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When Coverage Ends
Obtaining New Medical Coverage (HIPAA)
Third-Party Reimbursement (Right Of Subrogation)
Non-Duplication of Benefits
Coordination With Medicare For Active Employees

WHEN COVERAGE ENDS

Medical coverage ends when the first of these events occurs:

You or your dependents are no longer eligible to participate in the Vought Aircraft medical plan
Vought Aircraft terminates the Vought Aircraft medical plan.

Changes in coverage are outlined in "What Happens to Your Benefits in Special Situations."

You and your dependents may continue medical coverage under certain circumstances when coverage would otherwise end, as described in the General Plan Administration section, under COBRA.

OBTAINING NEW MEDICAL COVERAGE (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) can help you and your family obtain new medical coverage if your coverage ends under the Vought Aircraft medical plan (e.g., if you terminate employment).

If you change jobs, for example, you most likely would request coverage under your new employer's health care plan.

If you or your dependents have a pre-existing condition, your new health care plan would not be required to cover any expenses related to the pre-existing condition for the first 12 months. On the other hand, if you and your dependents previously were enrolled in the Vought Aircraft medical plan for 12 months or more, your new plan would be required to cover any pre-existing conditions immediately However, if you had no health care coverage for a period of 63 days or more before your next coverage begins, your previous coverage does not count as "creditable coverage" and cannot be applied against a pre-existing condition exclusion.

By law under HIPAA, Vought Aircraft must provide you with a Certificate of Creditable Coverage when you or your dependents stop participating in a Vought Aircraft health care plan. The certificate is sent to you within 45 days of the date Vought Aircraft is notified of your termination.

You can present your Certificate of Creditable Coverage to a new health care plan to prove that you previously had coverage. This can reduce the length of time preexisting conditions affect your new coverage.

Your Certificate of Creditable Coverage states:

The date the certificate was issued
The name of the Vought Aircraft medical plan option you or your dependents are leaving
The period of time you or your dependents were enrolled in the medical plan option
The name, address, and telephone number of the issuer of the certificate
Whom to contact for further information.

Certificates of Creditable Coverage are issued to you:

Automatically, when your coverage under the plan ends - whether or not you elect COBRA
Automatically, when your COBRA coverage ends, if you elected COBRA coverage

On request within 24 months of the date your coverage ends. If you need to request a Certificate of Creditable Coverage, or if you are interested in more information about HIPAA, call the Vought Benefits Center at 1-866-689-5999 .

THIRD-PARTY REIMBURSEMENT (RIGHT OF SUBROGATION)

In some situations, another person or insurance company may be legally responsible for your medical expenses. For example, in the case of an automobile accident, a no-fault automobile insurance policy may be responsible for paying your medical expenses.

If Vought Aircraft pays expenses for which you or a dependent later recovers damages, you are required to reimburse the plan. When you accept benefit payments made on your behalf from the Vought Aircraft medical plan, you agree to:

Reimburse Vought Aircraft for the full amount of benefit payments made on your behalf
Provide any documents that allow Vought Aircraft to recover the payments it made to you or to a medical professional
Provide any other assistance to Vought Aircraft in enforcing these rights.

The legal term for Vought Aircraft's right of recovery is subrogation.
You must notify Blue Cross Blue Shield when you take legal action against a third party as a result of an illness or injury, or if a third party is responsible for payment.

NON-DUPLICATION OF BENEFITS

You or your dependents may be covered by more than one group medical plan, such as the Vought Aircraft medical plan and your spouse's employer's plan. In such an event, the Vought Aircraft medical plan options use a nonduplication of benefits provision to coordinate payments with the other plan.

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

This provision ensures that payments from the other plan, plus payments from the Vought Aircraft medical plan, do not exceed the amount Vought Aircraft would have paid if there were no other coverage.

Non-duplication of benefits does not apply to any private personal insurance, CHAMPUS (Civilian Health and Medical Program), or school policies that you or an enrolled family member may have.

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

if you are divorced, legally separated, or not married to your child's parent and your child is enrolled in both the Vought Aircraft medical plan and the other parent's employer's plan, the plans pay in this order.

First, the plan of the parent awarded financial responsibility for the child's medical expenses by a court decree
Then, the plan of the parent with custody of the child
Then, the plan of the stepparent whose spouse has custody of the child
Then, the plan of the parent who does not have custody of the child.

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

NON-DUPLICATION OF BENEFITS IF YOU ARE MARRIED

If medical expenses are for :

You, the employee the Vought Aircraft Plan pays primary
Your child, and your birthday falls earlier in the year than the other parent’s birthday (if you and the other parents have the same birthday, the plan covering the parent longer pays benefits first.) the Vought Aircraft Plan pays primary
You or enrolled family members, and you and/or they have COBRA coverage under another group medical plan the Vought Aircraft Plan pays primary
Your spouse, who is covered by another employer's plan (as an active employee or a former employee) the Vought Aircraft Plan pays secondary
Your spouse, if your spouse is a Vought retiree the Vought Aircraft Plan pays primary
Your child, and, according to the "birthday rule" described above, the other parent's plan is primary the Vought Aircraft Plan pays secondary
Your dependents, and the other plan does not have a coordination-of-benefits provision the Vought Aircraft Plan pays secondary

COORDINATION WITH MEDICARE FOR ACTIVE EMPLOYEES

if you or your dependents have coverage with Vought Aircraft because you are an active employee, and any of you also is enrolled in Medicare, the Vought Aircraft medical plan pays primary to Medicare. That means Vought Aircraft pays benefits first, and then Medicare pays benefits.

Medicare coverage is available on the first day of the month in which you:

Complete 25 months of disability
Complete 31 months of end-stage renal disease
Become age 65, whether you are retired or still working.

If you plan to work past age 65, you can:

Apply for Medicare when you become age 65, or
Decide to wait until you retire to apply for Medicare, if you are enrolled in one of the Vought Aircraft medical plan options. You are not obligated to enroll in Medicare while you are still an active employee.

If you or your dependent does not enroll in Medicare Part B (Supplementary Medical Insurance) as soon as you become eligible or, if you enroll, then discontinue coverage and subsequently re-enroll, you may pay higher Medicare premiums. However, the higher premiums do not apply to you or your spouse for periods when you are an active employee enrolled in one of the Vought Aircraft medical plan options.

End-Stage Renal Disease

If you are enrolled in Medicare because you have end-stage renal disease, Vought Aircraft pays primary for the first 30 months of your disease. Thereafter, Vought Aircraft pays secondary to Medicare. If , after 30 months, you are still an active employee, Vought Aircraft reimburses your Medicare Part B premium.

Disability

If you are disabled, the order in which the Vought Aircraft medical plan pays benefits depends on whether you are enrolled as an employee or as a dependent, as follows:

If you are a disabled employee, your Vought Aircraft medical plan option pays secondary to Medicare if all of the following apply:

You no longer work because of your disability.
You qualify for Social Security benefits because of a disability.
You are eligible for Medicare.
You are not enrolled in another group health plan as an active employee (for example, if you are a dependent, you are not enrolled in your employer's plan).

When you meet these criteria, any payments that the Vought Aircraft medical plan makes are calculated as if you are enrolled in Medicare, regardless of your actual enrollment status.

If you are a disabled dependent, your Vought Aircraft medical plan option pays primary to Medicare.

Qualified Medical Child Support Order

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

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

A child born to a single parent
A child who is not claimed as a dependent on the parent's federal income tax return
A child who does not live with the parent.

If you are subject to an order, Vought Aircraft notifies you and each affected child (or the child's representative) about the procedures that determine the validity of the order and how it will be implemented.

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