Health and Chemical Dependency Care 64
Wellness Resources 65
Employee Assistance Programs (EAP) 66
Standard Medical Option 67
How the Standard Medical Option Works 67
In-Network Services, Deductible and Out-of-Pocket Maximums 68
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Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 68
Covered and Excluded Expenses 69
Prescription Drug Benefits 69
Retail Drug Coverage 70
Retail Refill Allowance — Long-Term Medications 71
Retail Prescription Clinical Programs 72
Mail Order Prescription Clinical Programs 75
Internet Refill Option 76
Other Refill Options 76
Pharmacy Discount Cards and Manufacturer Coupons 76
Claims Filing Deadline 76
Reimbursement of Co-insurance 76
HRA - Health Reimbursement Account 77
Gender Reassignment Benefit (GRB) 77
GRB Coverage 77
Travel Reimbursement 78
Preauthorization for the GRB 78
How the Value Medical Option Works 79
In-Network Services, Deductible and Out-of-Pocket Maximums 80
Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 80
Covered and Excluded Expenses 81
Prescription Drug Benefits 81
Retail Drug Coverage 82
Retail Refill Allowance — Long-Term Medications 83
Retail Prescription Clinical Programs 84
Mail Order Prescription Clinical Programs 87
Internet Refill Option 88
Other Refill Options 88
Pharmacy Discount Cards and Manufacturer Coupons 88
Claims Filing Deadline 89
Reimbursement of Co-insurance 89
HIA - Health Incentive Account 89
Core Medical Option 90
How the CORE Medical Option Works 90
Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 91
Covered and Excluded Expenses 92
Prescription Drug Benefits 92
Retail Drug Coverage 92
Filling Prescriptions and Filing Claims 93
Retail Refill Allowance — Long-Term Medications 93
Retail Prescription Clinical Programs 94
Specialty Pharmacy Services 95
Mail Order Prescription Clinical Programs 96
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Internet Refill Option 97
Other Refill Options 97
Pharmacy Discount Cards and Manufacturer Coupons 97
Reimbursement of Co-insurance 98
HSA - Health Savings Account 98
HSA Funds 98
Setting Up an HSA 99
Using Your HSA Funds 99
Limited Purpose Flexible Spending Account (LPFSA) 100
Out-of-Area Coverage 101
How Out-of-Area Coverage Works 102
Network/Claims Administrator 103
Special Provisions 103
Prescription Drug Benefits 104
Retail Drug Coverage 104
Retail Refill Allowance — Long-Term Medications 105
Retail Prescription Clinical Programs 106
Specialty Pharmacy Services 107
Express Scripts Mail Order 107
Generic Drugs 109
Internet Refill Option 109
Other Refill Options 109
Pharmacy Discount Cards and Manufacturer Coupons 109
Claims Filing Deadline 110
Reimbursement of Co-insurance 110
HRA - Health Reimbursement Account 110
Health Maintenance Organizations (HMOs) 111
Eligibility 112
Children Living Outside of the Service Area 112
Termination of Coverage 112
If You Reach Age 65 and are Still an Active Employee 113
How HMOs Work 113
HMO Contact Information 113
Dental Benefits 115
How the Dental Benefit Works 116
Eligibility 116
Plan Comparison Chart 116
Special Provisions 117
Covered Expenses 118
Preventive treatment: 118
Basic and Major Services 118
Orthodontia 119
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Excluded Expenses 120
Filing Claims 121
Claim Filing Deadline 121
Vision Benefit 123
How the Vision Insurance Benefit Works 123
Eligibility 124
Covered Expenses 124
Filing Claims 126
Flexible Spending Accounts 127
How the HCFSA - Health Care Flexible Spending Account Works 127
Special Provisions 128
Covered Expenses 129
Excluded Expenses 130
Filing Claims 131
How the LPFSA - Limited Purpose Flexible Spending Account Works 131
Filing Claims 132
How the DCFSA- Dependent Care Flexible Spending Account Works 133
Covered Expenses 135
Filing Claims 135
If You Elect Both an HCFSA/LPFSA and a DCFSA 135
Life Insurance Benefits 137
How the Life Insurance Benefit Works 137
Benefit Overview 138
Basic Term Life Insurance Benefit 138
Voluntary Term Life Insurance Benefit 138
Spouse and Child Term Life Insurance Benefit 140
Designating Beneficiaries 141
Coverage if You Become Disabled 143
Special Provisions 143
Accelerated Benefit Option (ABO) 143
Taxation of Life Insurance 144
Conversion and Portability 145
Assignment of Benefits 146
Total Control Account 146
Verbal Representation 147
Filing Claims 147
Accidental Death & Dismemberment (AD&D) Insurance Benefits 148
Basic and Voluntary Accidental Death & Dismemberment Insurance (AD&D) 150
What Is Covered 150
Special Benefit Features 151
Exclusions 155
Filing a Claim 156
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Insurance Policy 156
Other Accident Insurance: Special Risk Accident Insurance (SRAI) Benefit, Special Purpose
Accident Insurance (SPAI) Benefit and Management Personal Accident Insurance (MPAI)
157
SRAI Benefit 157
SPAI Benefits 157
MPAI Benefits (For Management/Specialist and Officer employees only) 157
Policy Aggregates 157
Exclusions 158
Disability Benefits 159
How the OSTD Insurance Benefit Works 163
Definition of Total Disability 164
Appropriate Care and Treatment 164
OSTD Insurance Benefits 165
Filing a Claim 165
Return-to-Work Program 166
Family Care Incentive 166
When Benefits Begin 166
Benefits from Other Sources 167
When Benefits End 167
Exclusions and Limitations 167
Management and Support Staff Short-Term Disability Insurance Plan 168
Agent, Representative and Planner Voluntary Long-Term Disability Plan 168
How the Plan Works 168
Definition of Total Disability 168
LTD Plan Benefits 169
Severe Condition Benefit 170
Duration of LTD Benefits 174
Filing a Claim for LTD Benefits 175
When LTD Benefits Begin 175
When LTD Benefits End 176
LTD Exclusions and Limitations 176
Benefits from Other Sources 179
Management & Support Staff Long-Term Disability Plan 182
How do I enroll? 197
Annual Enrollment 197
How to Enroll 198
New Employee Enrollment 198
When Coverage Begins as a Newly Hired Employee 198
When Coverage Begins as a Current Employee 199
Waiving Coverage 199
Default Coverage 199
HIPAA Special Enrollment Rights – Medical Benefit Option Only 200
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When Coverage Ends 201
Making Changes During the Year: Life Events 202
Life Events 203
If Your Dependent(s) Lose Eligibility Under the Plan 218
If You Process Your Life Event after the Deadline 218
Special Life Event Considerations 218
Additional Health Benefit Rules 221
Qualified Medical Child Support Orders (QMCSO) Procedures 221
Use of Terms 222
Procedures upon Receipt of Qualified Medical Child Support Order (QMCSO) or State
Agency Notice 222
Review of a Medical Child Support Order or Notice 224
Procedures upon Final Determination 224
Appeal Process 224
Coordination of Benefits 224
Other Plans 225
Benefits for Individuals Who Are Eligible for Medicare 227
Benefits for Disabled Individuals 227
When Coverage Ends 228
Continuation of Coverage – COBRA 228
Eligibility 229
Continuation of Coverage for You and Your Dependents Qualifying Events 229
Continuation of Coverage for Your Dependents Only (Qualifying Events) 230
How to Elect Continuation of Coverage 230
Continuation of Coverage for Employees in the Uniformed Services 232
Continuation of Coverage While on a Family and Medical Leave 233
Other Employee Obligations 233
Impact of Failing to Elect Continuation of Coverage on Future Coverage 233
Additional Questions 234
Plan Administration 235
Plan Information 235
Administrative Information 237
Plan Amendments 238
Plan Funding 238
Collective Bargaining Agreement 239
Assignment of Benefits 240
Confidentiality of Claims 240
Payment of Benefits 241
Right to Recovery 241
Subrogation 241
Claim Processing Requirements and Appeals 244
Appealing a Denial — For Non-Grandfathered Medical Options (STANDARD, CORE, VALUE,
OUT-OF-AREA) and HMO Medical Options 250
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