22
TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA, CWA, IAM and TWU TO YOUR 2015 BENEFITS PETER GAYLORD First Officer, LAX

TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

  • Upload
    vuquynh

  • View
    215

  • Download
    0

Embed Size (px)

Citation preview

Page 1: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

DESTINATION:2015 COVERAGE

For Legacy US AirwaysTeam MembersRepresented by AFA,CWA, IAM and TWU

TO YOUR 2015 BENEFITS

PETER GAYLORDFirst Officer, LAX

Page 2: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

EXPLORE SOME MORE

This guide provides an overview of your benefit plans and programs. The complete provisions of the benefit plans are set forth in the plan documents, available for review on my.aa.com. If the information in this guide is inconsistent with the plan documents or company policies, the plan documents or company policies will govern. This guide is not intended as a contract of employment or a guarantee of current or future employment. To the extent these plans and programs conflict with state or local law, we will, of course, follow the applicable laws. The company(s) reserve the right to amend or terminate each plan or program at any time. 2

WELCOME TO THE TEAM!YOU’VE GOT GREAT BENEFITS …AND A WORLD OF CHOICE.Reach your destination — 2015 benefits coverage — with a littlehelp from this guide.

Page 3: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

ELIGIBILITY

YOUR MEDICAL OPTIONS

TAX SAVINGS

HEALTHMATTERS

ACCOUNT DETAILS

HEALTH OPTIONS & RATES

INCOME PROTECTION

VOLUNTARY BENEFITS

ENROLL

CONTACTS

IMPORTANT NOTICES

TO DOsMake sure you and your family get the benefits you need by enrolling within 31 days of your first day of active service. If you enroll any dependents, you will have another 31 days after you receive a request for documentation from the Benefits Service Center to submit any required documentation.Go to my.aa.com:

h For all the information you need to enroll.

h To make your elections.

Get one-on-one support — Call 888-860-6178 with any questions or for support enrolling in your benefits.

h Representatives are available Monday through Friday, 9 a.m.–6 p.m. (CT).

TOC

3

INSIDE

Page 4: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

ELIGIBILITYAs a U.S.-based team member, you are eligible for a wide array of benefits. You may also enroll your eligible dependents. Your eligible dependents include:

h Spouse or same-sex domestic partner1

h Dependent children up to the end of the year the child turns age 26, or to any age if disabled2 before age 261 State laws and the IRS do not universally recognize same-gender domestic partners. For that reason, imputed income may apply.2 Refer to your Employee Benefits Guide for the details.

You will be asked to provide documentation for your eligible dependents when you enroll.

ELIGIBILITY

4

Are You an American Employee Married to Another American Employee?

h Enroll in medical, dental and vision coverage separately or as a dependent. Be sure to compare costs — you may save more if you enroll separately. If you’re already covered under your American spouse/domestic partner’s coverage, you need to waive dependent coverage before you can enroll for yourself.

h You will have a separate HUSA (Health US Account) regardless of whether you choose separate or joint coverage.

h If you choose the Core Option, you may only open one HSA (Health Savings Account). Your and your spouse/domestic partner’s Healthmatters Rewards will be added to your shared HSA.

Page 5: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

YOUR MEDICAL OPTIONSYou want a solid health care plan to protect you and your family. Choose from the PPO 80/90/100 Options, and the Core Option.

How the Options Are Alike h You and American share costs.

h Your costs are lower when you choose in-network providers and generic medications.

h Each option offers a spending account that can be used to pay the same eligible medical, prescription drug, dental and vision expenses. Earned Healthmatters Rewards are deposited into these accounts.

h ActiveHealth provides programs and support for you and your family, including 24-hour Nurseline, lifestyle coaching and more.

How the Options Are Different h The amount you pay for medical contributions, deductibles, co-pays and

co-insurance varies by option. See the details.

h Your state of residence determines your administrator. This is based on your benefits address. See the 2015 medical administrator map.

h Preventive care is covered after a co-pay in the PPO 80/90/100 Options. Under the Core Option, it’s covered at 100% in-network.

h The options use different spending accounts.

� The PPO 80/90/100 Options come with an HUSA (Health US Account).

� The Core Option is a high-deductible health plan that offers an HSA (Health Savings Account).

h Prescription drug coverage (including retail and mail order) is provided through:

� CVS Caremark for the PPO 80/90/100 Options

� Express Scripts for the Core Option

GETYOUR BEARINGSTHINGS TO CONSIDER BEFORE ENROLLING

YOUR MEDICAL OPTIONS

5

Page 6: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

Healthmatters helps me learn about my health and find ways to improve it. It’s like having your own personal coach!

Gretchen Muccillo Senior Manager, Claims & Litigation, PHX

“”

TO SMART AND HEALTHY SAVINGS

HEALTHMATTERSRewardsYou and your covered spouse or domestic partner enrolled in a PPO Option or the Core Option can each earn Healthmatters Rewards when you complete certain wellness activities. Your Healthmatters Rewards are added to the spending account associated with your medical option.

You and your dependents can use your Healthmatters Rewards to pay for eligible medical, prescription, dental and vision expenses.

YOU CHOOSE THE ACTIVITIES YOU WANT TO COMPLETE The more activities you complete, the more you earn. In 2015, you can earn up to the maximum of $250 for yourself and $250 for your covered spouse or domestic partner (up to $500 combined) by choosing any combination of the activities below:

Get a Quest biometric screening $50

Meet 4 of 5 results (blood pressure, LDL, HDL, total cholesterol and A1C)

$100

Complete your health assessment $100

Complete online coaching OR two calls with a coach or nurse $100

The sooner you start, the sooner you get your rewards. The deadline to earn rewards is October 31, 2015.

TAX SAVINGSHSA (Health Savings Account) If you enroll in the Core Option, you can contribute on a pre-tax basis to your HSA through payroll deduction, up to IRS limits each year. For 2015, the limits — minus Healthmatters Rewards — are $3,100 individual and $6,150 family. If you will be at least 55 years old by the end of 2015, you can add $1,000 more.

WHY CONTRIBUTE h The account rolls over from year to year so you can use the funds to pay

for health care expenses now or save for retirement. h Contributions are triple tax advantaged:

� No taxes on contributions � No taxes when funds are used for eligible expenses � No taxes on any interest earned on the balance

Flexible Spending Accounts (FSAs) If you are hired during November or December, you may not participate in the FSAs during the current year, but may enroll for the following calendar year.

Health Care FSA — You can contribute up to $2,500 per year on a pre-tax basis.

Limited Purpose FSA — If you enroll in the Core Option, instead of a Health Care FSA, you may contribute up to $2,500 per year to a Limited Purpose FSA, which means you can only use it for dental and vision expenses.

Dependent Care FSA — You can contribute up to $5,000 per year ($2,500 if you are married and filing separately) to pay for eligible child and elder care.

Transit ProgramYou can buy monthly commuter passes on a pre-tax basis for bus and rail travel to and from work, lowering your taxable income, helping the environment and buying a little nap (or reading) time.

Budget CarefullyYou forfeit any amount you contribute to your FSA that you don’t use by the deadlines. More details are here.

TAX SAVINGS & HEALTHMATTERS

6

Page 7: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

ACCOUNT DETAILSSpending Accounts: What You Need to Know

HSA HUSA (HEALTH US ACCOUNT)

Medical option Core PPO 80/90/100

Administered by Aon Hewitt Your Spending

Account (YSA)

YSA

Compatible with Limited Purpose FSA

(LPFSA)

Health Care FSA (HCFSA)

Opening your account

You must sign the terms

and conditions for your

account with Aon Hewitt

YSA before your account

can be opened

Account is opened

automatically when you

earn Healthmatters Rewards

How is it funded?

1. Healthmatters Rewards2. You can contribute on a

pre-tax basis

Healthmatters Rewards

Which account pays first?

You decide whether to

have your HSA or LPFSA

pay first

Your HCFSA will pay first, if

you have one

Does it roll over from year to year and can I continue to use the funds?

Yes Yes

Do I have access to remaining funds if I leave American?

Yes Only if you continue

medical coverage under

COBRA

ACCOUNT DETAILS

7

HOW HEALTH CARE EXPENSES ARE REIMBURSED FROM THE ACCOUNTS

IF YOU WANT… HERE’S WHAT YOU NEED TO DO…

To use the health care card to have

payments made directly from your

account at the time of service…

You must activate the YSA health care card and use it when you receive health

care services.

To have claims reimbursed automatically

from your account when they are

approved…

You must go online to the YSA website and enroll for auto-reimbursement . No

claim for reimbursement is needed. Please note: If you go online and choose the

auto-reimbursement feature, this election

inactivates the health care card.

To receive a check for expenses not paid by the health care card or

reimbursed automatically…

To manually submit claims as you incur

them, do not activate your card but

keep your reimbursement method

as Pay with Card. Then submit claims

to the YSA website or through your

iOS or Android device. Download the

Reimburse Me app free from the Apple

or Google Play Store.

To register on the YSA website and choose auto-reimbursement, access the Benefits Service Center via my.aa.com. You’ll need your American employee ID number and password to log in. If you are a legacy US Airways employee and haven’t done so already, register your American employee ID number today. (Hint: If you forgot your password, go to sam.aa.com to have it reset.).

Page 8: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

FSAs: What You Need to Know

HEALTH CARE FSA LIMITED PURPOSE FSA DEPENDENT CARE FSAAdministered by YSA YSA YSA

Contribute up to $2,500 $2,500 $5,000 (or $2,500 if married and filing

separately)1

Can be used for eligible expenses incurred between

The beginning of each plan year on January 1 through March 15 of the following year

Eligible expenses include Deductibles, co-insurance, co-pays,

prescription drugs, dental and vision expenses,

and certain over-the-counter items (see IRS Publication 502 for details) — funds must be

used first before HUSA

Eligible dental and vision expenses (see IRS Publications 969 and 502 for details)

Care of an eligible dependent child2 or

adult (see IRS Publication 503 for details)

When can you use the funds? The total annual amount you choose to contribute is available immediately for use The amount available at any time is limited

to the amount you have contributed

If you leave American You may submit claims for eligible expenses incurred only through the last day of your

employment, unless you continue coverage under COBRA

You may submit claims for eligible

expenses incurred only through the last

day of your employment

1 You should consult your tax advisor to determine whether to contribute to the Dependent Care FSA or take the federal income tax credit. You cannot do both.2 Eligible dependents must be under age 13 or disabled for their expenses to qualify.

ACCOUNT DETAILS

8

Reimburse Me AppThe YSA Reimburse Me mobile app makes it easy for participants with an iOS or Android powered device to take action or find up-to-date spending account and FSA information — from the doctor’s office, coffee shop and everywhere in between. Download the Reimburse Me app free from the Apple or Google Play Store.

8

Page 9: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

COMPARE OPTIONSYou and American share the cost of your care. And remember, you can save a lot by choosing in-network providers.

SEE YOUR RATESAmerican covers the majority of your health care costs. Managing those costs while balancing our budgets is a challenge we all face together.

EXPL

ORE

TH

E H

IGH

LIG

HTS

HEALTH OPTIONS & RATES

9

Page 10: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

2015 MEDICAL ADMINISTRATORS

BlueCross and BlueShield

BlueCross

UnitedHealthcare

Looking for Information on HMO Options?

If you work at SFO or SJU, you may be eligible to enroll in an HMO option.

Find HMO information.

MedicalPPO 80 PPO 90 PPO 100 CORE

In-Network Out-of-Network1 In-Network Out-of-Network1 In-Network Out-of-Network1 In-Network Out-of-Network1

Deductible $450 individual$900 family

$900 individual$1,800 family

$225 individual$450 family

$450 individual$900 family

$225 individual$450 family

$450 individual$900 family

$2,000 individual$4,000 family2

$4,000 individual$8,000 family2

Co-insurance 20% 40% 10% 30% 0% 20% 20% 40%

Out-of-Pocket Maximum (includes deductible)

$3,000 individual$6,000 family

$6,000 individual$12,000 family

$1,500 individual$3,000 family

$3,000 individual$6,000 family

$225 individual$450 family

$3,000 individual$6,000 family

$4,000 individual$8,000 family2

$12,000 individual$24,000 family2

Medical: What You PayPreventive Care $253 40% after

deductible$253 30% after

deductible$253 20% after

deductible$0 no deductible 40% after

deductible

PCP Visit $253 40% after deductible

$253 30% after deductible

$253 20% after deductible

20% after deductible

40% after deductible

Specialist Visit $403 40% after deductible

$403 30% after deductible

$403 20% after deductible

20% after deductible

40% after deductible

Urgent Care $403 40% after deductible

$403 30% after deductible

$403 20% after deductible

20% after deductible

40% after deductible

ER $1003 $1003 $1003 $1003 $1003 $1003 20% after deductible

40% after deductible

1 Out-of-network expenses are paid based on the reasonable and customary (R&C) charge. You are responsible for any amount that exceeds the R&C charge, even after you meet your out-of-pocket maximum. 2 If more than one person is covered, the family deductible and out-of-pocket maximum apply. 3 Co-pays do not count toward the deductible.

HEALTH OPTIONS & RATES

10

Page 11: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

Prescriptions: What You PayPPO 80 PPO 90 PPO 100 CORE

In-Network Out-of-Nework In-Network Out-of-Nework In-Network Out-of-Nework In-Network Out-of-Nework

Retail

Generic $151 40% after deductible

$151 30% after deductible

$151 20% after deductible

20% after deductible

40% after deductible

Brand $301 40% after deductible

$301 30% after deductible

$301 20% after deductible

20% after deductible

40% after deductible

Non-Preferred Brand $501 40% after deductible

$501 30% after deductible

$501 20% after deductible

20% after deductible

40% after deductible

Mail Order

Generic $301,2 Not covered $301,2 Not covered $301,2 Not covered 20% after deductible

Not covered

Brand $601 Not covered $601 Not covered $601 Not covered 20% after deductible

Not covered

Non-Preferred Brand $1001 Not covered $1001 Not covered $1001 Not covered 20% after deductible

Not covered

1 Co-pays do not count toward the deductible.2 Some generic drugs are available through mail order for a $10 co-pay for up to a 90-day supply.

HEALTH OPTIONS & RATES

11

Want More Details?Take a look at the Summaries of Benefits and Coverage for each option.

StayWell RxReceive many generic diabetes and high blood pressure prescriptions

free with StayWell Rx. Call Healthmatters at 888-227-6598 to confirm

eligibility of your medication and to enroll in the program.

Page 12: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

VisionYou may enroll in vision coverage through Superior Vision.

IN-NETWORK, YOU PAY…

OUT-OF-NETWORK, YOU ARE REIMBURSED UP TO…

Eye Exam (every 12 months) $10 $40

Materials Combined Co-pay — Frames and Lenses (each service covered once every 12 months)

$10 (for frames, standard lenses,

lens options)

Frames: Up to $130 retail value Frames: $45

Standard lenses: Single, lined bi-focal, lined tri-focal or lenticular Standard lenses: h Single vision lenses: $60 h Bi-focal lenses: $80 h Tri-focal lenses: $80 h Lenticular lenses: $80

Lens options: Standard scratch-resistant coating, basic progressives,

polycarbonate lenses or UV coating

Lens options: Basic progressives are reimbursed

up to $80; other options not covered

Contact Lenses (once every 12 months)

Standard fitting examSpecialty fitting exam: Up to $50 $120 contact lens allowance in lieu of frames

$25 Contact Lenses: h All contact lenses services and supplies: $105

HEALTH OPTIONS & RATES

12

Page 13: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

DentalYou may enroll in dental coverage through MetLife.

IN-NETWORK OUT-OF-NETWORKDeductible None $50 per person; $100 per family

Annual Maximum Benefit: Basic and Major Care $1,500 per person $1,000 per person

Lifetime Maximum Benefit: Orthodontic Care $2,000 per person $2,000 per person

What the Plan PaysPreventive Care (up to two visits per year) 100% 80% after deductible

Basic Care 80% 50% after deductible

Major Care 50% 50% after deductible

Orthodontic Care (including adults) 50% 50% after deductible

HEALTH OPTIONS & RATES

13

Page 14: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

2015 Monthly Medical ContributionsACTIVE

PPO 80 PPO 90 PPO 100 COREFull TimeYou Only $26.18 $75.47 $178.34 $74.40

You + Spouse/Domestic Partner $52.36 $150.94 $355.90 $193.44

You + Child(ren) $50.96 $146.87 $350.44 $133.92

You + Family $88.52 $255.47 $609.34 $260.40

Part TimeYou Only $52.36 $150.94 $356.68 $74.40

You + Spouse/Domestic Partner $104.72 $301.88 $711.80 $193.44

You + Child(ren) $101.92 $293.74 $700.88 $133.92

You + Family $177.04 $510.94 $1,218.68 $260.40

HEALTH OPTIONS & RATES

14

Page 15: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

2015 Monthly Vision ContributionsVISION

You Only $5.98

You + Spouse/Domestic Partner $14.27

You + Child(ren) $14.27

You + Family $14.27

2015 Monthly Dental ContributionsDENTAL

You Only $3.18

You + Spouse/Domestic Partner $6.09

You + Child(ren) $5.91

You + Family $10.36

HEALTH OPTIONS & RATES

15

Page 16: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

DON’T FORGET

THEEXTRASLife and AD&D Insurance

American provides Basic Life and Accidental Death and Dismemberment (AD&D) coverage to eligible team members. You can also purchase Voluntary Life coverage and Voluntary AD&D insurance for yourself and your dependents. As a newly eligible employee, you can elect up to $300,000 in employee Voluntary Life coverage with no statement of health (SOH) required. You can elect spouse/domestic partner coverage equal to the lower of your coverage amount or $100,000 with no SOH.

DisabilityYou may be covered under Short-Term Disability (STD), Long-Term Disability (LTD) or Voluntary LTD, depending on your work group eligibility. Check your coverage options when you enroll and ensure you have the disability coverage you need.

Be Sure to Name BeneficiariesBe sure to name your beneficiary(ies) for Life and AD&D insurance, as well as for the Employee Savings 401(k) plan, when you enroll.

MIKE REHLINGSupervisor, Inspection, TUL

INCOME PROTECTION

INCOME PROTECTION

16

Page 17: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

The voluntary benefits let me get the insurance I need at a group rate and pay through convenient payroll deduction.

Matthew Johnson Shift Manager, Customer Service, CLT

“”

Enroll Anytime

Auto and Home InsuranceCompare quotes on cost-effective protection for your auto (including recreational vehicles) and home (including condo or renter’s insurance) from three national carriers — Liberty Mutual, MetLife Auto & Home and Travelers.

You can choose whether to pay through payroll deduction, electronic funds transfer or direct billing.

Pet InsuranceEnroll your pets for coverage through VPI, and receive benefits for veterinary treatments related to accidents and illnesses. Visit any veterinarian, even specialists or emergency providers. You pay through convenient payroll deduction.

Lifelock Identity Theft ProtectionThis protection provides monitoring services 24/7 to safeguard your personal information both online and off, helping prevent identity theft before it happens. You can receive up to a 40% discount by enrolling with a credit or debit card and using promotion code AAEMP1.

TO EVEN MORE GREAT CHOICES

VOLUNTARY BENEFITSEnroll Within 31 Days of Your First Day of Active Service

MetLife Accident Insurance and Critical Illness Insurance Accident Insurance and Critical Illness Insurance can help you be better prepared to take care of the unexpected expenses related to an unforeseen accidental injury or serious illness. These voluntary benefits offer competitive employee rates and convenient payroll deduction so you don’t have to worry about writing a check or missing a payment!

Hyatt Legal PlanEnroll for the legal plan and receive representation, unlimited phone advice and office consultations on a wide variety of personal legal matters for you and your family. Services include:

h Estate planning

h Sale or purchase of your home, including refinancing

h Family law

h Document review/preparation, including wills

h Much more!

You pay through convenient payroll deduction.

VOLUNTARY BENEFITS

17

Page 18: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

GET READY TO

GOENROLL WITHIN 31 DAYS OF YOUR FIRST DAY OF ACTIVE SERVICE

ENROLL

18

Page 19: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

ARRIVE WITH NO REGRETS

We encourage you to review your options and choose the benefits that meet your needs. If you

don’t enroll within 31 days of your first day of

active service, you will be enrolled automatically for

certain benefits.

ENROLLDay or Night To enroll, go to my.aa.com and click on the Benefits Service Center link anytime within 31 days of your first day of active service. Call the Benefits Service Center at 888-860-6178 with any questions or for support enrolling in your benefits. Representatives are available Monday through Friday, 9 a.m.–6 p.m. (CT).

IF YOU ENROLL DEPENDENTSYou will need to provide proof of dependent eligibility — such as marriage or birth certificates — for your spouse and children. You will have 31 days after you receive a request for documentation from the Benefits Service Center to submit required documentation.

Coverage for dependents won’t be approved until your proof has been accepted. You can keep track of the progress of your dependents’ proof of eligibility on the Benefits Service Center website or by calling 888-860-6178.

IF YOU ENROLL FOR VOLUNTARY LIFE INSURANCEA statement of health (SOH) is required for certain levels of employee and spouse/domestic partner Voluntary Life coverage. The enrollment system will show you if a SOH is necessary and the steps you need to take. If a SOH is required, coverage will not be effective until the day the first deduction is made for the coverage after the SOH is approved.

IF YOU ARE REHIREDIf you are rehired within the same calendar year, you will be enrolled automatically in the benefits you had when you left. To change your elections, call 888-860-6178 within 31 days of your rehire date.

LEARN MORE

How to Enroll for Voluntary BenefitsGo to AAaddedBenefits.com or call 855-550-0706.

ENROLL

19

Page 20: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

Feel Good About Your Choices!Take action within 31 days of your first day of active service to get the benefits you and your family need.

Changing Your Elections During the Plan YearYou may make changes to most benefits within 31 days of a life event. You must make your changes online within 31 days of the event. You will have another 31 days after you receive a request for documentation from the Benefits Service Center to submit any required documentation.

If You Do Not Enroll Within 31 Days...If you do not enroll within 31 days of your first day of active service:

h You will not be enrolled in medical, dental or vision coverage. You must actively enroll if you want these coverages.

h You will be enrolled in company-paid basic life insurance coverage, if eligible.

ENROLL

I like having benefit options. It lets me decide what’s right for me and my family.

Andre Scott Domestic/International Shift Manager, PHL

“”TO CHOOSING

AFFORDABLE AND FLEXIBLE BENEFITS

20

RON ROIK, TERRY SHOOK

COLLEEN HAWKINS MARTHA ALVAREZ

Flight Attendants, CLT

Page 21: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

CONTACTSIF YOU WANT TO... CONTACT

h Find benefits information, contact lists and links to plan administrators’ websites h Get information on life events h Enroll online h Find information about your spending accounts and Flexible Spending Accounts h See your current benefit election summary h Find Summary Plan Descriptions (SPDs)

my.aa.comAmerican Airlines Benefits Service Center888-860-6178(9 a.m.–6 p.m. CT, Monday–Friday)

h Check online claim status and details h Compare hospitals and medical costs h Find a doctor h Order and print ID cards

UnitedHealthcare800-955-8095BlueCross and BlueShield of Texas 877-235-9258Anthem BlueCross BlueShield855-267-1772

h Find pharmacy information and a list of preventive drugs h Review formulary and drug costs

Express Scripts800-988-4125 CVS Caremark866-760-4276

h Ask dental coverage questions h Check dental claims

MetLife866-838-1072

h Ask vision coverage questions and find additional information h Print ID card

Superior Vision800-638-3120

h Find out more about Healthmatters, including your eligibility, and enroll in the program Healthmatters 888-227-6598

h Review and enroll in voluntary benefits Voluntary Benefits855-550-0706

h Find out more or ask for assistance from the OptumHealth Employee Assistance Program (EAP) OptumHealth access code: American

800-363-7190

CONTACTS

21

Page 22: TOC DESTINATION - AA.comc.hub.aa.com/images/my/705.059 Evergreen Clickable PDF USAir-ER.pdf · TOC | DESTINATION: 2015 COVERAGE For Legacy US Airways Team Members Represented by AFA,

TOC |

IMPORTANT NOTICESSummary of Benefits and Coverage American Airlines is required to provide you the Summary of Benefits and Coverage (SBC) and the Uniform Glossary (UG). We’ve created a separate SBC for each of the self-funded medical benefit options, and the UG applies to all of the options. You can use the SBCs and the UG as quick references for what benefits are available in each option, and an explanation of terms used in benefit plans.

Access the SBCs and UG. You can also obtain paper copies of the SBCs and UG free of charge by calling the Benefits Service Center at 888-860-6178.

Grandfathered Plan StatusThe US Airways, Inc. Health Benefit Plan is comprised of the following medical plans: PPO 80/60, PPO 90/70, PPO 100/80, OOA 80, OOA 90, OOA 100 and Kaiser Permanente HMO. For purposes of this notice, the term “Plan” refers to all medical plan options listed above, except the Kaiser Permanente HMO.

The Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the Plan is not required to include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan, and what might cause a plan to change from grandfathered health plan status can be directed to 888-860-6178.

You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 866-444-3272 or dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

IMPORTANT NOTICES

22

About This OverviewDISCLAIMER: This is an overview of your benefit options. The complete provisions of the plans are set forth in the plan documents, available for review from Your Health Resources under Official Plan Document and Summary Plan Description or by contacting HR Services. If the information in this overview is inconsistent with the plan documents, the plan documents will govern. This overview is not intended as a contract of employment or a guarantee of current, past or future employment.

The plan sponsor(s) reserves the right to amend or terminate each plan at any time.