1 SPD covers NO codes 7/30/04 9:58 AM Page 3 US Airways, Inc. Flight Attendant Long Term Disability Benefit Plan Summary Plan Description As of January 1, 2004
2 September 2004 Dear US Airways Benefit Plan Participant: We are pleased to present to you this Summary Plan Description ( SPD ) for the US Airways Flight Attendant Long Term Disability Benefit Plan ( the Plan ). Please take some time to review this SPD, since it includes a comprehensive overview of: Your participation and the Plan s eligibility rules; How the Plan works in general; Your benefits under the Plan should you become disabled; and Important information about the operation of the Plan and your rights as a participant. If you have general questions about the benefits information contained in this SPD, please call US Airways Benefits Administration at , prompt 2. Sincerely, John Hedblom Vice President HR Policy and Development
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4 Table of Contents INTRODUCTION...1 ABOUT YOUR PARTICIPATION...2 Who Is Eligible...2 When Coverage Begins...2 Paying for Coverage...2 When Coverage Ends...2 Continuation of Benefits for Employees in the Uniformed Services...3 YOUR LONG TERM DISABILITY BENEFITS...4 When Benefit Payments Begin...4 Benefits During Maternity Leave...4 Definition of Disability...5 Your Disability Benefit Amount...5 Coordination with Other Benefits...5 Retirement Benefits...6 When Benefits End...6 What s Not Covered...7 ADDITIONAL RULES THAT APPLY TO THIS PLAN...8 How Your Disability Benefit Is Taxed...8 i
5 Plan Benefits and Your Other US Airways Benefits...8 Working During Your Disability...8 Return to Work Program...8 Other Employment...9 CLAIMS PROCEDURES...10 Filing a Claim...10 Proof of Continuing Disability...10 YOUR RIGHT TO APPEAL...12 Time Frame for Claim Determinations...12 If You Receive an Adverse Benefit Determination...13 Procedures for Appealing an Adverse Benefit Determination...13 PLAN ADMINISTRATION...16 Plan Sponsor...16 Plan Administrator...16 Agent for Service of Legal Process...16 Identification Numbers...17 Plan Year...17 Organization Providing Administrative Services...17 Plan Funding...17 ii
6 Plan Document...17 Future of the Plan...18 Collective Bargaining Agreement...18 Limitation on Assignment...18 YOUR RIGHTS UNDER ERISA...19 Receive Information About Your Plan and Benefits...19 Prudent Actions by Plan Fiduciaries...19 Enforce Your Rights...20 Assistance with Your Questions...20 YOUR EMPLOYMENT...21 GLOSSARY...22 iii
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8 INTRODUCTION The US Airways, Inc. Flight Attendant Long Term Disability ( LTD ) Benefit Plan ( the Plan ) gives you financial protection by paying a portion of your income if you become Disabled through illness or injury. US Airways provides this coverage at no cost to you. This booklet summarizes the main provisions of the Plan and serves as the summary plan description ( SPD ) for this Plan. It describes the Plan as it applies to eligible employees. Please read this booklet carefully. If you have any questions about your benefits, please contact US Airways Benefits Administration at When you hear the telephone prompts, select 2. Note also that this SPD is only a summary. Complete details of the Plan are contained in the legal Plan document. If there is any difference between the information in this SPD and in the legal Plan document, the Plan document will govern. 1
9 ABOUT YOUR PARTICIPATION Who Is Eligible You are eligible for coverage under the Plan if you: Are employed as a flight attendant by US Airways and represented by the Association of Flight Attendants; and Are in active status, or on an employer-approved leave of absence (excluding any periods during which you have elected a voluntary furlough or a leave of absence in lieu of furlough). When Coverage Begins Your coverage under the Plan begins on the first day you are eligible for participation. Paying for Coverage US Airways provides coverage under the Plan at no cost to you. When Coverage Ends In general, coverage under the Plan will end the day you are no longer an eligible employee. However, coverage will continue if your employment ends because: You transfer directly from active or on-leave payroll status to retirement; or US Airways places you on furlough while you are receiving benefits under the Plan and you are determined by the Social Security Administration to be totally and permanently disabled. 2
10 Coverage may end for other reasons, such as: US Airways terminates this Plan; You are no longer eligible for benefits; You die. Continuation of Benefits for Employees in the Uniformed Services The Uniformed Services Employment and Reemployment Rights Act of 1994 ( USERRA ) guarantees certain rights to eligible employees who enter military service. If you are receiving benefits under the Plan at the time your military service begins, benefits will continue. Any income that you receive related to your military service will offset the amount of your Disability benefits. However, if you incur a service-related disability, you will be ineligible to receive benefits related to that disability. In general, to be eligible for the rights guaranteed by USERRA, you must: Return to work on the first full, regularly scheduled work day following your leave, safe transport home, and an eight-hour rest period if you are on a military leave of less than 31 days; Return to or reapply for reemployment within 14 days of completion of such period of duty, if your absence from employment is from 31 to 180 days; and Return to or reapply for reemployment within 90 days of completion of your period of duty, if your military service lasts more than 180 days. 3
11 YOUR LONG TERM DISABILITY BENEFITS The Plan continues a portion of your income if you become Disabled (as defined below) due to illness or injury and are unable to work for an extended period of time. As you review the Plan s benefit provisions on the following pages, you should use the Glossary starting on page 22 to become familiar with the terms used. When Benefit Payments Begin Benefits are payable after the Elimination Period described below: For disabilities that began before January 1, 2003, benefits are payable after you have been disabled for 90 days. For disabilities beginning on or after January 1, 2003, benefits are payable after you have been disabled for 120 days. If you recover and return to work, then experience a relapse related to the prior Disability within 90 days of returning to work, you will not have to satisfy a new Elimination Period and your benefit payments will resume as soon as administratively possible. However, you will be subject to a new Elimination Period if you return to work then: Experience an unrelated Disability; or Experience a related or unrelated Disability after returning to work for more than 90 days. Benefits During Maternity Leave After your 29 th week of pregnancy, you are considered Disabled and are eligible to begin the 120-day Elimination Period unless your Physician determines that you are not Disabled. However, if your Physician determines that you are Disabled before the end of your 29 th week of pregnancy, you may apply for Plan benefits as described under Filing a Claim on page 10. 4
12 Definition of Disability You are Disabled if you meet the following conditions: For disabilities that began prior to April 1, 2001, you are unable due to illness or injury to perform any available occupation for which you are reasonably suited by reason of education and experience. For disabilities that began on or after April 1, 2001, you are unable due to illness or injury to perform your duties as a flight attendant for the first 24 months of benefit payments. After 24 months of benefit payments, the illness or injury renders you unable to perform any occupation for which you are reasonably qualified by reason of education and experience. Your Disability Benefit Amount If you qualify for benefit payments under the Plan, your monthly benefit will be as follows: If you became Disabled before January 1, 2003, you will receive 60% of your Average Monthly Earnings, up to a maximum benefit of $2,350 per month. If you become Disabled on or after January 1, 2003, you will receive 50% of your Average Monthly Earnings, up to a maximum benefit of $7,500 per month. Coordination with Other Benefits Your Plan benefits will be offset, dollar-for-dollar, by any of the following amounts you may receive, or are entitled to receive, from other sources listed below: Primary Disability benefits paid or payable under federal Social Security law, even if you fail to apply for Social Security benefits when you are eligible;* Disability benefits paid or payable under any workers compensation law; or Disability benefits paid or payable under any federal or state law. *These amounts may be reduced by any attorneys fees approved by the Social Security Administration that you incur to obtain the benefits. 5
13 Retirement Benefits Your Plan benefits will also be reduced by any normal or early retirement benefits payable to you from US Airways Retirement Plans, regardless of whether you have started receiving benefit payments from any of those plans. These include: Employer contributions made on your behalf to the US Airways, Inc. 401(k) Savings Plan; and The Retirement Plan for Flight Attendants in the Service of US Airways, Inc. For purposes of the Plan, these retirement benefits are assumed to be paid as a single life annuity on your early or normal retirement date. If you do not receive your retirement benefits at age 65, your Plan benefit will be reduced by the amount of any normal retirement benefit you would have been entitled to receive. When Benefits End If you became disabled before January 1, 2003, your benefit duration depends on your age when your Disability begins, as follows: If You Became Disabled: Benefits Can Continue While You Remain Disabled: Before age 60 Until age 65 Age 60 or more For up to five years If you become disabled on or after January 1, 2003, your benefits will end when you reach age 65. Regardless of your age and the date you became disabled, your benefits will also end when one of the following happens: You are no longer Disabled; You are no longer an active employee; 6
14 You do not provide proof of Disability as required by the Plan; or You die. What s Not Covered The Plan does not cover Disabilities due to or related to any of the following: Active participation in a riot; Committing or attempting to commit a felony; or An intentionally self-inflicted injury. 7
15 ADDITIONAL RULES THAT APPLY TO THIS PLAN How Your Disability Benefit Is Taxed Because US Airways provides coverage at no cost to you, any benefit you receive from the Plan will be considered taxable income. Plan Benefits and Your Other US Airways Benefits Any medical and dental coverage you had before going on a medical leave of absence will continue for 12 months at active employee contribution levels. After 12 months, coverage continues indefinitely provided you pay the full cost. Any group term life insurance coverage you had before going on medical leave of absence will continue for 60 days at no cost to you. After 60 days, you are responsible for paying full cost of Basic and Optional Life Insurance coverage while on a leave status. If deemed totally and permanently disabled, your Basic and Optional Life Insurance will be paid by US Airways. Working During Your Disability Return to Work Program If your Disability began before April 1, 2001, under the terms of the Return to Work Program, US Airways reserves the right to reassign you to another non-flight attendant job for which you are reasonably qualified by training, education or experience. If you decline a legitimate job offer for which you are reasonably qualified, your Plan payments will stop, and you can continue your Disability leave as an unpaid medical leave of absence. The Return to Work Program is further described in the collective bargaining agreement between US Airways and the Association of Flight Attendants. If your Disability begins on or after April 1, 2001, the Return to Work Program does not apply to you; however, you may apply for other US Airways positions. If you apply for a 8
16 position and then decide not to accept it, you will still be eligible to receive Plan benefits, subject to Plan limitations. Other Employment You may, with US Airways advance permission, work for an employer other than US Airways while Disabled and continue to receive Plan benefits. However, if you earn more from the outside employer while you are Disabled than you earned from that employer in the year before your Disability began, your Plan benefit amount will be reduced by the difference. For example, if you earned $10,000 from an outside employer in the year before your Disability began, then earned $25,000 from the same employer during the year of your Disability, your Disability benefits from the Plan would be reduced by $15,000. If the sum of (a) your income from the outside employer during your Disability and (b) your Plan benefits exceeds your pre-disability income from that employer, your Plan benefits will stop. 9
17 CLAIMS PROCEDURES Filing a Claim To receive Plan benefits, you must submit your completed claim application to the Plan Administrator as soon as possible but in no event later than 60 days following the date on which you return to work. The application must include all requested documentation. Applications may be obtained from your Base or on thehub at Your claim application must include written proof of your Disability from your Physician or Mental Health Practitioner. The Plan Administrator will review your application, including the medical documentation, and decide on your claim. The Plan Administrator will then notify you of its determination in writing. If the Plan Administrator determines that the medical documentation does not prove that you are Disabled, you may be required to submit to an independent medical evaluation with a Physician or Mental Health Practitioner chosen and paid for by US Airways. If the Physician selected by US Airways disagrees with the opinion of your Physician or Mental Health Practitioner, you may request a third medical evaluation. The Physicians who provided the first two assessments must agree upon and appoint a third, impartial Physician to provide another medical evaluation. US Airways will pay the full cost of obtaining a third opinion. Proof of Continuing Disability Benefits will continue as determined under the Plan, as long as you comply with the treatment plan recommended by your Physician or Mental Health Practitioner and approved by the Plan Administrator. While you are receiving Plan benefits, the Plan Administrator may ask you, from time to time, to provide written proof of your continued Disability from your Physician or Mental Health Practitioner. 10
18 If the Plan Administrator determines that the medical documentation does not prove that you continue to be Disabled, you may be required to submit to an independent medical evaluation with a Physician or Mental Health Practitioner chosen and paid for by US Airways. If the Physician selected by US Airways disagrees with your Physician or Mental Health Practitioner, you may request a third medical evaluation. The Physicians who provided the first two assessments must agree upon and appoint a third, impartial Physician to provide another medical evaluation. US Airways will pay the full cost of obtaining a third opinion. Your Plan benefits may stop if you fail to provide proof of Disability or proof of continued Disability to the Plan Administrator, or if you provide the Plan Administrator with false documentation 11
19 YOUR RIGHT TO APPEAL Time Frame for Claim Determinations If you receive an adverse benefit determination (i.e., a denial, reduction or termination of a benefit, or a failure to provide or make a payment), the Plan Administrator will notify you within 45 days after receiving the claim. This 45-day period may be extended for up to 30 days if the Plan Administrator: Determines the extension is necessary due to matters beyond the Plan s control; and Notifies you, before the initial 45-day period expires, of the reason(s) for the extension and the date by which the Plan Administrator expects to render a decision. If the Plan Administrator again determines that it cannot make a decision within that extension period, the determination period may be extended for up to an additional 30 days. In such case, the Plan Administrator must notify you, before the first 30-day extension period expires, of the reason(s) for the additional extension and the date the Plan Administrator expects to make a decision. All extension notices you receive must specifically explain: The standards on which your entitlement to a benefit is based; The unresolved issues hindering a decision on the claim; and The additional information needed to resolve those issues. If an extension is necessary because you must provide additional information, the Plan s time frame for making a determination is stopped from the date the Plan Administrator sends you the extension notification to the date you provide the additional information. You have up to 45 days to furnish the requested information. 12
20 If You Receive an Adverse Benefit Determination If your claim is denied, in whole or in part, the Plan Administrator will send you a notification of adverse benefit determination which will include: The specific reason(s) for the adverse benefit determination; Reference to the specific Plan provisions on which the benefit determination is based; A description of any additional material or information necessary for your claim to be reconsidered, and the reason this information is necessary; and A description of the Plan s appeal procedures and applicable time limits, including a statement of your rights to bring a civil action under ERISA following an adverse benefit determination on review. Procedures for Appealing an Adverse Benefit Determination You, or your authorized representative, have 180 days from the date you receive an adverse determination notification to appeal the determination and to request, in writing, that the determination be reviewed by the Plan Administrator. The written request must contain: The date your request was filed with the Plan Administrator; The specific portion of the claim denial you want the Plan Administrator to review; A statement explaining why you believe the Plan Administrator should reverse the adverse determination; and Any written comments, documents, records and other information relating to the claim. 13
21 You have the right to: Request, free of charge, reasonable access to and copies of all documents, records and other information relevant to your claim. A document, record, or other information is treated as relevant to your claim if it: Was used in making the benefit determination; Was submitted, considered, or generated in the course of making the benefit determination, regardless of whether such document, record or other information was used in making the benefit determination; Demonstrates compliance with the administrative processes and safeguards required in making the benefit determination; or Constitutes a statement of policy or guidance with respect to the Plan concerning the denied benefit, regardless of whether such statement was used to make the benefit determination; and Receive a review that takes into account all comments, documents, records and other information submitted by you relating to the claim, regardless of whether such information was submitted or considered in the initial benefit determination. The Plan Administrator will notify you of its written decision on review within 45 days after receiving your request for review. This 45-day period may be extended for up to an additional 45 days if the Plan Administrator (a) determines that an extension is required due to special circumstances; and (b) notifies you in writing, before the end of the initial 45-day period, of the special circumstances and the date by which the Plan Administrator expects to make a determination on review. The Plan Administrator s notice of an adverse benefit determination on appeal will contain all of the following information: The specific reason(s) for the adverse benefit determination; 14
22 Reference to the specific Plan provisions on which the benefit determination is based; A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits; and A statement describing your rights under ERISA to bring a civil action. No one, including your employer, may fire you or discriminate against you in order to prevent you from obtaining a benefit or exercising the rights you have under ERISA. 15
23 PLAN ADMINISTRATION This Plan Administration information is provided in compliance with the Employee Retirement Income Security Act ( ERISA ) of 1974, as amended. While you should not need these details on a regular basis, the information may be useful if you have specific questions about your Plan. Plan Sponsor US Airways, Inc. Crystal Park Four 2345 Crystal Drive Arlington, VA This Plan is a welfare benefit plan providing long term disability benefits. Plan Administrator US Airways, Inc. Benefits Administration Crystal Park Four 2345 Crystal Drive Arlington, VA , Prompt 2 The administration of the Plan will be under the supervision of the Plan Administrator. To the fullest extent permitted by law, the Plan Administrator will have the discretion to determine all matters relating to eligibility, coverage and benefits under the Plan. The Plan Administrator will also have the discretion to determine all matters relating to interpretation and operation of the Plan. Agent for Service of Legal Process US Airways, Inc. Crystal Park Four 2345 Crystal Drive Arlington, VA Legal process also can be served on the Plan Administrator. 16
24 Identification Numbers The Employer Identification Number ( EIN ) assigned by the Internal Revenue Service to US Airways is The Plan number is 507. Plan Year The Plan Year is January 1 through December 31. Organization Providing Administrative Services Listed below is the name, address, and phone number of the organization that provides administrative services. These services include administering claims and providing customer assistance. US Airways, Inc. Benefits Administration Crystal Park Four 2345 Crystal Drive Arlington, VA , Prompt 2 Plan Funding Benefits from this Plan are paid from the general assets of US Airways. Plan Document Plan Document This SPD is intended to help you understand the main features of the Plan. It should not be considered a substitute for the Plan document, which governs the operation of the Plan. That document sets forth all of the details and provisions concerning the Plan and is subject to amendment. If any questions arise that are not covered in this SPD or if this SPD appears to conflict with the official Plan document, the text of the official Plan document will determine how questions will be resolved. 17
25 Future of the Plan It is US Airways intent that the Plan will continue indefinitely. However, US Airways reserves the right to amend, modify, suspend or terminate the Plan, in whole or in part, subject to the terms of the collective bargaining agreement. Any such action would be taken in writing and maintained with the records of the Plan. Plan amendment, modification, suspension or termination may be made for any reason, and at any time. If the Plan, or any part of the Plan, is terminated, you will receive the benefits due to you to the extent funded or provided contractually under the terms defined in the Plan s legal contracts. Collective Bargaining Agreement This Plan is maintained subject to a collective bargaining agreement. Participants and beneficiaries can obtain a copy of the collective bargaining agreement upon written request to the Plan Administrator. The agreement is also available for review during normal business hours at any US Airways Inflight Services office. Limitation on Assignment Your rights and benefits under the Plan cannot be assigned, sold, or transferred to your creditors or anyone else. 18
26 YOUR RIGHTS UNDER ERISA As a Participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 ( ERISA ). ERISA provides that all Plan Participants shall be entitled to: Receive Information About Your Plan and Benefits If you request, the Plan Administrator must: Allow you to examine, without charge, at the Plan Administrator s office and at other specified locations, such as worksites, all documents governing the Plan, 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; Provide you with copies of documents governing the operation of the Plan, and copies of the latest annual report (Form 5500 Series) and updated SPD. There may be a reasonable charge for the copies; and Provide you with 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. Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan Participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your 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 or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a Plan benefit or exercising your rights under ERISA. 19
27 Enforce Your Rights If a claim for a Plan benefit is denied or ignored, in whole or in part, you or your beneficiary has the 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. You can file a suit in a federal or state court (provided you have exhausted the Plan s claims and appeals procedure, as described starting on page 12) if: You request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days. 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 Plan Administrator; You believe you have been improperly denied a benefit (in whole, or in part); You believe the Plan fiduciaries are misusing Plan funds; or You believe you may have been discriminated against for asserting your rights (in this case, you may file suit in court or request assistance from the U.S. Department of Labor). 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. However, if you lose, or if the court finds that your suit is frivolous, you may be required to pay the costs and fees. Assistance with Your Questions 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 obtaining documents from the Plan Administrator, you should contact the nearest office of Employee Benefits Security Administration ( EBSA ), 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
28 You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at EBSA (3272). YOUR EMPLOYMENT Your eligibility or your right to benefits under the Plan should not be interpreted as a guarantee of employment. The company s employment decisions are made without regard to the benefits to which you are entitled upon employment. This SPD provides detailed information about the Plan and how it works. This SPD does not constitute an expressed or implied contract or guarantee of employment. 21
29 GLOSSARY Average Monthly Earnings a Participant s gross salary as reported on IRS Form W-2 for the tax year preceding the commencement of the Disability benefit, divided by the number of full and partial months for which the Participant actually received compensation. This number will be adjusted to reflect pre-tax contributions and any non-wage compensation. Disability or Disabled if a Participant meets the following conditions: For disabilities that began prior to April 1, 2001, you are unable due to illness or injury to perform any available occupation for which you are reasonably suited by reason of education and experience. For disabilities that began on or after April 1, 2001, you are unable due to illness or injury to perform your duties as a flight attendant for the first 24 months of benefit payments. After 24 months of benefit payments, the illness or injury renders you unable to perform any occupation for which you are reasonably qualified by reason of education and experience. Elimination Period for disabilities that began before January 1, 2003, benefits are payable after you have been disabled for 90 days. For disabilities beginning on or after January 1, 2003, benefits are payable after you have been disabled for 120 days. ERISA the Employee Retirement Income Security Act of 1974, as amended. Mental Health Practitioner a) A Physician who is board-certified, board-eligible, or who limits his or her practice to clinical and consulting psychiatry and/or neurology; or b) A psychologist who has a doctorate in his or her respective discipline, is licensed by the appropriate state regulatory board to practice without restriction at an independent level, and who limits his or her practice to clinical and consulting psychology. Participant any employee who satisfies the necessary eligibility requirements. 22
30 Physician a) An individual licensed as a Medical Doctor (M.D.) by the appropriate state regulatory authority to practice medicine independently and without restrictions; or b) an individual licensed as a Doctor of Osteopathic Medicine (O.D.) by the appropriate state regulatory authority to practice medicine independently and without restrictions. Plan the US Airways, Inc. Flight Attendant Long Term Disability Benefit Plan. Plan Administrator the Employer or such other person or committee as may be appointed from time to time by the Employer to administer the provisions of the Plan. Plan Year January 1 through December 31. Retirement Plans all pension benefit plans sponsored by the employer for the benefit of the employee, including, but not limited to, the Retirement Plan for Flight Attendants in the Service of US Airways, Inc. and employer contributions to the US Airways, Inc. 401(k) Savings Plan, as such plans may be amended from time to time. 23
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With Respect to Texas Employees IMPORTANT NOTICE To obtain information or make a complaint: You may call Aetna's toll-free telephone number for information or to make a complaint at: 1-800-MY -Health (694-3258)
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