United pilots contract, Section 24 — Insurance
24-A Plans and Eligibility
24-A-1 Insurance Benefits and Plans to Be Provided
This Section 24 provides for medical, dental, vision, flexible spending account, retiree medical, retiree health accounts, LTD, and life & accident benefits for Pilots. The Company agrees that the following employee welfare benefit plans shall be maintained for the benefit of Pilots and, where applicable, their eligible Dependents and Survivors, subject to the applicable provisions of this Section 24, and such plans are hereby incorporated into the Agreement:
24-A-1-a The United Airlines Medical Program—Core Options (the “Core Medical Options”)
24-A-1-b The United Airlines Dental Program—Core Option (the “Core Dental Option”)
24-A-1-c The United Airlines Pilot Long Term Disability Plan (the “LTD Plan”)
24-A-1-d The United Airlines Pilot Long Term Disability Trust (the “LTD VEBA”)
24-A-1-e The United Airlines Pilot Retiree Health Account Plan and Trust (the “RHA VEBA”) and the United Airlines Pilot Health Reimbursement Account Plan and Trust (the “Active HRA VEBA”)
In addition, the Company shall continue to provide disability benefits according to the terms of prior disability plans to certain Pilots whose disability dates occur prior to December 30, 2012 as set forth in LOA 12-05 and shall continue to provide retiree medical benefits as required under, and in accordance with, the terms of any prior agreements to certain Pilots who retired prior to December 30, 2012 and to those Pilots covered by Paragraph IV of LOA 12-04. The benefits described herein and the plans incorporated above shall not be amended, modified, altered or terminated without the prior written agreement of the Association, except as provided in Section 24-J-11 with respect to amendments required by law or as otherwise provided herein or in the applicable Transition Agreement.
24-A-2 Eligibility for Insurance Benefits
Subject to the specific provisions of Sections 24-B through 24-I, Pilots and their Dependents are eligible for benefits under this Section 24 on the Pilot’s Date of Hire (i.e. the first day of employment as a Pilot), in accordance with the following:
24-A-2-a Eligibility for Medical (including Prescription Drug), Dental, Vision, and Flexible Spending Account Plans
Except as otherwise set forth in Sections 24-B through 24-E, all Pilots in Active Service and their Dependents shall be eligible for coverage under the medical plans described in Section 24-B, the dental plans described in Section 24-C, the vision plans described in Section 24-D, and the flexible spending account plans described in Section 24-E, in accordance with the following:
24-A-2-a-(1) Eligible Pilots
For purposes of Section 24-A-2-a, the term “Pilot in Active Service” includes any individual employed by the Company as a Pilot who is receiving pay as a Pilot in Active Service. In addition, as set forth in Section 24-A-4, certain Pilots not in Active Service are treated in some respects the same as a “Pilot in Active Service.” Further, in accordance with Section 24-A-5, a Pilot receiving benefits under the LTD Plan is treated the same as a “Pilot in Active Service.”
24-A-2-a-(2) Eligible Dependent
The eligible “Dependents” of a Pilot are all persons who are “dependents” of a Pilot under the terms of the applicable plan offered by the Company to Pilots now or in the future, in which the Pilot is enrolled. For purposes of determining a Pilot’s eligible Dependents under the terms of the applicable plan, in addition to any individuals who qualify as a Pilot’s “child” under the terms of the plan (such as a Pilot’s natural born children, adopted children, or step children), a Pilot’s “child” shall also include any other individual related to the Pilot (or the Pilot’s spouse or domestic partner) by blood or marriage provided: i) neither of the child’s parents is living with the Pilot; ii) the child is living with the Pilot in a parent-child relationship; and iii) the child is primarily dependent upon the Pilot for support.
24-A-2-b Eligibility for Coverage Under the LTD Plan
Pilots shall be eligible for coverage under the LTD Plan as provided in Section 24-H.
24-A-2-c Eligibility for Participation in Active Health Reimbursement Account VEBA and the Retiree Health VEBA and Life & Accident Plans
Pilots shall be eligible for coverage under the Active Health Reimbursement Account VEBA and the Retiree Health Account VEBA as provided in Section 24-G and shall be eligible to participate in the life & accident plans as provided in Section 24-I.
24-A-2-d Eligibility for Coverage Under the Retiree Medical Plan
Pilots and their Dependents shall be eligible for coverage under the Retiree Medical Plan as provided in Section 24-F.
24-A-3 Coverage Elections
At each Annual Enrollment (and any Special Enrollment), each Pilot may elect for himself and any eligible Dependents any of the insurance options that require elections provided under this Section 24. Pilots may be required to re-certify spousal/domestic partner eligibility every five (5) years.
24-A-4 Insurance Benefits for Pilots Not In Active Service
The benefits for which a Pilot is eligible during any period in which the Pilot is not in Active Service are set forth in Section 12.
24-A-5 Pilots Receiving LTD Benefits
Pilot receiving benefits under the LTD Plan shall be eligible to participate in medical, dental, vision, and life & accident plans on the same basis and at the same rates as a Pilot in Active Service, provided that premiums shall be paid by direct bill on an after-tax basis.
24-A-6 Survivors
A Pilot’s Dependents enrolled in any medical option on the date of the Pilot’s death, or a spouse who is covered by alternate insurance on the date of the Pilot’s death and for whom the Pilot would have been required to pay the spousal surcharge, shall be “Survivors” entitled to continue medical coverage in accordance with the terms of Section 24-B-7, dental coverage in accordance with the terms of Section 24-C-5, and retiree medical coverage in accordance with the terms of Section 24-F-6.
24-A-7 Domestic Partners
Except as otherwise prohibited by state or federal law, a Pilot’s domestic partner shall be treated the same as a spouse for purposes of any benefits described in this Section 24. A domestic partner is an individual for whom the Pilot has submitted proof of domestic partnership under Section 24- J-5-c, and provided the domestic partnership has not been terminated. Income shall be imputed to the Pilot for any domestic partner benefits elected by the Pilot as required by state or federal law.
24-B Active Pilot Medical Benefits, including Prescription Drug Benefits
24-B-1 Required Domestic Medical Plans
The Company shall offer the following domestic medical plans. The plan designs for plans marked with an asterisk are outlined in Appendix A.
24-B-1-a A Core Medical PPO*
24-B-1-b A Core Medical EPO*
24-B-1-c A Core Medical High Deductible Health Plan with Health Savings Account (“HDHP”)*, subject to the Company’s right to discontinue after one year provided no other high deductible health plan with health savings plan is offered by the Company
24-B-1-d The “Select Regional Medical Plans” described in Section 24-B-6.
24-B-2 Required International Medical Plan
The Company shall offer an Aetna Global or similar international medical plan to Pilots in a Pilot Base outside the 50 states.
24-B-3 Optional Medical Plans
In addition to the required medical plans under Sections 24-B-1 and 24-B-2, each eligible Pilot shall be offered the opportunity to participate in any additional medical plan options offered by the Company. The Company shall have the sole authority to establish, modify and discontinue any such additional medical plan(s) and their terms and conditions of participation (including, but not limited to, eligibility, plan design, applicable plan documents, plan rules) uniformly across all participating employee groups but may vary contribution rates by employee group. Pilots based
in Guam shall be eligible to participate in domestic medical plans or in Guam-based medical plans, subject to residency requirements of the plans.
24-B-4 Failure to Make Election During Enrollment Periods
In cases in which a Pilot fails to make a coverage election, the following rules shall govern unless agreed to otherwise by the Association and the Company:
24-B-4-a default to current coverage if available;
24-B-4-b if waived coverage (or a new hire), default to waive coverage;
24-B-4-c if enrolled in an optional PPO that is being eliminated for the ensuing plan year, default to Core Medical PPO;
24-B-4-d if enrolled in an optional EPO that is being eliminated for the ensuing plan year, default to Core Medical EPO;
24-B-4-e if enrolled in an optional HDHP that is being eliminated for the ensuing plan year, default to Core Medical HDHP, if offered, otherwise Core Medical PPO;
24-B-4-f if enrolled in an HMO or Aetna Select option that is being replaced for the ensuing plan year, default to replacement HMO;
24-B-4-g if enrolled in an HMO or Aetna Select option that is being eliminated for the ensuing plan year, default to Core Medical EPO; and
24-B-4-h if enrolled in an International Medical Plan under Section 24-B-2 that is being replaced for the ensuing plan year, default to the new required international option if eligible (if not eligible, default to Core Medical PPO).
24-B-5 Required Monthly Contributions
Pilots electing medical coverage under Section 24-B shall be required to make “Required Monthly Contributions” as provided in Section 24-B-5 and as determined in accordance with LOA 12-04. Required Monthly Contributions shall be made by payroll deduction, except in the case of Pilots on unpaid leave, disability, or other status during which they are not receiving pay, in which case Required Monthly Contributions shall be directly billed to, and paid by, the Pilot.
24-B-5-a Core Option 80%/20% Limit
Required Monthly Contributions for the Core Medical Options and Select Regional Medical Plans shall not exceed twenty percent (20%) of the Total Projected Cost for the Coverage Tier elected, except that this percentage shall vary for the individual Pilot after taking into account credits and surcharges described below.
24-B-5-b Required International Medical Plan and Optional Medical Plans
Contributions for the Required International Medical Plan under Section 24-B-2 and the Optional Medical Plans under Section 24-B-3 shall be set at the Company’s discretion but shall be included in the Aggregate Contribution Limit.
24-B-5-c Aggregate Contribution Limit
Pilot contributions for all medical plans offered by the Company under Section 24-B (excluding the Core Medical HDHP), shall not in the aggregate exceed twenty percent (20%) of Total Projected Costs. Compliance with the Aggregate Contribution Limit shall be determined after any required normalization of contributions to recognize the effect of credits and surcharges.
24-B-5-d Credits and Surcharges
The Company has the authority to establish tobacco wellness credits and spousal surcharges. The tobacco wellness credit shall be a minimum of forty-eight dollars ($48) per month per enrolled Pilot and spouse or domestic partner. The spousal surcharge, which shall not exceed fifty dollars ($50) per month, shall be applied to Pilots covering a spouse or domestic partner with alternate employer-subsidized coverage available. If the Company determines to provide an opt-out credit or to modify tobacco wellness credit to a more general wellness credit, then the Company and the Association shall meet and agree before implementation. The Company and the Association shall determine to what extent the opt-out credit shall be taken into account in the Core Option 80%/20% Limit and the Aggregate Contribution Limit.
24-B-5-e Annual Medical Cost Increases
Any increase in the Required Monthly Contribution for the Core Medical Options and Select Regional Medical Plans, from one calendar year to the next, shall not exceed nine and one- quarter percent (9.25%) of the prior year’s contribution as governed by LOA 12-04. This percentage may vary for the individual Pilot after taking into account credits and surcharges.
24-B-5-f Coverage Tiers
The Monthly Required Contribution for any Core Medical Option shall be based on a four-tier structure with relativity rating reviewed annually as part of the annual actuarial review:
24-B-5-f-(1) Employee only or spouse/qualified domestic partner only or Dependent children only (“employee only”);
24-B-5-f-(2) Employee and spouse/qualified domestic partner (“employee and spouse/domestic partner”);
24-B-5-f-(3) Employee and one or more children, or spouse/qualified domestic partner and one or more children (“employee and child(ren)”); and
24-B-5-f-(4) Employee and spouse/qualified domestic partner and one or more children (“family”).
24-B-5-g Core Medical Option Design
Core Medical Option deductibles, co-pays and out of pocket maximums for the 2023 Plan Year shall be as set forth in Appendix A to Section 24. No other changes to Appendix A may be made without the Association’s agreement.
24-B-6 Select Regional Medical Plans
Any plan offered under Section 24-B-6 shall be referred to herein as a “Select Regional Medical Plan.” Unless replaced or discontinued in accordance with Section 24-B-6, the Company shall continue to offer to eligible Pilots the following existing plans: all Kaiser HMOs, NetCare Guam
HMO, NetCare Guam Health Plan Plus, HMO Illinois, HMO Colorado, HMSA Hawaii and Group Health Washington. In the event the Company desires to replace or discontinue offering any of the foregoing plans for the following year, it shall so notify the Association no later than the second quarterly meeting of the current year, or as soon as possible thereafter if the necessary information is not yet available to the Company at the time of the second quarterly meeting, and shall meet with the Association to discuss the possible replacement or discontinuance of such plan, provided that:
24-B-6-a none of the foregoing plans shall be replaced by a new plan without the Association’s agreement, which agreement shall not be unreasonably withheld by the Association if the resulting disruption of Pilot enrollees in terms of their ability to continue utilizing the same medical providers in the proposed replacement plan is less than twenty percent (20%) (in which case the replacement plan shall be in all respects treated as a Select Regional Medical Plan covered by Section 24); and
24-B-6-b none of the foregoing plans shall be discontinued and not replaced without the Association’s agreement, which agreement shall not be unreasonably withheld by the Association if: i) the year-over-year increase in the gross premium for such plan is more than 20%; or ii) Pilot enrollment in such plan has declined to a level less than fifty percent (50%) of the enrollment on the effective date of the Agreement.
24-B-7 Survivors
A Pilot’s Survivors shall be entitled to continue coverage in accordance with the terms of the applicable plan document, provided that if the Pilot has less than ten (10) Years of Service (as defined in Section 24-F-2-a) the period of continued coverage shall be limited to three (3) months (exclusive of COBRA).
24-B-8 Medical Reimbursements
24-B-8-a Each Pilot shall be entitled to reimbursement of up to one hundred dollars ($100) for each FAA-required medical examination (currently, twice annually).
24-B-8-b Each Pilot shall be entitled to reimbursement of up to seventy-five dollars ($75) annually for the FAA-required EKG.
24-B-9 Covered Medical Procedures
In the event the third-party administrator of a Core Medical Option or the Traditional PPO denies coverage for a medical procedure that would have been covered under the same facts and circumstances by another current third-party administrator for such plan or by Medicare (at the time the procedure occurred or would have occurred), and all appeals have been exhausted and following discussion with the ALPA Retirement & Insurance Committee, the plan administrator shall instruct the third-party administrator of such plan to cover such procedure as a covered expense. The foregoing applies to denials based upon determinations regarding medical necessity and experimental/investigational treatments pursuant to the third-party administrator’s internal policies and protocols and does not apply to differences in plan design.
24-C Active Pilot Dental Benefits
24-C-1 Required Dental Plan
The Company shall offer, and each Pilot shall be eligible to participate in, the Core Dental Option. The plan design for the Core Dental Option is outlined in Appendix B.
24-C-2 Optional Dental Plans In addition to the Core Dental Option, each Pilot may participate in any additional dental plan options offered by the Company. The Company shall have the sole authority to establish, modify and discontinue such programs and their terms and conditions of participation (including, but not limited to, eligibility, plan design, applicable plan documents, plan rules) uniformly across all participating employee groups but may vary contribution rates by employee group. Pilots based in Guam shall be eligible to participate in domestic dental plans or in Guam-based dental plans subject to residency requirements of the plans.
24-C-3 Failure to Make Election During Enrollment Periods In cases in which a Pilot fails to make a coverage election, the following rules shall govern unless agreed to otherwise by the Association and the Company:
24-C-3-a default to current coverage if available;
24-C-3-b if waived coverage (or new hire), default to waive coverage; and
24-C-3-c if enrolled in an optional dental plan that is being replaced or eliminated, default to Core Dental Option.
24-C-4 Required Monthly Contributions Pilots electing dental coverage shall be required to make monthly contributions as provided in Section 24-C and as determined under LOA 12-04.
24-C-4-a Core Option 80%/20% Limit Required Monthly Contributions for the Core Dental Option shall not exceed twenty percent (20%) of the Total Projected Cost for the Coverage Tier elected.
24-C-4-b Optional Dental Plans Contributions for any optional dental plans shall be set at the Company’s discretion.
24-C-4-c Annual Dental Cost Increases Any increase in the Required Monthly Contribution for the Core Dental Option, from one calendar year to the next, shall not exceed nine and one-quarter percent (9.25%) of the prior year’s contribution as governed by LOA 12-04.
24-C-4-d Coverage Tiers The required contribution for each month of coverage for the Core Dental Option shall be based on a four (4)-tier structure with relativity rating reviewed annually as part of the annual actuarial review:
24-C-4-d-(1) Employee only or spouse/qualified domestic partner only or Dependent children only (“employee only”);
24-C-4-d-(2) Employee and spouse/qualified domestic partner (“employee and spouse/domestic partner”);
24-C-4-d-(3) Employee and one (1) or more children, or spouse/qualified domestic partner and one (1) or more children (“employee and child(ren)”); and
24-C-4-d-(4) Employee and spouse/qualified domestic partner and one (1) or more children (“family”).
24-C-5 Survivors
A Pilot’s Dependents enrolled in any dental option on the date of the Pilot’s death shall be “Survivors” entitled to continue coverage for three (3) months (exclusive of COBRA) in accordance with the terms of the applicable plan document.
24-D Active Pilot Vision Benefits
Each Pilot may participate in any vision plan options offered by the Company. The Company shall have the sole authority to establish such programs and their terms and conditions of participation, including, but not limited to, eligibility, plan design, applicable plan documents, plan rules, and contribution rates. Pilots based in Guam shall be eligible to participate in domestic vision plans or in Guam-based vision plans subject to residency requirements of the plans.
24-E Active Pilot Flexible Spending Account Plans
Each Pilot shall be eligible to participate in the Company’s flexible spending account plans for health expenses and dependent care expenses by making an election to contribute a portion of their pay. The maximum election for health expenses shall be the statutory limit (currently $3,050 for 2023). However, the maximum election shall never be higher than the greater of $10,000 or the amount that any non-Pilot may elect. Reimbursement shall be available for expenses incurred during the plan year and following the plan year through the date currently permitted by law, or later if legally permissible and administratively feasible. Forfeitures shall be used to defray the administrative expenses of the program. The maximum election for reimbursement for dependent care expenses shall be the maximum statutorily permissible election.
24-F Retiree Medical Benefits
24-F-1 Application
24-F-1-a Covered Pilots
The retiree medical rights, benefits and contribution obligations of Pilots and their Eligible Dependents provided by Section 24-F (hereinafter referred to as the “Retiree Medical Benefits”) apply to all Pilots (and their eligible Dependents) who retire on or after the effective date of the Agreement, except as otherwise provided in Section 24-F-2-d.
24-F-1-b Pilots Who Retired Prior to Effective Date
The retiree medical rights, benefits and contribution obligations, if any, of all Pilots who retired prior to the effective date of the Agreement and of their eligible dependents and eligible survivors shall continue to be determined in accordance with the provisions of the applicable collective bargaining agreement (including any applicable retiree medical plan(s) or letter(s)
of agreement) and/or court order, as applicable, in effect prior to the effective date of this Agreement.
24-F-2 Eligibility
24-F-2-a Eligibility Standards
A Pilot who retires on or after the effective date of the Agreement from Active Service, medical leave of absence, personal leave of absence, or from disability status shall be eligible for Retiree Medical Benefits if on the date the Pilot retires, the Pilot:
24-F-2-a-(1) has attained at least age fifty (50) and completed at least ten (10) Years of Service; or
24-F-2-a-(2) has attained age sixty-five (65).
For these purposes, a Pilot's "Years of Service" are equal to the period from company seniority date through retirement date (including the entire period during which the Pilot is disabled). The Pilot is not required to be enrolled in active medical coverage at the time of retirement in order to qualify for Retiree Medical Coverage.
24-F-2-b Return to Active Service
If a retired Pilot returns to Active Service with the Company, his Retiree Medical Benefit coverage shall be suspended (and his eligibility for active medical benefits shall be governed by the terms of his employment). In such case, the Pilot and eligible Dependents shall again be eligible for Retiree Medical Benefits coverage when the Pilot ceases to be employed by the Company.
24-F-2-c Eligibility of Dependents of Retired Pilots
Eligibility of Dependents of a retired Pilot for Retiree Medical Benefits shall be governed by the following:
24-F-2-c-(1) General
Each Dependent shall become eligible for Dependent coverage on the day the Dependent becomes a Dependent of a retired Pilot who is eligible for Retiree Medical Benefits, provided the retired Pilot is actually enrolled for Retiree Medical Benefits coverage on that date and the Dependent becomes enrolled within forty-five (45) days after the date the Dependent became eligible. A Dependent who is eligible for coverage is eligible for Before- Medicare Benefits coverage or After-Medicare Benefits coverage depending on whether the Dependent is eligible for Medicare. All Dependents must enroll in the same option as the Pilot, unless they are in the other coverage category (i.e., Before-Medicare Benefits or After-Medicare Benefits) in which case all such Dependents must be enrolled in the same option under that category.
24-F-2-c-(2) Dependent Also an Employee
No Dependent who, as an employee, is eligible for medical coverage under any plan or program sponsored or subsidized by the Company shall be eligible to be covered under Section 24-F as a Dependent, except as provided in Section 24-F-2-c-(3).
24-F-2-c-(3) Dual Retirees
In the case of a retired Pilot and his Dependent spouse or domestic partner who are both retirees: (i) one such retiree may enroll as the participant and cover the other retiree and any other Dependents as dependents, or (ii) each retiree may each enroll as separate participants, in which case all other Dependents must be covered as dependents under a single retiree’s enrollment.
24-F-2-c-(4) Continued Eligibility Conditioned on Payment of Contributions
Once eligible for coverage, a retiree shall remain eligible only if he pays the Required Monthly Contribution.
24-F-2-c-(5) Loss of Eligibility on Termination of Coverage
Except as otherwise provided in Sections 24-F-2-d and 24-F-2-e, once coverage under Section 24-F has terminated with respect to a retiree or Dependent, such retiree or Dependent shall no longer be eligible for Retiree Medical Benefit coverage hereunder.
24-F-2-d Voluntary Suspension of Coverage and Subsequent Re-Enrollment
A retiree may suspend medical coverage for the retiree and any eligible dependents, provided the retiree and any dependents have alternative coverage under any of the following types of plans:
24-F-2-d-(1) Group health plan sponsored by another employer;
24-F-2-d-(2) Medigap Plan with prescription drug coverage;
24-F-2-d-(3) Medigap Plan with Medicare Part D;
24-F-2-d-(4) Medicare Advantage Plan (PPO or HMO) with prescription drug coverage;
24-F-2-d-(5) Medicare Advantage Plan (PPO or HMO) with Medicare Part D;
24-F-2-d-(6) TRICARE;
24-F-2-d-(7) Qualified individual medical insurance policy eligible for the federal Health Coverage Tax Credit (“HCTC”) or
24-F-2-d-(8) Individual policy under a state health insurance exchange;
24-F-2-d-(9) Non-US national health insurance.
24-F-2-d-(10) The retiree may make the election to suspend coverage upon first becoming eligible for retiree medical coverage or during any subsequent annual enrollment period. Alternatively, the retiree may choose to suspend coverage of one (1) or more eligible dependents and either retain or suspend coverage for the retiree at the same time. However, the retiree may not suspend coverage for the retiree while maintaining coverage for the dependents. The retiree (and/or dependents if applicable) may re-enroll for coverage during a future annual enrollment period or within forty-five (45) days following a qualifying status change. In order to re-enroll, the retiree (and/or dependents if applicable) must provide the UABC with satisfactory proof of the alternative coverage described above for all periods that coverage was suspended.
24-F-2-e Effective Date of Coverage
24-F-2-e-(1) Coverage for each retired Pilot shall become effective on the first day of the month following the first date on which the retiree is both eligible for coverage and has enrolled. If on that date an eligible Dependent has not yet attained the age for Medicare eligibility and is not otherwise eligible for Medicare, then he shall receive Before-Medicare Benefit coverage effective on that date. After-Medicare Medical Benefits coverage shall be effective for an eligible Dependent on the earlier of the date he attains the age for Medicare eligibility or otherwise becomes eligible for Medicare whether or not he has enrolled for Medicare, provided he is enrolled for Retiree Medical Benefits coverage within forty-five (45) days after that date.
24-F-2-e-(2) Coverage for the Dependents of a retired Pilot shall become effective on the date the Dependent is first eligible for coverage and the retiree is actually enrolled provided the retiree enrolls the Dependent for coverage in accordance with the procedures prescribed by the Plan Administrator. If Dependent coverage terminates during a period when the retiree has returned to Active Service, Dependent coverage shall be reinstated on the date the retiree again retires and timely enrolls for coverage under the Plan, but only with respect to Dependents who are eligible on that date. No benefits shall be paid with respect to expenses incurred for any Dependent prior to the date the retiree enrolls such Dependent for coverage. Any enrollment made within forty-five (45) days after the date the Dependent became eligible for coverage shall be effective retroactively to such date.
24-F-3 Choices of Coverage
24-F-3-a Retiree Elections
At the time specified by the Plan Administrator coincident with or following the date a retired Pilot first becomes eligible for coverage or during any later Annual Enrollment Period, the retiree may choose from among the Retiree Medical Benefits coverage options and coverage levels available under Section 24-F. If, after initial enrollment, a retiree fails to make an election in a later Annual Enrollment Period, the retiree’s previous election shall continue in effect, unless the option elected is no longer available, in which case the default provisions under Section 24-B-4 shall be followed, to the extent reasonably applicable.
24-F-3-b Coverage Options
Depending on their Medicare eligibility, the coverage options available to retired Pilots and Dependents under Section 24-F are as follows:
24-F-3-b-(1) Before-Medicare Medical Benefits
When first eligible, and during any subsequent Annual Enrollment, a retired Pilot may elect from among the same options (Required or Optional coverage options) as are available to Active Pilots under Section 24-B, as modified or amended by the Company and the Association from time to time. Coverage shall not be offered again once coverage has been waived or has ceased due to nonpayment of the required monthly contribution, subject
to Section 24-F-2-d. Before-Medicare Retiree Medical Benefits are subject to change as active medical benefits change.
24-F-3-b-(2) After-Medicare Medical Benefits
When first eligible, and during any subsequent Annual Enrollment, a retired Pilot may elect from among one or more supplemental plans to Medicare offered by the Company. Coverage shall not be offered again once coverage has been waived or has ceased due to nonpayment of the required monthly contribution, subject to Section 24-F-2-d.
24-F-3-c Coverage Tiers
Retired Pilots may elect Retiree Medical Benefits coverage under any of the coverage options specified in Section 24-F-3-b in the tiers set forth in Section 24-B-5-f, provided that any reference in that Section to “employee” shall be a reference to “retiree.”
24-F-4 Required Monthly Contributions
Retired Pilots who elect Retiree Medical Benefit coverage under Section 24-F for themselves and their eligible Dependents are required to make contributions for each month of coverage in amounts determined on the basis of the coverage option and coverage tier elected.
24-F-4-a Before-Medicare Medical Benefits
Except for any HMO (insured or self-insured), the required contribution for each month of coverage under a particular Before-Medicare coverage option (e.g., PPO or “build your own” EPO) and coverage tier elected is equal to a percentage of the Total Projected Cost of that coverage option and coverage tier, based on the Pilot's
| Years of Service | Percentage of Cost |
|---|---|
| Fewer than 20 | 80% |
| 20 up to 25 | 60% |
| 25 and over | 40% |
Section 24-B-5-d shall apply in determining Required Monthly Contributions for Before- Medicare Medical Benefits. Therefore, these percentages shall vary for the individual Pilot after taking into account credits and surcharges. The contribution for each month of coverage under any HMO (insured or self-insured) is equal to the total monthly cost of the HMO minus the amount of the Company's contribution that would apply for such coverage tier for such month of coverage under the Core Medical PPO. Neither the nine and one-quarter percent (9.25%) limit on year-over-year increases in contribution rates for Pilots in Active Service under Section 24-B-5-e nor the Aggregate 80%/20% Limit under Section 24-B-5-c shall apply to contributions for Before-Medicare Medical Benefits.
24-F-4-b After-Medicare Medical Benefits
Eligible individuals must pay a monthly contribution for the cost of After-Medicare coverage. The monthly contribution is equal to the Total Projected Cost of such After-Medicare coverage for the calendar year, per person, minus a Company contribution equal to ninety dollars ($90)
per month per person covered. Neither the Aggregate 80%/20% Limit under Section 24-B-5- c, nor credits and surcharges under Section 24-B-5-d, nor the nine and one-quarter percent (9.25%) limit on year-over-year increases in contribution rates for Pilots in Active Service under Section 24-B-5-e shall apply to contributions for After-Medicare Medical Benefits.
24-F-5 Determination of Total Projected Cost
For purposes of Section 24-F, Total Projected Cost shall be determined as part of, and in accordance with, the annual rate-setting process described in LOA 12-04, except that:
24-F-5-a The Experience True-Up Adjustment shall not apply for After-Medicare Medical Benefit coverage, and
24-F-5-b Total Projected Cost of After-Medicare Medical Benefits shall be determined on the basis of the Claims Experience of all Medicare-eligible employees of the Company who have After-Medicare Medical Benefit coverage.
24-F-6 Retiree Medical Benefits of Deceased Pilots’ Survivors and Dependents
Section 24-F-6 applies to the surviving eligible Dependents (surviving spouse/domestic partner and other surviving eligible Dependents) of Pilots who die on or after the effective date of the Agreement, concerning their entitlement to Retiree Medical Benefits pursuant to Section 24-F. The Pilot’s eligible Dependents are determined under Section 24-A-2-a-(2) above and the terms of the medical option in which the Pilot was enrolled on the date of his death.
24-F-6-a Survivors of Pilots Who Die Before Retirement
If a Pilot dies before retirement, the Pilot’s Survivors’ medical coverage shall continue to be provided under Section 24-B to each surviving eligible Dependent until Retiree Medical Benefit coverage is offered under this Section 24-F. Retiree Medical Benefit coverage shall be offered under Section 24-F, as follows:
24-F-6-a-(1) Surviving Eligible Dependents Includes Spouse/Domestic Partner
If there is a surviving spouse or domestic partner, active medical benefit coverage under Section 24-B shall end and Retiree Medical Coverage under Section 24-F shall be offered when the surviving spouse/domestic partner becomes eligible for Medicare on the basis of attained age. If the deceased Pilot’s surviving spouse/domestic partner becomes eligible for Medicare on any other basis, the surviving spouse/domestic partner and any other surviving eligible Dependents shall remain covered under Section 24-B until the surviving spouse/domestic partner becomes eligible for Medicare on the basis of attained age at which time Retiree Medical Coverage under Section 24-F shall be offered.
24-F-6-a-(2) Surviving Eligible Dependents Do Not Include Spouse/Domestic Partner
If there is no surviving spouse or domestic partner (or if the surviving spouse domestic partner has died), coverage under Section 24-B shall end and Retiree Medical Benefit coverage under Section 24-F shall be offered when any one of the other surviving eligible Dependents becomes eligible for Medicare because of reaching the attained age.
24-F-6-b Enrollment of Surviving Eligible Dependents in Retiree Medical Benefit Coverage
When Retiree Medical Benefit coverage is offered under Section 24-F, all eligible Dependents of the deceased Pilot shall be given the opportunity to enroll in such coverage. The Medicare- eligible Dependent(s) may enroll for After-Medicare Medical Benefits hereunder and shall be responsible for paying the Required Monthly Contributions. All other eligible Dependents may enroll for Before-Medicare Medical Benefits hereunder and any monthly contributions for Before-Medicare Medical Benefits shall be waived.
24-F-6-c Medical Coverage of Surviving Eligible Dependents of Pilot Who Dies While Retired
The surviving eligible Dependents of a Pilot who dies while retired shall continue to be eligible for Retiree Medical Benefits under Section 24-F on the same basis as if the Pilot had not died. Required Monthly Contributions, if any, must be paid by the surviving eligible Dependents.
24-F-6-d Coordination of Benefits with Medicare
If a surviving eligible Dependent is eligible for Medicare, Medicare shall be the primary payer, to the extent permitted by law, and the coverage option elected under Section 24-F shall be the secondary payer. As the secondary payer, the coverage option elected under Section 24- F shall coordinate benefits with Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) whether or not the individual is enrolled in Medicare. If Medicare is the primary payer under Section 24-F-6-d, the Plan Administrator shall first estimate the benefits Medicare Part A and Part B would have paid and shall then coordinate benefits as if Medicare Part A and Part B had actually paid the estimated benefits. No Medicare coordination shall apply with respect to an individual who is not eligible for Medicare.
24-F-6-e Notwithstanding the foregoing provisions of Section 24-F-6, Pilots shall be entitled to survivor retiree medical coverage provisions no less favorable than the medical coverage provisions for any other employee group other than provisions limited in their application to corporate officers, Executive Vice-Presidents and above.
24-G Active Health Reimbursement Account (Active HRA) VEBA and Retiree Health Account (RHA)
VEBA
24-G-1 Establishment of Active HRA and RHA Plan and VEBA Trust
Contributions under Section 24-G for each Pilot shall be deposited into either an active health reimbursement account (“Active HRA”) or a retiree health account (“RHA”), each of which shall be under a voluntary employees’ beneficiary association (VEBA) trust that is intended to comply with the requirements of Internal Revenue Code section 501(c)(9). The plan and trust documents for the Active HRA VEBA and the RHA VEBA shall be created by agreement between the Company and the Association. The Association shall have the same rights, and the Company shall have the same obligations, for the Active HRA VEBA and the RHA VEBA as are set forth in Section 24-J-4. Contributions under Sections 24-G-2, 24-G-3 and 24-G-4 shall be allocated to the Active HRA VEBA with respect to any Pilot who is covered by a Company-provided medical plan under Section 24- B, and to the RHA VEBA with respect to any Pilot who is not covered by a Company-provided medical plan.
24-G-2 Employer Contributions
For each hour of a Pilot’s pay, one dollar ($1) shall be deducted from such pay and contributed by the Company to the Pilot’s Active HRA or RHA (as applicable), as a mandatory salary reduction contribution excludible from gross income. Such one dollar ($1) shall be included in the calculation of any other benefits that are based upon a Pilot’s hourly pay. Contributions shall be made bi-monthly by the Company.
24-G-3 Employer Excess Contributions
24-G-3-a Prior to the implementation of the Market Based Cash Balance Plan set forth in Section 22-B-2, any direct employer contributions that cannot be made to the PRAP due to the 401(a)(17) compensation limits for such plan year shall be paid a follows; the first $10,000 is contributed to the Active HRA/RHA and the remainder is paid as cash. Any direct employer contribution that cannot be made to the PRAP due to the 415(c) limits shall be made to the Active HRA/RHA. Such payments will be made at the same time as the direct employer contribution would have been made, or as soon as reasonably practicable thereafter.
24-G-3-b Upon the implementation of the Market Based Cash Balance Plan, direct employer contributions that cannot be contributed to the PRAP due to the limits under Section 401(a)(17) or 415(c) of the Internal Revenue Code shall be forfeited and a contribution shall be made to the Market Based Cash Balance Plan in accordance with Section 22-B-2 and/or the Pilot’s Active HRA or RHA (as applicable), as elected by the Pilot, or as determined by the Company and the Association if such an election is not permitted by the IRS.
24-G-4 Employer Vacation Forfeiture Contributions
A Pilot may make an annual election that any forfeited vacation under Section 11-H up to a maximum of twenty-one (21) days, shall be contributed to the PRAP or to the Pilot’s Active HRA or RHA (as applicable). If no election is made, the forfeited vacation shall be contributed to the PRAP. In the case of any employer contributions under the PRAP attributable to forfeited vacation under Section 11-H that cannot be contributed to the PRAP due to the limits under Sections 401(a)(17) or 415(c) of the Internal Revenue Code, an equivalent amount shall instead be contributed by the Company to the Pilot’s Active HRA or RHA (as applicable), at the same time as the employer contribution to the PRAP would have been made. Notwithstanding the foregoing, if IRS rules permit such contributions to instead be made to the Market Based Cash Balance Plan pursuant to each Pilot’s election in Section 22-B-2-b, the Company and the Association will meet and confer to determine whether it is appropriate to implement such feature.
24-G-5 Employee Contributions
Employee post-tax contributions to the Active HRA and RHA VEBAs shall not be permitted unless agreed to by the Company and the Association. Employee pre-tax contributions to the Active HRA and RHA VEBAs shall not be permitted.
24-G-6 RHA VEBA Benefits
Each Pilot’s RHA shall be usable upon retirement to pay for qualified medical expenses under Section 213(d) of the Internal Revenue Code, as well as any additional expenses permissible under Section 501(c)(9) of the Internal Revenue Code as agreed to by the Company and the Association.
24-G-6-a Benefits shall be payable with respect to the Pilot and the Pilot’s eligible dependents as determined in accordance with Section 152 of the Internal Revenue Code.
24-G-6-b In the event of the Pilot’s death, the surviving eligible dependents shall remain eligible for the benefits described above paid from the Pilot’s RHA.
24-G-6-c Once the Pilot and all of the Pilot’s surviving eligible dependents have died or ceased to be eligible, the remaining portion of the Pilot’s RHA shall be forfeited and re-allocated per capita among the RHA’s of the remaining Pilots in the RHA VEBA.
24-G-6-d The RHA VEBA may provide, if administratively feasible, direct payments for Retiree Medical Benefit coverage under Section 24-F.
24-G-7 Active HRA VEBA Benefits
Each Pilot’s Active HRA shall be usable while employed by the Company and covered by a Company-provided medical plan to pay for qualified medical expenses under Section 213(d) of the Internal Revenue Code, as well as any additional expenses permissible under Section 501(c)(9) of the Internal Revenue Code as agreed to by the Company and the Association.
24-G-7-a Benefits shall be payable with respect to the Pilot and the Pilot’s eligible dependents as determined in accordance with Section 152 of the Internal Revenue Code.
24-G-7-b In the event of the Pilot’s death, retirement or termination of employment, any assets remaining in the Active HRA shall be transferred to the Pilot’s RHA.
24-G-7-c With respect to a Pilot who is furloughed, the Pilot’s Active HRA balance shall be transferred to the RHA after the earlier of (i) the Pilot’s retirement or (ii) five years after the Pilot’s last day worked with the Company. In addition, such a Pilot may make a one-time election prior to such date to have the Pilot’s Active HRA balance transferred to the RHA.
24-G-7-d With respect to a Pilot who becomes entitled to benefits under the LTD Plan, the Pilot’s Active HRA balance shall be transferred to the RHA after the earlier of (i) the Pilot’s retirement or (ii) five years after the Pilot’s date of disability. In addition, such a Pilot may make a one-time election prior to such date to have the Pilot’s Active HRA balance transferred to the RHA.
24-G-7-e A portion of Pilot Active HRA balances may periodically be transferred to the RHA as agreed to by the Company and the Association.
24-G-8 Investment Committee
The Company and the Association shall form a joint Investment Committee responsible for managing the investment of assets held in the Active HRA and RHA VEBAs. The Company and the Association each may appoint up to three (3) members. One of the Association appointed members may be a retired Pilot. The parties need not appoint an equal number of members, provided, however that the Company members and the Association members each collectively have one (1) vote. Individual votes on a particular issue may be recorded in the minutes at the request of any member. Each party may appoint alternates. A quorum shall consist of one (1) Company member/alternate and two (2) Association members/alternates. The Investment Committee shall select an investment advisor to advise the Investment Committee with respect
to the selection and monitoring of investments. Fees charged by the Investment Advisor shall be paid by the Company. The Investment Committee shall meet quarterly, unless otherwise agreed to by the Company and the Association. In the event of a deadlock, the Company and the Association shall utilize the independent tie-breaker provisions of Section 22 for the PRAP.
24-H LTD Plan
24-H-1 Eligibility and Enrollment
Except as provided under LOA 12-05, each Pilot is eligible to participate in the LTD Plan as of December 30, 2012 or, if later, his Date of Hire. Each Pilot shall be automatically enrolled to participate in the LTD Plan on the date the Pilot is eligible for the LTD Plan, with no exclusion for pre-existing conditions. A Pilot may opt out of participation at any time by providing notice in accordance with rules established by the Administrative Committee.
24-H-2 Cost of Coverage
24-H-2-a General
Unless otherwise agreed to by the Company and the Association, the Plan shall be funded by a trust to be established pursuant to Section 24-H-18 to which contributions shall be made sufficient to i) fully fund the actuarial liability for all benefits projected to be paid to participants becoming disabled in the applicable year, plus ii) fund over three (3) years any surplus or shortfall in the trust as of the beginning of the twelve-month period determined by the LTD Administrative Committee. The Company and the Association shall establish, and may change, any of the actuarial funding assumptions, including without limitation the discount rate, by written agreement.
24-H-2-b Contributions
Seventy-five percent (75%) of the contributions to the trust shall be made by the employer and twenty-five percent (25%) shall be made by the participants. A participant shall not be charged any contribution for the participant’s compensation in excess of two (2) times the applicable maximum under Section 24-H-3 in any calendar month. In order to provide Pilots disability benefits on a tax-free basis, the Pilot’s contribution to the Plan shall be made on an after-tax basis and the Company’s contribution shall be imputed as income to the Pilot for tax purposes. A Pilot shall not be required to make contributions while receiving LTD benefits, and contributions made by a Pilot following formal application for LTD benefits shall be refunded to the Pilot in the event the Pilot is approved for LTD benefits. All employer and participant contributions shall be made bi-monthly.
24-H-3 Amount of Benefit
For disability dates on or after September 29, 2023, the amount of the monthly LTD benefit (determined before offsets) is equal to forty-two and three-quarter (42.75) hours (50% of 1026 annual hours divided by twelve months) times the blended rate the Pilot is earning for flight hours as of the disability date, with the monthly benefit not to exceed the amounts set forth in the chart below, except as otherwise provided in this subsection . Benefits are paid monthly in arrears.
| Disability Dates On or After | Maximum LTD Plan Benefit |
|---|---|
| September 29, 2023 | $13,521.40 |
| After Snap-Up | $13,656.70 |
| 01/01/2024 | $14,339.63 |
| 01/01/2025 | $14,913.23 |
| 01/01/2026 | $15,509.91 |
| 01/01/2027 | $15,975.14 |
The maximum LTD benefit amounts set forth above shall be increased by the same percentage and on the same date as the hourly pay rates contained in Section 3-A-1, when such hourly pay rates are increased.
24-H-3-a For disability dates on or after September 29, 2023, an amount equal to the following shall be contributed by the Company to the MBCBP: the LTD benefit amount and maximum monthly benefit set forth in this Section 24-H-3 increased by two (2) times the amount specified in Section 22-A-1-a, as determined on the Pilot’s date of disability. Until the MBCBP is established, such amount shall be credited as a contribution to the MBCBP. Notwithstanding Section 22-B-2-c-(9), to the extent any contribution cannot be made to the MBCBP on behalf of a disabled Pilot, an equivalent amount shall be divided 50/50 as PRAP contributions and as taxable earnings, with no contribution to the MBCBP, and such PRAP contributions will not be offset under the MBCBP. To the extent that 50% of the benefit cannot be contributed to the PRAP due to IRS limits, the maximum amount allowed will be contributed to the PRAP with the remainder paid as taxable earnings.
24-H-3-b In the event a disabled Pilot returns to Active Employment for fewer than twelve (12) months and subsequently becomes disabled due to the same injury or illness as the initial disability, then the two periods of disability shall be treated as one continuous period of disability for purposes of the applicable maximum benefit under this Section 24-H-3. In the event such Pilot returns to Active Employment for twelve (12) months or more, then the subsequently disability shall be treated as a new disability for such purposes.
24-H-4 Offsets to Monthly Benefit
The benefit determined above shall be offset (reduced) by any compensation received from the Company; provided, however, there shall be no offset for vacation pay or Profit Sharing received from the Company.
24-H-5 Disability
A Pilot is considered to be disabled under the LTD Plan if the Pilot is ineligible to exercise the privileges of the Airman Medical Certificate that the Company requires to operate in the Pilot’s bid position as the result of an injury or medical condition, including natural deterioration, and provided that the date of disability determined in accordance with the terms of the LTD Plan occurs on or after the effective date of the Agreement. A Pilot on LTD as of the date of signing of
this Agreement shall be governed by the terms of the LTD program in effect on the Pilot’s date of disability.
24-H-6 Waiting Period
24-H-6-a Non-occupational
The LTD benefit for non-occupational injuries (other than drug, alcohol, substance abuse) shall commence as of the first day after the later of:
24-H-6-a-(1) the sixty (60) day period beginning on the Pilot’s disability date determined under the LTD Plan;
24-H-6-a-(2) exhaustion of the Pilot’s sick leave to one hundred twenty (120) hours; or
24-H-6-a-(3) at the Pilot’s option, the exhaustion of any additional period of sick leave.
24-H-6-b Occupational
The LTD benefit for an occupational injury shall commence as of the first day after the later of:
24-H-6-b-(1) the sixty (60) day period beginning on the Pilot’s disability date determined under the LTD Plan; or
24-H-6-b-(2) at the Pilot’s option, the exhaustion of any additional period of sick leave.
24-H-6-c In the event the Pilot reserves sick hours but does not return from LTD, then those hours shall be forfeited. The waiting period applies to each separate disability (except in the case of concurrent disabilities). The waiting period shall not apply to a Pilot who has received disability benefits, returned to work, and become disabled for the same cause within twenty- four (24) months after receiving disability benefits. If a Pilot commences the waiting period but does not complete the waiting period prior to returning to work, and then the Pilot becomes disabled for the same cause within twenty-four (24) months of returning to work, the Pilot shall receive credit for the portion of the waiting period previously served.
24-H-7 Vacation Pay
Vacation pay shall not offset LTD Plan benefits. A Pilot who is receiving LTD benefits shall also receive vacation pay for previously awarded vacation at the time such awarded vacation would have been taken and paid but for the Pilot’s Disability. A Pilot on LTD who has prorated accrued vacation for the following year shall participate in a bid for vacation under Section 11 in order to determine when his vacation would have been taken. A Pilot who submits a signed LTD application and exhausts his sick leave within the waiting period may elect to be paid for his awarded, unawarded, and accrued vacation to the extent needed to fill out the waiting period. If the Pilot returns to Active Service, the Pilot’s awarded, unawarded, and accrued vacation, as applicable, shall be reduced to the extent utilized in the waiting period.
24-H-8 Participants Who Take a Leave of Absence
A Pilot participating in the LTD Plan who takes a leave of absence may continue to participate in the LTD Plan by paying the contribution required under Section 24-H-2 (as modified by Section 12). If the Pilot continues participation during the leave of absence, the Pilot shall be eligible to
receive LTD benefits for disabilities which occur during the leave of absence in accordance with the terms of the LTD Plan, provided that the Pilot must terminate the leave of absence and commence the benefit waiting period in order to receive disability benefits. If a Pilot makes a claim for LTD benefits during a leave of absence in which he did not maintain the required Medical Certificate for the Pilot’s bid position immediately prior to the leave, the Pilot shall be eligible for LTD benefits if the LTD Administrative Committee determines that the Pilot would have qualified for LTD benefits if the Pilot had maintained the required Medical Certificate during the leave. A Pilot participating in the LTD Plan who takes a leave of absence may also elect not to participate at the commencement of or during the leave of absence, in which case the Pilot may re-enter the Plan automatically upon return to Active Service by presenting his required FAA Medical Certificate.
24-H-9 Evidence of Insurability
No Pilot shall be required to show evidence of insurability in order to participate in the LTD Plan. However, any Pilot who opts out while not on a leave of absence must show evidence of insurability in order to later obtain entry into the LTD Plan (including upon return from a leave of absence).
24-H-10 Notice of Opt-Out
Within fourteen (14) days following the closing of each annual enrollment window, the Company shall provide the Association with a list of all Pilots who opt out of the LTD Plan so that the Association may contact each Pilot to ensure that each Pilot understands the consequences of his action and may promptly (prior to the end of the year in which such annual enrollment occurs) take corrective action to remain in the LTD Plan if the Pilot so desires. The Company and the Association shall meet and confer to discuss development of a notice process for Pilots who decline or drop coverage outside of annual enrollment.
24-H-11 Termination of Benefit
Benefits shall continue until the earliest of the following events: (i) the Pilot no longer satisfies the requirements for receipt of benefits as determined in accordance with the LTD Plan; (ii) the Pilot is furloughed (but benefits shall be reinstated upon the Pilot's return from furlough if the Pilot is still disabled); (iii) resignation or discharge for cause of the Pilot’s employment; (iv) the Pilot attains the government-established mandatory retirement age; or (v) the participant dies.
24-H-12 Cognitive or Psychological Disorders
In the case of a Pilot receiving benefits for a cognitive or psychological disorder, the Pilot shall continue to receive LTD benefits until the date determined under Section 24-H-11. The LTD Administrative Committee shall require that the Pilot have his condition reviewed by an independent medical examiner or independent psychological examiner no less frequently than every twenty-four (24) months, unless otherwise determined by the LTD Administrative Committee.
24-H-13 Drug, Alcohol, Substance Abuse Treatment Benefit
In the case of a Pilot who participates in the Company’s HIMS/EAP treatment program for drug, alcohol or substance abuse, regardless of the date of disability the Pilot shall be eligible for a
lifetime drug, alcohol and substance abuse benefit of twenty-four (24) months of disability benefits (determined in accordance with the LTD Plan but administered by the Company’s HIMS/EAP) while in active treatment and recovery. If the Pilot is a participant in the LTD Plan, the benefit shall be paid under the LTD Plan and shall not limit benefits payable for other disabilities under the LTD Plan. If the Pilot is not a participant in the LTD Plan, the benefit shall be paid by the Company and grossed up for taxes. All Pilots receiving such benefit shall be eligible to receive other benefits as defined in Section 24-H-14. The drug, alcohol and substance abuse benefit shall not be subject to any waiting period. Pilots shall be eligible for this benefit during their probationary period.
24-H-14 Other Benefits While Receiving LTD Benefits
A Pilot receiving LTD benefits shall participate in the Pilot medical (including prescription drug), dental, vision, and life & accident plans with the same benefits and with same cost-sharing offered to Pilots in Active Service. LTD benefits are not considered eligible earnings under any defined contribution plan. However, vacation that is paid to a Pilot in the waiting period or while on LTD is deferrable as an employee contribution into the applicable Pilot defined contribution plan on the same basis as an Active Pilot. A Pilot receiving LTD benefits may participate in Company pass travel programs on the same basis as an Active Pilot. Additional provisions related to Pilots receiving LTD benefits are in Section 24-I-7.
24-H-15 Regained Medical Certificate
24-H-15-a Notification and Continued Receipt of LTD Benefits
Within three (3) Business Days of regaining the required medical certification, a Pilot shall provide notice in accordance with procedures established by the LTD Administrative Committee. A Pilot shall continue to receive LTD benefits until the earlier of: (i) the date the Pilot commences training; or (ii) fifteen (15) days following the date the Pilot regained the required medical certification at which time the Pilot shall be placed in paid status for his bid position.
24-H-15-b Access to Previous OI Bank Balance
A Pilot on Pilot LTD or LOL/LTD prior to the OI bank conversion (who now has a sick-bank balance) has access to the sick-bank balance if he returns to work or if his benefit terminates before he reaches mandatory retirement age, except in the case of a benefit termination requested by the Pilot.
24-H-16 Administrative Committee
The LTD Administrative Committee of the LTD Plan shall meet monthly and shall be composed of five (5) members, three (3) of whom shall be appointed by the Company and two (2) of whom shall be appointed by the Association. Each party may appoint alternates. The post of Chairman of the Administrative Committee shall alternate annually between Company and Association members. A quorum of the Administrative Committee consists of two (2) Company appointed members/alternates and two (2) Association members/alternates, in person at Administrative Committee meetings. Any other attendees may attend by teleconference. At any meeting of the Administrative Committee, the Association appointed members shall have the right to be
accompanied by advisor(s) of their choosing. The Administrative Committee shall have such powers and duties as set forth in the LTD Plan document.
24-H-17 Review of Denied Appeals
Appeal of a final adverse determination by the LTD Administrative Committee is governed by Section 24-J-6.
24-H-18 VEBA SubTrusts
24-H-18-a Provision for Separate Subtrusts
The Disability VEBA Trust shall be divided into two separate accounts. One account shall be designated the Subtrust for the Continental Airlines, Inc. Long Term Disability Program for Pilots (the “CAL LOL/LTD Subtrust”); the other account shall be designated the Subtrust for the United Airlines Pilot Long Term Disability Plan (the “UAL Pilot LTD Subtrust”). The assets of the two Subtrusts shall be commingled for investment purposes unless the Investment Committee otherwise determines, but the books and records of the Disability VEBA Trust shall at all times reflect the separate interests of each Subtrust in the assets and such interests shall be separately accounted for and valued.
24-H-18-b The CAL LOL/LTD Subtrust
All assets and liabilities of the Prior CAL Trust shall be allocated to the CAL LOL/LTD Subtrust. The following provisions apply to the CAL LOL/LTD Subtrust:
24-H-18-b-(1) No contributions shall be required or permitted to the CAL LOL/LTD Subtrust; provided, however, that the Company shall be liable for any benefits in the event the assets of the trust are insufficient to cover remaining benefits. The CAL LOL/LTD Subtrust shall be credited (as frequently as administratively feasible and in no event less than once annually) with its proportionate share of the Disability VEBA Trust’s investment gains and losses, earnings and expenses, in the same proportion which the CAL LOL/LTD Subtrust’s assets bear to the total assets of the Disability VEBA Trust.
24-H-18-b-(2) The CAL LOL/LTD Subtrust shall be used and applied for the sole and exclusive purpose of paying benefit liabilities of the Continental Airlines, Inc. Long Term Disability Program for Pilots (the “CAL LOL/LTD Plan”) and reasonable expenses of administration, except as provided in Section 24-H-18-d with respect to the distribution of excess assets to or for the benefit of participants of the CAL LOL/LTD Plan. Without limiting the generality of the foregoing, in no event shall the amounts held in the CAL LOL/LTD Subtrust be used to provide benefits under the LTD Plan or any other plan funded by any other subaccount under the Disability VEBA Trust. The amendment provision of the Disability VEBA Trust instrument shall prohibit any amendment purporting to modify or eliminate the limitations of Section 24-H-18-b-(2).
24-H-18-b-(3) A separate actuarial valuation of the CAL LOL/LTD Subtrust shall be performed to determine the funded status of the Subtrust annually.
24-H-18-c The UAL Pilot LTD Subtrust.
All assets and liabilities with respect to the LTD Plan shall be allocated to the UAL Pilot LTD Subtrust. The following provisions apply to the UAL Pilot LTD Subtrust:
24-H-18-c-(1) All Company and Pilot contributions under the LTD Plan shall be credited to the UAL Pilot LTD Subtrust. The UAL Pilot LTD Subtrust shall be credited (as frequently as administratively feasible and in no event less than once annually) with its proportionate share of the Disability VEBA Trust’s investment gains and losses, earnings and expenses, in the same proportion which the UAL Pilot LTD Subtrust’s assets bear to the total assets of the Disability VEBA Trust.
24-H-18-c-(2) The assets of the UAL Pilot LTD Subtrust shall be used and applied for the sole and exclusive purpose of paying benefit liabilities of the LTD Plan and reasonable expenses of administration. Without limiting the generality of the foregoing, in no event shall the amounts held in the UAL Pilot LTD Subtrust under the Disability VEBA Trust be used to provide benefits under the CAL LOL/LTD Plan or any other plan funded by any other subaccount under the Disability VEBA Trust. In the event the Disability VEBA Trust is amended hereafter to provide any other form of benefit permissible for a VEBA, the assets then accumulated in the UAL Pilot LTD Subtrust shall be protected against diversion to any other use or purpose, except in the case of assets in excess of those necessary to satisfy all benefit liabilities to participants in the LTD Plan.
24-H-18-c-(3) A separate actuarial valuation of the UAL Pilot LTD Subtrust shall be performed to determine the funded status of the Subtrust annually.
24-H-18-d Once all benefits have been paid or provided for (by purchase of commercial insurance covering all remaining benefit liabilities, reserving funds determined to be actuarially sufficient for such purpose, or otherwise), for disabled Pilots under the CAL LOL/LTD Plan, any assets in the CAL LOL/LTD Subtrust in excess of the amount required to pay or provide for benefit liabilities shall be spun off and merged into the RHA VEBA and the assets allocated to the RHAs of each Pilot who was a participant in the CAL LOL/LTD Plan immediately prior to December 30, 2012, provided that any such allocations forfeited as a result of the death of the Pilot (and all eligible Dependents) shall be reallocated to the remaining accounts of Pilots (and any surviving eligible Dependents of deceased Pilots) identified in the final sentence of Section 24-H-18-d. Notwithstanding the foregoing, the Company and the Association may agree upon a different method and timing of providing equivalent value to such Pilots (recognizing that Pilot premiums were taxed upon contribution and Company premiums were imputed as taxable income to each Pilot). The Company and the Association shall retain the current pro-rata share of each such Pilot and no later agreement by the Parties may modify each such Pilot’s share.
24-H-18-e All expenses of maintaining the Disability VEBA Trust shall be paid by the Company.
24-H-19 Investment Committee.
The Investment Committee of the Disability VEBA Trust shall be composed of one (1) member appointed by the Association and two (2) members appointed by the Company. Each party may appoint alternates. The post of Chairman of the Investment Committee shall alternate annually between Company and Association members. A quorum of the Investment Committee consists of
one (1) Company appointed member/alternate and one (1) Association member/alternate, provided that the Company appointed members/alternates in attendance shall have in the aggregate two (2) votes. At any meeting of the Investment Committee, the Association appointed member shall have the right to be accompanied by advisor(s) of his choosing. The Investment Committee shall have such powers and duties as set forth in the LTD Plan document.
24-H-20 Coverage for Certain Procedures The LTD Plan will reimburse any participating Pilot’s out of pocket medical expenses that are not covered by a Company-provided medical plan option (either because the Pilot is not enrolled in Company-provided medical or because the claim was denied) and that are not covered by other third-party private or governmental medical insurance in which the Pilot is enrolled, other than a regular FAA-required physical examination or EKG covered by Section 24-B-8, as follows:
24-H-20-a Medical expenses incurred in connection with procedures or examinations required by the FAA for the attainment or maintenance of an FAA First Class Medical Certificate and/or Special Issuance.
24-H-20-b Medical expenses incurred in connection with procedures or examinations required by the LTD Administrative Committee.
24-H-20-c The applicability and amount of reimbursement under this Section 24-H-20 shall be determined by the LTD Administrative Committee.
24-I Active Life & Accident Insurance
The Company shall provide the following 100% Company-paid life & accident insurance coverage:
24-I-1 Basic Life Insurance
24-I-1-a Pilot - The amount of Pilot basic life insurance coverage is equal to the Pilot's hourly pay rate (determined in accordance with Section 3) times 2,052, unless the Pilot elects a lower amount, but shall never be less than $100,000. The amount of a Pilot's basic life insurance shall be adjusted concurrent with changes to the Pilot's hourly pay rate.
24-I-1-b Spouse/Domestic Partner - The amount of spouse/domestic partner basic life insurance coverage is equal to $5,000.
24-I-1-c Child – The amount of basic child life insurance coverage is equal to $1,000 per child.
24-I-2 Basic Personal Accident Insurance The maximum benefit payable under the basic personal accident insurance shall be $39,000.
24-I-3 Business Travel Accident Insurance for Active Pilots. The maximum benefit payable under the business travel accident insurance shall be $250,000.
24-I-4 Invalidated Life Insurance The maximum benefit payable under the invalidated life insurance plan shall be $1,000,000, subject to an aggregate maximum of $5,000,000 for all covered co-workers per incident.
24-I-5 AMC/CRAF Life Insurance and Disability Plans
The maximum benefit payable under the AMC/CRAF life insurance plan shall be $150,000.
24-I-6 Special Hazard Insurance
The maximum benefit payable under the special hazard insurance shall be $150,000, subject to an aggregate maximum of $7,000,000 per incident for all covered co-workers.
24-I-7 The Company shall provide the following 100% Pilot-paid life & accident insurance coverage:
24-I-7-a Voluntary Life Insurance Plan
24-I-7-a-(1) Pilot - In the case of a Pilot who is permanently disabled, as determined by the LTD Administrative Committee, the premium shall be waived by the insurance carrier; provided, however, that the Company shall provide a reimbursement of the required premium if the insurance carrier cannot or shall not accommodate such a premium waiver.
24-I-7-a-(2) Spouse/Domestic Partner - The benefit payable under the voluntary life insurance plan for Spouse/Domestic Partner shall be $10,000 - $500,000, in increments of $10,000 and cannot exceed 50% of the Pilot’s combined options. The maximum benefit amount is subject to insurance carrier review and approval. The guaranteed issue amount shall be $30,000.
24-I-7-a-(3) Child - The benefit payable under the voluntary life insurance plan shall be $10,000 per child.
24-I-7-b Voluntary Personal Accident Insurance Plan
24-I-7-b-(1) Pilots - Pilots shall have the option to purchase coverage of $25,000 up to $500,000 in $25,000 increments.
24-I-7-b-(2) Spouse/Domestic Partner - Pilots shall have the option to purchase coverage of $10,000 up to $500,000 in $10,000 increments.
24-I-7-b-(3) Child - Pilots shall have the option to purchase coverage of $10,000 up to $100,000 in $10,000 increments.
24-J General
24-J-1 Quarterly Insurance Meetings
The Company and the Association shall meet quarterly to discuss, and make a good faith effort to resolve, any and all problems (including individual claim issues) relative to the insurance plans described herein.
24-J-2 Information Sharing
The Company shall provide promptly after preparation or receipt, copies of all insurance contracts, medical (including prescription drug) and dental plan costing (projected and actuarial), actuarial reports, annual reports and summary annual reports. Upon the Association’s request, the Company shall provide within twenty (20) Business Days after the request, other reports, participant data, asset performance reports and other information pertinent to any insurance plan or trust in which Pilots participate. All documents and information provided shall be provided
electronically if available, and shall be subject to the Association’s reasonable use and protection of confidentiality. For purposes of Section 24-J-2, “Business Day” means Monday through Friday, excluding federal holidays.
24-J-3 Advance Notice to ALPA of Proposed Communications to Pilots
The Company shall furnish to the Association for comment a draft of any proposed Company communication to Pilots with respect to any matter in any way relating to the plan set forth in Sections 24-A-1-a through 24-A-1-e as soon as reasonably practicable and in no event later than seven (7) days (or such shorter period as expressly agreed to by the Company and the Association with respect to any specific communication) in advance of the date the Company proposes to transmit the communication to Pilots (in the case of electronic, telephonic or other non-hard copy communication) or the date the Company proposes to send the draft communication to the printer (in the case of any written communication). Nothing in the foregoing shall be deemed to limit, diminish or otherwise effect the Company’s obligations under any other Section of the Agreement. Nothing herein is intended to limit a vendor’s ability to administer the plan with standard communications as needed from time to time.
24-J-4 Material Changes to Medical, Dental or Prescription Drug Plan Administration
24-J-4-a Notice of Material Changes
In order to afford the Association a reasonable time and opportunity to consider and comment on any contemplated material change to the Core Medical Options (including Rx) or Core Dental Option administration affecting Pilots, to the end that the parties can identify any problems or potential disagreements and can attempt to resolve any problems or disagreements in advance of implementation, the Company agrees that it shall make full, fair and timely disclosure in good faith, prior to making any final decision to adopt such material change to the Core Medical Options or Core Dental Option administration affecting Pilots and/or their Dependents, and prior to taking any actions (such as initiating computer programming to implement the change, or printing of communications to Pilots regarding the change, or entering into final contracts with vendors) that might restrict the Company’s willingness or ability to respond to the Association’s input or concerns. In addition to other reasonable methods of disclosure, the Company shall, to the extent reasonably possible, use the quarterly meetings described in Section 24-J-1 to make any such disclosures. A change to the Core Medical Options or Core Dental Option administration shall be considered “material” if the change is disruptive or potentially disruptive for more than a de minimis number of Pilots and Dependents, significantly increases the burden on Pilots and Dependents in documenting or claiming reimbursement for covered expenses, results or potentially results in cessation of reimbursement of previously reimbursed covered expenses, or otherwise materially and adversely affects payment of benefits that are covered expenses. Normal course modifications to PPO networks and the retail pharmacy networks outside of the Company’s control, such as doctors, hospitals or pharmacies dropping out of a network, shall not be considered material changes to administration of the Core Medical Options or Core Dental Option.
24-J-4-b Effective Date of Material Changes in Administration
Unless under all relevant circumstances an earlier effective date is reasonably required, the effective date for any material modification to the Core Medical Options or Core Dental Option administration (as defined in Section 24-J-4-a) shall be January 1 of the calendar year immediately following the most recent calendar year for which medical costing has been established. Consistent with its commitment under Section 24-J-4-a, whenever the Company determines that mid-year material modifications are reasonably required, it shall give notice to the Association sufficient to afford the Association reasonable time and opportunity to consider and comment on such material modifications and/or the reasonable necessity of mid-year implementation of such modifications.
24-J-5 Dependent Eligibility Verification for Pilots
As applied to Pilots, any dependent eligibility verification process conducted by the Company (or any vendor on the Company’s behalf) with respect to any welfare benefit plan maintained by Company (and/or eligibility for pass travel privileges or otherwise), shall conform to the following rules:
24-J-5-a Pilots who have satisfied their obligation under any prior dependent eligibility verification process (or upon hire) to furnish documentation sufficient to establish proof of relationship during any dependent eligibility verification program conducted by the Company before or after the effective date of the Agreement shall not thereafter be required to provide such documentation establishing proof of relationship, except as provided in Section 24-A-3. Newly-hired Pilots shall satisfy all reasonable documentation requirements for the dependent eligibility verification process in effect at the time they are hired.
24-J-5-b The claims administrator may require proof of disability sixty (60) days before the child attains age twenty-six (26) years and at any later time. If proof is requested by the claims administrator and is not furnished within sixty (60) days of such request, such child shall cease to be considered a Dependent effective as of such sixtieth (60th) day.
24-J-5-c As applied to Pilots under any medical plan option, the Pilot may establish proof of domestic partnership by any of the following: (A) a certified copy of the registration of a same- gender relationship under a governmental (international, national, state or local) registry service; (B) a certified copy of a certificate of same-gender marriage or civil union from a state under the laws of which such marriage or union is a legally recognized relationship; or (C) a valid, written form of affidavit, approved by the Plan Administrator, and executed by the Pilot and his domestic partner, and supporting documentation, which establishes compliance with the Plan Administrator’s requirements for qualification as a domestic partner. The Pilot may establish termination of a domestic partnership by any of the following: (W) a certification of the registration of a same-gender relationship under a governmental (international, national, state or local) registry service; (X) a certified copy of a decree of divorce or dissolution or other recognized evidence of termination of same-gender marriage or civil union from a state under the laws of which such marriage or civil union is a legally recognized relationship; or (Y) a written form of affidavit, approved by the Plan Administrator, and executed by either the Participant or his domestic partner; or (Z) other evidence of the termination of the relations determined by the Plan Administrator to be sufficient.
In the case of an affidavit of domestic partnership, such affidavit shall demonstrate that the Pilot and his domestic partner meet the following requirements:
24-J-5-c-(1) Both are at least age eighteen (18) years and considered to be of legal age in their state of residence.
24-J-5-c-(2) Share joint responsibility for financial and personal welfare, and can provide proof of at least two of the following: i) jointly held mortgage or lease on their primary residence; ii) joint checking account to which the Pilot’s paycheck is directly deposited and a jointly held credit account; iii) designation of the Pilot’s domestic partner as a substantial beneficiary on the Pilot’s life insurance and retirement plans in which the Pilot participates, to the extent permitted by law; iv) designation of the Pilot’s domestic partner as a substantial beneficiary under the Pilot’s Will to the extent permitted by law; v) execution of a durable power of attorney in favor of the Pilot’s domestic partner over at least fifty percent (50%) of the Pilot’s assets; and vi) execution of a durable power of attorney in favor of the Pilot’s domestic partner over the Pilot’s health care.
24-J-5-c-(3) Formally reside in the same principal household.
24-J-5-c-(4) Share a committed, intimate relationship and continue that indefinitely, and have no similar relationship with any other person.
24-J-5-c-(5) Not be related by blood to a degree of kinship that prevents marriage between the Pilot and his domestic partner under the laws of the state of their residence.
24-J-5-c-(6) Not be married to any other person.
24-J-6 Benefits Board
24-J-6-a LTD Appeals
The Benefits Board shall have the exclusive jurisdiction to hear and determine any appeal from a final adverse determination of the LTD Administrative Committee where three (3) members of the committee vote to deny the Pilot’s claim and two (2) members of the committee vote to approve the Pilot’s claim, subject to the following:
24-J-6-a-(1) Within sixty (60) days following such an adverse determination, the Association shall notify the Company in writing that it is invoking the right to appeal before the Benefits Board. Otherwise, the determination of the LTD Administrative Committee shall be final and binding. In no event shall a grievance be brought under Section 17 with respect to such adverse determination.
24-J-6-a-(2) For any LTD appeal described above, the Benefits Board shall operate as a System Board of Adjustment in accordance with the provisions of Section 18, provided that there shall be no maximum number of days per calendar year that the Benefits Board may meet.
24-J-6-a-(3) The Benefits Board shall not have jurisdiction over any adverse determination of the LTD Administrative Committee where the vote is other than three (3) to two (2), and any such adverse determination shall be subject to the provisions of Section 17.
24-J-6-b Other Matters
The Association may pursue its rights under Section 17 or instead invoke the procedures of the Benefits Board set forth below in the case of any controversy under i) LOA 12-05, ii) the dependent verification provisions of Section 24-J-5, iii) the confidentiality provisions of Sections 22-C-5 and 24-J-10, or iv) the statutory amendments provisions of Sections 22-C-6 and 24-J-11. If the Association invokes the procedures of the Benefits Board, the following shall apply:
24-J-6-b-(1) Within 180 days after the Association reasonably would have had knowledge of the facts upon which the controversy is based, the Association shall request a written response from the Company regarding the Company’s position.
24-J-6-b-(2) Within twenty-one (21) days of receipt of such request, the Company shall provide a written response to the Association.
24-J-6-b-(3) Within sixty (60) days following receipt by the Association of the Company’s response, the Association shall notify the Company in writing that it intends to appeal the Company’s determination to the Benefits Board.
24-J-6-b-(4) For any controversy described above, the Benefits Board shall operate as a System Board of Adjustment in accordance with the provisions of Section 18, provided that the maximum number of appeals to the Benefits Board under Section 24-J-6-b shall be three (3) per calendar year, and, unless otherwise agreed to by the parties, the maximum number of hearing days of the Benefits Board shall be six (6) per calendar year.
24-J-6-c No Other Jurisdiction
The Benefits Board shall have no other jurisdiction than as set forth in Section 24-J-6-a and Section 24-J-6-b.
24-J-6-d Modification of Section 18 System Board Procedures
Notwithstanding anything in Section 18, Benefits Board dates shall be scheduled on an ad hoc basis as needed, and the Company and the Association may agree to a different panel of arbitrators than the panel specified by the parties pursuant to Section 18 utilizing an American Arbitration Association list of arbitrators suitable for benefits arbitrations limited to arbitrators who are members of the National Academy of Arbitrators, or such other method agreed to by the parties.
24-J-7 Third Party Liability
This Section 24 applies from and after the effective date of the Agreement to the Core Medical Options, the Core Dental Option, any self-insured Select Regional Medical Plan, and the LTD Plan (collectively the “Covered Plans”).
24-J-7-a Third Party Liability Is Primary as to Benefits Under the Covered Plans
The Plan shall not be primarily responsible or liable for the payment of benefits in accordance with their terms because of a disability, injury or other medical condition caused by the fault of a Third Party (a “Reimbursable Event”), as provided in Section 24-J-7. Accordingly, and in accordance with the provisions and subject to the limitations of Section 24-J-7, the Company shall be and is entitled to the benefit of any Recovery or right of Recovery which a Pilot or
Dependent may have related to a Reimbursable Event for which the Third Party was, is or may become liable without regard to whether the liability of such Third Party is reduced to a Recovery as a result of legal proceedings, arbitration, compromise, settlement or otherwise. For purposes of Section 24-J-7, “Recovery” means an amount obtained by or for the benefit of a Pilot or Dependent in a Covered Plan from a Third Party, such Third Party’s liability carrier, or, in the case of an uninsured or underinsured motorist coverage, from such Pilot’s or Dependent’s automobile insurance carrier because of a Reimbursable Event for which the Third Party is legally liable. In the case of a Recovery which, in whole or in part, includes assets other than cash or cash equivalents, the Administrative Committee or the Plan Administrator, as applicable, shall determine the monetary value thereof. A “Third Party” is any individual (or entity) who (or which) is or may be liable to a Pilot or Dependent for a Reimbursable Event or for payment of damages or expenses related to such Reimbursable Event; provided, however, that “Third Party” does not include the issuer of any disability, loss of license or insurance policy maintained by a Pilot at his own personal expense.
24-J-7-b Company’s Right of Reimbursement and Covered Plan’s Right to Reduce Future Benefits
If a Covered Plan has paid benefits to a Pilot or Dependent because of a Reimbursable Event and Recovery is obtained by the Pilot or Dependent with respect to such Reimbursable Event, then the Pilot or Dependent shall be obligated to reimburse the Company for all such benefits paid by the Covered Plan, provided, however, that (i) the Pilot or Dependent shall have no obligation of reimbursement in excess of the total amount of such Recovery and (ii) the Pilot’s or Dependent’s obligation of reimbursement shall be limited as described in Section 24-J-7-c. If a Reimbursable Event occurs and a Recovery is obtained with respect to such Reimbursable Event, then, subject to the limitations set for in Section 24-J-7-c, the Covered Plan involved shall have no obligation to pay and there shall be excluded from future coverage by the Covered Plan any and all benefits thereafter payable under the Covered Plan for such Pilot or Dependent, for, in connection with or relating to such Reimbursable Event until such benefits exceed in the aggregate the total amount of such Recovery remaining after reimbursement of the Company pursuant to the preceding sentence.
24-J-7-c Limitation of Company’s Right of Reimbursement and Covered Plan’s Right to Reduce Future Disability Benefits
The Company’s right to reimbursement and the Covered Plan’s right to reduce future benefits as described in Section 24-J-7-b shall apply only after a Pilot or Dependent has obtained a Recovery. In the case of the LTD Plan, the Company’s right of reimbursement and the Covered Plan’s right to reduce future benefits shall be limited to the difference between:
24-J-7-c-(1) the portion of the Recovery determined by the Administrative Committee to be reasonably allocable to the Participant’s loss of income resulting from, caused by or otherwise related to his Disability, and
24-J-7-c-(2) a pro rata portion of the attorneys’ fees and of litigation expenses allowed by the court or other forum in which the recovery is obtained (or, in the case of a settlement, which would have been allowable by such court or forum) incurred by the Participant in obtaining the Recovery that is allocable to the amount described in Section 24-J-7-c-(1);
provided, however, that if the amount described in the preceding provisions of this sentence is subject to federal or state income taxes, then such amount shall be reduced by the additional income taxes attributable to such amount. In the case of the Core Medical Options, the Company’s right of reimbursement and the Covered Plan’s right to reduce future benefits shall be limited to the amount of the total Recovery, reduced by that portion of the attorneys’ fees, and of the litigation expenses allowed by the court or other forum in which the recovery is obtained (or, in the case of a settlement, which would have been allowable by such court or forum), incurred by the Pilot or Dependent in obtaining the Recovery which is equal to the same percentage (not greater than 100%) of the total attorneys fees and litigation expenses as the benefits paid by the Core Medical Option with respect to the Reimbursable Event bears to the total Recovery obtained by the Pilot or Dependent; provided, however, that if the amount described in the preceding provisions of this sentence is subject to federal or state income taxes, then such amount shall be reduced by the amount of additional income taxes attributable to such amount. The Company’s right to reimbursement and the Covered Plan’s right to reduce future benefits is predicated on express disclaimer of the "make whole" doctrine, and, after the reductions of the gross Recovery amount for attorneys’ fees, litigation expenses and taxes, as described above, shall apply to the first dollar of any Recovery so reduced, regardless of any categorization or label placed upon any part of the Recovery and even if the Recovery obtained is less than the amount needed to make the Pilot (or Dependent) whole. The Company and the Covered Plan shall be granted a lien upon any such Recovery in the amount specified above.
24-J-7-d Obligations of Pilot and Dependent
The Pilot and Dependent shall have an affirmative obligation to reasonably cooperate in reimbursing the Covered Plan and in otherwise assuring the Covered Plan’s rights of reimbursement and offset pursuant to Section 24-J-7, shall execute and deliver to the Company, the Administrative Committee and/or the Plan Administrator all assignments and other documents requested by them for enforcing the Company’s and/or a Covered Plan’s rights under Section 24-J-7, shall not take any action that might prejudice the Company’s or a Covered Plan’s rights thereunder, and shall not release any Third Party (even if such release purports to be a partial release or a release for the excess liability over Plan benefits) without the consent of the Company, the Administrative Committee or the Plan Administrator as the case may be, which consent(s) shall not be unreasonably withheld. The Company’s right of reimbursement and the Covered Plan’s right of offset hereunder shall not be affected by the release of any Third Party entered into without the consent of the Company, the Administrative Committee and/or the Plan Administrator as applicable. If a Pilot or Dependent initiates a liability claim against any Third Party or a Third Party’s liability carrier or reimbursement is sought from such Pilot’s or Dependent’s own automobile insurance carrier under the uninsured or underinsured motorist endorsement, then the amounts described in Section 24-J-7-b and amounts to cover all future benefit payments under the applicable Covered Plan relating to the Reimbursable Event which is the basis for the liability claim must be included in the claim. Each Pilot or Dependent who incurs any Reimbursable Event shall
inform the Company, the Administrative Committee and/or the Plan Administrator as applicable whenever it appears that a Third Party is or may be liable to the Pilot or Dependent.
24-J-7-e Exclusivity of Remedy
The right of reimbursement afforded to the Company and the right to reduce future benefit payments afforded to Covered Plans under Section 24-J-7, shall be the sole and exclusive remedy of the Company and the Covered Plans, and of any insurance carrier, claims administrator or other vendor, regarding Reimbursable Events and Pilot and Dependent Recoveries with respect to Reimbursable Events, and shall be in lieu of any other remedy, legal or equitable, statutory or contractual, whether based on subrogation, credit, offset or any other theory, otherwise available to the Company, the Covered Plan or to either of their respective carriers or vendors. Without limiting the generality of the foregoing, it is agreed that neither the Company, any Covered Plan, or any of their respective claims administrators, insurance carriers or vendors, shall assert any statutory right of subrogation or reimbursement under any applicable state workers compensation or similar law with respect to any Reimbursable Event.
24-J-8 Prior LOAs, MOUs and Settlement Agreements
The prior agreements provisions of Section 22-C-3 shall apply with respect to any committee or board described in this Section 24.
24-J-9 Indemnification
The indemnification provisions of Section 22-C-4 shall apply with respect to any committee or board described in this Section 24.
24-J-10 Confidentiality
The confidentiality provisions of Section 22-C-5 shall apply with respect to any committee or board described in this Section 24.
24-J-11 Procedure for Amendments Required by Law
The procedures set forth in Section 22-C-6 shall apply with respect to any plan described in this Section 24.
24-J-12 Definitions
24-J-12-a For purposes of this Section 24, the term “Pilot” or “Pilots” shall have the same meaning as in Section 22-C-7-a. References to “Pilot” or “Pilots” throughout this Section 24 shall be interpreted in the context of the eligibility provisions of this Section 24, and, if the context so requires, shall be deemed to include the Pilot’s Eligible Dependents and Eligible Survivors.
24-J-12-b Notwithstanding anything to the contrary in the Agreement, for purposes of this Section 24, the term “Company” means United Airlines and includes United Air Lines, Inc., Continental Airlines, Inc., and any other affiliate of such entities which sponsors any welfare benefit plan referred to in this Section 24.
| Core PPO Option | Core EPO Option | Core HDHP | |||
|---|---|---|---|---|---|
| PLAN DESIGN | In-Network | Out-of-Network | In-Network | In-Network | Out-of-Network |
| Annual Deductibles | $300 single/ $600 family | $600 single/ $1200 family | $200 single/ $400 family | $2500 single only $5000 true family deductible* | $5000 single only $10,000 true family deductible* |
| HSA Seed Amount (pro-rated per paycheck) | NA | NA | NA | $750 single / $1500 family | $750 single / $1500 family |
| Annual Out-of- Pocket (OOP) Limits | $2000 single/ $4000 family (includes medical coinsurance and deductible, but not copays) | $4000 single/ $8000 family (includes medical coinsurance and deductible, but not copays) | 90%/10% coins, $1,500/$3,000 (includes medical coinsurance and deductible, but not copays) | $3000 single only $6000 true family maximum* (includes deductible and coinsurance) | $6000 single only $12000 true family maximum* (includes deductible and coinsurance) |
| Cross Application Out-of-Network Deductibles and OOP to In- Network | Yes | Yes | NA | Yes | Yes |
| Office Visit PCP | $25 co-pay | Covered at 60% after deductible | $25 co-pay | Covered at 95% after deductible | Covered at 60% after deductible |
| Office Visit Specialist | $40 co-pay | Covered at 60% after deductible | $40 co-pay | Covered at 95% after deductible | Covered at 60% after deductible |
| Preventative Services (comprehensive array) | 100% preventative | Covered at 60% after deductible | 100% preventative | 100% preventative | Covered at 60% after deductible |
| Laboratory, x-ray and diagnostic testing | Covered at 80% after deductible | Covered at 60% after deductible | Included w/office visit | Covered at 95% after deductible | Covered at 60% after deductible |
| Hospital/Inpatien t | Covered at 80% after deductible | Covered at 60% after deductible | Covered at 90% after deductible | Covered at 95% after deductible | Covered at 60% after deductible |
| Outpatient Facilities/Surgical | Covered at 80% after deductible | Covered at 60% after deductible | Covered at 90% after deductible | Covered at 95% after deductible | Covered at 60% after deductible |
| Urgent Care Center | $50 | Covered at 60% after deductible | $50 co-pay | Covered at 95% after deductible | Covered at 60% after deductible |
| Emergency Room | $200 flat copay, waived if admitted | $200 flat copay, waived if admitted | $200 co-pay, waived if admitted | Covered at 95% after deductible | Covered at 60% after deductible |
| Retail Generic Drugs | $10 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs* (Workaround for lower costs Rx at Target/Costco) | $10 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs* (Workaround for lower costs Rx at Target/Costco) | $10 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs (Workaround for lower costs Rx at Target/Costco) | Covered at 100% after deductible | Covered at 100% after deductible |
| Retail Brand Preferred Drugs | $30 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs- only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | $30 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs- only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | $30 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs- only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | Covered at 95% after deductible | Covered at 95% after deductible |
| Retail Brand Non- Preferred Drugs | $50 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs - only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | $50 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs - only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | $50 co-pay Mandatory Mail – Limit 3 retail fills for maintenance drugs - only if less expensive than retail (Workaround for lower costs Rx at Target/Costco) | Covered at 95% after deductible | Covered at 95% after deductible |
| Retail Drug Supply Limit | 30 day supply | 30 day supply | 30 day supply | 30 day supply | 30 day supply |
| Mail Order Generic Drugs | $25 co-pay | $25 co-pay | $25 co-pay | Covered at 100% after deductible (plan provides coverage for drugs that are allowed to be covered pre-deductible) | Covered at 100% after deductible (plan provides coverage for drugs that are allowed to be covered pre-deductible) |
| Mail Order Brand Preferred Drugs | $75 co-pay | $75 co-pay | $75 co-pay | Covered at 95% after deductible | Covered at 95% after deductible |
| Mail Order Brand Non-preferred | $125 co-pay | $125 co-pay | $125 co-pay | Covered at 95% after deductible | Covered at 95% after deductible |
| Mail Order Drug Supply Limit | 90 day supply | 90 day supply | 90 day supply | 90 day supply | 90 day supply |
Additional provisions set forth in the Plan Document.
| Traditional PPO Dental Benefits | ||
|---|---|---|
| Benefit Features | In-network | Out-of-network |
| ANNUAL DEDUCTIBLES | ||
| Individual | $50 | $50 |
| Family (2 members of family must each satisfy individual deductible) | $100 | $100 |
| Annual Benefit Maximum | $2,000 | $2,000 |
| Orthodontics Lifetime Maximum | $2,000 | $2,000 |
| Office Visit Copay | $0 | $0 |
| PREVENTIVE SERVICES and DIAGNOSTIC SERVICES | ||
| Dental cleaning Topical Application of Fluoride, Sealants and Space Maintainers | 100% Covered frequency and/or age limitations may apply to these services | 100% Covered frequency and/or age limitations may apply to these services |
| MINOR RESTORATIVE SERVICES | ||
| Fillings, Endodontics, Periodontics, Oral Surgery | Covered up to 80%; after deductible | Covered up to 80%; after deductible; Subject to reasonable and customary limits |
| MAJOR RESTORATIVE AND PROSTHODONTICS | ||
| Initial placement of Dentures or Bridges to one or more natural teeth which are lost while covered by the Plan. Inlays and Crowns (Porcelain or Stainless Steel) | Covered up to 50%; after deductible; frequency and/or age limitations may apply to these services | Covered up to 50% after deductible; Subject to reasonable and customary limits; frequency and/or age limitations may apply to these services |
| ORTHODONTICS | ||
| Exams, X-Rays, Models, Appliances (Adult and Child) | Covered up to 50%; after deductible; frequency and/or age limitations may apply to these services | Covered up to 50% after deductible; Subject to reasonable and customary limits; frequency and/or age limitations may apply to these services |
Additional provisions set forth in the Plan Document.