Updated: 07/10/2007. Employee Benefits Guide for Flight Attendants

Transcription

1 Updated: 07/10/2007 Employee Benefits Guide for Flight Attendants

2 SUMMARY OF MATERIAL MODIFICATIONS FOR HEALTH AND WELFARE BENEFIT PLANS SPONSORED BY AMERICAN AIRLINES, INC. December 15, 2008 This document serves as notice to active and Leave-of-Absence Flight Attendants of changes to the American Airlines, Inc.-sponsored health and welfare benefit plans listed below. This Summary of Material Modifications describes the changes that affect your benefit plans and updates your Summary Plan Descriptions. This Summary of Material Modifications, together with the Employee Benefits Guide, makes up the official plan documents and Summary Plan Descriptions. Please read this notice carefully, and place this notice with your Summary Plan Description(s) (the Summary Plan Descriptions are contained in the Employee Benefit Guide for Flight Attendants ( EBG )). These changes are effective January 1, 2009, unless otherwise stated elsewhere in this document. These changes apply to all plans in the benefit program for American Airlines, Inc. Flight Attendants, including the Group Life and Health Benefits Plan for Employees of Participating AMR Corporation Subsidiaries (Plan 501, EIN # ; referred to herein as the Plan ), and Supplemental Medical Plan for Employees of Participating AMR Corporation Subsidiaries (Plan 503, EIN # , referred to herein as the Supplemental Medical Plan ). In Contact Information on page 1, the following text replaces the following sections under Medical Coverage : For Information About: Contact: At: Medical Coverage Standard Medical Option Claims processor UnitedHealthcare AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX (800) For other information, visit: Web site: Provider directory: (800) For other information, visit: Web site: Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX Point-of-Service Option UnitedHealthcare (800) Provider directory: lines (877) For other information, visit: Web site: Provider directory: Page 1

3 For Information About: Contact: At: Medical Coverage Claims processor AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX For other information, visit: Web site: Provider directory: (800) For other information, visit: Web site: Point-of-Service Option Mental Health Care Maximum Medical Benefit Requests (Standard Medical and Point-of-Service Options) Coverage for Incapacitated Child and Special Dependents (Standard Medical and Point-of-Service Options) Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX United Behavioral Health AMR Medical Claim Unit P.O. Box Salt Lake City, UT UnitedHealthcare AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX UnitedHealthcare AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX Provider directory: lines (877) For other information, visit: Web site: Provider directory: (888) (800) (800) (877) (800) (800) (877) CheckFirst (Predetermination of Benefits) (Except HMOs) Page 2

4 For Information About: Contact: At: Medical Coverage Standard Medical Option Point-of-Service Option Dental Coverage Dental Benefits Claims Processor Vision Insurance Vision Insurance Benefit UnitedHealthcare AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX UnitedHealthcare AMR Medical Claim Unit P.O. Box Salt Lake City, UT Aetna P.O. Box El Paso, TX Blue Cross and Blue Shield of Texas P.O. Box Dallas, TX MetLife AMR Dental Claim Unit P.O. Box El Paso, TX OptumHealth Vision (formerly Spectera, Inc.) 2811 Lord Baltimore Drive Baltimore, MD (800) (800) (877) (800) (800) (877) (800) (Select Dental Plan at the Prompt.) For claims tracking, to review your coverage options, or to locate a network dentist, visit the MetLife Web site at You will be prompted to enter a company name. Enter AMR Corporation. To continue the sign-in process, enter your uniquely-created User Name and Password. If you are a first-time visitor to the site, click on register here under Welcome to MyBenefits or click the Register Now icon on the left. Follow the prompts to establish your account. If you have problems accessing the site, please contact MetLife s technical help desk at MET-WEB ( ), or by info@metlife.com. (800) Web site: Page 3

5 In Benefits at a Glance, Medical Benefit Options on page 5, the second sentence of the first paragraph is replaced as follows: The Standard Medical Options and the Point-of-Service Option are self-funded by the Company and administered by UnitedHealthcare (UHC), Aetna, and Blue Cross and Blue Shield of Texas. In Benefits at a Glance, Medical Benefit Options on page 5, the following text is inserted before the subheading Standard Medical Option : Beginning January 1, 2009, the Plan s self-funded medical option the Standard Medical Options and the Point-of-Service Option are administered by three network and/or claims administrators: UnitedHealthcare (UHC) Aetna Blue Cross and Blue Shield of Texas Each state will have one preferred network and/or claims administrator. Your preferred network and/or claims administrator is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your network and/or claims administrator. If you do not have an alternate address listed in Jetnet, your network and/or claims administrator is based on your permanent address. A network and/or claims administrator is the health plan administrator that processes health care claims and manages a network of care providers and health care facilities. In Benefits at a Glance, Medical Benefit Options, Standard Medical Option on page 5, the following text is inserted as the first paragraph after the subheading Standard Medical Option : The preferred network and/or claims administrator for each state will be the sole network provider of health care services. You cannot select a different network and/or claims administrator. Your preferred network and/or claims administrator is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your network and/or claims administrator. If you do not have an alternate address listed in Jetnet, your network and/or claims administrator is based on your permanent address. Page 4

6 If you relocate to a new state, your medical election and contribution rates remain the same for the remainder of the plan year. You elected network and/or claims administrator and medical contribution rates do not change based on your relocation. You must wait until the next annual enrollment period to change your medical option election, unless you experience a qualifying life event. In Benefits at a Glance, Medical Benefit Options, Standard Medical Option on page 6, the following paragraph replaces the paragraph after the table: All four Standard Medical Options offer a medical discount through a voluntary preferred provider organization (PPO). The PPO is a network of over 400,000 physicians, hospitals and other medical service providers that have agreed to charge discounted fees for medical services. Contact your network and/or claims administrator for more information about this program or to access a list of network providers. In Benefits at a Glance, Medical Benefit Options, Point-of-Service Option on page 6, the following text is inserted as the first paragraph after the subheading Point-of- Service Option : When you enroll for the POS Option, you have a choice between three network and/or claims administrators. The administrator with the lowest employee contribution costs will be the preferred network and/or claims administrator for your state. You can choose a non-preferred network and/or claims administrator called Tier 1 or Tier 2 but you will pay more in employee contributions. The Tier 1 and Tier 2 non-preferred network and/or claims administrators will vary from state to state. For example, Aetna may be a Tier 1 non-preferred network and/or claims administrator in one state and a Tier 2 network and/or claims administrator in another. Tier 1 and Tier 2 network and/or claims administrators reflect monthly contributions that are 25 percent and 50 percent higher, respectively, than the cost of the preferred network and/or claims administrator. The list of the network and/or claims administrators by state resides via Jetnet on e-hr. Your state is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your state. If you do not have an alternate address listed in Jetnet, your state is based on your permanent address. If you relocate to a new state, your medical election and contribution rates remain the same for the remainder of the plan year. You elected network and/or claims administrator and medical contribution rates do not change based on your relocation. You must wait until the next annual enrollment period to change your medical option election, unless you experience a qualifying life event. Page 5

7 In Benefits at a Glance, Medical Benefit Options, Point-of-Service Option on page 6, the following paragraph replaces the first paragraph after subhead Point-of-Service Option : The Point-of-Service Option ( POS Option ) offers access to the network of physicians and hospitals that have agreed to provide medical services to plan participants at preferred rates. Each time you need medical care, you can choose to use a network or out-of-network provider, but you generally save money when you use a network provider. In Benefits at a Glance, Medical Benefit Options, Point-of-Service Option on page 6, the following paragraph replaces the seventh paragraph: You can receive network benefits for specialist care without a referral from a primary care physician (PCP), but you are encouraged to have a PCP to coordinate network services for you. Contact your network and/or claims administrator to review a list of network providers. In Eligibility, Employee Eligibility, Active Employees on page 13, the following text replaces the second sentence in the fifth paragraph: Keep in mind that in addition to all other eligibility requirements, you are eligible for the Point-of-Service (or HMO) Option only if you reside where your network and/or claims administrator offers a network, and your eligibility is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your network and/or claims administrator. If you do not have an alternate address listed in Jetnet, your network and/or claims administrator is based on your permanent address. In Eligibility, Dependent Eligibility, Dependent Eligibility Criteria, Determining a Child s Eligibility on page 17, the following text replaces the sub-bullets under the sixth bullet: You must submit a Special Dependent Statement to HR Services. Complete and return the form to HR Services, along with copies of the official court documents awarding you custodianship or guardianship of the child. HR Services will send you a letter notifying you of its findings. If your request is approved, the notification letter will include an approval date. If you submit your request within 60 days of the date that legal guardianship or legal custodianship is awarded by the court, coverage for the child is effective as of that date, pending approval by HR Services. If you submit the request after the 60-day time frame, coverage is not effective until the date that HR Services approves the coverage. Page 6

8 In Eligibility, Dependent Eligibility, Dependent Eligibility Criteria, Coverage for an Incapacitated Child on page 18, the following text replaces the first bullet in this section: For UnitedHealthcare: Within 60 days of the date coverage would otherwise end, you must file a Statement of Dependent Eligibility and your network and/or claims administrator must approve the application. For Blue Cross and Blue Shield of Texas: Within 45 days of the date coverage would otherwise end, you must file a Statement of Dependent Eligibility and your network and/or claims administrator must approve the application. For Aetna: Within 90 days of the date coverage would otherwise end, you must file a Statement of Dependent Eligibility and your network and/or claims administrator must approve the application. In Eligibility, Dependent Eligibility, Dependent Eligibility Criteria, Coverage for an Incapacitated Child on page 18, the following text replaces the third bullet in this section: You provide additional medical proof of incapacity as may be required by your network and/or claims administrator from time to time. Coverage will be terminated and cannot be reinstated if you cannot provide proof or if your network and/or claims administrator determines the child is no longer incapacitated. If you elect to drop coverage for your child, you may not later reinstate it. In Enrollment, Benefit ID Cards on page 30, the following text replaces the paragraph in this the section: If you are a Point-of-Service (POS) Option or Standard Medical Option participant, your network and/or claims administrator will mail your benefit ID cards to you. If you have elected to participate in an HMO, your HMO will mail your benefit ID cards to you. Contact your HMO directly if you have questions. ID cards are not provided for Dental Benefits. Standard Medical Option participants also receive a Medco ID card for retail prescription drug purchases. If you have elected to participate in Flexible Spending Account(s), PayFlex will mail your consumer account card to you, if you elected a consumer account card during October benefits enrollment. For information on how the Flexible Spending Accounts work, see the Flexible Spending Accounts section beginning on page 162. In Enrollment, Making Changes During the Year, Life Events in the table on page 35, the second bullet in the section You or your spouse becomes pregnant is replaced as follows: Contact: Your network and/or claims administrator and select the phone prompt for the prenatal care program, if you are covered by the Point-of-Service Option Page 7

9 In Enrollment, Making Changes During the Year, Special Life Considerations on page 39, the following text replaces the second paragraph: Special dependent: To cover a special dependent (foster child or child for whom you become the legal guardian), you must complete a Special Dependent Statement (available via Jetnet on e-hr) and return it to HR Services, regardless of the medical option you select, along with a copy of the court decree or guardianship papers. For detailed criteria regarding coverage for a special dependent, see also Dependent Eligibility Criteria on page 16. In Medical Benefit Options, Overview on page 42, the following text replaces the first bullet: The Standard Medical Options and the Point-of-Service Option are self-funded by the Company. UnitedHealthcare (UHC), Aetna, and Blue Cross and Blue Shield of Texas administers these options; however, reimbursements for covered health care expenses are paid from the general assets of the Company, not by an insurance company. In Medical Benefit Options, Key Features of the Standard and Point-of-Service Options on page 42, the following text replaces the eighth paragraph: Charges for services and supplies provided at an urgent care clinic are covered under the Standard Medical Options. Under the Point-of-Service Option, you should contact your network provider or your network and/or claims administrator for authorization before seeking care at an urgent care clinic, or if you are traveling and need urgent medical care. If your network and/or claims administrator s offices are closed, seek treatment and then call your network and/or claims administrator within 48 hours to ensure that you receive the network level of benefits. In Medical Benefit Options, Key Features of the Standard and Point-of-Service Options on page 44, the following text replaces the third and fourth bullets: If you are covered by the POS Option and are using out-of-network services, you must call your network and/or claims administrator to pre-authorize (QuickReview) any surgery or hospitalization. If you need emergency care under the POS Option, you should contact your network and/or claims administrator within 48 hours after you receive initial care to ensure you receive the network benefit level. In Medical Benefit Options, Medical Benefit Options Comparison on page 46, the following text replaces the fifth bullet: Visit the Benefits page of Jetnet for a link to your network and/or claims administrator s Web site to determine if your physician is a network provider. In Medical Benefit Options, Medical Benefit Options Comparison, Out of Hospital Care on page 50, the reference to UnitedHealthcare in the table in Home health care changes to your network and/or claims administrator. Page 8

10 In Medical Benefit Options, Medical Benefit Options Comparison, Mental Health and Chemical Dependency Care on page 51, the following text is added before the table: United Behavioral Health will continue to serve as the network, administrator and care management vendor for mental health care for the Point-of-Service Option (regardless of network and/or claims administrator you elect). The network and/or claims administrators will utilize different mental health care management vendors for the Standard Medical Options: For UnitedHealthcare, the mental health administrator is United Behavioral Health For Aetna, the mental health administrator is Aetna Behavioral Health For Blue Cross and Blue Shield of Texas, the mental health administrator is Magellan Health Services. In Medical Benefit Options, Standard Medical Options, How the Standard Medical Options Work on page 54, the following text replaces the first sentence in the second paragraph: Beginning January 1, 2009, the Standard Medical Options are administered by three network and/or claims administrators: UnitedHealthcare (UHC), Aetna, and Blue Cross and Blue Shield of Texas. Each state will have one preferred network and/or claims administrator. A network and/or claims administrator is the health plan administrator that processes health care claims and manages a network of care providers and health care facilities. The preferred network and/or claims administrator for each state will be the sole network provider of health care services. You cannot select a different network and/or claims administrator. Your preferred network and/or claims administrator is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your network and/or claims administrator. If you do not have an alternate address listed in Jetnet, your network and/or claims administrator is based on your permanent address. In Medical Benefit Options, Standard Medical Options, Special Provisions, Medical Discount Program on page 55, in all instances of Medical Discount Program is replaced with medical discounts. In Medical Benefit Options, Standard Medical Options, Special Provisions, CheckFirst (Pre-Determination of Benefits) on page 56, in all instances UnitedHealthcare is replaced with your network and/or claims administrator. In Medical Benefit Options, Standard Medical Options, Special Provisions, QuickReview (Pre-Authorization) on pages 57 58, in all instances UnitedHealthcare is replaced with your network and/or claims administrator. Page 9

11 In Medical Benefit Options, Standard Medical Options, Covered Expenses on page 59, the following text replaces the third bullet under Ambulance : A network hospital if you are covered under the Point-of-Service Option and your network and/or claims administrator authorizes the transfer. In Medical Benefit Options, Standard Medical Options, Covered Expenses on page 65, the following text replaces the text under Urgent Care : Charges for services and supplies provided at an urgent care clinic are covered under the Standard Medical Options. Under the Point-of-Service Option, you should contact your network provider or your network and/or claims administrator for authorization before seeking care at an urgent care clinic, or if you are traveling and need urgent medical care. If your network and/or claims administrator s offices are closed, seek treatment and then call your network and/or claims administrator within 48 hours to ensure that you receive the network level of benefits. In Medical Benefit Options, Standard Medical Options, Prescription Drug Benefits, Retail Drug Coverage, on page 60, the following text replaces the third paragraph under the section Filing Prescriptions : Medco reports the claim to your network and/or claims administrator. Your network and/or claims administrator then mails you an Explanation of Benefits (EOB) and applicable payment, advising you of the total charges you submitted, any amounts not covered and the reason, and the amounts eligible and paid under the medical plan. In Medical Benefit Options, Standard Medical Options, Prescription Drug Benefits, Filing Prescriptions on page 68, the following text replaces the first paragraph: If you have questions concerning this program, call the Medco Member Services number on your Medco ID card. If you have questions about the benefit amount paid, call your network and/or claims administrator. In Medical Benefit Options, Standard Medical Options, Excluded Expenses on page 72, the following text replaces the first paragraph: Dietician services: Dietician services are covered only under the Point-of-Service Option and only if you are using network providers. Contact your network provider to determine the services that are covered. All other dietician services are excluded. In Medical Benefit Options, Standard Medical Options, Excluded Expenses on page 74, the following text replaces the text under Wellness items : Wellness items: Items that promote well-being and are not medical in nature, and which are not specific for the illness or injury involved (including but not limited to, dehumidifiers, air filtering systems, air conditioners, bicycles, exercise equipment, whirlpool spas, and health club memberships). Also excluded are: Services or equipment intended to enhance performance (primarily in sports-related or artistic activities), including strengthening and physical conditioning Page 10

12 Services related to vocation, including but not limited to: physical or FAA exams, performance testing, and work hardening programs. If you are covered under the Point-of-Service Option, contact your network and/or claims administrator to determine if your option covers a specific preventive service for a particular medical condition. In Medical Benefit Options, Standard Medical Options on page 75, the following text replaces the first four paragraphs in the section Filing Claims : Depending on the preferred network and/or claims administrator for your state, UnitedHealthcare, Aetna, or Blue Cross and Blue Shield of Texas is the claims processor for the Standard Medical Options. Your preferred network and/or claims administrator provides claim services; however, it does not insure the health benefits. Benefits for the Standard Medical Options are self-funded, which means that all claims are paid from the Company s general assets. If you received services from a medical discount PPO provider, your provider will generally file the claim for you. If you must file the claim yourself, follow the procedures below: Complete a medical claim form. See your preferred network and/or claims administrator s Web site for the form and instructions Submit the completed form to your network and/or claims administrator, along with all itemized receipts (originals) from your physician or other health care provider. A cancelled check is not acceptable. Each bill or receipt submitted to your network and/or claims administrator must include the following: Name of patient Date the treatment or service was provided Diagnosis of the injury or illness for which treatment or service was given Itemized charges for the treatment or service Provider s name, address, and tax ID number In Medical Benefit Options, Standard Medical Options, Filing Claims on page 75, the following text replaces the seventh paragraph: If you have questions about your coverage or your claim under one of the Standard Medical Options, contract your network and/or claims administrator. Contact information is provided in the section Contact Information on page 1. Page 11

13 In Medical Benefit Options, Point-of-Service Option, How the Point-of-Service Option Works on page 76, the following text should be inserted after the second paragraph: Beginning January 1, 2009, the Point-of-Service Option is administered by three network and/or claims administrators - UnitedHealthcare (UHC), Aetna, and Blue Cross and Blue Shield of Texas. Each state will have one preferred network and/or claims administrator. Your preferred network and/or claims administrator is determined by the ZIP code of your Jetnet alternate address on record. Jetnet allows you to list two addresses a permanent address (for tax purposes or for your permanent residence) and an alternate address (for a P.O. Box or street address other than your permanent residence). Since many employees maintain more than one residence, you may list both addresses in Jetnet; however, your alternate address determines your network and/or claims administrator. If you do not have an alternate address listed in Jetnet, your network and/or claims administrator is based on your permanent address. A network and/or claims administrator is the health plan administrator that processes health care claims and manages a network of care providers and health care facilities. When you enroll for the POS Option, you have a choice between three network and/or claims administrators. The administrator with the lowest employee contribution costs will be the preferred network and/or claims administrator for your state. You can choose a non-preferred network and/or claims administrator called Tier 1 or Tier 2 but you will pay more in employee contributions. The Tier 1 and Tier 2 non-preferred network and/or claims administrators will vary from state to state. For example, Aetna may be a Tier 1 non-preferred network and/or claims administrator in one state and a Tier 2 network and/or claims administrator in another. Tier 1 and Tier 2 network and/or claims administrators reflect monthly contributions that are 25 percent and 50 percent higher, respectively, than the cost of the preferred network and/or claims administrator. The following chart demonstrates the monthly contribution cost differential for the Point-of-Service Option: Employee Only Employee + 1 Dependent Employee + 2 or More Dependents Preferred Network and Claim $55.48 $ $ Administrator Tier 1 Network and/or claims administrator $69.35 (25% increase) $ (25% increase) $ (25% increase) Tier 2 Network and/or claims administrator $83.22 (50% increase) $ (50% increase) $ (50% increase) The numbers in this chart are for illustrative purposes only. Your actual costs may be different. The list of the network and/or claims administrators by state resides via Jetnet on e-hr. Page 12

14 If you relocate to a new state, your medical election and contribution rates remain the same for the remainder of the plan year. You elected network and/or claims administrator and medical contribution rates do not change based on your relocation. You must wait until the next annual enrollment period to change your medical option election, unless you experience a qualifying life event. In Medical Benefit Options, Point-of-Service Option, How the Point-of-Service Option Works on page 75, the following text should replace the first bullet: Access to network providers wherever your network and/or claims administrator has a network location. For a list of network providers, visit your network and/or claims administrator s provider Web site to determine if your physician is in the network. The provider Web sites are provided in the section Contact Information on page 1. In Medical Benefit Options, Point-of-Service Option, How the Point-of-Service Option Works on page 76, the following text should replace the fifth bullet: If you live in a location where the Point-of-Service Option is offered, this option will be listed as an option in your Benefits Service Center on Jetnet. Eligibility for the POS Medical Option is determined using your network and/or claims administrator s standard access requirements based on your (the employee s) five-digit home ZIP code. Employees living outside the provider access areas are not eligible for POS coverage and must select either a Standard Medical Option or an HMO (if available in your area). In Medical Benefit Options, Point-of-Service Option, How the Point-of-Service Option Works, Specialist Care on page 77, the following text replaces the second and third paragraphs in this section: If you need the care of a specialist and the network in your area does not offer providers in that specialty, you should contact your PCP or your network and/or claims administrator to determine if a referral to an out-of-network specialist is needed. In these rare instances, your out-of-network care is covered at the network benefit level, but only with prior approval through your network and/or claims administrator. Please note that not all Point-of-Service areas have network specialist providers near where you live. When you enroll, you should check to see if there are providers within a comfortable distance. After you have enrolled, you will receive a Point-of-Service Option ID card from your network and/or claims administrator indicating that you and your covered dependents are covered by the Plan. The ID card includes important phone numbers and should be presented each time you go to a network physician or hospital. Point-of-Service members will receive a Medco ID card for prescription drug services. Page 13

15 In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 78, the following text replaces the eighth paragraph: Emergency care: If you have a medical emergency, go directly to an emergency facility. You or a family member must call your network and/or claims administrator within 48 hours of your emergency care to be eligible for the network benefit level. You should arrange any follow-up treatment through your PCP. If you receive services at an out-ofnetwork facility, you must submit a claim. In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 79, the following text replaces the first and second paragraphs: Care while traveling: If you have a medical emergency while traveling, get medical attention immediately. If you need urgent (not emergency) care, you should call your network and/or claims administrator for a list of network providers and urgent care facilities. If it is after hours, seek treatment but call your network and/or claims administrator within 48 hours. If you go to a network provider, you should only have to pay your co-payment or coinsurance and the provider should file your claim for you. If you go to an out-of-network provider, you or a family member must call your network and/or claims administrator within 48 hours of your care. You must submit a claim; however, you are eligible for the network level benefits if you follow these procedures. In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 79, the following text replaces the third paragraph: Continuing care: In the event you are newly enrolled in the Point-of-Service Option, and you or a covered family member has a serious illness, or you or your spouse is in the 20th (or later) week of pregnancy, you can ask your network and/or claims administrator to evaluate your need for continuing care. You may be eligible to continue with your current care provider at the network benefit level for a period of time, even if that provider is not part of the network. Contact your network and/or claims administrator for more information. In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 79, the following text replaces the fourth paragraph: Network and/or claims administrator: Your network and/or claims administrator establishes standards for participating providers, including physicians, hospitals, and other service providers. They carefully screen providers and verify their medical licenses, board certifications, hospital admitting privileges, and medical practice records. They also periodically monitor whether participating providers continue to meet network standards. The network and/or claims administrator performs all these selection and accreditation activities. Page 14

16 In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 79, the following text replaces the fifth paragraph: Dependents living in different states: Your network and/or claims administrator has national network providers, thereby providing access to network providers for the entire family. If you have a dependent who lives in a different state than you (commuters, children away at school, divorced families), your dependent is covered by the preferred network and/or claims administrator for the state where you reside, not the state where he or she resides. For example, if you live in Texas and your dependent lives in California, your dependent is covered under the network and/or claims administrator for Texas (your state of residence), not California. This means your dependent will use the same network of providers that you use, regardless if your dependent resides in a different state than you. In Medical Benefit Options, Point-of-Service Option, Special Provisions on page 79, the following text replaces the sixth paragraph: Special health programs: In addition to the coverage available to all Point-of-Service Option participants, effective January 1, 2009, American Airlines will offer Healthmatters, in partnership with ActiveHealth Management. Participants will have access to care management, wellness programs, health risk assessments and disease management programs. See the Benefits page of Jetnet for more information. These program and services are not part of the AA sponsored health and welfare Plans. The program is offered at no cost to participants and participation is completely voluntary. Healthmatters is available to all American Airlines employees, retirees under 65, and covered family members eligible to participate in the Group Life and Health Benefits Plan for American Airlines employees for the AA sponsored health plans. Family member eligibility may vary by program. ActiveHealth Management does not determine claim eligibility, nor does it determine whether or not benefits are payable under the plan. In Medical Benefit Options, Point-of-Service Option, Special Provisions, CheckFirst and QuickReview on pages 79 80, in all instances UnitedHealthcare is replaced with your network and/or claims administrator. In Medical Benefit Options, Point-of-Service Option, Prescription Drug Benefits, Retail Drug Program, Retail Prescription Clinical Programs on page 81, the following text replaces the last sentence in this section: Additional information about these clinical programs and the specific drugs subject to these programs may be obtained from the prescription drug administrator (see Contact Information). Page 15

17 In Medical Benefit Options, Point-of-Service Option, Prescription Drug Benefits, Retail Drug Program, Filing Claims on page 81, the following text replaces the second bullet: Complete and file a Medco claim form (available via Jetnet on e-hr) with Medco for consideration of reimbursement, in the same way that you file a claim for out-ofnetwork medical expenses. Remember to attach a receipt for the prescription medication. In Medical Benefit Options, Point-of-Service Option, Prescription Drug Benefits, Mail Service Prescription Drug Program, Mail Service Prescription Clinical Programs on page 75, the following text replaces the second paragraph: Additional information about these programs may be obtained from the prescription drug administrator (see Contact Information on page 1). In Medical Benefit Options, Point-of-Service Option, Filing Claims on page 83, the following text replaces the last sentence: If you have questions about your coverage or your claim, call your network and/or claims administrator. Changes to the Choices of HMO Medical Options (page 84) and the SMM effective 1/1/08 (page 2): The Plan has eliminated one HMO from the 2009 medical plan options: the Health Net of California HMO. A list of the HMOs available in 2009 can be found via Jetnet on e-hr. In Dental Benefits, How the Dental Benefit Options Work on page 123, the following text replaces the last sentence in the fifth paragraph: Note: Effective January 1, 2009, the FSA administrator changes from UnitedHealthcare to PayFlex. In Dental Benefits, Covered Orthodontia Expenses on page 125, the following text replaces the last sentence in the fourth paragraph: Note: Effective January 1, 2009, the FSA administrator changes from UnitedHealthcare to PayFlex. In Life and Accident Insurance Benefits on pages , Contributory Life will be referred to as Voluntary Life Insurance Benefit in all instances. In Life and Accident Insurance Benefits on page 131, the following text is added directly under the heading Employee Term Life Insurance: Effective January 1, 2009, Basic Life Insurance (paid for by American Airlines) will no longer be imbedded in the Contributory Life amount. Contributory Life (paid for by the employee) may be purchased in amounts between one times annual salary and eight times annual salary, and this amount will be in addition to the Basic Life Insurance amount. Page 16

18 In Life and Accident Insurance Benefits, Overview, Employee Term Life Insurance, Basic Term Life Insurance Benefits on page 131, the following text is added under the last paragraph on the page: Effective January 1, 2009, the rates for the Employee Term Life Insurance, will be based on an amount calculated to the one-hundredth, as reflected in the following chart: Rate Component Based on Age MetLife Rates Per $1,000 of Coverage Pre MetLife Monthly Cost Per $1,000 of Coverage 2009 and Beyond $0.035 $ $0.043 $ $0.051 $ $0.059 $ $0.097 $ $0.150 $ $0.229 $ $0.408 $ $0.609 $ $1.094 $ $1.094 $1.09 In Flexible Spending Accounts the note on page 162 is replaced: Note: Effective January 1, 2009, the Flexible Spending Account administrator changed from UnitedHealthcare to PayFlex. In Flexible Spending Accounts, Overview on page 162, following text replaces the fifth paragraph: Effective January 1, 2009, employees who elect participation in an HCFSA and/or a DDFSA will use either a consumer account card or automatic reimbursement, depending on the medical plan option elected during October benefits enrollment. See the sections Health Care FSA and Dependent Day Care FSA for more information. In Flexible Spending Accounts, Overview on page 162, the following text replaces the sixth paragraph: Effective January 1, 2009, the FSA administrator changed from UnitedHealthcare to PayFlex for both HCFSAs and DDFSAs. PayFlex s Web site, allows you to check contributions and account balances, view claim information, verify eligible expenses, download forms, access Frequently Asked Questions (FAQs), and manage direct deposit and automatic rollover features. Page 17

19 In Flexible Spending Accounts, Health Care FSA on page 163, the following paragraph is inserted as the first paragraph in the section: Prior to January 1, 2009, UnitedHealthcare administered the FSAs and processed your claims once you enrolled in an FSA. Effective January 1, 2009, the FSA administrator changed from UnitedHealthcare to PayFlex. Claims for eligible expenses incurred on or after January 1, 2009, should be submitted to PayFlex. Claims incurred in 2008 and though the grace period (March 15, 2009) should be submitted to PayFlex by June 15, In Flexible Spending Accounts, Dependent Day Care Flexible Spending Account, How the DDFSA Works on pages , the following text is added as the last sentence in the section Conditions for Deposit and Maximum Allowable Deposit Amounts : If you are a Highly Compensated Employee, as defined by the Internal Revenue Code, your allowable annual pre-tax contribution may be less than $5,000 per calendar year. For example, for 2009 a Highly Compensated Employee, as defined by the Internal Revenue Code is an individual who has an annual income on his or her 2008 W-2 of $105,000 or more. The DDFSA limit in 2009 for Highly Compensated Employees is $2,500. This amount may be subject to change, and you will be notified if your maximum contribution changes. In Flexible Spending Accounts, Health Care FSA, Receiving Reimbursement and Filing Claims on pages the text in these sections is replaced with the following text: You may receive reimbursement from your HCFSA through four different methods. How you receive reimbursement depends on the medical option you elect during October benefits enrollment. See the chart below for more information. Your medical option Your reimbursement method is... Point-of-Service (POS) Option Standard Options HMO A consumer account card or auto rollover. You chose one of these methods when you enrolled. You will automatically default to auto rollover; you will not be able to elect a consumer account card. You will automatically receive a consumer account card; auto rollover is not available. You may elect to have your reimbursements deposited directly into your checking or savings account, simply by providing your account information online via the Direct Deposit link at All participants have the option to file online or paper claims with PayFlex. See for more information. Beginning January 1, 2009, if you had an FSA for 2008 and did not elect an FSA for 2009, you will file any remaining 2008 FSA claims through PayFlex using online and paper claims. See for more information. Page 18

20 You have until March 15 to use your prior year s balance and until June 15 to file claims. In Flexible Spending Accounts, Dependent Day Care Flexible Spending Accounts, on page 170, the following text replaces the first paragraph: Note: Prior to January 1, 2009, UnitedHealthcare administered the FSAs and processed your claims once you enrolled in an FSA. Effective January 1, 2009, the FSA administrator changed from UnitedHealthcare to PayFlex. Claims for eligible expenses incurred on or after January 1, 2009, should be submitted to PayFlex. Claims incurred in 2008 and though the grace period (March 15, 2009) should be submitted to PayFlex by June 15, In Flexible Spending Accounts, Dependent Day Care Flexible Spending Account, Receiving Reimbursement and Filing Claims on pages , the following text replaces these sections: All participants who have a DDFSA will automatically receive a consumer account card. You can also submit a claim for reimbursement online at or complete a paper claim and send it to PayFlex by fax or mail. The fax number and mailing address are available on You may elect to have your reimbursements deposited directly into your checking or savings account, simply by providing your account information online via the Direct Deposit link at Beginning January 1, 2009, if you had an FSA for 2008 and did not elect an FSA for 2009, you will file any remaining 2008 FSA claims through PayFlex using online and paper claims. See for more information. You have until March 15 to use your prior year s balance and until June 15 to file claims. In Flexible Spending Accounts, on page 173, the following section is added as a new section: If You Elect Both a Health Care and Dependent Day Care FSA If you elect both types of FSAs it will affect how you are reimbursement for eligible expenses. All participants may submit claim for reimbursement online at or complete a paper claim and send it to PayFlex by fax or mail. The fax number and mailing address are available on Your medical option If you have Your reimbursement method is... Point-of-Service (POS) Option The Health Care FSA and the Dependent Day Care FSA For the Health Care FSA, you will choose between consumer account card and auto rollover at the time of enrollment. If you elect a consumer account card, you will receive a single consumer account card that will work for both the Health Care and Dependent Day Care FSAs. If you elect auto rollover, you will have to file manual and/or electronic claims for the Dependent Day Care FSA. Page 19

21 Your medical option If you have Your reimbursement method is... Standard Options HMO The Health Care FSA and the Dependent Day Care FSA The Health Care FSA and the Dependent Day Care FSA For the Health Care FSA, you will automatically default to auto rollover; you will not be able to elect a consumer account card. For the Dependent Day Care FSA, you will be required to file manual claims. If you elect a consumer account card, you will receive a single consumer account card that will work for both the Health Care and Dependent Day Care FSAs. If you chose not to receive a consumer account card for the Dependent Day Care FSA, you will be required to file manual claims for that FSA. You may elect to have your reimbursements deposited directly into your checking or savings account, simply by providing your account information online via the Direct Deposit link at If you had an FSA for 2008 and did not elect an FSA for 2009, you will file your remaining 2008 FSA claims using online and paper claims. See for more information. You have until March 15 to use your prior year s balance and until June 15 to file claims. In Glossary on page 216, the following text replaces in the first bullet in the following section: Medical benefit Medical Benefit Highlights The Standard Medical Options (also called indemnity plans) and the Point-of- Service Option are self-funded by the Company. UnitedHealthcare, Aetna, and Blue Cross and Blue Shield of Texas administer these programs; however, reimbursements for covered health care expenses are paid from the general assets of the Company, not by an insurance company. END OF SUMMARY OF MATERIAL MODIFICATIONS Page 20

22 CLARIFICATIONS TO THE EMPLOYEE BENEFITS GUIDE FOR FLIGHT ATTENDANTS December 15, 2008 This document serves as notice to active and Leave-of-Absence Flight Attendants of clarifications to the Summary Plan Description the American Airlines Employee Benefits Guide for Flight Attendants ( EBG ). These clarifications, together with the EBG, make up the official plan documents and Summary Plan Descriptions. Please read this notice carefully, and place this notice with your Summary Plan Description(s) (the Summary Plan Descriptions are contained in your EBG). These clarifications apply to all plans in the Flexible Benefits benefit program for American Airlines, Inc,. Flight Attendants, including the: Group Life and Health Benefits Plan for Employees of Participating AMR Corporation Subsidiaries (Plan 501, EIN # ; referred to herein as the Plan ) Supplemental Medical Plan for Employees of Participating AMR Corporation Subsidiaries (Plan 503, EIN # ; referred to herein as the Supplemental Medical Plan ). In Benefits at a Glance, Vision Insurance Benefit on page 8, the following clarifications apply: You have the opportunity to enroll in vision coverage, insured and administered by OptumHealth Vision (formerly known as Spectera, Inc.), a national vision care company. The Vision Benefit offers a network of providers, including retail chains such as Eyemasters, as well as independent providers. To locate participating providers, log on to or contact OptumHealth Vision (formerly known as Spectera, Inc.) at In Eligibility, Dependent Eligibility on page 16, the following clarification applies: When a dependent is covered, that dependent must be covered under the same medical, dental and vision benefits as the employee. A dependent cannot be covered under a different benefit than the employee. For example, if you elect to cover your dependents for medical and you select the Standard Medical Option for yourself, you cannot select POS coverage for your dependents. They will receive Standard Medical Option coverage the same as you. This applies to all dependents of an employee. The Eligibility, Eligibility for Retiree Benefits, Retiree Medical Benefits on pages 21 22, the following clarifications apply: As a Flight Attendant employee, you have two options for Retiree Medical Benefits the Retiree Standard Medical Option and the Retiree Point-of-Service Option provided you did not take an Article 30 retirement which is explained below. You are eligible for the Retiree Medical Benefits coverage if you: Have at least 15 years of Company seniority, and Are age 55 or older or become eligible for Social Security Disability Benefits before the end of your one-year sick leave, and Page 21