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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The Benefits Service Center is available 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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