HE ALT H W E ALT H C AREER HUNTINGTON INGALLS …

H E A L T H W E A L T H C A R E E R

HUNTINGTON INGALLS INDUSTRIES H&W WRAP SUMMARY PLAN DESCRIPTION

Huntington Ingalls Industries, Inc. Group Benefits Plan: Huntington Ingalls Industries Health Plan

Huntington Ingalls Industries

Huntington Ingalls Industries Health Plan

July 1, 2020

2020


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Table of Contents

ABOUT THIS SPD ............................................................................................................................................................ 2

BENEFITS HIGHLIGHTS ................................................................................................................................................. 4

HEALTH CARE BENEFITS .............................................................................................................................................. 9

PARTICIPATING IN HEALTHCARE BENEFITS ........................................................................................................ 10 MEDICAL COVERAGE .................................................................................................................................... 29 DENTAL COVERAGE ..................................................................................................................................... 63 VISION COVERAGE ....................................................................................................................................... 72

FLEXIBLE SPENDING ACCOUNTS .............................................................................................................................. 76

HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA) PLAN ................................................................................... 77 DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT .............................................................................................. 83

DISABILITY BENEFITS ................................................................................................................................................. 88

SHORT-TERM DISABILITY .............................................................................................................................. 89 LONG-TERM DISABILITY ................................................................................................................................ 93

LIFE AND ACCIDENT INSURANCE .............................................................................................................................. 96

LIFE AND AD&D INSURANCE ......................................................................................................................... 97

ADDITIONAL BENEFITS ............................................................................................................................................. 106

GROUP LEGAL SERVICES ............................................................................................................................. 107 EMPLOYEE ASSISTANCE PROGRAM (EAP) ...................................................................................................... 118

ADMINISTRATIVE INFORMATION ............................................................................................................................. 119

CONTACTS .................................................................................................................................................................. 137

APPENDIX .................................................................................................................................................................... 139


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About This SPD

Huntington Ingalls Industries, Inc. (also referred to as the “Company” in this booklet) maintains the Huntington Ingalls Industries, Inc. Group Benefits Plan (the “Group Benefits Plan”), which allows eligible employees to choose from a variety of health and welfare benefit options to meet their individual and family needs, and, for some of these benefits, to pay for them on a pre-tax basis.

As an employee of the Company (or a participating affiliate), you and your family have a wide range of health and welfare benefits available. This booklet provides a summary of the Huntington Ingalls Industries Health Plan (the “Plan”), a component plan under the Group Benefits Plan, which offers the following health and welfare benefits (which are referred to in this booklet as the “benefit options,” the “component plans” or simply the “plans”):

Medical Plans

Dental Plans

Vision Plan

Health Care Flexible Spending Account

Dependent Care Flexible Spending Account

Short-Term Disability Plan

Long-Term Disability Plan

Life and AD&D Plan

Group Legal Services Plan

Business Travel Insurance Plan

Employee Assistance Plan

The Plan gives you access to meaningful benefit choices at competitive rates. You have the flexibility to choose the benefits and coverage levels that are right for you — based on your personal situation. Understanding the benefits is the key to getting the most out of all the offerings.

This booklet describes the benefit options available under the Plan. Each of the benefit options listed above is summarized in a separate document prepared by the Company or a certificate of insurance booklet, brochure, benefit description, evidence of coverage document or other material prepared by the third-party administrator or insurance carrier that administers and provides services to such plan (which are referred to collectively in this booklet as the “Benefit Booklets”), and which are incorporated by reference and are considered a part of this booklet. The Benefit Booklets contain the Plan rules regarding eligibility, participation, costs, administration and other important information that applies to the benefit option being described therein. A listing of the applicable Benefit Booklets can be found in the Appendix and are available by contacting the Huntington Ingalls Benefits Center (HIBC) (see “Questions?” below for contact information).

This booklet, along with each of the Benefit Booklets, constitutes the Plan’s “summary plan description” (“SPD”) required by the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), for the benefit options subject to ERISA. It is important, when reviewing the information in this SPD, to refer to the Benefit Booklets to get a complete picture of the benefit plans.

The Company reserves the right to amend, modify or terminate any and all parts of the Plan at any time and for any reason (subject to any relevant collective bargaining agreements). This SPD is not a contract for, nor a guarantee of, present or continued employment between you and the Company. If there are any differences between the information contained in this SPD and the Group Benefits Plan document, the Group Benefits Plan document will always govern.


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Questions?

Please read the information in this SPD carefully and share it with your family. If you have questions not answered in this guide, contact the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 (International: 408-916-9765). Benefits service representatives are available to answer your questions Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern time, excluding holidays. If you are hearing impaired, you will need to use a relay service through your TTY/TDD service provider.


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Benefits Highlights

The Plan provides you and your family with health care coverage and financial protection. It also offers a great deal of flexibility by allowing you to select the benefits that best meet your needs and the ability to change your benefit elections annually as those needs change.

The Plan includes two general types of benefits -- basic and optional.

Basic Benefits

You automatically receive your “basic” benefits at no cost to you. Enrollment is not required for your basic benefits, which include:

Basic life insurance

Basic accidental death and dismemberment (AD&D) insurance

Business travel accident insurance

Basic short-term disability (STD) insurance

Basic long-term disability (LTD) insurance

Employee Assistance Program (EAP)

Optional Benefits

You can also purchase additional benefits for yourself and your family. These are called “optional” benefits, and you need to make an election to receive them.

You and Huntington Ingalls Industries, Inc. share the cost of these optional benefits:

Medical

Dental (some business units offer 100% employee-paid dental coverage only)

Vision (some business units offer 100% employee-paid vision coverage only)

In addition, you can elect to purchase the following optional benefits. You pay the entire cost of these optional benefits at Huntington Ingalls Industries, Inc. group rates:

Optional life insurance

Optional long-term disability (LTD) insurance

Optional short-term disability (STD) insurance

Optional accidental death and dismemberment (AD&D) insurance

Group legal insurance

You can also choose to participate in the flexible spending accounts (FSAs). You can elect to set aside before-tax dollars in one or both of the following accounts:

Health care FSA

Dependent care FSA.


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Health Care Benefits

The Huntington Ingalls Industries Health Plan provides a number of health care options designed to promote good health and wellness. You can select the combination of coverage that fits the needs of you and your family. If you select medical, dental, or vision coverage, you choose from the following coverage categories:

You only

You + child(ren)/domestic child(ren)

You + spouse/domestic partner

You + family (employee, child(ren)/domestic child(ren), and spouse/domestic partner).

You may have a different coverage category for each benefit. For example, you can enroll yourself only in a medical plan option and enroll yourself and your entire family in a dental plan option.

Medical Plan Options

The Plan offers the following medical options:

Anthem Preferred PPO Medical Plan Option

Anthem Consumer Driven Health Plan (CDHP)

Regional Health Maintenance Organization (HMO) Medical Plan Options, if offered in your ZIP code area

Aetna Global Benefits Plan option (if you work and live outside the United States)

All of the medical options provide comprehensive coverage for a broad range of covered services, including 100% coverage for preventive care when you use an in-network provider, as well as prescription drug coverage. Each plan provides access to quality care and protection from the high cost of medical services and supplies. The medical plan options differ by level of coverage, your contribution for coverage, and the way you receive medical care.

Both the PPO and CDHP medical plan options are provided through Anthem. With both plans, you have access to in-network and out-of-network providers. However, you will generally have higher out-of-pocket costs when you use an out-of-network provider.

The CDHP option may be used with a Health Reimbursement Account (HRA) that is funded with contributions from Huntington Ingalls to help you pay for your health care expenses.

Depending on your ZIP code area, you may have access to an HMO option. HMOs provide care through a network of primary care providers (PCPs) and specialists. In most HMO plan options, you must choose a network PCP to provide or coordinate all of your care (including specialist referrals). The HMO options pay no benefits if you use a physician, hospital, or other provider that is not a member of the HMO’s network — except in an emergency situation.

Dental Plan Options

The dental plan options, administered through Delta Dental, cover a wide range of dental services and supplies, including preventive, basic and major care services. You and Huntington Ingalls share in the cost of dental benefits. You can choose from the following options:

Dental Care PPO Plan option

Dental Care Plus PPO Plan option

Preventive Care PPO Plan option

The options differ by which services are covered, the cost of coverage, and the way you receive dental care.


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Vision Plan

You can elect vision coverage through the Vision Service Plan (VSP) network to help pay for covered vision services and supplies, such as eye examinations and eyewear. You don’t have to use the VSP network providers, but you’ll get discounts and higher benefits when you do; plus, network providers will file the claim for you.

Flexible Spending Accounts

Health care and dependent care flexible spending accounts (FSAs) let you contribute to an account you can use to reimburse yourself for eligible health care or dependent care expenses. Your FSA contributions are deducted from each paycheck before taxes and deposited into your account.

With the flexible spending accounts (FSAs), you can:

Set aside $0 to $2,750 of before-tax dollars annually in the health care FSA for reimbursement of your and your dependent(s)’s eligible health care expenses

Set aside $0 to $5,000 of before-tax dollars annually in the dependent care FSA for reimbursement of your eligible dependent care expenses.

You can enroll in one or both of the FSAs — or you can choose not to participate. The choice is yours! FSAs are sometimes referred to as “use it or lose it” accounts, as you will lose any FSA money you don’t use within the eligible period. So plan carefully.

Life and Accident Insurance

The Plan’s life and accidental death & dismemberment (AD&D) insurance plans provide income protection in the case of death or accidental injury.

You automatically receive the following basic benefits at no cost to you:



Business travel accident insurance

For added protection, you can elect to purchase the following additional coverage options at low group rates:


Optional accidental death and dismemberment (AD&D) insurance


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Life and Accidental Death & Dismemberment Insurance

The Plan’s life and accidental death & dismemberment (AD&D) insurance plans provide income protection in the case of an accident or death. Below are the options available to you:

Survivor Benefit Plan

Enrollment Cost Sharing Coverage

Basic Life Insurance

Automatic The Company pays the full cost

1× annual base pay or $50,000, whichever is greater

Optional Life Insurance

You need to elect coverage

You pay the full cost on an after-tax basis

You: 1× to 8× annual base pay ($1.25 million maximum)

Spouse*:

$25,000

$50,000

1× your annual base pay




Up to the lesser of 50% of your total basic and optional coverage, or $500,000

Children

$10,000;

$20,000, or

$30,000

Basic Accidental Death & Dismemberment Insurance


1× annual base pay or $50,000, whichever is greater (up to a max of $1 million)

Optional AD&D You need to elect coverage

You pay the full cost

You: 1× to 10× your annual base pay (up to $1 million)

Spouse Only:

75% of your optional AD&D coverage

Children Only:

25% of your optional AD&D coverage per child (up to $50,000 per child)

Spouse and Children:

Spouse: 60% of your optional AD&D coverage

Each Child: 15% of your optional AD&D coverage

Business Travel Accident Insurance


You: up to 4× your annual base salary, up to $500,000 max.

Spouse: Up to $100,000

Children: Up to $50,000

A percentage of this benefit amount is paid for specific losses

* You can purchase dependent life and AD&D insurance regardless of whether you purchase optional life and AD&D insurance for yourself, but your spouse’s life coverage cannot exceed 50% of your combined basic and optional insurance coverage.


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Disability Coverage

In the event that you are unable to work due to a disability, the Plan offers benefits that provide you with a source of income during that time.

The Company provides the following benefits at no cost to you:



In addition, you can elect to purchase additional coverage:



Disability Plan Enrollment Cost Sharing Amount of Coverage

Basic Short-Term Disability (STD) Insurance


Provides 100% of your weekly earnings for the first 6 weeks; and 50% of your weekly earnings thereafter, up to a maximum of $4,000 per week.

Optional Short-Term Disability (STD) Insurance


You pay a share of the cost


Basic Long-Term Disability (LTD) Insurance


Provides up to 50% of your monthly earnings (rounded to the nearest $1), up to a maximum of $15,000.

Optional LTD Insurance



Option 1: Provides up to 60% of your monthly earnings (rounded to the nearest $1), up to a maximum of $15,000.


Additional Benefits

Your Plan also includes additional benefits to provide support and peace of mind to you and your family for legal, health or personal matters:

Program Benefits Offered Enrollment Required to Participate

Group Legal Services Legal representation for you and your family members in areas such as wills, family matters and real estate

Yes


A free, confidential source for information, referrals and counseling for you and your family.

No


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Health Care Benefits

Your overall health and well-being is important. To help support your wellness needs, Huntington Ingalls offers a wide range of quality health care benefits consisting of medical (including prescription drug), dental and vision coverage and health care spending accounts. These benefit plans offer flexibility and choice so you can enroll in the options that best meet your needs.

Huntington Ingalls provides the resources to help you get the most out of your benefits. It’s your responsibility to stay informed, use the appropriate resources and take charge of your health.

For additional information about your health care benefits, see “Administrative Information” on page 119.

Section Contents

PARTICIPATING IN HEALTHCARE BENEFITS ........................................................................................................... 10

ELIGIBILITY AND ENROLLMENT ....................................................................................................................... 11 CHANGING YOUR COVERAGE DURING THE YEAR ............................................................................................... 16 QUALIFIED LIFE EVENTS RESULTING IN A LOSS OF ELIGIBILITY ............................................................................... 17 OTHER QUALIFIED LIFE EVENTS ...................................................................................................................... 17 WHEN COVERAGE BEGINS ............................................................................................................................ 18 COST OF COVERAGE ..................................................................................................................................... 18 WHEN COVERAGE ENDS ............................................................................................................................... 18 CONTINUING YOUR COVERAGE ...................................................................................................................... 21 IF YOU HAVE OTHER COVERAGE OR BENEFITS................................................................................................... 25

MEDICAL COVERAGE .................................................................................................................................................. 29

THE MEDICAL OPTIONS AT A GLANCE ............................................................................................................. 30 HOW THE ANTHEM MEDICAL PLANS WORK ..................................................................................................... 33 WHAT THE ANTHEM MEDICAL PLAN COVERS ................................................................................................... 45 WHAT’S NOT COVERED ................................................................................................................................ 58 FILING A CLAIM ........................................................................................................................................... 61

DENTAL COVERAGE .................................................................................................................................................... 63

BENEFITS AT A GLANCE ................................................................................................................................. 64 HOW THE PLANS WORK ............................................................................................................................... 65 WHAT THE PLANS COVER ............................................................................................................................. 67 LIMITATIONS ON COVERAGE .......................................................................................................................... 69 WHAT’S NOT COVERED ................................................................................................................................ 70 FILING A CLAIM ........................................................................................................................................... 71

VISION COVERAGE ...................................................................................................................................................... 72

THE VISION PLAN AT A GLANCE ..................................................................................................................... 73 HOW THE PLAN WORKS ............................................................................................................................... 73 WHAT THE PLAN COVERS ............................................................................................................................. 74 WHAT’S NOT COVERED ................................................................................................................................ 74 HOW TO USE THE VISION PLAN OPTIONS ......................................................................................................... 74

More Information

For additional details about each health care plan, please refer to the supplemental documents. You can access these documents from the “Appendix” section on page 139.


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Participating in Healthcare Benefits

Huntington Ingalls provides medical (including prescription drug), dental and vision benefits, as well as health care spending accounts. The healthcare plans offer valuable financial protection against the high cost of illness and injury, and benefits to help keep you well.

This section includes information about who is eligible for healthcare benefits, how to enroll or make changes to your benefit elections, when coverage is effective and when it ends.

Subsection Contents

PARTICIPATING IN HEALTHCARE BENEFITS ........................................................................................................... 10

ELIGIBILITY AND ENROLLMENT ....................................................................................................................... 11 Eligibility .......................................................................................................................................... 11 Enrollment ....................................................................................................................................... 14

CHANGING YOUR COVERAGE DURING THE YEAR ................................................................................................. 16

QUALIFIED LIFE EVENTS RESULTING IN A LOSS OF ELIGIBILITY ........................................................................ 17

OTHER QUALIFIED LIFE EVENTS ............................................................................................................................... 17

WHEN COVERAGE BEGINS ......................................................................................................................................... 18

COST OF COVERAGE ................................................................................................................................................... 18

WHEN COVERAGE ENDS ............................................................................................................................................. 18

RESCISSION OF COVERAGE ............................................................................................................................ 19 LEAVES OF ABSENCE .................................................................................................................................... 19

CONTINUING YOUR COVERAGE ................................................................................................................................ 21

COBRA CONTINUATION PERIOD.................................................................................................................... 22 NEWLY ELIGIBLE CHILD ................................................................................................................................. 22 COST FOR COBRA ...................................................................................................................................... 23 NOTIFICATION ............................................................................................................................................ 23 YOUR DUTIES UPON A SECOND QUALIFYING EVENT ........................................................................................... 23 SPECIAL RULES FOR DISABILITY ....................................................................................................................... 23 MEDICARE ................................................................................................................................................. 24 TRADE REFORM ACT OF 2002 ....................................................................................................................... 24 WHEN COBRA ENDS .................................................................................................................................. 24 COBRA AND FMLA .................................................................................................................................... 25 QUESTIONS ABOUT COBRA ......................................................................................................................... 25 KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES .......................................................................................... 25

IF YOU HAVE OTHER COVERAGE OR BENEFITS ..................................................................................................... 25

COORDINATION OF BENEFITS ......................................................................................................................... 25 COORDINATION WITH MEDICARE ................................................................................................................... 27 RIGHT OF RECOVERY .................................................................................................................................... 28


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Eligibility and Enrollment

You must meet certain eligibility requirements and follow specific enrollment rules in order to receive your healthcare benefits.

Eligibility

You are eligible for the benefits described in this guide if you are regularly scheduled to work 20 or more hours per week, and you are a U.S. citizen or legal resident. In addition, you must be:

A non-represented hourly or salaried employee of a Huntington Ingalls Industries, Inc. business unit that participates in the Plan, or

An eligible employee of a participating represented group that has bargained to participate in the Plan.

The following business units participate in the Plan:

Huntington Ingalls Incorporated (Newport News Shipbuilding Division and Ingalls Shipbuilding Division)

Huntington Ingalls Industries International Shipbuilding, Inc.

HII Services Corporation

You are not eligible for the benefits described in this guide if you are:

A temporary employee

An independent contractor

A non-resident alien

Covered by a non-participating bargaining unit

Covered by certain contracts (refer to your human resources representative for details)

An individual hired by an outside agency (called a “job shopper” or “leased employee”)

Not reported on Huntington Ingalls Industries, Inc. payroll records as an employee.

If you fall into any of these categories, you will not be eligible for coverage under the Huntington Ingalls Industries Health Plan unless and until you are later reclassified as an eligible employee.

Dependent Eligibility

You may enroll your eligible dependents for coverage in the medical, dental and/or vision care programs. Coverage for your eligible, enrolled dependent(s) generally begins at the same time as your coverage. Your eligible dependents include your:

Legal spouse (including your common-law spouse with a state-approved affidavit of common-law spouse status). If your spouse works, please read “Special Provisions for Working Spouses”.

Dependent children younger than 26; children include:

A natural child,

An adopted child,

A stepchild who has a regular parent/child relationship with you or your spouse,

A child for whom you are the legal guardian or managing conservator and with whom you have a regular parent/child relationship,


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A child placed for adoption,

A grandchild who lives with you and you claim as a dependent on your federal income tax return, and you have legal guardianship,

A dependent for whom you have received a court order to provide health care coverage.

Coverage for a child may continue after age 26 only if the child is mentally or physically unable to earn a living and is otherwise your dependent. Periodically, you may be asked to provide evidence of continuing disability and status as your dependent.

The term “dependent” also includes those individuals who no longer meet the definition of a dependent, but are covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

When you enroll a dependent in the Plan, you represent the following:

The individual is eligible under the terms of the Plan; and

You will provide evidence of eligibility on request.

Further, you understand that —

The Plan is relying on your representation of eligibility in accepting the enrollment of your dependents;

Your failure to provide required evidence of eligibility is evidence of fraud and material misrepresentation; and

Your failure to provide evidence of eligibility will result in disenrollment of the individual, which may be retroactive to the date as of which the individual become ineligible for Plan coverage, as determined by the Plan Administrator and subject to the Plan's provisions.

Special Provisions for Working Spouse

If You Both Work for Huntington Ingalls Industries, Inc.

If you and our spouse (or eligible domestic partner) work for Huntington Ingalls Industries, Inc. one spouse can cover both of you. Or, each spouse can select separate coverage. You and your dependents cannot be covered twice under any plan (except for life insurance coverage, as noted below).

In the case of life and AD&D coverage:

You and your spouse (or eligible domestic partner) cannot both select employee plus family AD&D coverage. One spouse may select optional employee AD&D coverage, and the other may select optional employee plus family AD&D coverage, but only one benefit would be paid in the event of the death of the spouse who had chosen employee-only coverage.

You and your spouse (or eligible domestic partner) can select optional spouse life insurance for one another, but only one of you may elect optional life insurance coverage for your eligible dependent children.

If Your Spouse Works for a Company Other than Huntington Ingalls Industries, Inc.

If you have a working spouse (or eligible domestic partner) who has medical coverage available through his or her employer, you can enroll your spouse in a Huntington Ingalls Industries, Inc. medical plan option. However, if you enroll your spouse, Huntington Ingalls Industries, Inc. requires that your spouse also enroll in his or her employer’s medical plan if that employer pays 50% or more of the cost of their plan. If this applies to you and your spouse is not currently enrolled in his or her employer’s plan, your spouse is required to enroll in that company’s plan at the earliest opportunity, but not later than the next annual enrollment period. Even if your spouse’s employer offers only one medical plan option, your spouse must enroll in that option.


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Claims for your spouse’s medical care must first be submitted to his or her employer’s plan because that plan is the primary payer. Then, once you receive an explanation of benefits (EOB) from your spouse’s plan (reflecting either the amount of payment or a denial), you can submit it along with your claim to your Huntington Ingalls Industries, Inc. medical plan option claims administrator for reimbursement as a secondary payer.

Huntington Ingalls Industries, Inc. reserves the right to ask for proof of working spouse coverage and you may be required to provide an affidavit or other documents. Failure to comply with this provision will result in loss of coverage for the spouse and may result in disciplinary action for the employee. The working spouse provisions does not apply if your spouse is considered a “Service Contract Act” employee, or if you or your spouse are retired.

Domestic Partner Eligibility

Your domestic partner can be enrolled for coverage under the medical, dental and/or vision care programs provided he or she meets the eligibility requirements.

An eligible domestic partner is an individual of the same-sex or opposite sex who is your life partner and not your legal spouse. The domestic partner must meet all of the following requirements:

Be at least 18 years of age and not related to you by blood;

Not be married to anyone else and not be the domestic partner of anyone else;

Live with you in the same permanent residence in an exclusive, emotionally committed, and financially responsible relationship similar to marriage for at least the last six months; and

Be your sole domestic partner and intend to remain so indefinitely.

Children of Your Domestic Partner

You can also cover children of your domestic partner who meet the following requirements:

A child of your domestic partner who is unmarried, lives with you and your domestic partner in a parent/child relationship is eligible for coverage if:

The child is under the age of 19; or

The child is at least age 19, but under age 25 and a full-time student.

You may provide coverage for your eligible domestic partner and his or her eligible children in the same health plan options in which you are enrolled, provided the plan option you select offers domestic partner coverage.

For additional information about domestic partner benefits, call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 to request the Domestic Partner Plan Details guide. The guide provides details about domestic partner benefits that are not covered within the summary plan description.

Domestic Partner Tax Note

For domestic partner benefits, the IRS treats employee contributions and the Company’s contribution (as applicable) as taxable unless your domestic partner qualifies as your tax dependent under IRS rules. If your domestic partner is not your tax dependent, contributions for domestic partner coverage will be made on an after-tax basis (even though contributions for married partners are not). In addition, the value of the benefit may be considered additional taxable income.

It is important that you understand the tax and legal implications of creating a domestic partner relationship and covering your domestic partner and your partner’s eligible children. Therefore, you may want to consult your tax and legal advisors before making any benefit elections.


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If your domestic partner is you tax dependent, be sure to submit to the plan a Declaration of Tax Status for Domestic Partner/Child of Domestic Partner form. The form is available by contacting the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222.

Qualified Medical Child Support Orders

A qualified medical child support order (QMCSO) is an order or judgment from a state court or administrative agency. This order directs the Plan Administrator to cover a child for benefits under a health care plan.

Here are a few examples of individuals who may be covered under a QMCSO:

A child born to a single parent

A child who is not claimed as a dependent on the parent’s federal income tax return

A child who does not live with the parent.

If you are subject to an order, Huntington Ingalls Industries will notify you and each affected child (or the child’s representative) about the procedures that determine the validity of the order and how it will be implemented.

Federal law provides that a medical child support order must meet certain form and content requirements in order to be a QMCSO. After Huntington Ingalls Industries verifies that an order is a QMCSO, Huntington Ingalls Industries enrolls the child according to the terms of the order.

Judgment, Decree, or Order Including QMCSOs

If a judgment, decree or order including a Qualified Medical Child Support Order (QMCSO) requires the Plan to provide coverage to your child, the Plan Administrator automatically may change your election under the Plan to provide coverage for that child, and the amount deducted from your pay may increase as a result. In addition, you may make corresponding election changes as a result of such judgment, decree, or order if you desire, but only within 31 days of the event.

If the judgment, decree, or order requires another person (such as your spouse or former spouse) to provide coverage for the child, then you may cancel coverage for that child under the Huntington Ingalls Industries Health Plan if you provide proof to the Plan Administrator that such person actually provides the coverage for that child.

Enrollment

It is very important that you understand how to enroll, and that you enroll for the coverage you want when you become eligible. Once your coverage begins, it will remain in effect for the remainder of the calendar year. You cannot change your elected coverage during the year unless you meet certain criteria described in “Changing Your Coverage during the Year” on page 16.

Annual Enrollment

Each year, the Company conducts an annual enrollment period. During this time, you may make changes in your benefit elections. These changes will become effective on the July 1 of the upcoming benefit plan year (July 1 through June 30 each year).

Annual enrollment gives you the opportunity to review your benefit options and your personal situation. You then change your benefit elections as necessary to ensure that your coverage continues to meet your needs. This is the only time you can make changes in your benefit elections without a Family Status Change (or a Special Enrollment or other permitted election change event). See the “Medical Coverage” section on page 29 for more information on the medical options available.


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If you are enrolled in the flexible spending accounts but do not re-enroll during annual enrollment, your contributions will not continue beyond June 30 of the plan year in which you are enrolled. You are required to make a positive election for these spending accounts each plan year.

If you are a tobacco user (that means you smoke cigarettes or use other tobacco products or e-cigarettes), a tobacco user surcharge will be added to your medical plan option contribution amount. More specifically, effective July 1, 2019, a tobacco surcharge will be added to your weekly premium contribution for medical coverage unless you satisfy one of the following conditions: (1) during the annual enrollment period (and prior to July 1st) you report that you have been tobacco-free for six months; or (2) during the annual enrollment period (and prior to July 1st) you report that you have completed a tobacco cessation program (if you do not otherwise satisfy condition (1) (i.e., report that you are tobacco-free), you must complete a tobacco cessation program each year before annual enrollment to avoid incurring the tobacco user surcharge). If you satisfy one of these conditions during the annual enrollment period (and prior to July 1st), then the tobacco surcharge will not be added to your weekly premium contribution for the current plan year. You will need to report your tobacco-free status each year during annual enrollment.

Please note that if you do not take any action when you become eligible for and enroll in medical coverage, the tobacco surcharge will apply for the current plan year.

If you become tobacco-free (or complete a tobacco cessation program) after July 1st but before December 31st, you may change your tobacco status before the end of the calendar year to avoid having the tobacco surcharge added to your premium contribution for the period beginning on January 1st of the current plan year and ending on the last day of the plan year (i.e., June 30th). You will not receive a refund for any tobacco surcharge amounts paid before January 1st. For example, on November 1 you report that you have been tobacco-free for six months (and you did not report such tobacco-free status or complete a tobacco cessation program during annual enrollment). Your weekly premium contribution will continue to include the tobacco surcharge until January 1. From January 1 to June 30, your weekly premium contribution will not include the tobacco surcharge since you reported your tobacco-free status before the end of the calendar year.

Alternatively, as indicated above, if during the annual enrollment period you report that you have been tobacco-free for six months, then the tobacco surcharge will not be added to your premium contribution for the upcoming plan year (i.e., July 1 – June 30). Please contact the HIBC at (877) 216-3222 if you have questions regarding how to change your tobacco status and / or what tobacco cessation programs are available to you. You may also visit www.HIIBenefits.com and “click” Physical Wellbeing in the top menu and then select the Tobacco Free Incentive Program Tile to obtain information on the tobacco cessation programs and additional information regarding the tobacco surcharge.

Enrollment for New Hires

If you are a new hire, you must enroll in medical, dental and vision benefits within 31 days of your date of hire (or within 31 days of the date your enrollment instructions are mailed, if later) and your benefits will be effective retroactive to your first day of employment.

The coverage levels for the medical, dental and vision care programs are:

You only

You + child(ren)/domestic child(ren)

You + spouse/domestic partner

You + family (employee, child(ren)/domestic child(ren), and spouse/domestic partner).

You may have a different coverage category for each benefit. For example, you can enroll yourself only in a medical plan option and enroll yourself and your entire family in a dental plan option.

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You may separately elect coverage for medical, dental and/or vision care. It is important that you enroll when you first become eligible. Otherwise, you could miss the opportunity to make the choices that are best for you.

If you do not want medical, dental or vision care coverage, you can elect to waive coverage.

Special Enrollment Rules

If you waive medical coverage for yourself or your spouse or eligible dependents during enrollment because you or they have other health insurance coverage, and then you or they lose that coverage, you may be able to enroll yourself or your dependents in medical benefits before the next annual enrollment. Specifically, you may enroll in the Plan within 31 days of the date you or your dependents:

Lose eligibility for coverage under another group health plan,

Lose the employer contribution toward another group plan’s coverage, or

Exhaust COBRA coverage under another group health plan (your COBRA coverage ends, but not because you failed to make the premium payment).

Once you enroll, your coverage is effective retroactive to the date you lost coverage.

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you can enroll yourself, your spouse and/or your new eligible dependent child(ren) for coverage, by requesting enrollment within 31 days of the event (or you can make a corresponding change to drop). Otherwise, if you decline medical, dental and/or vision care coverage when you first are eligible, restrictions may apply if you wish to enroll at a later time.

If you experience a special enrollment event such as the events described above, you must notify the Huntington Ingalls Benefits Center at 1-877-216-3222 within 31 days of the event in order to make a change to your benefit elections.

If you request a change due to a birth, adoption or placement for adoption within the 31-day timeframe, coverage will be effective as of the date of the birth, adoption or placement for adoption.

The Plan must (as required by law) allow a special enrollment for employees and dependents (including your spouse) who are eligible but not enrolled, and in such a case only if you or your dependents lose Medicaid or CHIP coverage because you or your dependent are no longer eligible, or become eligible for a state’s premium assistance program. You have 60 days from the date of the Medicaid/CHIP event to request enrollment under the Plan. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.

To request special enrollment or obtain more information, contact the Huntington Ingalls Benefits Center at 1-877-216-3222.

Changing Your Coverage during the Year

In exchange for the advantages offered by paying for coverage with before-tax dollars, the Internal Revenue Service (IRS) limits your ability to make changes to your benefit elections during the year. You may not change your medical, dental, vision care or FSA plan elections until the next annual enrollment period, unless you have a Family Status Change, another permitted election change, or you are eligible for Special Enrollment (not applicable to the FSAs).

Default

If you do not enroll within 31 days of your hire date (or the date your enrollment instructions were mailed), you will not have medical, dental or vision coverage for the remainder of the plan year. In addition, you cannot participate in the FSAs. You must wait for the next annual enrollment period to enroll, unless you have a Family Status Change (or a Special Enrollment or other permitted election change event).


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Qualified Life Events

A qualified life event is a change in your personal situation that results in the gain or loss of eligibility for a Huntington Ingalls Industries Health Plan option, your spouse’s employer’s plan, or your dependent’s employer’s plan. Qualified life events include:

Change in marital status, including marriage, divorce, annulment, and death of spouse

Change in number of dependents, including birth, adoption, placement for adoption, and death of dependent

Change in employment status (termination or commencement of employment), resulting in loss or gain of benefit eligibility for you, your spouse, or your dependent

Change in work schedule, including a reduction or increase in hours of employment for you, your spouse, or your dependent, a switch between part-time and full-time status, and beginning or returning from an unpaid leave of absence, that results in a gain or loss of eligibility

Inability of your dependent to meet the Plan’s coverage requirements due to a change in age or other conditions of eligibility

Change in residence or worksite for you, your spouse, or your dependent that results in a loss of coverage

Your dependent becomes eligible for coverage under his or her employer’s plan

Enrollment by you, your spouse, or a dependent in Medicare or Medicaid

Significant gain or loss in coverage (e.g., your spouse loses coverage in his or her employer’s plan)

A court judgment, decree, or order requiring coverage for your dependent child(ren)

HIPAA special enrollment event

Any other changes allowed by IRS regulations.

The benefit change you make must be on account of and consistent with the qualified life event. For example, if your dependent spouse who is enrolled in a Huntington Ingalls Industries, Inc. medical plan option gains benefit coverage through his or her employer, you are allowed to discontinue his or her coverage (as well as your own coverage and that of your dependent child(ren)), but you are not allowed to change from one Huntington Ingalls Industries, Inc. medical plan option to another.

Qualified Life Events Resulting in a Loss of Eligibility

If a qualified life event results in a loss of eligibility for the Plan, you must immediately report the qualified life event through the life events link on UPoint at www.hiibenefits.com or by calling the Huntington Ingalls Benefits Center at 1-877-216-3222. If you do not report the qualified life event within 31 days after the qualified life event, any premiums you have paid will not be refunded.

Other Qualified Life Events

For all other qualified life events, you may only make permissible changes within 31 days after the qualified life event. You may make such changes by clicking on the life events link on UPoint at www.hiibenefits.com or by calling the Huntington Ingalls Benefits Center at 1-877-216-3222.

For information about qualified life events that affect domestic partner coverage, call the HIBC at 1-877-216-3222.

http://www.hiibenefits.com/



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When Coverage Begins

If you enroll in medical, dental and vision coverage when you are first eligible, your coverage is effective retroactive to your date of hire (or eligibility date). You must enroll within 31 days of your hire date (or of the date your enrollment instructions are mailed).

Cost of Coverage

You and the Company share the cost of your medical, dental and/or vision care coverage. Your cost for medical, dental and/or vision care coverage depends on which options you choose and which coverage level you elect.

Your contributions are paid with before-tax dollars through payroll deductions. Since your contributions are deducted from your pay before taxes are withheld, you will not pay federal, Social Security, and, in many cases, state or local income taxes on this money.

Paying with before-tax dollars may slightly impact your Social Security benefits because you may be paying lower Social Security taxes. Generally, the tax savings you receive now far outweighs any nominal decrease in future Social Security benefits. However, if you have questions, check with a personal tax advisor.

As noted above, effective July 1, 2019, a tobacco surcharge will be added to your weekly premium contribution for medical coverage unless you satisfy one of the following conditions: (1) during the annual enrollment period (and prior to July 1st); you report that you have been tobacco-free for six months; or (2) during the annual enrollment period (and prior to July 1st); you report that you have completed a tobacco cessation program.

When Coverage Ends

If your employment with Huntington Ingalls Industries, Inc. ends, the date your medical, dental and vision coverage will end is as follows:

If your employment ends because: Your coverage...

You voluntarily quit or are discharged Stops on your termination date

Of a layoff/reduction in force Continues to the end of the month plus one month from your termination date.

You retire Continues to the end of the month in which you terminate employment, or ends on the first day of the month if your termination date and retirement date fall on the first of the month.

You are disabled Continues to the end of the month in which your leave benefit continuation period ends.

You die while actively employed For your covered dependents continues at no charge to your eligible survivor(s) (spouse/domestic partner and eligible dependent children) to the end of the month plus one year from the date of your death.

Coverage also will end when any of the following occurs:

You no longer meet the programs’ eligibility requirements

You cancel your coverage

You fail to make any required contribution


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Your coverage also will end if the Plan or a program that is part of the Plan is terminated for all employees of the category of employees to which you belong.

Coverage for a dependent will end when any of the following occurs:

Your coverage ends

He or she no longer meets the definition of an eligible dependent, which occurs at the earliest of the applicable dates below:

The last day of the calendar month in which your dependent turns 26

For children covered pursuant to a QMCSO, the date the child is no longer required to be covered under a QMCSO

You cancel your dependent coverage

You fail to make any required contribution

All dependent coverage under the Plan is terminated or a program that is part of the Plan is terminated

Flexible Spending Account (FSA)

If you terminate employment, your participation in the health care and/or dependent care flexible spending accounts ends on the last day of employment unless you are eligible for COBRA coverage (not applicable to the dependent care flexible spending account).

Your contributions will end if the Plan is terminated or if either of the following occurs:

You elect not to re-enroll for the following year during the annual enrollment period

You no longer meet the eligibility requirements

However, you can submit eligible expenses for reimbursement of expenses incurred through the date your participation ends.

Rescission of Coverage

Group health plans and insurers may generally not rescind coverage once you are covered under the plan, unless you perform an act, practice or omission that constitutes fraud or make an intentional misrepresentation of material fact, as prohibited by the terms of such plan. Rescission is defined as a cancellation or discontinuance of coverage that has a retroactive effect (other than one based on nonpayment of premiums or contributions). If rescission is permitted, the plan must provide you with 30 days advance written notice prior to such rescission. Any such rescission of coverage is subject to the claims and appeals procedures.

Leaves of Absence

If you take a leave of absence from Huntington Ingalls Industries, Inc., how your benefits will be affected depends on the type of leave:

Medical leave of absence

Personal or educational leave of absence

Family leave of absence

Military leave of absence/military mobilization

Furlough


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While you are on leave, you are required to continue to make contributions for your benefits. Your contributions will continue through automatic payroll deductions for as long as you are receiving a paycheck from Huntington Ingalls Industries, Inc. If your paychecks stop, your business unit will continue to pay its share of the premium for your benefits, but it is your responsibility to continue to pay your share of the cost. You automatically will receive an invoice from the Plan Administrator on a monthly basis. Failure to make required payments in a timely manner will result in loss of coverage. In some instances where the employee is on a very short LOA, the Plan may arrange to have payroll deductions taken in arrears rather than having direct bill. If this circumstance pertains to your specific type of leave, you will be advised.

Reinstatement of Your Benefits After a Leave

If you take a leave of absence, your benefits generally will continue for a specified period. If your benefits are terminated during the leave, they will be reinstated when you return to work, assuming that you continue to be eligible. (Note: Your annual flexible spending account contributions will be reinstated, but the per-pay-period contributions will likely be higher than they were before your leave, since the annual amount you are contributing will remain the same but be divided among fewer pay periods.)

FMLA Leave

The federal Family and Medical Leave Act (FMLA) and related laws regarding military service allow eligible employees to take a specific amount of unpaid leave each year for serious illness, the birth or adoption of a child or to care for a spouse, child or parent who has a serious health condition, to care for family members wounded while on active duty in the Armed Forces, or to deal with any qualifying exigency that arises from a family member’s active duty in the Armed Forces. This leave is also available for family members of veterans for up to five years after a veteran leaves service if he or she develops a service-related injury or illness incurred or aggravated while on active duty.

If you take a leave of absence for family reasons (for example, to care for a sick family member) coverage continues to the end of the month plus four additional months from the day your leave begins. If you are receiving a paycheck from Huntington Ingalls Industries, Inc., your regular contributions will continue. When you go on unpaid leave, you will be required to make monthly contributions.

Military Leave

Huntington Ingalls Industries, Inc. complies with specific plan and contract provisions, as well as federal and state laws regarding military leaves. If you take a military leave of absence, are called to active military duty, or are reassigned to another military duty station, here is how your benefits will be affected. If you are receiving a paycheck from Huntington Ingalls Industries, Inc., your regular contributions will continue. When you go on unpaid leave, you will be required to make monthly contributions.

Your medical, dental and vision coverage continues at no cost for the employee only. You must make any required contributions for your covered family members. If you are receiving a paycheck from Huntington Ingalls Industries, Inc. during your leave, your contributions continue on a before-tax basis. If you are on an unpaid leave, you will be direct billed for your dependents’ contributions.

If you are participating in the health care FSA and you are receiving a paycheck from Huntington Ingalls Industries, Inc. during your leave, your contributions continue on a before-tax basis.

If you are on an unpaid leave, your health care FSA contributions stop. You can be reimbursed for eligible expenses incurred only during the time you made contributions. Claims that you incur after the last day of the last pay period in which you made contributions are not eligible for reimbursement. Once you no longer receive a paycheck, if you wish to continue your FSA, you can continue with after-tax contributions through COBRA for the remainder of the plan year. See “Continuing Your Coverage” on page 21.


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If you are a member of the reserves and you are called to active duty for at least 180 days, you may withdraw, on a taxable basis, a portion or all of your health care FSA balance without penalty.

Note: if you are on a military LOA, coverage continues for a maximum of five years. If you are on a military mobilization LOA, coverage continues indefinitely. For more information about a military leave of absence or military mobilization, you can call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 or contact your local human resources office.

If You Are Disabled

If your employment ends because you become disabled (as determined by the long-term disability insurance company), and you have exhausted your medical leave, your medical, dental and vision coverage continues to the end of the month in which your leave benefit continuation period ends. Certain employees may be eligible for a retiree medical plan until age 65 (check your retiree benefit program for details).

You and your covered dependents may be able to extend coverage under the provisions of COBRA. See “Continuing Your Coverage” on page 21.

Continuing Your Coverage

According to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, you and your enrolled family members are eligible to pay for continued group health care coverage if you lose your benefits under certain circumstances, including termination of employment (unless due to gross misconduct). Continued coverage rights apply only to health care coverage (medical, dental, vision, and health care flexible spending account), not to other types of benefits (dependent care flexible spending account, life insurance and disability insurance).

You and your enrolled family members will be considered qualified beneficiaries and can continue coverage for a maximum of 18, 29, or 36 months, depending on the reason your coverage ended, as shown in the chart below. If multiple circumstances occur, the maximum period is a total of 36 months. For the health care flexible spending account, you can continue participation until the end of the benefit plan year in which you lose your benefits.

You and your eligible dependents have 60 days from the date coverage ends or the date of receipt of your COBRA notice, whichever is later, to elect continued participation under COBRA. (Each family member who is a qualified beneficiary may make a separate COBRA election.) You have an additional 45 days from the date of your election to pay your first COBRA premium. After that time, your premium payments are due as of the first of the month, with a 30-day grace period. If you do not make a timely election, COBRA rights are waived.

If you elect COBRA continuation:

Initially, you and your dependents will keep the same type of plan coverage you were enrolled in while an active employee. This includes access to Teladoc and the Family Health Center if you enroll in the Anthem PPO or CDHP Medical Plan.

You may keep the same coverage category you had as an active employee or choose a different category. For example, if your spouse and all of your dependents were enrolled under the Huntington Ingalls Industries, Inc. medical plan, you could choose to enroll all, some or none under COBRA.

Coverage is effective on the date of the event that qualified you for COBRA coverage, unless you waive COBRA coverage and subsequently revoke your waiver within the 60-day election period. In that case, your coverage begins on the date you revoke your waiver.

You may change plan coverage and coverage category (including adding eligible dependents) during the annual enrollment period or if you have a qualified life event.

You may add newly acquired dependents during the benefit plan year.


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You can enroll your newly eligible spouse or child under the same guidelines that apply to active employees.

If you or a covered dependent is Medicare eligible, Medicare pays primary for that individual, regardless of whether the individual enrolls in Medicare Parts A and/or B.

COBRA-like coverage is also available for eligible domestic partners. For details, call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222.

COBRA Continuation Period

Qualifying Event Maximum Continuation Period

Employee Spouse Child

You lose coverage because you reduce your work hours or take unpaid leave

18 months 18 months 18 months

You terminate employment for any reason (except gross misconduct)


You or your dependent is disabled (as defined by Title II or XVI of the Social Security Act) during the first 60 days after COBRA begins


You die N/A 36 months 36 months

You and your spouse divorce N/A 36 months 36 months

You are already on COBRA and become disabled and entitled to Medicare, which causes your dependents to lose coverage

N/A 18 months 18 months

Your child no longer qualifies as a dependent N/A N/A 36 months

Newly Eligible Child

If you, the former Huntington Ingalls Industries, Inc. employee, elect continuation coverage and then have a child (either by birth, adoption, or placement for adoption) during the period of continuation coverage, the new child is also eligible to become a qualified beneficiary. In accordance with the terms of the Huntington Ingalls Industries, Inc.-sponsored group health plan and the requirements of the federal law, these qualified beneficiaries can be added to COBRA coverage by providing the HIBC with notice of the new child’s birth, adoption or placement for adoption. This notice must be provided within 30 days of birth, adoption, placement for adoption, or appointment as a legal guardian. The notice must include the name of the new qualified beneficiary, date of birth or adoption of new qualified beneficiary, and birth certificate or adoption decree.

If you fail to notify Huntington Ingalls Industries, Inc. in a timely fashion regarding your newly acquired child, you will not be offered the option to elect COBRA coverage for that child. Newly acquired dependent child(ren) (other than children born to, adopted by, or placed for adoption with the employee) will not be considered qualified beneficiaries, but may be added to the employee’s continuation coverage, if enrolled in a timely fashion, subject to the Plan’s rules for adding a new dependent.


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Cost for COBRA

COBRA participants pay monthly premiums for their coverage on the following basis:

For health care coverage (medical, dental, vision, and EAP), premiums are based on the full group rate per enrolled person set at the beginning of the benefit plan year, plus 2% for administrative costs. Your spouse or child who is a qualified beneficiary making a separate election is charged the same rate as a single employee.

Health care flexible spending account contributions can be continued through the end of the benefit plan year on an after-tax basis, plus the 2% administrative charge.

If you or your enrolled dependent is disabled, as defined by Social Security, COBRA premiums for months 19 through 29 may be increased to reflect 150% of the full group cost per person.

Notification

You are notified by mail of your COBRA election rights and enrollment instructions when you qualify due to a reduction in hours or termination of employment (other than for gross misconduct). Your spouse and dependent children are notified of their COBRA election rights when they lose health coverage with Huntington Ingalls Industries, Inc. as a result of your death or Medicare entitlement.

If your dependents lose coverage due to divorce, legal separation, or loss of dependent status, you (or a family member) must notify the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 within 60 days of the event so that COBRA can be offered and information on election rights can be mailed. Also, to extend coverage beyond 18 months because of disability, you must provide notice of the Social Security Administration’s determination during the initial 18-month period and within 60 days of the date you receive your determination letter.

Your Duties Upon a Second Qualifying Event

If an employee or covered family member experiences a second qualifying event that would entitle him or her to additional months of continuation coverage, he or she must notify the HIBC. This notice must be provided in writing and must include the name of the employee, the name of the qualified beneficiary receiving COBRA coverage, and the type and date of second qualifying event.

This notice must be provided within 60 days from the date of the second qualifying event (or, if later, the date coverage would normally be lost because of the second qualifying event). In addition, the employee or covered family member may also be required to provide a copy of a death certificate, divorce decree, separation agreement, and dependent child(ren)’s birth certificate(s).

When Huntington Ingalls Industries, Inc. is notified that one of these events has happened, the covered family member will automatically be entitled to the extended period of continuation coverage. If an employee or covered family member fails to provide the appropriate notice and supporting documentation to Huntington Ingalls Industries, Inc. during this 60-day notice period, the covered family member will not be entitled to extended continuation coverage.

Special Rules for Disability

The 18 months of COBRA coverage may be extended for up to 29 months if the employee or covered family member is determined by the Social Security Administration to be disabled (for Social Security disability purposes) at the time of the qualifying event or at any time during the first 60 days of COBRA continuation coverage. This 11-month extension is available to all family members who are qualified beneficiaries due to termination or reduction in hours of employment, even those who are not disabled. To benefit from the extension, the qualified beneficiary must notify the HIBC, within 60 days of the Social Security determination of disability and before the end of the original 18-month continuation coverage period. The notice must be provided in writing and must include the name of the employee or


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qualified beneficiary receiving COBRA coverage, information about his or her disability, and a copy of a letter from the Social Security Administration indicating a disability determination.

If, during continued coverage, the Social Security Administration determines that the qualified beneficiary is no longer disabled, the individual must notify the local human resource representative of this determination within 30 days of the date it is made, and COBRA coverage will end. The notice must be provided in the same manner as, and include the same information required for, a notice of disability as described above.

If a qualified beneficiary is disabled and another qualifying event occurs within the 29-month continuation period, then the continuation coverage period is 36 months from the termination of employment or reduction in hours.

Medicare

If you experience a qualifying event due to termination of employment or reduction of hours within 18 months after you have enrolled in Medicare, your spouse and dependent children who are qualified beneficiaries may elect COBRA for medical and/or dental/vision coverage for up to 18 months measured from the date of your Medicare enrollment.

Trade Reform Act of 2002

The Trade Reform act of 2002 created a special COBRA right applicable to employees who have been terminated or experienced a reduction of hours and who qualify for a “trade readjustment allowance” or “alternative trade adjustment assistance.” These individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance coverage, including COBRA continuation coverage. These individuals are also entitled to a second opportunity to elect COBRA coverage for themselves and certain family members (if they did not already elect COBRA coverage). This election must be made within the 60-day period that begins on the first day of the month in which the individual becomes eligible for assistance under the Trade Reform Act of 2002. However, this election may not be made more than six months after the date the individual’s group health plan coverage ends.

When COBRA Ends

COBRA coverage ends before the maximum continuation period ends if one of the following occurs:

You or your dependent becomes covered under another group health plan not offered by Huntington Ingalls Industries, Inc. after the date of your COBRA election (unless the Plan has pre-existing condition limitations that affect the enrolled person)

You or your dependent becomes enrolled in Medicare after the date of your COBRA election (if you or your dependent is not entitled to or enrolled in Medicare, you or your dependent can continue coverage under COBRA until the maximum continuation period ends)

You or your dependent fails to make a timely monthly payment. After the initial COBRA premium payment, payments are due on the first day of each month and, if your payment is not received within 31 days after the first day of the month (the “grace period”), coverage will be terminated effective as of the last day of the period for which payment was made. For example, if payment for May coverage is due May 1, and you fail to make the applicable payment by May 31, your coverage will be terminated retroactive to April 30.

After your initial 18-month period, you or your dependent ceases to be considered disabled for Social Security purposes and is not otherwise eligible for a longer continuation coverage period

Huntington Ingalls Industries, Inc. ceases to provide medical benefits to any employee.


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COBRA and FMLA

For purposes of a Family and Medical Leave Act (FMLA) leave, you will be eligible for COBRA, as described above, only if:

You or your dependent is covered by the Plan on the day before the leave begins (or if you or your dependent becomes covered during the FMLA leave); and

You do not return to employment at the end of the FMLA leave.

A leave that qualifies under the Family and Medical Leave Act (FMLA) does not make you eligible for COBRA coverage. However, regardless of whether you lose coverage because of nonpayment of premium during an FMLA leave, you are still eligible for COBRA on the last day of the FMLA leave if you decide not to return to active employment. Your COBRA continuation coverage will begin on the earliest of the following to occur:

When you definitively inform Huntington Ingalls Industries, Inc. that you are not returning at the end of the leave, or

The end of the leave, assuming you do not return to work.

Questions About COBRA

If you have any questions about COBRA coverage or the application of the law, please contact the HIBC or contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website at www.dol.gov/ebsa.

Keep Your Plan Informed of Address Changes

In order to protect your and your family’s rights, you should keep your local human resources representative or Payroll Department informed of any changes in your address. Notify the HIBC if there are any changes in your family member’s address, if different from yours. You should also keep a copy, for your records, of any notices you send.

If You Have Other Coverage or Benefits

Other coverage includes coordination of benefits, Medicare and right of recovery.

Coordination of Benefits

Remember, the benefits you receive from a Huntington Ingalls Industries, Inc. medical plan option may affect the benefits you receive from another group health plan, and vice versa. It is very important to let your health care providers and claims administrator know if you or a family member is enrolled in more than one health plan (for example, if your spouse is enrolled in a Huntington Ingalls Industries, Inc. medical plan option and his or her employer’s plan). When this happens, the Huntington Ingalls Industries, Inc. medical plan option will apply a non-duplication of benefits provision to coordinate payments with the other plan.

Under the non-duplication of benefits provision, the Huntington Ingalls Industries, Inc. medical plan options consider the benefit payments you receive from another group plan. When Huntington Ingalls Industries, Inc. is the secondary payer, the Huntington Ingalls Industries, Inc. medical plan makes up the difference between the amount the other plan pays and the benefit that otherwise would be payable under the Huntington Ingalls Industries, Inc. medical plan option.

This provision ensures that payments from the other plan, plus any payments from the Huntington Ingalls Industries, Inc. medical plan, do not exceed the amount Huntington Ingalls Industries, Inc. would have paid if there were no other coverage.

http://www.dol.gov/ebsa


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To calculate non-duplication of benefits, it is necessary to determine which plan is the primary plan and which is the secondary plan. The primary plan pays benefits first. The secondary plan pays benefits after the primary plan has paid.

The Huntington Ingalls Industries, Inc. medical plan is always secondary to any automobile insurance coverage, including, but not limited to, no-fault coverage and uninsured motorist coverage, and to any medical payment provision under homeowner’s or renter’s insurance.

For all other plans subject to coordination of benefits, the following rules apply to determine which plan is primary:

If a plan does not have a coordination of benefits provision, that plan will always be primary.

The plan that covers the person as an employee (or retiree) is primary over a plan covering the person as a dependent, unless the person is enrolled in Medicare. If the person is enrolled in Medicare (and if under the Medicare rules, Medicare is secondary to the plan that covers the person as a dependent and primary to the plan that covers the person as an employee or retiree), the plan that covers the individual as a dependent is primary, Medicare is secondary, and the plan that covers the claimant as an employee or as a retiree pays third.

The plan covering the person as an active employee, or as that employee’s dependent, is primary over the plan covering the person as a retiree (or laid-off employee) or as that person’s dependent. However, if the other plan does not determine the order of benefits in this same way and, as a result, does not agree on the order of benefits, this rule will be ignored.

If two or more plans cover the person receiving care as a dependent, then the plan of the parent whose birthday (month and day) falls earlier in the calendar year is primary unless the other plan uses a rule based on the person’s gender and — as a result — the plans do not agree on the order of benefits. In that case, the rule in the other plan will be used to determine which plan is primary. If the birthday rule applies and both parents have the same birthday, the plan covering a parent longer will be primary.

If you are divorced or not married to your child’s parent and your child is enrolled in both a Huntington Ingalls Industries, Inc. medical plan option and the other parent’s employer’s plan, the plans pay in this order:

First, the plan of the parent awarded financial responsibility for the child’s medical expenses by a court decree

Then, the plan of the parent with custody of the child

Then, the plan of the stepparent whose spouse has custody of the child

Then, the plan of the parent who does not have custody of the child.

If none of these rules determine the order of payment, the plan that covered the child in question the longest is the primary plan.

To ensure proper payment of claims under the non-duplication of benefits provision, Huntington Ingalls Industries, Inc. may ask you to confirm your other coverage, if any. Your claims administrator will send you a coordination of benefits (COB) questionnaire, usually after your claims administrator receives the first claim for your enrolled spouse or children, and annually thereafter.

The COB questionnaire requests information about any other insurance under which your spouse or children are covered. Claims administrators vary on their process for processing the claim associated with the questionnaire. In some cases, until your claims administrator receives your completed questionnaire (which can be completed in writing or over the telephone with the claims administrator), the claim that triggered the questionnaire is “pended” or put on hold. If your claims administrator does not receive a completed questionnaire, the claim is denied and you are sent an explanation of benefits (EOB) statement. The statement provides the reason for the denial and instructs you


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to complete the COB questionnaire and submit it to your claims administrator along with the denied claim. In other cases, the claims administrator will pay the claim while the questionnaire is being processed. If a determination is made that you received benefits that should not have been paid, or that you have failed or refused to reimburse the Plan as required, the Plan may (in addition to taking other action) withhold future benefit payments.

Coordination with Medicare

While you are an active employee, if you or one of your dependents has coverage under the Huntington Ingalls Industries Health Plan and under Medicare due to age or disability, the Huntington Ingalls Industries, Inc. medical plan pays primary to Medicare. That means the Huntington Ingalls Industries, Inc. plan pays benefits first, and then Medicare pays benefits second. A separate rule applies to individuals who are eligible for coverage under Medicare due to end-stage renal disease.

Medicare coverage will be available to you (or your spouse or dependents) when you (or they) become age 65, whether you are retired or still working. You (or your spouse or dependents) may become eligible for Medicare before age 65 as a result of a qualified disability or end-stage renal disease. If you plan to work past age 65, you can:

Apply for Medicare when you become age 65, or

Decide to wait until you retire to apply for Medicare, if you are enrolled in one of the Huntington Ingalls Industries, Inc. medical plan options. You do not have to enroll in Medicare while you are still an active employee and covered under a Huntington Ingalls Industries, Inc. medical plan option as an active employee (or spouse of an active employee).

When your active employment ends, you and/or any Medicare eligible dependent must enroll in Medicare Part B for coverage to be effective as soon as your employment ends, even if you are continuing coverage under COBRA or a severance plan. If you and/or your dependent does not enroll in Medicare Part B (Medical Insurance) as soon as you (and/or they) become eligible you and/or they may pay higher Medicare premiums. In addition, the Huntington Ingalls Industries Health Plan will pay benefits as if the Medicare-eligible individual has enrolled in Medicare, whether or not the individual has enrolled in Medicare, so you could be responsible for paying significant medical expenses not covered by Medicare or the Plan.

End-Stage Renal Disease

If you (or a covered dependent) receive Medicare coverage because of end-stage renal disease, your Huntington Ingalls Industries, Inc. medical plan option pays primary for the first 30 months you (or they) are enrolled in (or eligible to enroll in) Medicare. Thereafter, Huntington Ingalls Industries, Inc. pays secondary to Medicare.

Disability

If you (or a covered dependent) are eligible for Medicare coverage due to disability, the order in which your Huntington Ingalls Industries, Inc. medical plan option pays benefits depends on whether the disabled person is the employee or a dependent, as follows:

If you are a disabled employee, your Huntington Ingalls Industries, Inc. medical plan option pays secondary to Medicare if all of the following apply:

You no longer work due to your disability

You qualify for Social Security benefits because of a disability

You are eligible for Medicare

You are not enrolled in another group health plan as an active employee.


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When you meet these criteria, any payments that the Huntington Ingalls Industries, Inc. medical plan makes are calculated as if you are enrolled in Medicare, regardless of your actual enrollment status (unless your disability is due to End Stage Renal Disease and you have been eligible for Medicare for at least 30 months). If you are on a leave of absence, your Huntington Ingalls Industries, Inc. medical plan option pays primary through the end of the leave.

If you are a disabled dependent covered through the active employment of an employee, your Huntington Ingalls Industries, Inc. medical plan option pays primary to Medicare (unless the dependent’s disability is due to end-stage renal disease and the dependent has been eligible for Medicare for at least 30 months).

This section is subject to the terms of the Medicare laws and regulations. Any changes in these related laws and regulations will apply to the provisions set forth above. For details on all aspects of your Medicare benefits, go to the Medicare web site at www.Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

If a determination is made that you received benefits that should not have been paid, or that you have failed or refused to reimburse the Plan as required, the Plan may (in addition to taking other action) withhold future benefit payments.

Right of Recovery

In some situations, another person or insurance company may be financially responsible for your medical expenses. For example, in the case of an automobile accident, a no-fault automobile insurance policy may be responsible for paying all or part of your medical expenses. If the Plan reimburses expenses for which you or a dependent later recovers damages, you are required to reimburse the Plan for those expenses. When you accept benefit payments made on your behalf from a Huntington Ingalls Industries, Inc. medical plan option, you agree to:

Reimburse the Plan for the full amount of benefit payments made on your behalf

Provide any documents that allow the Plan to recover the payments it made to you or to a medical professional

Provide any other assistance to the Plan in enforcing these rights and not do anything to hinder the Plan.

The legal term for the Plan’s right of recovery is subrogation. The Plan has the right to recover 100 percent of the benefits paid or to be paid by the Plan in connection with the injury or illness for which another person or insurance company may be responsible.

The Plan’s subrogation rights apply to any and all payments made or to be made to the injured person or the person’s heir, guardian or other representative relating to the injury or illness. This includes, but is not limited to, payments as a result of judgment or settlement and payments from any automobile, homeowners, business or other insurance policy, including the covered person’s own insurance policy. The Plan’s rights apply regardless of whether the payments are designated as payment for pain and suffering, medical benefits or other specified damages. The Plan has the right of first recovery, regardless of whether the covered person has been made whole. This means that the Plan is entitled to recovery before attorneys’ fees and other legal expenses are paid and even if the amount paid or payable relating to the injury or illness is less than the individual’s total loss, including medical expenses, lost wages, pain and suffering and other damages.

You must notify your claims administrator when you take legal action against a third party as a result of an illness or injury, or if a third party is responsible for payment. You may be required to sign a reimbursement agreement before Plan benefits are paid in connection with the injury or illness, but the Plan’s subrogation rights are not dependent on having a signed agreement.

If a determination is made that you received benefits that should not have been paid, or that you have failed or refused to reimburse the Plan as required, the Plan may (in addition to taking other action) withhold future benefit payments.

http://www.medicare.gov/


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Medical Coverage

The medical plan options offered by Huntington Ingalls Industries provide coverage for a broad range of benefits, including doctor’s visits, prescription drugs, hospitalizations and surgery. The medical plan options available include:

Anthem Preferred PPO Medical Plan Option


Regional Health Maintenance Organization (HMO) Medical Plan Options, if offered in your ZIP code area

Aetna Global Benefits Plan option (if you work and live outside the United States)

When you elect medical coverage, your plan includes prescription drug coverage.

While this guide provides an overview of the Anthem Preferred PPO and Anthem Consumer Driven Health Plan (CDHP), additional medical plan information, as well as information about the Aetna Global Benefits Plan and HMO options, can be found in the Appendix. The summary plan descriptions, coverage certificates and subscriber contracts included in the Appendix are considered part of and must be read together with this “main” portion of the SPD.

In addition, you can compare plans by going to HII Benefits at www.hiibenefits.com and click on the “Summary of Benefits Coverage (SBC)” under “Quick Links”.

More Information

You will find information about your medical benefits throughout this handbook:

Eligibility and Enrollment subsection of the Health Care Benefits section – Contains important information about eligibility and enrollment rules for participation in the medical plan.

Administrative Information section – Contains information about your rights under the medical plan, including information about the claims appeals process.

“Continuing Your Coverage” in the Eligibility and Enrollment subsection – Contains information about your right to continue your medical plan participation under COBRA.

Subsection Contents

THE MEDICAL OPTIONS AT A GLANCE ..................................................................................................................... 30

THE ANTHEM PPO MEDICAL PLAN AT A GLANCE .............................................................................................. 30 THE ANTHEM CONSUMER DRIVEN HEALTH PLAN (CDHP) AT A GLANCE ................................................................ 31 PRESCRIPTION DRUG COVERAGE AT A GLANCE .................................................................................................. 32 ABOUT THE HMO OPTIONS .......................................................................................................................... 33 ABOUT THE AETNA GLOBAL BENEFITS PLAN OPTION .......................................................................................... 33

HOW THE ANTHEM MEDICAL PLANS WORK ............................................................................................................ 33

HOW THE ANTHEM PPO MEDICAL PLAN WORKS .............................................................................................. 34 HOW THE ANTHEM CDHP MEDICAL PLAN WORKS ........................................................................................... 34 ANTHEM BENEFIT MANAGEMENT FEATURES .................................................................................................... 37 HII FAMILY HEALTH CENTER .......................................................................................................................... 39 PRESCRIPTION DRUG COVERAGE .................................................................................................................... 40

WHAT THE ANTHEM MEDICAL PLAN COVERS ........................................................................................................ 45

WHAT’S NOT COVERED ............................................................................................................................................... 58

FILING A CLAIM ............................................................................................................................................................ 61

http://teamsites-west.mercer.com/sites/jane-wojcik/Documents/SharePoint%20Drafts/hii-hnw-wrap-nonrep.doc#Xref_Manual_Appendix




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The Medical Options at a Glance

Huntington Ingalls Industries offers you a choice of several medical plan options. All of the medical options provide comprehensive coverage for a broad range of covered services, including 100% coverage for preventive care when you use an in-network provider, as well as prescription drug coverage. Each plan provides access to quality care and protection from the high cost of medical services and supplies. The medical plan options differ by level of coverage, your contribution for coverage, and the way you receive medical care.

Both the PPO and CDHP medical plan options are provided through Anthem. With both plans, you have access to both in-network and out-of-network providers. However, you will generally have higher out-of-pocket costs when you use an out-of-network provider.

The CDHP option may be used with a Health Reimbursement Account (HRA) that is funded with contributions from Huntington Ingalls to help you pay for your health care expenses.

The Anthem PPO Medical Plan at a Glance

Highlights of the Anthem PPO Medical Plan include:

In-Network Out-of-Network

Annual Deductible

Individual $500 $800

Family $1,000 $1,600

Annual Out-of-Pocket Maximum (includes deductible)

Individual $5,000 $6,350

Family $10,000 $12,700

Covered Services

What You Pay In-Network

What You Pay Out-Of-Network

Preventive Care Free Not Covered

Office Visit $20 per visit (no deductible) 40% after deductible

Specialist Office Visit $40 per visit (no deductible) 40% after deductible

Emergency Room $250 per visit; then, 20% after deductible $250 per visit; then, 20% after deductible

Hospital

Outpatient

Inpatient

20% after deductible





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The Anthem Consumer Driven Health Plan (CDHP) at a Glance

Highlights of the Anthem CDHP include:

Health Reimbursement Account (HRA)

Benefit plan year allocation from Huntington Ingalls Industries, Inc.

HRA

$1,000 for employee coverage

$1,500 for employee + spouse coverage

$1,500 for employee + child(ren) coverage

$2,000 for family coverage

Bridge

Amount not covered by benefit plan year HRA allocation (you may have to pay this amount out-of-pocket)

Bridge Amount

$800 for employee coverage




Traditional Health Coverage

Protects you if you need additional coverage. Begins after you use your benefit plan year HRA allocation and pay your Bridge

Traditional Health Coverage

Plan pays 80% for providers offering discounts

Plan pays 60% for providers not offering discounts

Coinsurance Maximum

$5,550 for employee coverage




After reaching the coinsurance maximum, the plan pays 100% of the allowable amount for covered services for the remainder of the benefit plan year.

Covered Services

What You Pay

In-Network

What You Pay

Out-Of-Network

Preventive Care Free Free

Office Visit 20% after deductible 40% after deductible

Specialist Office Visit 20% after deductible 40% after deductible

Urgent Care 20% after deductible 40% after deductible

Emergency Room 20% after deductible 20% after deductible

Hospital

Outpatient

Inpatient

20% after deductible 40% after deductible


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Prescription Drug Coverage at a Glance

The amount you pay for prescription drugs depends on the medical plan option that you choose, but you will receive the same quality benefits with both the Anthem PPO and CDHP options. Highlights of the prescription drug coverage under each option are as follows:

Prescription Drugs PPO Medical Plan Anthem CDHP

Amount You Pay After Deductible...

Retail (CVS/caremark Network)

(30-day supply)

Generic At Health Center ONLY: $3 maximum, Bypass Deductible

Other Pharmacies: 10% ($5 minimum) for a generic prescription at all other pharmacies

At Health Center ONLY: $3 maximum, Bypass Deductible

Other Pharmacies: 20% for a generic prescription at all other pharmacies

Preferred Brand Name 10% ($20 minimum) for a preferred brand-name prescription at all pharmacies

20% for a preferred brand-name prescription at all pharmacies

Non-Preferred Brand Name 10% ($40 minimum) for a non-preferred brand-name prescription at all pharmacies

20% for a non-preferred brand-name prescription at all pharmacies

CVS/caremark Network Retail 90 Pharmacy or Mail Service Pharmacy

(Up to 90-day supply)


Other Pharmacies: 10% ($10 minimum) for generic prescription at all other pharmacies


Other Pharmacies: 20% for generic prescription at all other pharmacies





Prescription Annual Out-of-Pocket Maximum

In-Network: $1,600 per individual/$3,200 per family

Out-of-Network: $2,000 per individual/$4,000 per family

$6,350 employee

$8,500 employee + child

$10,500 employee + children


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About the HMO Options

Depending on your ZIP code area, you may have access to an HMO option. HMOs provide care through a network of primary care providers (PCPs) and specialists. In most HMO plan options, you must choose a network PCP to provide or coordinate all of your care (including specialist referrals). A PCP may be a family practitioner, general practitioner, internist, or pediatrician. All network PCPs meet the HMO’s qualification standards and are subject to periodic review. Care that is not coordinated by your PCP is not covered by the HMO.

Your PCP will refer you to other HMO providers, when necessary. The HMO options pay no benefits if you use a physician, hospital, or other provider that is not a member of the HMO’s network — except in an emergency situation.

HMOs generally pay 100% of your eligible expenses after you pay a copayment. You pay no deductibles, and there are no claim forms.

If you enroll in one of the HMO plan options, you will receive prescription drug coverage and mental health and substance abuse coverage directly through the HMO.

The HMO, not Huntington Ingalls Industries, Inc., is responsible for the payment of all benefits covered under the HMO contract and has the sole authority, discretion and responsibility to interpret the terms of the HMO contract. When you enroll in an HMO, you agree to resolve all differences between you or your dependents and the HMO through binding arbitration. Binding arbitration is a legal method used to efficiently resolve disputes outside the court system.

Domestic partner coverage may not be offered by all HMOs in all states.

For more information about the HMO plan options, you can contact the HMO’s member services directly. If you are currently enrolled in an HMO, you can find member services contact information in your HMO member materials and on your medical plan ID card. In addition, for information about the HMO plan options, refer to the supplemental documents in the “Appendix” on page 139.

About the Aetna Global Benefits Plan Option

The Aetna Global Benefits Plan option is available to eligible Huntington Ingalls Industries, Inc. employees and their eligible dependents. If you have an APO/FPO address or international address, you automatically are eligible for this option.

In this plan, you can go to any provider to access care. If your covered dependents live in the U.S., they must access care from Aetna PPO network providers to receive the highest level of coverage (unless they live in an area where there are no network providers, in which case they would receive the out-of-area benefit).

The Aetna Global Benefits Plan option provides medical, prescription drug, and dental coverage. If you enroll in the Aetna Global Benefits Plan, you cannot choose separate dental coverage under one of the dental plan options.

Aetna, not Huntington Ingalls Industries, Inc., is responsible for the payment of all benefits covered under the insurance contract and has the sole authority, discretion and responsibility to interpret and apply the terms of the contract.

If you live outside the United States and this option does not appear on your enrollment worksheet, contact the Huntington Ingalls Benefits Center (HIBC) at 408-916-9765. For information about the Aetna Global Benefits Medical Plan option, refer to the supplemental documents in the “Appendix” on page 139.

How the Anthem Medical Plans Work

The Huntington Ingalls medical options provide comprehensive coverage for a broad range of covered services, including 100% coverage for preventive care when you use an in-network provider, as well as prescription drug coverage. Each plan provides access to quality care and protection from the high cost of medical services and supplies. The medical plan options differ by level of coverage, your contribution for coverage, and the way you receive medical care.


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While this guide provides an overview of the Anthem Preferred PPO and Anthem Consumer Driven Health Plan (CDHP) additional information about these plans as well as information about the Aetna Global Benefits Plan and HMO options, can be found in the Appendix. The summary plan descriptions, coverage certificates and subscriber contracts included in the Appendix are considered part of and must be read together with this “main” portion of the SPD.

In addition, you can learn more about the plans by going to HII Benefits at www.hiibenefits.com and click on the “Summary of Benefits Coverage (SBC)” under “Quick Links”.

How the Anthem PPO Medical Plan Works

If you elect the Anthem Preferred Provider Organization (PPO) Medical Plan, you can go to any licensed provider for your health care, but you save money when you access care through PPO network providers.

To locate a network provider or find out if your current provider is in the PPO network, access the Find a Doctor tool on the Anthem.com/ca web site, which is accessible from the Provider Link at www.hiibenefits.com. You also can call Anthem directly to request assistance in finding a provider.

The PPO network is a group of physicians, hospitals, and other health care providers that agree to:

Undergo a quality screening process

Comply with the PPO’s quality measures and protocols

Provide care at discounted rates.

For the medical PPO plan:

Prescription drug coverage is provided through CVS/caremark

Coverage for mental health and substance abuse treatment is provided through Anthem.

How the Anthem CDHP Medical Plan Works

The Anthem Consumer Driven Health Plan (CDHP) is offered through Anthem’s national network. It is a consumer driven health program that puts you in charge of how your health care dollars are spent. Here is an overview of how the Anthem CDHP plan option works:

Preventive Care is 100% covered. You pay nothing for eligible expenses.

Each benefit plan year, Huntington Ingalls Industries, Inc. credits a specified dollar amount to a Health Reimbursement Account (HRA) for you and your enrolled dependents.

The funds credited to your HRA are used to pay for covered medical expenses. As long as there is enough benefit plan year allocation in your account, you pay nothing for covered services or prescription drugs — no copays, coinsurance or deductibles.

Unused funds credited to your HRA roll over to the next benefit plan year, and can be used to reduce your future out-of-pocket medical costs.

More Information

For a description of the benefits offered under the Anthem PPO Medical Plan, please refer to the summary available in the “Appendix” on page 139. You can also find information at www.hiibenefits.com.

More Information

For a description of the benefits offered under the Anthem CDHP Medical Plan, please refer to the Benefit Summary in the “Appendix” on page 139.




http://www.anthem.com/ca




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If you use all of your annual HRA credit, you are responsible for paying an out-of-pocket amount — called the Bridge. The Bridge is paid as you incur additional eligible expenses.

After you pay the Bridge, the plan pays a majority of the cost of services, and you pay a percentage of the cost (called coinsurance) up to an annual coinsurance maximum.

After you reach the annual out-of-pocket maximum, the plan pays 100% of your eligible expenses for the remainder of the benefit plan year.

Note that the Company’s HRA contributions and bridge amounts are prorated on a quarterly basis and are adjusted based on your actual date of enrollment.

Prescription drugs in the Anthem CDHP, provided through the Anthem prescription drug plan with CVS, are covered the same way as any other medical expenses under the program. There is no preferred drug list (or formulary) with the Anthem CDHP and no separate out-of-pocket maximum (once you reach your annual out-of-pocket maximum, prescriptions are covered at 100% of the discounted price when you use a network pharmacy). In addition, the program includes a mail-order service available to order most maintenance medications, generally at a lower cost.

How the HRA Works

When you choose the Anthem CDHP medical option, you are eligible to participate in a Health Reimbursement Account (HRA) designed to help offset your out-of-pocket medical expenses.

Each year, Huntington Ingalls Industries, Inc. puts a specified dollar amount into a Health Reimbursement Account (HRA) for you and your covered dependents. The amounts for each benefit plan year are as follows:

$1,000 for employee-only coverage



$2,000 for family coverage (combined family limit).

These amounts may be prorated if you participate in the Anthem CDHP for less than a full benefit plan year, depending on when your participation begins. Any unused amounts in your HRA after the end of the benefit plan year can be rolled over and used in the next plan year, as long as you continue to participate in the Anthem CDHP.

The funds in your HRA (including any amounts that have been rolled over from a prior benefit plan period) are used to pay for covered medical expenses. As long as there is enough money in your account, you pay nothing for

covered services or prescription drugs no copays, coinsurance, or deductibles. Covered services include routine medical services (such as physician office visits and lab tests). You can also use your HRA funds to pay for HRA

Qualified Health Expenses special services not typically covered by a traditional health plan, such as a smoking cessation program, post-tax premiums for Huntington Ingalls Industries, Inc.-sponsored retiree medical coverage, or a prescribed weight loss program.

In addition, you can use your HRA to cover other Anthem CDHP costs, such as any covered services over the allowable amount. Any HRA amounts that you use to cover expenses above the allowable amount or for services beyond the benefit maximums or HRA Qualified Health Expenses will not count toward meeting your deductible or out-of-pocket maximum.

You are allowed to use the funds in your HRA to pay for Internal Revenue Code Section 213 Qualified Medical Expenses only, and even these are subject to the terms of the Huntington Ingalls Industries Health Plan. You cannot receive a cash reimbursement of the funds in your account for anything other than the benefits covered under the Anthem CDHP.

Note: If you experience a qualifying life event during the benefit plan year that results in a decrease in coverage level (e.g., going from family to employee-only coverage), your HRA allocation will not change until the beginning of the next benefit plan year. If the qualifying life event results in an increase in coverage level (e.g., from employee-only to


36

family coverage), Huntington Ingalls Industries, Inc. will provide an additional HRA allocation equal to the difference between the prorated amounts for the coverage level you are moving from to the coverage level you are moving to. If your participation in the Anthem CDHP ends or any reason during the benefit plan year, any unused balance in your HRA will be forfeited.

Your HRA dollars can be used to pay for select copays, coinsurance, deductibles, prescription drugs and medical services such as physician office visits and lab tests. The CDHP plan has copays for the following services:

Emergency room visit: $250 copay

HII Family Health Center acute care visit: $15 copay

Teladoc general medical or behavioral health consult: $10 copay

Employees enrolled in the CDHP plan pay the Family Health Center and Teladoc copays out-of-pocket and be reimbursed via their HRA dollars. The emergency room copay, however, cannot be reimbursed from any available HRA dollars.

HRA Qualified Health Expenses

In addition to using your HRA balance to pay for eligible medical expenses as defined by the Anthem CDHP, you can use your HRA to cover the cost of certain qualified medical care expenses. These services are not usually covered by traditional health plans, including:

Braille books and equipment

Construction for installation of necessary medical equipment*

Experimental treatments*

Family planning counseling

Genetic testing*

Guide dogs*

Lodging while receiving medical treatment*

Massage therapy provided by a physician*

Premiums for COBRA for the Anthem CDHP only

Reversal of sterilization procedures

Smoking cessation programs

Smoking deterrents*

Special equipment in car for person with disability*

Special equipment for hearing impaired*

Training for the hearing impaired*

Weight loss programs*.

* Require that your doctor complete your Qualified Health Expense claim form to verify that the expense meets the criteria defined under Section 213 of the Internal Revenue Code.


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Filing HRA Claims

Unless a qualified HRA health expense requires your doctor to complete the claim form, you generally file your own claim form without your doctor’s verification. You can get a Qualified Health Expense claim form by calling Anthem Customer Service at 1-844-465-7237 or through the Anthem member web site (accessible from the Provider Link at www.hiibenefits.com). From the Anthem site, go to My Benefits, and then Forms Library.

My Health Assessment

A $100 additional HRA allocation will be credited to your HRA upon the completion of the online health risk assessment. Your additional $100 will be allocated to your account and available for claims payment within 30 days of the completion of My Health Assessment. You are allowed only one benefit plan year allocation reward per HRA account. The health information you provide is strictly confidential.

MyHealth Coach

A $100 additional HRA allocation will be credited to your HRA upon agreeing to participate in the My Health Coach Program. Anthem provides CDHP participants with one-on-one consultations with a nurse ― a Health Coach. You and covered family members are eligible if you have a health condition that requires ongoing attention. Health conditions may include, but are not limited to, diabetes, asthma, depression, high blood pressure, heart disease, and pregnancy. A Health Coach will provide you with important health information, help you set personal health goals with your doctor and give you practical ideas to improve your health. Participate in regularly scheduled phone meetings with your Health Coach and you will receive your additional HRA allocation.

Each eligible family member is allowed only one Personal Health Coach Participation Reward per benefit plan year.

If you graduate by achieving your goals and successfully complete the program, another $200 HRA allocation will be credited to your HRA. Your additional $200 will be allocated to your account within 60 days of graduating from the program. Each eligible family member is allowed only one Health Coach Graduation Reward per benefit plan year.

Anthem Benefit Management Features

The benefit management features apply to the Anthem PPO and CDHP medical plan options. It is very important that you understand how these features work and use them if the need arises. If you receive certain services without following the procedures outlined here, your benefits will be reduced – resulting in a greater, and unnecessary, out-of-pocket cost to you.

Precertification

With the Anthem PPO and CDHP medical plan options, precertification is required for the following medical services:

Hospital admissions and increases in lengths of stay (except for maternity, as described under “Statement of Rights under the Newborns’ and Mothers’ Health Protection Act” on pg. 135). Maternity hospital stays for mothers and newborn children are considered medically necessary for at least 48 hours following a normal vaginal delivery or 96 hours following a caesarian birth. Precertification is required if there is an increase in the length of stay.

Inpatient surgery

Skilled nursing facility care

Private duty nursing

Home health care

Home infusion therapy



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Inpatient care for mental health and substance abuse services

Partial hospitalization, intensive outpatient therapy and residential treatment centers for mental or nervous disorders or substance abuse

Applied Behavioral Analysis (ABA) Therapy

Precertification is also required within 72 hours of an emergency-based hospital admission or surgery.

If you fail to precertify inpatient hospital care, home health care, skilled nursing facility, home infusion therapy, and inpatient mental health and substance abuse services, you may be responsible for a $500 non-compliance penalty in addition to your normal coinsurance and deductible.

While precertification is not required for outpatient procedures or medical imaging, such as CT scans or PET scans, you should be aware that these and other tests are not covered in all circumstances even if ordered by your physician. If a test is considered to be experimental, not medically necessary, or not effective, it will not be covered, and you will be responsible for the full cost. Because of the cost of these procedures, it is a good idea to ask your provider to request review by calling the number for High Tech Imaging on the back of your card.

Anthem manages the precertification process for the PPO and CDHP. In most cases, your provider will contact Anthem for precertification. Ultimately, however, precertification is your responsibility — not the doctor’s or hospital’s responsibility.

Anthem will review your treatment and work with your doctors to determine the appropriateness of your treatment and length of your stay in the hospital, if applicable. Anthem will also work with you and your doctor to help you obtain the right follow-up care and services. Precertification helps manage medical costs by confirming the need for things like medical necessity and duration.

Anthem’s medical management recommendations are neither health care nor medical services and are neither treatment advice nor treatment recommendations.

Precertification is not required for occupational, physical, or speech therapy.

Health Resources and Tools

The Anthem PPO and CDHP offer online financial tools to help you keep track of your health care dollars. You can review what you have spent on health care or look up the status of a particular claim any time of the day.

Anthem also offers several resources designed to help you stay healthy, deal with an illness or injury, and prepare for a medical procedure or treatment, including:

Hospital Comparison

Medical Cost Estimators

MyHealth Assessment

MyHealth Record

MyHealth Coach

24/7 NurseLine

ConditionCare.

Whether you are going for a routine checkup, managing a medical condition, or getting ready for surgery, the Anthem online health resources and tools deliver the information and support you need around these topics and more.


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MyHealth Assessment

Evaluate your overall health, help identify risks and find out how to help optimize your health. Use MyHealth Assessment to prepare for a routine physical — evaluate your health online, print out your family health history to share with your doctor, and find out what questions you should ask and what tests your doctor should perform.

MyHealth Record

MyHealth Record combines treatment and preventive care services, doctors’ appointments, and your medications list into one convenient personal health record. Member education, health management programs, health news and tools are all customized based on your unique health profile. Your personal health record allows you to track doctor visits, vaccinations and other wellness services. Stay organized by consolidating your health history in one secure location.

My Health Coach

A Health Coach is a registered nurse who assists you in receiving available health care services when you are faced with a serious illness or ongoing health problem. If the Anthem claims review indicates you might benefit from having a Health Coach, one will contact you to discuss your needs.

This confidential service is designed to help you use your benefits most effectively, answer health care questions, arrange for treatment, coordinate your care and help you follow through with your doctor’s instructions. The Health Coach will work with you to coordinate your health care.

24/7 Nurse Line

The 24/7 Nurse Line is staffed 24 hours a day seven days a week by registered nurses. Nurses provide you and your family members with health care education and decision support for routine health conditions.

Teladoc

Teladoc provides access to a national network of board-certified doctors, including psychiatrists and pediatricians, in the U.S. who are available on-demand 24 hours a day, 7 days a week, 365 days a year to diagnose, treat and prescribe medication (when necessary) for many medical issues via phone or online video consultations. Teladoc does not replace existing physician relationships, but supplements them as a convenient, affordable alternative for medical care.

Teladoc is available to all employees and their covered dependents who are enrolled in the Aetna PPO or CDHP options. You pay just $10 per consultation, including:

Visits with a board-certified doctor for many common conditions, such as cold symptoms, flu, allergies, bronchitis and more. Prescriptions can be provided if medically necessary.

Behavioral health visits, such as therapist sessions, psychiatrist evaluation and ongoing sessions, as well as support for stress, anxiety, depression and more. Confidential counseling is available seven days a week from any location.

Tobacco cessation is available for a one-time $10 payment. This multi-faceted program combines nurse coach support, physician treatment, and tobacco cessation support materials to give you a proven plan to quit using tobacco for good. To get started, simply request a general medical visit and tell the doctor you're interested in the Tobacco Cessation program.

HII Family Health Center

The HII Family Health Centers are available to employees and dependents covered by an eligible HII health plan. The center provides a convenient alternative to quality health care. Whether you’d like help managing a chronic condition such as high blood pressure, you need a physical or you have a sore throat that needs immediate attention


40

— the HII Family Health Center can help. Wellness visits and preventive visits, such as physicals, preventive health screenings and immunizations, are provided to you at no cost. All other services and treatments received during your visit cost $15. Generic medications at CVS pharmacy cost $3 for a 30-day supply and $6 for a 90-day supply.

Covered services include:

Physicals including school and sports

Preventive health screenings

Immunizations (including flu shots)

Treatment for illnesses and injuries (such as sore throats, ear/eye infections, headaches, minor burns, coughs, cuts and contusions)

Lab work including urinalysis, strep screen, pregnancy testing, cholesterol, glucose, potassium, thyroid

Weight and/or blood pressure checks

Skin checks/minor procedures (such as removals of skin tags, moles and warts)

Basic X-ray

Pediatric care

Physical therapy such as general orthopedic and sports injury treatment, post-operative care, work conditioning, chronic pain management and injury prevention education

Wellness care (goal setting and motivation, smoking cessation and management of weight, stress and time)

Nutrition guidance for (weight management, healthy eating, sports performance enhancement, menu planning and lifestyle changes)

Employee Assistance Program

CVS/CarePlus Pharmacy

HII Family Vision Center

The HII Family Health Center is available at the following locations:

Location Hours

2105 Old Spanish Trail, Gautier, MS 39553 Monday to Friday from 7 a.m. to 6 p.m.

Saturday from 8 a.m. to noon

4500 Washington Ave., Newport News, VA 2307 Monday to Friday from 7 a.m. to 6 p.m.

Saturday from 8 a.m. to noon

For more information or to schedule an appointment, visit myquadmedical.com/hii or call 1-757-327-4200. You can download the MyQuadMed mobile app from the app store (search for “MyQuadMed”).

Prescription Drug Coverage

Prescription drug benefits are automatically provided when you are enroll in a medical plan. Benefits are provided by CVS/caremark at retail pharmacies and through a convenient home delivery program.


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How Prescription Drugs Are Covered

Depending on the medical plan option you elect, you pay the coinsurance (after you have met your medical plan deductible) for each prescription drug you purchase. Generally, the amount you pay for coverage depends on how you have the prescription filled and the type of drug: generic, preferred brand or non-preferred brand prescription drugs as follows:

Prescription Drugs PPO Medical Plan Anthem CDHP

Amount You Pay After Deductible...

Retail (CVS/caremark Network)

(30-day supply)


Other Pharmacies: 10% ($5 minimum) for a generic prescription at all other pharmacies


Other Pharmacies: 20% for a generic prescription at all other pharmacies





CVS/caremark Network Retail 90 Pharmacy or Mail Service Pharmacy

(Up to 90-day supply)


Other Pharmacies: 10% ($10 minimum) for generic prescription at all other pharmacies


Other Pharmacies: 20% for generic prescription at all other pharmacies





Prescription Annual Out-of-Pocket Maximum**

In-Network: $1,600 per individual/$3,200 per family

Out-of-Network: $2,000 per individual/$4,000 per family

$6,350 employee

$8,500 employee + child

$10,500 employee + children


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Preventive Drugs

Because medication adherence is critical to keeping members healthy and keeping health care costs in check, the Plan does not require that you satisfy the medical plan deductible for certain medications on the CVS/caremark Preventive Drug List. This solution focuses on reducing member financial barriers to adherence for a defined list of medications to help prevent disease or the reoccurrence of disease (e.g., statins to help prevent heart disease). Covered members taking these medications only pay their coinsurance or copay, even if they have not yet met their annual plan deductible.

Keep in mind that if you choose a brand prescription drug when a generic is available, you will pay the appropriate brand drug coinsurance as well as the difference between the cost of the generic and the brand-name drug.

Generic. Drugs whose active ingredients, safety, quality and strength are the same as their brand-name counterparts.

Preferred Brand. Drugs that generally have no generic equivalent. Within a class of drugs, there are often several brand-name drugs protected by separate patents. Each of these is equally effective for treating a particular condition. A list of preferred brand-name drugs, which identifies drug classes that may have generic availability that could save you money, is available from CVS/ caremark Customer Care or www.caremark.com.

Non-Preferred Brand. Drugs that have equally effective and less costly generic equivalents and/or have one or more preferred brand options.

Preferred Drug List

When you enroll in an eligible plan, CVS/caremark will send you a copy of the Performance Drug List with your prescription drug booklet. Be sure to keep the booklet for your reference and for sharing with your doctor. You can also request a list, or check a specific prescription drug, by calling CVS/caremark at 1-844-287-1289 or access the CVS/caremark web site, which is accessible from the Provider List at www.hiibenefits.com. (The list of preferred drugs is called the Performance Drug List.)

If you currently have a prescription for a brand-name drug that is not preferred, there may be an alternative preferred brand-name drug that may work just as well for you. Check with your doctor and share the list of preferred drugs with him or her.

Where to Fill Your Prescription

Choosing where to fill your prescription depends on whether you are ordering a short-term or long-term medication:

Short-term medications are generally taken for a limited amount of time and have a limited amount of refills, such as an antibiotic. You can fill prescriptions for these medications at any pharmacy in the CVS/caremark retail network.

Choose from more than 68,000 network pharmacies nationwide, including independent pharmacies, chain pharmacies and 7,700 CVS pharmacy locations

Find a participating pharmacy at www.caremark.com

Long-term medications are taken regularly for chronic conditions, such as high blood pressure, asthma, diabetes or high cholesterol. You will generally save money by using mail service for these prescriptions.

Choose one of four easy ways to start using the CVS/caremark Retail-90 program:

1. Bring your prescription to a CVS/caremark Retail-90 program

2. Fill out and send in a mail service order form

http://www.caremark.com/




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3. Visit www.caremark.com/faststart

4. Call FastStart toll-free at 1-800-875-0867

Step Therapy

Step Therapy is developed under the direction of independent doctors, pharmacists and medical experts. It’s especially for people taking prescription drugs for ongoing medical conditions, such as arthritis, high cholesterol or high blood pressure. The program guides members and doctors into using lower-cost “front-line” medications that provide the same medical benefits as more expensive alternatives in an effort to save you money.

The Step Therapy program automatically sends a message to the dispensing pharmacist to encourage him or her to check whether a front-line medication would be right for you.

The pharmacist can also call your doctor to ask whether you can switch to the lower-cost, equivalent front-line medication. The following classes of brand-name and generic drugs will be subject to Step Therapy*:

Condition Brand-Name and Generic Drugs:

Arthritis/Pain and Inflammation Cambia®, Tivorbex®, Vivlodex®, Zipsor®, Zorvolex®

Heartburn Dexilant®, Prilosec® Packets, Protonix® Packets

High Blood Pressure Edarbi®, Edarbyclor®, Tekturna®, Tekturna® HCT, Teveten® HCT

Chronic skin conditions Elidel®, Protopic®

High Cholesterol Altoprev®, Flolipid®, Livalo®, Triglide®

Depression Fetzima®, Pexeva®, Trintellix®, Viibryd®

Insomnia Belsomra®, Edluar®, Rozerem®, Silenor®, Zolpimist®

Neuropathic Pain Gralise®, Horizant®, Lyrica®

Osteoporosis Binosto®, Fosamax® Plus D

* Additional prescription drugs may be included in this program.

Note: If you attempt to fill a prescription for a second-line (higher-cost or brand) medication without having tried the front-line medication or more than 130 days have passed since your last refill of one of these drugs, your prescription will not be covered. If this happens, your pharmacist can immediately call your doctor to ask if you can switch to a front-line alternative, or you can speak to your doctor on your own.

Exclusions or Limitations

Some medications are not available through the mail-order program, including:

Medications (e.g., antibiotics) used to treat short-term illnesses

Narcotics

Drugs that cannot be refilled without a written prescription, etc.

Call 1-800-386-0553 or contact www.caremark.com for more information on exclusions or limits that may apply to mail-order drugs.

http://www.caremark.com/faststart



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Prior Authorization for Certain Drugs

Certain drugs, due to safety, health and cost concerns, require prior authorization by CVS/caremark prior to dispensing. For a list of these drugs, log in to www.caremark.com or obtain a list from CVS/caremark (visit www.caremark.com or call Customer Care at 1-800-386-0553).

Over-the-Counter Medications

An over-the-counter medication is one that you can obtain without a prescription. The prescription drug program does not cover over-the-counter medications, including those that previously required a prescription (for example, Claritin, Zantac, and Tagamet).

In some cases, certain over-the-counter medications may have similar prescription medications that may be used as an alternative. For example, Allegra and Clarinex, which are prescription medications, may be alternatives to over-the-counter Claritin. Although the prescription drug program may cover the prescription alternatives, (usually at the non-preferred brand-name level), the prescription drug often will cost you more than the over-the-counter drug.

Eligible Prescription Drugs

To be eligible for coverage, a prescription drug must be:

Necessary for the treatment of a disease or illness and widely accepted as effective, appropriate and essential — based on the recognized standards of the medical community and as approved by CVS/caremark for reimbursement,

Prescribed by a licensed physician, and

Prescribed in accordance with type, frequency and duration-of-treatment guidelines of national medical, research and governmental agencies.

Visit the CVS/caremark web site for the lists of prescription drugs that are eligible and ineligible for reimbursement under the CVS/caremark prescription drug program. If you have questions about a particular prescription drug, or if you go to your pharmacy and are told that a particular drug is not covered, call CVS/caremark at 1-844-287-1289. The fact that your physician prescribes, orders, recommends, or approves a prescription or supply does not automatically mean it is an eligible expense. Always call CVS/caremark to confirm coverage.

As new drugs become available, they will be considered for coverage under the Huntington Ingalls Industries Health Plan. The PPO Administrator has the right to decide which drugs are covered and to what extent as well as the right to modify coverage, including the exclusion of any prescription drugs.

Specialty Copay Card Program

CVS Specialty®, an affiliate of CVS/caremark, provides assistance with prescriptions for specialty medications. The CVS Specialty Copay Card Program helps maximize savings through the True Accumulation and Copay Optimization programs. Under these programs, some specialty medications may qualify for third-party copayment assistance that could lower your out-of-pocket costs for those products. Note, however, that receipt of any such assistance will not count towards your maximum out-of-pocket amount or deductible. If you choose not to participate in the copayment assistance programs, you will be subject to the full copayment liability. Eligibility for third-party copay assistance programs is dependent on the applicable terms and conditions required by that particular program and are subject to change. Copay assistance programs may not be used with any government payor plan. This program is offered as part of the Plan’s exclusive specialty pharmacy network with CVS Specialty. The list of specialty drugs eligible for specialty copayment assistance programs is subject to change. If you




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have any questions regarding the Specialty Copay Card Program, please contact CVS Specialty (using the contact information in the “Administrative Details” section of this document).

Special Information for Diabetics

The prescription drug benefit includes a special provision for diabetic supplies. You pay nothing for diabetic supplies if:

Your physician lists all of your diabetic supply requirements on one prescription, and

You order all of the supplies at the same time through the CVS/caremark, and

You fill a prescription for a diabetic drug at the same time

Supplies include:

Alcohol wipes

Diagnostic strips

Lancets and syringes.

If you need a glucose monitor, you can order one at no charge by calling CVS/caremark at 1-844-287-1289.

What the Anthem Medical Plan Covers

Both the Anthem PPO Medical Plan and CDHP medical plan options provide important benefits that protect you and your family from catastrophic medical bills. In general, the options cover the same basic medical services and supplies. A partial list of covered services is included below. For a more detailed list of covered services, see the benefits summary included in the “Appendix” on page 139.

Acupuncture and Acupressure

Acupuncture and acupressure services will be covered, up to 20 visits (for both acupuncture and acupressure combined) per benefit plan year per covered individual, if rendered by a licensed provider.

Allergy Care ― Injections and Tests

Allergy care is covered when administered by a physician, allergist, or specialist. Serum is covered only when received and administered within the provider’s office. If received from a pharmacy, the serum may be covered under the pharmaceutical benefit.

Ambulance

Ambulance service to a local facility for a life-threatening condition or a condition that could cause serious harm to your body. The medical plan options also cover air ambulance service to the nearest appropriate facility when this service is medically necessary. There is no coverage for ambulance use in non-emergency situations, except for physician-prescribed medical transports.

Notification is required except in a life-threatening circumstance. You must notify Anthem within 72 hours of using ambulance services by calling the number listed on the back of your Anthem ID card.

Anesthesia

Coverage is provided for the administration of anesthesia, other than local infiltration anesthesia, in connection with a covered surgical procedure, and provided the anesthesia is administered and charged for by a physician other than the operating surgeon or his assistant.


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Anesthesia benefits will be reimbursed at 80% for providers offering discounts or 80% of the allowable amount for providers not offering discounts.

Blood Transfusions

Blood and blood plasma, including the storage of your own blood.

Breast Reconstruction

Coverage includes breast reconstruction in connection with a mastectomy, specifically:

Reconstruction of the breast on which the mastectomy was performed

Surgery and reconstruction of the other breast to produce a symmetrical appearance

Prostheses and treatment of physical complications for all stages of mastectomy, including lymphedemas.

Cardiac Rehabilitation Therapy

Cardiac rehabilitation phases 1 and 2, when received as a hospital outpatient within three months after your discharge from the hospital for a heart-related condition.

Chiropractic

Chiropractic services performed by a doctor of chiropractic (D.C.) (up to 40 visits per person per benefit plan year).

Dental Services and Oral Surgery

Dental services to treat injuries to natural, rooted teeth (excluding damage to dental implants such as dentures, crowns, and bridges) resulting from an accident, including services provided by a physician, dentist, or dental surgeon. This includes replacement of the teeth and any related X-rays. For your expenses to be eligible, you must receive treatment within 12 months of the injury and you must remain enrolled in one of the medical plan options.

Note: Normal extraction and care of teeth and structures directly supporting the teeth are not covered.

Diagnostic Lab Services and X-rays

Diagnostic X-ray and laboratory services ordered by a physician to diagnose an illness or injury.

Durable Medical Equipment

Coverage is provided for rental or, at the discretion of the plan, purchase of durable medical equipment, which is prescribed by a professional provider and required for therapeutic use. If purchased, charges for repair or medically necessary replacement of durable medical equipment will be considered a covered expense.

Coverage includes but is not limited to crutches, commodes, hospital beds, nebulizers, monitoring equipment and wheelchairs.

Emergency Room Care

Facility and professional provider services and supplies for the initial treatment of traumatic bodily injuries resulting from an accident are covered.

Emergency medical care meeting the following definition is also covered: Facility and professional provider services and supplies for the initial treatment of a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention could result in:

Permanently placing the covered person’s health in jeopardy


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Causing other serious medical consequences

Causing serious impairment to bodily functions, or causing serious and permanent dysfunction of any bodily organ or part.

If the emergency room visit results in a hospital admission, you should notify Anthem within 72 hours of the admission.

Family Planning

Coverage for family planning is provided for:

D & C/Abortion ― therapeutic or voluntary

Diaphragm ― device and/or fitting

IUD ― device and/or insertion and removal

Tubal ligation

Vasectomy

Sterilization

Contraceptives administered in a doctor’s office are covered, such as Depo-Provera®.

Note: Reversal of sterilization is not a covered service.

Foreign Claims

Claims for services rendered while you are out of the country are reimbursed at 80% for emergent care and for non-emergent care. Preventive care is reimbursed at 100% of charges.

All monetary conversions and rates of exchange are calculated based on the date of service.

Hearing

Hearing care coverage is provided, limited to two hearing aids per benefit plan year, limited to $3,000 per hearing aid.

Home Health Care

Home health care expenses are covered if the services are provided by a licensed home health care agency, and all of the following conditions are met:

The charge is made by a home health care agency

The care is given according to a home health care treatment plan

The care is given to a person in his or her home.

Home health expenses are charges for:

Part-time or intermittent care by an RN or by an LPN if an RN is not available

Part-time or intermittent home health aide services for patient care

Physical, occupational and speech therapy

The following to the extent they would have been covered under this plan option if the person had been confined in a hospital or convalescent facility:

Medical supplies


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Drugs and medicines provided by a physician

Lab services provided by a home health care agency.

The following expenses are not considered payable under home health care:

Services or supplies that are not part of the home health care treatment plan

Services of a person who usually lives with the patient or who is a member of the patient’s family

Services of a social worker

Transportation.

Home health care benefits are limited to 120 visits per person per benefit plan year. A visit is considered to be 4 hours.

Hospice Care

Hospice is a health care program providing a coordinated set of services rendered at home, in an outpatient setting or in an institutional setting for those suffering from a condition that has a terminal prognosis.

To be covered, the hospice program must be licensed and the attending physician must certify that the covered person is terminally ill with a life expectancy of six months or less. Charges incurred during periods of remission are not eligible under the provision of the plan.

Hospice care for you and your eligible dependents is covered for up to six months. A Nurse Case Manager is available to coordinate coverage beyond six months.

Services and supplies typically provided and billed by a hospice are:

Inpatient care

Nutrition counseling and special meals

Part-time nursing

Homemaker services

Respite care — limited to five days per episode

Physical and chemical therapy.

Hospital and Facility Services

For more information on eligible services, please see the appropriate topic within this section:

Emergency room care

Emergency room care for non-emergencies

Inpatient medical facility

Inpatient rehabilitation facility

Skilled nursing facility

Urgent care center.

Immunizations for Travel

Immunizations for travel are covered, such as immunizations for yellow fever and typhoid.


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Infertility Treatment

Infertility treatment or assisted reproductive technologies (ART) are covered under the plan if treatments that foster natural conception are not successful. The plan covers:

Artificial insemination

In vitro technologies (IVF)

Gamete intrafallopian transfer (GIFT)

Zygote intrafallopian transfer (ZIFT).

Once the ART procedures listed above have been attempted by the plan participant, all future office visits, drugs, lab tests, or any other treatments to aid conception will fall under the infertility treatment portion of the plan.

Infertility treatment benefits are limited to a lifetime maximum of $12,500 per person. After you reach the $12,500 lifetime maximum, your infertility coverage ends under Huntington Ingalls Industries Health Plan. The lifetime maximum includes reproductive technology, such as in vitro fertilization, and prescriptions to treat an infertility condition.

Inpatient Medical Facility

The Anthem PPO and CDHP pays benefits toward the cost of the following types of inpatient hospital care services:

Inpatient room and board

Inpatient ancillary services.

Inpatient Room and Board

Coverage provided for room and board is limited to the semi-private room rate. Private room, intensive care, coronary care and other specialized care units of a facility are covered when such special care or isolation is consistent with professional standards for the care of the patient’s condition.

When room and board for other than semi-private care is at the convenience of the patient, payment will be made only for semi-private accommodations.

Inpatient Ancillary Charges

Coverage is provided for necessary inpatient ancillary charges, such as services and supplies including but not limited to admission fees, use of operating, delivery, and treatment rooms; prescribed drugs; whole blood, administration of blood, blood processing, and blood derivatives (to the extent blood or blood derivatives are not donated or otherwise replaced); anesthesia, anesthesia supplies and the administration of anesthesia by an employee of the facility; medical and surgical dressings, supplies, casts and splints; diagnostic services; and therapy services; but not services of a physician, or drugs or supplies not consumed or used in the facility.

Inpatient Rehabilitation Facility

Coverage is provided for inpatient rehabilitation facilities. Most people who are admitted to an inpatient rehabilitation facility are recovering from injuries or illnesses that severely impair their physical functioning or understanding. These include strokes, spinal cord injuries, traumatic brain injuries, chronic pulmonary problems, neurological disorders and other debilitating conditions.

Administered by treatment teams, individual patient programs can include these services:

Behavioral medicine

Case management


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Dialysis

Nutrition services

Neuropsychology

Occupational therapy

On-site orthotic and prosthetic services

Physical therapy

Psychology

Recreation therapy

Rehabilitation engineering and technology

Rehabilitation nursing

Social work

Speech and language therapy

Vocational and community re-entry services.

Mental health/chemical dependency rehabilitation is not covered under this benefit but is covered under the mental health and chemical dependency benefit.

Maternity Care

Benefits are payable for pregnancy-related expenses of female employees and covered dependents on the same basis as a covered illness. The expenses must be incurred while the person is covered under the Anthem PPO or CDHP.

If you become pregnant, you are invited to enroll in the Future Moms maternity program provided by Anthem. The program has important information to help you have a healthy pregnancy. Depending on your needs, a nurse will follow you throughout your pregnancy to provide support and help you carry out your doctor’s instructions.

Also covered are services rendered in a birthing facility, provided that the physician in charge is acting within the scope of his license and the birthing facility meets all legal requirements; and midwife delivery services, provided that the state in which such services are performed has legally recognized midwife delivery, and provided the midwife is licensed at the time delivery is performed.

Nursery charges, other hospital services and supplies and physician’s charges for hospital visits for healthy newborn children will be covered under the mother’s benefit.

A newborn child will be considered a dependent under the Anthem medical plan immediately following birth for 31 days. If the member wishes to continue coverage for the newborn beyond that date, application must be made within the Plan’s defined period of 31 days, and the appropriate contributions must be made, otherwise coverage will be terminated retroactively.

Medical Supplies

Medical supplies that are prescribed by a licensed provider for a medical condition or diagnosis are covered, except for those that are available over the counter. Over-the-counter supplies, such as band-aids and aspirin, are excluded from the Anthem PPO or CDHP.


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Examples of medical supplies include:

Diabetic supplies (lancets, glucometers, syringes, if not covered under the pharmacy benefit)

Surgical dressings not purchased over-the-counter.

Mental Health and Substance Abuse

The Anthem medical plans include mental health and substance abuse benefits. Anthem administers its own inpatient hospital and outpatient counseling and therapy for mental health conditions and substance abuse. It offers a large network of clinicians, including psychiatrists, psychologists, and independently licensed master’s-level therapists.

Eligible Mental Health and Substance Abuse Expenses

The medical plan pays for a wide range of inpatient and outpatient services when they are medically necessary. For benefits to be considered medically necessary, the service or treatment must be:

Appropriate, adequate, and essential for your condition

Expected to improve your condition or level of functioning.

The fact that your physician prescribes, orders, recommends, or approves a service or supply does not make it medically or psychologically necessary. That determination is made by Anthem. Call Anthem if you have questions about a particular service.

Covered mental health and substance abuse expenses and services include:

Charges for medically necessary licensed local ambulance service to or from the nearest hospital or approved qualified mental health and/or substance abuse treatment facility where the needed mental health treatment or evaluation can be provided, as authorized by Anthem.

Medically necessary outpatient charges at a hospital or approved qualified mental health and/or substance abuse treatment facility.

The services of qualified mental health and/or substance abuse treatment providers, as determined by Anthem, who provide services within the lawful scope of the practice of:

Licensed psychiatrists

Licensed or registered psychologists

Licensed or registered psychotherapists

Licensed or registered psychiatric social workers.

Semi-private room and board charges, and medically necessary inpatient services and supplies at a hospital or qualified mental health and/or substance abuse treatment facility approved by Anthem.

Ineligible Mental Health and Substance Abuse Expenses

The following mental health and substance abuse services and treatments are not eligible for coverage. Although a service or supply may not specifically be listed as an ineligible expense, it is not necessarily eligible. If you are uncertain whether a service or treatment is eligible, call Anthem.

Aversion therapy.

Services or treatment rendered by you, your spouse, or your child, or by your parent, parent-in-law, brother, sister, brother-in-law, or sister-in-law.


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Conditions resulting from:

Insurrection

Atomic explosion

Other release of nuclear energy under any conditions (except when used solely as a medical treatment).

Couples therapy, except when certified as a medically necessary part of the treatment plan of a spouse with a Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) mental disorder that is covered under the mental health and substance abuse program.

Court-ordered psychiatric or substance abuse treatment, except when certified as medically necessary.

Custodial care.

Educational rehabilitation or treatment of learning disabilities, regardless of the setting in which services are provided.

Evaluations, consultations, or therapy for educational or professional training or for investigational purposes relating to employment.

Experimental or investigational services or supplies, as determined by Anthem. Any of the following criteria may be cause for classification as experimental or investigational:

Lack of federal or other governmental body approval, such as drugs and devices that do not have unrestricted market approval from the Food and Drug Administration (FDA) or final approval from any other governmental body for use in treatment of a specified condition. Any approval that is granted as an interim step in the regulatory process is not a substitute for final or unrestricted market approval

Insufficient or inconclusive scientific evidence in peer-reviewed medical literature to permit the plan’s evaluation of the therapeutic value of the service or supply

Inconclusive evidence that the service or supply has a beneficial effect on health outcomes

Evidence that the service or supply is not as beneficial as any established alternatives

Insufficient information or inconclusive scientific evidence that, when used in a non-investigational setting, the service or supply has a beneficial effect on health outcomes and is as beneficial as any established alternatives.

Injuries or illnesses caused by the conduct or omission of a third party for which you have a claim for damages or relief, unless you provide Anthem with a lien against such claim for damages or relief.

Non-abstinence-based or nutritionally based treatment for substance abuse.

Prescription drugs; however, your prescription may be eligible under the Huntington Ingalls Industries, Inc. medical plan prescription drug benefits. (Prescription drugs prescribed during a medically necessary inpatient treatment are covered as part of the inpatient benefit).

Private duty nursing, except when medically necessary.

Psychological testing, except when medically necessary.

Remedial education beyond evaluation and diagnosis of learning disabilities, education rehabilitation, academic education, and educational therapy for learning disabilities.

Services, supplies, or treatment covered under the Huntington Ingalls Industries, Inc. medical plan.

Services to treat conditions not attributable to a mental disorder but as additional conditions that may be a focus of clinical attention, such as V Codes as identified in the DSM IV-TR.


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Services, treatment, or supplies provided as a result of any workers’ compensation law or similar legislation.

Services, treatment, or supplies obtained through, or required by, any governmental agency or program, whether federal, state, or any subdivision thereof (exclusive of Medicaid/MediCal).

Sex therapy programs.

Therapies that do not meet national standards for mental health professional practice, including — but not limited to — Erhard/The Landmark Forum, primal therapy, Rolfing, sensitivity training, bioenergetic therapy, and crystal healing therapy.

Treatment by any providers not pre-approved by the claims administrator.

Treatment for caffeine or nicotine addiction, withdrawal, or dependence.

Treatment for co-dependency.

Treatment for personal or professional growth, development, training, or professional certification.

Treatment of certain congenital and/or organic disorders (e.g., mental retardation) except for associated treatable and acute behavioral manifestations.

Treatment or consultations provided by telephone.

Wilderness therapy programs.

Hospital and Facility Services

For more information on eligible services, please see the appropriate topic within this section:

Emergency room care

Emergency room care for non-emergencies

Inpatient medical facility

Inpatient rehabilitation facility

Skilled nursing facility

Urgent care center.

Nutritional Counseling

Coverage is provided for health services rendered by a registered dietician, or other licensed provider, for individuals with medical conditions that require a special diet. Some examples of such medical conditions include diabetes mellitus, coronary heart disease, congestive heart failure, severe obstructive airway disease, gout, renal failure, phenylketonuria and hyperlipidemias. Coverage for nutritional counseling is limited to six visits per person per benefit plan year.

Orthognathic Surgery

Orthognathic surgery is covered when medically necessary. Call Anthem at the number provided on your ID card for details on medical necessity requirements.

Orthotic Devices

Coverage is provided for orthotic devices (a rigid or semi-rigid supportive device which restricts or eliminates motion for a weak or diseased body part), including custom shoes or custom molded inserts prescribed by a physician (up to one pair per person per benefit plan year).


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Podiatry

Coverage is provided for certain surgical podiatry services, including incision and drainage of infected tissue of the foot, removal of lesions of the foot, removal or debridement of infected toenails, and treatment of fractures and dislocations of bones of the foot. Podiatry services not covered are those procedures considered to be a part of a routine foot care, or of a cosmetic nature.

Preventive Care

The Anthem PPO and CDHP cover preventive services based on guidelines from the U. S. Preventive Services Task Force, American Cancer Society, the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics. The preventive benefit includes screening tests, immunizations and counseling services designed to detect and treat medical conditions to prevent avoidable premature injury, illness, and death.

In order for services to be covered as preventive benefit, preventive services, such as colonoscopies must be coded by the provider as routine preventive in order to be covered with no copayment.

Private Duty Nursing

Coverage is provided for the services of a private duty nurse on an outpatient basis only. Nursing services must be rendered by a nurse who neither resides in the patient’s home, nor is a member of the immediate family. To be covered, the physician in charge of the case must certify that the patient’s condition requires the requested care, which can only be provided by an RN or LPN. Private duty nursing applies only for care given in the patient’s home and not part of the home health care agency’s plan of treatment.

Private duty nursing benefits are limited to 120 visits per person per benefit plan year. A visit is considered to be 4 hours.

Professional Services

Professional services are those services billed by a provider’s office rather than by a facility ― such as office visits and inpatient hospital visits. Covered professional services are:

Office Visits — Visits made by patients to health service providers’ offices for diagnosis, treatment, and follow-up.

Inpatient Hospital Visit — A visit by a provider for persons admitted to health facilities that provide room and board, for the purpose of observation, care, diagnosis, or treatment.

Prosthetics

Coverage is provided for the purchase and fitting of external prosthetic appliances which are used as a replacement or substitute for a missing body part, and are necessary for the alleviation or correction of illness, injury, or congenital defect.

Replacement or repair, as appropriate, of external prosthetic appliances is covered if necessitated by such circumstances as normal anatomical growth, physical changes which render the device ineffective, or excessive wear.

Coverage is also provided for internal prosthetic appliances; this includes the purchase, maintenance, or repair of permanent or temporary internal aids and supports for defective body parts, specifically, intraocular lenses, artificial heart valves, cardiac pacemakers, artificial joints, and other surgical materials such as screw nails, sutures, and wire mesh.


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Second Surgical Opinion

Coverage is provided for an opinion provided by a second physician, when one physician recommends surgery to an individual.

Skilled Nursing Facility

Coverage is provided for skilled nursing facilities, a residential care setting offering a protective, therapeutic environment for individuals who require rehabilitative care or can no longer live independently because of a chronic physical or mental condition requiring round-the-clock skilled nursing care. Skilled nursing facilities must be licensed by the state and are subject to certain state and federal regulations.

Skilled nursing facility care is limited to 120 days per person per benefit plan year.

Covered services and supplies include semi-private room and board, charges for other medical services and supplies, and physician’s services.

Surgery

Coverage is provided for surgery rendered in both inpatient and outpatient settings for the treatment of disease or injury. Separate payment will not be made for pre-operative care or post-operative care normally provided by the surgeon as part of the surgical procedure.

Surgical Services (Other)

Coverage is provided for the following surgical personnel and services, as described below:

Assistant surgeon

Bilateral surgical procedures

Co-surgeon

Multiple surgical procedures

Weight reduction surgery.

Assistant Surgeon

Benefits may be provided for services of a physician who actively assists the operating surgeon when it is determined that the condition of the patient or the type of surgical service requires such assistance.

When considered necessary by the surgeon, the service of an assistant surgeon is a covered service.

Bilateral Surgical Procedures

Bilateral surgical procedures are defined as more than one procedure associated with a single surgical event. The benefit payable for bilateral procedures is 50% of the eligible benefit for the primary surgical procedure.

Co-Surgeon

A co-surgeon is usually a surgeon who is in the operating room performing a different surgery than the other surgeon who is present at the same time. Also, a co-surgeon is allowed in complicated surgeries (such as heart surgery) due to the length of time of the operation. The co-surgeons have the same responsibility. Co-surgeon services are covered at 50% of the eligible benefit of the surgeon’s fee.

Multiple Surgical Procedures

For multiple surgeries (related operations or procedures performed through the same incision or in the same operative field, performed at the same operative session), Anthem considers as an eligible expense 100% of the


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eligible surgical allowance for the highest paying procedure plus 50% of the eligible surgical allowance for the second highest paying procedure and 50% of the eligible surgical allowance for each additional procedure. For example, if the benefit normally pays 80%, the primary surgical procedure would be paid at 80%, and the remaining surgical procedures would be paid at 50% of the 80% benefit.

Weight Reduction Surgery

Gastric bypass surgeries are covered under the surgical benefit. Gastric bypass surgery requires precertification for medical necessity determination prior to scheduling the member’s procedure. Coverage is provided only with a diagnosis of morbid obesity, based on National Institutes of Health criteria, which can change periodically. For details, call Anthem Customer Service at 1-844-465-7237.

Temporomandibular Joint Dysfunction (TMJ)

Coverage is provided for surgical treatment only of temporomandibular joint dysfunction (TMJ) if due to accident, congenital defect, or developmental defect. No coverage is provided for appliances or therapy services related to TMJ.

Therapy Services

Coverage is provided for therapy services when used for the treatment of a sickness or injury to promote the recovery of the covered person. To be covered, the therapy services must be rendered in accordance with a physician’s written treatment plan.

Services covered under the medical plan include:

Radiation Therapy ― the treatment of disease by X-ray, gamma ray, accelerated particles, mesons, neutrons, radium, or radioactive isotopes

Chemotherapy — the treatment of malignant disease by chemical or biological antineoplastic agents (the cost of the antineoplastic agent is included)

Physical Therapy — the treatment by physical means, hydrotherapy, heat, or similar modalities; physical agents; bio-mechanical and neuro-physical principles; and devices to relieve pain, restore maximum function lost or impaired by disease or accidental injury, and prevent disability following disease, injury or loss of body part (services are limited to 30 visits per person per benefit plan year)

Respiratory Therapy — the introduction of dry or moist gases into the lungs for treatment purposes

Occupational Therapy — the treatment of a physically disabled person by means of constructive activities designed and adapted to promote the functional restoration of the person’s abilities lost or impaired by disease or accidental injury, to satisfactorily accomplish the ordinary tasks of daily living (services are limited to 30 visits per person per benefit plan year)

Speech Therapy — Speech therapy is covered up to an annual maximum of 30 visits per covered individual per benefit plan year, including therapy by a qualified speech therapist. Speech therapy is considered medically necessary when the following criteria are met:

Services are used to treat a communication impairment or swallowing disorder resulting from illness, injury, surgery, or congenital abnormality

Therapy sessions have a reasonable expectation of achieving measurable, significant functional improvement in a reasonable and predictable period of time; and

Therapy sessions provide specific, effective, and reasonable treatment for the patient’s diagnosis and physical condition


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Vision Therapy — Vision therapy is covered when medically necessary. Call Anthem at the number provided on your ID card for details on medical necessity requirements

Dialysis Treatment — the treatment of acute renal failure or chronic irreversible renal insufficiency for removal of waste materials from the body, to include hemodialysis or peritoneal dialysis.

Transplant Services

Coverage is provided for expenses related to human-to-human organ or tissue transplants, including:

Kidney

Heart/lung

Cornea

Liver

Bone marrow/stem cell

Pancreas

Heart

Lung

Kidney/pancreas

Liver/small bowel

Small bowel.

Centers of Excellence

If you participate in the PPO or CDHP medical plan option, you — and your covered family members — have access to transplant Centers of Excellence, referred to as Blue Distinction Centers, which is coordinated by Anthem.

A Center of Excellence is a medical institution and health care provider that has demonstrated they can provide excellent results with regard to your treatment, at a competitive price, with high patient satisfaction ratings. If you or your family members use a Center of Excellence for organ transplant care and treatment that has been pre-approved by Anthem, your benefits will be paid at 100%.

In addition, if you live over 100 miles from the center, travel to a Center of Excellence in your personal vehicle for medical treatment will be reimbursed according to IRS regulations. Airfare, other ground transportation as described below, and hotel accommodations for you and one companion will be reimbursed at 100%, subject to coordination and approval by Anthem.

The following methods of transportation are acceptable for reimbursement:

Bus, taxi, train, or plane fares or ambulance service

Transportation expenses of a parent who must go with a child who needs medical care

Transportation expenses of a nurse or other person who can give injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone

Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as a part of treatment.


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You can also include out-of-pocket car expenses, such as the cost of gas and oil, when you use a car for medical reasons relating to an organ transplant. You cannot include depreciation, insurance, general repair, or maintenance expenses.

If you do not want to use your actual car expenses, you can use a standard mileage rate, as defined by the IRS, for use of a car for medical reasons relating to an organ transplant.

You can also include parking fees and tolls. You can add these fees and tolls to your medical expenses whether you use actual expenses or use the standard mileage rate.

If you or your family members use a Center of Excellence for organ transplant care and/or treatment that has been pre-approved by Anthem, your benefits will be paid at 100%, subject to the following maximums:

Per diem maximum of $250 per day for room and board (does not include airfare, which is paid separately)

Lifetime maximum of $10,000 for, lodging, and all travel expenses including coach class airfare (excludes air ambulance expenses, which are covered under regular, non-Center of Excellence benefits). Expenses will begin to accrue at the initial evaluation, and end at 365 days post-procedure or when the $10,000 lifetime maximum is reached, whichever occurs earlier.

For more information, call Anthem at 1-844-465-7237.

Urgent Care Center

Coverage is provided at an emergency medical service center, which is separate from any other hospital or medical facility.

Wigs

Benefits are provided when baldness is a result of chemotherapy, alopecia, radiation therapy or surgery. Wigs are limited to one per person per benefit plan year up to $1,500.

What’s Not Covered

Some expenses are not covered by the plan, including any services or supplies which are not medically necessary and essential to the diagnosis or direct care and treatment of a sickness, injury, condition, disease, or bodily malfunction; or any experimental/investigational services and supplies.

The cost of ambulance service for non-emergencies or patient convenience.

The cost of anesthesia for non-covered services, unless otherwise specified.

Expenses related to artificial organs — other than limbs, larynx, and eyes — including surgery and related expenses for any type of artificial organ transplant.

The cost of caffeine or nicotine addiction, withdrawal, or dependence-related care, including prescription and non-prescription drugs.

Charges above the allowable amounts, or claims filed after the filing deadline.

Charges for an injury incurred while committing a crime.

Charges for transportation or lodging or mileage costs, except as defined for transplant coverage.

Charges for services or supplies that are not medically necessary, as determined by the claims administrator, including charges for equipment containing features of an aesthetic nature or features of a medical nature not required by the patient’s condition.


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Charges for services that are not ordered by a physician for the diagnosis, care, or treatment of an illness, injury, or pregnancy, except preventive or well-child care.

Charges that you are not legally required or obligated to pay, or charges that would not have been billed, such as for free immunizations provided at a local clinic or drugstore.

The cost of comfort or convenience equipment or supplies, such as exercise and bathroom equipment, seat-lift chairs, air conditioners, humidifiers, dehumidifiers, and purifiers, shoes or related corrective devices, spas, or computer “story boards” or “light talkers.”

Expenses related to cosmetic/reconstructive surgery, except as described under “Covered Services.”

Expenses related to court-ordered treatment, unless certified as medically or psychologically necessary.

Expenses related to custodial care or maintenance therapy, including care for conditions not typically responsive to treatment as well as conditions that are no longer responsive to treatment due the attainment of maximum ability levels.

The cost of transplant donor fees.

The cost of dental services, including the extraction of wisdom teeth, except those described under “Covered Services.” (This exclusion encompasses shortening or lengthening the maxilla or mandible for cosmetic purposes or correction of malocclusion. If you select dental coverage, these expenses may be eligible under your dental plan option).

Expenses for vocational, work hardening, or training programs regardless of diagnosis or symptoms or for non-medically necessary education, except as specifically provided under the plan.

Expenses related to educational programs for mental impairment or for developmental disorders such as cluttering and stuttering.

Expenses related to experimental or investigational services or supplies, as determined by the claims administrator. Any of the following criteria may be cause for classification as experimental or investigational:

Requiring federal or other governmental body approval, such as drugs and devices that do not have unrestricted market approval from the Food and Drug Administration (FDA) or final approval from any other governmental body for use in treatment of a specified condition. Any approval that is granted as an interim step in the regulatory process is not a substitute for final or unrestricted market approval

Insufficient or inconclusive scientific evidence in peer-reviewed medical literature to permit the claims administrator’s evaluation of the therapeutic value of the service or supply

Inconclusive evidence that the service or supply has a beneficial effect on health outcomes

Evidence that the service or supply is not as beneficial as any established alternatives

Insufficient information or inconclusive scientific evidence that, when utilized in a non-investigational setting, the service or supply has a beneficial effect on health outcomes and is as beneficial as any established alternatives.

Anthem, in its discretion, determines whether services or supplies are experimental.

Charges for eye refractions, eyeglasses, and contact lenses.

Expenses for any deductibles or copayments under a separate health care plan, managed care plan, health maintenance organization, or pharmacy plan, either through Huntington Ingalls Industries, Inc. or any other company’s plan.


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Expenses reimbursed or paid through Medicare or any other public program, or, if the participant did not sign up for Medicare A and/or B, expenses that would have been eligible for reimbursement through Medicare.

The cost of foot treatment for:

Weak, strained, flat, unstable or unbalanced feet, metatarsalgia, or bunions (except open-cutting operations)

Corns, calluses or toenails, except the removal of nail roots and necessary services prescribed by a physician (M.D. or D.O.) to treat metabolic or peripheral-vascular disease.

The cost of homeopathic or related treatment.

The cost of treating any illness or injury related to employment that is covered under workers’ compensation or similar laws.

Expenses related to infertility administration fees that are not medically necessary, such as egg and sperm costs and donor search fees and surrogate mother charges, unless the surrogate mother is eligible under the Anthem medical option at the time services are rendered.

Expenses for non-human organs, including services and supplies related to non-human organs.

Charges for massage therapy not rendered by a physician.

The cost of care for the newborn child of an enrolled child, unless the newborn becomes an eligible dependent under the Huntington Ingalls Industries Health Plan.

The cost of over-the-counter medications or dietary supplements that do not require a prescription by law.

Expenses related to periodontal or periapical disease, or any condition other than a malignant tumor involving teeth, surrounding tissue or structure, except as described under “Covered Services.” (If you select dental coverage, these expenses may be eligible under your dental plan option.)

Personal non-medical expenses, such as telephone and television charges while in a hospital.

Expenses related to any exercise program, except as part of Phase I and Phase II cardiac rehabilitation.

Fees for physician assistant services, if not accepted medical practice in your state.

Expenses related to home births.

Expenses for counseling services for the purpose of career or financial reasons.

Fees for private duty nursing while a patient in a hospital or other treatment facility.

Physician charges for duplication of records, telephone consultations, failure to keep a scheduled appointment, or for completion of claim forms.

The cost of radial keratotomy (RK), photo refractive keratectomy (PRK), astigmatic keratectomy (AK), LASIK, or other similar surgical procedures to improve or correct vision problems.

Expenses related to the reversal of voluntary sterilization, treatment of sexual dysfunction not related to organic disease, and for any drugs or devices used for contraception, unless otherwise specified.

The cost of services furnished by a hospital or facility operated by the U.S. government or any authorized agency of the U.S. government or furnished at the expense of such government or agency, unless payment is legally required.

Charges for shipping and handling for covered items.

The cost of services or supplies that any school system provides as required by law.


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The cost of services or supplies provided by any Huntington Ingalls Industries, Inc. Medical Department.

Charges related to services or treatment rendered by you or your spouse, child, parent, parent-in-law, brother, sister, brother-in-law, or sister-in-law.

The cost of services received before coverage begins or after coverage ends.

Expenses related to physical, occupational, or speech therapy for maintenance purposes.

Expenses related to speech therapy to correct pre-speech deficiencies or to improve speech skills not fully developed, such as stuttering.

Expenses related to the non-surgical treatment of temporomandibular joint disorders and related conditions by any method, including therapy services related to temporomandibular joint disorders.

Expenses related to weight reduction treatment, unless medically necessary for morbid obesity, as defined by the criteria of the National Institutes of Health.

For a full list of expenses not covered by the plan, see the plan summary in the “Appendix” on page 139.

Filing a Claim

If you receive services from a provider who offers an Anthem discount, your provider should submit the claim for reimbursement on your behalf. If you receive services from a provider who does not offer an Anthem discount, you must file your own claim. If you need to file your own claim you should take the claim form along with you when you see your provider.

When you need to file a claim for benefits, complete the appropriate form and mail them with all required documentation to the claims administrator at:

Medical Claims: Anthem P.O. Box 37690, Louisville, KY 40233-7690

Pharmacy Claims: CVS/caremark P.O. Box 52136 Phoenix, AZ 85072-2136

Note: When services are rendered by a provider who offers an Anthem discount, claims should be submitted by the provider to the address included on your Anthem identification card.


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Filing a Claim Under the Anthem CDHP

Medical expenses eligible for reimbursement through the Anthem CDHP and your HRA must first be submitted to Anthem for payment. Only if these expenses are not reimbursable from the Anthem CDHP are they eligible to be reimbursed from your health care flexible spending account, if you have one. Charges not reimbursed, such as Bridge amounts and coinsurance, may be eligible for reimbursement from your health care flexible spending account, if they are not reimbursable from any other source.

Claims should be submitted as soon as possible. Claims submitted more than 15 months from the date of service will not be honored. Previous benefit plan year HRA claims will be applied against your previous benefit plan year HRA funds and never against current benefit plan year funds. Current benefit plan year claims will be applied against previous benefit plan year HRA funds but only after you have used all your current benefit plan year HRA funds.

For more information on claim filing, please refer to the summary of coverage applicable to your program available in the “Appendix” on page 139.


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Dental Coverage

Huntington Ingalls offers dental coverage through Delta Dental for you and your eligible dependents. The dental plan options give you the choice to enroll for coverage that suits your individual situation. Alternatively, you can waive coverage.

The options available include:

Dental Care PPO Plan option

Dental Care Plus PPO Plan option

Preventive Care PPO Plan option

For more information, contact:

Delta Dental of Virginia Claims Services 4818 Starkey Road Roanoke, VA 24018-8542 Phone: 800-237-6060

Website: www.deltadental/va.com

More Information

You will find information about your dental benefits throughout this SPD:

Eligibility and Enrollment subsection of the Health Care Benefits section – Contains important information about Huntington Ingalls eligibility and enrollment rules for participation in the Dental plans.

Administrative Information section – Contains information about your rights under the Dental plans, including information about the claims appeals process.

“Continuing Your Coverage” in the Eligibility and Enrollment subsection – Contains information about your right to continue your dental plan participation under COBRA.

Subsection Contents

BENEFITS AT A GLANCE ............................................................................................................................................. 64

HOW THE PLANS WORK .............................................................................................................................................. 65

YOUR DENTAL NETWORK OPTIONS ................................................................................................................. 66 ALLOWABLE AMOUNT (OR AVERAGE FEES) ...................................................................................................... 66 PREDETERMINATION OF BENEFITS .................................................................................................................. 66 EXTENSION OF BENEFITS ............................................................................................................................... 67

WHAT THE PLANS COVER .......................................................................................................................................... 67

PREVENTIVE AND DIAGNOSTIC CARE ............................................................................................................... 67 BASIC CARE ................................................................................................................................................ 68 MAJOR CARE.............................................................................................................................................. 68 ORTHODONTIC SERVICES .............................................................................................................................. 69

LIMITATIONS ON COVERAGE ..................................................................................................................................... 69


FILING A CLAIM ............................................................................................................................................................ 71


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Benefits at a Glance

Highlights of each of the Delta Dental PPO plan options are as follows.

Dental Care PPO Plan

Dental Care Plus PPO Plan

Preventive Care PPO Plan

Your contribution (cost for coverage):

Moderate Higher Lower

What the Plan covers: Preventive and diagnostic

Basic and major restorative

Preventive and diagnostic

Basic and major restorative

Orthodontia

Preventive and diagnostic

Plan Features (maximums are in- and out-of-network combined)

Deductible (Individual/ Family)

$50/$100 in-network

$100/$200 reduced network

$150/$250 out-of-network

$50/$100 in-network

$100/$200 reduced network

$150/$250 out-of-network

None

Annual maximum per person

$1,500 in-network

$1,250 reduced network

$1,000 out-of-network

$3,000 in-network

$2,500 reduced network

$1,000 out-of-network

$500

Orthodontia lifetime maximum per person

Not covered $3,000 Not covered

Non-surgical treatment of TMJ lifetime maximum per person**

$500 in-network

$300 reduced network

$250 out-of-network

$500 in-network

$300 reduced network

$250 out-of-network

Not covered

Coinsurance (amount you pay)

Preventive and diagnostic care

Covered at 100%, no deductible

Basic restorative care 20% in-network

25% reduced network

30% out-of-network

20% in-network

25% reduced network

30% out-of-network

Not covered

Major restorative care 50% after deductible 50% after deductible Not covered

Orthodontia Not covered 50% after deductible Not covered

Note: There is one lifetime maximum regardless if you change to another PPO dental plan option.

Annual maximums apply regardless of whether services are in or out-of-network. For example, if you are in the Dental Care PPO Plan and incur $1,000 of in-network expenses, you will have exhausted the annual maximum for out-of-network benefits. Annual maximums are not cumulative. For example, if you are in the Dental Care Plus PPO Plan, the maximum benefit you can receive for dental care (excluding orthodontia) is $2000.

For full plan details, refer to the “Appendix” on page 139.


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How the Plans Work

The three PPO dental plan options work in much the same way. You can go to any licensed dental provider for your dental care, but you save money when you access care through PPO network providers. Delta Dental administers the PPO dental plans and provides the PPO network of dental providers.

When you use a Delta Dental PPO network provider, you will receive in-network benefits in the PPO dental plan options, which means you pay less for your care. It is important to note that not every Delta dentist participates in the PPO network, so you must be careful when choosing your dentist. If you access care from a dentist who is not in the PPO network, you will receive a lower level of coverage — even if the dentist is in another Delta Dental network.

If you want to receive in-network benefits in any of the dental PPO plan options, be sure you receive care from a dentist who is in the PPO network. This same network applies to all three of the PPO dental plan options. To find a PPO dentist, visit Delta’s web site, which is accessible from the Provider Link at www.hiibenefits.com (select “Delta Dental PPO” to search the provider list for all three PPO dental plan options) or call Delta Dental at 1-800-237-6060.

Delta dentists who do not participate in the PPO network are called Delta Premier dentists. If you go to one of these Delta dentists, you will receive reduced in-network coverage.

If you go to a non-Delta dentist, you will receive out-of-network coverage, and your costs may be higher because non-Delta dentists are not subject to negotiated fees and you are responsible for any charges that exceed the plan’s allowable amounts.

In the Dental Care and Dental Care Plus PPO dental plan options only (not Preventive Care): If you live in an area where you do not have access to at least two Delta general dentists* in the Delta Premier network within a 30-mile radius, you may be eligible to receive in-network coverage — meaning you pay the same coinsurance you would pay if you used a PPO dentist, up to the in-network benefit maximums — even if you use a non-Delta Dental dentist.

Likewise, if you live in an area where you do not have access to at least one Delta Dental orthodontist (or other specialist) within a 30-mile radius, you may be eligible to receive in-network coverage for specialist services, even if you use a non-Delta specialist provider. This will not qualify you to use non-network generalist dentists* unless you also meet the requirements listed above. Keep in mind that the Delta Dental network of dentists is constantly changing. If you are eligible or become eligible for out-of-area coverage, you will remain eligible through the end of the benefit plan year (June 30). You will be notified by Delta Dental if you are eligible for this out-of-area feature.

* General dentists are non-specialist dentists.

When you receive care from a dentist outside the Delta Dental network, you also pay any expenses that exceed the allowable amount (also called the average fee) for dentists in your area, as determined by Delta.

The deductible is the amount you must pay each benefit plan year before the plan begins to pay benefits for most services. You do not have to meet the deductible before the plan begins paying for your preventive care.

Coinsurance is the percentage of the covered charges you pay after you meet the deductible. The annual maximum is the maximum benefit amount your plan option will pay each plan year. If you visit an in-network provider, your in-network claims are applied to both the in- and out-of-network annual maximums. As a result, if you reach the annual out-of-network maximum while using in-network providers and services, you will not be eligible for out-of-network benefits until the next plan year (when the annual maximum starts over).



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Your Dental Network Options

If you enroll in one of the dental PPO plan options, you have a choice to make each time you need care you may choose to see a provider in the Delta Dental PPO network or a provider outside the PPO network. However, when you use a PPO network provider, you will receive a higher level of coverage, which means you pay less for your care. When you use a provider in the Delta Dental PPO network or Delta Premier network, you do not have to worry about charges above the allowable amount, and your doctor will file your claims for you.

Your network options include:

In-Network -- You must use a provider in the Delta Dental PPO network.

Reduced In-Network -- You must use a provider in the Delta Premier network.

Out-of-Network -- You can go to any licensed provider outside the Delta Dental PPO network.

The same network applies to all three of the PPO dental plan options. To find a PPO dentist, call Delta Dental at 1-800-237-6060 or visit the Delta Dental web site at www.deltadentalva.com, which is also accessible from the Provider Link at www.hiibenefits.com (select “DeltaPreferred” to search the provider list for all three dental PPO plans).

Allowable Amount (or Average Fees)

In the PPO dental plan options, if you go to a non-network provider, you are responsible for any charges that exceed the plan’s allowable amount (also called the average fee), as determined by Delta Dental in its sole discretion.

When you use a dental provider who participates in the Delta Dental network, you do not have to worry about amounts above the allowable amount. Delta dentists charge Delta patients only the negotiated fees.

Predetermination of Benefits

If you do not have a predetermination of benefits for any treatment costing more than $300, when your claim is reviewed after treatment, the reimbursement may be less than you expect. This is not a penalty for failing to request predetermination. However, Delta Dental pays only for the least expensive but equally effective procedure.

To avoid this risk, for dental treatments likely to cost more than $300, your dentist should request a predetermination of benefits before beginning treatment. To make this request, you do not need a special claim form. Your dentist should complete a regular Delta Dental or universal claim form, with a diagnosis of the condition, the proposed course of treatment with itemized services, and charges for each procedure. Dates of service do not need to be included with this initial approval request.

Delta Dental reviews the proposed treatment to determine how coverage would apply and sends back to the dentist a predetermination of benefits form. This form states that Delta Dental approved costs for the procedures recommended.

If alternative, less costly treatments are available, Delta Dental informs you and your dentist, in writing, of benefits that the dental plan option pays. You and your dentist are free to pursue any treatment plan but Delta will not pay more than the cost for an equally effective but less costly treatment.



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Extension of Benefits

If your dental coverage ends, you may extend your Delta Dental coverage for 30 days for the following dental services, provided your dental plan option would have otherwise paid benefits:

For an appliance — or modification of an appliance — for which an impression was taken before your coverage ended

For a crown, bridge, or gold restoration for which the tooth was prepared before your coverage ended

For root canal therapy, provided the pulp chamber was opened before your coverage ended.

You may also be eligible for dental coverage under COBRA. Refer to “Continuing Your Coverage” on page 21 for details.

What the Plans Cover

Following is a description of eligible expenses under the PPO dental plan options. If you have questions about eligible expenses under your dental plan option, call Delta Dental at 1-800-237-6060. For a more complete list of covered services, see the Delta Dental summary included in the “Appendix” on page 139.

Preventive and Diagnostic Care

The PPO dental plan options all provide coverage for the following preventive and diagnostic care expenses (you do not have to meet the Plan deductible):

Biopsy tissue examination.

Bitewing X-rays — Includes two per benefit plan year for children to age 19, and one set every benefit plan year for adults age 19 and older.

Emergency treatment — Includes relief of dental pain when the dental plan option pays no other benefit, other than required X-rays.

Fluoride treatment — Includes up to two treatments in a benefit plan year to age 19.

Panoramic and full-mouth X-rays — Includes one set every 60 months, unless a special need is shown.

Office visits and specialist consultations — Only the first two oral examinations, including office visits for observation and specialist consultations, or combination thereof, are covered benefits during a benefit plan year.

Pulp vitality testing.

Sealants — Allowed for permanent first molars (through age 8) and second molars (through age 14) only. One replacement per tooth per lifetime after three years from the first placement. Includes topically applied acrylic, plastics, or composite material applied to permanent posterior molars to seal teeth and prevent decay.

Space maintainers for children to age 14, once every five years.

Teeth cleaning (prophylaxis) includes up to two in a benefit plan year (up to three in a benefit plan year for participants who are pregnant).


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Basic Care

The Dental Care PPO Plan option and the Dental Care Plus PPO Plan option provide coverage for the following basic dental care after you meet the deductible:

Anesthesia — General anesthesia, nitrous oxide or IV sedation when medically necessary, including endodontic and periodontal surgeries, is covered when provided in conjunction with covered oral surgery procedures.

Crowns, jackets, and cast restorations — Limited to once every five years per tooth. The dental plan option covers this treatment for cavities that cannot be restored with amalgam, synthetic, plastic, or resin fillings. A broken tooth is also covered. A tooth worn down by day-to-day wear is not covered.

Drugs — Includes antibiotic injections and other drugs administered or ordered by a dentist. If your dentist writes a prescription for you, take the prescription to your pharmacy and fill it as you would any other health care prescription.

Endodontics — Includes treatment of tooth pulp, such as root canals and other endodontic treatments.

Oral surgery — Includes extractions of one or more teeth, cutting procedures in the mouth, and treatment of fractures and dislocations of the jaw.

Periodontics — Includes deep cleaning and scaling, treatment of disease of the gums, mouth tissue, and bones supporting teeth. Periodontal root planning (limited to once per quadrant in a 24-month period). Gingevectomy, gingeval curettage, muco gingeval surgery, osseous surgery and osseous grafts as part of osseous surgery (limited to once every 36 months).

Restorative (fillings) — Includes amalgam, synthetic, plastic, or resin fillings for treatment of cavities (decay). Direct composite (resin) restorations are only benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services, and Delta’s payment is limited to the cost of the equivalent amalgam restorations.

Major Care

The Dental Care PPO Plan option and the Dental Care Plus PPO Plan option provide coverage for the following major dental care after you meet the deductible:

Implants — Implant surgery, including the removal of implants, and implant devices (up to $1,000 in-network/$500 out-of- network combined per lifetime subject to the annual maximum). There is one lifetime maximum, regardless if you change to another PPO plan option.

Prosthodontics — Limited to once every five years, unless existing appliance cannot be made repairable. Construction or repair of fixed bridges, partial dentures, and complete dentures if provided to replace missing natural teeth.

Non-surgical treatment of TMJ disorder — Includes nightguards, splints, acclusal orthotic devices, and equilibration (subject to lifetime maximum). There is one lifetime maximum, regardless if you change to another PPO plan option.


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Orthodontic Services

The Dental Care Plus PPO Plan option provides coverage for the following orthodontic care after you meet the deductible:

Bands

Braces

Correction of malocclusion

Orthodontic appliances

Services for strengthening teeth.

The lifetime maximum for orthodontia is $3,000.

Limitations on Coverage

Limited treatments, services, and supplies include:

Initial examinations, periodic examinations, and emergency examinations (even if the plan has already paid for two examinations that year) are covered.

Only the first two oral examinations, including any office visits for observation and specialist consultations, or combination thereof, provided to a patient in a plan year while he or she is an enrollee under any Delta program are covered.

Panoramic and full-mouth X-rays are covered after five years have elapsed following any prior provision of panoramic and full-mouth X-rays under a Delta program.

Bitewing X-rays are covered on request by the dentist, but not more than twice in any plan year for children up to age 19, and once in any plan year for adults age 18 and older.

Diagnostic casts are a benefit only when made in connection with covered orthodontic treatment.

Only the first two cleanings (three for participant who is pregnant), fluoride treatments or single procedures that include cleaning, or combination thereof, provided to a patient in a plan year while he or she is an enrollee of any Delta program are covered.

Sealant benefits include the application of sealants only to permanent first molars through age eight and second molars through age 14 if they are without caries (decay) or restorations on the occlusal surface.

Direct composite (resin) restorations are benefits on anterior teeth and the facial surface of bicuspids. Any other posterior composite (resin) restoration is an optional service, and Delta’s payment is limited to the cost of the equivalent amalgam restorations.

Crowns, jackets, inlays, outlays, and cast restorations on the same tooth will be replaced only after five years have elapsed following any prior provision under any Delta program, unless Delta determines that replacement is required because the restoration is unsatisfactory as a result of poor quality of care, or because the tooth involved has experienced extensive loss or change to tooth structure or supporting tissues since the replacement of the restoration.

Prosthodontic appliances that were provided under any Delta program, including but not limited to fixed bridges and partial or complete dentures, will be replaced only after five years have passed unless Delta determines that there is such extensive loss of remaining teeth or change in supporting tissues that the existing appliance cannot be made satisfactory. Replacement will be made of a prosthodontic appliance not provided under a Delta program if it is unsatisfactory and cannot be made satisfactory.


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Delta will pay the applicable percentage of the dentist’s fee for a standard cast chrome or acrylic partial denture or a standard complete denture (a standard complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and that is constructed using accepted and conventional procedures and materials).

If an enrollee selects a more expensive plan of treatment than is customarily provided, or specialized techniques, an allowance will be made for the least expensive, professionally acceptable, alternative treatment plan. Delta will pay the applicable percentage of the lesser fee, and the patient is responsible for the remainder of the dentist’s fee (e.g., a crown where a silver filling would restore the tooth, or a precision denture where a standard denture would suffice).

Periodontal maintenance is a benefit following active periodontal therapy (surgery and/or root planning), provided treatment commences after the first three-month post-operative period. Limited to two per plan year alone or in combination with prophylaxis and/or fluoride procedures.

Nitrous oxide analgesia is limited to cases of medical necessity, such as young children or handicapped patients.


The following list provides some examples of coverage exclusions that may apply to the Delta Dental PPO plans; however, this list is not all-inclusive. Call Delta Dental at 1-800-237-6060 for information about covered expenses and exclusions. For a more detailed list of limitations on basic, major, orthodontic, diagnostic and preventive benefits, see the “Appendix” on page 139.

Ineligible treatments, services, and supplies are:

Charges by any hospital or other surgical or treatment facility and any additional fees charged by the dentist for treatment in any such facility

Crowns, jackets, and cast restorations used to treat cavities that could be restored with amalgam, synthetic, plastic, or resin fillings

Crowns, jackets, and cast restorations to replace a tooth more than once every five years

Diagnostic photos

Applications of fluoride or other anti-cavity substance to adult teeth

Experimental procedures, techniques, or materials that are used by some dentists but have not received the full approval of government, scientific, or dental committees; procedures remain experimental until studies are completed under scientific conditions and published in scientific literature, and when they become part of what is known as “generally accepted dental practice”

Grafting of tissue from outside the mouth to tissue inside the mouth (extraoral grafts)

Orthodontic services, unless you are enrolled in the Dental Care Plus PPO Plan

Post-operative examinations, the removal of stitches, or any other procedure included in the cost of surgery

Repair or replacement of a sealant on any tooth within three years of its application.

Replacement of prosthodontic appliances more than once every five years — unless Delta determines extensive loss of the remaining teeth (or a change in supporting tissues) made the existing appliance unsatisfactory

Services for cosmetic purposes or for conditions that are a result of heredity or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth, and teeth that are discolored or lacking enamel


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Services for injuries covered by workers’ compensation or employer’s liability laws, or services paid for by a federal, state, or local government agency — except Medi-Cal or Medicaid benefits

Services performed by someone other than a dentist, except where performed by a qualified technician under the direction of a dentist

Services that, in the absence of dental coverage, are furnished without cost

Services started before the participant became covered by the Huntington Ingalls Industries, Inc. dental plan

Specialized techniques involving precision attachments, personalization or characterization, and additional charges for adjustments within six months of the installation of prosthetic appliances

Temporary dentures, if billed as a separate item.

Treatment that restores worn tooth structure, rebuilds or maintains chewing surfaces that are damaged because teeth are out of alignment or occlusion, or stabilizes the teeth, such as equilibration and periodontal splinting.

Note that this list provides some examples of coverage limitations; however, this list is not all-inclusive. Call Delta Dental at 1-800-237-6060 for details regarding your specific coverage eligibility.

Filing a Claim

Whether or not you need to file a claim to receive benefits depends on if you used a network dentist.

If you used a network dentist, the dentist will file the claim for you.

If you used an out-of-network dentist, you will pay for your out-of-network care when you receive it, then submit a claim for reimbursement of eligible expenses.

If you have any questions about a claim, you can call the Delta Dental directly. See “Administrative Information” on page 119 for information about how to contact the Delta Dental.


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Vision Coverage

If you wear eyeglasses or contacts, you know how costly vision care can be. In addition to any vision care available as part of your medical plan option, you can elect vision coverage for you and your dependents through Vision Service Plan (VSP).

For more information, contact:

Vision Service Plan Phone: 800-877-7195 www.vsp.com

More Information

You will find information about your vision benefits throughout this SPD:

Eligibility and Enrollment subsection of the Health Care Benefits section – Contains important information about Huntington Ingalls eligibility and enrollment rules for participation in the Vision plan.

Administrative Information section – Contains information about your rights under the Vision plan, including information about the claims appeals process.

Subsection Contents

THE VISION PLAN AT A GLANCE ............................................................................................................................... 73

HOW THE PLAN WORKS .............................................................................................................................................. 73

WHAT THE PLAN COVERS .......................................................................................................................................... 74

EYE EXAMS AND EYE CARE PRODUCTS ............................................................................................................. 74 SAFETY GLASSES OPTION .............................................................................................................................. 74 ADDITIONAL DISCOUNT PROGRAMS ................................................................................................................ 74 PROVIDER DIRECTORIES ................................................................................................................................ 74


HOW TO USE THE VISION PLAN OPTIONS ................................................................................................................ 74

http://teamsites-west.mercer.com/sites/Documentor_HIng_SPD/Shared%20Documents/AppData/Local/Microsoft/Windows/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.Outlook/RO4046FP/www.vsp.com


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The Vision Plan at a Glance

Here’s an overview of the benefits the plan provides if you enroll for vision coverage. For full plan details, refer to the “Appendix” on page 139.

Plan Features Low Option (In-Network)***

Medium Option (In-Network)***

High Option (In-Network)***

Your Cost Out-Of-Network

Eye Exam (once a year) $10 $10 $10 Amount over $40

Eyeglass Frames* $10 plus any amount over $150**

1 every other plan year

$10 plus any amount over $250**

1 every plan year

$10 plus any amount over $250**

2 every plan year

Amount over $45

Eyeglass Lenses** Every plan year Every plan year

Single vision $10 $10 $10 Amount over $40

Lined bifocal $10 $10 $10 Amount over $60

Lined trifocal $10 $10 $10 Amount over $80

Contact lenses (once a year)

Amount over $150 Amount over $200

Amount over $200

Amount over $105

* If you purchase frames and lenses together through a VSP provider, you pay only one $10 copayment.

** You receive 20% – 25% discount through a VSP provider on remaining cost over plan limit, if any.

*** There are Safety Glass feature options available.

How the Plan Works

The Huntington Ingalls Industries, Inc. vision plan option helps you pay for vision exams and corrective eyewear. Each time you need care, you can choose to see a provider who participates in the provider network or any licensed

provider outside the network but you will save money when you access care from a network provider.

Vision Service Plan (VSP) administers the plan and the network of vision care providers. VSP has one of the nation’s largest networks of vision care providers, so finding a participating provider is easy in most locations. To locate a VSP provider, call VSP at 1-800-877-7195 or go to the VSP Web site, which is accessible from the Provider Links at www.hiibenefits.com.

Vision Service Plan (VSP) is the provider network.

Choose the Low, Medium or High option or the Safety Glass options.

You don’t have to use VSP network providers, but you’ll get discounts and higher benefits when you do.

Network providers will file the claim for you.

If you decide to participate in the vision plan, you select an optical provider from the VSP network optical provider list, or by calling VSP. Then, call the provider and make an appointment. Your optical provider will discuss the results of your eye examination and review your eyewear options. You and each of your covered family members can use the plan to choose lenses, frames or contact lenses as frequently as permitted by your plan option.



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What the Plan Covers

You and each of your covered family members can use the vision plan to receive eye exams, lenses and frames or contact lenses.

Eye Exams and Eye Care Products

Complete eye exams include refraction and a prescription for lenses. Contact lens examinations may require additional fees. Your doctor also may recommend additional procedures (such as dilation). You are responsible for the full cost of these additional procedures.

Safety Glasses Option

With the Low, Medium or High option, you can elect to purchase the additional safety glasses coverage option. This benefit provides coverage for Protec Prescription Safety Glasses through in-network providers. The plan covers one pair of safety glasses every plan year in full with $10 copay. This benefit is available to employees and covered spouses only and includes:

Necessary corrective lenses (i.e. single vision, bifocal, trifocal or other more complex lenses) in polycarbonate is covered in full

Minimum prescription of +/- .50 diopter required

Lenses must be tested and certified as meeting current American National Standards Institute (ANSI) standards for safety.

Additional Discount Programs

The vision plan provides the following discounted services through VSP providers:

Additional Complete sets of eyeglasses -- Receive a 20-25% discount on unlimited additional pairs of prescription glasses and non-prescription sunglasses (when purchased from a VSP provider on the same day as the member’s eye exam)

Laser Vision Care Program (PRK and LASIK) -- You receive a 15% discount on contracted laser center’s fees or 5% on promotional prices, whichever gives you the lesser cost.

Provider Directories

You may access provider directories on the VSP website at www.vsp.com.


For a full list of limitations on vision services and supplies, see the “Appendix” on page 139.

How to Use the Vision Plan Options

If you want to access services from a VSP provider, follow these steps:

1. Select and contact a VSP provider by calling VSP at 1-800-877-7195 or by going to the VSP Web site at www.vsp.com. This link is also accessible from the Provider Links at www.hiibenefits.com.

2. When you go to the provider’s office, identify yourself as a VSP member. Your provider will verify your eligibility directly with VSP (you will not receive a VSP ID card).

3. Pay the applicable copayment and any additional costs not covered by the plan directly to the provider.

http://www.vsp.com/

http://www.vsp.com/



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If you want to access services from a vision care provider who does not participate in the VSP network, follow these steps:

1. Pay the full cost of your services to the provider at the time of service and keep a copy of the itemized receipt.

2. For reimbursement of your eligible expenses, complete and file a VSP claim form with VSP within six months of receiving the services. You can do this electronically at the VSP Web site, which is accessible from the Provider Links at www.hiibenefits.com (at the VSP site, go to Benefits & Claims > Claims & Reimbursement > How to Submit an OON Claim > Start New Claim).

If you do not have Internet access, send the following to VSP:

An itemized receipt listing the services received and include a completed claim form, or

The name, address and phone number of the out-of-network provider

The last four digits of the member’s ID number, name, address, phone number, and employer (Huntington Ingalls Industries, Inc.)

The patient’s name, date of birth, address, and phone number

The patient’s relationship to the covered member, such as “self,” “spouse,” “child.”

Keep a copy of the claim information and send the originals to: VSP, P.O. Box 997105, Sacramento, CA 95899-7105.



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Flexible Spending Accounts

Flexible spending accounts (FSAs) allow you to set aside pre-tax dollars to use for eligible health and/or dependent care expenses. The following types of FSAs are available:

Health care flexible spending accounts (FSA)

Dependent care flexible spending account (FSA).

You can enroll in one or both of the FSAs — or you can choose not to participate when you are first hired and during annual enrollment. Your choice remains in effect for the entire benefit plan year, and you cannot make changes until the next annual enrollment, unless you experience a qualified life event. (See “Continuing Your Coverage” on page 21 for details.)

For more information about the flexible spending accounts contact the Plan Administrator:

Your Spending Account (YSA™) Phone number: 1-877-216-3222 Website: www.hiibenefits.com, Click on “UPoint Log On”

More Information

You will find information about your flexible spending account benefits throughout this SPD:

Eligibility and Enrollment subsection of the Health Care Benefits section – Contains important information about Huntington Ingalls eligibility and enrollment rules for participation in the Health Care FSA.

Administrative Information section – Contains information about your rights under the health care FSA, including information about the claims appeals process.

“Continuing Your Coverage” in the Eligibility and Enrollment subsection – Contains information about your right to continue your health care FSA participation under COBRA.

Section Contents

HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA) PLAN ................................................................................ 77

THE HEALTH CARE FLEXIBLE SPENDING ACCOUNT AT A GLANCE ........................................................................... 77 HOW THE HEALTH CARE FSA WORKS ............................................................................................................. 77 ELIGIBLE EXPENSES ...................................................................................................................................... 78

Expenses Eligible for Reimbursement under Health Care FSA ......................................................... 78 PAYING FOR ELIGIBLE EXPENSES ..................................................................................................................... 80 ADDITIONAL RULES ...................................................................................................................................... 81

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT .............................................................................................. 83

THE DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT AT A GLANCE...................................................................... 83 HOW THE DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT WORKS ..................................................................... 83

Eligible Dependents ......................................................................................................................... 84 ELIGIBLE EXPENSES ...................................................................................................................................... 84 PAYING FOR ELIGIBLE EXPENSES ..................................................................................................................... 85 ADDITIONAL RULES ...................................................................................................................................... 86



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Health Care Flexible Spending Account (FSA) Plan

If you choose to participate in a health care flexible spending account (FSA) plan you set aside a certain amount of money for qualified health care expenses from your paycheck before federal income taxes and Social Security taxes are withheld. This reduces your taxable income, and therefore the amount of income taxes you pay.

The Health Care Flexible Spending Account at a Glance

Who’s Eligible You can elect to participate in the health care FSA provided you meet the eligibility requirements outlined in “Eligibility” on page 11.

Plan Year Use money for expenses incurred during the plan year (July 1 through June 30) or applicable grace period (2 months and 15 days after the end of each plan year). Any remaining balances after the end of the calendar year will be forfeited.

Employee Pre-Tax Contribution Limit

$2,750**

Eligible Expenses Medical, dental, vision and pharmacy expenses (including eligible over-the-counter medicines and medically necessary health care products)

Debit Card Yes, you will automatically receive a YSA™ debit card to pay for eligible expenses.

Save Receipts Yes, to get reimbursed for your eligible expenses you must save your receipts.

** This is the contribution limit for 2020. Please note that this limit may be adjusted for cost of living in future years.

How the Health Care FSA Works

You can use the health care flexible spending account (FSA) for most health care expenses that are considered eligible medical expense deductions on your federal income tax return, but are not reimbursed by another health plan. For example, you can use the account for your out-of-pocket costs, including deductibles, coinsurance, and copayments.

You can use the account to reimburse you for eligible medical expenses even if you are not enrolled for medical, dental, or vision coverage. For example, even if you do not have vision coverage in a vision plan, you can submit your expenses for vision exams, eyeglasses, contact lenses, and vision correction laser surgery.

Note: Your premium contributions for coverage under the Huntington Ingalls Industries Health Plan are not eligible for reimbursement through the health care FSA because your premium payments are already made on a before-tax basis.

Eligible health care expenses can be for:

You

Your spouse

Any person you claim as a dependent on your tax return


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Any person you could have claimed as a dependent on your tax return except that:

The person filed a joint return,

The person had gross income of $4,150 or more, or

You, or your spouse if filing jointly, could be claimed as a dependent on someone else's return.

Your biological child, adopted child, stepchild or foster child who is under age 27 at the end of your tax year

You can contribute from $0 to $2,750 each year (based on current IRS guidelines, which may be adjusted annually for cost of living increases) to a health care flexible spending account. To determine your per-paycheck deduction, simply divide the annual amount you want to deposit by the number of pay periods from which benefit deductions are made during in the year (e.g., 12 for monthly, 52 for weekly).

Although your health care FSA will save you money by lowering your federal taxable income (and in most cases state and local taxable income), you may not take a deduction on your income tax return for health care expenses reimbursed through your account. Since you are responsible for the tax consequences of using an FSA, you should consider discussing your personal financial situation with a tax advisor before you enroll in a health care FSA. You cannot use funds from your health care FSA to pay for Dependent Care FSA expenses and vice versa. You cannot switch money from one fund to another.

Eligible Expenses

There are many health care expenses that currently qualify for reimbursement from a health care FSA. In general, an eligible health care expense meets all the following requirements:

Is incurred during the plan year (or applicable grace period) for which you are participating

Is not paid or reimbursed by a health plan or any insurance

Is eligible for deduction as a medical expense on your federal income tax return. However, some expenses may be eligible for deduction on your tax return, but are not eligible under the health care FSA and vice versa.

Some examples of eligible health care expenses include your medical, dental and vision plan deductibles, coinsurance and copayment amounts, as well as expenses that are not covered at all, such as charges that exceed the Plan’s limits.

There are other health care expenses considered eligible under Internal Revenue Service guidelines. Below is a partial list of eligible health care expenses. In reviewing the list, keep in mind that it is subject to change.

Also keep in mind that the list is not all-inclusive. You can obtain Publications 969 and 502 from your local IRS office or the IRS web site at www.irs.gov for further information on health care expenses that are eligible for reimbursement from a health care FSA, or you can view a comprehensive list of eligible expenses by logging into your YSA account.

Expenses Eligible for Reimbursement under Health Care FSA

Chiropractor

Physical therapist

Physician (including podiatrist and osteopath) and dentist

Practical or other nonprofessional nurse, for medical services only (not for care of a healthy person)

Psychologist and psychoanalyst (medical care only)

http://www.irs.gov/


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Equipment and Supplies

Athletic treatments/braces

Car modifications (as required for a diagnosed medical condition)

Contact lenses and solutions

Eyeglasses (prescription)

Hearing aids and batteries

Home modifications (as required for a diagnosed medical condition)

Orthodontia (braces and retainers)

Orthopedic and surgical supports

Orthopedic shoes and inserts

Oxygen received for a medical condition

Prescription drugs and insulin

Wheelchair and repairs

Over-the-Counter Products

The following over-the-counter products will continue to be available without a doctor’s prescription to the extent allowed by Internal Revenue Service (IRS) guidance*:

Bandages and related items

Braces and supports

Family planning (birth control, pregnancy tests, ovulation predictor kits)

First-aid kits

Insulin and diabetic supplies

Reading glasses

Sleep aids and sedatives

Walking aids

* IRS guidance is evolving so this list may change over time.

Products that require a Prescription Form

Antacid

Antibiotic ointment

Aspirin or other pain reliever

Allergy and sinus medications

Alternative dietary supplements

Cold sore remedies

Cough, cold and flu products


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Dental and teething pain products

Diaper rash and ointments

Eye drops and treatments

Motion sickness medication

Nasal sprays

Smoking cessation products

Medical Treatments

Acupuncture

Eye surgery, including surgeries to correct vision defects

Sterilization

Treatment for infertility

Vasectomy

Miscellaneous

Braille books (excess cost of Braille books over cost of regular edition)

Nursing services (wages and taxes)

Premiums for individual medical insurance policies

Room and board charges for a sanitarium and similar institutions

Guide dog (dog, training, care)

Special school costs for physically and mentally handicapped children

Weight loss program (for treatment of a medical condition)

Paying for Eligible Expenses

There are a few ways you can use your health care FSA funds to pay for eligible expenses:

When you enroll in a health care FSA, you will receive a YSA debit card. You can use this card just like a bank card. Just swipe and go. The payment is drawn directly from your health care FSA.

Reimbursement option—if you are unable to use your debit card, you will need to file a claim for reimbursement from your account. You will be reimbursed for eligible expenses in one of two ways:

Have a check mailed directly to your provider; or

Have your reimbursements mailed directly to your home or deposited directly into your bank account through direct deposit. Note: You must set up the direct deposit from your YSA online account in order to use this option.


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How the YSA Debit Card Works

Your YSA debit card will be automatically mailed to you when you elect to participate in the health care FSA. You can use your card to pay for eligible expenses and products on the same day you receive them. While most transactions are automatically verified, the card is regulated by IRS rules. The easiest way to comply with IRS rules when using your card is to save your receipts. Every time you use your card, make sure you get a receipt.

How to File a Claim for Reimbursement

If you are unable to use your YSA debit card for health care expenses, you can file a claim for reimbursement. When you incur an eligible expense, you pay the provider and submit a claim form along with your receipts. Claim forms are available through the YSA Service Center. Health care claims are reimbursed based on your annual contribution amount. You will be reimbursed through direct deposit with tax-free dollars from your account.

To submit a claim from your YSA online account, go to www.hiibenefits.com, click on “UPoint Log On” and visit the Reimbursements Account page. You can also log on to your account through the YSA mobile app.

Select the “Get Reimbursed” tab in the Your Accounts section of home page (or “Get Reimbursed” from the drop down menu if using the Take Action tab).

Create Claim Step 1: Choose Account Type: Health Care, type of expense, date of service, and requested amount

Create Claim Step 2: Enter Service Provider and dependent name. Then elect Pay Me Directly or Pay My Provider (requires account number for this option)

Create Claim Step 3: Sent receipts — Choose from Upload, Fax/Mail, or Send Later

Create Claim Step 4: Review Claim Information – Hit submit at the bottom of page

Create Claim Step 5: Print cover sheet or upload documents.

Along with the claim form, you will need to provide documentation to verify that the expense is eligible, such as an itemized receipt or explanation of benefits (EOB). Your documentation must include:

Name of service provider or retailer

Date of service or purchase

Identification of drug or product, or description of service

Purchase amount for each product or service

Total purchase amount.

Your claim should be processed within one to two business days after it is received and verified. Payments are sent shortly thereafter.

Additional Rules

Deadline for Filing

You will be reimbursed for expenses incurred during the plan year (July 1 through June 30) or applicable grace period (2 months and 15 days after the end of each plan year). You have until the end of the calendar year to submit your request for reimbursement of these expenses.

For information on continuing your health care FSA after you become ineligible (for example, upon termination of employment), please see “Continuing Your Coverage” on page 21.



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Use It or Lose It

In exchange for the health care FSA tax benefits, the Internal Revenue Service (IRS) has strict rules governing the operation of an FSA. One of these is the “use it or lose it” rule, which states that any money remaining in your account after you submit all claims for the plan year and grace period is forfeited. Keep in mind that you have until the end of the calendar year (December 31 – the “run out” period) to submit claims for eligible health expenses incurred during the applicable plan year and/or grace period. Furthermore, you cannot transfer money between your health care and dependent care flexible spending accounts.

Forfeited amounts may be used to pay reasonable administrative costs of the plan. Because of these IRS rules, it is important that you carefully estimate the amount of eligible expenses you are likely to incur in a given year.

Remember - A run out period and grace period are two separate and distinct things. A run out period is a period following the end of the plan year during which expenses incurred during the previous plan year may be submitted for reimbursement. A grace period is a period following the end of the plan year during which expenses incurred may be reimbursed with contributions from the prior year.

Example: For the July 1, 2020 – June 30, 2021 plan year, you may submit claims for eligible health expenses incurred during the plan year and during the grace period (i.e., July 1, 2021 – September 15, 2021). You have until December 31, 2021 to submit claims incurred during these periods; after December 31, 2021, you will forfeit any balance remaining after subtracting all timely claims for eligible health expenses incurred during the plan year and/or grace period.

Eligible health expenses incurred during a grace period and approved for reimbursement will be paid first from available amounts that were remaining at the end of the preceding plan year and then from any amounts that are available to reimburse expenses incurred during the current plan year.

Example: Assume that you have $50 remaining in your health care FSA at the end of the 2020-2021 plan year. On July 15, 2021, you incur an eligible health expense of $150 and properly submit a claim for such expense. Your $50 balance from the 2020-2021 plan year is applied to reduce the outstanding balance of the expense to $100, and $100 is deducted from your current plan year balance to pay the rest of the expense.

Health Care FSA and Anthem Consumer Driven Health Plan (CDHP)

Medical expenses eligible for reimbursement through the Anthem CDHP option and your HRA must first be submitted to Anthem for payment. Only if these expenses are not reimbursable from the Anthem CDHP option are they eligible to be reimbursed from your Health Plan FSA. Charges not reimbursed, such as Bridge amounts and coinsurance, may be eligible for reimbursement from your Health Plan FSA, if they are not reimbursable from any other source.

Health Care FSA vs. Tax Deduction

Even though the health care flexible spending account (FSA) reimbursements can reduce your taxable income, the federal income tax deduction might provide greater savings for some employees. To claim such a deduction, your health care expenses must exceed a certain percentage of your adjusted gross income. Most employees find that their eligible health care expenses do not reach that amount. However, you should consult with your tax advisor to determine which method is best for your personal situation.


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Federal tax law allows you to use the dependent care flexible spending account for charges relating to care for an eligible dependent that are incurred to enable you – and your spouse, if you are married – to be gainfully employed or to look for work.

The Dependent Care Flexible Spending Account at a Glance

Who’s Eligible You may establish a Dependent Care FSA if you incur certain dependent care expenses that are necessary for your eligible dependents so you can work. (Refer to Eligible Dependents for more details)

Portability Use money for expenses incurred during the plan year (July 1 through June 30) or applicable grace period (2 months and 15 days after the end of each plan year). Unused dollars will be forfeited.

Employee Pre-Tax Contribution Limit

$5,000 (or $2,500 if married filing separate federal tax returns)

Eligible Expenses Licensed day care centers, day camps, home care and nursery school for children not yet in first grade, elder care and other related services to help care for your qualifying dependent.

Debit Card No

Save Receipts Yes, to get reimbursed for your eligible expenses you must save your receipts.

How the Dependent Care Flexible Spending Account Works

The dependent care flexible spending account (FSA) allows you to use before-tax dollars to pay for eligible dependent care expenses for a child, an incapacitated spouse, an elderly parent (who resides with you) or any other individual who qualifies as your dependent for federal tax purposes and who is unable to care for him/herself.

The Dependent Care FSA cannot be used to pay for your dependents’ health care expenses – the health care FSA plan is designed for those expenses.

If you elect to participate, you can set aside $0 up to $5,000 each year (depending on your marital status, your annual income and the way you file your income tax return).

The amount you can deposit to a Dependent Care FSA account may also be limited due to requirements that contributions not discriminate in favor of highly compensated or key employees. Once your contributions reach the maximum allowed, your contributions will automatically stop. For purposes of calculating your maximum contribution, if your spouse is a full-time student, or mentally or physically incapable of self-care, tax laws allow you to assume your spouse’s earned income to be $250 a month if you have one eligible dependent, or $500 a month if you have two or more eligible dependents.

Tax Considerations

Although the Dependent Care FSA can save you money by lowering your taxable federal income (and, in most cases, your state and local taxable income as well), it is important to note that the IRS will not allow you to take the federal Dependent Care Tax Credit on your personal income tax return for expenses already reimbursed through your account.


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You should determine whether the federal Dependent Care Tax Credit or the Dependent Care FSA is better for you. Keep in mind that the maximum amount of dependent care expenses that can be used in calculating your federal Dependent Care Tax Credit is $3,000 for one qualifying individual and $6,000 for two or more. The Dependent Care FSA permits reimbursements of up to $5,000, even if you have only one qualifying individual.

In some cases, you may be able to use both the Tax Credit and the Dependent Care FSA. Again, keep in mind that any dependent care expenses otherwise eligible for the federal Dependent Care Tax Credit will be reduced, dollar for dollar, by the amounts you receive from your Dependent Care FSA.

Since you are responsible for the tax consequences of using an FSA, you should consider discussing your personal financial situation with a tax advisor before you open a Dependent Care FSA account.

Eligible Dependents

You may establish a Dependent Care FSA account if you incur eligible dependent care expenses that are necessary for your eligible dependents so you can work. If you are married, the expenses must be necessary so that both you and your spouse can work, unless your spouse is incapable of self-care, or so that your spouse can attend school on a full-time basis. Your eligible dependents include:

Your dependent child who is under the age of thirteen (13) that you are entitled to receive an income tax deduction for under the Code

Your dependent child or spouse who is physically or mentally unable to care for himself or herself and who has the same principal place of abode as you for more than one-half of the plan year

Your dependent, as generally defined by IRS rules per section 152 of the Internal Revenue Code, who is physically or mentally incapable of caring for himself or herself and who has the same principal place of abode as the participant for more than one-half of the plan year

Eligible Expenses

Federal tax law allows you to use the Dependent Care FSA for charges relating to the care of an eligible dependent that are incurred to enable you, and your spouse, if you are married, to be gainfully employed or to look for work.

Eligible dependent care expenses can include:

Babysitting (work-related, in your home or someone else’s home)

Before or after school programs

Elder care

Expenses for household services related to care of an eligible dependent

Payroll taxes related to eligible care

Nursery schools and day care centers that meet local regulations and provide care for more than six non-resident people and receive fees for services provided

Summer day camps

Transportation to and from eligible care

To be eligible, expenses must have been incurred during the plan year (or applicable grace period) and while you were covered under the plan. An expense is considered incurred when the care or service is provided – not when your provider issues a bill, nor when you receive or pay that bill.


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If the care is provided in your home or the home of another person, the care provider must not be claimed as a dependent on your tax return and must be age 19 or older (determined as of the close of the taxable year). An adult dependent must spend at least 8 hours a day in your home in order for expenses for caring for that person to be eligible. Services must be for the physical care of the child, not for education, meals, etc., unless incidental to the cost of care.

The Dependent Care FSA account cannot be used to pay for the care of someone who lives in a nursing home or other residential facility.

When filing your tax return, you will need to provide the taxpayer ID number or Social Security number of the caregiver.

Paying for Eligible Expenses

When you incur an eligible expense, you pay the provider and submit a claim form along with your receipts. Claim forms are available through the YSA Service Center. For the Dependent Care FSA, you will be reimbursed up to the amount of your current account balance. You will be reimbursed through direct deposit with tax-free dollars from your account.

To submit a claim from your YSA online account, visit www.hiibenefits.com, click on “UPoint Log On” (or through the mobile app), and go to the Reimbursements Account page.


Create Claim Step 1: Choose Account Type: Dependent Care, type of expense, date of service, and requested amount

Create Claim Step 2: Enter Service Provider and dependent name. Then elect Pay Me Directly or Pay My Provider (requires account number for this option)

Create Claim Step 3: Sent receipts – Choose from Upload, Fax/Mail, or Send Later

Create Claim Step 4: Review Claim Information – Hit submit at the bottom of page

Create Claim Step 5: Print cover sheet or upload documents.

Along with the claim form, you will need to provide documentation to verify that the expense is eligible, such as an itemized receipt. Your documentation must include:

Name of service provider or retailer

Date of service or purchase

Description of service

Purchase amount for each product or service

Total purchase amount.

Your claim should be processed within one to two business days after it is received and verified. Payments are sent shortly thereafter.



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How the Pay My Provider Option Works

To arrange to pay your dependent care providers directly from your FSA for your eligible expenses, log into your YSA account online or through the mobile app. If this is your first time logging into your account, be sure to register for your account.

Once you’ve logged in to your YSA online account:


Create Claim Step 1: Choose Account Type: Dependent Care. Choose service begin and end date and requested amount

Create Claim Step 2: Enter service provider and dependent name. Pay My Provider (requires an account number for this option along with address, city, state, ZIP)

Create Claim Step 3: Send supporting documents.

This allows for the service provider signature (this can be done via mobile app where the provider can enter their signature on phone) this limits the need for receipts or they can choose the Send receipts option

Create Claim Step 4: Review Claim Information – Hit submit at bottom

Create Claim Step 5: Print cover sheet which is a dependent certification form.

Additional Rules

Deadline for Filing

You will be reimbursed for expenses incurred during the plan year (July 1 through June 30) or applicable grace period (2 months and 15 days after the end of each plan year) but you have until the end of the calendar year to submit your request for reimbursement of these expenses.

If you terminate employment or otherwise become ineligible to participate in the Dependent Care FSA, you will be reimbursed for dependent care expenses incurred up to the date on which you became ineligible to participate, but only up to the amount you had deposited in your account as of your date of termination or other cause of ineligibility, less any prior reimbursements. You have until the end of the calendar year to submit your request for reimbursement of such expenses.

Use It or Lose It

In exchange for the tax benefits, the Internal Revenue Service (IRS) has strict rules governing the operation of FSA(s). One of these is the “use it or lose it” rule, which states that any money remaining in your account(s) after submitting all claims for the plan year and grace period is forfeited. Keep in mind that you have until the end of the calendar year (December 31 – the “run out" period) to submit claims for dependent care expenses incurred during the previous plan year and/or applicable grace period.

Forfeited amounts may be used to pay reasonable administrative costs of the Plan. Because of these IRS rules, it is important that you carefully estimate the amount of eligible expenses you are likely to incur in a given year.

Remember - A run out period and grace period are two separate and distinct things. A run out period is a period following the end of the plan year during which expenses incurred during the previous plan year may be submitted for reimbursement. A grace period is a period following the end of the plan year during which expenses incurred may be reimbursed with contributions from the prior year.


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In order to take advantage of the grace period, you must be a participant in the Plan with Dependent Care FSA coverage that is in effect on the last day of the plan year to which the grace period relates (i.e., June 30).

Example: For the July 1, 2020 – June 30, 2021 plan year, you may submit claims for eligible dependent care expenses incurred during the plan year and during the grace period (i.e., July 1, 2021 – September 15, 2021). You have until December 31, 2021 to submit claims incurred during these periods; after December 31, 2021, you will forfeit any balance remaining after subtracting all timely claims for eligible dependent care expenses incurred during the plan year and/or grace period.

Eligible dependent care expenses incurred during a grace period and approved for reimbursement will be paid first from available amounts that were remaining at the end of the preceding plan year and then from any amounts that are available to reimburse expenses incurred during the current plan year.

Example: Assume that you have $50 remaining in your Dependent Care FSA at the end of the 2020-2021 plan year. On July 15, 2021, you incur an eligible dependent care expense of $150 and properly submit a claim for such expense. Your $50 balance from the 2020-2021 plan year is applied to reduce the outstanding balance of the expense to $100, and $100 is deducted from your current plan year balance to pay the rest of the expense.


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Disability Benefits

Huntington Ingalls provides you with a level of financial protection against a substantial economic loss should you become unable to work due to a disability. Disability benefits are designed to provide assurance that you will continue to have income during certain periods of illness or injury when you cannot work.

In the event that you are unable to work due to a disability, the Plan offers benefits that provide you with a source of income during that time.

The Company provides the following benefits at no cost to you:



In addition, you can elect to purchase additional coverage:



If you become disabled due to an occupational illness or injury, you may be entitled to benefits from Workers’ Compensation. For more information, contact your business unit’s Workers’ Compensation representative.

More Information

Administrative Information section – Contains information about your rights under the disability plans, including information about the claims appeals process.

Section Contents

SHORT-TERM DISABILITY ........................................................................................................................................... 89

SHORT-TERM DISABILITY AT A GLANCE ............................................................................................................ 89 ELIGIBILITY AND PARTICIPATION ..................................................................................................................... 89

Eligibility .......................................................................................................................................... 90 Enrollment ....................................................................................................................................... 90

HOW THE PLAN WORKS ............................................................................................................................... 90 What’s Not Covered ........................................................................................................................ 90

WHEN YOU ARE CONSIDERED DISABLED.......................................................................................................... 91 Leaves of Absence ........................................................................................................................... 91

WHEN COVERAGE ENDS ............................................................................................................................... 92

LONG-TERM DISABILITY ............................................................................................................................................. 93

LONG-TERM DISABILITY AT A GLANCE ............................................................................................................. 93 ELIGIBILITY AND PARTICIPATION ..................................................................................................................... 93

Eligibility .......................................................................................................................................... 93 Enrollment ....................................................................................................................................... 93

HOW THE PLAN WORKS ............................................................................................................................... 94 What’s Not Covered ........................................................................................................................ 94

WHEN COVERAGE BEGINS ............................................................................................................................ 95 WHEN COVERAGE ENDS ............................................................................................................................... 95


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Short-Term Disability

Short-Term Disability can help protect you from financial loss if you have a non-work related illness or injury (including pregnancy) that keeps you from performing your job.

Note that for some business units, short-term disability supplements workers’ compensation benefits. Contact your business unit’s Leave of Absence representative for more information.

Short-Term Disability at a Glance

Benefits are paid if you can’t work due to an approved illness, injury or pregnancy.

You can choose from two coverage options – basic coverage or optional coverage.

The amount paid to you is based on how long you remain disabled and your weekly earnings (see the chart below for details).

Benefits begin once you have been continuously disabled through an elimination period and continue for up to 26 weeks. The elimination period is seven days and will end on the day before you are confined as an inpatient in a hospital because of your disability and a room and board charge is made.

If you receive other disability benefits, such as Social Security or state disability, your Huntington Ingalls disability benefits will be reduced if the disabling condition remains the same. Note that the disabling condition does not need to remain the same for purposes of workers’ compensation benefits.


Basic Short-Term Disability (STD) Insurance



Optional Short-Term Disability (STD) Insurance




Note that after you satisfy the elimination period, if you are disabled for less than one week, your benefit will be 1/7 of your weekly benefit amount for each day of disability.

Eligibility and Participation

Basic short-term disability (STD) insurance is provided by Huntington Ingalls to eligible employees at no cost. You can elect to purchase optional short-term disability coverage.


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Eligibility

You are eligible for the STD plan if you are an active non-represented employee working at least 20 hours a week.

If you are entitled to receive other disability benefits, such as Social Security or state disability, these will be deducted from your gross disability payment.

Enrollment

All eligible employees are automatically enrolled for basic short-term disability insurance. The Company pays the full cost of this coverage. You can elect to purchase optional short-term disability coverage as of your eligibility date, or during the annual enrollment period each year.

Process for Requesting Leave

In the event that you become disabled and are eligible for benefits, please contact your business unit’s Leave of Absence administrator who can assist you on how to file a claim with the disability administrator. In addition, you must notify your Manager. You should provide 30 days advance notice of the need to take leave when the need is foreseeable, when a 30-day notice is not possible, you should provide notice as soon as practicable. To file a claim you should contact Prudential at 1-800-842-1718.

How the Plan Works

If you continue to be disabled past the elimination period (i.e., an absence of seven continuous calendar days), the STD plan will provide you with income up to the maximum payment period.

Your coverage is based on how long you remain disabled and your weekly earnings.

Note that after you satisfy the elimination period, if you are disabled for less than one week, your benefit will be 1/7 of your weekly benefit amount for each day of disability.


The plan does not cover any disabilities caused by, contributed to by, or resulting from your:

Intentionally self-inflicted injuries;

Active participation in a riot;

Elective treatment or procedure that is not medically necessary unless due to an organ transplant; or

Commission of a crime for which you have been convicted under state or federal law.

In addition, the plan does not cover a disability due to war, declared or undeclared, or any act of war.

Weekly Earnings

For purposes of your STD benefits, your weekly earnings means your gross weekly income in effect just prior to your date of disability. It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than the Company.


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When You Are Considered Disabled

Under the plan, you can continue to receive a portion of your income if you are disabled as a result of a disabling illness or injury and you have met the elimination period, provided that your claim for benefits is approved by Prudential.

You are disabled when:

You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury;

You are under the regular care of a doctor; and

You have a 20% or more loss in weekly earnings due to the same sickness or injury.

The loss of a professional or occupational license or certification does not, in itself, constitute disability.

The plan will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from:

Your doctors; and

Specified doctors, other medical practitioners or vocational experts.

When the plan requires you to be examined by specified doctors, other medical practitioners or vocational experts, the Company will pay for these examinations. The insurance provider may require examinations as often as it is reasonable to do so. The insurance provider may also require you to be interviewed by an authorized Representative. Refusal to be examined or interviewed may result in denial or termination of your claim.

Reoccurring Disability

If you return to work and have a disability that is related or due to the same cause(s) as your prior disability for which you received a payment, your current disability will be treated as part of your prior claim and you will not have to complete another elimination period. However, you must have returned to active employment on a full-time basis for a period of 30 consecutive days or less. Your disability will be subject to the same terms of the plan as your prior claim.

If your current disability is unrelated to your prior disability for which you received a payment, it will be treated as a new claim and you will have to complete another elimination period. Your disability will be subject to all of the plan provisions.

Leaves of Absence

If you are on an approved leave of absence, continuation of coverage will depend on the type of leave as follows:

If you are on a furlough or temporary layoff, and if any required contribution is paid, you will be covered to the end of the month, plus one month following the date your temporary layoff begins.

If you are on a medical leave of absence, and if any required contribution is paid, you will be covered to the end of six months following the date your leave of absence begins.

If you are on a personal or educational leave of absence, and if any required contribution is paid, you will be covered to the end of the month, plus one month following the date your leave of absence begins.

If you are on a military/mobilization leave of absence, coverage terminates on the date your leave of absence begins.

If you are on a family care leave of absence, and if any required contribution is paid, you will be covered to the end of the month, plus four months following the date your leave of absence begins.


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When Coverage Ends

Your coverage under the STD plan ends on the earliest of:

The date the plan is terminated;

The date you no longer meet the eligibility requirements;

The last day of the period for which you made any required contributions;

The last day you are in active employment, unless you are eligible for continuation of coverage during an approved leave of absence; or

The date you are no longer in active employment due to a disability that is not covered under the plan.

More Information

For more details about short-term disability benefits, please refer to the summary of coverage in the “Appendix” on page 139.


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Long-Term Disability

Long-Term Disability (LTD) benefits may replace a portion of your salary after STD benefits end.

Long-Term Disability at a Glance

Benefits are paid if you cannot work due to an approved illness or injury*.

Basic LTD replaces up to 50% of your monthly earnings (up to a maximum of $15,000) and is provided at no cost to you.

You may purchase optional LTD insurance which replaces up to 60% or 70% of your monthly earnings (up to a maximum of $15,000). You contribute towards the cost of optional LTD coverage.

Benefits begin after 180 days of disability.

LTD benefits are subject to pre-existing condition limits, and benefits are reduced if they begin after age 60.

If you receive other disability benefits, such as Social Security or state disability, your Huntington Ingalls Disability benefits will be reduced.

* Payment is subject to approval by Prudential.


Basic Long-Term Disability (LTD) Insurance


Provides up to 50% of your monthly earnings (rounded to the nearest $1), up to a maximum of $15,000.

Optional LTD Insurance You need to elect coverage




Eligibility and Participation

Basic long-term disability (LTD) insurance is provided by Huntington Ingalls to eligible employees at no cost to the employee. If you elect optional LTD coverage, you contribute towards the cost.

Eligibility

You are eligible for the LTD plan if you are a non-represented employee working at least 20 hours a week.

Enrollment

All eligible employees are automatically enrolled for basic long-term disability insurance, unless you elect optional LTD coverage.

You can enroll in optional LTD during annual enrollment or within 31 days of becoming eligible.


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If you elect optional LTD coverage when you are first eligible, you will not be required to provide Evidence of Insurability (EOI). If you waive coverage when first eligible and decide to enroll at a future date, or if you elect to increase your coverage by more than one level, EOI is required.

Process for Requesting Leave

In the event that you become disabled and are eligible for LTD benefits, please contact your business unit’s Leave of Absence Administrator. To file a claim you should contact Prudential at 1-800-842-1718. Please note that if you are being paid short-term disability by Prudential, they will refer your claim to an LTD claim manager two months prior to the date your STD benefits are scheduled to end.

How the Plan Works

Below is a summary of how LTD works.

Basic LTD Optional LTD

Monthly benefit Provides up to 50% of your monthly earnings (rounded to the nearest $1), up to a maximum of $15,000.



Tax status Disability benefits are taxable when you receive them.

Because you pay for LTD Plus coverage on an after-tax basis, the additional 10% or 20% benefit is not taxable when you receive it.

Duration of Benefit As long as you are disabled (generally, up to age 65)


The LTD plan does not cover any disabilities caused by, contributed to by, or resulting from your:

Intentionally self-inflicted injuries;

Active participation in a riot; or

Commission of a crime for which you have been convicted under state or federal law.

The LTD plan does not cover a disability due to a pre-existing condition.

In addition, the plan does not cover a disability due to war, declared or undeclared, or any act of war.

Note that the pay period is limited for certain types of disabilities.

Pre-Existing Conditions

You are considered to have a pre-existing condition if:

You received medical treatment, consultation, care or services, including diagnostic measures, or took prescribed drugs or medicines, or followed treatment recommendation in the 3 months just prior to your effective date of coverage or the date an increase in benefits would otherwise be available, and


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Your disability begins within 12 months of the date your coverage under the plan becomes effective.

If there is an increase in your benefits due to an amendment of the plan or your enrollment in another plan option, a benefit limit will apply if your disability is due to a pre-existing condition.

You will be limited to the benefits you had on the day before the increase. The increase will not take effect until your disability ends.


After you have experienced 180 days of continuous disability, LTD benefits begin. You will be considered “totally disabled” if, during the first 24 months that benefits are payable, Prudential determines that:

You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and

You are under the regular care of a doctor; and

You have a 20% or more loss in your monthly earnings due to that sickness or injury.

After 24 months of payments, you are disabled when Prudential determines that due to the same sickness or injury:

You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience; and

You are under the regular care of a doctor.

The loss of a professional or occupational license or certification does not, in itself, constitute disability. Prudential will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from:

Your doctors; and

Doctors, other medical practitioners or vocational experts of our choice.

Prudential may require you to be examined by doctors, other medical practitioners or vocational experts of their choice and Prudential will pay for these examinations. The plan can require examinations as often as it is reasonable to do so during the pendency of claim. You may be required to be interviewed by an authorized Prudential Representative. Refusal to be examined or interviewed may result in denial or termination of your claim.

You will receive the first monthly benefit one month after the date benefits begin to accrue. Subsequent payments will be made monthly thereafter so long as you are disabled.

When Coverage Ends

Your coverage under the LTD plan ends on the earliest of:

The date the plan is terminated;

The date you no longer meet the eligibility requirements;

The last day of the period for which you made any required contributions;

The last day you are in active employment, unless you are eligible for continuation of coverage during an approved leave of absence; or

The date you are no longer in active employment due to a disability that is not covered under the plan.

More Information

For more details about Long-Term Disability benefits, please refer to the “Appendix” on page 139.


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Life and Accident Insurance

Huntington Ingalls offers protection benefits for you and your family to provide important financial support if you or a covered family member dies or is seriously injured in an accident. By offering both Company-paid and optional life and AD&D benefits, the Company gives you the flexibility to obtain the financial coverage that meets your personal needs.

You automatically receive the following basic benefits at no cost to you:



Business travel accident insurance.

For added protection, you can elect to purchase the following additional coverage options at low group rates:


Optional accidental death and dismemberment (AD&D) insurance.

More Information

You will find information about your survivor benefits throughout this handbook:

Administrative Information section – Contains information about your rights under the survivor benefit plans, including information about the claims appeals process.

Section Contents

LIFE AND AD&D INSURANCE AT A GLANCE ............................................................................................................ 97

ELIGIBILITY AND ENROLLMENT ................................................................................................................................. 98

FAMILY ELIGIBILITY ...................................................................................................................................... 98 ENROLLMENT ............................................................................................................................................. 98 BASIC LIFE INSURANCE ................................................................................................................................. 99 OPTIONAL LIFE INSURANCE ........................................................................................................................... 99 BASIC AD&D INSURANCE ........................................................................................................................... 100 OPTIONAL AD&D INSURANCE ..................................................................................................................... 100 BUSINESS TRAVEL ACCIDENT INSURANCE ....................................................................................................... 100 EVIDENCE OF INSURABILITY ......................................................................................................................... 102 NAMING A BENEFICIARY ............................................................................................................................. 102

COST OF COVERAGE ................................................................................................................................................. 103

WHEN COVERAGE BEGINS ....................................................................................................................................... 103

LEAVES OF ABSENCE .................................................................................................................................. 103

ASSIGNING YOUR BENEFITS .................................................................................................................................... 104

WHEN COVERAGE ENDS ........................................................................................................................................... 104

CONVERTING YOUR COVERAGE ............................................................................................................................. 104

FILING A CLAIM .......................................................................................................................................................... 105


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Life and AD&D Insurance

Life and AD&D Insurance at a Glance

The Huntington Ingalls life and accidental death & dismemberment (AD&D) insurance plans provide income protection in the case of an accident or death. Below are the options available to you:





1× annual base pay or $50,000, whichever is greater



You pay the full cost on an after-tax basis

You: 1× to 8× annual base pay ($1.25 million maximum)

Spouse*:

$25,000

$50,000





Up to the lesser of 50% of your total basic and optional coverage, or $500,000

Children

$10,000;

$20,000, or

$30,000

Basic Accidental Death & Dismemberment Insurance


1× annual base pay or $50,000, whichever is greater (up to a max of $1 million)

Optional AD&D You need to elect coverage

You pay the full cost

You: 1× to 10× your annual base pay (up to $1 million)

Spouse Only:

75% of your optional AD&D coverage

Children Only:

25% of your optional AD&D coverage per child (up to $50,000 per child)

Spouse and Children:

Spouse: 60% of your optional AD&D coverage

Each Child: 15% of your optional AD&D coverage


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You: up to 4× your annual base salary, up to $500,000 max.

Spouse: Up to $100,000

Children: Up to $50,000

A percentage of this benefit amount is paid for specific losses

* You can purchase dependent life and AD&D insurance regardless of whether you purchase optional life and AD&D insurance for yourself, but your spouse’s life coverage cannot exceed 50% of your combined basic and optional insurance coverage.


You are eligible for life and AD&D insurance coverage if you are a non-represented employee working at least 20 hours a week.

Family Eligibility

You may enroll your eligible dependents in the life and AD&D insurance plans.

Eligible Dependents

“Eligible dependent” means a person, other than a full-time member of the armed forces of any country, who is your:

Spouse

Your unmarried child from birth up to the end of the month in which your child becomes 26 years of age

For more details regarding the criteria for eligible dependents, please refer to “Eligibility” on page 11.

The term “child” includes your own natural or adopted children, step-children, foster children and children placed with you by court order provided they both live with you and are primarily dependent on you for support.

If your spouse or a dependent child is confined at home, in the hospital or elsewhere when coverage normally would start, coverage for that dependent will begin the day after release from confinement at home, hospital or other health care facility.

Enrollment

All eligible employees are automatically enrolled for basic life and AD&D insurance, and business travel accident insurance. The Company pays the full cost of this coverage.

You can elect optional life and/or AD&D insurance:

Within 31 days of when you (and your dependents) first become eligible for coverage (which is usually your date of hire)

Anytime during the benefit plan year, subject to Evidence of Insurability (EOI) requirements.

Depending on the amount of coverage you choose, you may need to provide satisfactory EOI.


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Huntington Ingalls Industries, Inc. provides you with basic life insurance equal to one times your annual base pay or $50,000, whichever is greater. You are automatically covered by this insurance; you do not have to enroll in the plan. Huntington Ingalls Industries, Inc. pays the full cost of basic life insurance for you.

If you die, the plan pays benefits to the beneficiary or beneficiaries you choose. If you have not named a beneficiary, the benefit will be paid to your current spouse, if living, or to your estate.

Note: You can limit your basic life insurance coverage to $50,000 to avoid paying imputed income tax.


You may purchase optional life insurance for yourself and your dependents. If you select optional life insurance, you pay the full cost with after-tax dollars, based on group rates negotiated by Huntington Ingalls Industries, Inc.

Your cost for optional life insurance for yourself and your spouse is determined by the employee’s age as of December 31 of the benefit plan year and the coverage level selected. As your base pay changes, so will your coverage amount and rate for coverage for yourself and your spouse, if applicable. Your cost for child life insurance is determined as a flat rate per option.

You can select optional life insurance at the following times:

Within 31 days of when you (and your dependents) first become eligible for coverage (which is usually your date of hire)

Anytime during the benefit plan year, subject to Evidence of Insurability (EOI) requirements.

Depending on the amount of coverage you choose, you may need to provide satisfactory EOI.

You can purchase dependent life insurance regardless of whether you purchase optional life insurance for yourself, but your spouse’s life coverage cannot exceed 50% of your combined basic and optional insurance coverage.

If you are still covered by the optional life insurance plan at age 65, your benefit will be reduced by the plan’s age reduction factors.

For details about domestic partner optional life insurance, call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222.

Accelerated Death Benefit Option

The Huntington Ingalls Industries, Inc. basic and optional life insurance coverage includes a special feature that helps you cope with the financial difficulties often associated with terminal illness. Under the Accelerated Death Benefit Option, if you or your spouse is expected to live for six months or less, you may receive 80% of the total life insurance (basic and optional combined) amount, up to $500,000. Ordinarily, this benefit would be paid to you or your spouse’s beneficiary only upon death.

To receive this benefit, the plan requires medical documentation of your or your spouse’s condition. The plan pays benefits when your request is approved, and in the manner that you select — for example, in a lump sum or as installment payments. After you or your spouse dies, the remaining life insurance benefits are paid to the beneficiary.

Your Annual Base Pay

Your “annual base pay” for life and accident insurance purposes is your gross straight-time pay for regularly scheduled hours for a seven-day week, as determined by your business unit.


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Basic AD&D insurance

Huntington Ingalls Industries, Inc. provides you with basic accidental death and dismemberment (AD&D) insurance equal to one times your salary or $50,000, whichever is greater, up to $1 million. You are automatically covered by this insurance; you do not have to enroll in the plan. Huntington Ingalls Industries, Inc. pays the full cost of basic AD&D insurance for you.

If you die, the plan pays benefits to the beneficiary or beneficiaries you choose. If you lose a limb or your sight, speech, or hearing or become paralyzed as a result of a covered accident, the plan pays a portion of your AD&D benefits to you.

Optional AD&D insurance

You may purchase optional accidental death and dismemberment (AD&D) insurance for yourself only or for yourself and your family. If you select optional AD&D insurance, you pay the full cost with after-tax dollars, based on rates negotiated by Huntington Ingalls Industries, Inc.

You can choose optional AD&D insurance when you are first hired and during annual enrollment. Because you pay for optional AD&D insurance with after-tax dollars, you can also enroll in optional AD&D insurance for yourself and your dependents at any time during the benefit plan year.

If you and your spouse work for Huntington Ingalls Industries, Inc., only one of you may cover the entire family for AD&D insurance. The other employee may elect employee-only coverage.

For details about domestic partner optional AD&D insurance, call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222.

Business Travel Accident insurance

Huntington Ingalls Industries, Inc. provides business travel accident insurance to you automatically you do not have to enroll in this coverage. Business travel accident insurance is administered by AIG.

This plan pays benefits if you or any of your eligible dependents die or lose a limb, sight, speech, or hearing or become paralyzed within 365 days of and as a result of a covered accident that occurs while you are traveling on Company business. If your dependents accompany you on Company business, they are eligible for benefits if Huntington Ingalls Industries, Inc. pays their travel expenses.

You are considered to be traveling on business when you are traveling to advance Huntington Ingalls Industries, Inc.’s business. Business travel accident insurance provides a benefit for a covered accident that occurs from the time you leave your home or workplace — whichever occurs last — until you return to your home or workplace, whichever occurs first. Accidents that occur during your normal course of travel to and from work are not covered. Accidental injuries you receive during a leave of absence or vacation also are not covered.

The amount of your coverage is based on the coverage description below:

Coverage Description Amount of Insurance

All eligible employees, including test pilots and engineers in flight tests, flying as a pilot or crew member

4 times annual base salary up to $500,000 maximum

All eligible dependent spouses, provided Huntington Ingalls Industries, Inc. agreed in advance to pay transportation expenses (including relocation)

$100,000

All eligible dependent children, provided Huntington Ingalls Industries, Inc. agreed in advance to pay transportation expenses (including relocation)

$50,000


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Business travel accident insurance pays a percentage of the business travel accident coverage amount based on the type of loss incurred, as shown in this chart:

Type of Loss*: Percentage of Business Travel Accident Coverage Amount Paid

Life 100%

Two or more (hands or feet) 100%

Sight in both eyes 100%

One hand or one foot and sight in one eye 100%

Speech and hearing in both ears 100%

Use of four limbs (quadriplegia) 100%

Use of both lower limbs or both upper limbs (Paraplegia) 75%

Use of both limbs on the same side of the body (hemiplegia) 50%

One hand or one foot 50%

Sight in one eye 50%

Speech or hearing in both ears 50%

Thumb and index finger of same hand 25%

Severance and reattachment of one hand or foot 25%

Maximum benefit for all losses in any one accident 100%

* A loss is defined as:

For a hand or a foot: severance through or above the wrist or ankle

For sight: complete, total and irrecoverable loss to the sight of the eye

For speech: complete, total and irrecoverable loss of speech

For hearing: complete, total and irrecoverable loss of hearing

For thumb and index finger: complete and total severance at or above the knuckles

For quadriplegia: total paralysis of both arms and legs

For paraplegia: total paralysis of both arms or both legs

For hemiplegia: total paralysis of the arm and leg on the same side of the body.

Paralysis means the total loss of use of an arm or leg. Severance means the complete and permanent separation and dismemberment of the part from the body.

Maximum Aggregate Business Travel Accident Benefit

In a catastrophic accident that results in significant loss to more than one covered person, the plan pays a maximum benefit for all losses of $5,000,000. If the total loss exceeds $5,000,000, each covered person or his or her beneficiary receives a proportionate share of the $5,000,000 based on the covered person’s amount of insurance and determined by the insurance company.


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Evidence of Insurability

Evidence of insurability (EOI) refers to proof that you and/or your spouse are in good health at the time you enroll for optional life insurance. You must provide EOI under the following circumstances:

When you (and your dependents) first become eligible (usually on your date of hire), and you choose:

Optional coverage for yourself that is greater than five times your salary or $600,000, whichever is less.

Optional coverage for your spouse that is greater than $50,000.

You select or increase optional coverage for yourself (and your dependents) at any time other than within 31 days of the date you first become eligible (e.g., in the event of a qualified life event). However, if you gain a new dependent through marriage, birth, or adoption, or purchase a home, you can: Select employee coverage of one times your pay or increase your current coverage by one level (up to $600,000) without EOI.

Select spouse coverage up to $50,000 without EOI.

If your spouse loses his or her life and AD&D insurance from another source, you may select spouse coverage up to $50,000 without EOI. Also, you may enroll in or increase child life insurance without EOI, if you experience a qualified life event.

You receive a salary increase that causes your optional life and AD&D insurance to exceed $600,000. EOI for automatic benefit increases due to a salary change will be required only with the initial salary increase that results in your coverage being greater than $600,000.

You receive a salary increase that causes your spouse’s life insurance coverage automatically to increase to greater than $50,000. EOI for automatic benefit increases due to a salary change will be required only with the initial salary increase that results in your spouse’s life insurance coverage being greater than $50,000.

When EOI is required, you must complete and submit your EOI form to Prudential (the life insurance company). Employee EOI can be completed and submitted electronically through the online enrollment system.

The EOI process requires information about your health, medical history, and pre-existing conditions. In addition, your doctor may be required to submit information regarding your health or give you a physical exam. You may be required to pay the cost of any physical exams performed to obtain coverage.

Until your EOI is processed, your coverage will be limited to an amount allowed without EOI. For example, if you enroll as a new employee and choose coverage equal to four times your annual base pay of $155,000, your coverage will be limited to $600,000 until your EOI is processed and your coverage is approved.

Naming a Beneficiary

It is very important that you designate a beneficiary when you first become eligible for coverage. By doing so, there should be no question regarding the individual(s) to whom you want your benefits paid.

You may name anyone you wish as your beneficiary except the Company or any of its affiliates. You also may choose more than one person to be your beneficiary. If you name more than one person, you must indicate the percentage of benefit you would like each named beneficiary to receive. If you do not do this, benefits will be distributed equally among all of your named beneficiaries.

You may change your beneficiary at any time. Changes in your beneficiary designation must be made on UPoint at www.hiibenefits.com or by calling the Huntington Ingalls Benefits Center at 1-877-216-3222.



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Cost of Coverage

Huntington Ingalls provides basic life and AD&D insurance to you at no cost. In addition, you can purchase optional life and/or AD&D insurance for yourself, your spouse and your dependents. You pay for optional life and AD&D insurance coverage with after-tax dollars. Refer to your annual enrollment guide for your monthly cost of coverage.

Your cost for optional life and AD&D insurance for yourself and your spouse is determined by your age as of December 31 of the benefit plan year and the coverage level selected. As your base pay changes, so will your coverage amount and rate for coverage for yourself and your spouse, if applicable. Your cost for child life insurance is determined as a flat rate per option.

Imputed Income

Federal tax law requires you to pay income taxes on the value of your employer provided group life insurance in excess of $50,000 (basic + optional) and on spouse life insurance when applicable. This is called imputed income. You may choose to avoid imputed income by limiting your basic life insurance benefit to $50,000 and not electing any spouse life insurance. You can limit your basic life insurance benefit during enrollment when you make your other benefit choices.


If you meet the eligibility requirements, coverage becomes effective as of the first of the month following enrollment. Any coverage amounts that require EOI will become effective once your Evidence of Insurability has been approved by Prudential.

For your optional life and AD&D insurance to take effect, you must be an active employee and not on a leave of absence at the start of the benefit plan year. If you are on a leave of absence, and you want to increase your coverage, you must call the Huntington Ingalls Benefits Center (HIBC) when you return to work.

For your dependent’s coverage to take effect, he or she must not be confined for medical care or treatment — either in a medical treatment facility or at home — on the effective date of the coverage. If your dependent is confined, coverage begins when he or she is released from confinement.

Leaves of Absence

If you are on an approved leave of absence, continuation of coverage will depend on the type of leave as follows:

If you are on a furlough or temporary layoff, and if any required contribution is paid, you will be covered to the end of the month, plus one month following the date your temporary layoff begins.

If you are on a medical leave of absence, and if any required contribution is paid, you will be covered to the end of two years following the date your leave of absence begins.

If you are on a personal or educational leave of absence, and if any required contribution is paid, you will be covered to the end of the month, plus one month following the date your leave of absence begins.

If you are on a military/mobilization leave of absence, coverage terminates on the date your leave of absence begins.

If you are on a family leave of absence, and if any required contribution is paid, you will be covered to the end of the month, plus four months following the date your leave of absence begins.


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Assigning Your Benefits

Your life and AD&D insurance may be assigned only as a gift assignment. Any rights, benefits or privileges that you have as an employee may be assigned. This includes any right you have to choose a beneficiary or to convert to another contract of insurance. Prudential will not decide if an assignment does what it is intended to do. Prudential will not be held to know that one has been made unless it or a copy is filed with Prudential through the contract holder.

This applies only to insurance for which you have the right to choose a beneficiary, when that right has been assigned. If an assigned amount of insurance becomes payable on account of your death and, on the date of that death, there is no beneficiary chosen by the assignee, it will be payable to:

The assignee, if living; or

The estate of the assignee, if the assignee is not living.

When Coverage Ends

Coverage normally will continue as long as you remain eligible and pay any required premiums. However, coverage will end on the earliest of the following:

The last day of the month in which your employment ends

The day on which the plans are discontinued

Converting Your Coverage

If your (or your spouse’s or dependents’) coverage ends because your employment with Huntington Ingalls Industries, Inc. ends or because you (or your spouse or dependents) are no longer eligible for coverage, you (and your spouse and dependents) may choose to either:

Convert the terminating coverage to an individual policy of your own; or

Use the plan’s portability feature to continue the terminating coverage as part of the Huntington Ingalls Industries, Inc. Health Plan.

Conversion and portability are characterized as follows:

Conversion allows you to convert all or a portion of the terminating coverage to an individual policy (subject to conversion amount limitations). Amounts you convert are no longer part of your Huntington Ingalls Industries, Inc. coverage, and you are solely responsible for keeping the individual policy(ies) active. You pay the insurance company directly. Your cost is based on the insurance company’s standard individual rates, which may differ from the rates you currently pay.

Portability allows you to continue all or a portion of your optional life insurance (for yourself, your spouse and/or your dependents) under the Huntington Ingalls Industries, Inc. Health Plan when that coverage would otherwise terminate. You pay the insurance company directly. Your cost is based on the insurance company’s standard group rates, which may differ from the rates you currently pay.

For life insurance, you must choose conversion or portability in writing within 31 days of the date coverage ends. Converted coverage becomes effective the first day after the 31-day conversion period ends. Ported coverage becomes effective the first of the month following the 31-day election period.

If you elect to convert your life insurance, you may add an AD&D Benefit Rider to your policy.

For more information or to request a conversion or portable policy, contact Prudential at 1-800-524-0542.


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Filing a Claim

To receive benefits under any of the life insurance plans, you or your beneficiary must report the death of the enrolled person. Here are some simple steps to follow to initiate the payment of life insurance benefits:

1. Call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 to report the death. The HIBC notifies the insurance company, gathers the necessary information, and provides you or your beneficiary with information about the payment of life insurance benefits.

2. You will be asked to provide certified copies of the death certificate, birth certificate, and marriage certificate of the deceased. These must be certified; photocopied certificates are not valid. You may also be required to provide other information, as requested by the insurance carrier.


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Additional Benefits

As an employee of Huntington Ingalls, you also have access to a variety of other benefits.

More Information

You will find information about these benefits throughout this SPD:

Administrative Information – Contains information about your rights under these benefits, including information about the claims appeals process.

Section Contents

GROUP LEGAL SERVICES ......................................................................................................................................... 107

ELIGIBILITY AND ENROLLMENT ..................................................................................................................... 107 HOW THE PLAN WORKS ............................................................................................................................. 107

Hyatt Legal Plans’ Web Site .......................................................................................................... 108 Client Service Center ...................................................................................................................... 109

COST OF COVERAGE ................................................................................................................................... 109 COVERED SERVICES .................................................................................................................................... 109

Basic Plan ...................................................................................................................................... 109 Advantage Plan ............................................................................................................................. 111

EXCLUSIONS ............................................................................................................................................. 117

EMPLOYEE ASSISTANCE PROGRAM (EAP) ........................................................................................................... 118

ELIGIBILITY ............................................................................................................................................... 118 HOW THE PLAN WORKS ............................................................................................................................. 118


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Group Legal Services

The Group Legal Plan provides you and your eligible dependents access to legal assistance. You pay for your Group Legal Plan coverage through automatic after-tax payroll deductions. Once you elect this coverage, you can change your election only during the next annual enrollment period. (Your coverage automatically will roll over in the next benefit plan year unless you change your election.)

The level of benefit you receive depends on the option you choose Basic or Advantage. When you face a situation that has legal implications, the Hyatt Legal Plans’ web site, www.legalplans.com, provides instant access to information about your legal plan benefits and more. You can locate attorneys, obtain a case number and contact an attorney by e-mail. You will need your membership number (printed on your group legal membership card) to access the web site.

You may also call Hyatt Legal Plans’ Client Service Center at 800-821-6400, Monday through Friday 8 am to 7 pm, Eastern Time. A Client Service Representative will assist you in locating a plan attorney near your home or workplace and will answer any questions you may have about the plan.


You can choose to participate in the Group Legal Plan each year during annual enrollment. When you select group legal coverage, you automatically cover yourself and your eligible dependents. Your eligible dependents include:

Your spouse

Your same-sex or opposite-sex domestic partner

Your unmarried children under age 19, or age 25 if a full-time student or performing missionary service.

Please keep in mind that once you select group legal coverage, you can change your election only during the next annual enrollment period. Your coverage automatically will roll over in the next benefit plan year, unless you change your election. There are no exceptions.

How the Plan Works

The level of benefit you receive depends on the option you choose Basic or Advantage. When you face a situation that has legal implications, the Hyatt Legal Plans’ web site, www.legalplans.com, provides instant access to information about your legal plan benefits and more. You can locate attorneys, obtain a case number and contact an attorney by e-mail. You will need your Membership Number on your group legal membership card to access the web site.

You may also call Hyatt Legal Plans’ Client Service Center at 800-821-6400, Monday through Friday 8 am to 7 pm, Eastern Time. A Client Service Representative will assist you in locating a plan attorney near your home or workplace and will answer any questions you may have about the plan.

When you use an attorney outside the network, the plan will reimburse your legal fees up to a maximum amount.

The level of benefit you receive depends on the option you choose Basic or Advantage.

http://www.legalplans.com/

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Here are some of the services fully covered by the plan:

Administrative Hearing Representation

Adoption and Legitimization

Civil Litigation Defense

Consumer Protection Matters

Criminal Matters

Debt Collection Defense

Document Review and Preparation

Restoration of Driving Privileges

Traffic Ticket Defense (No DUI)

Estate Matters

Juvenile Court Defense

Divorce, Dissolution and Annulment (Contested and Uncontested)

Enforcement of Modification of Support Order

Misdemeanor Defense

Real Estate Matters

Wills, Living Wills, and Powers of Attorney

Hyatt Legal Plans’ Web Site

To use Group Legal Plan® visit the Hyatt Legal Plans’ web site at www.legalplans.com. Once there, click on the “Members Log in” icon at the top of the page. You will be taken to a secure page that will require you to enter your Social Security Number. After you enter your Social Security Number you will jump to a page that is specific for member services. On this page you can choose the following options:

How Do I Use the Plan?

Covered Services

Attorney Locator

Obtain Case Number

Life Guide

Self-Help Documents/Forms

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Client Service Center

You may also use Group Legal Plan®, by calling Hyatt Legal Plans' Client Service Center at 800-821-6400. Client Service Representatives are available Monday through Friday from 8 a.m. to 7 p.m., Eastern Time. Be prepared to give your Social Security Number. If you are a spouse or an eligible dependent child, you will need the Social Security Number of the employee through whom you are eligible. The Client Service Representative who answers your call will:

Verify your eligibility for services;

Make an initial determination of whether and to what extent your case is covered (the plan attorney will make the final determination of coverage);

Give you a case number which is similar to a claim number (you will need a new case number for each new case you have);

Give you the telephone number of the plan attorney most convenient to you; and

Answer any questions you have about the legal plan.

You then call the plan attorney to schedule an appointment at a time convenient to you. Evening and Saturday appointments are available.

If you choose, you may select your own attorney. Also, where there are no participating law firms, you will be asked to select your own attorney. In both of these circumstances, Hyatt Legal Plans will reimburse you for these non-plan attorneys' fees in accordance with a set fee schedule.

For services to be covered, you or your eligible dependents must have obtained a case number, retained an attorney and the attorney must begin work on the covered legal matter while you are an eligible member of the legal plan.

Cost of Coverage

You pay the full cost for group legal services for yourself and your eligible dependents. The premium is deducted from your paycheck on an after-tax basis.

Covered Services

There are two Group Legal Plan options to choose from ― the Basic Plan and the Advantage Plan. The covered services provided under each option are as follows:

Basic Plan

Advice and Consultation

Office Consultation

This service provides the opportunity to discuss with an attorney any personal legal problems that are not specifically excluded. The plan attorney will explain the participant's rights, point out his or her options and recommend a course of action. The attorney will identify any further coverage available under the plan, and will undertake representation if the participant so requests. If representation is covered by the plan, the participant will not be charged for the plan attorney's services. If representation is recommended, but is not covered by the plan, the plan attorney will provide a written fee statement in advance. The participant may choose whether to retain the plan attorney at his or her own expense, seek outside counsel, or do nothing. There are no restrictions on the number of times per year a participant may use this service; however, for a non-covered matter, this service is not intended to provide the participant with continuing access to a plan attorney in order to seek advice that would allow the participant to undertake his or her own representation.


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Telephone Advice

This service provides the opportunity to discuss with an attorney any personal legal problems that are not specifically excluded. The plan attorney will explain the participant's rights, point out his or her options and recommend a course of action, identify any further coverage available under the plan, and will undertake representation if the participant so requests. If representation is covered by the plan, the participant will not be charged for the plan attorney's services. If representation is recommended, but is not covered by the plan, the plan attorney will provide a written fee statement in advance. The participant may choose whether to retain the plan attorney at his or her own expense, seek outside counsel, or do nothing. There are no restrictions on the number of times per year a participant may use this service; however, for a non-covered matter, this service is not intended to provide the participant with continuing access to a plan attorney in order to seek advice that would allow the participant to undertake his or her own representation.

Document Preparation

Demand Letters

This service covers the preparation of letters that demand money, property or some other property interest of the participant, except an interest that is an excluded service. It also covers mailing them to the addressee and forwarding and explaining any response to the participant. Negotiations and representation in litigation are not included.

Document Review

This service covers the review of any personal legal document of the participant, such as letters, leases or purchase agreements.

Elder Law Matters

This service covers counseling the participant over the phone or in the office on any personal issues relating to the participant’s parents as they affect the participant. The service includes reviewing documents of the parents to advise the participant on the effect on the participant. The documents include Medicare or Medicaid materials, prescription plans, leases, nursing homes agreements, powers of attorney, living wills and wills. The service also includes preparing deeds involving the parents when the participant is either the grantor or grantee; and preparing promissory notes involving the parents when the participant is the payer or payee.

Personal Injury

Personal Injury (25% Network Maximum)

Subject to applicable law and court rules, plan attorneys will handle personal injury matters (where the participant is the plaintiff) at a maximum fee of 25% of the gross award. It is the participant's responsibility to pay this fee and all costs.

Will and Estate Matters

Probate (10% Network Discount)

Subject to applicable law and court rules, plan attorneys will handle probate matters at a fee 10% less than the plan attorney's normal fee. It is the participant's responsibility to pay this reduced fee and all costs.

Wills and Codicils

This service covers the preparation of a simple or complex will for the participant. The creation of any testamentary trust is covered. The benefit includes the preparation of codicils and will amendments. It does not include tax planning.


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Advantage Plan

Advice and Consultation

Office Consultation

This service provides the opportunity to discuss with an attorney any personal legal problems that are not specifically excluded. The plan attorney will explain the participant's rights, point out his or her options and recommend a course of action. The plan attorney will identify any further coverage available under the plan, and will undertake representation if the participant so requests. If representation is covered by the plan, the participant will not be charged for the plan attorney's services. If representation is recommended, but is not covered by the plan, the plan attorney will provide a written fee statement in advance. The participant may choose whether to retain the plan attorney at his or her own expense, seek outside counsel, or do nothing. There are no restrictions on the number of times per year a participant may use this service; however, for a non-covered matter, this service is not intended to provide the participant with continuing access to a plan attorney in order to seek advice that would allow the participant to undertake his or her own representation.

Telephone Advice

This service provides the opportunity to discuss with an attorney any personal legal problems that are not specifically excluded. The plan attorney will explain the participant's rights, point out his or her options and recommend a course of action. The plan attorney will identify any further coverage available under the plan, and will undertake representation if the participant so requests. If representation is covered by the plan, the participant will not be charged for the plan attorney's services. If representation is recommended, but is not covered by the plan, the plan attorney will provide a written fee statement in advance. The participant may choose whether to retain the plan attorney at his or her own expense, seek outside counsel, or do nothing. There are no restrictions on the number of times per year a participant may use this service; however, for a non-covered matter, this service is not intended to provide the participant with continuing access to a plan attorney in order to seek advice that would allow the participant to undertake his or her own representation.

Consumer Protection

Consumer Protection Matters

This service covers the participant as a plaintiff, for representation, including trial, in disputes over consumer goods and services where the amount being contested exceeds the small claims court limit in that jurisdiction and is documented in writing. This service does not include disputes over real estate, construction, insurance or collection activities after a judgment.

Personal Property Protection

This service covers counseling the participant over the phone or in the office on any personal property issue such as consumer credit reports, contracts for the purchase of personal property, consumer credit agreements or installment sales agreements. Counseling on pursuing or defending small claims actions is also included. The service also includes reviewing any personal legal documents and preparing promissory notes, affidavits and demand letters.

Small Claims Assistance

This service covers counseling the participant on prosecuting a small claims action; helping the participant prepare documents; advising the participant on evidence, documentation and witnesses; and preparing the participant for trial. The service does not include the plan attorney's attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.


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Debt Matters

Debt Collection Defense

This service provides participants with an attorney's services for negotiation with creditors for a repayment schedule and to limit creditor harassment, and representation in defense of any action for personal debt collection, tax agency debt collection, foreclosure, repossession or garnishment, up to and including trial if necessary. It does not include vacating a judgment; counter, cross or third party claims; bankruptcy; any action arising out of family law matters, including support and post-decree issues; or any matter where the creditor is affiliated with the Company.

Identity Theft Defense

This service provides the participant with consultations with an attorney regarding potential creditor actions resulting from identity theft and attorney services as needed to contact creditors, credit bureaus and financial institutions. It also provides defense services for specific creditor actions over disputed accounts. The defense services include limiting creditor harassment and representation in defense of any action that arises out of the identity theft such as foreclosure, repossession or garnishment, up to and including trial if necessary. The service also provides the participant with online help and information about identity theft and prevention. It does not include counter, cross or third party claims; bankruptcy; any action arising out of family law matters, including support and post-decree issues; or any matter where the creditor is affiliated with the Company.

Tax Audits

This service covers reviewing tax returns and answering questions the IRS or a state or local taxing authority has concerning the participant's tax return; negotiating with the agency; advising the participant on necessary documentation; and attending an IRS or a state or local taxing authority audit. The service does not include prosecuting a claim for the return of overpaid taxes or the preparation of any tax returns.

Defense of Civil Lawsuits

Administrative Hearing Representation

This service covers participants in defense of civil proceedings before a municipal, county, state or federal administrative board, agency or commission. It includes the hearing before an administrative board or agency over an adverse governmental action. It does not apply where services are available or are being provided by virtue of an insurance policy. It does not include family law matters, post judgment matters or litigation of a job-related incident.

Civil Litigation Defense

This service covers the participant in defense of an arbitration proceeding or civil proceeding before a municipal, county, state or federal administrative board, agency or commission, or in a trial court of general jurisdiction. It does not apply where services are available or are being provided by virtue of an insurance policy. It does not include family law matters, post judgment matters, matters with criminal penalties or litigation of a job-related incident. Services do not include bringing counterclaims, third party or cross claims.

Incompetency Defense

This service covers the participant in the defense of any incompetency action, including court hearings when there is a proceeding to find the participant incompetent.

Document Preparation

Affidavits

This service covers preparation of any affidavit in which the participant is the person making the statement.


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Deeds

This service covers the preparation of any deed for which the participant is either the grantor or grantee.

Demand Letters

This service covers the preparation of letters that demand money, property or some other property interest of the participant, except an interest that is an excluded service. It also covers mailing them to the addressee and forwarding and explaining any response to the participant. Negotiations and representation in litigation are not included.

Document Review

This service covers the review of any personal legal document of the participant, such as letters, leases or purchase agreements.

Elder Law Matters

This service covers counseling the participant over the phone or in the office on any personal issues relating to the participant’s parents as they affect the participant. The service includes reviewing documents of the parents to advise the participant on the effect on the participant. The documents include Medicare or Medicaid materials, prescription plans, leases, nursing homes agreements, powers of attorney, living wills and wills. The service also includes preparing deeds involving the parents when the participant is either the grantor or grantee; and preparing promissory notes involving the parents when the participant is the payer or payee.

Mortgages

This service covers the preparation of any mortgage or deed of trust for which the participant is the mortgagor. This service does not include documents pertaining to business, commercial or rental property

Notes

This service covers the preparation of any promissory note for which the participant is the payer or payee.

Family Law

Adoption and Legitimization (Contested and Uncontested)

This service covers all legal services and court work in a state or federal court for an adoption for the plan member and spouse. Legitimization of a child for the plan member and spouse, including reformation of a birth certificate, is also covered.

Divorce, Dissolution and Annulment (Contested and Uncontested)

This service is available to the plan member only, not to a spouse or dependents, for the first fifteen hours of service. This service includes preparing and filing all necessary pleadings, motions and affidavits, drafting settlement or separation agreements, and representation at the hearing or trial, whether the plan member is a plaintiff or a defendant. This service does not include disputes that arise after a decree is issued. It is the plan member’s responsibility to pay fees beyond the first fifteen hours.


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Enforcement of Modification of Support Order

This service is available to the plan member and spouse, and covers representation after a judgment has been entered to enforce or modify a court's award of support or alimony, whether the plan member or spouse is a plaintiff or a defendant. This service does not cover transfer of a divorce decree from one state to another, the division of property, or collection activities after a judgment.

Name Change

This service covers the participant for all necessary pleadings and court hearings for a legal name change.

Prenuptial Agreement

This service covers the preparation of an agreement by a plan member and his or her fiancé/partner prior to their marriage or legal union (where allowed by law), outlining how property is to be divided in the event of separation, divorce or death of a spouse. Representation is provided only to the plan member. The fiancé/partner must have separate counsel or must waive representation.

Protection from Domestic Violence

This service covers the plan member only, not the spouse or dependents, as the victim of domestic violence. It provides the plan member with representation to obtain a protective order, including all required paperwork and attendance at all court appearances. The service does not include representation in suits for damages, defense of any action, or representation for the offender.

Uncontested Change or Establishment of Custody Order

This service is available to the plan member and spouse, and covers preparation of petitions, consent forms and waivers, and representation at any court hearings provided all parties are in agreement to establish or modify a child custody order.

Uncontested Guardianship or Conservatorship

This service covers establishing an uncontested guardianship or conservatorship over a person and his or her estate when the plan member or spouse is appointed guardian or conservator. It includes obtaining a permanent and/or temporary guardianship or conservatorship, gathering any necessary medical evidence, preparing the paperwork, attending the hearing and preparing the initial accounting. If the proceeding becomes contested, the plan member or spouse must pay all additional legal fees. This service does not include representation of the person over whom guardianship or conservatorship is sought, or any annual accountings after the initial accounting.

Immigration

This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any immigration documents and helping the participant prepare for hearings.

Insurance Matters

Insurance Claims

This service provides the participant with assistance in making insurance claims with the participant's own carrier, provided the carrier is not affiliated with the Company. Litigation of coverage issues is included. Litigation of damages is not included.


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Personal Injury

Personal Injury (25% Network Maximum)

Subject to applicable law and court rules, plan attorneys will handle personal injury matters (where the participant is the plaintiff) at a maximum fee of 25% of the gross award. It is the participant's responsibility to pay this fee and all costs.

Real Estate Matters

Boundary or Title Disputes (Primary Residence)

This service covers negotiations and litigation arising from boundary or title disputes involving a participant's primary residence, where coverage is not available under the participant's homeowner or title insurance policies.

Eviction and Tenant Problems (Primary Residence – Tenant Only)

This service covers the participant as a tenant for matters involving leases, security deposits or disputes with a residential landlord. The service includes eviction defense, up to and including trial. It does not include representation in disputes with other tenants or as a plaintiff in a lawsuit against the landlord, including an action for return of a security deposit.

Home Equity Loans (Primary Residence)

This service covers the review or preparation of a home equity loan on the participant’s primary residence.

Property Tax Assessment (Primary Residence)

This service covers the participant for review and advice on a property tax assessment on the participant's primary residence. It also includes filing the paperwork; gathering the evidence; negotiating a settlement; and attending the hearing necessary to seek a reduction of the assessment.

Refinancing Of Home (Primary Residence)

This service covers the review or preparation, by an attorney representing the participant, of all relevant documents (including the mortgage and deed, and documents pertaining to title, insurance, recordation and taxation), which are involved in the refinancing of or in obtaining a home equity loan on a participant's primary residence. This benefit includes obtaining a permanent mortgage on a newly constructed home. It does not include services provided by any attorney representing a lending institution or title company. The benefit does not include the refinancing of a second home, vacation property, rental property or property held for business or investment.

Sale or Purchase of Home (Primary Residence)

This service covers the review or preparation, by an attorney representing the participant, of all relevant documents (including the construction documents for a new home, the purchase agreement, mortgage and deed, and documents pertaining to title, insurance, recordation and taxation), which are involved in the purchase or sale of a participant's primary residence or of a vacant property to be used for building a primary residence. The benefit also includes attendance of an attorney at closing. It does not include services provided by any attorney representing a lending institution or title company. The benefit does not include the sale or purchase of a second home, vacation property, rental property, property held for business or investment or leases with an option to buy.

Zoning Applications

This service provides the participant with the services of a lawyer to help get a zoning change or variance for the participant's primary residence. Services include reviewing the law, reviewing the surveys, advising the participant, preparing applications, and preparing for and attending the hearing to change zoning.


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Traffic and Criminal Matters

Felony Defense

This service covers representation for participants in defense of any criminal felony charge. Representation includes court hearings, negotiation with the prosecutor and trial.

Juvenile Court Defense

This service covers the defense of a plan member and a plan member's dependent child in any juvenile court matter, provided there is no conflict of interest between the plan member and child. In that event, this service provides an attorney for the plan member only, including services for Parental Responsibility.

Misdemeanor Defense

This service covers representation for participants in defense of any criminal misdemeanor charge except those relating to traffic or driving under influence charges. Representation includes court hearings negotiation with the prosecutor and trial. It does not include representation of a felony charge that is subsequently reduced to a misdemeanor.

Restoration of Driving Privileges

This service covers the participant with representation in proceedings to restore the participant's driving license.

Traffic Ticket Defense (No DUI)

This service covers representation of the participant in defense of any traffic ticket including traffic misdemeanor offenses, except driving under influence or vehicular homicide, including court hearings, negotiation with the prosecutor and trial.

Wills and Estate Matters

Trusts

This service covers the preparation of revocable and irrevocable living trusts for the participant. It does not include tax planning or services associated with funding the trust after it is created.

Living Wills

This service covers the preparation of a living will for the participant.

Powers Of Attorney

This service covers the preparation of any power of attorney when the participant is granting the power.

Probate (10% Network Discount)

Subject to applicable law and court rules, plan attorneys will handle probate matters at a fee 10% less than the plan attorney's normal fee. It is the participant's responsibility to pay this reduced fee and all costs.

Wills and Codicils

This service covers the preparation of a simple or complex will for the participant. The creation of any testamentary trust is covered. The benefit includes the preparation of codicils and will amendments. It does not include tax planning.


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Major Trial

Major Trial – In-Network

All covered matters that require a trial are covered through completion with no hour limits or dollar caps when service is provided by a plan attorney.

Major Trial – Out-Of-Network

This service covers up to $10,000 for a covered matter when using a non-network attorney.

Exclusions

The following excluded services are legal services that are not provided under the plan:

Employment-related matters, including company or statutory benefits

Matters involving the employer, MetLife® and affiliates, and plan attorneys

Matters in which there is a conflict of interest between the employee and spouse or dependents in which case services are excluded for the spouse and dependents

Appeals and class actions

Farm and business matters, including rental issues when the participant is the landlord

Patent, trademark and copyright matters

Costs or fines

Frivolous or unethical matters

Matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits


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The employee assistance program (EAP) is a free, professional, and confidential counseling and referral program that is available to you and your family members who are eligible to enroll in the Huntington Ingalls Industries Health Plan. The EAP is separate from the mental health and substance abuse program described under the medical plan options.

For more information about the EAP and Work/Life Services administered by Anthem, access the Anthem EAP Provider Link at www.hiibenefits.com.

Eligibility

Employees and family members can use the EAP services, even if they are not enrolled in a Huntington Ingalls Industries, Inc. medical plan option or HMO.

How the Plan Works

The EAP provides eight free counseling sessions for each participating individual per issue per year, including marriage, family and bereavement counseling. The EAP also provides telephonic assistance to include information on a variety of behavioral health topics, community resources and referrals. Assistance required beyond your EAP benefit is coordinated with the mental health benefits under your medical plan option, if applicable. EAP services do not include inpatient treatment for mental health or chemical dependency or other intensive or specialty services designed to treat acute and chronic mental illness or chemical dependency diagnoses.

Work/Life Services are additional benefits provided under the EAP, and includes 24/7 confidential assistance in balancing work and life commitments. Work/Life services offers information, resources and referrals for many everyday issues included but not limited to ongoing or emergency child and elder care, help for care givers, school and college information, assistance for children with special needs, adoption resources, housing options, assistance with relocation, resources to assist in preparing for retirement and pet care. The program can also help you locate community resources for financial counseling or debt management.

For more information about the EAP administered by Anthem, access the Anthem EAP Provider Link at www.hiibenefits.com.




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Administrative Information

This section provides important information about your legal rights as they apply to the following Huntington Ingalls benefits:

Health care benefits (including medical and prescription drug, dental and vision care)

Flexible spending account plans

Disability benefits

Life and AD&D insurance

Additional benefits

The Plan will comply, to the extent applicable, with the requirements of all applicable state and federal laws, including but not limited to USERRA, COBRA, HIPAA, Health Information Technology for Economic and Clinical Health Act, Newborns' and Mothers' Health Protection Act of 1996, Women's Health and Cancer Rights Act of 1998, Family and Medical Leave Act of 1993, Mental Health Parity Act of 1996, Mental Health Parity and Addiction Equity Act of 2008, Michelle's Law, Genetic Information Nondiscrimination Act of 2008, and Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010.

Section Contents

ADMINISTRATIVE DETAILS ....................................................................................................................................... 120

GENERAL PLAN FACTS ................................................................................................................................ 120 SPECIFIC PLAN FACTS ................................................................................................................................. 120

FUTURE OF THE PLANS ............................................................................................................................................ 123

PLAN ADMINISTRATION ............................................................................................................................................ 123

POWER AND AUTHORITY OF THE HMO .................................................................................................................. 124

LIABILITY OF INSURER .............................................................................................................................................. 124

CLAIMS PROCEDURES .............................................................................................................................................. 124

CLAIMS AND APPEALS FOR FULLY-INSURED BENEFITS ....................................................................................... 124 CLAIMS AND APPEALS FOR SELF-FUNDED BENEFITS ......................................................................................... 125 GENERAL REQUIREMENTS ........................................................................................................................... 125 TYPES OF CLAIMS ...................................................................................................................................... 125 HOW TO FILE A CLAIM ............................................................................................................................... 125 TIMEFRAMES FOR DETERMINATIONS ............................................................................................................. 126 IF YOUR BENEFIT OR ADMINISTRATIVE CLAIM IS DENIED ................................................................................... 127 APPEALING A DENIED BENEFIT CLAIM (EXCEPT DISABILITY) ............................................................................... 128 APPEALING A DENIED CLAIM FOR DISABILITY BENEFITS ..................................................................................... 128 APPEALING A DENIED ADMINISTRATIVE CLAIM ................................................................................................ 129 TIMING OF YOUR APPEAL ........................................................................................................................... 130 CLAIMS AND APPEALS CONTACT INFORMATION............................................................................................... 131 ADDITIONAL INFORMATION ABOUT THE APPEALS PROCESS ............................................................................... 132 AUTHORIZED REPRESENTATIVE ..................................................................................................................... 133

YOUR ERISA RIGHTS ................................................................................................................................................. 134

YOUR HIPAA PRIVACY RIGHTS ................................................................................................................................ 135

SPECIAL ENROLLMENT RIGHTS ..................................................................................................................... 135 STATEMENT OF RIGHTS UNDER THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT ................................... 136


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Administrative Details

The following provides important Plan information about your Huntington Ingalls Industries Health Plan benefits.

General Plan Facts

Employer/Plan Sponsor Huntington Ingalls Industries, Inc.

4101 Washington Avenue

Newport News, VA 23607

Employer Identification Number (EIN)

90-0607005

Type of Plan Welfare benefit plan

Type of Administration Insured and self-insured

Plan Administrator Employee Welfare Benefits Committee

Huntington Ingalls Industries, Inc.

P.O. Box 661095 Dallas, TX 75266-1095 1-877-216-3222

Agent for Service of Legal Process

Huntington Ingalls Industries, Inc. c/o Corporate Secretary Huntington Ingalls Industries, Inc. 4101 Washington Avenue Newport News, VA 23607

Service of process may also be made to the Plan Administrator.

Benefit Plan Year July 1 to June 30; for annual reporting purposes (Form 5500), the plan year is the calendar year

Plan Name and Number The Huntington Ingalls Industries Health Plan is a component plan under the Huntington Ingalls Industries, Inc. Group Benefits Plan; plan number 501

Specific Plan Facts

Medical Plan

Insured by: Huntington Ingalls Industries, Inc. self-insures the PPO and CDHP medical plan options. All other medical plan options are fully insured under contracts with insurers.

Claims administered by:

Refer to the claims administrators and addresses provided in the chart under “Claims and Appeals Contact Information” in “Claims and Appeals Contact Information” on page 131.

For all other plan options, refer to your medical ID card for claims administration details.

Sources of contributions:

Depending on the benefits selected by the employee, the cost of benefits will either be covered by contributions from Huntington Ingalls Industries, Inc. or shared by Huntington Ingalls Industries, Inc. and the participant


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Prescription Drug Plan in the Medical Plan Options

Insured by: Huntington Ingalls Industries, Inc. self-insures the prescription drug benefits in the PPO and CDHP medical plan options. Prescription drug benefits under all other medical plan options are provided under contracts between the medical plan and prescription drug providers.


For prescription drug benefits in the PPO and CDHP, claims are administered by:

CVS/caremark P.O. Box 659541 San Antonio, TX 78265-9541

For all other plan options, refer to the claims administrators and addresses provided in the chart under “Claims and Appeals Contact Information” in ““Claims and Appeals Contact Information” on page 131, or refer to your medical ID card for claims administration details.

Funded by Huntington Ingalls Industries, Inc. and participant contributions

Dental Plan

Insured by: The dental plan options are self-insured by Huntington Ingalls Industries, Inc.

Claims administered by: Delta Dental of Virginia 4818 Starkey Road Roanoke, VA 24018-8542


Vision Plan

Insured by: The vision plan is self-insured by Huntington Ingalls Industries, Inc.

Claims administered by: Vision Service Plan (VSP) 333 Quality Drive Rancho Cordova, CA 95670 1-800-877-7195

www.vsp.com

Funded by: Huntington Ingalls Industries, Inc. and participant contributions


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Basic and Optional Life and Accidental Death and Dismemberment Insurance

Insured by: Lincoln Financial

100 Liberty Way Mail Stop 02-5 Dover, NH 03821

Claims administered by: Lincoln Financial

100 Liberty Way Mail Stop 02-5 Dover, NH 03821

Funded by: For basic: Huntington Ingalls Industries, Inc.; for optional: participant contributions


Insured by: AIG P.O. Box 25746 Shawnee Mission, KS 66225

1-800-551-0824

Claims administered by: AIG P.O. Box 25746 Shawnee Mission, KS 66225

1-800-551-0824

Funded by For basic: Huntington Ingalls Industries, Inc.; for optional: participant contributions

Long-Term Disability Plan

Insured by: Prudential Insurance Company of America P.O. Box 101241 Atlanta, GA 30392-1241

Claims administered by: Prudential Insurance Company of America P.O. Box 13480 Philadelphia, PA 19176



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Health Care and Dependent Care Flexible Spending Account Plans

Insured by: Huntington Ingalls Industries, Inc. self-insures the Health Care and Dependent Care Flexible Spending Account plans


Your Spending Account (YSA) P.O. Box 661095

Dallas, TX 75266-1095

877-216-3222

Funded by Participant contributions

Future of the Plans

Huntington Ingalls Industries, Inc. has the absolute right in its sole discretion to amend or terminate any plan or plan provision in whole or in part at any time, including any cost sharing arrangements. This right includes, but is not limited to, the amendment of any plan or plan provision in response to the occurrence of a natural disaster, emergency, pandemic or similar catastrophic event, to the extent permitted or mandated by law.

Amendments to or termination of a plan may apply to active, inactive or former employees. A plan change may transfer plan assets to another plan, or split a plan into two or more parts. The Plan Administrator will notify you if an amendment or termination substantially affects your benefits.

If a welfare benefit plan is terminated, you will have no further rights other than payment of claims for eligible expenses that you incurred before the plan terminated. The amount and form of any final benefit you may receive under a welfare benefit plan will depend on plan assets, any contract or insurance provisions affecting the Plan, and decisions made by Huntington Ingalls Industries, Inc.

If a plan is terminated, retired employees and beneficiaries who are receiving coverage or benefits under such plan will stop their participation and receive no additional benefits. Claims for expenses incurred before the termination date, however, will be honored.

After all benefits are paid and legal requirements are met, the plan assets, if any, will become the sole property of Huntington Ingalls Industries, Inc., to the extent permitted by law.

Plan Administration

Huntington Ingalls Industries, Inc. is responsible for the general administration of the Plan, and will be the named fiduciary to the extent not otherwise specified in this SPD, another component “Group Benefits Plan” document or in an insurance contract. Huntington Ingalls Industries, Inc. has the discretionary authority to construe and interpret the provisions of the Plan and make factual determinations regarding all aspects of the Plan and its benefits, including the power to determine the rights or eligibility of employees and any other persons, and the amounts of their benefits under the Plan, and to remedy ambiguities, inconsistencies or omissions. Such determinations shall be conclusive and binding on all parties. A misstatement or other mistake of fact will be corrected when it becomes known, and Huntington Ingalls Industries, Inc. will make such adjustment on account of the mistake as it considers equitable and practicable, in light of applicable law. Neither the Plan Administrator nor Huntington Ingalls Industries, Inc. will be liable in any manner for any determination made in good faith.


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Huntington Ingalls Industries, Inc. may designate other organizations or persons to carry out specific fiduciary responsibilities for Huntington Ingalls Industries, Inc. in administering the Plan including, but not limited to, the following:

Pursuant to an administrative services or claims administration agreement, if any, the responsibility for administering and managing the Plan, including the processing and payment of claims under the Plan and the related recordkeeping.

The responsibility to prepare, report, file and disclose any forms, documents, and other information required to be reported and filed by law with any governmental agency, or to be prepared and disclosed to employees or other persons entitled to benefits under the Plan, and

The responsibility to act as claims administrator and to review claims and claim denials under the Plan to the extent an insurer or administrator has not been delegated such authority.

Huntington Ingalls Industries, Inc. will administer the Plan on a reasonable and nondiscriminatory basis and shall apply uniform rules to all persons similarly situated.

Power and Authority of the HMO

Benefits may be provided under a group insurance contract entered into between Huntington Ingalls Industries, Inc. and an HMO. With respect to fully insured benefits, claims for benefits are sent to the HMO. The HMO is responsible for paying claims — not Huntington Ingalls Industries, Inc.

The HMO is also responsible for:

Determining eligibility for and the amount of any benefits payable under the Plan.

Prescribing claims procedures to be followed and the claim forms to be used by employees and beneficiaries pursuant to the Plan.

The HMO also has the authority to require employees and beneficiaries to furnish it with such information as it determines is necessary for the proper administration of the benefits provided through the HMO.

Claim procedures are set forth in the next section.

If you have any questions about this information, call the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 or contact the nearest regional office of the Employee Benefits Security Administration (formerly known as the Pension and Welfare Benefits Administration), an agency of the U.S. Department of Labor.

Liability of Insurer

For benefits that are provided on an insured basis (not self-insured by Huntington Ingalls Industries, Inc.), the insurance carrier or health maintenance organization (HMO) through which coverage is provided is solely responsible for the payment of benefits and has the sole authority, discretion and responsibility to interpret the terms of the insurance or HMO coverage contract, including eligibility for benefits. Huntington Ingalls Industries, Inc. does not guarantee the payment of any benefit described in an insurance or HMO coverage contract, and you must look solely to the insurance carrier or HMO for the payment of benefits.

Claims Procedures

The following provides important information about the claims procedures for the benefits offered by Huntington Ingalls Industries, Inc.

Claims and Appeals for Fully-Insured Benefits

For purposes of determining the amount of, and entitlement to, benefits of the component plans that are provided under insurance contracts, the respective insurer is the named fiduciary and claims administrator under the Plan, with the full power to interpret and apply the terms of the Plan as they relate to the benefits provided under the applicable


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insurance contract. To obtain benefits from the insurer, you must follow that insurer’s claims procedures. Refer to the applicable Benefit Booklet listed in the Appendix for more information.

The insurer will decide your claim in accordance with its reasonable claims procedures, as required by ERISA (if ERISA applies) and other applicable law. The insurer has the right to secure independent medical advice and to require such other evidence as it deems necessary in order to decide your claim. If the insurer denies your claim, in whole or in part, you will receive a written notification setting forth the reason(s) for the denial.

If your claim is denied, you may appeal to the insurer for a review of the denied claim. The insurer will decide your appeal in accordance with its reasonable claims procedures, as required by ERISA (if ERISA applies) and other applicable law. If you do not appeal on time, you may lose your right to file suit in a state or federal court, because you will not have exhausted your internal administrative appeal rights (which generally is a prerequisite to bringing suit in state or federal court). Note that under certain component benefit options you may also have the right to obtain external review (that is, review outside of the Plan). Refer to the applicable Benefit Booklet listed in the Appendix for more information about the claims process for insured benefits.

Claims and Appeals for Self-Funded Benefits

For purposes of determining the amount of, and entitlement to, benefits under the self-funded component plan options provided through the Company’s general assets (as well as for purposes of determining eligibility to participate in the Plan), the Plan Administrator is the named fiduciary and claims administrator under the Plan (unless a different claims administrator has been designated for that benefit), with the full power to make factual determinations and to interpret and apply the terms of the Plan as they relate to benefits provided through a self-funded arrangement.

To obtain benefits from a self-funded arrangement, you must submit a claim to the Plan Administrator (or, if applicable, to the claims administrator for that benefit) in accordance with the claims procedure for that component benefit option, as set forth in the applicable Benefit Booklet listed in the Appendix.

General Requirements

Except to the extent otherwise provided by the applicable claims administrator, or as provided under a particular Benefit Booklet, claims and appeals for benefits provided under the Plan will be subject to the timing and notice requirements set forth below.

Types of Claims

A claim that relates to the payment of a specific benefit under the Plan is called a “Benefit Claim.” For example, when you receive medical care and the provider submits a claim to the Plan to be paid for the service, that is considered a Benefit Claim. Claims that are not a claim for a specific benefit under the Plan are called “Administrative Claims.” For example, you believe that you are being charged too much for the benefit coverage you have elected and file a claim. Because your claim is not for the payment of a specific benefit under the Plan, your claim is treated as an Administrative Claim.

How to File a Claim

Benefit Claims. When you receive medical (including prescription drugs or mental health and/or chemical dependency care), dental, or vision care from an in-network provider, your provider should automatically file a claim for you.

If you receive care or treatment from an out-of-network provider (if applicable), you will usually need to pay the provider directly at the time you receive care and then file a claim with the claims administrator for reimbursement of your eligible expenses. Your claim must include the appropriate paperwork and receipts. If you receive


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reimbursement from another source, such as your spouse’s plan, your claim must include the explanation of benefits from that plan. Be sure to keep a copy of everything for your records.

Most claim forms can be obtained at the Forms link at www.hiibenefits.com. You can also request claim forms by calling the Huntington Ingalls Benefits Center (HIBC) at 1-877-216-3222 or by calling the claims administrator directly at the number provided on your ID card.

You must submit medical, dental, and vision claims that you incur during the benefit plan year within 12 months after the benefit plan year ends (please note, if you are enrolled in the CDHP or the PPO plan option administered by Anthem, you must submit medical claims that you incur during the benefit plan year within 15 months after the benefit plan year ends). For example, assume you incur a claim in October 2020. Since the benefit plan year ends on June 30, 2021, you have until June 30, 2022 to submit your claim for reimbursement (if you are in a medical plan administered by Anthem, you have until September 30, 2022 to submit your medical claim for reimbursement). The medical, dental, and vision plan options do not pay claims that are submitted after the 12-month (for medical plans administered by Anthem, 15-month) deadline.

For details about how to file a claim for flexible spending account reimbursement, disability benefits, life insurance, and AD&D insurance, refer to those specific sections.

Administrative Claims. Administrative Claims must be submitted to the claims administrator within 65 days from the date you know or should have known that there is an issue, dispute, problem or other claim with respect to the Plan. If a claim involves a Plan change or amendment, you are considered to know about your claim when the change or amendment is first communicated to participants in the Plan, and the 65-day period for filing a claim begins on the date the change is first communicated, whether or not the change or amendment has become effective by that date.

If you do not file a Benefit Claim or an Administrative Claim by the applicable deadline and in the proper manner, your claim will expire and be automatically denied if it is subsequently filed. You will not be able to proceed with a lawsuit based on that claim.

Timeframes for Determinations

The timeframes for benefit determination for medical and disability benefits vary depending on the benefit and the type of claim. In this table, “Medical” benefit claims include medical, prescription drug, mental health and substance abuse treatment, dental, vision, and health care flexible spending account (FSA) benefit claims.

Type of Claim Initial Deadline for Claims Review

Time for You to Provide Additional Information

Extensions for Claims Review, if Necessary

Medical: Urgent 72 hours 48 hours None

Medical: Urgent, concurrent care

24 hours* 48 hours None

Medical: Pre-Service 15 days 45 days 15 days

Medical: Post-Service 30 days 45 days 15 days

Disability 45 days 45 days Up to Two 30-day Extensions

Life, AD&D and Business Travel Accident Insurance

90 days 45 days 90 days

Administrative 90 days 45 days 90 days

* Applies only when claim is submitted at least 24 hours before end of approved treatment.



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Medical urgent claims: Medical care is “urgent” if a longer time could seriously jeopardize the participant’s life, health, or ability to regain maximum function. Also, care may be urgent if, in a doctor’s opinion, it would subject the participant to severe pain if care or treatment were not provided. If you require care that is classified as being urgent, but do not submit enough information for the claims administrator to make a determination, the claims administrator will notify you within 24 hours. You have 48 hours after that time to supply any additional information. Until you supply this information, the time limits that apply for the review are suspended (or “tolled”).

Medical concurrent care decisions: These are decisions involving an ongoing course of treatment over a period of time or a number of treatments. If you or your dependent is undergoing a course of treatment, or is nearing the end of a prescribed number of treatments, you may request extended treatment or benefits. If the course of treatment involves urgent care and you request at least 24 hours before the expiration of the authorized treatments, the claims administrator will respond to your claim within 24 hours. If you reach the end of a pre-approved course of treatment before requesting additional benefits, the normal “pre-service” or “post-service” time limits will apply, as described below.

Medical pre-service determinations: A “pre-service” determination requires the receipt of approval of those benefits in advance of obtaining the medical care. If you request a review for pre-service benefits, but do not submit enough information for the claims administrator to make a determination, the claims administrator will notify you within 15 days. You have 45 days after that to supply any additional information. Until you supply this information, the time limits that apply to the claims administrator are tolled.

Medical post-service claims: A “post-service” determination is made for benefits after you have already received care or treatment. A “post-service” determination does not require advance approval of benefits.

In the case of pre-service determinations and urgent claims, if you fail to follow the specified procedure for filing your claim, the claims administrator will notify you of the failure and of the proper procedure. This notice will be provided to you no later than five days after your incorrectly filed claim is received (24 hours in the case of an urgent claim). The notice from the claims administrator may be an oral notice, unless you specifically request written notice.

If Your Benefit or Administrative Claim Is Denied

If your Benefit or Administrative Claim is denied (either in whole or in part), the claims administrator will send you a written explanation of why the claim was denied. In the case of an urgent claim, this can include oral notification, as long as you are provided with a written notice within three days.

This explanation will contain the following information to the extent required by law:

If a medical (not including dental, vision or FSA) claim, the date of the service, name of the health care provider, claim amount, diagnosis code and its corresponding meaning and the treatment code and its corresponding meaning

The specific reason for the denial

References to the specific Plan provisions on which the denial is based

If a medical (not including dental, vision or FSA) claim, the denial code and its corresponding meaning, as well as a description of the standard, if any, that was used in denying the claim

A description of additional material or information that you may need to perfect the claim and an explanation of why such material or information is necessary

A description of the Plan’s review procedures (including any external review process) and applicable time limits, including a statement of your rights to bring a lawsuit under ERISA following an adverse decision at the final level of appeal.


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Depending on the type of claim, the explanation will also contain the following information:

If the denial is based on an internal rule, guideline, protocol or standard, the denial will say so and state that you can obtain a copy of the rule, guideline, or protocol, free of charge upon request

If the denial is based on an exclusion applicable to medical necessity or experimental treatment or similar exclusion, the denial must explain the scientific or clinical judgment for determination, applying the terms of the Plan to the medical circumstances, or state that such an explanation will be provided upon request, free of charge

If the denial involves urgent care, you will be provided an explanation of the expedited review procedures applicable to urgent claims.

Appealing a Denied Benefit Claim (Except Disability)

If your Benefit Claim is denied, you have the right to make an appeal:

You may call the claims administrator and ask why your claim was denied. You may discover that a simple error was made. If so, you may be able to correct the problem right over the telephone.

If you cannot correct the problem by phone, or if you choose not to call the claims administrator, you have the right to file a level 1 appeal by writing directly to the claims administrator. Be sure to explain why you think your claim should be paid and provide all relevant details.

If your claim is denied by the level 1 appeals review committee, and it is not an urgent claim or Administrative Claim, ask the claims administrator to submit your claim to the appropriate level 2 appeals review committee as indicated in the chart entitled “Claims and Appeals Contact Information”.

In deciding appeals, the claims administrator acts as or for the appropriate named fiduciary for purposes of deciding appeals and has discretionary authority to interpret the Plan and to make factual determinations as to whether you are entitled to benefits.

Appealing a Denied Claim for Disability Benefits

Prudential Insurance Company of America (“Prudential”) is the decision-maker for both disability claims and appeals, with fully delegated authority for such decisions. You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeal should be sent to the address specified in the claim denial. A decision on review will be made not later than 45 days following receipt of the written request for review. If Prudential determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). Prudential will notify you in writing if an additional 45-day extension is needed.

If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide the specified information. If you deliver the requested information within the time specified, the 45-day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Prudential may decide your appeal without that information. However, if the period of time is extended due to your failure to submit information necessary to decide the appeal, the period for making the benefit determination will be tolled (i.e., suspended) from the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional information.

You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. Prudential will provide


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you with any new or additional evidence/rationale reviewed in connection with your appeal before the 45-day period expires (or 90-day period, in the event of an extension), and you will be given a reasonable opportunity to respond to such new evidence/rationale.

The review will be conducted by Prudential and will be made by a person different from the person who made the initial determination, and such person will not be the original decision-maker’s subordinate. In the case of a claim denied on the grounds of a medical judgment, Prudential will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination, or a subordinate. If the advice of a medical or vocational expert was obtained by the Plan in connection with the denial of your claim, Prudential will provide you with the names of each such expert, regardless of whether the advice was relied upon.

A notice that your request on appeal is denied will contain the following information:

The specific reason(s) for the determination (including an explanation for the basis for disagreeing with or not following: (i) the views of the health care professionals who treated you or the vocational professionals who evaluated you; (ii) the views of medical/vocational experts whose advice was obtained on behalf of the plan in connection with the determination; and/or (iii) a Social Security Administration disability determination);

A reference to the specific plan provision(s) on which the determination is based;

If the determination is based on a medical necessity or experimental or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination (or a statement that such explanation will be provided free of charge upon request);

A statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request);

A statement describing your right to bring a civil suit under Section 502(a) of ERISA if you disagree with the decision;

The statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination; and

The statement that "You or your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency."

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

Appealing a Denied Administrative Claim

If your Administrative Claim is denied, you have the right to make an appeal by writing to the claims administrator. Be sure to explain why you think your Administrative Claim should be approved and provide all relevant details. There is only one level of appeal for Administrative Claims. See the “Claims and Appeals Contact Information” on page 131 for the contact information of the claims administrator. The claims administrator identified in the chart acts as the appropriate named fiduciary for purposes of deciding appeals and has discretionary authority to interpret the Plan and to make factual determinations.


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Timing of Your Appeal

If you make a Benefit or Administrative Claim and the claims administrator denies that claim, you have the right to appeal the denial. The appeal procedures must be exhausted before you can initiate a lawsuit to enforce your rights under ERISA (see “Administrative Information” on page 119 for details).

In the case of medical, dental, vision, health care flexible spending account (FSA), and disability benefit claims, you have 180 days from the time that you receive a claim denial from the claims administrator to file an appeal. In the case of administrative claims and all other benefits, you have 65 days from the time that you receive a claim denial from the claims administrator to file an appeal. Below are the timeframes that apply when you file an appeal.

Type of Claim Time to Appeal From Date Claim Is Denied

Time for Decision on Appeal

Extensions for Claims Administrator, If Necessary

Medical: Urgent claims 180 days 72 hours None

Medical: Pre-Service claims

180 days for each level of appeal

Two levels of appeal: 15 days from the receipt of the appeal for each level

None

Medical: Post-Service claims

180 days for each level of appeal

Two levels of appeal: 30 days from the receipt of the appeal for each level

None

Life, AD & D and Business Travel Accident

65 days One level of appeal: 60 days

60 days

Disability 180 days 45 days 45 days

Administrative 65 days One level of appeal: 60 days from the receipt of the appeal

60 days

Urgent Medical Claims. There is only one level of appeal that is required for urgent claims. You may file an urgent claim appeal with the claims administrator within 180 days if your initial claim for benefits is denied. Your appeal must be considered within 72 hours, with no extensions. You may file a lawsuit under ERISA if your appeal of an urgent claim is denied. However, if you wish, you may file a voluntary level 2 appeal of an urgent claim denial with the claims administrator within 180 days, and your appeal will be considered within 72 hours, with no extensions. For urgent claims, the level 2 appeal is voluntary — it is your choice to request it or not — and you are not required to file a voluntary level 2 appeal in order to file a lawsuit. If you would like additional information to help you decide whether to file a voluntary level 2 appeal of an urgent claim denial, please call the claim administrator. Your decision as to whether to file a voluntary level 2 appeal of an urgent claim denial will have no effect on any of your other rights under the Plan, and the same rules and procedures apply to a voluntary level 2 appeal of an urgent claim denial as for all other level 2 appeals.

Pre-Service Medical Claims (other than urgent claims). There are two levels of appeal.

Level 1 appeal: You may file a level 1 appeal with the claims administrator within 180 days after you receive the claim denial. Your appeal must be considered within 15 days, with no extensions.


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Level 2 appeal: If your first appeal is denied by the claims administrator, you may file a level 2 appeal with the claims administrator within 180 days after you receive the denial of your level 1 appeal. Your appeal must be considered within 15 days, with no extensions.

Post-Service Medical Claims. There are two levels of appeal.

Level 1 appeal: You may file a level 1 appeal with the claims administrator within 180 days after you receive the claim denial. Your appeal must be considered within 30 days, with no extensions.

Level 2 appeal: If your first appeal is denied by the claims administrator, you may file a level 2 appeal with the claims administrator within 180 days after you receive the denial of your level 1 appeal. Your appeal must be considered within 30 days, with no extensions.

Disability Claims. There is one level of appeal. If your initial claim for disability benefits was denied, you may appeal that denial within 180 days after you receive the claim denial. Your appeal must be considered within 45 days, with a 45-day extension permitted if necessary.

Administrative Claims. There is only one level of appeal for administrative claims. You may file an appeal with the claims administrator within 65 days after you receive the claim denial. Your appeal must be considered within 60 days, with a 60-day extension permitted if necessary.

Claims and Appeals Contact Information

Claims Administrator Claims Level 1 and Level 2 Appeals

Anthem PPO Medical Plan Options

All Claims must be submitted to your local plan. Please contact customer service with questions.

Anthem PO Box 4310 Los Angeles, CA 90060-0007


Medical Claims:

Anthem P.O. Box 37690 Louisville, KY 40233-7690

Medical:

Anthem Member Appeals P.O. Box 4310 Woodland Hills, CA 91365

Delta Dental

(PPO dental plan options)

Delta Dental of Virginia Claims Services 4818 Starkey Road Roanoke, VA 24018-8542

Delta Dental of Virginia Member Appeals 4818 Starkey Road Roanoke, VA 24018-8542

Vision Service Plan Vision Service Plan Claims Services 3333 Quality Drive Rancho Cordova, Ca 95670

Vision Service Plan Appeals 3333 Quality Drive Rancho Cordova, Ca 95670

CVS/caremark (Prescription Drugs)

CVS/caremark P.O. Box 52136 Phoenix, AZ 85072-2136

CVS/caremark P.O. Box 52136 Phoenix, AZ 85072-2136 Fax: 1-866-443-1172

Prudential Insurance Company of America (Long-Term Disability)

Prudential Disability Management Services P.O. Box 13480 Philadelphia, PA 19176



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Claims Administrator Claims Level 1 and Level 2 Appeals

Lincoln Financial (Life & AD&D insurance)

Lincoln Financial 100 Liberty Way Mail Stop 02-5 Dover, NH 03821


AIG (Business Travel Accident)

Claims Services P.O. Box 25987 Shawnee Mission, KS 66225

Claims Services P.O. Box 25987 Shawnee Mission, KS 66225

Your Spending Account (YSA™) (Flexible Spending Account Administrator)

Your Spending Account (YSA) Claims Administrator PO Box 661095 Dallas, TX 75266-1095

Your Spending Account (YSA) Claims Administrator PO Box 661095 Dallas, TX 75266-1095

COBRA Huntington Ingalls Benefits Center COBRA Administration P.O. Box 661095 Dallas, TX 75266-1095

Employee Welfare Benefits Committee Huntington Ingalls Industries, Inc. P.O. Box 661095 Dallas, TX 75266-1095

Administrative Claims Huntington Ingalls Benefits Center P.O. Box 661095 Dallas, TX 75266-1095

Employee Welfare Benefits Committee Huntington Ingalls Industries, Inc. P.O. Box 661095 Dallas, TX 75266-1095

Family Health Center/Wellness Solutions

QuadMed W227 N6103 Sussex Road Sussex, WI 53089

QuadMed W227 N6103 Sussex Road Sussex, WI 53089

Additional Information About the Appeals Process

In filing an appeal, you have the opportunity to:

Submit written comments, documents, records and other information relating to your claim for benefits

Have reasonable access to and review, upon request and free of charge, copies of all documents, records and other information relevant to your claim, including the name of any medical or vocational expert whose advice was obtained in connection with your initial claim

Have all relevant information considered on appeal, even if it wasn’t submitted or considered in your initial claim.

To the extent required by law, in the case of appeals of medical, dental, vision, health care flexible spending account (FSA), and disability benefit claims:

The decision on the appeal will be made by a person or persons at the claim administrator who is not the person who made the initial claim decision and who is not a subordinate of that person

The decision will be made in a manner designed to ensure the independence and impartiality of the persons involved in making the decision

In making the decision on the appeal, the claims administrator will give no deference to the initial claim decision


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If the determination is based in whole or in part on a medical judgment, the claims administrator will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. The health care professional will not be the same individual who was consulted (if one was consulted) with regard to the initial claim decision and will not be a subordinate of that person

If the claims administrator considers, relies upon or generates new or additional evidence in the process of considering your claim, such evidence will be provided to you as soon as possible in advance of the date by which the claims administrator is required to provide notice of its final decision on appeal

If the claims administrator intends to issue an adverse final decision on appeal (deny your appeal in whole or part) based on a new or additional rationale, the claims administrator will provide you with the rationale as soon as possible in advance of the date by which the claims administrator is required to provide notice of its final decision on appeal

If benefits are still denied on appeal, the notice that you receive will provide, to the extent required by law:

The specific reasons for the denial

Reference to the Plan provisions on which the decision was based

If a medical (excluding dental, vision and FSA) claim, the date of the service, name of the health care provider, claim amount, diagnosis code and its corresponding meaning and the treatment code and its corresponding meaning

If a medical (excluding dental, vision and FSA) claim, the denial code and its corresponding meaning, as well as a description of the standard, if any, that was used in denying the appeal, including a discussion of the decision

If a medical (excluding dental, vision and FSA) claim, a description of any available external review process and how to initiate an external review

A statement that you may receive, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim

A statement describing any additional appeal procedures, and a statement of your rights to bring suit under ERISA. (See “Employee Retirement Income Security Act of 1974” for details.)

Depending on the type of claim, the notice that you receive from the final review level will also contain the following information:

If the denial is based on an internal rule, guideline, or protocol, the denial will say so and state that you can obtain a copy of the rule, etc., free of charge upon request

If the denial is based on an exclusion related to medical necessity or experimental treatment or similar exclusion, the denial will explain the scientific or clinical judgment for determination, applying the terms of the Plan to the medical circumstances, or state that such an explanation will be provided upon request, free of charge.

Authorized Representative

At both the initial claim level, and on appeal, you may have an authorized representative submit your claim for you. To designate an authorized representative, you must follow the process established by the claims administrator. Contact the claims administrator for information about what you need to do. The claim administrator may require you to certify that the representative has permission to act for you. The representative may be a health care or other professional. If you designate an authorized representative, all communications from the claims administrator regarding your claim will be made to your authorized representative, not to you. You may withdraw your designation of an authorized representative by following the process established by the claims administrator.


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Your ERISA Rights

In 1974, the President of the United States signed into law the Employee Retirement Income Security Act (ERISA). ERISA sets out certain rights to which you are automatically entitled as a participant in the employee benefits program.

The Company will continue its long-established compliance with all legal requirements concerning full disclosure of your rights as a benefit Plan participant. Since we are sincerely interested in communicating these rights, we want you to know that you are entitled to certain rights and protections under ERISA.

Under ERISA, all Plan participants are entitled to receive information about your Plan and benefits. You are entitled to:

Receive Information About Your Plan Benefits

Examine, without charge, at the Plan Administrator’s office and other specified locations, all documents governing the Plan, including insurance contracts 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

Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts and copies of the latest annual report (Form 5500 series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies

Receive 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

Continue Group Health Plan Coverage

If there is a loss of coverage under the Plan as a result of a qualifying event, you or your dependents may have to pay for such coverage. Review the rules governing your COBRA continuation rights.

You should be provided a certificate of creditable coverage (HIPAA certificate), free of charge, from your group health plan or health insurance issuer when you lose coverage under the Plan and when your COBRA continuation coverage ceases.

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,” 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 benefit or exercising your rights under ERISA.

Enforce Your Rights

If your claim for a benefit is denied or ignored, in whole or in part, you have a 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. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and don’t receive them within 30 days, you may file suit in federal court. 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 a reason beyond the control of the Plan Administrator.


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If your claim for benefits is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor. You also may file suit in a federal court.

The court will decide who should pay court costs and legal fees. If your suit is successful, the court may order the person you have sued to pay these costs and fees. If your suit is not successful, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with Your Questions

If you have any questions about the 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 in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory. You also may contact:

The Division of Technical Assistance and Inquiries Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, D.C. 20210

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 866-444-3272.

Your HIPAA Privacy Rights

The privacy rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulate how an employer group health plan:

Permits special enrollment periods and prohibits discrimination based on health status.

Maintains the privacy of your health information.

HIPAA requires Huntington Ingalls Industries, Inc. to provide you with a notice of the Plan’s legal duties and privacy practices with respect to your protected health information (PHI). The Plan creates, receives, uses, maintains and discloses health information about you and your covered dependents in the course of providing these benefits: medical, dental, vision, health spending accounts and the employee assistance program. The privacy notice describes how the Plan may use or disclose your health information, and under what circumstances it may share this information without your authorization (generally, to carry out treatment, payment or health care operations).

Huntington Ingalls Industries, Inc. distributes the notice via mail or in electronic form. You should retain this notice with your personal records. To receive a copy of the Plan’s Privacy Notice, please contact the Huntington Ingalls Benefits Center at 1-877-216-3222.

Special Enrollment Rights

In accordance with the terms of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), if you are declining group health plan coverage for yourself or your eligible dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and/or your eligible dependents in the Plans if you or your eligible dependents lose eligibility for that other coverage (or if the other employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your


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or your eligible dependents’ other coverage ends (or after the other employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you can enroll yourself, your spouse and/or your new eligible dependent children by processing enrollment within 31 days of the event. Otherwise, if you decline group health plan coverage when you first are eligible, restrictions may apply if you wish to enroll at a later time.

If you experience a special enrollment event or a qualified life event, you must contact the Huntington Ingalls Benefits Center at 1-877-216-3222 within 31 days in order to make a change to your election.

If you request a change due to a qualified life event within the 31 day timeframe, coverage will be effective the date of the event.

To request special enrollment or obtain more information, contact the Huntington Ingalls Benefits Center at 1-877-216-3222.

Statement of Rights Under the Newborns’ and Mothers’ Health Protection Act

Under federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier.

Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.

In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification. For information on precertification, contact the Plan Administrator.


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Contacts

For questions not answered in this SPD, or to learn more about a provider network, etc., we have provided contact information for all the carriers for your reference. Please use these resources as an added tool to get the most out of your benefits.

You can also contact the Huntington Ingalls Benefits Center at 1-877-216-3222.

Plan Name Address Phone Web site

General

Huntington Ingalls Benefits Center

1-877-216-3222

Medical Plans

Anthem PPO Medical Plan Options

Medical Claims:

Anthem P.O. Box 4310 Los Angeles, CA 90060-0007

1-844-465-7237 www.Anthem.com/CA


Anthem P.O. Box 37690 Louisville, KY 40233-7690

1-844-465-7237 www.Anthem.com/CA

Prescription Drug Plan

Prescription Drug Program

CVS/caremark P.O. Box 52136 Phoenix, AZ 85072-2136

1-844-287-1289 http://www.caremark.com/

www.cvscarmarkspecialtyrx.com

Dental Plan

Delta Dental Delta Dental of Virginia Claims Services 4818 Starkey Road Roanoke, VA 24018-8542

800-237-6060 http://www.deltadental/va.com

Vision Care Plan

Vision Service Plan (VSP)

Vision Service Plan Claims Services 3333 Quality Drive Rancho Cordova, Ca 95670

800-877-7195 www.vsp.com

Flexible Spending Account Plans

Health Care Flexible Spending Account


Your Spending Account (YSA) Claims Administrator P.O. Box 661095 Dallas, TX 75266-1095

1-877-216-3222 www.hiibenefits.com, click on UPoint

http://www.anthem.com/


http://www.cvscarmarkspecialtyrx.com/

http://www.deltadental/va.com

http://www.vsp.com/



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Plan Name Address Phone Web site

Disability, Life Insurance, AD&D

Short-Term Disability/

Long-Term Disability


1-800-843-1718

www.Prudential.com

Life Insurance

Accidental Death & Dismemberment


1-888-787-2129

Additional Benefits

Group Legal Services

Hyatt Legal Plans 1-800-821-6400 www.info.legalplans.com

access code: 6530010

Employee Assistance Program

Anthem 1-855-400-9185 Access the Anthem EAP Provider Link at www.hiibenefits.com.

http://www.prudential.com/

http://www.info.legalplans.com/



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Appendix

This appendix is a complete list of all the Benefit Booklets – for each of the benefit plans that are incorporated by reference into this SPD. These supplemental documents along with the information contained in this document constitute the SPD for the Huntington Ingalls Industries Health Plan.

This table provides a list of each specific document and the file name, so you can access them directly at HII Benefits at www.hiibenefits.com.

Plan Name Document Title

Medical Plans

Anthem Preferred PPO Anthem Preferred PPO Plan Benefit Booklet

Anthem CDHP Anthem CDHP HRA Benefit Booklet

Aetna Global Benefits Plan Aetna Global Benefits Plan Booklet

Kaiser Permanente HMO Kaiser Permanente Traditional Plan Booklet

Dental Plan

Delta Dental Delta Dental New Member Welcome Kit

Vision Care Plan

Vision Service Plan (VSP) VSP Client Vision Care Plan booklet

Disability

Short-Term Disability Prudential Short-Term Disability Plan booklet

Long-Term Disability Prudential Long-Term Disability Plan booklet

Life Insurance/AD&D

Life and AD&D Insurance Lincoln Financial Insurance Certificate of Coverage

Legal Services Plan The Hyatt Legal Plan brochure
