In Brief...

The Vought Aircraft medical plan offers a variety of options for your medical coverage. Each option provides access to quality care and protection from the high cost of medical services and supplies. This summary is designed to help you get the most out of the option that you choose.

On This Page

Your Medical Plan Options
Choose In-Network Providers To Receive Maximum Benefits
Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO Options
Choose the Correct Provider Network!
Health Maintenance Organization (HMO) Options
Binding Arbitration For HMOs
Opting Out of Medical Coverage
Usual, Reasonable and Customary
Penalties May Apply To Your Hospital Admission If You Do Not Follow These Rules

YOUR MEDICAL PLAN OPTIONS

Vought Aircraft offers you five medical plan options from which to choose:

• Premium preferred provider organization (PPO) option, administered
  by Blue Cross Blue Shield
  
• Healthcare Essentials preferred provider organization (PPO) option, administered by Blue Cross Blue Shield
  
• Balanced Choice preferred provider organization (PPO) option, administered by Blue Cross Blue Shield
  
• Health maintenance organization (HMO) options, if available in your ZIP code area
  
• No coverage, if you opt out of the Vought Aircraft medical plan.

When you enroll in any of the Vought Aircraft medical plan options administered by Blue Cross Blue Shield, ValueOptions administers your mental health and substance abuse benefits. These benefits are separate from your medical plan benefits. If you enroll in an HMO outside of Texas, your HMO administers your mental health and substance abuse benefits.

Likewise, if you enroll in any of the Vought Aircraft medical plan options administered by Blue Cross Blue Shield, Caremark administers your prescription drug coverage. However, when you enroll in any HMO, the HMO provides prescription drug coverage.

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CHOOSE IN-NETWORK PROVIDERS TO RECEIVE MAXIMUM BENEFITS

Network providers sometimes leave the network. You might select a network provider from the directory and find, at the time of your visit, that he or she is no longer a network member. If you are in doubt, call Blue Cross Blue Shield before you visit your provider and confirm that your provider is still a part of the network. Blue Cross Blue Shield keeps a record of your call, and should your provider subsequently leave the network, Blue Cross Blue Shield will still pay your claim as an in-network benefit.

With the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options, you can visit any network provider and receive in-network benefits. However, to receive in-network benefits, it is your responsibility - not your physician’s - to ensure that you are treated by network providers. You will pay more when you receive care from an out-of-network provider.

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PREMIUM PPO, HEALTHCARE ESSENTIALS PPO AND BALANCED CHOICE PPO OPTIONS

The Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options feature a network of preferred health care providers. The network is a group of physicians, hospitals, and other health care providers who meet Blue Cross Blue Shield's quality standards. Each provider agrees to:

• Undergo an extensive quality screening process
  
• Comply with Blue Cross Blue Shield's quality measures and protocols
  
• Provide care at discounted rates.

The PPO network includes providers in all states. The PPO network excludes locations outside the United States. If you live in one of these areas, see the chart about out-of-area benefits available to you.

After you pay the benefit plan year deductible, the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options pay a higher percentage of eligible expenses when you use a PPO network provider:

• The Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options typically pay 90%

After you pay the benefit plan year deductible, these medical plan options typically pay a lower percentage of eligible expenses when you receive care from an out-of-network provider:

• The Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options pay 60%

When you enroll in either the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options, you also may visit any doctor, hospital or ancillary provider - for lab or X-ray services - outside the network. But when you do so, you receive out-of-network benefits. That means you pay a higher coinsurance, and you may be responsible for expenses above the URC charge.

If you are admitted to an out-of network hospital, you pay a $500 penalty in addition to your benefit plan year deductible.

This penalty does not apply when you use an out-of-network hospital for emergency room treatment, outpatient treatment or laboratory services.

To request a list of network providers for the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options, call Blue Cross Blue Shield at 1-888-979-4514. You also can view or search provider directories by clicking here.

What Is the Difference?

There are important differences between the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options. The main differences are the following:

• The deductible amounts vary significantly under each plan option.
  
• The out-of-pocket maximums vary significantly under each plan option.

It is also important to remember that the Balanced Choice PPO option is designed as a catastrophic medical plan option that provides a "Balanced Choice" of coverage if you have a major illness or injury.

Under the Balanced Choice PPO option, you pay:

• A smaller weekly contribution for coverage
  
• A significantly higher deductible
  
• More in out-of-pocket expenses.

Click to view a chart reviewing Out-Of-Area Benefits.

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CHOOSE THE CORRECT PROVIDER NETWORK!

The Vought Aircraft medical plan options administered by Blue Cross Blue Shield include a PPO network. All PPO options offer the PPO provider network. To receive in-network benefits, make sure you use the correct network by choosing a provider from the directory for your medical plan option.

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HEALTH MAINTENANCE ORGANIZATION (HMO) OPTIONS

An HMO is a medical plan that offers its members a wide range of medical services - including preventive care - from a specific group of medical providers. Depending on your ZIP code area, Vought Aircraft may offer you several HMO options.

HMOs provide care through a network of PCP and specialist providers. To receive benefits, you must use an HMO provider. The HMO options pay no benefits if you use a physician or hospital that is not a member of the HMO network - except in an emergency situation.

HMOs generally pay 100% of eligible expenses after you pay a small copayment. You pay no deductibles, and there are no claim forms. Specific benefits and provisions vary by HMO option.

If an HMO is offered in your area (as determined by your ZIP code), you will receive information about it in your enrollment materials. This includes how to request detailed information from the HMO about:

• The ZIP code service area
  
• Participating physicians and hospitals
  
• Referral procedures
  
• Services provided, including prescription drugs and mental health and substance abuse treatment
  
• Eligibility requirements for services, including circumstances under which services may be denied
  
• Procedures for obtaining services
  
• Procedures for review of denied claims and the HMO appeal process. (You must exhaust the HMO appeal process before filing a formal appeal with Vought Aircraft.)

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BINDING ARBITRATION FOR HMOs

Binding arbitration is a legal method used to efficiently resolve disputes outside the court system. When you enroll in an HMO, you agree to resolve all differences between you or your dependents and the HMO through binding arbitration.

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OPTING OUT OF MEDICAL COVERAGE

If you do not want medical coverage or you have coverage from another source, you may choose to opt out of the Vought Aircraft medical plan options altogether. If you make that choice, neither you nor your eligible family members will have medical, prescription drug, vision, hearing or mental health and substance abuse benefits through Vought Benefits. However, you still receive benefits under the employee assistance program (EAP).

To opt out of the Vought Aircraft medical plan, you must sign and return a waiver of coverage. The form is available from the Excel Web site, or from the Vought Benefits Center. You must return the waiver to the Vought Benefits Center:

• Within 31 days of the date you become eligible to join the Vought Aircraft medical plan,
  
• Within 31 days of a qualified change in status, or
  
• By the Annual Enrollment deadline.

Waiver forms are available from the Vought Benefits Center at 1-866-689-5999 . After you return your signed waiver form, the Vought Benefits Center sends you a benefits enrollment confirmation statement to confirm your waiver of medical coverage.

If the Vought Benefits Center does not receive your signed waiver form by the deadline, you are enrolled in default coverage, as follows:

• If you are a newly eligible employee, you are automatically enrolled in the Balanced Choice PPO option for yourself only; your eligible family members receive no coverage.
  
• If you currently are enrolled in a Vought Aircraft medical plan option, your existing coverage continues.

You cannot change your opt-out election or default coverage until the next Annual Enrollment period, unless you have a qualified change in status during the benefit plan year.

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USUAL, REASONABLE AND CUSTOMARY

Usual, reasonable and customary (URC) means the "going rate" for services in your geographic area. The Vought Aircraft claims administrator determines the URC charge for all services covered under the Vought Aircraft medical plan options. When your expenses exceed the URC charge, your medical plan option reimburses for your expenses based on the URC charge. You pay 100% of the fees over the URC charge. The good news is, when you receive care from a network provider, expenses do not exceed the URC rate.

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AVOID PENALTIES BY FOLLOWING HOSPITAL ADMISSION RULES

• Under the Premium PPO, Healthcare Essentials PPO and Balanced Choice PPO options, someone - you, a family member, a friend or a member of the hospital staff - must notify Blue Cross Blue Shield to obtain approval within 72 hours of an emergency hospital admission.
  
• Otherwise, you pay a $500 penalty.
  
• If you are enrolled in one of the PPO options and you are admitted to an out-of-network hospital, you pay a $500 penalty, except in a life-threatening emergency.

Note: You must obtain precertification from Blue Cross Blue Shield whenever you are admitted to a hospital or are scheduled for in-hospital surgery. This applies to all inpatient procedures, unless it is an emergency If you do not precertify, you are required to pay a $500 penalty.

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