SECTION 29
INSURANCE
A. General
1. Eligibility
a. Flight Attendants
(1) The Company shall provide to Flight Attendants covered by this Agreement while on active payroll the opportunity to be covered by the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan and/or the Flexible Spending Account Program which shall provide the benefits described in paragraphs B., C., D. and E., below.
(2) The Company shall provide to Flight Attendants covered by this Agreement while on active payroll the Company-paid life insurance described in subparagraphs F.1.a. and F.1.b., below, and other insurance coverage described in subparagraphs F.5., F.6. and F.7., below.
(3) The Company shall provide to Flight Attendants covered by this Agreement while on active payroll the opportunity to purchase the Flight Attendant-paid life insurance coverage described in subparagraphs F.2., F.3. and F.4., below.
(4) There is no "waiting period" for benefits to commence for newly hired or rehired Flight Attendants. Flight Attendants and their eligible dependents can participate in the NWA Medical Plan, Prescription Drug Program and/or the NWA Dental Plan immediately.
b. Eligible Dependents
(1) The Company shall provide to Flight Attendants covered by this Agreement while on active payroll the opportunity for a Flight Attendant's eligible dependents to be covered by the NWA Medical and Prescription Drug Program and/or the NWA Dental Plan and/or the Flexible Spending Account Program which provide the benefits described in paragraphs B., C., D. and E., below. Such "eligible dependent coverage" shall extend only to a Flight Attendant's:
(a) Spouse of the opposite sex, as recognized by the Flight Attendant's state of residence. A spouse does not include a person from whom the Flight Attendant is legally separated or divorced. In the case of a common law marriage, proof shall be required. A Flight Attendant shall contact the NWA Benefits Department for information;
(b) "Domestic Partner" who is of the same gender of the Flight Attendant. Before a Flight Attendant can enroll a Domestic Partner, he/she must first register him/her via the Internet through the NROL website available through RADAR, except that Domestic Partners who have been married pursuant to state law automatically qualify for dependent coverage upon submission of a valid marriage certificate;
(c) Unmarried "children" up to nineteen (19) years of age;
(d) Unmarried "children" from nineteen (19) to twenty-six (26) years of age who are full-time students (as defined by the child's school) and primarily dependent upon the Flight Attendant for support;
(e) Unmarried "children" over the maximum age who are "totally" disabled, either physically or mentally, who are primarily dependent upon the Flight Attendant for support, as long as the child:
i. Became disabled on or before reaching nineteen (19) years of age or on or before reaching twenty-six (26) years of age if the child is a full-time student;
ii. Was covered by the Plan(s) when he/she became disabled; and
iii. Is incapable of earning his/her own living.
NOTE: A Flight Attendant must call the Claims Administrator and provide proof of the child's disability within thirty (30) days of the child reaching nineteen (19) years of age or twenty-six (26) years of age, if a full-time student. If a covered child first becomes disabled between nineteen (19) and twenty-six (26) years of age, a Flight Attendant must call and provide proof to the Claims Administrator within (30) days of the child becoming disabled. "Totally" disabled will be determined by the Claims Administrator.
(f) Eligible children of a Flight Attendant's eligible Domestic Partner who live with the Flight Attendant and are dependant on the Flight Attendant for support (this includes a Domestic Partner's natural children), provided that a Flight Attendant's Domestic Partner is also enrolled.
(g) "Children" include:
i. Natural children;ii. Adopted children who are placed in the Flight Attendant's home and for whom the Flight Attendant is legally obligated to provide total or partial support;
iii. Stepchildren who live with the Flight Attendant in a parent/child relationship (e.g., go to school from a Flight Attendant's home);
iv. Children from whom a court awards the Flight Attendant legal guardianship, who live with the Flight Attendant and are primarily dependent upon the Flight Attendant for their support;v. Foster Children who live with the Flight Attendant in a parent-child relationship, are primarily dependent upon the Flight Attendant for support, and for whom the Flight Attendant receives no government reimbursement for maintenance and support;
vi. Grandchildren, as long as their mother is covered by the Plan(s) as the Flight Attendant's dependant child, the mother lives in the Flight Attendant's home with the grandchildren and the grandchildren are primarily dependent on the Flight Attendant for support; and
vii. Children covered under the terms of a Qualified Medical Child Support Order (QMCSO).
For purposes of the Flexible Spending Account (FSA) such eligible dependent coverage shall be provided in accordance with the provisions covering eligible dependents in the FlexSaver Summary Plan Description (SPD).
(2) It is recognized that no one can be covered under the NWA Medical Plan and Prescription Drug Program and the NWA Dental Plan as both an eligible dependent and an Employee, and no one can be a dependent of more than one (1) employee.
(3) Flight Attendants who have elected coverage for an eligible dependent(s), who is no longer eligible for such coverage, shall promptly notify Benefits Administration at Mailstop A1430 in MSP within thirty (30) days of such event. If the Flight Attendant does not notify the Company of the dependent's lack of eligibility within such thirty (30) day period, the Flight Attendant shall be responsible to repay the full cost of any claims paid out on that dependent’s behalf after coverage should have ended.
NOTE: Flight Attendants may notify the Company of a dependent's loss of eligibility via the Internet through the NROL website available through RADAR.
(4) Family Security Benefit for the NWA Medical Plan and Prescription Drug Program and NWA Dental Plan.
(a) General Rule: In the event of a Flight Attendant's death, benefits under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan shall be continued for his/her eligible dependent(s) covered on that date, by the monthly advance payment of the applicable premium contribution amount, until the earliest of the following dates:i. Remarriage of the surviving spouse, in which case the coverage for all family members terminates;
ii. The date an eligible dependent becomes eligible for Medicare (there is no continuation for an eligible dependent who is already eligible for Medicare at the time of the Flight Attendant's death);iii. The date an eligible dependent ceases to qualify as an eligible dependent for any reason other than lack of primary support by the Flight Attendant;
iv. Two (2) years from the date of the Flight Attendant's death;
v. The date the eligible dependent fails to make a required premium contribution.
NOTE: For all purposes in this Section 29, eligibility for Medicare shall refer to eligibility for non-contributory Medicare Part A coverage.
(b) The coverage which is continued for eligible dependents shall be the coverage in force for eligible dependents of Flight Attendants on active payroll.
(c) The coverage, which is continued in force for eligible dependent children because of the Flight Attendant's death, shall not be affected if the surviving spouse dies during the two (2) year (maximum) continuation of coverage.(d) When the coverage provided by the Family Security Benefit terminates, the Flight Attendant's eligible dependents may continue their coverage under the NWA Medical Plan, Prescription Drug Program and/or NWA Dental Plan by the monthly advance payment of the premium(s) to the Company until the earlier of the dates below (subject to a maximum of thirty-six (36) months), from the Flight Attendant's date of death:
i. The date of the remarriage of the surviving spouse, or
ii. The date coverage would otherwise have been terminated if the Flight Attendant had lived, or
iii. The date the family members fail to make the required premium contribution.
(e) In the event of an inactive Flight Attendant's death, benefits under the NWA Medical Plan, Prescription Drug Program and NWA Dental Plan may be continued for his/her eligible dependents covered on that date, with the advance payment of the full monthly premiums for up to three (3) years from the Flight Attendant's date of death.
NOTE: Although a Domestic Partner and his/her eligible dependents do not have rights to COBRA coverage under existing federal law, the Company will allow for the continuation of medical and/or dental coverage under terms comparable to those applicable to spouses and their children.
a. Retiree Medical Plan Coverage
(1) Eligibility(a) A Flight Attendant retiring who meets the eligibility criteria for a Disability, Early or Normal Retirement under the Northwest Airlines, Inc. Pension Plan for Contract Employees (Pension Plan):
i. At fifty-five (55) years of age or older with ten (10) or more years of Benefit Accrual Service (BAS), or
ii. At any age with at least ten (10) years of Benefit Accrual Service (BAS) and who is receiving Long Term Disability (LTD) benefits, and
iii. who is enrolled in the NWA Medical Plan and Prescription Drug Program and/or NWA Dental Plan on his/her Retirement Date
may continue his/her coverage on a single basis or Flight Attendant with eligible dependent(s) until the first (1st) day of the month in which he/she attains sixty-five (65) years of age providing the Flight Attendant is not eligible for group medical or dental coverage in other employment. Medical and/or dental coverage also may be continued for the Flight Attendant’s spouse who is covered as of the date of the Flight Attendant’s retirement until the first (1st) day of the month in which the spouse turns sixty-five (65) years of age.
(b) Eligible Flight Attendants who retire while in a Domestic Partner relationship that is registered with the Company at the time of retirement are eligible to continue coverage for the Domestic Partner and any eligible dependents. Retirees may not add or substitute a Domestic Partner after retirement.
(c) A dependent child covered as of the date of retirement may continue to be covered as long as the child meets the dependent eligibility requirements and the Flight Attendant or spouse is covered under the plan(s). The definition of eligible dependents under the retiree medical plan is the same as eligible dependents under the active medical plan.
(d) A Flight Attendant who is under fifty-five (55) years of age or who has less than ten (10) years of Benefit Accrual Service (BAS) at the time employment ends may continue medical and/or dental coverage through COBRA.
(2) Cost of Coverage
(a) Retirees are required to pay a monthly premium contribution amount in advance for coverage based on the coverage tier they are enrolled in. The percentage of the monthly medical premium rate that a retiree is responsible for depends on the age and length of Benefit Accrual Service (BAS) as of the date of his/her retirement:
i. Flight Attendants who retire at fifty-five (55) years of age or older with twenty-three (23) or more years of Benefit Accrual Service (BAS) pay fifty percent (50%) of the monthly premium;ii. Flight Attendants who retire and are receiving payments from the Long Term Disability (LTD) Plan who have at least ten (10) years of Benefit Accrual Service (BAS) pay fifty percent (50%) of the monthly premium; and
iii. Flight Attendants who retire at fifty-five (55) years of age or older with at least ten (10) years but less than twenty-three (23) years of Benefit Accrual Service (BAS) pay one hundred (100%) of the monthly premium.
(b) For purposes of this Section 29, Benefit Accrual Service (BAS) means "Benefit Service" as defined in the Northwest Airlines, Inc. Pension Plan for Contract Employees (Pension Plan), including all Benefit Service under the Pension Plan actually accrued prior to the date of the plan freeze and all service thereafter which would have constituted Benefit Service under the Pension Plan had the accrual of Benefit Service not been frozen.
NOTE: Former Hughes Airwest Flight Attendants who did not receive Benefit Accrual Service (BAS) under the Northwest Airlines Retirement Plan for Union Represented Employees (Northwest Airlines, Inc. Pension Plan for Contract Employees) for any service prior to June 1, 1988, shall have their past years of service credited to the Plan. The Company shall, in determining their eligibility for retiree medical coverage, determine their years of "Benefit Accrual Service" (BAS) as if they had always been under the Northwest Airlines Retirement Plan for Union Represented Employees (Northwest Airlines, Inc. Pension Plan for Contract Employees) while employed by Republic Airlines and its predecessors. The net effect is that the former Hughes Airwest Flight Attendants will be treated the same as all other Flight Attendants in determining their eligibility for retiree medical benefits.
(c) The premium equivalent rate for the NWA Medical Plan, including the Prescription Drug Program, and NWA Dental Plan will be determined annually based upon a blended cost pool that includes the cost of coverage for active employees, COBRA and pre-age sixty-five (65) Retirees.
(d) The premium equivalent rate for medical coverage is subject to no more than a seven percent (7%) annual increase. This cap goes into effect on January 1, 2007.
(e) A Flight Attendant who selects coverage as a retiree under the NWA Dental Program shall pay one hundred percent (100%) of the premium cost.
(3) Retirees who have elected family coverage but who no longer have dependents (including a spouse) eligible for such coverage (see subparagraph 1.b., above) shall promptly notify Benefits Administration in writing at Mailstop A1430 in MSP within thirty (30) days of such event. If the retiree does not so notify the Company within such thirty (30) day period, the retiree shall be responsible to repay the full cost of any claims paid out on that dependent's behalf after coverage should have ended.
(4) A retired Flight Attendant who is eligible to participate in, but chooses not to participate in any of the Company sponsored medical and/or dental plans at the time of his/her retirement, may resume such coverage at a later time provided that at all times during the period of his/her retirement he/she has been covered by an employer-sponsored group plan.
2. Enrollment
a. NWA Medical Plan and Prescription Drug Program and/or NWA Dental Plan
(1) A Flight Attendant who desires to be covered under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan must enroll for single or Flight Attendant and eligible dependent coverage within thirty (30) days of the date that the Flight Attendant or his/her spouse and/or eligible dependent(s) first becomes eligible for coverage, plus an additional thirty (30) day grace period (sixty (60) days total).
(2) A Flight Attendant who fails to so enroll within sixty (60) days of his/her initial eligibility shall not be eligible for coverage under the NWA Medical Plan and Prescription Drug Program and the NWA Dental Plan, and will only be allowed to enroll in the Plan(s) during the next open enrollment period (with coverage effective on the following January 1st) unless the Flight Attendant experiences a change in eligible dependent status.
(3) A Flight Attendant who declines to enroll in the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan (for himself/herself, or his/her eligible dependent(s)) at the time of initial eligibility or any subsequent open enrollment period because of coverage under another group health plan or other health insurance coverage may enroll himself/herself, or his/her eligible dependents during a special enrollment period to the extent such special enrollment rights are required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
b. After a Flight Attendant has elected coverage under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan, changes in coverage can be made if the Flight Attendant experiences a change in eligible dependent status due to events such as:
(1) Change in legal marital status;
(2) Change in Domestic Partner status;
(1) Change in dependents’ status;
(2) Change in spouse’s or dependent child’s employment or full-time student status;
(3) Significant changes in the Flight Attendant’s or his/her spouse’s employment;
(4) Beginning of an unpaid leave of absence by the Flight Attendant or his/her spouse;
(5) Issuance of a family relations judgment, decree or order, such as a qualified medical child support order.
NOTE: In the event of an eligible dependent status change, the Flight Attendant may change his/her coverage levels within thirty (30) days of the date of the change in eligible dependent status.
b. Flight Attendants returning to active payroll status in the same calendar year that coverage under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan was allowed to lapse and be canceled for nonpayment of premiums shall be reinstated in the same plan and classification of coverage under which they were covered prior to cancellation, unless a new election is made pursuant to the status change rules set forth in subparagraph 2.b., above. Any covered Medical or Dental Expenses which were used to satisfy that calendar year's deductible while coverage was in effect, shall apply to such deductible as if no interruption of coverage had occurred.
c. The Company shall require enrollment or reenrollment by Flight Attendants who desire coverage under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan during an open enrollment period each year. A Flight Attendant who does not make an election prior to the end of the open enrollment period shall not be eligible for coverage under the NWA Medical Plan and Prescription Drug Program and the NWA Dental Plan.
d. Flight Attendants are required to use the "NROL & More" website to enroll for coverage. Active and inactive Flight Attendants and retirees will be able to access "NROL & More" through the RADAR website provided by the Company on the internet.
e. When a Flight Attendant and his/her spouse are both Company employees, the Flight Attendant has the opportunity to enroll as a participant in the Plan(s) or he/she may enroll as a dependent of another employee. Only the Flight Attendant or his/her spouse may enroll eligible dependents. If a Flight Attendant and his/her Domestic Partner are both Company employees, both employees may enroll as participants in the Plan(s) and enroll each employee's own eligible dependent children, but not the other employee's dependent children.
f. When a Flight Attendant enrolls a dependent, he/she will have to provide proof that his/her dependent meets all of the eligibility rules of the Plan, i.e. a copy of a birth certificate, marriage certificate, etc. Details about acceptable forms of proof can be found on the RADAR website. Failure of the Flight Attendant to provide adequate proof will result in the Flight Attendant's dependent being dropped from coverage.
3. Flexible Spending Account (FSA)
A Flight Attendant who desires to contribute money to a Flexible Spending Account (FSA) as provided in paragraph E., below, may enroll only at one (1) of the following times:
a. During annual open enrollment; or
b. Within thirty (30) days of being hired, if a new employee; or
c. Within thirty (30) days of a change in eligible dependent status (see subparagraph 2.b., above); or
d. Within thirty (30) days of return to work if a change in eligible dependent status (see subparagraph 2.b., above) occurred while off payroll on leave or if annual open enrollment occurred while off payroll on leave.
4. Life Insurance
In order to enroll for group life insurance coverage provided under subparagraphs F.1. through F.4., below, a Flight Attendant must complete an enrollment form provided by the Company for such purpose and submit such form to Benefits Administration at Mailstop A1430 in MSP. Coverage shall become effective as set forth in the booklet entitled "Employee Life and AD&D Insurance Summary Plan Description".
5. Effective Date of Coverage
a. NWA Medical Plan and Prescription Drug Program and/or NWA Dental Plan
(1) The effective date of coverage of a Flight Attendant who elects to be covered under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan shall be retroactive to the first (1st) day that the Flight Attendant or his/her dependent(s) first became eligible.
(2) Coverage changes made as a result of a change in eligible dependent status (see subparagraph 2.b., above) shall be retroactively effective to the date of the family status change.(3) Coverage elected during open enrollment shall become effective on January 1st of the next calendar year.
b. Flexible Spending Account (FSA)
Coverage in the Flexible Spending Account (FSA) program shall be effective beginning January 1 for a Flight Attendant who enrolls during annual open enrollment. Coverage in the Flexible Spending Account (FSA) program shall be effective as provided in such program's Summary Plan Description (SPD) for a Flight Attendant who enrolls at any time other than during annual open enrollment.
c. Life Insurance and Other Insurance
Coverage under Company-paid life insurance and other insurance provided in paragraphs F.1., F.5., F.6. and F.7., below, shall be effective on the date the Flight Attendant became eligible for such benefits (provided the Flight Attendant has submitted a completed enrollment form in the case of paragraph F.1., below). Coverage under Flight Attendant-paid insurance provided in paragraph F.2., F.3. or F.4., below, shall be effective as provided in the booklet entitled "Employee Life and AD&D Insurance Summary Plan Description".
6. Termination of Coverage
a. NWA Medical Plan and Prescription Drug Program and/or NWA Dental Plan
(1) Flight Attendant coverage under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan shall terminate at the end of the month in which one (1) of the following events occurs:
(a) The Flight Attendant is no longer eligible (see subparagraphs 1.a.(1) and 1.c.(1), above); or
(b) The required premium contributions are not made; or
(c) The NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan terminates.
(2)Eligible dependent coverage under the NWA Medical Plan and Prescription Drug Program and/or the NWA Dental Plan shall terminate when the Flight Attendant's coverage terminates, when any required premium contribution for an eligible dependent is not made or when a dependent is no longer eligible. Coverage for a dependent student over nineteen (19) years of age who was a full-time student for the spring semester/quarter shall terminate on August 31, unless the dependent is again registered as a full-time student for the following school year.
b. Flexible Spending Account (FSA)
Coverage under the Dependent (Day) Care Flexible Spending Account Program terminates when the Flight Attendant’s employment terminates. Coverage under the Health Care Flexible Spending Account shall be automatically modified upon the Flight Attendant's termination of employment , to provide that the Flight Attendant shall be responsible for delivery, directly to the Company, of his/her required contributions to his/her Health Care Flexible Spending Account. Coverage under the Health Care Flexible Spending Account shall terminate upon the earlier of the Flight Attendant's failure to make required contributions when due or the end of the Plan year in which the Flight Attendant's termination of employment occurs, subject, however, to an appropriate election of COBRA continuation coverage.
c. Life Insurance
Life insurance coverage for the Flight Attendant shall terminate when the Flight Attendant is no longer eligible (see subparagraphs 1.a.(2) and (3), above), when any required premium contributions are not made, when the group policy terminates, or when the Flight Attendant's employment terminates, whichever occurs first. However, when a Flight Attendant retires, the provisions of the Flight Attendant term life insurance apply, as set forth in the "Employee Life and AD&D Insurance Summary Plan Description". Life insurance coverage for the Flight Attendant's eligible dependents, if covered, shall terminate upon the earlier of the following: when the dependent is no longer eligible; when the Flight Attendant is no longer eligible; when the required premium(s) are not paid by the Flight Attendant; or when the group policy terminates.
7. Continuation of Coverage
a. NWA Medical Plan and Prescription Drug Program and/or NWA Dental Plan
(1) Flight Attendants who are off payroll may continue their NWA Medical Plan and Prescription Drug and/or NWA Dental coverage as specified in the Summary Plan Description (SPD) for the NWA Health Care Plans as revised to comply with the requirements of federal law, provided:
(a) Flight Attendants who are on a leave of absence (other than a medical leave or military leave) or furlough may, by the monthly advance payment of the premium to the Company, continue their coverage until the next premium due date following eighteen (18) months from the effective date of the Flight Attendant's leave of absence or furlough.
(b) Flight Attendants who are on a medical leave may by monthly advance payment of premium to the Company, continue their coverage for the duration of the leave subject to a minimum continuation period of eighteen (18) months from the date the Flight Attendant’s medical leave begins.
(c) Flight Attendants who are transferred from active payroll status to military leave of absence status and are covered under the NWA Medical Plan, Prescription Drug Program and/or NWA Dental Plan, may by monthly advance payment of premiums to the Company, continue their coverage for the duration of their military leave. In addition, the Company-paid Group I and II basic life insurance will be continued at no cost to the Flight Attendant during his/her first (1st) eighteen (18) months of military leave of absence.
(2) Continuation of coverage for a Flight Attendant's former spouse and other dependents, after a Flight Attendant’s divorce or legal separation, shall comply with the requirements of federal law.
(3) Continuation of Retiree's Family Coverage
In the event of a retiree's death, benefits under the NWA Medical Plan, Prescription Drug Program and NWA Dental Plan will be continued for his/her eligible dependents covered on that date, with the advance monthly payment of the monthly premium (at the applicable percentage rate in effect on the date of the retiree's death) until the earliest of the following dates (subject to a minimum of thirty-six (36) months unless the surviving spouse attains sixty-five (65) years of age, in which case coverage ends):
(a) Remarriage of the surviving spouse, in which case the coverage for the eligible dependents terminates; or
(b) The date an eligible dependent ceases to qualify as a dependent for any reason other than lack of primary support by the retiree.
b. Flexible Spending Account (FSA)
Coverage under the Health Care Flexible Spending Account provided in paragraph E., below, may be continued in accordance with federal law in the event of a Flight Attendant's termination of employment or unpaid leave status. Coverage under the Dependent (Day) Care Flexible Spending Account may not be continued in the event of a Flight Attendant’s termination of employment or unpaid leave status.
c. Life Insurance
(1) Flight Attendants who are off payroll because of medical leave of absence, personal leave of absence, furlough or military leave of absence may continue their Group Life Insurance coverage, both Company-paid and Flight Attendant-paid, pursuant to paragraphs F.1. through F.4., below, and as specified in the booklet entitled "Employee Life and AD&D Insurance Summary Plan Description", as revised to comply with the requirements of state and federal law.
(2) Terminated Flight Attendants may continue their Company-paid and Flight Attendant-paid life insurance coverage pursuant to paragraphs F.1. and F.2., below, by advance payment to the Company of the full monthly premium(s) due, as specified in the booklet entitled "Employee Life and AD&D Insurance Summary Plan Description".
(3) Retired Flight Attendants may continue the difference between the active and retiree Company-paid life insurance coverage and all Flight Attendant-paid life insurance coverage pursuant to paragraphs F.1. and F.2., below, by advance payment to the Company of the full monthly premium(s) due, as specified in the booklet entitled “Employee Life and AD&D Insurance Summary Plan Description”.
3. Coordination of Benefits (COB)
The NWA Medical Plan and Prescription Drug Program and the NWA Dental Plan shall include the following coordination of benefits provisions:
a. If a covered Flight Attendant, or eligible dependent, is eligible to receive benefits under this or another group plan, benefits from the Plan administered by Northwest Airlines, Inc. shall be coordinated with the benefits provided under this or the other plan, so that not more than one hundred percent (100%) of the "allowable expenses" incurred during a calendar year shall be paid jointly by the plan(s). An "allowable expense" is any necessary, reasonable and customary item of expense covered in full or in part by any one of the group plans involved. A "plan" is considered to be any group insurance coverage or other arrangement for coverage of individuals in a group (including Medicaid and Medicare) which provides medical or dental benefits or services on an insured or uninsured basis. The NWA Medical Plan and Prescription Drug Program and NWA Dental Plans referenced herein shall be coordinated with any national health insurance plan(s).
b. The rules below establish the order in which benefits shall be determined:
(1) The benefits of a Plan which covers the person for whom claim is made other than as a dependent shall be determined before a Plan which covers that person as a dependent.
(2) The benefits of a Plan which covers the person for whom claim is made as a dependent of a person whose day of birth occurs first (1st) in a calendar year shall be determined before a Plan which covers that person as a dependent of a person whose day of birth occurs later in that year; except that: (a) if the other Plan does not have this rule, its alternate rule shall govern; and (b) in the case of a dependent child of divorced or separated parents, the rules in subparagraph b.(3), below, shall apply.
(3) If there is a court decree which establishes financial responsibility for medical, dental or other health care of the child, the benefits of the Plan which covers the child as a dependent of the parent so responsible shall be determined before any other plan; otherwise:
(a) The benefits of a Plan which covers the child as a dependent of the parent with custody shall be determined before a Plan which covers the child as a dependent of a stepparent or a parent without custody.(b) The benefits of a Plan which covers the child as a dependent of a stepparent shall be determined before a plan which covers the child as a dependent of the parent without custody.
NOTE: In any case, upon request by the parent with custody of the child, payment shall be made directly to the provider of care for medical expenses incurred for the child.
(4) When the above rules do not establish the order, the benefits of a Plan which has covered the person for whom claim is made for the longer period of time shall be determined before a Plan which has covered the person for the shorter period of time; except that:
(a) The benefits of a Plan which covers the person as a laid off or retired employee, or his/her dependent, shall be determined after a Plan which covers the person as an employee, other than a laid off or retired employee, or his/her dependent.
(b) If the other Plan does not have the rule in subparagraph (4)(a), above, which results in each Plan determining its benefits after the other, then subparagraph (4)(a), above, shall not apply.
B. NWA Medical Plan
1. The NWA Medical Plan shall provide a nationwide PPO (Preferred Provider Organization) Medical Plan for all Flight Attendants with In and Out-of-Network coverage. In the event services are received from an In-Network provider, the provider shall file the claims and benefits shall be paid based on the allowable charge. In the event services are received from an Out-of-Network provider, the Flight Attendant or his/her eligible dependent(s) shall be responsible for filing the claims and benefits shall be paid based on reasonable and customary (R&C) limits. There shall be no limit imposed on the amount of group Medical Benefits payable over an individual's lifetime.
2. The Company shall deduct monthly premium contributions for a Flight Attendant based on the following levels of coverage:
a. Flight Attendant
b. Flight Attendant and Spouse or registered Domestic PartnerFlight Attendant and Child/Children
a. Flight Attendant and Family
NOTE 1: For Flight Attendants on active payroll, such payments will be made by semi-monthly deductions made on a pre-tax basis. The contribution amount shall be twenty-five percent (25%) of the cost of the premium on a blended active employee, COBRA and Retiree rate that shall be subject to no more than a seven percent (7%) annual increase. This cap goes into effect on January 1, 2007. These payroll deductions shall not reduce W-2 earnings for pension purposes.
NOTE 2: The medical/dental coverage for Domestic Partners will be provided on the same employee contribution basis as coverage for spouses and eligible dependents. However, the Internal Revenue Service (IRS) and most state laws do not recognize Domestic Partner relationships the same as spousal relationships as they relate to employer provided health care coverage. Consequently, there are tax implications to the eligible employee for medical and/or dental coverage provided to a Domestic Partner and eligible dependents of the Domestic Partner, if any, that do not exist for married employees, their spouses and eligible dependents of Northwest Airlines, Inc., employees. The only opportunity for Domestic Partner coverage to qualify for the IRS §106 exclusion is if the Domestic Partner falls within the definition of "dependent" under IRS §152.
3. NWA Medical Plan Deductible Amounts
The individual deductible shall be three hundred and fifty dollars ($350.00) per calendar year, except that when three (3) or more family members incur Covered Medical Expenses during the same calendar year and the total expenses used toward satisfying their individual deductible amounts are at least equal to seven hundred dollars ($700.00), no further deductible amounts shall be required for the remainder of the calendar year for that family.
4. NWA Medical Plan Out-of-Pocket Maximum Amounts
The maximum amount of Covered Medical Expenses payable by an individual in a calendar year shall be two thousand dollars ($2,000.00) per individual, plus the applicable deductible amount. A separate maximum amount payable shall apply to each family member individually; however, the maximum amount of Covered Medical Expenses payable by a family in a calendar year shall be four thousand dollars ($4,000.00) plus the family deductible amount. This stop loss provision shall not apply to Covered Medical Expenses incurred for or in connection with mental illness or a functional nervous disorder. The plan has a separate out-of-pocket maximum for mental health expenses. The individual mental health out-of-pocket maximum is two thousand dollars ($2,000.00). The family out-of-pocket maximum is four thousand dollars ($4,000.00). The mental health out-of-pocket maximum does not include the deductible, medical or prescription drug copay/coinsurance.
5. NWA Medical Plan Covered Expenses
a. To be covered by the Plan, medical care, treatment, services and supplies must be for the diagnosis or treatment of an "illness" or "injury" (except for certain In-Network covered preventive/wellness care). An illness means a non-work related sickness, disease or related condition of the body requiring medical treatment. An illness includes pregnancy, routine Hospital and pediatric care of a newborn before discharge from the Hospital and birth defects and related conditions. An injury means non-work related physical harm to the body requiring medical treatment. In addition, to be covered by the Plan, medical care, treatment, services and supplies must be recommended or performed by a Doctor or other licensed provider and be "medically necessary." Some services require pre-approval.
b. Generally, after the deductible has been met, plan benefits are paid at eighty percent (80%) for In-Network care and seventy percent (70%) for Out-of-Network care except (however, copays and other limits apply to certain benefits):
(1) Chiropractic Care - when In-Network the plan covers the first six hundred dollars ($600.00) of eligible chiropractic care at one hundred percent (100%). Thereafter eligible expenses are covered at eighty percent (80%) after the deductible. In- and Out-of-Network benefits are limited to twenty (20) visits per covered person per calendar year unless additional visits are authorized by the Claims Administrator.
(2) Emergency Room - If a true emergency occurs, the plan covers eligible charges for an emergency room or urgent care facility and associated doctors services at one hundred percent (100%) after a fifty dollar ($50.00) co-pay.
NOTE: During an on-duty period, a Flight Attendant is eligible for emergency room treatment as if it were a "true emergency". The Flight Attendant shall submit a copy of his/her pattern to the Claims Administrator for adjustment to his/her claim.
(3) Hospice Care - eligible expenses are not subject to the deductible and covered at one hundred percent (100%) with pre-approval.
(4) Preventive Care - when received In-Network, eligible expenses are not subject to the deductible and covered at 90% (see paragraph n., below).
c. Covered Medical Expenses charged by a Hospital for services provided while an individual was a registered bed patient in a Hospital. The plan covers eligible medical or surgical services that are recommended by a Doctor for the treatment of acute illness, injury or pregnancy that requires the level of care only provided in an acute care facility. To receive In-Network benefits, all services must be provided in an In-Network Hospital or facility. A Flight Attendant or his/her eligible dependent must get pre-approval before all Hospital admissions, except for certain maternity admissions. Covered services while confined in a Hospital include:
(1) Anesthesia;
(2) Biologicals, fluids, blood and the administration of blood transfusions;
(3) Doctor, surgeon and anesthesiologist services and other medical professional services while in the Hospital;
(4) Dressings and casts;
(5) General nursing care;
(6) Intensive care facilities and newborn nursery facilities;
(7) Lab, X-ray and other diagnostic services, including MRIs;
(8) Oxygen;
(9) Prescription drugs and other medications administered in an inpatient setting, including existing and new drugs not otherwise excluded by the Plan;
(10) Private room and board - Only if the claims administrator determines that a private room is medically necessary;
(11) Professional ambulance service to or from a Hospital, whether the Flight Attendant is billed by the Hospital or ambulance service;
(12) Radiation therapy, chemotherapy and physical/occupational therapy;
(13) Semi-private room and board;
(14) Special diets;
(15) Surgery, including services and supplies;
(16) The use of operating rooms and maternity delivery rooms;
(17) Treatment of mental illness and functional nervous disorders (if billed by the Hospital); and
(18) Treatment of chemical dependency (if billed by the Hospital).
NOTE: Services for items for personal convenience are not covered eligible expenses.
d. Ambulance Services - the Plan covers emergency ambulance service to the nearest medical facility capable of providing required emergency services. Transfer from one Hospital or facility for subsequent covered treatment also is covered if medical supervision is required en route.
e. Home Health Care - the Plan covers home health care services and supplies when they are part of a “home health plan.”
f. Laboratory Services - the Plan covers diagnostic laboratory services performed in a lab facility or performed in an office or clinic.
g. Mental Health - the Plan covers both inpatient and outpatient treatment. Coverage is provided for diagnosable mental health conditions, including autism and eating disorders. Treatment for mental health care that is based on an evaluation and recommendation for such treatment or services by a Doctor, psychiatrist, licensed psychologist, licensed alcohol and drug dependency counselor or a certified substance abuse assessor is considered medically necessary. Prior authorization for care beyond twenty (20) visits is required for services to be covered under the Plan.
h. Alcohol & Chemical Dependency - the Plan covers both inpatient and outpatient treatment. You must get pre-approval before you are admitted to a facility for inpatient alcohol or chemical dependency treatment whether in or out-of-network.(1) The following inpatient services and supplies are covered by the Plan:
(a) Detoxification;
(b) Semi-private room and board;
(c) Services of appropriate medical professionals, including a Doctor or Psychologist; and
(d) Other medically necessary services for the diagnosis and treatment of alcohol or chemical dependency, including lab work, X-rays and emergency room treatment.
(2) For outpatient treatment, the following services are covered by the Plan:
(a) Group therapy;
(b) Individual therapy; and
(c) Services of a Doctor or Psychologist.
NOTE: A Flight Attendant must get pre-approval for outpatient care beyond twenty (20) visits. If his/her pre-approval request is approved, additional services may be covered.
i. Charges made by a physician, surgeon, physician's assistant, or clinical psychologist or licensed clinical social worker (LCSW) for professional services. "LCSW" means a social worker who has a masters degree in social work from an accredited institution, has at least two (2) years of post-graduate supervised clinical social work experience, and has met the clinical licensure requirements (or equivalent credentialing) of the state in which he/she practices.
j. Charges made by a registered graduate nurse, a licensed practical nurse, nurse practitioner, or a home health aide, other than a member of the patient's family, for professional nursing services.
k. Charges made for professional anesthesia and its administration by an anesthesiologist; diagnostic x-ray and laboratory examinations; x-ray, radium and radioactive isotope treatment; blood transfusions and cost of blood not donated or replaced; oxygen and other gases and their administration; rental of oxygen breather and other durable equipment; physical therapy; prosthetic appliances and dressings.
l. Charges made for physical, occupational and speech therapy limited to twenty (20) visits per year both In and Out-of-Network combined unless additional visits are authorized by the Plan.
m. Charges made for weight management or Bariatric Surgery and include four (4) physician visits per year for the treatment of obesity, six (6) dietician visits per year, plus counseling (including weight-loss drugs covered under the Prescription Drug Program). Prior authorization is required for surgery which shall be performed at a "Center of Excellence", where they are available.
n. Preventive Care/Wellness Care
The following examinations and screenings shall only be covered In-Network. There shall be no Out-of-Network coverage for examinations and screenings:
(1) Well-child care is available through eighteen (18) years of age. Adult preventive care (well-adult care) is available after eighteen (18) years of age.
(2) Well-child care includes the following:
(a) Exams and Office Visits:
i. Six (6) visits zero (0) to twelve (12) months;
ii. Three (3) visits twelve (12) to twenty-four (24) months;
iii. Annual visits from twenty-four (24) months through eighteen (18) years of age;
iv. Annual eye and hearing exam.
(b) Immunizations:
i. Meningococcal vaccine ;
ii. Two (2) doses of hepatitis A;
iii. Three (3) doses of hepatitis B;
iv. Six (6) doses of diphtheria, tetanus, pertussis (DTP);
v. Four (4) doses of haemophilus influenza type B;
vi. Four (4) doses of polio;
vii. Four (4) doses of pneumococcal conjugate;
viii. Two (2) doses of varicella;
ix. Two (2) doses of measles, mumps, rubella;
x. One (1) dose of influenza vaccine (flu shot) annually;
xi. One (1) dose of influenza vaccine (flu shot) annually; children eight (8) years of age or less who are receiving the influenza vaccine for the first (1st) time should receive two (2) doses separated by at least four (4) weeks.
(c) Screenings:
i. Lead level testing, one (1) between nine (9) to twelve (12) months of age and one (1) at twenty-four (24) months of age or after;
ii. Vision screening when done as part of well-child care office visit;
iii. Hearing screening when done as part of well-child care office visit;
iv. Pap smear and routine pelvic exam annually beginning at eighteen (18) years of age or the onset of sexual activity, whichever comes first(1st).
(2) Well-adult care includes:
(a) Exams and Office Visits:
i. Annual routine office visit and examination;
ii. Annual eye and hearing exam.
(b) Immunizations:
i. Tetanus/Diphtheria (TD) booster once every ten (10) years;
ii. Influenza vaccination (flu shot) once per Plan year;
iii. Meningococcal vaccine;
iv. Pneumococcal vaccination (pneumovaz) one (1) dose for persons sixty-five (65) years of age and over.
(c) Screenings:
i. Cholesterol screening including triglycerides, LDL, HDL, or lipid panel once every five (5) years beginning at twenty (20) years of age;
ii. Mammogram annually starting at forty (40) years of age;
iii. Pap Smear and routine pelvic exam once per Plan year beginning at eighteen (18) years of age;
iv. Bone density test for osteoporosis once for women sixty-five (65) years of age and over;
v. Colorectal cancer screenings:
vi. Fecal occult blood test (FOBT) once per Plan year and flexible sigmoidoscopy once every five (5) years both beginning at fifty (50) years of age; or
vii. Colonoscopy once every ten (10) years beginning at fifty (50) years of age; orviii. Double contrast barium enema once every five (5) years beginning at fifty (50) years of age;
ix. Digital rectal examination (DRE) and prostate specific antigen (PSA) test once per Plan year beginning at forty-five (45) years of age.
o. All Covered Medical Expenses received from Out-of-Network providers are subject to Out-of-Network Reasonable and Customary limits. The criteria for determining the Reasonable and Customary limits shall include what other providers in the same general area normally charge and also the complexity or degree of skill needed to provide the service. The Reasonable and Customary limits imposed by the NWA Medical Plan shall be based on the eightieth (80th) percentile of such Reasonable and Customary charges as determined by Ingenix data.
6. Excluded Medical Expenses for which no payment shall be made:
a. Expenses for or in connection with cosmetic surgery unless an individual receives an accidental injury, while covered, which requires cosmetic surgery
b. Expenses for eyeglasses
c. Expenses for or in connection with dental treatment unless:
(1) The dental work is made necessary by accidental injury to natural teeth received while an individual is covered, or
(2) The expenses are incurred for Hospital charges for bed, board and necessary services and supplies.
7. Covered Medical Expenses incurred for an illness, injury or pregnancy which causes an individual to be continuously and totally disabled from the date his/her coverage cancels shall be payable to the same extent as if the coverage had not canceled, during continuance of total disability, but in no event for a period in excess of the earlier of the following dates:
a. One (1) year from the date the coverage is canceled, or
b. The date the individual becomes covered under another group plan providing medical care benefits.
c. Benefits, however, shall not be payable for any child born as a result of any such pregnancy.
NOTE: For the purposes of this subparagraph 7., a Flight Attendant shall be considered totally disabled when, as a result of the Flight Attendant’s illness, injury or pregnancy, the Flight Attendant is unable to perform his/her Flight Attendant duties. A Flight Attendant's eligible dependent shall be considered totally disabled when, as a result of illness, injury or pregnancy, that eligible dependent is unable to engage in the normal activities of a person of the same sex and age. This continuance shall be concurrent with any COBRA continuation election.
8. Except as expressly modified in this Section 29, eligibility, employee contributions, benefit amounts and payments, exclusions, general limitations and definitions shall be as defined in the booklet entitled "NWA Health Care Plans Summary Plan Description". The Company shall, on a timely basis, provide the Union on request with copies of any changes in the Plan SPD with respect to Flight Attendants.
9. It is understood and agreed that benefits provided hereunder for medical disabilities due to pregnancy shall conform to the requirements of applicable federal law.
10. Pre-Approval and Continued Stay Approval
a. Pre-approval and continued stay approval is a program for medical cost containment utilizing the expertise of a professional review organization of consultant physicians and registered graduate nurses to certify the medical necessity for admission to a hospital as a registered bed patient. Pre-approval is a mandatory prerequisite to all non-emergency hospital admissions. Pre-approval is initiated by a patient through his/her treating physician.
b. If a pre-approval request is not received by the review organization prior to the date of the patient's hospital admission, then Covered Expenses shall not include and no payment shall be made for the first (1st) five hundred dollars ($500.00) of an In-Network and one thousand dollars ($1,000.00) of an Out-of-Network hospital’s charges made with respect to such confinement.
c. If a pre-approval request is received by the review organization and a hospital admission as a registered bed patient is not certified by the review organization as medically necessary, and the Flight Attendant and/or eligible dependent(s) proceed with the admission anyway, no benefits will be payable for any expenses that are not medically necessary and medically necessary expenses will be paid at fifty percent (50%). Pre-approval is not required if Medicare is the patient's primary coverage.
NOTE: All mothers-to-be must register for a prenatal program or will otherwise be subject to the pre-approval penalty on inpatient hospitalization.
C. Prescription Drug Program
1. The Company shall provide to Flight Attendants who elect to be covered under the NWA Medical Plan set forth in paragraph B., above, a Prescription Drug Program which shall provide coverage for eligible prescriptions as follows:
a. A separate Out-of-Pocket (OOP) maximum of one thousand dollars ($1,000.00) per eligible person shall apply to both prescriptions filled at retail pharmacies and through the mail.
b. The Prescription Drug Program participant shall pay the difference for brand drugs when a generic drug is available (generic drug copay plus the difference in cost between the brand drug and the generic drug.)
c. There shall be no deductible for the Prescription Drug Program.
d. There shall be unlimited maximum lifetime prescription drug benefits.
2. At an In-Network pharmacy. The network includes most national pharmacy chains plus many local independent pharmacies.
a. Maintenance Drugs:
(1) For the initial prescription and for the first (1st) refill of that prescription, the Plan shall pay one hundred percent (100%) after the copayment for up to a thirty (30) day supply.
(2) For refills after the first (1st) refill, the plan will pay fifty percent (50%) of the cost of the drug, taking into consideration any discounts available to the Plan at retail.
Exception: Certain maintenance medications, such as narcotic drugs, shall be paid at one hundred percent (100%) after the copayment when dispensing rules prohibit use of the mail order option described in subparagraph a.4., below.
(3) For Plan years 2006 and 2007 the following copayments shall apply:
(a) Generic Drugs, fourteen dollars ($14.00);
(b) Preferred Brand Drugs, twenty-four dollars ($24.00);
(c) Non-Preferred Brand Drugs, thirty-six dollars ($36.00); and
Lifestyle Drugs, fifty percent (50%) of the cost of the drug, with a thirty dollar ($30.00) minimum and no maximum.
(4) For Plan years 2008 and until the Agreement is amended, the following copayments shall apply:
(a) Generic Drugs, fifteen dollars ($15.00);
(b) Preferred Brand Drugs, thirty dollars ($30.00);
(c) Non-Preferred Brand Drugs, forty-five dollars ($45.00); and
(d) Lifestyle Drugs, fifty percent (50%) of the cost of the drug, with a thirty dollar ($30.00) minimum and no maximum.
(5) A Prescription Drug Program identification card shall ordinarily be presented at the participating pharmacy to obtain In-Network benefits. In the absence of such identification card, other proof of eligibility acceptable to the participating pharmacy may be presented. In the absence of such proof of eligibility, payment shall be made in accordance with subparagraph C.3., below.
(6) The Company shall maintain an updated list of maintenance drugs, subject to this subparagraph 2.a., and shall make such list available to Plan participants.
b. Non-Maintenance Drugs:
(1) Non-maintenance drugs include medications taken regularly but on an intermittent or as-needed basis.
(2) The Plan will pay for one hundred (100%), after copayment, for up to a thirty (30) day supply
3. At a non-participating pharmacy, or if the Flight Attendant's Prescription Drug Program identifying information is not utilized (e.g., the Flight Attendant's Prescription Drug Program card is not presented).
a. For the initial prescription and the first (1st) refill of maintenance medications, the Plan shall reimburse one hundred percent (100%) of the prescription expense after deducting the appropriate In-Network copayment and the lost discount from the cost of the prescription for up to a thirty (30) day supply.
b. For refills of maintenance medications, after the first (1st) refill, the Plan will reimburse fifty percent (50%) of the cost of the drug, net of the lost discount.
c. For the initial prescription and following refills of non-maintenance medications, the Plan shall reimburse one hundred percent (100%) of the prescription expense after deducting the appropriate In-Network copayment and the lost discount from the cost of the prescription for up to a thirty (30) day supply.
d. The lost discount is the difference between the amount the Plan would have paid to a participating pharmacy and what the non-participating pharmacy charges for the full retail mark-up.
e. A claim form must be completed and sent to the Prescription Drug Program along with pharmacy receipt(s) and description of the prescription(s).
4. Through a mail order program (Medco By Mail).
a. This program offers a convenient way to purchase up to a ninety (90) day supply.
b. The copayment shall be two and a half (2½) times the regular copayment as adjusted per subparagraph 2.a.(3), above, allowing for a ninety (90) day supply for the cost of a seventy-five (75) day supply copayment.
c. Shipping and handling fees shall be paid by the Prescription Drug Plan.
5. Certain Drugs require prior authorization from the Prescription Drug Program administrator prior to dispensing (Traditional and Smart Authorization Programs).
6. There shall be a preferred formulary for the Plan which shall include both single source and multi-source brand drugs. Additions are made to the formulary four (4) times a year and deletions are made two (2) times a year except when a drug loses Federal Drug Administration (FDA) approval and/or the Pharmacy Benefit Manager (PBM) loses its contractual right to offer the drug. However, certain drugs shall be subject to review for medical necessity and authorization by the Prescription Drug Program administrator prior to being dispensed. The list of drugs requiring such review shall be provided to Plan participants and shall be updated periodically as necessary. The formulary shall be no less favorable to Flight Attendants than the formulary used in other prescription drug programs provided to other employees of the Company.
Exception: Formulary First Coverage Review will be utilized for Proton Pump Inhibitors (PPIs). For non-formulary prescriptions of PPIs, dispensing of the drug will be stopped at the point of sale. If the Plan participant does not want a generic brand, he/she shall be offered the formulary brand. If the Plan participant purchases a non-formulary PPI, no coverage will be provided under the Prescription Drug Program and the patient shall pay the full cost of the drug.
7. Drugs not covered under the Prescription Drug Program include the following:
a. Over the counter (OTC) and prescribed medications with OTC equivalents;
b. Appetite suppressants (except if approved via prior authorization);
c. Cosmetic medications;
d. Contraceptives and contraceptive devices (however, oral contraceptives and contraceptive patches covered In-Network and through Medco By Mail);
e. Experimental or investigational medications;f. Replacement prescriptions resulting from loss, theft or breakage;
g. Vitamins, except for prescription vitamins.
8. Eligibility, employee contributions, benefit amounts and payments, definitions and general limitations shall be defined in the NWA Health Care Plans SPD.9. The Company shall notify the Union six (6) months prior to a change of the Prescription Benefit Manager (PBM).
D. The NWA Dental Plan
1. The Company will deduct monthly premium contributions for a Flight Attendant based on the following levels of coverage:
a. Flight Attendant only
b. Flight Attendant and Spouse or registered Domestic Partner
c. Flight Attendant and Child/Children
d. Flight Attendant and FamilyFor Flight Attendants on active payroll, such payments will be made by semi monthly deductions made on a pre-tax basis. The contribution amount shall be twenty percent (20%) of the premium amount based on the Active, COBRA and Retiree rate, subject to no more than a seven percent (7%) annual increase. This cap goes into effect on January 1, 2007. These payroll deductions shall not reduce pay-based benefits such as W-2 earnings for pension purposes.
2. In-Network and Out-of-Network Providers
a. If the Plan participant uses a participating Delta Dental Premier provider there are no claim forms to file and benefits are paid based on the allowed charge. There shall be no balance billing and payment shall be made directly by the Plan to the provider.
b. If the Plan participant uses a Delta Dental PPO sub-network provider there are no claim forms to file and benefits are paid based on the allowed charge. There shall be no balance billing and payment shall be made directly by the Plan to the provider.
c. If an Out-of-Network provider is used, the Plan participant must file a claim form. Benefits shall be paid according to the Reasonable and Customary charges outlined in subparagraph D.7., below, and paid directly to the Flight Attendant.
3. There shall be one (1) individual calendar year deductible of fifty dollars ($50.00) per person for Class II and Class III Services, except that when three (3) or more family members incur Covered Expenses during the same calendar year and the total expenses incurred toward satisfying their individual deductible amounts are at least equal to one hundred twenty-five dollars ($125.00), no further deductible amounts shall be required for the remainder of the calendar year for that family.
4. The maximum amount payable for each individual for the total of Class I, II and III Dental Services during a calendar year shall be two thousand dollars ($2,000.00).
5. Covered Dental Expenses shall be payable as follows:
a. Class I Services at ninety percent (90%);
b. Class II Services at eighty percent (80%); and
c. Class III Services at sixty percent (60%). Class III Services listed shall include dental implants under the criteria listed in the NWA Health Care Plans SPD.
NOTE: For each class of service, the basis for the reimbursement will be determined by the provider's network participation status as outlined in paragraph D.2., above.
6. Covered Dental Expenses for orthodontic services (Class IV Services) listed on the existing Schedule of Dental Services shall be payable at fifty percent (50%) and the lifetime maximum benefit shall be two thousand dollars ($2,000.00) per person.
7. All Covered Out-of-Network Dental Expenses (listed in this paragraph D.) are subject to Reasonable and Customary limits. The criteria for determining the Reasonable and Customary limit shall include what other providers in the same general area normally charge and also the complexity or degree of skill needed to provide the service. The Reasonable and Customary limits imposed by the NWA Dental Plan shall be based on the eightieth (80th) percentile of such Reasonable and Customary charges.
8. Except as expressly modified in this Section 29, Covered Dental Expenses, Limitations On Benefits and Covered Dental Expenses, Definitions and General Limitations shall be as defined in the NWA Health Care Plans SPD. The Company shall, on a timely basis, provide the Union on request with copies of any changes in the SPD with respect to Flight Attendants.
E. Flexible Spending Accounts (FSA)
1. The Company shall maintain a Flexible Spending Account (FSA) Plan for Flight Attendants covered by this Agreement. The FSA Plan shall be designed and administered by the Company and may be modified from time-to-time at the Company's discretion, provided however, that the maximum amount a Flight Attendant may contribute to his/her health care expense account and dependent care expense account as set forth in subparagraph E.2., below, shall not be modified without the consent of the Union. The Company shall prepare and make available to Flight Attendants a Summary Plan Description (SPD) booklet for the FSA Plan.
2. The FSA Plan shall consist of two (2) individualized accounts, one (1) for payment of a Flight Attendant's health care expenses and the other for payment of the Flight Attendant's dependent care expenses. The maximum amount a Flight Attendant may contribute to the health care expense account per year shall be limited to seven thousand five hundred dollars ($7,500.00), and the maximum amount a Flight Attendant may contribute to the dependent care expense account per year shall be limited to five thousand dollars ($5,000.00). Flight Attendants shall be permitted to contribute a portion of their compensation through payroll deduction into one or both accounts on a pre-tax basis. These payroll deductions shall not reduce pay-based benefits such as W-2 earnings for pension purposes.
3. As Flight Attendants submit claims for eligible expenses throughout the Plan year, they shall be reimbursed from their account(s).
4. Eligible expenses may be incurred during the Plan year for which a Flight Attendant made his/her election up to the end of the first two and a half (2½) months of the following Plan year (March 15th). Eligible expenses must be submitted to the Plan for reimbursement by April 15th.
5. Money contributed by a Flight Attendant to his/her account during a Plan year that is not reimbursed by April 15th following the Plan year for which elections were made, shall be used to reduce expenses incurred by the Company in the ongoing administration of the Plan.
F. Group Life Insurance and Other Insurance
1. Company-Paid Life Insurance
a. The Company shall provide to a Flight Attendant covered by this Agreement while he/she is on active payroll status, Company-paid Group Term Life Insurance ("Group Term Life I") coverage in the amount of fifteen thousand dollars ($15,000.00) and Group Term Life Insurance (Group Term Life II) in the amount of twenty thousand dollars ($20,000.00).
b. Upon the insurance company’s determination of a covered Flight Attendant's disability, the Flight Attendant shall receive the face value of the Group Term II policy in a lump sum. A disabled Flight Attendant who receives the face value of his/her Group Term Life II policy shall be excluded from coverage under such policy if he/she is returned to duty with the Company.
c. Group Term Life I shall include an accelerated death benefit provision.
d. The Company shall provide to Flight Attendants who are at least fifty-five (55) years of age with ten (10) or more years of Benefit Accrual Service (BAS) who retire and meet the definition for a Normal, Disability or Early Retirement Pension from the Northwest Airlines Pension Plan for Contract Employees, ten thousand dollars ($10,000.00) of Company-paid Group Term Life I Insurance. Upon the Flight Attendant's retirement, the Company paid Group Term Life I coverage will be reduced from fifteen thousand dollars ($15,000.00) to ten thousand dollars ($10,000.00).
2. Flight Attendant-Paid Life Insurance
The Company shall continue to provide administrative services, including payroll deduction, for optional Term Life Insurance under the Group Term Life I and II coverages which is wholly Flight Attendant-paid. Flight Attendants may elect to purchase additional Group Term I coverage in increments of ten thousand dollars ($10,000.00) to a maximum of two hundred thousand dollars ($200,000.00) and Group Term II coverage in increments of ten thousand dollars ($10,000.00) to a maximum of fifty thousand dollars ($50,000.00).
3. Flight Attendant-Paid Dependent Life Insurance
The Company shall provide administrative services, including payroll deduction, for optional Dependent Life Insurance, provided by an insurer selected by the Company. Premiums for such insurance shall be wholly Flight Attendant-paid.
4. Flight Attendant-Paid Accidental Death and Dismemberment Coverage
The Company shall provide administrative services, including payroll deduction, for an Accidental Death and Dismemberment Program selected by the Company. The Program shall provide insurance coverage paid wholly by the Flight Attendant in increments from ten thousand dollars ($10,000.00) to a maximum of three hundred and fifty thousand dollars ($350,000.00).
5. War Risk Life Insurance
The Company shall continue in effect the existing War Risk Life Insurance in the amount of one hundred thousand dollars ($100,000.00) and said insurance coverage shall be applicable to operations anywhere in the world, except in the United States.
6. Legal Liability Indemnity Insurance
The Company shall continue in effect the existing Legal Liability Indemnity Insurance in the amount of five hundred million dollars ($500,000,000.00).
7. Group Long Term Disability Coverage
a. The Company shall provide administrative services, including payroll deduction, for a Group Long Term Disability (LTD) Plan provided by an insurer selected by the Company and approved by the MEC President, or his/her designee. Premiums for such coverage shall be shared equally between the Flight Attendant and the Company.
b. The essential elements of this coverage include the following:
(1) Eligibility - All active full-time Flight Attendants who have completed twelve (12) months of service as an employee of the Company
(2) Definition of Earnings - Base pay
(3) Elimination Period - ninety (90) days
(4) Monthly Benefit - seventy percent (70%) of base pay
(5) Monthly Minimum Benefit - fifty dollars ($50.00)
(6) Monthly Maximum Benefit - five thousand dollars ($5,000.00)
(7) Definition of Disability - Two (2) years own occupation; any occupation thereafter
Benefit Period |
|
Age at Disability |
Maximum Benefit |
Less than age 62 |
To age 65 (or normal retirement age) |
62 |
3 1/2 years |
63 |
3 |
64 |
2 1/2 |
65 |
2 |
66 |
1 3/4 |
67 |
1 1/2 |
68 |
1 1/4 |
69+ |
1 |
(8) Pre-existing Conditions - Three/Twelve months
(9) Social Security Offset - Primary
(10) Pension Offset - Actual
(11) Coverage for mental and nervous conditions - twenty-four (24) month lifetime
(12) Partial Disability provision - Included
(13) Survivor benefit - Included
(14) Waiver of Premium Provision - Included
(15) Continuation - Coverage may be continued for up to twelve (12) months while on a Company approved leave.
(16) Contributions - Participation is mandatory with fifty percent (50%) Company-paid and fifty percent (50%) Flight Attendant-paid.
NOTE: As part of the Flight Attendant Long Term Disability Program, the Company hereby agrees that it will meet with Union Representatives annually to review the experience under the Long Term Disability Program and discuss insurance carrier proposed rate changes, if any, subsequent to the expiration of the original policy.