Retired Employees Formerly Represented by IAM 837 and IAM 2383

Transcription

1 Benefits Information Update October 2007 Summary of Benefit Plan Changes and Clarifications Retired Employees Formerly Represented by IAM 837 and IAM 2383 This Update summarizes the benefit and administrative changes and clarifications that will affect your benefit plan and updates your summary plan description. The effective date of each change is January 1, 2008, unless otherwise noted. The changes and clarifications in this Update will apply to you if you are a retired employee of The Boeing Company (the Company ) who was formerly represented by the International Association of Machinists and Aerospace Workers (IAM) District Lodge 837 and Local Lodge This Update is for your information and is being provided to you as required by Federal law. No action on your part is required. The changes and clarifications in this Update will apply to the McDonnell Douglas Group Life, Disability & Health Benefits Plan (Plan 529). Contact the Boeing Service Center through Boeing TotalAccess for details. Enrollment Changes in Status If you experience a status change, you may be able to enroll or change medical coverage midyear. In addition to the current list of status changes, a new status change follows: n The Company adds a new benefit option or significantly improves an existing benefit option. Medical Plans for Retirees Not Eligible for Medicare UnitedHealthcare Traditional PPO and Basic PPO The following changes will apply to the Non-Medicare Traditional PPO and Non-Medicare Basic PPO. For changes specific to the Non-Medicare Traditional PPO, see Traditional PPO, on page 4. Lifetime Maximum Benefit The lifetime maximum benefit will be $2 million per individual. Table of Contents Enrollment Medical Plans for Retirees Not Eligible for Medicare Medical Plans for Retirees Eligible for Medicare... 5 Other Retiree Medical Plan Changes For More Information Plan Amendment Information BOEING is a trademark of Boeing Management Company. Copyright 2007 Boeing. All rights reserved. A

2 Preventive Care Network preventive care services and supplies will be covered as follows: n Preventive care services, including covered examinations, well child benefits, related laboratory and X-ray charges, and immunizations will be covered at 100 percent (deductible does not apply) up to a $500 annual maximum. n Routine Pap tests, mammograms, prostate screenings, and colorectal screenings (including colonoscopies) will be covered at 100 percent (deductible does not apply) with no annual maximum (subject to applicable standards of the appropriate medical associations and agencies). Copayment Once the annual deductible is met, network emergency room treatment will be covered at 80 percent after a copayment of $75 per visit. Once the annual deductible is met, nonnetwork emergency room treatment will be covered at 60 percent after a copayment of $75 per visit. Prescription Drug Program Prescription drugs will be covered as follows: PPO Prescription Drug Program Schedule of Benefits The non-medicare PPO prescription drug program is administered by Medco By Mail (the service representative). Retail pharmacy card program Mail-order pharmacy program Note: When insulin and diabetic supplies are purchased at the same time, a copayment will apply to each. Prescription Drug Program Exclusions The following exclusion will be added under both the retail pharmacy card program and the mail-order pharmacy program: n Any prescription drug for which the person is covered or eligible to receive benefits under another employer s group benefit plan or a workers compensation law or from any municipality, state, or Federal program, including a Medicare prescription drug plan, except as required by law. When an Injury or Illness Is Caused by the Negligence of Another In some situations, you or a covered dependent may be eligible to receive, as a result of an accident or illness, health care benefits or disability income replacement from an automobile insurance policy, homeowner s insurance policy or other type of insurance policy, or from a responsible third party. In these cases, this plan will pay benefits if the covered person agrees to cooperate with the service representative in administering the plan s recovery rights. Copyright 2007 Boeing. A

3 If a person covered by this plan is injured by another party who is legally liable for the medical bills, he or she may request this plan to pay its regular benefit on his or her behalf. In exchange, the covered person agrees to n Complete a claim and submit all bills related to the injury or illness to the responsible party or insurer. n Complete and submit all of the necessary information requested by the service representative. n Reimburse the plan if he or she recovers payment from the responsible party or any other source. n Allow the plan to be subrogated to all rights of recovery a covered person has against the responsible party or any other source and to cooperate with the service representative s efforts to recover from the responsible party or any other source any amounts this plan pays in benefits related to the injury or illness, including any lawsuit brought against the responsible party or insurer. This provision applies whenever you or a covered dependent is entitled to or receives benefits under this plan and also is entitled to or receives compensation or any other funds from another party in connection with that same disability or medical condition, whether by insurance, litigation, settlement, or otherwise. The plan is entitled to such funds to the extent of plan benefits paid to or on behalf of the individual as a firstpriority right, whether or not the individual has been made whole, and without regard to any common fund doctrine. The plan is entitled to such funds regardless of whether the plan s benefits are identified as being included in the funds and regardless of whether liability for payment of the funds is admitted by the responsible party or any other source of the funds. This plan may recover such funds by constructive trust, equitable lien, right of subrogation, reimbursement, or any other remedy allowed under applicable law. If an individual fails, refuses, or neglects to reimburse the plan or otherwise comply with the requirements of this provision, or if payments are made under the plan based on fraudulent information or otherwise in excess of the amount necessary to satisfy the provisions of the plan, then, in addition to all other remedies and rights of recovery that the plan may have, the plan has the right to terminate or suspend benefit payments and/or recover the reimbursement due to the plan by withholding, offsetting, and recovering such amount out of any future plan benefits or amounts otherwise due from the plan to or with respect to such individual. The plan also has the right in any proceeding at law or equity to assert a constructive trust, equitable lien, or any other remedy or recovery allowed under applicable law, against any and all persons or entities who have assets that the plan can claim rights to. The plan has a first-priority right of recovery from any judgment, settlement, or other payment, regardless of whether the individual has been made whole, and without regard to any common fund doctrine. Definitions The following definition will be revised: Usual and Customary The maximum charge for a covered service or supply the service representative will consider for reimbursement from a nonnetwork provider. The service representative may refer to this as the maximum reimbursable charge, maximum allowable charge, reasonable and customary charge, allowed amount, or a similar term. The usual and customary charge is the least of n The provider s actual charge for the service or supply, n The provider s normal charge for a similar service or supply, or n A predetermined percentile (negotiated between each carrier and plan sponsor) of charges made by providers of a comparable service or supply in the geographic area where it is received. Copyright 2007 Boeing. A

4 To determine if a charge exceeds the usual and customary charge for medical services or supplies in situations involving unusual or complicated services or supplies, the nature and severity of the injury or sickness may be considered. The service representative uses a database of provider charges to determine the usual and customary charge in an area. Information about the database and percentile used to determine the usual and customary charge can be obtained by contacting the service representative. Traditional PPO The changes in this section will apply only to the Non-Medicare Traditional PPO. Annual Deductible The network annual deductible will have a $350 maximum per individual and a $1,050 maximum per family of three or more. The nonnetwork annual deductible will have a $700 maximum per individual and a $2,100 maximum per family of three or more. Annual Out-of-Pocket Maximum The network annual out-of-pocket maximum will be $6,000 per family of three or more, but not more than $2,000 for any one person. The nonnetwork annual out-of-pocket maximum will be $12,000 per family of three or more, but not more than $4,000 for any one person. The annual deductible no longer will apply to the annual out-of-pocket maximum. Non-Medicare HMO Plans The following changes will apply to all the non-medicare HMO plans. For changes specific to the UnitedHealthcare Choice HMO, see UnitedHealthcare Choice HMO, on page 5. n The annual out-of-pocket maximum per individual will be $2,500. The annual out-of-pocket maximum per family will be $5,000. n Inpatient hospital services copayment will be $250 per inpatient confinement. n The emergency room copayment will be $75 per visit. Prescription Drugs Prescription drugs will be covered as follows under all non-medicare HMO plans: HMO Prescription Drug Schedule of Benefits Participating retail pharmacy Mail-order program Copyright 2007 Boeing. A

5 UnitedHealthcare Choice HMO The lifetime maximum benefit will be $2 million per individual. Medical Plans for Retirees Eligible for Medicare UnitedHealthcare Indemnity Plan and Basic Indemnity Plan The following changes will apply to the Medicare Traditional Indemnity Plan and the Medicare Basic Indemnity Plan. See page 6 for changes specific to each plan. Lifetime Maximum Benefit The lifetime maximum benefit will be $2 million per individual. Preventive Care Network preventive care services and supplies will be covered as follows: n Preventive care services, including covered examinations, well child benefits, related laboratory and X-ray charges, and immunizations will be covered at 100 percent (deductible does not apply) up to a $500 annual maximum. n Routine Pap tests, mammograms, prostate screenings, and colorectal screenings (including colonoscopies) will be covered at 100 percent (deductible does not apply) with no annual maximum (subject to applicable standards of the appropriate medical associations and agencies). Prescription Drug Program Prescription drugs will be covered as follows: Medicare Indemnity Plans Prescription Drug Program Schedule of Benefits The Medicare Traditional Indemnity and Basic Indemnity Plans prescription drug program is administered by Medco By Mail (the service representative). Retail pharmacy card program Mail-order pharmacy program Prescription Drug Program Exclusions The following exclusion will be added under both the retail pharmacy card program and the mail-order pharmacy program: n Any prescription drug for which the person is covered or eligible to receive benefits under another employer s group benefit plan or a workers compensation law or from any municipality, state, or Federal program, including a Medicare prescription drug plan, except as required by law. Copyright 2007 Boeing. A

6 Medicare Traditional Indemnity Plan The changes in this section will apply only to the Traditional Indemnity Plan. Annual Deductible The annual deductible will have a $350 maximum per individual and a $1,050 maximum per family of three or more. Annual Out-of-Pocket Maximum The annual out-of-pocket maximum will be $6,000 per family of three or more, but not more than $2,000 for any one person. The annual deductible no longer will apply to the annual out-of-pocket maximum. Copayment Once the annual deductible is met, emergency room treatment will be covered at 90 percent after a copayment of $75 per visit. Medicare Basic Indemnity Plan The change in this section will apply only to the Basic Indemnity Plan. Copayment Once the annual deductible is met, emergency room treatment will be covered at 90 percent after a copayment of $75 per visit. Medicare HMO Plans The following changes will apply to all Medicare HMO plans. See below for changes to specific plans. n Inpatient hospital services copayment will be $250 per inpatient confinement. Prescription Drugs Prescription drugs will be covered as follows under all Medicare HMO plans: HMO Prescription Drug Schedule of Benefits Participating retail pharmacy Mail-order program Medicare Supplement HMOs The changes in this section will apply only to the Medicare Supplement HMOs. n The lifetime maximum benefit will be $2 million per individual. n The emergency room copayment will be $75 per visit. Copyright 2007 Boeing. A

7 Medicare Advantage HMOs The changes in this section will apply only to the Medicare Advantage HMOs. n The annual out-of-pocket maximum per individual will be $2,500. n The emergency room copayment will be $75 per visit for the following HMOs: Health First (Florida) Mercy St. John s Premier Plus (Springfield, Missouri) Mercy St. Louis Premier Plus (St. Louis, Missouri) Secure Horizons (Arizona, Nevada, Oklahoma) United Healthcare Medicare Complete (Missouri) Other Retiree Medical Plan Changes Special Enrollment If you or your eligible dependent reaches the lifetime maximum benefit under a Company-sponsored plan, you may enroll in another Company-sponsored plan in your area if you are eligible. Deferred Enrollment If you defer enrollment in retiree medical coverage because of other employer-sponsored health care coverage (such as through your spouse s employer), you may be able to enroll yourself and your eligible dependents in a Company-sponsored retiree medical plan at a later date as long as enrollment is within 60 days after other coverage ends. Your later enrollment in retiree medical coverage is not contingent on commencing your pension benefit. For More Information Contact the Boeing Service Center through Boeing TotalAccess. n On the World Wide Web: Log on to using your BEMS ID number (or Social Security number) and your Boeing TotalAccess password. n By telephone: Call TTY/TDD services are available at You must have your BEMS ID number (or Social Security number) and your Boeing TotalAccess password. Customer service hours vary by service center; representatives generally are available during regular business hours. Plan Amendment Information This Update is a summary of material modifications to your summary plan description for the McDonnell Douglas Group Life, Disability & Health Benefits Plan (Plan 529). This document is provided to you in accordance with the Employee Retirement Income Security Act of 1974, as amended (ERISA). If there is any discrepancy between this Update and the Plan document listed above, the Plan document will control. Although the Company fully intends to continue the Plan described here, the Company reserves the right to change, modify, amend, or terminate it at any time and for any reason for employees, former employees, retirees, and their dependents. Copyright 2007 Boeing. A