Upload
hathien
View
216
Download
0
Embed Size (px)
Citation preview
Honda Manufacturing of Alabama, LLC
June 2005
Your Benefits Guide
39549_SPDtabs 6/30/05 3:03 PM Page 1
Table of Contents
Introduction
About Your Health Care Coverage
Medical Plan
Prescription Drug Plan
Dental Plan
Short-Term Disability Plan (non-exempt)
Long-Term Disability Plan
About Your Life Insurance
Life and Accident Insurance Plan
Supplemental Life Insurance Plan
Other Benefit Services and Programs
Administrative Information
13
113137475155576365
Intr
odu
ctio
n
69
39549_SPDtabs 6/30/05 3:03 PM Page 2
Honda Manufacturing of Alabama, LLC
About Your Health CareCoverage
39549_SPDtabs 6/30/05 3:03 PM Page 3
Health CareTable of Contents
Who’s Eligible for Health Care Coverage
Health Care EnrollmentNew Hire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Annual Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Changes in Dependent Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Qualified Medical Child Support Order . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
When Health Care Coverage Begins
When Health Care Coverage Ends
Benefits While on Leave
Double Coverage for Medical or DentalDetermining Primary Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6How Benefits Coordinate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Medical and Dental Plan Rights
Women’s Health and Cancer Rights ActBenefit for Mammograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Medical Plan Administrator
Health Care Continuation — COBRA
Electing COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9When COBRA Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Abo
ut
You
r 33
5
55
6
7
8
88
39549_SPDtabs 6/30/05 3:03 PM Page 4
Table of Contents
Who’s Eligible 12When Coverage Begins 12How the Medical Plan Works 12Preferred Care 13Non-Preferred Care 13Certification for Inpatient Admissions 14
If You Don’t Certify Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Covered Expenses 15Physician Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Preventive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Vision Care Benefits and Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Spinal, Jaw Joint and Foot Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Outpatient Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Inpatient Hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Emergency Care and Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Maternity and Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Short-Term Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Skilled Nursing Care/Private Duty Nursing . . . . . . . . . . . . . . . . . . . . . . . 18Home Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Treatment of Mouth, Jaws, Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Mental Health Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Substance Dependency Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Associate Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Organ Transplant Centers of Excellence Facilities . . . . . . . . . . . . . . . . . . 22
Expenses Not Covered by the Plan 22Claims 25When Coverage Ends 26
Disability, Layoff and Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . 26If You Die . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Changing to a Personal Policy 26Glossary 27
PlanM
edic
al
39549_SPDtabs 6/30/05 3:03 PM Page 6
Table of Contents
Who’s Eligible
When Coverage Begins
Network Pharmacy Benefits
Covered Expenses
Expenses Not Covered by the Plan
Claims
Mail Order Benefits
When Coverage Ends
Drug Plan323232
33
32
32
35
36
Pre
scri
ptio
n39549_SPDtabs 6/30/05 3:03 PM Page 8
Table of Contents
Who’s Eligible
When Coverage Begins
How the Dental Plan Works
BenefitsAllowed Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Negotiated Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Covered Dental ExpensesBasic Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Restorative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Periodontic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Supplemental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Prosthetic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Orthodontia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Expenses Not Covered by the Plan
Claims
Double Coverage
When Coverage Ends
Glossary
Plan38
38
38
38
38
41
42
43
43
44
Den
tal
39549_SPDtabs 6/30/05 3:03 PM Page 10
Table of Contents
Who’s Eligible
When Coverage Begins
How the STD Plan Works
Benefits
What’s Not Covered
Claims
When Coverage Ends
Plan (non-exempt)
48
48
48
4949
48
49
Shor
t-Te
rm D
isabi
lity
39549_SPDtabs 6/30/05 3:03 PM Page 12
Table of Contents
Who’s Eligible
When Coverage Begins
How the LTD Plan WorksDisability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
BenefitsHow Long Benefits Are Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If You Return to Limited Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If Your Disability Recurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If You Die . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Mental Health/Chemical Dependency Limitation . . . . . . . . . . . . . . . . . . . 54
What’s Not Covered
ClaimsProof of Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
When Coverage Ends
Plan
52
52
52
54
54
52
54
Lon
g-Te
rm D
isabi
lity
39549_SPDtabs 6/30/05 3:03 PM Page 14
Table of Contents
Naming a Beneficiary
BenefitsDuring a Terminal Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Premium Waiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
When Coverage Ends
Claims
How Benefits Are Paid
Changing to a Personal Policy
Life Insurance
55
55
565656
55
Abo
ut Y
our
39549_SPDtabs 6/30/05 3:03 PM Page 16
Honda Manufacturing of Alabama, LLC
Life and AccidentInsurance Plan
39549_SPDtabs 6/30/05 3:03 PM Page 17
Table of Contents
Who’s Eligible
Basic Life and Accidental Death &Dismemberment Insurance Coverage
BenefitsCovered Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Additional Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Exclusions and Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
When Coverage Ends
Business Travel Accident Insurance Plan
Insurance Plan
58
58
58
60
61
Life
an
d A
ccid
ent
39549_SPDtabs 6/30/05 3:03 PM Page 18
Honda Manufacturing of Alabama, LLC
Supplemental LifeInsurance Plan
39549_SPDtabs 6/30/05 3:03 PM Page 19
Table of Contents
Who’s Eligible
When Coverage Begins
Supplemental Term Life Insurance Coverage
PlanSu
pple
men
al
Life
6464
64
39549_SPDtabs 6/30/05 3:03 PM Page 20
Honda Manufacturing of Alabama, LLC
Other Benefit Servicesand Programs
39549_SPDtabs 6/30/05 3:03 PM Page 21
ProgramsTable of Contents
Honda Educational Reimbursement
Honda Adoption Program
6667
Oth
er P
rogr
am
Ser
vice
s
39549_SPDtabs 6/30/05 3:03 PM Page 22
InformationTable of Contents
Welfare Plans
Family and Medical Leave Act (FMLA)
Health Insurance Portability and Acountability Act (HIPAA)
Continuation Coverage for Associates in the
Uniformed Services
Qualified Domestic Relations Order
Claim Appeals
Statement of RightsYour Rights Under ERISA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Enforce Your Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Plan Documents
Future of the Plans
707171
71
7272
7374
Ad
min
istr
ati
ve
39549_SPDtabs 6/30/05 3:03 PM Page 24