Benefits Guide

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Flight Employee Benefits Guide

Benefits Guide

American Airlines provides you with a comprehensive benefits package designed to help you meet the health and insurance needs of you and your eligible family members. To help you make the most of those benefits, this Guide describes the major provisions of the plans and explains how you can use them effectively.

The benefits described in this Guide include:

Medical Options, specifically

? STANDARD Medical Option with Health Reimbursement Account ? VALUE Medical Option with Health Incentive Account ? CORE Medical Option with Health Savings Account ? OUT-OF-AREA Medical Option with Health Reimbursement Account ? HMOs

Dental Coverage Vision Coverage

Flexible Spending Accounts ? Health Care Flexible Spending Account ? Limited Purpose Flexible Spending Account ? Dependent Care Flexible Spending Account ? Employee Assistance Program

Life Insurance & Accident Insurance Disability Benefits

Additional Important Information

In addition to the descriptions of the benefits provided and how each plan works, this Summary Plan Description also provides general and plan specific information in the:

About this Guide section General Eligibility section General Enrollment section Life Events section Additional Health Benefit Rules section Plan Administration section Reference Information section, including a Contacts list, the Glossary, and the Archives of

older versions of the Guide.

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Table of Contents

Flight Employee Benefits Guide

About This Guide

10

How do I determine my eligibility?

12

Benefits Effective Date

13

Employee Eligibility

13

Proof of Eligibility

13

Eligibility During Leaves of Absence and Disability

14

Family Medical Leave of Absence (FMLA) or Military Leave

14

Eligibility After Age 65

14

Dependent Eligibility by Benefit

15

Medical Coverage

15

Dental and Vision Coverage

15

Child Life Insurance and Child Accidental Death and

Dismemberment (AD&D) Insurance

15

Spouse Life Insurance and Spouse Accidental Death and

Dismemberment (AD&D) Insurance

16

Dependent Eligibility Requirements

16

Determining a Child's Eligibility

16

Dependents of Deceased Employees

17

Determining a Spouse (SP), Domestic Partner (DOMESTIC PARTNER (DP))

or Common Law Spouse Eligibility

17

Employees Married to Other Employees

19

Other Information

21

Ineligibility

22

What benefits could I be eligible for?

23

Medical Benefit Options Overview

24

Medical Benefit Options

25

Network/Claims Administrators

26

Administrator's Discretion

26

Medical Benefit Options Comparison

26

Mid-Year Medical Benefit Option Change: Impact on Deductibles and

Out-of-Pocket Maximums

46

Mental Health and Chemical Dependency Care

47

Gender Reassignment Benefit (GRB)

49

GRB Coverage

49

Surgical Benefit

49

Travel Reimbursement

50

Preauthorization for the GRB

50

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Flight Employee Benefits Guide

Wellness Resources

50

Covered Expenses

51

Excluded Expenses

59

CheckFirst (Predetermination of Benefits)

62

QuickReview (Pre-Authorization)

63

Standard Medical Option

65

Your Network/Claims Administrator

66

Network/Claims Administrator- Buy-up Option

66

How the Standard Medical Option Works

67

In-Network Services

67

Out-of-Network Services (OON)

68

Other Information

68

Special Features of the Standard Medical Option

68

Covered and Excluded Expenses

71

Filing Claims

72

Claims Filing Deadline

72

Prescription Drug Benefits

73

Retail Drug Coverage

73

Retail Refill Allowance -- Long-Term Medications

74

Retail Prescription Clinical Programs

75

Mail Order Prescription Clinical Programs

77

Internet Refill Option

78

Other Refill Options

78

Claims Filing Deadline

79

Reimbursement of Co-insurance

79

HRA - Health Reimbursement Account

79

Notice for Employees Who Work in (Are Based in) Massachusetts

80

Value Medical Option

81

Your Network/Claims Administrator

82

Network/Claims Administrator- Buy-up Option

82

How the Value Medical Option Works

83

In-Network Services

83

Out-of-Network Services (OON)

84

Other Information

84

Special Features of the VALUE Medical Option

84

Covered and Excluded Expenses

87

Filing Claims

88

Claims Filing Deadline

88

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Prescription Drug Benefits Retail Drug Coverage Filling Prescriptions and Filing Claims Retail Refill Allowance -- Long-Term Medications Retail Prescription Clinical Programs Specialty Pharmacy Services Express Scripts Mail Order Mail Order Prescription Clinical Programs Internet Refill Option Other Refill Options

Claims Filing Deadline HIA - Health Incentive Account Core Medical Option Your Network/Claims Administrator

Network/Claims Administrator- Buy-up Option How the CORE Medical Option Works

In-Network Services Out-of-Network Services Special Features of the CORE Medical Option Covered and Excluded Expenses Filing Claims Prescription Drug Benefits Retail Drug Coverage Filling Prescriptions and Filing Claims Retail Refill Allowance -- Long-Term Medications Retail Prescription Clinical Programs Specialty Pharmacy Services Express Scripts Mail Order Mail Order Prescription Clinical Programs Internet Refill Option Other Refill Options Reimbursement of Co-insurance HSA - Health Savings Account HSA Funds Setting Up an HSA Using Your HSA Funds Limited Purpose Flexible Spending Account (LPFSA)

Flight Employee Benefits Guide

89 89 90 90 91 92 93 93 94 94 95 95 96 97 97 98 98 99 99 101 101 102 102 102 103 103 104 105 105 106 106 106 107 107 107 108 109

Forms & guides can be located in Our Policies at



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Out-of-Area Coverage How Out-of-Area Coverage Works Network/Claims Administrator Special Provisions Covered and Excluded Expenses Filing Claims Claims Filing Deadline Prescription Drug Benefits Retail Drug Coverage Retail Refill Allowance -- Long-Term Medications Retail Prescription Clinical Programs Specialty Pharmacy Services ESI Mail Order Mail Order Prescription Clinical Programs Internet Refill Option Other Refill Options Claims Filing Deadline Reimbursement of Co-insurance HRA - Health Reimbursement Account

Health Maintenance Organizations (HMOs) Eligibility Children Living Outside of the Service Area Termination of Coverage If You Reach Age 65 and are Still an Active Employee How HMOs Work HMO Contact Information

Dental Benefits How the Dental Benefit Works Eligibility Plan Comparison Chart Special Provisions Covered Expenses Preventive Services Basic and Major Services Orthodontia Excluded Expenses Filing Claims Claim Filing Deadline

Flight Employee Benefits Guide

110 111 111 111 112 112 112 113 113 114 114 115 116 116 117 117 117 118 118 119 120 120 120 120 121 121 122 123 123 123 124 124 124 124 125 126 127 127

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Flight Employee Benefits Guide

Vision Benefit

128

How the Vision Insurance Benefit Works

129

Eligibility

129

Covered Expenses

130

Filing Claims

131

Flexible Spending Accounts

132

How the HCFSA - Health Care Flexible Spending Account Works

133

Special Provisions

133

Covered Expenses

134

Excluded Expenses

136

Filing Claims

136

How the LPFSA -Limited Purpose Flexible Spending Account Works

137

How the DCFSA- Dependent Care Flexible Spending Account Works

138

Covered Expenses

140

Filing Claims

141

If You Elect Both an HCFSA/LPFSA and a DCFSA

141

Life Insurance Benefits

142

Pilot Term Life Insurance

144

How the Life Insurance Benefit Works

144

Basic Term Life Insurance Benefit

144

Voluntary Term Life Insurance Benefit

144

Pilot Additional Life Insurance Benefit

145

Spouse and Child Term Life Insurance Benefit

145

Flight Attendant Life Insurance

146

How the Life Insurance Benefit Works

146

Basic Term Life Insurance Benefit

146

Voluntary Term Life Insurance Benefit

147

Spouse and Child Term Life Insurance Benefit

148

Designating Beneficiaries

149

Coverage if You Become Disabled

150

Special Provisions

151

Accelerated Benefit Option (ABO

151

Taxation of Life Insurance

151

Conversion and Portability

152

Assignment of Benefits

153

Total Control Account

153

Verbal Representation

154

Filing Claims

154

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Flight Employee Benefits Guide

Accident Insurance Benefits

155

Accidental Death & Dismemberment Insurance (AD&D) and

Voluntary Personal Accident Insurance (VPAI) Benefits

157

What is Covered

157

Special VPAI Benefit Features

158

Exclusions

162

Filing a Claim

162

Conversion Rights

163

Policy Aggregates

163

Disability Benefits

165

Pilot Disability Benefits Overview

166

Pilot Short-Term Disability (STD)

166

Definition of Total Disability

167

Filing a Claim

167

When Benefits Begin

167

When Benefits End

167

Exclusions and Limitations

168

Pilot Long-Term Disability (LTD)

168

Flight Attendant Optional Short-Term Disability (OSTD)

168

Optional Short Term Disability (OSTD) Insurance

168

Definition of Total Disability

169

Appropriate Care and Treatment

169

OSTD Insurance Benefits

169

Return-to-Work Program

170

Family Care Incentive

170

When Benefits Begin

171

When Benefits End

171

Exclusions and Limitations

171

Flight Attendant Long-Term Disability (LTD)

172

How the Plan Works

172

Definition of Total Disability

172

Appropriate Care and Treatment

173

LTD Plan Benefits

173

Severe Condition Benefit

174

LTD Benefit Elimination Period

176

Duration of LTD Benefits

176

Filing a Claim for LTD Benefits

177

When LTD Benefits Begin

177

When LTD Benefits End

178

LTD Exclusions and Limitations

178

Benefits from Other Sources

180

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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Flight Employee Benefits Guide

Return-to-Work Program

181

Vocational Rehabilitation Program

182

Employee Assistance Program (EAP)

183

How do I enroll?

184

Annual Enrollment

185

How to Enroll

185

New Employee Enrollment

185

When Coverage Begins as a Newly Hired Employee

186

When Coverage Begins as a Current Employee

186

Waiving Coverage

186

Default Coverage

186

HIPAA Special Enrollment Rights ? Medical Benefit Option Only

188

When Coverage Ends

189

Making Changes During the Year: Life Events

190

Life Events

190

If Your Dependent(s) Lose Eligibility Under the Plan

199

If You Process Your Life Event after the Deadline

199

Special Life Event Considerations

199

HIPAA Special Enrollment Rights ? Medical Benefit Option Only

201

What if I have questions?

202

Additional Health Benefit Rules

203

Qualified Medical Child Support Orders (QMCSO) Procedures

203

Coordination of Benefits

206

Coordination with Medicare

208

When Coverage Ends

209

Continuation of Coverage ? COBRA Continuation

210

How to Elect Continuation of Coverage

211

HIPAA Certificate of Creditable Coverage

215

Plan Administration

216

Plan Information

217

Administrative Information

218

Plan Amendments

219

Plan Funding

220

Collective Bargaining Agreement

220

Assignment of Benefits

221

Claims -- For Non-Grandfathered Medical Options

(Standard, Core, Value, Out-of-Area and HMO Medical Options)

221

Confidentiality of Claims

221

Payment of Benefits

221

Forms & guides can be located in Our Policies at



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The Benefits Service Center is available at

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