Health Care Plans

Health Care Plans

Summary Plan Description

2009 Union-Represented Employees SPEEA

(Professional and Technical Units) and AMPA

The summary plan description (SPD) for this Plan is

this booklet. Any benefit changes since this SPD was

originally published have been incorporated and

footnoted with the effective date.



The content and delivery of this booklet are intended

to comply with the Employee Retirement Income

Security Act of 1974, as amended (ERISA). If there is

any conflict between the information in this booklet

and the official Plan document, the official Plan docu-

ment will govern.



Updated: April 2009, January 2010, and January 2011









Health Care Plans | 2009 Edition A86320W

Grandfathered Status Notice



The Boeing Company Employee Health Benefit Plan (Plan 626) believes this plan is a “grandfathered health plan”

under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable

Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when

that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer

protections of the Affordable Care Act that apply to other plans: for example, the requirement for the provision of

preventive health services without any cost sharing. However, grandfathered health plans must comply with

certain other consumer protections in the Affordable Care Act: for example, the elimination of lifetime limits on

benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan

and what might cause a plan to change from grandfathered health plan status can be directed to the Plan

Administrator at Employee Benefit Plans Committee, The Boeing Company, 100 North Riverside, MC 5002-8421,

Chicago, IL 60606-1596; 312-544-2297. You may also contact the Employee Benefits Security Administration,

U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table

summarizing which protections do and do not apply to grandfathered health plans.

Plan Information and Notice

The Boeing Company provides a variety of medical and dental plan options. You are eligible for coverage

under these plans if you meet the conditions described in this booklet and you are represented by one of the

union groups listed in Section 1.

All benefits are provided through The Boeing Company Master Welfare Plan and its component benefit

programs. The benefits in this booklet are provided under The Boeing Company Employee Health Benefit

Plan (Plan 626) (the “Plan”).

Through this Plan, The Boeing Company (the “Company”) also provides different benefit plans to other

groups. Because they have different benefits, those groups receive separate summary plan description

booklets. (See “Other Groups That the Plan Covers,” in Section 7.)

Summary Plan Description and Plan Document

The summary plan description for the Traditional Medical Plan, Preferred Dental Plan, and Scheduled

Dental Plan is this booklet, any summaries of material modifications (Updates), and the applicable

provider directories.

For the PPO+Account and coordinated care plan (CCP), the summary plan description is this booklet,

any summaries of material modifications (Updates), the applicable coverage-specific brochure, and the

applicable provider directories.

For the health maintenance organization (HMO) plans, exclusive provider organization (EPO) plan,

and prepaid dental plan, the summary plan description is this booklet, any summaries of material

modifications (Updates), the applicable certificates of coverage (issued by the service representatives),

and the applicable provider directories.

The actual Plan is a complex legal document that was written in accordance with Federal rules, including

rules of the Internal Revenue Service. The Plan document is The Boeing Company Master Welfare Plan,

applicable summary plan descriptions, insurance contracts and funding vehicles, and other “governing

documents.”

The contents and delivery of this booklet are intended to comply with the Employee Retirement Income

Security Act of 1974, as amended (ERISA). If there is any conflict between the information in this booklet

and the official Plan document, the official Plan document will govern.

Any representations contrary to the Plan are not binding.

Network Provider Directory

You can obtain a network provider directory or a list of network providers at no cost to you by

• Connecting to the Your Benefits Resources web site and searching the online provider directory.

• Calling the service representative directly or through Boeing TotalAccess.

• Visiting the web site of your service representative.

Providers move in and out of networks periodically. Before you receive services, be sure to confirm with

your provider or the service representative that your provider still is participating in the plan’s network.

Prescription Drug Formulary

You can obtain the prescription drug formulary (a list of generic and preferred brand-name drugs) for your

medical plan at no cost to you by

• Calling the service representative (health care plan) directly or through Boeing TotalAccess.

• Visiting the web site of your service provider.



Updates

Periodically, the Company may add to or change benefits in this Plan. If this happens, you will receive an

Update describing the changes. Be sure to keep any Updates with this booklet.









Health Care Plans | 2009 Edition | A86320W Your Benefits i

Notice of Company Rights

The Company fully intends to continue the Plan. However, the Company reserves the right to terminate,

suspend, or modify any benefits described in this booklet, in whole or in part, at any time, and for any

reason for employees, former employees, retirees, and their dependents. The Plan Administrator, the

Boeing Service Center for Health and Insurance Plans (the “Boeing Service Center”), and the service

representatives have the right to recover overpayments, regardless of the cause, nature, or source of

the overpayments.

This summary plan description booklet does not guarantee current or future employment or benefits. Receiving

benefits under this Plan does not restrict the Company’s rights to discharge any employee at any time.

For important terms used in this booklet, please see Section 8.

Effective Date

This booklet highlights the benefits available to eligible employees and their eligible dependents under

The Boeing Company Employee Health Benefit Plan as of July 1, 2009, unless otherwise noted.

Definition of Terms

Key terms used throughout this booklet are in bold the first time the term is used under each heading. You

can find the definitions for these terms in Section 8, “Definitions.”

What This Booklet Does Not Include

This booklet does not describe the specific benefits of the PPO+Account, CCP, EPO plan, any HMO plan, or

the prepaid dental plan. If you enroll in one of those plans, the service representative will send you a booklet

that describes the features and benefits of that plan. To request a booklet, contact the service representative.



Whom do I contact with questions?

Throughout this booklet, you will be referred to three main sources for additional information:

• Boeing TotalAccess.

• The Boeing Service Center and its web site, Your Benefits Resources.

• Service representatives.

Boeing TotalAccess is your gateway to benefits information. Boeing TotalAccess connects you directly with the

Boeing Service Center and many of the service representatives.

You can contact Boeing TotalAccess 24 hours a day, seven days a week.

• On the World Wide Web: Log on to www.boeing.com/express using your BEMS ID number (or Social Security

number) and your Boeing TotalAccess password.

• On the Boeing Web (at work): Log on to https://my.boeing.com and click the TotalAccess tab.

• By telephone: Call 1-866-473-2016. TTY/TDD services are available at 1-800-755-6363. You must have your

BEMS ID number (or Social Security number) and Boeing TotalAccess password. Request the service you are

looking for, and the Boeing TotalAccess telephone system will direct you to the resources you need. Customer

service representatives are available to assist you and answer questions Monday through Friday from 7 a.m.

to 8 p.m. Central time. Self-service applications are available 24 hours a day, seven days a week.

The Boeing Service Center and its web site, Your Benefits Resources, provide information about your

medical and dental plan options and costs. You can connect to

• The Your Benefits Resources web site through Boeing TotalAccess on the World Wide Web or Boeing Web.

• The Boeing Service Center by calling Boeing TotalAccess.

You will need your Boeing TotalAccess password to access these services.

Service representatives: The Company has engaged third-party organizations, called service representatives,

to administer the plans, make benefit determinations, and pay claims. Each service representative answers

benefit and claim questions by telephone, and many provide web sites. Connect to a service representative by

• Calling Boeing TotalAccess.

• Connecting to the service representative’s web site directly. (Web sites are shown in Section 9.)

• Calling the number on your health care or prescription drug* identification card.

Refer to “Where to Get More Information,” in Section 9, for telephone numbers, addresses, and web sites.



*Updated: January 2010

ii Your Benefits Health Care Plans | 2009 Edition | A86320W

Table of Contents



Section 1—Eligibility and Enrollment

Who Is Eligible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Part-Time Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Your Dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Your Spouse or Same-Gender Domestic Partner . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Your Dependent Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Disabled Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

When You and Your Spouse or Same-Gender Domestic Partner Both

Work for the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

Coverage for Your Spouse or Same-Gender Domestic Partner . . . . . . . . . . . . . . . 1-3

Coverage for Your Dependent Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

How to Choose Your Medical and Dental Plans . . . . . . . . . . . . . . . . . . . . . . 1-3

Medical Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

Where to Find Detailed Plan Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

Dental Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

When to Enroll or Make Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

If You Are Newly Eligible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

During the Annual Enrollment Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

During the Year When Certain Life Events Occur . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

Special Enrollment Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

Qualified Status Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6

How to Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-7

When Additional Documentation Is Required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

Application for Disabled Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

Documentation for QMCSOs, Legal Custody, and Guardianship . . . . . . . . . . . . . . 1-8

Proof of Marriage or Qualifying Domestic Partnership . . . . . . . . . . . . . . . . . . . . . . 1-8

Evidence of Loss of Other Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

When Coverage Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

Coverage for You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

Coverage for Your Dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

What Coverage Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

How Much You Pay for Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

How Much You Pay if Your Spouse or Same-Gender Domestic Partner Works . . . . 1-10

Court-Ordered Child Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11

Medical Child Support Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-11

Qualified Medical Child Support Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-11

How the Company Notifies You of a Medical Child Support Order . . . . . . . . . . . . . .1-11

How Same-Gender Domestic Partner Coverage Affects Taxes . . . . . . . . . . 1-12









Health Care Plans | 2009 Edition | A86320W Your Benefits iii

Section 2—Traditional Medical Plan

How the Traditional Medical Plan Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Who Administers the Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Save Money by Using a Network Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Nonnetwork Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

How the Traditional Medical Plan Pays Benefits . . . . . . . . . . . . . . . . . . . . . . 2-2

Annual Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Copayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Coinsurance Percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Annual Out-of-Pocket Maximum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

How the Plan Determines the Covered Charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

Benefit Maximums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

How the Traditional Medical Plan Pays Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

When You Need Preadmission Review or Preapproval . . . . . . . . . . . . . . . 2-10

Request Preadmission Review for Hospital Services . . . . . . . . . . . . . . . . . . . . . . . 2-10

Request Preapproval for Certain Mental Health and

Substance Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Request Preapproval for Home Health Care and Hospice Care . . . . . . . . . . . . . . . 2-10

When to Request Preadmission Review or Preapproval . . . . . . . . . . . . . . . . . . . . . 2-11

How Much the Plan Pays With Preadmission Review or Preapproval . . . . . . . . . 2-11

How Much the Plan Pays Without Preadmission Review or Preapproval . . . . . . . 2-11

Individual Case Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

What the Traditional Medical Plan Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Ambulatory Surgical Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Christian Science Practitioner and Sanatorium . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Congenital Abnormalities and Hereditary Complications . . . . . . . . . . . . . . . . . . . 2-12

Cosmetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Dental Repair Due to Accidental Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Diagnostic X-Ray and Laboratory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Emergency Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Erectile Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Hearing Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Hemodialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Home Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15

Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15

Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Mental Health Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Oral Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Orthopedic Appliances and Braces (Orthotics) . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Orthoptic Therapy (Vision Training) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Pregnancy-Related Conditions and Coverage of Newborns . . . . . . . . . . . . . . . . 2-17

Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18





iv Your Benefits Health Care Plans | 2009 Edition | A86320W

Preventive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18

Prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18

Radiation and Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18

Reconstructive Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18

Second Surgical Opinion Election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Spinal and Extremity Manipulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Substance Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Temporomandibular Joint Dysfunction and Myofascial Pain Dysfunction

Syndrome Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Therapies (Neurodevelopmental, Occupational, Physical, and

Speech Therapy) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-19

Tobacco Cessation Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-20

Transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-20

Vasectomy or Tubal Ligation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21

Vision Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21

Wigs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21

How the Mental Health and Substance Abuse Program Works . . . . . . . . . 2-21

Boeing Helpline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22

Employee Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22

Emergency Mental Health or Substance Abuse Treatment . . . . . . . . . . . . . . . . .2-22

What the Program Covers for Mental Health Treatment . . . . . . . . . . . . . . . . . . . . .2-22

What the Program Covers for Substance Abuse Treatment . . . . . . . . . . . . . . . . . .2-22

How the Prescription Drug Program Works . . . . . . . . . . . . . . . . . . . . . . . . 2-23

What You Pay for Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-23

Filling a Prescription at a Participating Retail Pharmacy . . . . . . . . . . . . . . . . . . . . . .2-23

Filling a Prescription at a Nonparticipating Retail Pharmacy . . . . . . . . . . . . . . . . . . .2-24

Filling a Prescription by Mail Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-24

Filling a Prescription at a Specialty Care Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . .2-25

Covered Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-25

Generic Incentive Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-26

What the Traditional Medical Plan Does Not Cover . . . . . . . . . . . . . . . . . . . 2-26

Cosmetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-26

Dental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-26

Diagnostic X-Ray and Laboratory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Hearing Aids and Related Supplies and Services . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Home Health Care and Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Maintenance Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-28

Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-28

Tobacco Cessation Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-28

Transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-28

Vision Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-29

Other Medical Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-29

How to Submit a Medical Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-30







Health Care Plans | 2009 Edition | A86320W Your Benefits v

Section 3—Preferred Dental Plan

How the Preferred Dental Plan Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

Who Administers the Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

Save Money by Using a Network Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

How the Preferred Dental Plan Pays Benefits . . . . . . . . . . . . . . . . . . . . . . . . 3-2

Annual Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

Coinsurance Percentages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

What the Preferred Dental Plan Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Class I Covered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Class II Covered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Class III Covered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

Class IV Covered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

What the Preferred Dental Plan Does Not Cover . . . . . . . . . . . . . . . . . . . . . 3-6

How to Submit a Dental Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

How Dental Coverage May Be Extended . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7





Section 4—Scheduled Dental Plan

How the Scheduled Dental Plan Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

Who Administers the Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

How the Scheduled Dental Plan Pays Benefits . . . . . . . . . . . . . . . . . . . . . . . 4-1

Annual Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

Maximum Covered Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

What the Scheduled Dental Plan Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2

Scheduled Dental Plan Schedule of Covered Services . . . . . . . . . . . . . . . . . . . . . . . .4-3

Predetermination of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

What the Scheduled Dental Plan Does Not Cover . . . . . . . . . . . . . . . . . . . . . 4-7

How to Submit a Dental Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

How Dental Coverage May Be Extended . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8





Section 5—Claims and Appeals

How to Submit a Claim or File an Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

Medical and Dental Benefit Claims Process . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

How to File a Claim for Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2

Time Limits for Decisions on Benefit Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2

If Your Benefit Claim Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

How to Appeal if Your Benefit Claim Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

Time Limits for Decisions on Benefit Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

If Your Benefit Appeal Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Whom to Contact for Benefit Claim and Appeal Procedures . . . . . . . . . . . . . . . . .5-4









vi Your Benefits Health Care Plans | 2009 Edition | A86320W

Eligibility Claims Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

How to File a Claim for Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Time Limits for Decisions on Eligibility Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

If Your Eligibility Claim Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6

How to Appeal if Your Eligibility Claim Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6

Time Limits for Decisions on Eligibility Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7

If Your Eligibility Appeal Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7

Whom to Contact for Eligibility Claim and Appeal Procedures . . . . . . . . . . . . . . . . 5-7

What You Can Do if Your Appeal Is Denied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7

How Claims Are Paid When You Have Duplicate Coverage . . . . . . . . . . . . . 5-7

Determine Whether the Plan Is Primary or Secondary . . . . . . . . . . . . . . . . . . . . . . . .5-8

If You Are Covered by Two Boeing-Sponsored Plans . . . . . . . . . . . . . . . . . . . . . . .5-9

If You Are Covered by Medicare and This Plan . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9

Claim Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9

When an Injury or Illness Is Caused by the Negligence of Another . . . . . . . 5-9



Section 6—Coverage End Dates and Continuation of Coverage

How Coverage Can End . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

How You and Your Dependents Can Lose Eligibility for Coverage . . . . . . . . . . . . . . . 6-1

When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-2

Continue Coverage During a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . 6-2

Continue Coverage Through COBRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

Who Is Eligible for COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Your Right to COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Your Spouse’s or Same-Gender Domestic Partner’s Right to

COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Your Child’s Right to COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

How to Enroll for COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Notify the Boeing Service Center When Coverage Ends . . . . . . . . . . . . . . . . . . . .6-4

Watch Your Mail for COBRA Election Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Elect COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Pay for COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5

When COBRA Coverage Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5

When You Can Change COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5

How Long COBRA Coverage Can Continue and How Much It Costs . . . . . . . . . . . .6-6

Secondary COBRA Qualifying Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8

When COBRA Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-9

Convert Your Coverage to an Individual Policy . . . . . . . . . . . . . . . . . . . . . . . 6-9



Section 7—Plan Administration and Legal Rights

Your Rights and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1

What Rights You Have Under Federal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Receive Information About Your Plan and Benefits . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Continue Group Health Plan Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Prudent Actions by Plan Fiduciaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Enforce Your Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Receive Assistance With Your Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Your Responsibilities Under the Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2



Health Care Plans | 2009 Edition | A86320W Your Benefits vii

How the Plan Is Administered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Plan Administrator’s Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Company’s Right to Amend, Modify, and Terminate the Plan . . . . . . . . . . . . . . . . . . 7-3

Who Pays for This Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

How the VEBA Trust Fund Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

How Benefits Are Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Right to Recover Overpayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

No Contract of Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Plan Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Other Groups That the Plan Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5





Section 8—Definitions



Section 9—Contacts

Eligibility and Enrollment Section 1

Who Is Eligible

These plans are intended to cover you and your dependents who meet the eligibility requirements

described in this section. Generally, if you meet these conditions, you are eligible to enroll yourself, your

spouse or same-gender domestic partner, and your children as described in “When to Enroll or Make

Changes,” in this section. To enroll your eligible dependents, you must enroll yourself in the plans.

You

You are eligible for coverage under the health care plans described in this booklet if you are

• A full-time employee of The Boeing Company represented by one of the following unions:

Airplane Manufacturing Pilots Association

Society of Professional Engineering Employees in Aerospace

Professional Unit

Technical Unit

• On the active payroll and paid through the Company payroll system.

Part-Time Employees

If you are a part-time employee, you may be eligible for coverage under the medical and dental plans

offered at your location. To be eligible, you must work a fixed weekly schedule of more than 19 hours.



Who is not eligible for the health care plans?

You are not eligible for health care coverage if you are

• On a part-time work schedule and are regularly scheduled to work 19 or fewer hours each week.

• Working in a capacity that, at the Plan Administrator’s sole discretion, is considered contract labor or

independent contracting. (Regardless of this requirement, if you are represented under a Society of

Professional Engineering Employees in Aerospace collective bargaining agreement, you will be considered by

the Company as an employee.)

• Not represented by one of the union groups listed in “Who Is Eligible,” above.





Your Dependents

If you are enrolled in the plans as an employee, you also may cover your eligible dependents. Dependents

who are eligible include your spouse or same-gender domestic partner and children, as described below.

Proof of dependent eligibility will be required. Some HMO plans may have different eligibility based on

your state’s insurance regulations.*

Your Spouse or Same-Gender Domestic Partner

Under these plans, “spouse” and “same-gender domestic partner” mean

• Your legal spouse (as recognized under both applicable state law and the Internal Revenue Code).

• Your opposite-gender common-law spouse if your relationship meets the common-law requirements for

the state where you entered the common-law relationship.

• Your same-gender domestic partner if

– You and your partner live in the same permanent residence in a permanent, exclusive, emotionally

committed, and financially responsible relationship similar to a marriage.

– Your partner is at least 18 years old, is not related to you by blood, is not married to or separated from

another person, and is not a domestic partner to anyone else.

– Your domestic partner relationship does not exist solely to obtain coverage under the Plan.





*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-1

Covering your same-gender domestic partner may affect your Federal and/or state income taxes, and you

will be required to provide proof of your same-gender relationship. For more information, see “How

Same-Gender Domestic Partner Coverage Affects Taxes,” later in this section.

In some states, state law requires that insured health plans offer coverage to certain registered domestic

partners. To find out if this applies to you, call the Boeing Service Center through Boeing TotalAccess.

Note: An individual who is recognized under state law as your same-gender spouse qualifies as a same-

gender domestic partner under the plans, without being required to meet any of the other qualifications for

same-gender domestic partners.

Your Dependent Children*

You may cover the following children until the end of the month in which they turn 26 provided, in general,

they are not eligible for health coverage through their own employer:

• Your natural or adopted children.

• Your stepchildren.

You also may cover other children until the end of the month in which they turn 26 provided they are

unmarried and dependent on you for principal support and are one of the following:

• Related to you either directly or through marriage (for example, grandchildren, nieces, and nephews).

• Under your legal custody or guardianship (or for whom you have a pending application for legal custody

or guardianship) and are living with you.

• Dependents of your eligible same-gender domestic partner.

• Children, other than your natural, adopted children, or stepchildren, for whom the Company receives a

qualified medical child support order. (QMCSOs are described later in this section.)

A dependent child is not eligible for Boeing coverage if he or she is eligible for health care coverage

through his or her employer, unless the child is unmarried and dependent on you for principal support.

Proof of dependent eligibility will be required. For details, contact the Boeing Service Center through

Boeing TotalAccess.

Disabled Children*

A disabled child age 26 or older may continue to be eligible (or enrolled if the child of a newly eligible

employee) if a physician documents that the child is incapable of self-support because of any mental or

physical condition and the child became disabled before age 26. The child must be unmarried and

dependent on you for principal support. Coverage may continue under the medical and dental plans for

the duration of the disability as long as you continue to be eligible and enrolled in the plans and the child

continues to meet these eligibility requirements.

Special applications for coverage are required for disabled dependent children age 26 or older.



What is principal support?

Principal support means that you and/or your current or former spouse provides more than half the financial

support for your child. (In determining this, you can exclude any scholarships for study at a regular educational

institution unless the child is not your natural child, adopted child, or stepchild.) In most cases, if you claim

the child as a dependent on your annual Federal taxes, then you provide principal support for the purposes of

eligibility for these plans.

If you have never been married to the other parent of your child, then you must provide more than half the

support for your child, regardless of the other parent’s support. If you are divorced from the other parent of

your child, special rules apply; contact your tax adviser. You also may want to review Internal Revenue Service

Publication 502, Medical and Dental Expenses.









*Updated: January 2011



1-2 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

When You and Your Spouse or Same-Gender Domestic Partner

Both Work for the Company

If you and your spouse or same-gender domestic partner both work for the Company, special coverage

provisions will apply. Generally, no person may be covered both as an employee (active or retired) and

as a dependent under any type of plan offered by the Company. Certain exceptions apply, as follows.

Coverage for Your Spouse or Same-Gender Domestic Partner

If you and your spouse or same-gender domestic partner both work for the Company, generally you each

must choose your own plans. That is, you cannot cover your spouse or same-gender domestic partner as a

dependent under your plans, and he or she cannot cover you.

Coverage for Your Dependent Children

When you and your spouse or same-gender domestic partner both work for the Company, you must enroll

all dependent children in the same medical plan and the same dental plan (except as required by a

QMCSO). For details, contact the Boeing Service Center through Boeing TotalAccess.





How to Choose Your Medical and Dental Plans

The Company provides a variety of medical and dental plan options.



Medical Plan Options

Generally, your home zip code determines which medical plans are available to you. However, other plans

may be available to you based on your work location and if permitted under the service representative’s

policy. Medical plan options include the

• Traditional Medical Plan.

• PPO+Account (effective January 1, 2010).

• CCP available in your area.

• HMO plans available in your area.

• EPO plan available in your area.

For details, see the “Compare Medical Plan Features” table, below.

Where to Find Detailed Plan Information

During your initial enrollment or later during annual enrollment, you can get information about your

medical plan options, including detailed comparisons of covered services, costs, and a list of network

providers for each plan option, by

• Visiting the Your Benefits Resources web site.

• Calling the Boeing Service Center through Boeing TotalAccess.



Compare Medical Plan Features

This summary compares the basic differences among the primary types of medical plans: Traditional Medical Plan,

PPO+Account, CCP, HMO plans, and EPO plan. Consider the type of care you and your family typically need; then check

to see how the plan options meet your health care needs.

Traditional

Medical Plan PPO+Account CCP HMO Plans EPO Plan

Network of Yes Yes Yes Yes Yes

providers

PCP must No; any provider No Yes; contact Yes; PCP No; only a

coordinate all may be used the service generally must network provider

care representative to coordinate care may be used

coordinate care to receive the

maximum benefit





Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-3

Compare Medical Plan Features (continued)

This summary compares the basic differences among the primary types of medical plans: Traditional Medical Plan,

PPO+Account, CCP, HMO plans, and EPO plan. Consider the type of care you and your family typically need; then check

to see how the plan options meet your health care needs.

Traditional

Medical Plan PPO+Account CCP HMO Plans EPO Plan

PCP referral No; visit any No Yes; contact Yes; PCP generally No; visit any

required to visit specialist the service must provide network

a specialist representative to referral for specialist

coordinate care services to be

covered

Network annual Yes; however, many Yes No No No

deductible services, including

network office

visits, preventive

care, prescription

drugs, routine

vision care, and

tobacco cessation

treatment, are not

subject to an annual

deductible

Nonnetwork Yes; nonnetwork Yes; nonnetwork Yes; nonnetwork No; generally, No; generally,

annual services are subject services services services from services from

deductible to an annual are subject are subject to an nonnetwork nonnetwork

deductible to an annual annual deductible providers are not providers are not

deductible covered covered

Prescription Yes; coinsurance for Yes; coinsurance Yes; copayments Yes; copayments Yes; copayments

drug copayment/ retail participating for retail for retail for retail for retail

coinsurance pharmacies and participating participating participating participating

copayments for mail pharmacies and pharmacies and pharmacies and pharmacies and

order mail order mail order mail order mail order

Preventive care Yes Yes Yes Yes Yes

Routine vision Yes Yes Yes Yes Yes

care

Annual out-of- Yes; for network Yes; separate Yes; for Varies by plan No

pocket maximum and nonnetwork maximums for nonnetwork

combined network and services

nonnetwork

services

Health Savings No Yes No No No

Account





Dental Plan Options

The Company dental plans are designed to provide you and your covered dependents with quality,

comprehensive dental benefits. Your dental plan helps you pay for certain treatments such as preventive

care and routine examinations to help you maintain good dental health. Depending on your location, you

may have a choice of the following types of dental plans:

• Preferred Dental Plan.

• Scheduled Dental Plan.

• Prepaid dental plan.



1-4 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

When to Enroll or Make Changes

When you become eligible for coverage in the medical and dental plans, you generally may enroll

• By the date printed on the enrollment worksheet you receive as a newly eligible employee.

• During the annual enrollment period designated by the Company.

• Within the specified time frames for a special enrollment event or qualified status change during the year.

(See the table, “How and When to Enroll,” later in this section.)

Each of these enrollment periods is explained here.

If You Are Newly Eligible

If you are a newly eligible employee, you will receive an enrollment worksheet by mail that shows your

available health and insurance plan options, coverage levels, and costs. You also can find enrollment

information on line at the Your Benefits Resources web site. Medical and dental coverage is optional; you

may elect medical coverage, dental coverage, both, or neither. However, if you do not want coverage, you

must decline it; otherwise, you may be enrolled automatically.

During the Annual Enrollment Period

The Company establishes an annual enrollment period each year. During annual enrollment, you can add

or drop coverage for yourself or your eligible dependents in accordance with the eligibility rules. The

Company will send you information about the annual enrollment dates and when your coverage changes

will be effective.

During the Year When Certain Life Events Occur

After you enroll, you generally may change or drop coverage only during the annual enrollment period

designated by the Company. However, Federal rules allow you to add, change, or drop coverage during the

year as a result of certain special enrollment events or qualified status changes, as described below.

If you experience a special enrollment event or a qualified status change and you would like to enroll

or change your coverage, you must contact the Boeing Service Center through Boeing TotalAccess

and request enrollment within the time frames specified in the table, “How and When to Enroll,” later

in this section.

When you request enrollment or a change in coverage, you will be requested to provide required documentation

to the Boeing Service Center. For more information, see “When Additional Documentation Is Required,” later

in this section.

Special Enrollment Events

If you declined coverage in the medical or dental plans for yourself and/or your eligible dependents when

you were first eligible because you or your dependents had other health care coverage, you may enroll

yourself and/or your eligible dependents if you or your dependent experiences one of these special

enrollment events:

• You or your dependent loses or becomes ineligible for other health care coverage because of an event

such as loss of dependent status under another health care plan (through divorce, legal separation,

termination of a same-gender domestic partnership, or dependent child reaching the limiting age), death,

termination of employment, reduction in hours of employment, termination of employer contributions

toward the coverage, elimination of coverage for the class of similarly situated employees or dependents,

moving out of the plan’s service area with no other coverage available from the other health care plan, or

reaching the lifetime limit on all benefits under the other health care plan.**

• You or your dependent becomes ineligible for Medicaid or a state Children’s Health Insurance Program

and loses coverage; you or your dependent becomes eligible for premium assistance under Medicaid or a

state’s child health care plan.*

• You or your dependent exhausts any continuation coverage from another employer; that is, coverage

provided under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), ends.

• You gain a new dependent because of marriage, entering a same-gender domestic partnership, birth,

adoption, or placement for adoption.

*Updated: April 1, 2009

**Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-5

Note: For this purpose, “other health care coverage” does not include coverage through Medicare,

Medicaid, or the TRICARE Supplement Plan.

If you experience a special enrollment event, you can enroll yourself and/or your eligible dependents in a

medical and/or dental plan, as described earlier in this section. You can enroll in any family status tier and

any health plan option available to you.

Special enrollment is not available if you lose coverage because of failure to make timely premium

payments or termination from the plan for cause (such as for making a fraudulent claim).

Qualified Status Changes

If you experience one of the qualified status changes listed below, you may be able to enroll in medical or

dental coverage, change your current coverage, or drop your coverage midyear. Any change to your coverage

must be consistent with the status change that affects your or your dependent’s eligibility for Company-

sponsored health care coverage or health care coverage sponsored by your eligible dependent’s employer.

Qualified status changes are the following events:

Legal marital status (or qualifying same-gender domestic partnership). You marry, enter into a same-

gender domestic partnership, divorce, legally separate, or dissolve a same-gender domestic partnership or

your marriage is annulled or your spouse or same-gender domestic partner dies.

Number of dependent children. You lose or gain a dependent child through death, birth, adoption, or

placement of a child in your home for adoption.

Employment status. Your or your dependent’s eligibility for coverage is affected by a change in job

situation such as termination or commencement of employment, strike or lockout, commencement of or

return from an unpaid leave of absence, a change in work site, a transfer between a salaried and an hourly

position, a transfer between a full-time and a part-time position, or a transfer between a nonunion salaried

position and a union-represented position.

Dependent child’s eligibility. Your dependent child becomes eligible or ineligible for coverage (for

example, if your child exceeds the age limits).**

Residence. Your or your covered dependent’s place of residence changes, which affects access to health

care within the current plan or restricts his or her ability to access network providers.

Cost of coverage. You or your covered dependent experiences a significant change in the cost of employer-

sponsored coverage (including COBRA).

Significant change in coverage. You or your dependent experiences a significant curtailment of employer-

sponsored health care coverage or that coverage ends, including expiration of coverage under another

employer’s COBRA plan. Examples of curtailment include a significant increase in the annual deductible

or copayments or a loss of access to a significant portion of a provider network.

Addition or improvement of a benefit option. The Company adds a new benefit option or significantly

improves an existing benefit option.

Enrollment change in another plan. You or your dependent experiences a change in enrollment in another

plan sponsored by the Company or another employer, including an annual enrollment election change.

Entitlement to Medicare or Medicaid, or state Children’s Health Insurance Program. You or your

dependent becomes eligible or ineligible for Medicare or Medicaid; you or your dependent becomes

ineligible for a state Children’s Health Insurance program and loses coverage.*

Premium assistance: You or your dependent becomes eligible for premium assistance under Medicaid or a

state’s child health care plan.*

Loss of governmental or educational coverage. You or your dependent loses coverage under a group

health plan sponsored by a governmental or educational institution.

Judgment, decree, or order. You receive a judgment, decree, or court order from a divorce, legal

separation, annulment, or change in legal custody, including a QMCSO, that requires you to add or remove

health care coverage for a dependent child.

Family and Medical Leave Act leave of absence. You take an approved leave of absence in accordance

with the Family and Medical Leave Act of 1993 (FMLA).

*Updated: April 1, 2009

**Updated: January 2011

1-6 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

How to Enroll*

Soon after you become an eligible employee, you will receive a Boeing TotalAccess password and an

enrollment worksheet for your health and insurance benefits. You also can find an enrollment worksheet on

line at the Your Benefits Resources web site. You can use your enrollment worksheet as a guide when you

enroll; you will not need to submit it to enroll.

After you enroll, you can use the Your Benefits Resources web site to review your elections and see your

costs for coverage.

To do so, you will need

• Your Boeing TotalAccess password.

• Your BEMS ID number (or Social Security number, which may be required by the Centers for Medicare

& Medicaid Services [CMS]) and birth date.

• Social Security numbers and birth dates for the dependents you are enrolling.

• Information about your spouse’s or same-gender domestic partner’s employment and health care

coverage, if any.

• The name and identification number of your primary care provider if you enroll in the CCP, an HMO

plan, or the prepaid dental plan. You and your covered dependents can choose the same or different

primary care providers for your medical plan. (However, under some prepaid dental plans, you must

name the same dental primary care provider for all covered dependents.)

If you enroll in the Traditional Medical Plan, PPO+Account, the EPO plan, Preferred Dental Plan, or

Scheduled Dental Plan, you will not need to select primary care providers.

If you do not have access to a computer, you can enroll over the phone by calling the Boeing Service

Center through Boeing TotalAccess.

If you are rehired, you automatically may be enrolled in your prior coverage, depending on the length of

your lapse in service, the availability of the plan, and other factors. Contact the Boeing Service Center

through Boeing TotalAccess for information or to verify or change your coverage.



How and When to Enroll

To enroll . . . Enroll through the . . . By the . . .

As a newly eligible employee Your Benefits Resources web site* Date shown on your enrollment worksheet

During an annual enrollment period Your Benefits Resources web site* Last day of your designated annual

enrollment period

Yourself and your dependents because Your Benefits Resources web site 60th day after the event

of a special enrollment event or a

qualified status change (as defined

in “During the Year When Certain Life

Events Occur”)

A new dependent midyear because of Your Benefits Resources web site** 120th day after the event

marriage, entering into a same-gender

domestic partnership, birth, adoption,

or placement for adoption when you

already are enrolled in the plan

If you experience a change in work site Your Benefits Resources web site 31st day after the event

that results in a change in the medical

and/or dental plans available to you

* You will find links for enrollment on the Your Benefits Resources web site only when enrollment is available to you as a new employee or during the

annual enrollment periods specified by the Company.

** To enroll a new dependent after the 60th day, you must call the Boeing Service Center through Boeing TotalAccess and speak with a representative.







*Updated: January 2010



Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-7

When Additional Documentation Is Required

To cover dependents, or to enroll following loss of other employer-sponsored coverage, you will be required

to submit a Dependent Verification Notification form or other information to the Boeing Service Center.

If you do not submit the requested documentation by the date specified by the Boeing Service Center,

your request to add or change coverage will be denied. The situations described below commonly require

additional information. At the Plan Administrator’s discretion, other situations also may require more

information.

Application for Disabled Children*

Coverage for a disabled child normally ends on his or her 26th birthday. However, you may continue his or

her coverage if a physician provides proof that the child is incapable of self-support because of disability.

You may be required to confirm the disability from time to time.

If your eligible disabled dependent child is 26 or older and the disability started before age 26, you may

enroll the child by completing a special application. Call the Boeing Service Center through Boeing

TotalAccess for an application.

Documentation for QMCSOs, Legal Custody, and Guardianship

You will be required to submit documentation to the Boeing Service Center if

• You are required to cover a child (called an alternate recipient) by order of a court through a qualified

medical child support order (QMCSO).

• You assume legal custody or guardianship of a child.

Proof of Marriage or Qualifying Domestic Partnership

If you enroll your spouse, you will be required to document your marriage or common-law marriage. If you

enroll your eligible same-gender domestic partner or his or her eligible children, you will be required to

submit proof of your qualifying domestic partnership. For additional information, contact the Boeing

Service Center through Boeing TotalAccess.

Evidence of Loss of Other Coverage

If you enroll yourself and/or your dependents due to loss of other health plan coverage, you may be

required to submit evidence of the type of coverage, date coverage ended, reason coverage ended, and

family members who were covered under the other plan. The most convenient way to provide this

information is to send a copy of the certificate of creditable coverage issued by the other health plan or to

submit copies of other documents that contain the required information.





When Coverage Begins

The effective date of your coverage depends on when you enroll and what event initiates your enrollment.

The following tables explain when coverage begins for you and your dependents. In all cases, you must be

on the active payroll on the effective date for coverage to begin.



What if I am in the hospital when my new medical coverage is supposed to begin?

If you (or your dependent) are confined to a hospital or similar institution on the date coverage begins, this plan

will be secondary to any other coverage you may have. When you are discharged from the facility or if that

coverage ends, this plan will become primary.

If the previous health care plan (including a Company-sponsored health care plan) provides continued

coverage during the hospitalization, the previous plan will be primary and the new plan will be secondary until

hospitalization ends. (See Section 5.)









*Updated: January 2011

1-8 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

Coverage for You

If you . . . Your coverage will begin on the . . .

Are a newly hired employee (and you make your election by First day of the month after your first day of employment

the date indicated on your enrollment worksheet)

Enroll or change your coverage during an annual enrollment First day of the new benefit year

period

Enroll or change your coverage because of a special Special enrollment event date

enrollment event (see “Special Enrollment Events,” in this

section)

Enroll or change your coverage because of a qualified status Qualified status change date

change (see “Qualified Status Changes,” in this section)

Enroll in a new medical or dental plan if your current plan is Date Boeing TotalAccess receives your address change (if

no longer available following a change of address you call Boeing TotalAccess within 60 days of your address

change, coverage will begin on the date of your address

change)

Are recalled from a layoff within your recall rights period Date you are reinstated to the active payroll

Are reemployed after uniformed service (and return to work Date you are reinstated to the active payroll

promptly in accordance with Federal law)

Return to work from an approved leave of absence Date you are reinstated to the active payroll

Are rehired First day of the month after the date you are reinstated to

the active payroll

Transfer from one payroll to another First day of the month after or coinciding with your transfer

date





Coverage for Your Dependents

If you enroll your dependents or

change their coverage . . . Their coverage will begin on the . . .

When you are a newly hired employee Same day that your coverage begins (if applied for at the

same time)

During an annual enrollment period First day of the new benefit year

As a result of a special enrollment event (see “Special Special enrollment event date

Enrollment Events,” in this section)

As a result of a qualified status change (see “Qualified Qualified status change date

Status Changes,” in this section)

Following receipt of a QMCSO First of the month the QMCSO is received or on the date

specified in the QMCSO









Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-9

What Coverage Costs

How Much You Pay for Coverage

Generally, you and the Company share the cost of health care coverage. The amount you pay from each

paycheck toward the cost of your health care coverage is called a contribution. The amount you pay out of

your own pocket depends on which plan you choose (for a comparison of the basic differences among the

medical plans, see the table, “Compare Medical Plan Features,” earlier in this section).

Contribution amounts are governed by your collective bargaining agreement and are published each year

during the annual enrollment period. You can find your contribution amount on the information that will

be mailed to you, or you can find out more through the Your Benefits Resources web site or by calling the

Boeing Service Center through Boeing TotalAccess. A working spouse contribution also may be required,

as explained in “How Much You Pay if Your Spouse or Same-Gender Domestic Partner Works,” in this

section.

Your enrollment in health care coverage authorizes the Company to deduct your contributions (if any) on a

pretax basis from your paycheck each pay period.

Contributions for coverage are deducted beginning with the first paycheck of the month after the month in

which you enroll. Contributions for a partial month of coverage are taken retroactively on an aftertax basis.

Increased contributions due to a special enrollment event or a qualified status change are taken on an

aftertax basis for retroactive periods of coverage.



How Much You Pay if Your Spouse or Same-Gender Domestic

Partner Works

If your spouse or same-gender domestic partner has not enrolled in a medical plan available through his or

her employer and enrolls in your plan, you must pay an additional monthly contribution (called a working

spouse contribution).

You will not be required to pay this contribution if your spouse or same-gender domestic partner is

• Not employed full time through an employer other than the Company.

• Currently covered by his or her employer’s medical plan.

• Currently covered by other group health coverage as a retired employee and not by his or her employer.

• Not offered medical coverage by his or her employer.

• Retired and not employed, or employed but regularly scheduled to work less than 36 hours per week.

• Employed by the Company.

• Not enrolled in his or her employer’s medical plan but commits to join at the next annual enrollment

period or other opportunity, and within one year. You will be required to verify this information.

If your spouse no longer meets one of these conditions during the year, you must notify the Boeing Service

Center through Boeing TotalAccess. You may be required to pay any working spouse contributions that you

have missed.

If you are not sure whether this contribution applies to you, call the Boeing Service Center through Boeing

TotalAccess.



Can I stop the working spouse contribution during the year?

Yes. If your spouse or same-gender domestic partner becomes covered under another employer’s medical plan

or meets one of the conditions listed above, you will have 60 days to stop the working spouse contribution

retroactively. After 60 days, a change can be made prospectively only. Call the Boeing Service Center through

Boeing TotalAccess.









1-10 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

Court-Ordered Child Support

The Company also will provide health care coverage to certain children (called alternate recipients) if

directed to do so by a qualified medical child support order (QMCSO) that is issued by a court or state

agency of competent jurisdiction.

A QMCSO is a “medical child support order” that is “qualified” under requirements of the Omnibus

Budget Reconciliation Act of 1993, as amended.



Medical Child Support Order

A medical child support order is any decree, judgment, or order (including approval of a settlement

agreement) from a state court with jurisdiction over the child’s support or an order or administrative notice

from a state agency with such jurisdiction under state law that

• Recognizes the child as an alternate recipient for plan benefits.

• Provides, based on a state domestic relations law (including a community property law), for the child’s

support or health plan coverage.

• Specifically requires a health care plan to provide coverage.



Qualified Medical Child Support Order

Not all medical child support orders are qualified. A QMCSO

• Meets all of the above conditions for a medical child support order,

• Creates or recognizes an alternate recipient’s right to receive plan benefits, and

• Specifies

– Your (the employee’s) name and last known address.

– Each alternate recipient’s name and address (or, if the order provides, the name and address of a state

official or agency instead of each alternate recipient’s address).

– Coverage to which the alternate recipient is entitled.

– The coverage effective date.

– How long the child is entitled to coverage.

– That the health care plan is subject to the order.



What if I have to pay medical expenses after the QMCSO effective date but before the

QMCSO has been approved by the Company?

The health plans pay network providers directly for covered services. When a covered charge has been paid by

you, an alternate recipient, a custodial parent, or a legal guardian, the plan will reimburse the person who paid

the expense. You must file a claim for reimbursement. For claim-filing instructions, see Section 5.





How the Company Notifies You of a Medical Child Support Order

The Company promptly will notify you and the alternate recipient if it receives a medical child support

order and will provide an explanation of the procedures used to determine whether the order is qualified.

The Company then will decide, based on written procedures and within a reasonable time, whether the

order is a QMCSO.

If the order is a QMCSO, the Company will

• Notify you and the alternate recipient of the plan’s procedures for adding the alternate recipient to your

coverage.

• Allow the alternate recipient an opportunity to designate a representative to receive copies of any notices

due under the QMCSO.

• Begin coverage for the alternate recipient on the date specified in the QMCSO (which is not necessarily

the first of the month).

• Begin deducting any required contributions from your paycheck, including any contributions for

coverage retroactive to the coverage effective date specified in the QMCSO.





Health Care Plans | 2009 Edition | A86320W Eligibility and Enrollment 1-11

If the order is not a QMCSO, the Company will notify the employee and each alternate recipient, within a

reasonable time, of the reasons and the procedures for submitting a corrected medical child support order.



How can I learn more about QMCSOs?

For more information on QMCSOs, contact the Boeing Service Center through Boeing TotalAccess. You

can obtain the Company’s procedures governing medical child support orders at no charge by writing to

the Employee Benefit Plans Committee, The Boeing Company, 100 North Riverside, MC 5002-8421,

Chicago, IL 60606-1596.







How Same-Gender Domestic Partner Coverage Affects

Taxes

If you enroll your same-gender domestic partner or his or her eligible children in a Company-sponsored

health care plan, the benefit value may be taxable to you as ordinary income. The taxability of benefits

depends on whether your same-gender domestic partner (and his or her children) qualifies as a dependent

under Internal Revenue Code Section 105.

For additional information about domestic partner benefit tax implications, you should consult a

tax adviser.









1-12 Eligibility and Enrollment Health Care Plans | 2009 Edition | A86320W

Traditional Medical Plan Section 2

How the Traditional Medical Plan Works

The Traditional Medical Plan offers financial protection against large and often unforeseen medical

expenses. Through the service representatives listed in the table below, the plan covers medical services

and supplies such as

• Preventive care.

• Physician office visits.

• Physician and hospital services.

• Prescription drugs.

• Mental health and substance abuse treatment.

• Routine vision care.

You share in the cost of these services by paying a copayment, a coinsurance percentage, and/or an

annual deductible, as described in this section. The plan pays 100 percent of most covered services

received through a network provider after you pay the annual deductible. For other services, such as

physician office visits, you pay a copayment when you see a network provider (the deductible does

not apply).

The Traditional Medical Plan gives you the flexibility to see any physician you choose. However, your

out-of-pocket costs are lower when you see a network provider for services covered by this plan.



Who Administers the Benefits

The Company has contracted various service representatives to handle the day-to-day administration of

the plan. Service representatives answer benefit questions, make benefit decisions, pay claims, process

claim appeals, and account for premiums, service fees, and claim costs. The current service representatives

are as follows:



Traditional Medical Plan Service Representatives*

Traditional Medical Plan Benefit Current Service Representative Claims Are Processed by

Medical and hospital services BlueCross BlueShield of Illinois BlueCross BlueShield of Illinois

(BCBSIL) (BCBSIL)

Mental health and substance abuse program ValueOptions/Boeing Helpline ValueOptions/Boeing Helpline

Retail prescription drug program Medco Health Solutions, Inc. Medco Health Solutions, Inc.

Mail-order prescription drug program Medco By Mail Medco Health Solutions, Inc.

Routine vision care program Vision Service Plan (VSP) Vision Service Plan (VSP)





See Section 9, “Contacts,” for information on how to contact the service representatives.

The Company reserves the right to change a service representative at any time. If this happens, you will be

notified in writing.



What is a service representative?

A service representative is an agent, group, or organization with which the Company has contracted to handle

the day-to-day administration of the plan.









*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-1

Save Money by Using a Network Provider

Each service representative maintains a network of providers that have been contracted to provide

services and treatments under this plan at discounted fees.

• Contracted physicians, hospitals, and medical specialists are referred to as network providers.

• Contracted pharmacies are referred to as retail participating pharmacies.

These network providers and participating pharmacies are required to demonstrate that they meet certain

quality standards and hold certain credentials to become part of the service representative’s network. They

also provide direct claim billing to the plan so that you usually do not need to submit a claim form when

you use a network provider.

Each time you need medical care, you can choose whether to use a network provider or a provider who is

not in the network (referred to as a nonnetwork provider). Network providers accept a discounted fee

from the plan. This discount is applied before you pay your share of the bill. The plan generally pays a

larger portion of the covered charges when you use a network provider, which means that you pay less out

of your own pocket.

Network providers are available in most areas of the United States. For information on how to locate one,

visit the Your Benefits Resources web site or call the Boeing Service Center through Boeing TotalAccess.

Nonnetwork Providers

Generally, if you use a nonnetwork provider when a network provider is available in your area, the plan

will pay less of the covered charges than if you see a network provider.

Nonnetwork providers generally are physicians, hospitals, and other medical professionals who do not

have contracts with the service representatives for this medical plan.

Some Providers May Not Be Eligible for Networks. If the service representative does not maintain a

network of providers in a particular category (for example, podiatrists or ambulance service providers)

within the plan’s network service area, a special provision applies. The plan will pay 80 percent of usual

and customary charges for services and supplies received from those providers after you satisfy your

annual deductible. If you are not sure whether a network is available for providers in a certain category,

contact the service representative.



What if I live in an area that has no network providers?

The plan may pay your benefits at the network level based on the usual and customary charge if you are

enrolled in this plan and the plan determines that you live outside of a network service area. Contact the service

representative if you believe that you live outside a network service area.







How the Traditional Medical Plan Pays Benefits

For most services and supplies covered by this plan, you and the plan each pay a portion of your medical

care costs, as described below and shown in the table, “How the Traditional Medical Plan Pays Benefits,”

later in this section.



Annual Deductible

Generally, the annual deductible is the amount you must pay out of your own pocket for covered services

each benefit year before the plan begins to pay benefits. The annual deductible applies to many but not all

covered services, as listed on the next page.

Once you satisfy the annual deductible, the plan pays a percentage of the covered charges that are subject

to the annual deductible.









2-2 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Services That Do Not Apply Toward the Annual Deductible. This plan is designed to provide cost-

effective care to help you and your family members maintain or improve your health. Therefore, this plan

does not require you to satisfy the annual deductible before you begin receiving any of these services:

• Network provider office visits.

• Prescription drugs.

• Preventive care.

• Routine vision care and eyewear.

• Tobacco cessation treatment.

Amounts that you pay, such as copayments, toward the above-listed covered services do not count toward

the annual deductible.



Copayments

A copayment is a fixed dollar amount that you pay toward the cost of a particular covered service, when

the service is received.

Copayments do not apply toward the annual deductible or the annual out-of-pocket maximum.



Coinsurance Percentage

For certain network services, all nonnetwork services, and retail prescription drugs, you and the plan each

pay a percentage of the covered charge. These are referred to as coinsurance percentages.

Generally, you must first satisfy the entire annual deductible before the plan pays its coinsurance

percentage for services to which the annual deductible applies.

A coinsurance percentage does not include any amounts you pay for services that the plan does not cover

or any amounts that exceed the usual and customary charge.



Annual Out-of-Pocket Maximum*

This plan limits the maximum amount that you or your family must pay in any one benefit year for most

services to which a coinsurance percentage applies. Once you reach the out-of-pocket maximum, the plan

will begin to pay most covered services and supplies at 100 percent of the usual and customary charge

(see definition in Section 8) for the rest of that benefit year.

Amounts That Do Not Count Toward the Annual Out-of-Pocket Maximum. Amounts that you pay for

the following are not applied toward the individual or family out-of-pocket maximums:

• Annual deductibles.

• Any balance remaining after you reach a benefit maximum.

• Any difference between the usual and customary charge and the provider’s actual charge.

• Covered charges for

– TMJ/MPDS treatment.

– Tobacco cessation treatment.

• Covered services that are paid in full or paid at 100 percent of usual and customary charges.

• Emergency room copayments.

• Network provider office visit copayments.

• Retail and mail-order prescription drug coinsurance/copayments.

• Services or supplies that are paid at a reduced amount or denied if you do not meet medical review

program requirements.

• Services or supplies that the plan does not cover.









*Updated: January 2010

Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-3

How the Plan Determines the Covered Charge

This plan pays benefits based on the covered charges. A covered charge is the provider’s charge for a

covered service or supply, up to the service representative’s maximum allowance. The amount of the

covered charge depends on whether you see a network or a nonnetwork provider.

• For a network provider, the service representative determines the amount of the covered charge for a

particular service or supply under any applicable agreement between the service representative and

the provider.

• For a nonnetwork provider, the covered charge is based on the usual and customary charge for the

covered service or supply. This plan does not cover or otherwise recognize any portion of a provider’s

charge that exceeds the usual and customary charge; you are responsible for these charges.

Usual and Customary Charge. The usual and customary charge is the maximum charge for a covered

service or supply the service representative will consider for reimbursement from a nonnetwork provider.

The service representative may refer to this as the “maximum reimbursable charge,” “maximum allowable

charge,” “reasonable and customary charge,” “allowed amount,” or a similar term.

The usual and customary charge is the least of

• The provider’s actual charge for the service or supply,

• The provider’s normal charge for a similar service or supply, or

• A predetermined percentile (negotiated between each carrier and plan sponsor) of charges made by

providers of a comparable service or supply in the geographic area where it is received.

To determine if a charge exceeds the usual and customary charge for medical services or supplies in

situations involving unusual or complicated services or supplies, the nature and severity of the injury or

sickness may be considered.

The service representative uses a database of provider charges to determine the usual and customary charge

in an area. Information about the database and percentile used to determine the usual and customary

charge can be obtained by contacting the service representative.

If you use a nonnetwork provider, you pay any charges above the usual and customary amount.



Benefit Maximums*

A benefit maximum limits the amount the plan will pay for any one person covered by this plan for a

specific covered service for a specified period or visit, depending on the service. Once a participant

reaches a benefit maximum, this plan will not cover that specific service or supply for the rest of the

specified period.



How the Traditional Medical Plan Pays Benefits*

The plan pays benefits for medically necessary services and supplies (see definition in Section 8) at the

percentages given in the next table, “How the Traditional Medical Plan Pays Benefits,” after you pay any

copayment, annual deductible, or combination of the two. All claims are administered by BlueCross

BlueShield of Illinois (BCBSIL), the service representative, unless otherwise noted.

For more detailed information, see “What the Traditional Medical Plan Covers,” later in this section.









*Updated: January 2011

2-4 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

What are medically necessary services or supplies?

This plan covers only treatment, services, and supplies that are deemed preventive or medically necessary.

Medically necessary means that the treatment, service, or supply meets the following criteria in accordance

with the plan and as determined by the service representative. The treatment, service, or supply is

• Required to diagnose or treat the patient’s illness, injury, or condition, and the condition cannot be diagnosed

or treated without it.

• Consistent with the symptom or diagnosis and the treatment of the condition.

• The most appropriate service or supply that is essential to the patient’s needs.

• Appropriate as good medical practice.

• Professionally and broadly accepted as the usual, customary, and effective means of diagnosing or treating

the illness, injury, or condition.

• Unable to be provided safely to the patient as an outpatient (for an inpatient service or supply).

A treatment, service, or supply may be medically necessary in part only. The fact that a physician furnishes,

prescribes, recommends, or approves a treatment, service, or supply does not, by itself, make it medically

necessary.





How the Traditional Medical Plan Pays Benefits††

Network Provider* Nonnetwork Provider**,†

Annual deductible • The greater of $225 or 0.225% of your base annual salary per individual

(network and nonnetwork combined)

• The greater of $675 or 0.675% of your base annual salary per family of

three or more but not more than $225 or 0.225% of your base annual salary

for any individual (network and nonnetwork combined)

• Base annual salary is your base annual salary on January 1 of each year

(July 1, 2009, for the July 1, 2009, to December 31, 2009, benefit year); in

the year of your hire, it is your base annual salary on your date of hire

• Applies to all covered services and supplies except as otherwise noted

Annual out-of-pocket maximum • $2,000 per individual (network and nonnetwork combined)

(does not include annual deductible) • $4,000 per family of two or more but not more than $2,000 for any

individual (network and nonnetwork combined)

Copayments (annual deductible does not You pay the copayments listed below for network provider office visits, routine

apply) vision examinations, spinal and extremity manipulations, and mail-order

prescription drugs

Coinsurance The plan pays 100% The plan pays 60%

Limits and details on certain covered

services and supplies follow:

Acupuncture



Inpatient 100% 60%

Outpatient 100% after $15 copayment per visit 60%

(annual deductible does not apply)

Ambulance 100% Same as network provisions

Christian Science practitioner and 100%; certain limits apply Same as network provisions

sanatorium

Diagnostic X-ray and laboratory services 100% 60%







††

Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-5

How the Traditional Medical Plan Pays Benefits (continued)††

Network Provider* Nonnetwork Provider**,†

Durable medical equipment 100% 60%

Emergency room treatment



Medical emergency (must meet the • 100% after $50 copayment Same as network provisions

definition of true emergency) • The $50 copayment is waived if

you are admitted as an inpatient

immediately after emergency room

treatment

All other treatment • 100% after $50 copayment 60% after $50 copayment

Hearing aids • 100% up to $800 per ear • 60% up to $800 per ear

• Limited to one aid per ear every • Limited to one aid per ear every

three benefit years three benefit years

• Hearing aid overhaul in place of • Hearing aid overhaul in place of

new hearing aid after three benefit new hearing aid after three benefit

years years

• Network and nonnetwork combined • Network and nonnetwork combined

Home health care • 100% Same as network provisions

• Limited to 120 visits each benefit

year (network and nonnetwork

combined)

Hospice care • 100%; six-month maximum Same as network provisions

(network and nonnetwork

combined)

• Skilled care by a registered nurse,

licensed practical nurse, or home

health aide

• Respite care visits of 2 or more

hours per day up to 120 hours

per three months (network and

nonnetwork combined)

• Extensions must be recommended

by the physician and approved by

the service representative

Hospital 100% 60%

Mental health treatment (including eating • See “How the Mental Health and Substance Abuse Program Works,” later in

disorders) this section

• Care is managed by ValueOptions (Boeing Helpline)

• Claims are administered by ValueOptions (Boeing Helpline)

Covered inpatient, partial hospital, 100% when obtained from a provider 60% when obtained from a provider

residential, or intensive outpatient contracted with the Boeing Helpline not contracted with the Boeing

services Helpline

Covered outpatient services 100% after $15 copayment per visit 60%

(annual deductible does not apply)









Updated: January 2010 and January 2011

††





2-6 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

How the Traditional Medical Plan Pays Benefits (continued)††

Network Provider* Nonnetwork Provider**,†

Physician



Inpatient 100% 60%

Office visit (including home, hospital 100% after $15 copayment per visit 60%

outpatient, and second surgical opinion) (annual deductible does not apply)

Prescription drugs • Pharmacy benefits are provided through Medco Health Solutions, Inc.

• Quantities and dosages for certain prescription drugs may be limited by

general plan provisions, clinically established guidelines (including those for

medical necessity), and/or FDA-approved labeling

Retail participating pharmacy Supply limited to 34 days; annual deductible does not apply

Generic drug 90%; $5 minimum, $25 maximum

Formulary brand-name drug 80% except when a generic equivalent is available; $15 minimum, $75 maximum

Nonformulary brand-name drug 70% except when a generic equivalent is available; $30 minimum, no maximum

Mail-order pharmacy Supply limited to 90 days; annual deductible does not apply

Generic drug $10 copayment

Formulary brand-name drug $30 copayment except when a generic equivalent is available

Nonformulary brand-name drug $60 copayment except when a generic equivalent is available

Preventive care



Routine physical examinations



Employees, spouses, and children • 100% (annual deductible does not Not covered when received in a

age 2 and older apply), including related office network service area

visits, X-ray and laboratory charges,

and childhood and adult

immunizations and vaccines

(excluding travel vaccines) as

recommended by the U.S.

Preventive Services Task Force

(USPSTF) guidelines, including the

applicable catch-up immunization

schedule for children ages 2 to 18

as recommended by the USPSTF

guidelines

• Limited to one examination per

child every benefit year for children

age 2 through 18

• Limited to one examination per

person every three benefit years

for age 19 through age 34, then

one examination per person every

benefit year









††

Updated: January 2011



Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-7

How the Traditional Medical Plan Pays Benefits (continued)††

Network Provider* Nonnetwork Provider**,†

Children to age 2 • 100% (annual deductible does not Not covered when received in a

apply) network service area

• Limited to eight examinations from

birth to age 2

• Includes immunizations and

vaccines, excluding travel vaccines,

as recommended by the U.S.

Preventive Services Task Force

(USPSTF) guidelines and the

physician, including the applicable

catch-up immunization schedule

for children age 4 months to 2

years as recommended by the

USPSTF guidelines

Routine Pap tests, mammograms, • 100% (annual deductible does not Not covered when received in a

prostate screenings, and colorectal apply) network service area

screenings (including colonoscopies) • Covered as recommended by the

physician

Spinal and extremity manipulations (such • $15 copayment per visit (annual • 60%

as chiropractic care) deductible does not apply) • Limited to 26 visits for spinal

• Limited to 26 visits for spinal and/or extremity manipulations

and/or extremity manipulations combined per year (network and

combined per year (network and nonnetwork combined)

nonnetwork combined)

Substance abuse treatment† • See “How the Mental Health and Substance Abuse Program Works,” later in

this section

• Care is managed by ValueOptions (Boeing Helpline)

• Claims are administered by ValueOptions (Boeing Helpline)

Covered inpatient, partial hospital, 100% when obtained from a provider 60% when obtained from a provider

residential, or intensive outpatient contracted with the Boeing Helpline not contracted with the Boeing

services Helpline

Covered outpatient services 100% after $15 copayment per visit 60%

(annual deductible does not apply)

TMJ/MPDS treatment • 50% Same as network provisions

• $3,500 lifetime maximum

benefit (network and nonnetwork

combined)

Therapies (inpatient and outpatient)



Neurodevelopmental therapy • 100% • 60%

(for children age 6 and younger) • Limited to $1,500 each benefit year • Limited to $1,500 each benefit year

(network and nonnetwork (network and nonnetwork

combined) combined)









Updated: January 2010 and January 2011

††





2-8 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

How the Traditional Medical Plan Pays Benefits (continued)

Network Provider* Nonnetwork Provider**,†

Occupational, physical, and speech • 100% • 60%

therapy • Limited to three months; may be • Limited to three months; may be

extended if approved by the service extended if approved by the service

representative representative

Tobacco cessation treatment • 100% (annual deductible does not Same as network provisions

apply)

• $500 lifetime benefit maximum

(network and nonnetwork

combined)

Vision care Provided through Vision Service Plan (VSP)

Eye examination • 100% after a $15 copayment; • 100% up to $50; annual deductible

annual deductible does not apply does not apply

• Limited to one eye examination • Limited to one eye examination

per benefit year (network and per benefit year (network and

nonnetwork combined) nonnetwork combined)

Lenses Limited to two sets of lenses every Limited to two sets of lenses every

two benefit years (network and two benefit years (network and

nonnetwork combined) and subject nonnetwork combined) and subject

to the following benefit maximums to the following benefit maximums

(annual deductible does not apply): (annual deductible does not apply):

Single vision $50 $50

Bifocal $80 $80

Trifocal $95 $95

Lenticular $155 $155

Contact lenses (in place of allowance • $120; annual deductible does not • $120; annual deductible does not

for conventional lenses and frames) apply apply

• 15% discount on contact lens • No discount applies

fitting and evaluation examination

Frames • $90; annual deductible does not • $90; annual deductible does not

apply apply

• Limited to two frames every • Limited to two frames every

two benefit years (network and two benefit years (network and

nonnetwork combined) nonnetwork combined)

• 20% discount on complete pairs of • No discount applies

prescription glasses

Wigs • 80% Same as network provisions

• $500 maximum each benefit

year (network and nonnetwork

combined)

* The network payment level is based on the approved fees that the service representative negotiated for specific providers and services covered

by the plan.

** The nonnetwork payment level is based on the usual and customary charge (as defined by this plan). You are responsible for paying any charges in

excess of the amount the service representative determines to be the usual and customary charge.

†

For certain benefits, the plan will pay 80% of the usual and customary charges if the service representative does not maintain a network of providers in

a particular license category in a certain area. See “Some Providers May Not Be Eligible for Networks,” earlier in this section.









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-9

When You Need Preadmission Review or Preapproval*

Under the Traditional Medical Plan, the medical review program encourages the appropriate use of health

care services. This program is designed to let you and your physician know whether or not the plan will

cover certain procedures before you incur the expense.

Before you receive medical care, you may be required to request one or both of the following types of prior

approval from the service representative:

• Preadmission review. The service representative reviews the medical necessity, appropriateness, level

of care, and setting for most hospital-based services and procedures.

• Preapproval. The service representative verifies whether the plan will cover a specific type of service

or procedure. This determination is based on plan provisions and the medical necessity of the service

or procedure.

Generally, you should request preadmission review before a hospital admission (except emergencies and

childbirth) or admission to a skilled nursing facility. You should request preapproval before obtaining

inpatient mental health or substance abuse treatment, outpatient electroconvulsive therapy, home health care

or hospice services, undergoing any procedure for obesity or transplantation, or entering a clinical trial.

If you do not obtain preadmission review or preapproval as required, the plan may limit, reduce, or deny

your benefit. To request preadmission review or preapproval, contact the service representative.

If you receive care through a network provider, the physician may contact the service representative

for you. However, you are ultimately responsible for obtaining any required preadmission review or

preapproval.



Request Preadmission Review for Hospital Services

If you do not request preadmission review before you are admitted to one of the following types of

facilities, the plan may limit or deny coverage for services that otherwise may have been covered:

• Hospital—after the first 48 hours of stay after the normal delivery of a child (or 96 hours after a cesarean

section).

• Hospital—as an inpatient after admittance to an emergency room.

• Hospital—for nonemergency inpatient services and procedures.

• Skilled nursing facility.

You do not need to request preadmission approval before emergency or childbirth admissions. However,

you should contact the service representative soon after the admission to check whether or not the rest of

your hospitalization will be covered.

If you are admitted to a nonnetwork hospital, you will retain emergency status (with benefits paid at the

network level) for 24 hours or until you can be transferred safely to a network facility. However, care that is

received at a nonnetwork hospital when the condition is not a true medical emergency is covered at the

nonnetwork level.



Request Preapproval for Certain Mental Health and Substance

Abuse Treatment*

You or your provider must request preapproval for inpatient services or treatment or outpatient

electroconvulsive therapy. Other outpatient network and nonnetwork mental health or substance abuse

treatment does not require preauthorization. However, contacting the Boeing Helpline or your Employee

Assistance Program will help you find mental health or substance abuse provider best suited to your

needs. For more information, see “How the Mental Health and Substance Abuse Program Works,” in this

section.



Request Preapproval for Home Health Care and Hospice Care

You must request preapproval before you receive home health care or hospice care. If you do not

request preapproval, the plan may limit or deny coverage for those services even if they otherwise

may have been covered.

*Updated: January 2011

2-10 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

When to Request Preadmission Review or Preapproval

You or your physician must contact the service representative at least 10 days before any nonemergency

admission to a hospital or skilled nursing facility and at least 10 days before home health or hospice care.

You or your physician may be required to provide documentation of your medical condition.

Your request for preadmission review or preapproval will be processed in accordance with the plan’s

provisions for preservice claims. For more information, see Section 5.

How Much the Plan Pays With Preadmission Review or Preapproval

If the service representative approves your request for preadmission review or preapproval for a hospital or

skilled nursing facility stay, the plan will pay its regular benefit when the bill is submitted for payment.

If you request and receive preapproval for home health care or hospice agency services, the plan will pay

its regular benefit when the bill is submitted for payment.

See the table, “How the Traditional Medical Plan Pays Benefits,” earlier in this section.

How Much the Plan Pays Without Preadmission Review or Preapproval

If your request for preadmission review or preapproval is denied, the plan will not pay a benefit for the

service or procedure. You will be responsible for payment if you receive the service.

If you do not request preadmission review or preapproval (as applicable) before you are admitted to a

hospital or skilled nursing facility or begin receiving home health care or hospice services, and the

service representative later determines that the care was medically necessary, your benefit will be

paid at 50 percent of the first $2,000 of usual and customary charges for that particular service, after

the deductible.

The 50 percent you pay will not apply toward the annual deductible or annual out-of-pocket maximum.

Any amounts you pay for services that are denied by the service representative do not count toward your

50 percent.

If you do not receive approval for other services where preapproval is required (such as for obesity

treatment and certain transplants), you will not be reimbursed for the cost of any services determined by the

service representative to not be medically necessary.

If you do not receive preapproval for inpatient mental health or substance abuse treatment (or outpatient

electroconvulsive therapy) and the service representative determines the services were medically necessary,

covered charges will be reimbursed at the nonnetwork level.*

Although the plan may not cover a particular service or procedure, you and your physician always have the

right to make final decisions about your medical treatment. However, you will be responsible for paying

any expenses that the plan does not cover.



Individual Case Management*

In the event of a severe or long-term illness or injury, the service representative, or OptumHealth, will

assist the network provider in identifying treatment alternatives that are cost-effective and enhance quality

of life through an individual case manager.





What the Traditional Medical Plan Covers

In general, this plan covers services and supplies that are

• Medically necessary to diagnose or treat a nonoccupational accidental injury or illness.

• Medically appropriate for certain preventive care and other conditions, up to plan limits.

For an explanation of medically necessary services and supplies, see the definition in Section 8.

Coverage of the following services and supplies is subject to general plan provisions and medical necessity,

as applicable.





*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-11

Acupuncture

This plan covers medically necessary acupuncture for a covered illness or in place of covered anesthesia.

Treatment must be by a licensed acupuncturist (L.A.C.), doctor of medicine (M.D.), or doctor of osteopathy

(D.O.). Services performed must be within the scope of the provider’s license.

Ambulance

The plan covers professional ambulance services, including air ambulance, to transport you from the place

where you are injured or become ill to the first hospital where you receive treatment.

These services also are covered when a physician requires an ambulance to transport you to a hospital,

including from one hospital to another, but only to the nearest hospital with appropriate regional

specialized treatment facilities, equipment, or staff physicians.

No other costs in connection with travel are covered.

Ambulatory Surgical Facility

The plan covers the services of an approved freestanding surgical center or ambulatory surgical center

provided the services would be covered if received in a hospital.

Anesthesia

The plan covers anesthesia when it is provided in conjunction with a covered medical procedure when

specific criteria are met.

Christian Science Practitioner and Sanatorium

A Christian Science sanatorium is a facility that, at the time of treatment, is operated (or listed) and

certified by the First Church of Christ, Scientist, in Boston, Massachusetts.

The plan will cover a semiprivate sanatorium room if you are admitted for healing (not rest or study) and

are under the care of an authorized Christian Science practitioner. If you have a private room, you will be

responsible for the difference between the cost of the private room and the sanatorium’s average charge for

a semiprivate room. If the facility offers only private rooms, the plan will cover up to the amount charged

for semiprivate rooms in similar facilities in the area.

Congenital Abnormalities and Hereditary Complications

The plan covers medically necessary services and supplies that are required to treat congenital

abnormalities (a physiological or structural abnormality that exists from birth) and hereditary

complications. This benefit applies to covered newborns and to all other plan participants.

Cosmetic Surgery

The plan covers cosmetic surgery only in three cases:

• When it is required for the prompt repair of accidental injury.

• When it is required to correct an abnormal function.

• As specifically described for treatment after mastectomy. (See “Reconstructive Breast Surgery,” in

this section.)

Dental Repair Due to Accidental Injury

The plan covers services and supplies from a physician or dentist to promptly repair natural teeth or other

body tissues after an accidental injury. This may include surgical procedures of the jaw, cheek, lips, tongue,

and other parts of the mouth and treatment for fractures of the facial bones (maxilla or mandible).

Any teeth that are repaired must have been free from decay or in good repair and firmly attached at the time

of the accident. If the repair includes the installation of crowns, dentures, bridgework (fixed or removable),

or appliances, this plan will cover only the

• Appliance installed as the first course of orthodontic therapy after the injury.

• First crown to repair each damaged tooth.

• First denture or bridgework to replace lost teeth.





2-12 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

If these services also are covered by your Company-sponsored dental plan, the dental plan pays first and

the medical plan pays second under the plan’s coordination of benefit rules.

Diagnostic X-Ray and Laboratory Services

Generally, the plan covers the following services when the indications for the services meet the service

representative’s guidelines (including those for medical necessity), including when they are performed in

connection with a voluntary second or third surgical opinion:

• Computerized axial tomography (CAT or CT) scans.

• Diagnostic X-rays.

• Magnetic resonance imaging (MRI) performed in a facility accredited by the American College of

Radiology.

• Nuclear medicine.

• Prescribed laboratory tests and related procedures.

• Ultrasound.

Durable Medical Equipment

The plan covers the rental (or purchase, when approved by the service representative) of medically

necessary durable medical equipment that is prescribed by a physician. Covered equipment must be

• Able to withstand repeated use.

• Appropriate for use in the home.

• Not useful to a person without the medical condition.

• Solely for the treatment or improvement of a critical function related to the medical condition.

The plan also covers the repair or replacement of durable medical equipment due to normal use or a change

in the patient’s condition (including the growth of a child).



What is durable medical equipment?

Examples of covered durable medical equipment are crutches, wheelchairs, kidney dialysis equipment, standard

hospital beds, oxygen equipment, and diabetic supplies such as blood glucose monitors, insulin infusion

devices, and insulin pumps.





Emergency Room

Emergency room treatment—at a network or nonnetwork facility—is paid at the network level when the

condition is determined by the service representative to be a true medical emergency.

A true medical emergency is the sudden, unexpected onset of serious illness or severe injury that could

result in (or that a prudent person would have reason to believe could result in) death, permanent damage or

impairment of bodily function, or loss of limb use if not treated immediately.

For mental health and substance abuse coverage, a situation also is considered an emergency when there is

imminent danger to yourself or others or you are medically compromised as a result of mental illness or

substance abuse.

If you are admitted to a nonnetwork hospital, you will retain emergency status (with benefits paid at the

network level) for 24 hours or until you can be transferred safely to a network facility. However, care that is

received at a nonnetwork hospital when the condition is not a true medical emergency is covered at the

nonnetwork level.









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-13

Erectile Dysfunction

The plan covers organic erectile dysfunction treatment when the patient has a history of one or more of the

following conditions:

• Insulin-dependent diabetes.

• Major pelvic surgery.

• Peripheral neuropathy or autonomic insufficiency.

• Peripheral vascular disease or local penile vascular abnormalities.

• Prostate cancer.

• Severe Peyronie’s disease.

• Spinal cord disease or injury.

Covered therapy includes vacuum erection devices, injection therapy, penile prostheses, urethral pellets,

and prescription medications.

Hearing Aids

The plan covers hearing aids when recommended in writing by a physician or certified audiologist, up to

certain benefit maximums. Benefits include

• Cost and installation of a hearing aid when recommended in writing by a physician or certified

audiologist.

• Hearing aid overhaul in place of a new hearing aid.

For hearing aid benefit maximums, see the table, “How the Traditional Medical Plan Pays Benefits,” in

this section.

Hemodialysis

The plan covers repetitive hemodialysis treatment for chronic, irreversible kidney disease, including rental

or lease of hemodialysis equipment.

The plan pays benefits for the first 30 months of Medicare entitlement due to end-stage renal disease.

Thereafter, Medicare is primary and this plan is secondary.

Under certain conditions, the plan may cover the purchase of major hemodialysis equipment as well as

supplies and necessary training to operate the dialyzer. To be covered in these instances, the purchased

items must be of no use to you in the absence of the disease and of no value to other household members.

The service representative establishes specific conditions for purchasing the equipment, including an

amortization period.

Home Health Care

The plan covers home health care visits and supplies, but only when inpatient hospital or skilled nursing

facility care otherwise would be required. You also must be considered homebound, which means that

leaving home involves a considerable, taxing effort and that you cannot use public transportation

without help.

Home health care requires preapproval. For details, see “When to Request Preadmission Review or

Preapproval,” in this section.

Before you receive home health care, your attending physician must provide a written treatment plan that

describes your continued care and treatment. The physician must review the treatment plan at least once

every two months and certify that your condition and treatment continue to meet these criteria. See

examples of home health care services on the next page.









2-14 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

What services or providers does the plan cover for home health care?

The plan covers the following home health care when it is provided and billed by an approved home health

agency:*

• Home health aide visits.**

• Medical social visits by a person with a master’s degree in social work (M.S.W.).

• Medical supplies that are covered when provided on an inpatient basis.

• Nursing visits by a registered nurse (R.N.) or licensed practical nurse (L.P.N.).

• Nutritional guidance by a registered dietitian.

• Nutritional supplements (such as diet substitutes) that are administered intravenously or through

hyperalimentation.

• Occupational therapy visits by an occupational therapist.

• Physical therapy visits by a physical therapist.

• Physician services.

• Respiratory therapy visits by an inhalation therapist who is certified by the National Board of Respiratory

Therapists.

• Services and supplies for infusion therapy.†

• Speech therapy visits by a speech therapist.

* An approved home health care agency is a public or private agency or organization that (1) administers and provides home health care

and (2) is either Medicare approved or licensed and regulated by the applicable governmental agency in its location.

** A home health aide is an individual who is employed by a home health care agency or a hospice agency who (1) provides, under the

supervision of a registered nurse or physical or speech therapist, part-time or intermittent personal care, ambulation and exercise,

household services that are essential to home health care, and assistance with medications that normally are self-administered,

(2) reports on changes in the patient’s conditions and needs, and (3) completes appropriate records.

†

Patients do not need to meet the treatment plan and homebound requirements.







Hospice Care

This plan covers hospice care to control pain and other symptoms for terminally ill patients whose life

expectancy is six months or less. Covered services include visits and supplies of a hospice agency in place

of confinement in a hospital or skilled nursing facility.

Hospice care requires preapproval. Before the patient receives any hospice services, the attending

physician must provide a written treatment plan to the service representative that describes continued

care and treatment. If the service representative approves the care, the physician must review the treatment

plan at least once every two months and certify that the patient’s condition and treatment continue to meet

these criteria.

The plan also covers respite care as temporary relief to family members and friends who care for the

terminally ill patient. Coverage for respite care is limited to the benefit maximums in the table, “How the

Traditional Medical Plan Pays Benefits,” in this section.



What is an approved hospice agency?

An approved hospice agency is a public or private organization that

• Administers and provides hospice care and

• Is either approved by Medicare or licensed and regulated by the applicable governmental agency

in its location.





Hospital

An accredited general hospital is a covered provider under this plan.

All inpatient and outpatient hospital services require prior approval, except in an emergency. See “Request

Preadmission Review for Hospital Services,” in this section.

The plan covers medically necessary hospital services, such as emergency care and planned inpatient or

outpatient surgeries, and supplies.



Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-15

For inpatient care, the plan covers the cost of a semiprivate room. The plan covers a private room when

medically necessary.

If you have a private room when it is not medically necessary, you will be responsible for the difference

between the cost of a private room and the hospital’s average charge for a semiprivate room. If the hospital

offers only private rooms, the plan will cover up to the amount charged for semiprivate rooms in similar

facilities in the area.

Infertility

The plan covers these services to diagnose and treat infertility:

• Conventional medical treatment such as office visits, laboratory services, and prescription drugs.

• Diagnostic tests necessary to determine the cause.

• Surgical correction of a condition that is causing or contributing to infertility.

Mental Health Treatment

The plan covers certain services and treatments for mental health and substance abuse. For benefit

levels and coverage details, see “How the Mental Health and Substance Abuse Program Works,” later

in this section.

Oral Surgery

The plan covers certain services and supplies that are provided by a physician or dentist. These services

and supplies include

• Correcting developmental abnormalities of the jaw or malocclusion of the jaw by osteotomy (surgical

cutting of the bone or bony tissue), with or without bone grafting.

• Excising a tumor or cyst of the jaw, cheek, lips, tongue, or roof or floor of the mouth.

• Excising exostoses of the jaw and hard palate.

• Incising accessory sinuses, salivary glands, or ducts.

• Incising and draining cellulitis.

• Surgical placement of endosseous implants, but only if success is reasonably expected for at least five

years or longer.

If these services also are covered by your Company-sponsored dental plan, the dental plan pays first and

the medical plan pays second under the medical plan’s coordination of benefit rules.

Orthopedic Appliances and Braces (Orthotics)

The plan covers braces, splints, orthopedic appliances, and orthotics that are medically necessary. The

plan also covers repair and replacement required by normal use or a change in the patient’s condition (such

as the growth of a child). Orthopedic shoes, lifts, wedges, and inserts (orthotics) are covered if prescribed

by a physician and custom made for the patient.

These items are covered as part of durable medical equipment benefits. Over-the-counter items are

not covered.

Orthoptic Therapy (Vision Training)

The plan covers up to six months of medically necessary orthoptic therapy to treat muscle imbalance

(strabismus, esotropia, or exotropia) for children through age 11. Orthoptic therapy can be provided by

an ophthalmologist, optometrist, or other licensed provider under the direction of an ophthalmologist

or optometrist.

Physician

The plan covers the services of a licensed physician to diagnose or treat nonoccupational accidental

injuries, illnesses, or other covered conditions. The plan also covers physician services for

• Antigen, allergy vaccine, insulin, and other drugs, medicines, and medical devices (including

contraceptive injections, devices, and implants) dispensed by a physician.







2-16 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

• Eye examination, including refraction, but only if performed because of another medical condition such

as diabetes, glaucoma, or cataracts. (Routine eye examinations are covered under vision care benefits; see

“Vision Care,” later in this section.)

• Injectable legend drugs that are administered in the physician’s office to treat a covered condition.

• Preventive care.

• Voluntary second or third surgical opinions.



What other health care professionals are covered?

The plan covers certain health care services by a physician or other health care professional who is licensed

by the state where the services are performed and is acting within the scope of that license. If there are no

licensing requirements, appropriate certification is required. Covered health care professionals include

• An acupuncturist (L.A.C.) for covered acupuncture services. (See “Acupuncture.”)

• Chiropractors for chiropractic services. (See “Spinal and Extremity Manipulations.”)

• Christian Science practitioners who are listed in the current Christian Science Journal when they provide a

service. (See “Christian Science Practitioner and Sanatorium.”)

• Clinical psychologists and master’s-level therapists for mental health or substance abuse treatment of

covered conditions. (See “How the Mental Health and Substance Abuse Program Works.”)

• Dentists for dental work or surgery that is covered under the Traditional Medical Plan. (See “Dental Repair

Due to Accidental Injury” and “Oral Surgery.”)

• Neurodevelopmental, occupational, physical, and speech therapists. (See “Therapies.”)

• Optometrists providing covered vision care services. (See “Vision Care.”)

• Physician assistants (P.A.) for services that are covered when performed by a physician who is licensed as

an M.D. or D.O.

• Podiatrists for covered podiatric services.

• Registered nurses (R.N. and A.R.N.P.) for services that are covered when performed by a physician who

is licensed as an M.D. or D.O. The plan also covers intermittent R.N. visits when skilled care in place of

hospitalization is not available through another provider at a lesser cost.

The plan does not cover services received from a naturopath, unless he or she meets one of the licensing

requirements listed above and is acting within the scope of that license.





Pregnancy-Related Conditions and Coverage of Newborns

The plan covers services and supplies for pregnancy-related conditions, including

• Cesarean section.

• Complications of pregnancy.

• Legal abortion.

• Normal delivery.

• Spontaneous abortion (miscarriage).

The plan covers the services of an approved birthing center if they would be covered when received in a

hospital. (A birthing center is a facility for normal delivery that is licensed and regulated by the applicable

governmental agency in its location.)

The plan also covers the services of a midwife practicing within the scope of his or her license.

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for

any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48

hours following a normal delivery or less than 96 hours following a cesarean section. However, Federal law

generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother,

from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case,

plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or

the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-17

A newborn is eligible from the date of birth for the automatic coverage period described below if he or she

qualifies as your dependent and the mother’s hospital stay is for delivery and is covered by the plan. The

following services and supplies are covered for an enrolled newborn, subject to the plan’s annual

deductible, copayments, and benefit payment levels:

• Routine hospital services and supplies and physician services during the first 48 hours following a

normal delivery or 96 hours following a cesarean section.

• Medically necessary hospital and physician services and supplies.

Coverage of a newborn continues beyond the automatic coverage period as long as the child remains an

eligible dependent and is enrolled in the plan within changes in status time frames.

Prescription Drugs

Through the prescription drug program, the plan covers drugs and medicines that legally require a

physician’s or dentist’s prescription. The only exceptions to the prescription requirement are insulin and

certain related supplies that are provided for known diabetes.

For details, see “How the Prescription Drug Program Works,” later in this section.

Preventive Care

The plan covers the following preventive care services if you use a network provider and you live in the

network service area. (If you do not live in the network service area, you may use any licensed provider.)

• Hearing examinations when performed as part of a covered preventive care physical examination.

• Immunizations for covered adults and children as recommended by the U.S. Preventive Services Task

Force (USPSTF) guidelines and the schedule recommended by the physician.

• Physical examinations for employees and spouses, including related X-ray and laboratory charges.

• Physical examinations for dependent children.

• Screenings such as Papanicolaou (Pap) tests, mammograms, prostate screenings, and colorectal

screenings (including colonoscopies) as recommended by the patient’s physician.

Preventive care services are subject to the benefit maximums shown in the table, “How the Traditional

Medical Plan Pays Benefits,” earlier in this section.

Prostheses

The plan covers

• Artificial limbs, artificial eyes, and other prostheses that replace a missing body part.

• Repair and replacement of prostheses when required because of normal use or a change in condition

(such as the growth of a child).

Radiation and Chemotherapy

The plan covers radiation therapy (including X-ray therapy) and chemotherapy.

Reconstructive Breast Surgery

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the

Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related

benefits, coverage will be provided, in a manner determined in consultation with the attending physician

and the patient, for

• All stages of reconstruction of the breast on which the mastectomy was performed.

• Surgery and reconstruction of the other breast to produce a symmetrical appearance.

• Prostheses.

• Treatment of physical complications of the mastectomy, including lymphedemas.

These benefits will be provided subject to the same deductible, copayment, and coinsurance applicable to

other medical and surgical benefits provided under your plan. Additional information regarding benefit

coverage levels can be found in this booklet.

If you would like more information on WHCRA benefits, call the service representative at the telephone

number shown in Section 9.



2-18 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Second Surgical Opinion Election

The Company encourages you to get a second opinion before having nonemergency surgery. To facilitate

this, the plan covers a second or third surgical opinion, subject to the network and nonnetwork benefit

levels and copayment and/or annual deductible and coinsurance amounts.

Skilled Nursing Facility

Under this plan, a skilled nursing facility is an institution approved as such by Medicare.

All admissions to a skilled nursing facility require preadmission review. See “When You Need

Preadmission Review or Preapproval,” in this section.

The plan covers a semiprivate room in a skilled nursing facility and resulting services and supplies that are

provided in place of covered hospital inpatient care. The plan also covers skilled nursing facility care for a

terminally ill patient when the illness reaches a point of predictable end.

If you have a private room, you will be responsible for the difference between the cost of the private room

and the facility’s average charge for a semiprivate room. If the facility offers only private rooms, the plan

will cover up to the amount that similar facilities in the area charge for semiprivate rooms.

Spinal and Extremity Manipulations

The plan covers manipulations of the spine and extremities that are performed by hand by an approved

provider. Examples of approved providers include a doctor of medicine (M.D.), a doctor of osteopathy

(D.O.), and a chiropractic doctor (D.C.).

Manipulations of the spine and extremities are subject to a benefit maximum. See the table, “How the

Traditional Medical Plan Pays Benefits,” in this section.

The plan also covers related services such as an initial examination and initial X-rays.

Substance Abuse Treatment

The plan covers substance abuse treatment under the mental health and substance abuse program. See

“How the Mental Health and Substance Abuse Program Works,” in this section.

Temporomandibular Joint Dysfunction and Myofascial Pain Dysfunction Syndrome Treatment

The plan covers the following services and supplies from a physician or dentist to treat

temporomandibular joint dysfunction and myofascial pain dysfunction syndrome (TMJ/MPDS) or any

condition related to the temporomandibular joint, regardless of cause:

• Appliance management, including kinesitherapy, physical therapy, biofeedback therapy, joint

manipulation, prescription drugs, injections of muscle relaxants, and therapeutic drugs or agents.

• Appliances, including night guards, bite plates, orthopedic repositioning devices, and mandibular

orthopedic devices.

• Follow-up office visits.

• Initial diagnostic examinations and X-rays.

• Surgical procedures and related hospitalizations.

All TMJ/MPDS treatment must be approved in advance by the service representative in accordance with

written guidelines (including those for medical necessity) and is subject to a benefit maximum. See the

table, “How the Traditional Medical Plan Pays Benefits,” in this section.

Therapies (Neurodevelopmental, Occupational, Physical, and Speech Therapy)

The plan covers certain types of therapies for loss of function or lack of normal functional development as

a result of injury, illness, or congenital abnormality, but only if the therapy will restore function

significantly. The plan covers the following types of therapists for inpatient or outpatient treatment:

• Chiropractor, M.D., or D.O. for physical therapy.

• Occupational therapist for occupational therapy.









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-19

• Physical, occupational, or speech therapist for neurodevelopmental therapy (to treat lack of motor or

speech development that is not the result of injury, illness, or congenital abnormality, including in-home

therapy for homebound children) for children through age 6.

• Physical therapist for physical therapy.

• Speech therapist for speech therapy.

The type and duration of the therapy must be under an attending physician’s direction and supervision

while you remain under that attending physician’s care. Your attending physician must evaluate the therapy

treatment at least once every three months and certify that continuing therapy is necessary.

Massage therapy is not covered except when performed by one of the covered providers listed above as

part of an ongoing, medically necessary therapy program.

After three months, continued therapy must be approved by the service representative. The service

representative bases its decision on the attending physician’s evaluation of the treatment and the therapist’s

progress reports. The service representative reviews that information against established medical criteria to

determine whether the recommended care will continue to improve function and will be covered.

Neurodevelopmental therapy is subject to the benefit maximum shown in the table, “How the Traditional

Medical Plan Pays Benefits,” earlier in this section.



What types of therapists qualify for coverage?

Occupational, physical, and speech therapists must be duly licensed in the areas where services are performed

and must be practicing within the scope of that license.

In the absence of licensing requirements, the therapist must be certified as a registered

• Occupational therapist by the American Occupational Therapy Association.

• Physical therapist by the American Physical Therapy Association.

• Speech therapist by the American Speech and Hearing Association.





Tobacco Cessation Treatment

The plan covers tobacco cessation services and supplies (including prescription drugs) that are provided by

• A physician.

• Another health care professional who is practicing within the scope of his or her license.

• An approved tobacco cessation provider.

However, the plan will cover the cost only if the patient completes the full course of treatment. Tobacco

cessation treatment is subject to the benefit maximum shown in the table, “How the Traditional Medical

Plan Pays Benefits.”

Transplants

The plan covers services and supplies for medically necessary transplants that meet the service

representative’s guidelines, including certain transplants that are part of an approved clinical trial. You

must request prior approval for a transplant. See “When You Need Preadmission Review or Preapproval,”

in this section.

The plan limits coverage to

• Selection of the organ.

• Removal of the organ.

• Storage of the organ.

• Transportation of the surgical harvesting team and organ.

• Other medically necessary organ procurement costs.

If you or your covered dependent is eligible for a human organ or tissue transplant, the plan also may

cover certain donor organ procurement costs.







2-20 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Vasectomy or Tubal Ligation

The plan covers services and supplies required for a vasectomy or tubal ligation but not for a reversal.

Vision Care

The plan covers the following vision care services and hardware:

• A complete examination of visual function performed by a licensed ophthalmologist or optometrist.

• Contact lenses when chosen instead of conventional lenses and frames.

• Frames required for prescription lenses.

• Prescription lenses.

Vision Service Plan (VSP) administers the vision care program and is the service representative. When

you receive services from a network provider, the provider will verify eligibility and will bill the service

representative directly. When you receive services from a nonnetwork provider, claims for these vision

care services or hardware must be submitted to the VSP service representative for reimbursement.

Vision care benefits and hardware are subject to the benefit maximums shown in the table, “How the

Traditional Medical Plan Pays Benefits,” earlier in this section.

Expenses for vision care services not listed above might be covered as part of the other medical benefits

described in this booklet that are administered by BlueCross BlueShield of Illinois (BCBSIL).**

Wigs

The plan covers wigs (or hair prostheses) if hair loss is a result of chemotherapy or radiation therapy.



How the Mental Health and Substance Abuse Program

Works**

This program covers mental health and substance abuse treatment, including treatment for eating disorders

and the abuse of or addiction to alcohol, recreational drugs, or prescription drugs. ValueOptions, the service

representative, administers the program, maintains the provider network, and operates the Boeing

Helpline.

This confidential program offers you and your covered dependents the opportunity to talk with trained

professionals who will help you find appropriate care or treatment for a mental illness or alcohol or drug

dependency. Call the Boeing Helpline directly at 1-800-892-1411 (TTY/TDD: 1-800-855-2880) or contact

the Employee Assistance Program (EAP).

Mental health and substance abuse benefits are subject to the deductible, coinsurance, and copayment

shown in the table, “How the Traditional Medical Plan Pays Benefits,” earlier in this section.*

Obtain a Referral Before You Receive Certain Services**

This program uses a network of approved mental health and substance abuse treatment providers that is

separate from the medical plan network of physicians and hospitals.

You or your provider must request preapproval through the Boeing Helpline for inpatient mental health or

substance abuse treatment or outpatient electroconvulsive therapy. Other outpatient network and

nonnetwork mental health or substance abuse treatment does not require preauthorization. Your benefits

generally are greater when you see a network mental health or substance abuse treatment provider that has

been recommended to you by the Boeing Helpline or EAP.

You can obtain names and contact numbers for network mental health or substance abuse treatment

providers by calling the Boeing Helpline or EAP. All treatment, whether received from a network or

nonnetwork provider, will be reviewed for medical necessity by the service representative.









*Updated: January 2010

**Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-21

Boeing Helpline

The Boeing Helpline—available 24 hours a day, seven days a week—is staffed by independent

psychologists, psychiatrists, social workers, nurses, and other clinicians who specialize in managing

mental health and substance abuse treatment.

These clinical case managers are responsible for reviewing and authorizing all levels of care to ensure that

it is appropriate, effective, and of high quality. Periodically, your treatment provider will submit clinical

updates to these case managers to update authorization for claim payment.

When you call the Boeing Helpline, a clinician is available to assess your situation and treatment needs and

refer you to the most suitable provider. If you already have chosen a provider, the Boeing Helpline will

confirm whether that provider is in the network. If you are not satisfied with the care you are receiving, call

the Boeing Helpline for another referral.

Employee Assistance Program*

You also may access the mental health and substance abuse program by contacting the EAP. An EAP

counselor assesses your treatment needs (in person or by telephone) and, if outpatient therapy is indicated,

refers you to the most suitable network provider.

Emergency Mental Health or Substance Abuse Treatment*

If you are hospitalized in an emergency (see definition in Section 8) for mental health or substance abuse

treatment and you are unable to call the Boeing Helpline before admission, then you, your physician, a

family member, or a friend must call the Boeing Helpline within 24 hours of the admission. Boeing

Helpline staff will determine whether the plan will cover your hospital stay and will coordinate coverage

with the service representative.

If you are admitted to a nonnetwork hospital, you may be asked to transfer to a network hospital once your

condition stabilizes. Plan payment levels will be lower if you choose to remain in a nonnetwork hospital.

What the Program Covers for Mental Health Treatment

This program covers mental health treatment when it is medically necessary and is received from any

provider contracted with the Boeing Helpline or from an eligible provider, including any licensed

• Clinical psychologist.

• Hospital or treatment facility licensed as a mental health treatment facility by the appropriate state

licensing agency.

• Psychiatric physician (M.D.).

• Psychiatric nurse (R.N.) or psychiatric professional at the master’s level or above.

Generally, if the mental health treatment is related to, accompanies, or results from substance abuse, the

program will cover only substance abuse treatment, as described next.



What the Program Covers for Substance Abuse Treatment

The program covers the following substance abuse treatments and services:

• Medically necessary treatment for alcoholism.

• Other types of medically necessary substance abuse treatment at an approved treatment facility

or hospital.

• Medically necessary services of a physician and licensed therapist.

• Prescription drugs in connection with your physician’s specific treatment plan.

An approved substance abuse treatment facility is one that treats chronic alcoholism and/or drug abuse and

that is licensed and regulated by the appropriate governmental agency in its location.

The plan covers detoxification only when it is followed immediately by rehabilitation. To receive

coverage for substance abuse treatment, the patient must complete the prescribed course of medically

necessary treatment.





*Updated: January 2011

2-22 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

How the Prescription Drug Program Works

The prescription drug program covers medically necessary prescription drugs and medicines that are

required by Federal or state law to be prescribed in writing by a physician or dentist and dispensed by a

licensed pharmacist.

You can help control prescription drug costs by choosing generic drugs. To encourage generic drug use, the

plan requires that you pay a higher coinsurance or copayment when you choose a brand-name drug over a

generic version. These costs are explained in more detail below.

You can buy prescription drugs and medicines in two ways:

• Through a retail pharmacy for short-term or immediate prescriptions.

• Through a network mail-order pharmacy for maintenance or long-term prescriptions.

You can obtain the prescription drug formulary by contacting the service representative directly or through

Boeing TotalAccess.

The service representative for the prescription drug program is Medco Health Solutions, Inc.



What is a formulary?

A formulary is a list of medications that are

• Approved by the FDA.

• Determined effective in treatment and cost.

• Manufactured by major drug companies.

An independent group of practicing physicians and pharmacists developed the formulary and reviews it

routinely. When clinical data show that several drugs are equally effective, the most cost-effective drug usually

is chosen.

A nonformulary drug also may be effective for treatment, but it is not as cost-effective as formulary or generic

prescription drugs.

Be sure to tell your physician that your medical plan uses a formulary





What You Pay for Prescription Drugs

The prescription drug program has three benefit levels:

• Generic prescription drugs.

• Brand-name prescription drugs that are on the formulary (formulary drugs).

• Brand-name prescription drugs that are not on the formulary (nonformulary drugs).

Unless your physician indicated otherwise on the prescription, the pharmacist will dispense a generic

equivalent of the prescribed drug when available and permissible under the law. You also may receive a

different brand that is medically equivalent.

To encourage the use of generic drugs, if a brand-name drug is purchased when a chemically equivalent

generic is available—whether you or your physician requests the brand-name drug—you will pay the

generic coinsurance/copayment plus the cost difference between the brand-name drug and generic drug.

Each payment level is shown in the table, “How the Traditional Medical Plan Pays Benefits,” in

this section.



Filling a Prescription at a Participating Retail Pharmacy

You can find a list of participating pharmacies near you by

• Calling the service representative.

• Accessing the service representative’s web site.

• Asking your local pharmacist whether the pharmacy participates in this plan’s pharmacy network.









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-23

When you go to a participating pharmacy, present your prescription drug* ID card with your prescription.

You will be required to pay only your part of the prescription cost at the time of purchase. The pharmacy

will automatically file the claim for you.

To encourage the use of generic drugs, if a brand-name drug is purchased when a chemically equivalent

generic is available—whether you or your physician requests the brand-name drug—you will pay the

generic coinsurance plus the cost difference between the brand-name drug and generic drug.



Filling a Prescription at a Nonparticipating Retail Pharmacy

You also may fill your prescriptions at nonparticipating pharmacies. You are required to pay for the

prescription in full at the time of purchase and file a claim with Medco Health Solutions for reimbursement.

Your reimbursement amount will be based on the covered charges for a retail participating pharmacy.

To encourage the use of generic drugs, if a brand-name drug is purchased when a chemically equivalent

generic is available—whether you or your physician requests the brand-name drug—you will pay the

generic coinsurance plus the cost difference between the brand-name drug and generic drug.



What is the difference between generic and brand-name drugs?

Generic and brand-name drugs are chemically and therapeutically equivalent, which means they produce the

same effect on the body. Both types of drugs are approved by the FDA and must meet the same safety and

reliability standards.

The name of a generic drug is its chemical name. Brand-name drugs are known by their trade names.





Filling a Prescription by Mail Order

If you take maintenance prescription drugs for the treatment of a long-term or recurring condition (such as

arthritis, asthma, contraception, diabetes, high blood pressure), you can obtain up to a 90-day supply per

prescription through the mail for addresses within the United States and its territories.

You pay only one copayment for each drug that you order, yet the supply you receive can be nearly three

times larger than what you can purchase at a retail pharmacy.

To encourage the use of generic drugs, if a brand-name drug is purchased when a chemically equivalent

generic is available—whether you or your physician requests the brand-name drug—you will pay the

generic copayment plus the cost difference between the brand-name drug and generic drug.

The service representative provides two convenient ways for you to submit orders for new or renewal

prescriptions:

• By U.S. mail: Complete the mail-order pharmacy form and submit it with your prescription.

• By fax: Ask your physician to complete the fax request form and submit it directly to the service

representative. The service representative must receive the forms and prescriptions from a secure fax

machine that is associated with the physician’s office and will verify them.

After you enroll in the Traditional Medical Plan, the prescription drug program service representative will

send you an information kit, which will contain a mail-order request form. To request additional forms,

contact the service representative or print them directly from the service representative’s web site.

You can order refills by telephone, on line, and by mail. To order refills by mail, use the special mail-order

envelope that the service representative sent to you with your first order. If you order on line or by

telephone, you must provide your member number and the prescription number, which is found on the

medication container and refill slip. You generally will receive new prescriptions within 7 to 11 days.

For contact information, see Section 9.









*Updated: January 2010

2-24 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Filling a Prescription at a Specialty Care Pharmacy

Specialty medications are typically injectable medications administered by the individual or a health care

professional, and they often require special handling. Newly prescribed medications may be purchased at

any participating retail pharmacy up to two times. After that, the plan will cover these prescriptions only if

they are purchased through the service representative’s specialty care pharmacy.

The specialty care pharmacy program will not apply to medications ordered and billed through a

physician’s office.



Covered Prescriptions

To be covered under the prescription drug program, the prescription drug or device must

• Be approved by the U.S. Food and Drug Administration (FDA).

• Be dispensed by a licensed pharmacist.

• Be prescribed on an outpatient basis by a doctor.

• Not be sold over the counter.

• Not be specifically excluded by the plan.

When an existing drug changes or when the FDA approves new drugs, these drugs also must meet the

above criteria before the drug is covered under the prescription drug program. Furthermore, the Plan

has the right to determine which drugs will be covered, limited, or excluded under the prescription

drug program.

This program covers most kinds of prescription drugs as long as they meet the above criteria, including the

following drugs and supplies:

• Insulin as well as test strips, lancets, and alcohol swabs.

• Needles and syringes when prescribed with insulin or other covered injectables.

• Legend drugs, including allergy serum, contraceptive medications, self-administered injectable drugs,

and tobacco cessation medications.

Refills can be obtained near the end of your supply, as authorized by your prescription.



What is a legend drug?

A legend drug is any drug that, according to Federal law, must be labeled “Caution: Federal law prohibits

dispensing without a prescription.”





For information about drugs that are not covered under the prescription drug program, see “What the

Traditional Medical Plan Does Not Cover,” later in this section.









Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-25

Do any prescriptions require preapproval?

Yes. Certain dosages, quantities, and medications require preapproval by the service representative. Specific

drugs are reviewed by the service representative at the point of sale to determine if your prescription is covered

by the plan, clinically appropriate, and consistent with usage guidelines.

The service representative will apply standards based on FDA-approved labeling and clinical guidelines. The

service representative will seek to ensure that you receive the most appropriate prescription for your condition

by reviewing

• Possible interactions with other current prescriptions.

• Cost-effectiveness.

• Whether the prescription is age appropriate.

• Whether the dosage and quantity are appropriate.

In certain situations, it may be more clinically appropriate to take a stronger dose once a day than to take a

lower dose twice a day. If this opportunity exists, the service representative may ask your physician to approve

the changes to the dosage and strength before authorizing payment with your pharmacist.

Should a drug require preapproval, your physician will be required to furnish the service representative with

clinical information. You, the pharmacy, or the physician may initiate the request for this review by calling the

service representative.



Generic Incentive Program

To encourage the use of generic drugs, if a brand-name drug is purchased when a chemically equivalent

generic is available (for both retail pharmacy and mail order)—whether you or your physician requests the

brand-name drug—you will pay the generic coinsurance/copayment plus the cost difference between the

brand-name drug and generic drug.

If for any reason your physician believes that you must use a brand-name drug, he or she can ask for

coverage review by calling the service representative. The service representative will request information

from your physician and review it to determine if your need for the brand-name drug meets the conditions

to qualify for coverage. If coverage is approved, you will be charged the brand coinsurance/copayment for

the brand-name drug. If coverage is not approved, coverage will be provided according to the generic

incentive program.



What the Traditional Medical Plan Does Not Cover

The plan does not pay charges for any services or supplies the service representative determines are not

medically necessary to treat an accidental injury, illness, or other covered condition, including, but not

limited to, the following items.

Cosmetic Surgery

The plan does not cover any type of cosmetic surgery, except as described in “What the Traditional Medical

Plan Covers,” earlier in this section.

Dental Services

The plan does not cover the following dental services:

• Any dental services, except as specifically provided for prompt repair of accidental injury and certain

oral surgery services.

• General anesthesia and hospital charges, except for special needs child(ren) when certain criteria are met.*

• Banding treatment.

• Correction of the gums, teeth, or tissues of the mouth for dental purposes.

• Night guards or other oral appliances for treatment of bruxism.

• Nonsurgical orthodontia treatment, except as described for TMJ/MPDS.

• Removing, repairing, replacing, restoring, or repositioning teeth lost or damaged in the course of biting

or chewing.

• Repair or replacement of dentures as a result of accidental injury.

• Restorative techniques to build occlusion unless the tooth is diseased or accidentally damaged.

*Updated: January 2010

2-26 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Diagnostic X-Ray and Laboratory Services

The plan does not cover a full-body computerized axial tomography (CAT) scan or other

full-body imaging.

Durable Medical Equipment

The plan does not cover medical equipment or supplies not solely related to medical care of a diagnosed

illness or injury.

Hearing Aids and Related Supplies and Services

The plan does not cover the following hardware or supplies when they are related to hearing aid care:

• Eyeglass-type hearing aids to the extent the charge exceeds the covered amount for hearing aids.

• Hearing aids ordered before you become eligible for coverage or after coverage terminates.

• Hearing aids ordered before termination of coverage but delivered more than 60 days after coverage ends.

• Hearing aids that do not meet professionally accepted standards, including any experimental services

or supplies.

• Hearing or audiometric examinations, unless disease is present; however, hearing examinations are

covered if performed as part of a covered preventive care physical examination.

• Replacement batteries.

• Replacement of lost, broken, or stolen hearing aids, unless the three-year period has been exhausted.

• Replacement parts for hearing aid repair, unless part of an overhaul after three years.

Home Health Care and Hospice Care

The plan does not cover home health care or hospice care services or providers that are not included in the

written home health or hospice agency treatment plan and are not medically necessary.

Infertility

The plan does not cover services, supplies, tests, or procedures related to infertility treatment that results in

artificial means of conception.

Maintenance Therapy

The plan does not cover ongoing therapy (maintenance therapy) for a given condition after the patient has

reached maximum rehabilitation potential, or functional level, or has shown no significant improvement for

two weeks, and the initial instruction in a maintenance program is completed.

Prescription Drugs

The prescription drug program does not cover the following prescription drugs or related services:

• Administration or injection charges for any drug.

• Any prescription drug for which the person is covered or eligible to receive benefits under another

employer’s group benefit plan or a workers’ compensation law or from any municipality, state, or Federal

program, including a Medicare prescription drug plan, except as required by law.

• Any prescription filled in excess of the quantity prescribed.

• Any refill after one year from the date of the prescription.

• Appliances or devices, such as blood glucose monitors, or other nondrug items, including but not limited

to therapeutic devices or artificial appliances. However, this does not apply to needles and syringes when

they are prescribed along with insulin or other covered injectables or to other diabetic supplies.

• Delivery or handling charges.

• Drugs that are dispensed during an inpatient admission by a hospital, skilled nursing facility, sanatorium,

or other facility, unless covered as part of a hospital stay or administered by a physician as part of an

office visit.

• Drugs that are not medically necessary for the treatment of an illness, injury, or other covered condition,

including vitamins, except as specifically provided by the plan.

• Experimental or investigational drugs.





Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-27

• Fertility agents, unless approved by the service representative.

• Immunizing agents or allergy serums.

• Infusion therapy drugs, except as described in the home health care benefit.

• Medications (including those that are medically necessary) to treat sexual dysfunction, obesity, or

infertility, unless the patient is being treated for a diagnosed medical condition and the medication is

authorized in advance by the service representative.

• Obesity drugs (including those that are medically necessary), unless approved by the service

representative.

• Over-the-counter drugs that can be obtained without a prescription, except for insulin.

• Replacement of lost or misplaced prescriptions.

Skilled Nursing Facility

The plan does not cover skilled nursing facility services when they are not usually provided by such

facilities or are not expected to lessen the disability and enable the person to live outside the facility.

However, skilled nursing facility services are covered for the terminal patient when the illness has reached

a point of predictable end.

Therapies

The plan does not cover the following services relating to neurodevelopmental, occupational, physical, and

speech therapies: custodial maintenance; educational therapy; recreational therapy; self-help programs;

therapy elected by you; therapy given at a therapist’s discretion; and therapy to slow body degeneration but

not to improve or restore functionality.

Tobacco Cessation Treatment

The plan does not cover the following services or supplies for tobacco cessation:

• Acupuncture.

• Books or tapes.

• Hypnotherapy (unless performed by an approved provider).

• Inpatient services.

• Over-the-counter drugs.

• Vitamins, minerals, or other supplements.

Transplants

The plan does not cover the following transplant services or supplies:

• Any portion of the cost of a covered treatment that is funded by government or private entities as part of

an approved clinical trial.

• Donor or procurement services or costs incurred outside the United States, unless specifically approved

by the service representative.

• Donor services or supplies when donor benefits are available through other group coverage.

• Expenses for that portion of treatment funded by government or private entities as part of an approved

clinical trial.

• Expenses when the recipient is not covered under the medical plan.

• Experimental or investigational services or supplies unless they are part of an approved clinical trial.

• Living (noncadaver) donor transplants that are not specifically authorized and covered by the

medical plan.

• Lodging, food, or transportation costs, unless otherwise specifically provided under the medical plan.

• Nonhuman, artificial, or mechanical transplants, unless specifically approved by the service

representative.









2-28 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Vision Care

The vision care program does not cover the following vision services or hardware:

• Charges for sunglasses or light-sensitive glasses in excess of the amounts covered for nontinted glasses.

• Corrective experimental vision treatment. This means a procedure or lens that is not used universally or

accepted by the vision care profession, as determined by the service representative.

• Costs in excess of the maximum covered charges.

• Lens options (such as coatings or hardening, tints, photochromic, polycarbonate, or scratch-resistant or

shatter-resistant lenses).

• Lenses or frames that are furnished or ordered before coverage begins.

• Medical or surgical treatment of the eyes. (However, VSP network providers do offer discounts for

refractive surgery, and the medical plan covers treatment of diseases of the eye.)

• Nonprescription (over-the-counter) glasses.

• Orthoptics or vision training or any associated supplemental testing. (However, the medical plan may

cover this for children under age 12.)

• Plano lenses (less than a ±0.38 diopter power), two pair of glasses instead of bifocals, or extra charges

for progressive lenses in excess of the bifocal allowance.

• Services or supplies that are not listed as covered.

• Services or supplies received from network providers more than 60 days after the service representative

authorizes the patient’s vision care benefits.

• Services or supplies received while the patient is not covered by the plan.

• Solutions or cleaning products for spectacle glasses or contact lenses.

• Special supplies such as nonprescription sunglasses or subnormal vision aids.

Other Medical Exclusions

In addition to the services and supplies previously listed, the plan also does not pay charges for or related to

the following:

• Accident or illness covered by a workers’ compensation law.

• Amounts exceeding allowed charges or usual and customary charges. An allowed charge is the amount

that would have been paid for like services or supplies to a network provider.

• Benefits payable under any automobile medical, personal injury protection (PIP), automobile no-fault,

automobile uninsured or underinsured motorist, homeowner’s, or commercial premises medical

coverage, when that contract or insurance is issued to or provides benefits available to the patient. Any

benefits paid by the plan before benefits are paid under one of these other types of contracts or insurance

are to assist the patient, and do not indicate the service representative is acting as a volunteer or waiving

any right to reimbursement or subrogation.

• Completion of claim forms or reports.

• Confinement or surgical, medical, or other treatment, services, or supplies received in or from a U.S.

Government hospital, except as required by law.

• Counseling—career, child, family, financial, marriage, pastoral, or social adjustment—except as

preauthorized through the Boeing Helpline.

• Custodial care as follows:

– Care that does not require the continuing services of skilled medical or health professionals and

primarily is provided to assist in activities of daily living.

– Institutional care primarily to support self-care and provide room and board.

Custodial care includes, but is not limited to, help in walking, getting into and out of bed, bathing,

dressing, feeding, preparing special diets, and supervising medications that ordinarily are self-

administered.

• Dyslexia, visual analysis therapy, or training related to muscular imbalance of the eye or for orthoptics.

However, the medical plan may provide coverage for up to six months when necessary to correct muscle

imbalance (strabismus, esotropia, or exotropia) if treatment begins before the person’s 12th birthday.







Health Care Plans | 2009 Edition | A86320W Traditional Medical Plan 2-29

• Education, special education, or job training—whether or not by a facility that also provides medical or

psychiatric care.

• Experimental or investigational services or supplies or related complications.

• Inpatient hospital care (including physician visits while hospitalized) not considered medically

necessary (when the care can be provided safely in an outpatient setting—such as a hospital outpatient

department, physician’s office, or a freestanding surgical facility—without adversely affecting your

physical condition).

• Inpatient psychiatric care to control or change the patient’s environment.

• Intentionally self-inflicted injury, unless you are under treatment for a diagnosed mental illness.

• Missed appointments.

• Nonorganic impotence such as psychosexual dysfunction.

• Obesity services and supplies unless approved in advance as medically necessary by the service

representative in accordance with written guidelines. (A copy of the guidelines may be requested by

calling the service representative.)

• Over-the-counter items including but not limited to medications, orthopedic appliances, and braces

(unless otherwise covered under the durable medical equipment benefit).

• Recovery houses, school programs, or emergency service patrols.

• Refractive surgery including radial keratotomy, Lasik, or other eye surgery to correct refractive errors,

except when preoperative visual acuity is 20/50 or less with a lens.

• Routine physical examinations, immunizations, or other preventive services or supplies, except as

specifically covered by the plan as described in “What the Traditional Medical Plan Covers.”

• Services or supplies for which no charge is made or charges you or your dependent is not required

to pay.

• Services or supplies not recommended and approved by a physician or other covered health care

professional or those provided before the person becomes covered under the plan.

• Services or supplies required by law to be provided by any school system.

• Services or supplies to the extent they are covered under any discontinued Company-sponsored plan.

• Services or supplies covered under any Federal, state, or other government plan, except where required

by law.

• Services received from a naturopath or massage therapist, unless he or she meets one of the licensing

requirements listed above and is acting within the scope of that license.

• Sex transformation treatment or services.





How to Submit a Medical Claim

Whenever you receive medical care or pharmacy service, present your Traditional Medical Plan or

prescription drug* identification card to identify yourself as covered by the plan.

Network providers will submit an itemized bill directly to the service representative. You are responsible

for meeting your copayments and/or annual deductible, if any, before the plan pays a benefit on your

behalf. Many nonnetwork providers may submit claims for you. Under these circumstances, no claim

form is required. If direct billing is not available to you, submit the appropriate claim form along with an

itemized bill to the service representative.

Nonnetwork and nonparticipating providers may require full payment for their services at the time you

receive the care; in this instance, the service representative will reimburse you according to plan payment

levels.

You will receive a detailed explanation of benefits from the service representative each time it processes a

claim. The explanation of benefits will show how much the plan paid toward your medical services and will

advise you if your claim is approved or denied or if additional information is needed to process the claim.

If your claim is denied, in whole or in part, you have the right to appeal the decision.

For more information about submitting claims or appeals, see Section 5.

*Updated: January 2010

2-30 Traditional Medical Plan Health Care Plans | 2009 Edition | A86320W

Preferred Dental Plan Section 3

How the Preferred Dental Plan Works

The Preferred Dental Plan helps you pay for minor and major dental work. Through the service

representative listed below, the plan covers dental services and supplies such as

• Routine examinations and cleanings.

• Restorations, including fillings and crowns.

• Orthodontia work.

You share in the cost of these services by paying a coinsurance percentage and an annual deductible, as

described in this section.

The Preferred Dental Plan gives you the flexibility to see any licensed dentist or other licensed

professional who is approved by the plan. However, your out-of-pocket costs generally will be lower if you

use a network dentist. If you live outside of the network service area, the plan generally will cover dental

care at the network benefit level.



Who Administers the Benefits

The Company has contracted a service representative to handle the day-to-day administration of the plan.

The service representative answers benefit questions, makes benefit decisions, pays claims, processes claim

appeals, and accounts for premiums, service fees, and claim costs. The current service representative is

Washington Dental Service (a Delta Dental organization).

The Company reserves the right to change the service representative at any time. If this happens, you will

be notified in writing.



What is a service representative?

A service representative is an agent, group, or organization with which the Company has contracted to handle

the day-to-day administration of the plan.





Save Money by Using a Network Provider

The service representative contracts with certain providers who agree to provide services and treatments

under this plan at discounted fees. Contracted dental providers are referred to as member providers. There

are two types of member providers:

• Network providers are members of Delta Dental and participate in the Delta Dental preferred

provider network in your state. Your out-of-pocket costs generally will be lowest when you use a

network provider.

• Nonnetwork member providers are members of Delta Dental, but do not participate in the preferred

provider network.

Member providers are required to demonstrate that they meet certain quality standards and hold certain

credentials to become part of the service representative’s network. They also provide direct claim billing to

the plan so that you usually do not need to submit a claim form when you use a member provider.

Each time you need dental care, you can choose whether to use a member provider or a provider who does

not contract with the service representative (referred to as a nonmember provider). Your out-of-pocket costs

generally are higher when you use a nonmember provider.



What if I live in an area that has no network providers?

The plan will pay the network level of benefits if there are no network providers in your area.









Health Care Plans | 2009 Edition | A86320W Preferred Dental Plan 3-1

How the Preferred Dental Plan Pays Benefits

For most services and supplies covered by this plan, you and the plan each pay a portion of your dental care

costs, as described in this section.



Annual Deductible

Generally, the annual deductible is the amount you must pay out of your own pocket each benefit year

before the plan begins to pay benefits. The Preferred Dental Plan has separate deductibles for network and

nonnetwork services. Nonnetwork deductible expenses apply toward the network deductible.

The annual deductible applies to most covered services except

• Class I services and supplies received from network providers.

• Class IV services and supplies received from network or nonnetwork providers.



Coinsurance Percentages

For many services and supplies, you and the plan each pay a percentage of the recognized fee.

These percentages are called coinsurance percentages.

The amount of your coinsurance percentage varies by type of service. These classes determine how much

the plan will cover for a particular service.

• Class I: diagnostic and preventive services.

• Class II: minor restorative services using filling materials, oral surgery, periodontics, and endodontics.

• Class III: major restorative services using crowns, inlays, and onlays; prosthodontics.

• Class IV: orthodontia services.

A coinsurance percentage does not apply to

• Class I services and supplies received from network providers.

• Any amounts you pay for services and supplies that the plan does not cover.

• Any amounts that exceed the maximum allowable fees recognized by the plan.



How the Preferred Dental Plan Pays Benefits

Network Provider Nonnetwork Provider*



Annual deductible (applies to all covered • $50 per individual • $75 per individual

services and supplies, except as noted) • $150 per family of three or more, • $225 per family of three or more,

but not more than $50 for any but not more than $75 for any

individual individual

• Network and nonnetwork • Network and nonnetwork

combined combined

The plan pays benefits for these covered services and supplies as follows after you meet the annual deductible, if

applicable.









3-2 Preferred Dental Plan Health Care Plans | 2009 Edition | A86320W

How the Preferred Dental Plan Pays Benefits (continued)

Covered Services and Supplies Payment Levels

Network Provider Nonnetwork Provider*



Class I (diagnostic and preventive services) 100% (annual deductible does 80%

not apply)

Class II (minor restorations) 80% 50%

Class III (major restorations) 60% 50%

Class IV (orthodontia) 50% (network and nonnetwork combined; annual deductible does not apply)

Annual maximum benefit $2,000 per individual (network and nonnetwork combined)

(for Classes I, II, and III)**

Lifetime maximum benefit $2,000 per individual (network and nonnetwork combined)

(for Class IV)†

* If your provider is not a Delta Dental member, you pay any amounts that exceed the maximum allowable fees recognized by the plan.

** When multiple treatment dates are required, the charges apply toward the annual maximum benefit for the benefit year in which the procedure is

completed. (A prosthesis is considered complete on the date it is seated or delivered.)

†

This lifetime maximum benefit for orthodontia applies to all periods during which the person is covered under any Company-sponsored dental plan.



Note: The plan reimburses 100% of a network provider’s recognized fees for prompt repair of damage to sound natural teeth as a direct result of

accidental bodily injury.







What will happen if I reach my annual maximum?

You are responsible for paying any charges over the annual maximum benefit.





What are recognized fees?

This plan pays benefits based on the recognized fees. A recognized fee is the provider’s charge for a covered

service, up to the plan’s maximum allowance. The amount of the recognized fee depends on whether you see a

network or nonnetwork provider.

Under this plan, recognized fees are determined as follows:

• For a network dentist, recognized fees are network-allowed charges.

• For a member dentist who is a nonnetwork dentist, recognized fees are the fees that the dentist filed with the

service representative for specific dental services and supplies. The service representative approves these

fees and agrees to pay the plan’s nonnetwork benefit based on them.

• For a nonmember dentist, recognized fees are the lesser of either

– The amount charged by the dentist.

– The maximum allowable fee that the service representative approved for member dentists in the state

where services are performed.

When alternative procedures are available, the plan covers the least expensive procedure. However, if your

dentist submits satisfactory evidence to the service representative that a more expensive procedure is the

only one professionally adequate for you, the plan will cover the more expensive procedure according to the

appropriate benefit payment level.









Health Care Plans | 2009 Edition | A86320W Preferred Dental Plan 3-3

What the Preferred Dental Plan Covers

The Preferred Dental Plan covers the following services and supplies in accordance with the benefit

payment levels and maximums shown in the previous table, “How the Preferred Dental Plan Pays Benefits.”

Class I Covered Services and Supplies

The plan covers the following Class I services and supplies:

• Diagnostic examinations, including

– Biopsy/tissue examinations (also called histopathic examinations).

– Complete mouth or panographic X-rays, once in each five-year period.

– Emergency examinations.

– Examinations by a specialist (if the specialty is recognized by the American Dental Association and if

you are not receiving treatment from the specialist), up to three times in a six-month period.

– Routine examinations, twice in each one-year period.

– Comprehensive oral examinations, once in each three-year period, which count as one of the two

routine examinations in a year.

– Supplementary bitewing X-rays, once in each one-year period.

• Preventive care, including

– Fissure sealants through age 14 for permanent molars with intact occlusal surfaces, no decay, and no

prior restorations. The plan covers repair or replacement within a three-year period as part of the

original service.

– Prophylaxis (cleaning), either regular or periodontal maintenance, twice in each one-year period; two

additional cleanings are allowed if periodontal disease is present.

– Space maintainers when used to maintain space for eruption of permanent teeth.

– Topical application of fluoride or preventive therapies (such as flouridated varnishes), twice in each

one-year period for dependent children through age 18.



What are fissure sealants?

Fissure sealants are acrylic, plastic, or composite materials that are applied topically to prevent decay by

sealing developmental grooves and pits in the child’s teeth.





Class II Covered Services and Supplies

The plan covers the following Class II services and supplies:

• Endodontics for the following procedures once in each two-year period on the same tooth:

– Pulpal and root canal treatment.

– Pulpotomy and apicoectomy.

For more information on root canals performed in connection with an overdenture, see “Class III

Covered Services and Supplies.”

• General anesthesia or intravenous sedation, but not both, when administered by a licensed dentist in

connection with certain covered endodontic, oral, or periodontic surgery.

• Oral surgery, including

– Preparation of the alveolar ridge and soft tissues of the mouth to insert dentures.

– Surgical and nonsurgical extractions.

– Treatment of pathological conditions and traumatic facial injuries.

• Periodontics—surgical and nonsurgical procedures to treat tissues that support the teeth, including

– Gingivectomy.

– Limited adjustments to occlusion (eight or fewer teeth), such as smoothing teeth or reducing cusps.

– Osseous surgery, once in each three-year period per area.

– Periodontal scaling or root planing, once in each two-year period.

– Site-specific therapies for patients with pockets of at least 5 mm but not more than 10 mm.



3-4 Preferred Dental Plan Health Care Plans | 2009 Edition | A86320W

• Restorative services

– Amalgam, composite, or filled resin restorations (fillings).

– Stainless steel crowns.

– Composite or filled resin restorations placed in the front surface of bicuspids.

Restorations on the same surface or surfaces of a tooth are covered once in a two-year period. Stainless

steel crowns are covered once in a five-year period (once in a two-year period for primary teeth).

If a composite or plastic restoration is placed on a posterior tooth, the plan covers up to the amount

allowed for an amalgam restoration. If a tooth can be adequately restored with a filling material but a

crown, inlay, or onlay is elected instead, the plan covers the restoration as if a filling material had

been used.

The plan does not cover restorations necessary to correct vertical dimension or to alter morphology

(shape) or occlusion, overhang removal, or recontouring or polishing a restoration.



Class III Covered Services and Supplies

The plan covers the following Class III services and supplies:

• Prosthodontics, including

– A cast chrome or acrylic partial denture. If a more elaborate or precision device is used, the plan

covers up to the appropriate amount for covered partial dentures.

– A fixed bridge.

– A full denture, immediate denture, or overdenture. For any other procedure (such as personalized

restorations or specialized treatment), the plan covers up to the appropriate amount for a full denture,

immediate denture, or overdenture. Root canal treatment in conjunction with overdentures is limited to

two teeth per arch.

– Crown buildups when approved by the service representative, once in each two-year period.

– Denture adjustments and relines provided more than six months after initial placement. Later relines

and jump rebases (but not both) are covered once in each one-year period.

– Replacement of an existing prosthetic device once in each five-year period if it is unserviceable and

cannot be made serviceable. (Services to correct the device, if serviceable, are covered.)

– Stayplate dentures for replacing anterior teeth during the healing period, or in children age 16 or

younger for missing anterior permanent teeth.

• Restoration of a visibly decayed hard tooth surface (carious lesion) to a state of proper function by using

crowns (including stainless steel crowns), inlays, or onlays (gold, porcelain, plastic, gold substitute

casting, or a combination of these materials) once in each five-year period. Your dentist must verify that

the tooth cannot be restored with filling materials (amalgam, composite, plastic, or glass ionomer).

• Surgical placement or removal of implants or attachments to implants. Replacement is covered only after

five years have elapsed and only if the implant or superstructure is not serviceable and cannot be made

serviceable.

• Use of a crown as an abutment to a partial denture only when the tooth is decayed to the extent a crown

would be required whether or not a partial denture is required.



Class IV Covered Services and Supplies

Orthodontic services and supplies are in Class IV. The plan covers

• Nightguards and occlusal splints.

• Straightening of teeth, including correction or prevention of malocclusion.

To facilitate benefit payments, your orthodontist or you should submit the treatment plan to the service

representative before treatment starts.









Health Care Plans | 2009 Edition | A86320W Preferred Dental Plan 3-5

How can I obtain a pretreatment estimate?

If your dental care will be extensive, you may ask your dentist to submit a request for a pretreatment estimate,

called a “predetermination of benefits.” This predetermination will allow you to know in advance what

procedures are covered, the amount the service representative will pay toward the treatment, and your financial

responsibility.







What the Preferred Dental Plan Does Not Cover

The Preferred Dental Plan does not cover the following services or supplies:

• Analgesics such as nitrous oxide, intravenous sedation (unless administered in connection with certain

covered endodontic, oral, or periodontic surgery procedures), euphoric drugs, injections, prescription

drugs, or application of desensitizing agents.

• Appliances or cleaning of appliances and certain restorations as follows:

– Appliances or restorations necessary to correct vertical dimension or to alter morphology (shape) or

occlusion, overhang removal, or recontouring or polishing a restoration.

– Cleaning of prosthetic appliances.

– Duplicate dentures, temporary dentures, personalized dentures, or crowns and copings provided in

connection with overdentures.

– Fixed prosthodontics for children under age 16.

– Habit-breaking appliances.

– Replacement of a space maintainer previously covered by the plan.

• Cosmetic procedures (including laminates and tooth bleaching, whether vital or nonvital), appliances, or

restorations primarily for cosmetic purposes.

• Experimental services or supplies (or related complications)—the plan does not cover experimental

services or supplies whose use and acceptance as a course of dental treatment for a specific condition still

are under investigation or observation. To determine whether services are experimental, the service

representative uses American Dental Association guidelines and considers whether the services

– Are in general use in the local dental community.

– Are proven to be safe and effective.

– Are under continued scientific testing and research.

– Show a demonstrable benefit for a particular dental condition.

• Other dental exclusions as follows:

– Caries (decay) susceptibility tests.

– Charges for services or supplies that are received while the patient is not covered under the plan.

– Consultations or elective second opinions.

– Crowns used as abutments to a partial denture for purposes of recontouring, repositioning, or to

provide additional retention, unless the tooth is decayed to the extent that a crown would be required to

restore the tooth in the absence of a partial denture.

– Crowns used to repair microfractures of tooth structure when the tooth displays no symptoms.

– Diagnostic services or X-rays related to temporomandibular (jaw) joints.

– Fees for broken appointments.

– Fees for completing claim forms.

– Full mouth (major) occlusal adjustment.

– Gingival curettage.

– Home fluoride kits.

– Hospitalization charges or any additional dental fees associated with hospitalization.

– Iliac crest or rib grafts to alveolar ridges.

– Injuries or conditions covered under workers’ compensation or employers’ liability laws.





3-6 Preferred Dental Plan Health Care Plans | 2009 Edition | A86320W

– Oral hygiene or dietary instruction.

– Orthognathic surgery.

– Patient management problems.

– Periodontal splinting; any crown or bridgework provided with periodontal therapy or periodontal

appliances.

– Plaque control programs.

– Porcelain or resin inlay bridges.

– Proposed treatment plan review or case presentation by the attending dentist.

– Restorations on the same surface or surfaces of a tooth within two years of the original service.

– Ridge extension to insert dentures (vestibuloplasty).

– Services or supplies covered by any Federal, state, or provincial government agency or provided

without cost by any municipality, county, or other political subdivision or community agency.

However, if government agency payments are insufficient for covered services or supplies or if

benefits are provided by a government agency as an employer to its employees, dental coverage will

not be excluded and will be subject to coordination of benefits.

– Services or supplies to the extent that benefits are payable for them under any motor vehicle medical,

motor vehicle no-fault, uninsured motorist, underinsured motorist, personal injury protection (PIP),

commercial liability, homeowner’s policy, or other similar type of coverage.

– Services specifically excluded in this plan description and all other items that are not specifically

included in this plan as covered dental benefits.

– Study or diagnostic models.

– Tooth transplants or materials placed in extraction to generate osseous filling.

– Treatment of temporomandibular (jaw) joints.





How to Submit a Dental Claim

Washington Dental Service (a Delta Dental organization) is the service representative for the Preferred

Dental Plan. The Preferred Dental Plan address and phone number are listed in Section 9, “Contacts.”

Claim forms generally are not required under the Preferred Dental Plan as long as you receive services

from a member dentist. Provide your Preferred Dental Plan member number to identify yourself as covered

under the plan. The service representative provides each member dentist with claim forms, and the member

dentist usually will submit a claim directly to the plan on your behalf.

You will need to submit a claim for covered orthodontia care as well as care received from nonmember

dentists. Claim forms are available from the service representative; see Section 9, “Contacts.”

Claims must be submitted to the service representative within 12 months from the date you received dental

services or supplies. For tips on how to avoid problems with your claim, see Section 5, “Claims and Appeals.”





How Dental Coverage May Be Extended

The plan generally does not cover services or supplies that you receive while you are not covered under the

plan. However, the plan will cover certain services and supplies after the date coverage would otherwise

end. These services and supplies and the conditions for extending care are described below if the dentist

started the course of treatment before your coverage ends:

• Crown that is required to restore a tooth (independent of the crown’s use in connection with a partial

denture) if the tooth is prepared for the crown while you are covered and the crown is installed during the

31 days after your coverage ends.

• Orthodontia care that is provided within three calendar months after coverage ends.

• Prosthetic device (including abutment crowns of a partial denture), if the impressions are taken while you

are covered, and the device is installed or delivered within 31 days after your coverage ends.

• Restorative, endodontic, periodontic, and oral surgical procedures completed within 31 days after your

coverage ends.



Health Care Plans | 2009 Edition | A86320W Preferred Dental Plan 3-7

Scheduled Dental Plan Section 4

How the Scheduled Dental Plan Works

The Scheduled Dental Plan helps you pay for minor and major dental work, including routine

examinations, crowns, and orthodontia.

The Scheduled Dental Plan reimburses you for necessary dental care received from any licensed dentist

based on a schedule of maximum covered charges. Your out-of-pocket cost will vary depending on the

type of treatment you receive and, in many cases, on your dentist’s charges. This plan is available in all

areas of the country.



Who Administers the Benefits

The Company has contracted a service representative to handle the day-to-day administration of the plan.

The service representative answers benefit questions, makes benefit decisions, pays claims, processes claim

appeals, and accounts for premiums, service fees, and claim costs. The current service representative is

Aetna Life Insurance Company.

The Company reserves the right to change the service representative at any time. If this happens, you will

be notified in writing.



What is a service representative?

A service representative is an agent, group, or organization with which the Company has contracted to handle

the day-to-day administration of the plan.







How the Scheduled Dental Plan Pays Benefits

The Scheduled Dental Plan’s annual deductible and maximum covered charges are described below.



Annual Deductible

Generally, the annual deductible is the amount you must pay out of your own pocket each benefit year

before the plan begins to pay benefits. The annual deductible applies to most covered services and

supplies except

• Examinations, including specialist and emergency oral examinations.

• Fissure sealants.

• Fluoride treatments.

• Prophylaxis (teeth cleaning), including periodontal cleanings.

• X-rays.



Maximum Covered Charges

The plan pays the maximum covered charges listed in the “Scheduled Dental Plan Schedule of Covered

Services” for necessary dental services and supplies. If two or more covered services are received at the

same time, the plan pays up to the scheduled benefit for each service, unless the schedule has a maximum

for a particular combination of services.

In addition, certain other dental treatments may be covered even though they are not listed in the

schedule; details are available from the service representative. (See “Predetermination of Benefits,”

later in this section.)









Health Care Plans | 2009 Edition | A86320W Scheduled Dental Plan 4-1

What the Scheduled Dental Plan Covers

The Scheduled Dental Plan covers the following services and supplies in accordance with the provisions

shown in the tables below.



Scheduled Dental Plan Schedule of Benefits

Annual deductible • $25 per individual

• $75 per family of three or more but not more than $25 per individual

Diagnostic and preventive care • Plan pays up to the amounts listed in “Scheduled Dental Plan Schedule

of Covered Services”

• Annual deductible does not apply to examinations, X-rays, cleaning,

fluoride treatments, or fissure sealants

• Minor and major restorations • Plan pays up to the amounts listed in “Scheduled Dental Plan Schedule

• Endodontics and periodontics of Covered Services”

• Prosthodontics • Annual deductible applies

• Oral surgery

• Orthodontia

Annual maximum benefit (generally for all $2,000 per individual

services and supplies, except orthodontia)*

Lifetime maximum benefit (for orthodontia)** $2,000 per individual

* When multiple treatment dates are required, the charges apply toward the annual maximum benefit for the benefit year in which the procedure is

completed. (A prosthesis is considered complete on the date it is seated or delivered.)

** This lifetime maximum benefit for orthodontia applies to all periods during which the person is covered under any Company-sponsored dental plan.









4-2 Scheduled Dental Plan Health Care Plans | 2009 Edition | A86320W

Scheduled Dental Plan Schedule of Covered Services

American

Dental Maximum

Association Covered

Code Service or Supply Charge ($)

Diagnostic



Examinations (limited to one per course of treatment)



D0150 Comprehensive oral evaluation 48

D0120 Periodic oral examination (limited to twice in a one-year period) 26

D0140 Limited oral evaluation 37

Radiographs (X-rays)



Complete Mouth X-rays (limited to once in a five-year period)



D0210 Intraoral (including bitewings) 69

D0330 Panoramic (limited to once in a 36-month period) 53

Intraoral Periapical



D0220 Single, first film 14

D0230 Each additional film 11

Bitewings (limited to once in a 12-month period)



D0270 Single film 13

D0272 Two films 21

D0274 Four films 32

Preventive



Prophylaxis (limited to once in a four-month period)



D1110 Age 14 and over 58

D1120 To age 14 37

Fluoride Treatment (limited to once in a six-month period)



D1203/D1204 Topical application of fluoride 21

Fissure Sealants (to age 16)



D1351 Topical application of fissure sealants (per quadrant) 26

Minor Restorations



Amalgam Restorations



D2140 Primary or permanent—one surface 58

D2150 Primary or permanent—two surfaces 74

D2160 Primary or permanent—three surfaces 95

D2161 Permanent—four surfaces 116







Health Care Plans | 2009 Edition | A86320W Scheduled Dental Plan 4-3

American

Dental Maximum

Association Covered

Code Service or Supply Charge ($)

D2951 Pin retention—exclusive of amalgam 16

Other Minor Restorations



D2330 Resin—one surface anterior 69

D2331 Resin—two surfaces anterior 90

D2332 Resin—three surfaces anterior 116

D2335 Resin—four or more surfaces anterior 127

D2391 Resin-based composite—one surface (primary or permanent) 74

D2392 Resin-based composite—two surfaces (primary or permanent) 100

D2393 Resin-based composite—three surfaces (primary or permanent) 127

Major Restorations



Inlays and Onlays



D2510 Gold inlay—one surface 217

D2520 Gold inlay—two surfaces 275

D2530 Gold inlay—three surfaces 317

D2542 Metallic onlay—two surfaces 379

D2543 Metallic onlay—three surfaces 412

D2544 Metallic onlay—four surfaces 412

D2910 Recement inlay 32

Crowns



D2720 Resin with high noble metal 380

D2721 Resin with predominantly base metal 380

D2722 Resin with noble metal 380

D2740 Porcelain/ceramic noble 380

D2750 Porcelain fused to high noble 380

D2751 Porcelain to predominantly base metal 380

D2752 Porcelain fused to noble 380

D2790 Full cast high noble metal 380

D2791 Full cast predominantly base metal 380

D2792 Full cast noble metal 380

D2782 Crown ¾ cast noble metal 380

D2930/D2931 Stainless steel 85









4-4 Scheduled Dental Plan Health Care Plans | 2009 Edition | A86320W

American

Dental Maximum

Association Covered

Code Service or Supply Charge ($)

D2970 Temporary (fractured tooth) 63

D2950 Crown buildup 116

D2920 Recement crown 42

Endodontics



D3110 Pulp cap—direct 32

D3120 Pulp cap—indirect 26

D3220 Vital pulpotomy 69

D3222 Partial pulpotomy for apexogenesis 62

Root Canal Therapy (includes treatment plan, clinical procedures, and follow-up care;

excludes final restoration)

D3310 Single rooted 312

D3320 Bi-rooted 412

D3330 Tri-rooted 512

D3410 Apicoectomy (performed as a separate surgical procedure) 412

Periodontics



Nonsurgical Services



D0180 Comprehensive periodontal evaluation 74

D4910 Periodontal prophylaxis (limited to once in a four-month period) 79

D9951 Occlusal adjustment (limited) 106

D9952 Occlusal adjustment (complete) 306

D4341 Periodontal scaling and/or root planing (per quadrant) 95

Surgical Services



D4210 Gingivectomy (per quadrant) 291

D4260 Osseous surgery (per quadrant) 644

D4271 Free soft tissue grafts 417

D7340 Vestibuloplasty 349

Prosthodontics



Dentures (includes six months postdelivery care)



D5110/D5120 Complete upper or lower 481

D5130/D5140 Immediate upper or lower 528

D5211/D5212 Partial upper or lower acrylic base (including any conventional clasps and rests) 317









Health Care Plans | 2009 Edition | A86320W Scheduled Dental Plan 4-5

American

Dental Maximum

Association Covered

Code Service or Supply Charge ($)

D5213/D5214 Partial upper or lower, predominantly cast base with acrylic saddles (including any 581

conventional clasps and rests)

Related Denture Services



D5410–D5422 Denture adjustment (complete or partial) 34

D5510 Repair denture (no teeth damage) 48

D5520 Replace missing or broken tooth (per tooth) 48

D5710–D5721 Denture conversion 148

D5730–D5741 Reline denture—office 79

D5750–D5761 Reline denture—laboratory 148

Bridgework



D6240–D6242 Pontic—porcelain high noble, noble, and predominantly base 370

D6250–D6252 Pontic—resin high noble, noble, and predominantly base 370

D6930 Recement bridge 63

Oral Surgery



Extractions (includes local anesthesia and routine postoperative care)



D7140 Extraction, erupted tooth or exposed root 63

D7210 Erupted tooth 127

D7220 Impacted tooth—soft tissue 143

D7230 Impacted tooth—partially bony 185

D7240 Impacted tooth—completely bony 227

D7250 Root recovery (per tooth) 132

Related Oral Surgical Procedures



D7310 Alveoplasty—per quadrant 106

D7510 Incision and drainage of abscess—intraoral 85

D7960 Frenectomy (separate procedure) 190

General Anesthesia (not covered when provided at a hospital)



D9220 First 30 minutes 185

D9221 Each additional 15 minutes (or major fraction thereof) 63

Orthodontia (coverage for employees and dependents)



50% of covered charges to a lifetime maximum benefit of $2,000 per individual



In addition to the limits shown in the schedule on the previous pages, the plan also limits the following

services and supplies:





4-6 Scheduled Dental Plan Health Care Plans | 2009 Edition | A86320W

• Replacement of dentures and bridgework is covered once in a five-year period if it is unserviceable and

cannot be made serviceable.

• Replacement of temporary denture or bridgework with permanent denture or bridgework is covered

only if it is necessary and occurs within 12 months from the date the temporary denture or bridgework

is installed.

Fissure sealants are covered to age 16 only for permanent molars with chewing surfaces intact, no caries

(decay), and no restorations. Repair or replacement of a fissure sealant within three years is considered part

of the original service.



Predetermination of Benefits

Before you receive expensive dental treatment or services and supplies not listed in the “Scheduled Dental

Plan Schedule of Covered Services,” you or your dentist should request a predetermination of benefits

under the plan. This is a review by the service representative of your dentist’s description of planned

treatment and expected charges, including charges for related services.

The service representative will tell you in advance what procedures are covered, the amount the plan will

pay toward the treatment, and your out-of-pocket costs. The amount covered will be consistent with the

allowances listed in the “Scheduled Dental Plan Schedule of Covered Services.”





What the Scheduled Dental Plan Does Not Cover

The Scheduled Dental Plan does not cover the following services or supplies:

• Anesthetics, administration of anesthetics, or anesthetic supplies or drugs, except general anesthesia

when medically necessary.

• Charges that would not have been made if no dental plan existed, or charges that you or your dependents

are not required to pay.

• Costs that exceed the allowances listed in the “Scheduled Dental Plan Schedule of Covered Services” or

the usual and customary fee as determined by the service representative.

• Experimental services or supplies (or related complications) whose use and acceptance as a course of

dental treatment for a specific condition still are under investigation or observation. To determine

whether services are experimental, the service representative uses American Dental Association

guidelines and considers whether the services

– Are in general use in the local dental community.

– Are proven to be safe and effective.

– Are under continued scientific testing and research.

– Show a demonstrable benefit for a particular dental condition.

• Fees for completing claim forms.

• Fees for missed appointments.

• Fees that are not reasonable for the services performed.

• Injuries or conditions covered under a workers’ compensation law.

• Myofascial pain dysfunction syndrome.

• Orthodontia treatment, including correction or prevention of malocclusion, except as specifically

provided for under the plan.

• Periodontal splinting and bridgework.

• Procedures (including personalization or characterization of dentures) primarily or partly for

cosmetic purposes.

• Replacement of a lost or stolen prosthetic appliance or an appliance damaged by abuse, misuse,

or neglect.

• Services or supplies received because of past or present service in the armed forces of a government.

• Services or supplies received while the patient is not covered under the plan.









Health Care Plans | 2009 Edition | A86320W Scheduled Dental Plan 4-7

• Services or supplies that are paid or provided under government law. (However, if the government, as an

employer, provides benefits to its employees, dental coverage will not be excluded and will be subject to

coordination of benefits.)

• Temporomandibular (jaw) joint treatment.

• Treatment by a professional other than a dentist or licensed dental hygienist under the supervision and

direction of the dentist.

• Treatment of an injury or illness that is not necessary or is not recommended or approved by the

attending dentist.





How to Submit a Dental Claim

Aetna Life Insurance Company is the service representative for the Scheduled Dental Plan. The

Scheduled Dental Plan address and phone number are listed in Section 9, “Contacts.”

When you see a dentist, provide your Scheduled Dental Plan member number to identify yourself as

covered under this plan. You will need to submit a claim for benefits. Claim forms are available from the

service representative; see Section 9, “Contacts.”

Claims must be submitted to the service representative within 12 months from the date you received

dental services or supplies. For tips on how to avoid problems with your claim, see Section 5, “Claims

and Appeals.”





How Dental Coverage May Be Extended

The plan generally does not cover services or supplies that you receive while you are not covered under the

plan. However, the plan will cover certain prosthetic devices and crowns as described below:

• Prosthetic device (including abutment crowns of a partial denture) if the impressions are taken while you

are covered and the device is delivered and installed within two months after your coverage ends.

• Crown that is required to restore a tooth (independent of the crown’s use in connection with a partial

denture) if the tooth is prepared for the crown while you are covered and the crown is placed within two

months after your coverage ends.









4-8 Scheduled Dental Plan Health Care Plans | 2009 Edition | A86320W

Claims and Appeals Section 5

How to Submit a Claim or File an Appeal

This section describes two types of claim review and appeal procedures:

1. Medical and dental benefit claims and appeals for the medical and dental plans described in this

booklet, as well as the Company-sponsored PPO+Account and EPO plan. If you are enrolled in the

CCP, contact the Boeing Service Center through Boeing TotalAccess to find out if these review and

appeal procedures apply to your plan.

2. Eligibility claims and appeals for all medical and dental plans available to the groups listed in “Who Is

Eligible,” in Section 1.

The benefit claim review and appeal procedures described in this booklet do not apply to the HMOs and

prepaid dental plan. If you are enrolled in one of those plans, refer to the member handbook for

information about medical and dental claims and appeals.





Medical and Dental Benefit Claims Process

Each service representative is responsible for evaluating benefit claims in accordance with the terms of

the Plan and using a reasonable claims procedure in accordance with Federal rules. The service

representatives have the right to obtain independent health care advice and to request additional

information as necessary to decide your claims.

You will receive a written notice of the claim decision within the time limits described in this section. The

time limits are based on Federal laws, the type of claim, and whether or not the service representative has

all of the information needed to process the claim.

Your claim will fall into one of these four categories:

1. Preservice claim: a request for coverage of health care benefits for which the terms of this Plan require

you to obtain prior approval before receiving treatment or services, such as benefits requiring

preadmission review, preapproval, precertification, or predetermination.

2. Concurrent care claim: a request to continue coverage of services that the service representative

approved previously as an ongoing course of treatment or to be provided for a certain time. Concurrent

care claims are either urgent care claims or fall into one of the other claim categories: preservice or

postservice.

3. Postservice claim: a request for coverage of health care benefits that is not a preservice, concurrent

care, or urgent care claim. Generally, postservice claims are filed for payment or reimbursement of

benefits for care that already has been received.

4. Urgent care claim: a request for a claim determination needed quickly due to medical exigencies. An

urgent care claim is any claim for medical care or treatment with respect to which the application of the

time period that otherwise applies to nonurgent claim determinations could seriously jeopardize the

life, health, or ability of a patient to regain maximum function, or which—in the opinion of the

attending physician—would subject the patient to severe pain that could not be managed adequately

without the care or treatment that is the subject of the claim. In addition, if a physician with knowledge

of the patient’s medical condition determines that a claim is an urgent care claim, the claim shall

automatically be treated as an urgent care claim for the purposes of this provision.









Health Care Plans | 2009 Edition | A86320W Claims and Appeals 5-1

How to File a Claim for Benefits

Generally, whenever you receive services from a network provider, participating pharmacy, or member

dentist, that provider submits your claim to the appropriate service representative for review and

payment; you do not need to file a claim for yourself.

If you do need to file your own claim, which may be the case when you receive services from a

nonnetwork provider, nonparticipating pharmacy, or nonmember dentist, you must submit a written

claim form to the appropriate service representative. You can obtain claim forms by calling the service

representative or, in some cases, from the service representative’s web site.

You can ask your nonnetwork provider to submit your claim for you, but it is ultimately your responsibility

to ensure that your claim for benefits is filed.

Claims must be filed within 12 months from the date you receive the covered service, treatment, or product

to which the claim relates.



How do I expedite an urgent care claim?

Because urgent care claims are time sensitive and important, you should call the service representative as

soon as possible when you learn that you will need immediate care. If you (or your physician) provide all of the

information needed to review your claim, the service representative will give you an answer within 72 hours.





Time Limits for Decisions on Benefit Claims

The Federal Government sets time periods for reviewing and deciding health care claims. The service

representative will notify you within the following time limits as to whether your claim is approved or

denied, in whole or in part. If your claim is denied, you will have the opportunity to file an appeal within

certain time limits also described here. If your claim is denied due to inaccurate or incomplete information,

you can correct or submit additional information with your appeal.



Time Limits for Receiving Benefit Claim Decisions

You will receive notification of

Type of claim the decision within . . . But it may be extended for an additional . . .

Postservice care claim 30 days after your claim is received 15 days because of matters beyond the

control of the service representative**

Preservice care claim* 15 days after your claim is received 15 days because of matters beyond the

control of the service representative**

Concurrent urgent care 24 hours after your claim is received, Not applicable if you provide enough

claim provided that a request to extend an ongoing information†

course of treatment is made at least 24

hours before the previous approval expires

Concurrent preservice or Same as preservice or postservice claims, 15 days because of matters beyond the

postservice care claim depending on medical circumstances control of the service representative**

Urgent care claim* 72 hours after your claim is received Not applicable if you provide enough

information†

* If you or your authorized representative fails to follow the Plan’s procedures for filing a preservice or urgent care claim, within 5 days (24 hours for an

urgent care claim) the service representative will notify you or your authorized representative of the failure and explain the proper procedures.

** If more information is required to review your claim, the service representative will notify you before the end of the initial review period (or within 5

days for a preservice claim) of the specific information needed and will allow you at least 45 days to provide that information. The review time periods

for preservice and postservice claims will be suspended until the date that you respond to the request for more information.

†

If more information is required to review your claim, the service representative will notify you within 24 hours of the specific information needed and

will allow you at least 48 hours to provide that information. The review time periods for concurrent care and urgent care claims may be extended for as

long as 48 hours from the earlier of (1) the date that the service representative receives the additional information or (2) the end of the time period that

you were given to provide the additional information.









5-2 Claims and Appeals Health Care Plans | 2009 Edition | A86320W

If Your Benefit Claim Is Denied

If your medical or dental benefit claim is denied, in whole or in part, the service representative will send

you a notice that will include the following information:

• Specific reasons for the denial.

• Reference to the specific Plan provisions on which the claim determination was based.

• Description and explanation of any additional information that is needed to process your claim.

• Description of the Plan’s appeal procedures and the applicable time limits, as well as your right to bring

legal action if your claim is denied on appeal.

• Statement that you can request, free of charge, copies of documentation related to the decision.

• Description of any rule, protocol, or other criterion that was relied on in determining your claim, and

your right to obtain a copy, free of charge, upon request.

• Statement that you can request, free of charge, an explanation of the scientific or clinical judgment that

was used if your claim was denied based on a medical necessity, an experimental treatment, or another

similar exclusion or limitation.

• For an urgent care claim, a description of the expedited review process applicable to such claims.



How can I avoid claim delays?

In many cases, your physician or other health care provider will send a bill directly to the service representative.

If you are covered under the Traditional Medical Plan, PPO+Account, EPO plan, or certain CCPs, simply present

your medical or prescription drug* ID card to your provider. If you are covered under the Preferred Dental Plan

or the Scheduled Dental Plan, present your Preferred Dental Plan ID card or Scheduled Dental Plan ID card. You

also may be asked to provide your Social Security number.

If you are required to submit a claim, use the following tips to prevent delays and other claim-filing problems:

• Provide all information that is requested on the form, including your full name, address, and Social Security or

member ID number; the patient’s name and birth date; the date of the service; the diagnosis; and the types of

services received.

• Always attach an itemized bill that includes the provider’s name, address, and tax ID number. A notice from

the provider that payment is overdue generally does not provide enough information for determining benefits

and payments.

• If you are asked to provide more information, be sure to include the patient’s full name and your full name

and Social Security or member ID number.

• If you or a covered dependent is eligible for coverage under another employer’s group benefit plan, you should

submit the claim first to the plan that provides primary coverage (as determined under the coordination of

benefit provisions). When that plan sends you a written Explanation of Benefits form, send a copy of the

explanation, the appropriate claim form, and an itemized bill to the second plan. If you are not sure which plan

provides primary coverage, submit a claim to both plans at the same time.





How to Appeal if Your Benefit Claim Is Denied

If your benefit claim is denied, in whole or in part, you may be able to resolve the denied claim through an

informal review process. Simply call the service representative and discuss the situation.

If the claim is not resolved with a telephone call, you have the right to file a formal (written) appeal with

the service representative. You must file your appeal within 180 days after the date that you are notified of

the denial. To file your appeal, you must

• State, in writing, why you believe the claim should have been approved.

• Submit any information and documents you think are appropriate, including any additional information

not submitted with your initial claim.

• Send the appeal and any supporting documentation to the service representative at the appropriate

claim-filing address.

You may request, free of charge, copies of all documents, records, and other information relevant to your

claim for benefits.



*Updated: January 2010

Health Care Plans | 2009 Edition | A86320W Claims and Appeals 5-3

The service representative will review your appeal and make a decision. The review will be conducted by a

person who did not make the decision on your initial claim and is not the subordinate of that person. The

review will include all information you submit and will not give deference to the initial claim decision. If

deciding the appeal involves medical judgment, such as determining medical necessity or if treatment was

experimental, a qualified health care professional will be consulted. That health care professional will not

be one who was consulted in determining your initial claim and will not be a subordinate of such person. In

reviewing your appeal, the service representative will use its discretion in interpreting the terms of the Plan

and will apply them accordingly.

The decisions of the service representative are final and binding. Benefits will be paid under the plan only if

the Employee Benefit Plans Committee (the “Committee”) decides in its discretion that you have met the

eligibility and participation requirements and the service representative has determined that you are entitled

to the benefits.



How can I expedite an appeal for urgent care?

You can make an appeal for urgent care by calling the service representative. (All other appeals must be made

to the service representative in writing.)





Time Limits for Decisions on Benefit Appeals

The Federal Government provides time limits for reviewing and deciding health care benefit appeals. If the

service representative denies your appeal, in whole or in part, you will be notified as follows:



Time Limits for Receiving Benefit Appeal Decisions

You will receive notification

of the decision on your . . . Within . . .

Postservice care appeal 30 days for each of two levels of appeal

Preservice care appeal 15 days for each of two levels of appeal

Concurrent care appeal Same as preservice, postservice, or urgent care appeals, depending on medical

circumstances

Urgent care appeal 72 hours* after your appeal is received

* For an urgent care appeal, you can submit information by any timely method, including fax, telephone, other electronic means, or orally.





If Your Benefit Appeal Is Denied

If your benefit appeal is denied, in whole or in part, the service representative will send you a notice that

will include the following information:

• Specific reasons for the denial.

• Reference to the specific Plan provisions on which the claim determination was based.

• Statement of your right to obtain, free of charge, copies of documentation related to the decision.

• Summary of your right to additional appeals or legal action.

• Statement that you can request, free of charge, identification of medical or vocational experts whose

advice was obtained by the service representative.

• Description of any rule, protocol, or other criterion that was relied on in determining your appeal, and

your right to obtain a copy, free of charge, upon request.

• Statement that you can request, free of charge, an explanation of the scientific or clinical judgment that

was used if your appeal was denied based on a medical necessity, an experimental treatment, or another

similar exclusion or limitation.

Whom to Contact for Benefit Claim and Appeal Procedures

You can obtain a copy of the benefit claim review and appeal procedures by calling the service representative.





5-4 Claims and Appeals Health Care Plans | 2009 Edition | A86320W

Eligibility Claims Process

Call the Boeing Service Center through Boeing TotalAccess if

• You have questions about eligibility.

• You believe that you or an eligible dependent has been improperly denied

– Participation in a health care plan.

– The opportunity to make an election as a result of a qualified status change.

See Section 9 for the telephone number.



How to File a Claim for Eligibility

You may be able to resolve questions about eligibility for health plan benefits by calling the Boeing Service

Center through Boeing TotalAccess. If your question or request is not resolved by telephone (an informal

review process), you may file a formal (written) eligibility claim. To do so, call the Boeing Service Center

through Boeing TotalAccess and request a claim initiation form.

You can submit urgent care claims for eligibility by calling the Boeing Service Center through Boeing

TotalAccess. You may be required to provide information from your provider to substantiate your urgent

eligibility claim.

Eligibility claims must be filed within 12 months from the date your eligibility claim was denied. Any claims

submitted after that time will be denied.

Time Limits for Decisions on Eligibility Claims

The Boeing Service Center will review your eligibility claim and notify you of its decision within the

following time frames:



Time Limits for Receiving Eligibility Claim Decisions

If your claim for eligibility You will receive notification of the But it may be extended for an

involves . . . decision within . . . additional . . .

A preservice care claim* 15 days after your claim is received 15 days because of matters beyond

the control of the Boeing Service

Center**

A concurrent urgent care claim 24 hours after your claim is received, Not applicable if you provide enough

provided that a request to extend an information†

ongoing course of treatment is made

at least 24 hours before the previous

approval expires

A concurrent preservice or postservice Same as preservice or postservice 15 days because of matters beyond

care claim claims, depending on medical the control of the Boeing Service

circumstances Center**

An urgent care claim* 72 hours after your claim is received Not applicable if you provide enough

information†

Another claim, including a postservice 30 days after your claim is received 15 days because of matters beyond

claim or eligibility claim that does not the control of the Boeing Service

involve medical or dental services Center**

* If you or your authorized representative fails to follow the Plan’s procedures for filing a preservice or urgent care eligibility claim, within 5 days (24 hours

for an urgent care claim) the Boeing Service Center will notify you or your authorized representative of the failure and explain the proper procedures.

** If more information is required to review your claim, the Boeing Service Center will notify you before the end of the initial review period (or within

5 days for a preservice claim) of the specific information needed and will allow you at least 45 days to provide that information. The review time

periods for preservice and postservice claims will be suspended until the date that you respond to the request for more information.

†

If more information is required to review your claim, the Boeing Service Center will notify you within 24 hours of the specific information needed and

will allow you at least 48 hours to provide that information. The review time periods for concurrent care and urgent care claims may be extended for as

long as 48 hours from the earlier of (1) the date that the Boeing Service Center receives the additional information or (2) the end of the time period that

you were given to provide the additional information.







Health Care Plans | 2009 Edition | A86320W Claims and Appeals 5-5

If Your Eligibility Claim Is Denied

If your eligibility claim is denied, the Boeing Service Center will send you a notice that will include the

following information:

• Specific reasons for the denial.

• Reference to the specific Plan provisions on which the claim determination was based.

• Description and explanation of any additional information that is needed to process your claim.

• Description of the Plan’s appeal procedures and the applicable time limits, as well as your right to bring

legal action if your claim is denied on appeal.

• Statement that you can request, free of charge, copies of documentation related to the decision.

• Description of any rule, protocol, or other criterion that was relied on in determining your claim, and

your right to obtain a copy, free of charge, upon request.

• For an eligibility claim involving urgent care, a description of the expedited review process applicable to

such claims.

How to Appeal if Your Eligibility Claim Is Denied

If your eligibility claim is denied, you (or your legal representative) may file an appeal with the Committee

or its delegate.

You must file your appeal within 180 days after the date that you are notified of the denial. To file your

appeal, you must

• State, in writing, why you believe the claim should have been approved.

• Submit any information and documents you think are appropriate.

• Send the appeal and any supporting documentation to the Committee:

Address: Employee Benefit Plans Committee

The Boeing Company

100 North Riverside

MC 5002-8421

Chicago, IL 60606-1596

Fax: 312-544-2076*

Telephone

(for urgent appeals):

312-544-2799

You may request, free of charge, copies of all documents, records, and other information relevant to your

claim for eligibility.

The Committee may require you to provide information from your provider to substantiate your urgent

appeal. The Committee has the exclusive right to interpret and apply the terms of the Plan and to exercise

its discretion to determine all questions that arise under the Plan. The Committee will review all

information you submit and will not give deference to the initial eligibility claim decision.

The decisions of the Committee are final and binding. Benefits will be paid under the Plan only if the

Committee decides in its discretion that you have met the eligibility and participation requirements and the

service representative has determined that you are entitled to the benefits.









*Updated: January 2011

5-6 Claims and Appeals Health Care Plans | 2009 Edition | A86320W

Time Limits for Decisions on Eligibility Appeals

The Federal Government provides time limits for reviewing and deciding health care appeals. If the

Committee denies your appeal, in whole or in part, you will be notified as follows:



Time Limits for Receiving Eligibility Appeal Decisions

You will receive notification of the decision on your . . . Within . . .

Preservice care appeal 30 days after receipt of your appeal

Concurrent care appeal Same as preservice, postservice, or urgent care appeals,

depending on medical circumstances

Urgent care appeal 72 hours* after receipt of your appeal

Other appeal, including a postservice appeal or eligibility 60 days after receipt of your appeal

appeal that does not involve medical or dental services

* For an urgent care appeal, you can submit information by any timely method, including fax, telephone, other electronic means, or orally.







If Your Eligibility Appeal Is Denied

If your eligibility appeal is denied, in whole or in part, the Committee will send you a notice that will

include the following information:

• Specific reasons for the denial.

• Reference to the specific Plan provisions on which the appeal determination was based.

• Summary of your right to bring legal action.

• Statement of your right to obtain, free of charge, copies of documentation related to the decision.

• Statement that you may request, free of charge, identification of medical or vocational experts whose

advice was obtained by the Committee.

• Description of any rule, protocol, or other criterion that was relied on in determining your appeal, and

your right to obtain a copy, free of charge, upon request.

Whom to Contact for Eligibility Claim and Appeal Procedures

You can obtain a copy of the eligibility claim review and appeal procedures by calling the Boeing Service

Center through Boeing TotalAccess.



What You Can Do if Your Appeal Is Denied

If the service representative or the Committee denies your appeal, you may bring a civil action under

Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended (ERISA).

However, except as otherwise provided in an insured contract, you must bring any legal action within

180 days after the

• Decision on appeal of your claim for benefits or eligibility, or

• Expiration of time to take an appeal if no appeal is taken.

A post-denial review of your appeal will not extend the time period for commencing legal action.





How Claims Are Paid When You Have Duplicate Coverage

This section describes coordination of benefit rules for the Traditional Medical Plan, PPO+Account,

EPO plan, Preferred Dental Plan, and Scheduled Dental Plan. If you are enrolled in the CCP, contact the

Boeing Service Center through Boeing TotalAccess to find out if these rules apply to your plan.

Coordination of benefit rules for the HMO plans and prepaid dental plan are described in their respective

member handbooks.

Plans that offer medical or dental benefits follow certain rules when there is duplicate coverage.





Health Care Plans | 2009 Edition | A86320W Claims and Appeals 5-7

For example, if both you and your spouse are working, you or your family members might have duplicate

coverage. That is, one or more of you might be enrolled in more than one group health care plan. Other

coverage includes, whether insured or uninsured, another employer’s group benefit plan, another

arrangement of individuals in a group, Medicare (to the extent allowed by law), individual insurance or

health coverage, and insurance that pays without consideration of fault.

If you or your covered dependents have duplicate medical and/or dental coverage, the two plans must

coordinate their benefits to determine which plan will be responsible for paying which part of the bill. In

this coordination of benefits, one insurer will be considered primary (the plan that considers the charges

first) and the other will be considered secondary (the plan that considers the charges second). When you file

a claim, it is your responsibility to know which plan is primary and which plan is secondary for you and

your covered dependents.

When the Traditional Medical Plan, PPO+Account, EPO plan, CCP, Preferred Dental Plan, or

Scheduled Dental Plan is primary, this plan will pay its benefits first and without regard to any benefits

that may be payable under the secondary plan.

When the Traditional Medical Plan, PPO+Account, EPO plan, or CCP is secondary, this plan will

pay the difference between the benefits paid by the primary plan and what this plan would have paid had

it been primary.

When the Preferred Dental Plan or Scheduled Dental Plan is secondary, this plan will pay its benefits,

limited to an amount that, when added to the benefits paid by the primary plan, does not exceed the

covered charges for services covered at least in part by the primary or secondary plan.



Determine Whether the Plan Is Primary or Secondary

When determining whether this health care plan is primary or secondary, this plan applies the following

rules. A plan is considered primary when

• It has no order of benefit determination rules.

• It has benefit determination rules that differ from coordination of benefit rules under state regulations or,

if not insured, that differ from these rules.

• All plans that cover an individual use the same coordination of benefit rules, and under those rules, the

plan is primary.

If the aforementioned rules do not determine which group plan is considered primary, this plan applies the

following coordination of benefit rules:

1. A plan that covers a person as an employee, retired employee, member, or subscriber pays before a

plan that covers the person as a dependent.

2. A plan that covers a person as an active employee or dependent of an active employee is primary. The

plan that covers a person as a retired, laid-off, or other inactive employee or as a dependent of a retired,

laid-off, or other inactive employee is secondary.

3. If a dependent child is covered under both parents’ group plans, the child’s primary coverage is

provided through the plan of the parent whose birthday comes first in the calendar year, with secondary

coverage provided through the plan of the parent whose birthday comes later in the calendar year.

4. If a dependent child’s parents are divorced or separated and a court decree establishes financial

responsibility for the health care coverage of the child, the plan of the parent with such financial

responsibility is the primary plan of coverage. If the divorce decree is silent on the issue of coverage,

the following guidelines are used:

a. The plan of the parent with custody pays benefits first.

b. The plan of the spouse of the parent with custody pays second.

c. The plan of the parent without custody pays third.

d. The plan of the spouse of the parent without custody pays fourth.

5. If none of the aforementioned rules establishes which group plan should pay first, then the plan that has

covered the person for the longest period is considered the primary plan of coverage.





5-8 Claims and Appeals Health Care Plans | 2009 Edition | A86320W

6. Continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, as

amended (COBRA), always is secondary to other coverage, except as required by law.

7. If you or an eligible dependent is confined to a hospital when first becoming covered under this plan,

this plan is secondary to any plan (including a Company-sponsored health care plan) already covering

you or your dependent for the eligible expenses related to that hospital admission. If you or your

dependent does not have other coverage for hospital and related expenses, this plan is primary.

If You Are Covered by Two Boeing-Sponsored Plans

Benefits under a Company-sponsored medical or dental plan are not coordinated with benefits paid under

any other group plan offered by the Company, except as described below. You can receive benefits from

only one Company-sponsored medical or dental plan. However, when dental services performed by a

licensed dentist also are covered under the medical plan, the dental plan pays its benefits first and the

medical plan is secondary.

If You Are Covered by Medicare and This Plan

Federal rules govern coordination of benefits with Medicare. In most cases, Medicare is secondary to a plan

that covers a person as an active employee or dependent of an active employee. Medicare is primary in

most other circumstances.

Treatment of end-stage renal disease is covered by the Traditional Medical Plan, PPO+Account, EPO plan,

and CCP for the first 30 months following Medicare entitlement due to end-stage renal disease, and

Medicare provides secondary coverage. After this 30-month period, Medicare provides primary coverage,

and the Traditional Medical Plan, PPO+Account, EPO plan, or CCP provides secondary coverage.

Claim Administration

The service representative has the right to obtain and release any information or recover any payment it

considers necessary to administer these provisions.





When an Injury or Illness Is Caused by the Negligence

of Another

In some situations, you or a covered dependent may be eligible to receive, as a result of an accident or

illness, health care benefits from an automobile insurance policy, homeowner’s insurance policy or other

type of insurance policy, or from a responsible third party. In these cases, this plan will pay benefits if

the covered person agrees to cooperate with the service representative in administering the plan’s

subrogation rights.

If a person covered by this plan is injured by another party who is legally liable for the medical or dental

bills or disability income, he or she may request this plan to pay its regular benefit on his or her behalf. In

exchange, the covered person agrees to

• Complete a claim and submit all bills related to the injury or illness to the responsible party or insurer.

• Complete and submit all of the necessary information requested by the service representative.

• Reimburse the plan if he or she recovers payment from the responsible party or any other source.

• Cooperate with the service representative’s efforts to recover from the third party any amounts this plan

pays in benefits related to the injury or illness, including any lawsuit brought against the responsible

party or insurer.

This provision applies whenever you or a covered dependent is entitled to or receives benefits under this

plan and is also entitled to or receives compensation or any other funds from another party in connection

with that same disability or medical condition, whether by insurance, litigation, settlement, or otherwise.

The plan is entitled to such funds to the extent of plan benefits paid to or on behalf of the individual,

whether or not the individual has been “made whole,” and without regard to any common fund doctrine.

This plan may recover such funds by constructive trust, equitable lien, right of subrogation, reimbursement,

or any other equitable or legal remedy.







Health Care Plans | 2009 Edition | A86320W Claims and Appeals 5-9

If an individual fails, refuses, or neglects to reimburse the plan or otherwise comply with the requirements

of this provision, or if payments are made under the plan based on fraudulent information or otherwise in

excess of the amount necessary to satisfy the provisions of the plan, then, in addition to all other remedies

and rights of recovery that the plan may have, the plan has the right to terminate or suspend benefit

payments and/or recover the reimbursement due to the plan by withholding, offsetting, and recovering such

amount out of any future plan benefits or amounts otherwise due from the plan to or with respect to such

individual. The plan also has the right in any proceeding at law or equity to assert a constructive trust,

equitable lien, or any other equitable or legal remedy or recovery, against any and all persons who have

assets that the plan can claim rights to. The plan has the right of first recovery from any judgment,

settlement or other payment, regardless of whether the individual has been “made whole,” and without

regard to any common fund doctrine.









5-10 Claims and Appeals Health Care Plans | 2009 Edition | A86320W

Coverage End Dates and

Continuation of Coverage Section 6

How Coverage Can End

Once you and your eligible dependents enroll, health care coverage stays in effect until

• You cancel coverage during an annual enrollment period or after a qualified status change or event.

• You lose eligibility for coverage.

• You fail to make timely payments of required premium contributions while on an approved

leave of absence.

• The Company ends this Plan or changes the provisions so you are no longer eligible.

The Company fully intends to continue the Plan. However, the Company reserves the right to terminate,

suspend, or modify any benefits described in this booklet, in whole or in part, at any time, and for any

reason for employees, former employees, retirees, and their dependents.

If health care coverage ends, you and/or your covered dependents may be able to continue health care

coverage under this plan through the Consolidated Omnibus Budget Reconciliation Act of 1985, as

amended (COBRA).

If you take a leave of absence, your coverage may end. For when and how COBRA applies, see “Continue

Coverage During a Leave of Absence,” in this section.

For coverage continuation options, see “Continue Coverage Through COBRA,” in this section.



How You and Your Dependents Can Lose Eligibility for Coverage*

Health care coverage for you and your covered dependents will end if you and/or your dependent

become ineligible for participation in the plan for one of the following reasons:

• You quit.

• You are discharged or laid off.

• You experience a change in your job situation that causes you to become ineligible for coverage. (For

example, your position is reclassified to a part-time position of 19 or fewer regularly scheduled hours

per week.)

• You retire.

• You are not actively at work as a result of a labor dispute.

• You die.

• The Company ends this Plan.

• You fail to make timely payments of your required contribution while on an approved leave of absence.

• You cancel coverage.

Your spouse or same-gender domestic partner will become ineligible for coverage if

• You become ineligible for coverage, as described above.

• You divorce, you legally separate, your marriage is annulled, or your domestic partnership is dissolved.

• Your spouse or same-gender domestic partner enrolls in any Company-sponsored health plan (including

this one) as an employee or retiree.

• Your spouse or same-gender domestic partner otherwise no longer meets the eligibility requirements

described in Section 1.

Your child will become ineligible for coverage if

• You become ineligible for coverage, as described above.

• Your child reaches age 26 and he or she is not eligible to be covered as a disabled child.

• Your child (other than your natural or adopted child or your stepchild) marries.





*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Coverage End Dates and Continuation of Coverage 6-1

• Your child (other than your natural or adopted child or your stepchild) no longer depends on you for

principal support.

• Your child becomes an employee covered by this or any other Company-sponsored health care plan

unless the child is unmarried and dependent on you for principal support.

• Your child otherwise no longer meets the eligibility requirements described in Section 1.



When Coverage Ends*

Generally, coverage ends on the last day of the month in which you and/or your dependents become

ineligible for coverage. However, if you (or your covered dependent) are in a hospital when your

employment ends, coverage will continue for you (or your hospitalized dependent) for the duration of the

hospitalization or 31 days, whichever is shorter.

If you are eligible for retiree medical coverage through The Boeing Company and you terminate your

active employment, your active coverage will continue until the end of the month after the month you

terminate. Special rules apply if you terminate from a leave of absence. See “Continue Coverage During a

Leave of Absence,” below.

You and your dependents may be able to continue coverage through COBRA in certain circumstances. You

and your dependents cannot continue coverage through COBRA if the Company ends all its health care

plans.

For coverage continuation options, see “Continue Coverage Through COBRA,” in this section.



Will I receive evidence of my Boeing coverage?

Yes. When health care coverage ends, you automatically will receive a certificate of coverage as evidence of

insurance, describing your active employee coverage and the time period of your enrollment. You may present

this certificate of coverage to a new health care plan to reduce or eliminate any preexisting condition waiting

period.

If the coverage periods for your covered dependents are different from yours, their coverage dates will be noted

separately on the certificate. You may request a duplicate copy of your certificate within 24 months after your

coverage ends by calling the Boeing Service Center through Boeing TotalAccess.





Can I continue my active coverage for a disabled child age 26 or older?*

If your child is disabled and will lose coverage when he or she turns 26, you may continue your active coverage

for that child if he or she meets the eligibility conditions described in Section 1 and you continue to be enrolled

in the plan. You must notify the Boeing Service Center within 31 days of the child’s 26th birthday and provide

proof that the child is incapable of self-support because of the disability.







Continue Coverage During a Leave of Absence

You and your eligible dependents may continue to be covered by your active coverage during certain

approved leaves of absence. To continue your active coverage, you must pay your active contribution

amount while you are on an approved leave of absence. You can make payments through payroll deduction

or by aftertax payments if you stop receiving a paycheck. The Company may continue to pay its portion

of your coverage for some or all of the duration of your leave. See the table, “COBRA Coverage Periods

and Qualifying Events,” in this section, or call the Boeing Service Center through Boeing TotalAccess

for details.

For details about periods of active coverage, see the table, “COBRA Coverage Periods and Qualifying

Events,” in this section.









*Updated: January 2011

6-2 Coverage End Dates and Continuation of Coverage Health Care Plans | 2009 Edition | A86320W

If you remain on an approved leave of absence after your active coverage continuation period ends, you

may enroll in COBRA coverage. If you enroll and pay the required contribution amounts, your COBRA

coverage will begin during the next full calendar month of your leave and continue as shown in the table,

“COBRA Coverage Periods and Qualifying Events,” in this section.

Contact the Boeing Service Center through Boeing TotalAccess for additional information.





Continue Coverage Through COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), is a Federal law

that entitles you and your covered dependents to continue health care coverage for a period of time after

it would otherwise end.

Anyone who continues coverage under COBRA is covered by the medical or dental plan just as before

coverage was lost. There is no effect on the amounts still due to meet the annual deductible or on any plan

benefits paid to date, and the accrual of charges toward the annual out-of-pocket maximum for the plan

continues as before. The only difference is that you and/or your covered dependent may be required to pay

the full cost of coverage plus two percent for administration costs.

COBRA coverage becomes available when a qualifying COBRA event occurs. If you or your covered

dependents decline this coverage when you first are eligible, you may not enroll at a later date.

The Boeing Service Center administers COBRA coverage.



Who Is Eligible for COBRA Coverage

You, your spouse or same-gender domestic partner, and your covered dependent children may be eligible

to enroll for COBRA coverage. The circumstances that cause your loss of coverage determine your

eligibility for COBRA. These circumstances are outlined here.

Certain trade-displaced employees may have additional COBRA rights and possible tax credits if they have

been certified by the Department of Labor or state labor agencies as eligible for trade adjustment assistance

under the Trade Act of 2002. Qualifying individuals receive information from the Federal Government,

which describes a special enrollment period for trade-displaced workers who have not become covered

under COBRA coverage, a 65 percent tax credit for qualified health insurance premiums, an advance

payment program, and procedures for participating in the program.

You can obtain information about trade adjustment assistance by calling the Health Coverage Tax Credit

Customer Contact Center toll-free at 1-866-628-4282 (TDD/TTY: 1-866-626-4282) or visiting the

Department of Labor web site (http://www.doleta.gov/tradeact/).

Special rules may apply if you retire or are offered other medical coverage as an alternative to COBRA.

Your Right to COBRA Coverage

You have a right to elect COBRA coverage if you are covered by a Company-sponsored health care plan

and you lose coverage because

• Your employment ends.

• Your hours decrease.

Your Spouse’s or Same-Gender Domestic Partner’s Right to COBRA Coverage

Your covered spouse or same-gender domestic partner has a right to elect COBRA coverage if he or she is

covered by a Company-sponsored health care plan and loses coverage because of

• Your death.

• Your employment ending.

• Your work hours decreasing.

• Your divorce, legal separation from you, or dissolution of domestic partnership.









Health Care Plans | 2009 Edition | A86320W Coverage End Dates and Continuation of Coverage 6-3

Your Child’s Right to COBRA Coverage

Your covered dependent child has a right to elect COBRA coverage if he or she is covered by a Company-

sponsored health care plan and loses coverage because of

• Your death.

• Your employment ending.

• Your work hours decreasing.

• Your divorce, legal separation, or dissolution of domestic partnership.

• His or her loss of eligibility for coverage. (See “Who Is Eligible,” in Section 1.)



Are the medical benefits under COBRA coverage different from benefits under my

active coverage?

No. Your COBRA coverage will be identical to the coverage provided to similarly situated active employees or

dependents. However, costs may differ, as described in this section.





How to Enroll for COBRA Coverage

You are responsible for

• Notifying the Boeing Service Center when your dependent’s eligibility ends.

• Notifying the Boeing Service Center if you or your dependents become covered by another medical plan.

• Enrolling for COBRA coverage.

• Paying any required contributions in a timely manner.

• Notifying the Boeing Service Center if your or your dependent’s address changes.

The Company and the Boeing Service Center also have certain responsibilities to explain your COBRA

rights and how to request coverage. These responsibilities are explained here.

If your coverage ends because of your termination, death, or reduction in work hours, the Company will

notify the Boeing Service Center within 30 days from the date your coverage ends.

Notify the Boeing Service Center When Coverage Ends

You or your covered dependents must notify the Boeing Service Center, in writing or by telephone, if your

covered dependent loses coverage because of divorce, legal separation, or dissolution of domestic

partnership or if your child loses eligibility for coverage.

You must notify the Boeing Service Center of your dependent’s loss of coverage within 60 days from the

end of the month in which the loss of eligibility occurs. Otherwise, the right to enroll in COBRA coverage

will be forfeited.

Watch Your Mail for COBRA Election Forms

The Boeing Service Center will send you a notice of your COBRA rights and enrollment materials within

14 days of the date it is notified that your coverage will end or has ended.

Elect COBRA Coverage

You and/or any dependent who has lost coverage has an independent right to elect COBRA coverage. For

example, your spouse may elect COBRA coverage, but you or your spouse may decline COBRA coverage

for your dependent children.

You or your covered dependent must enroll by calling the Boeing Service Center or through the Your

Benefits Resources web site within 60 days after either (1) the date your coverage ends or (2) the date you

receive the notice, whichever is later. If you do not enroll within this 60 days, you will forfeit your right to

COBRA coverage.

During the 60-day election period, you may change your mind about enrolling for coverage. That is, you may

decline enrollment and then decide to elect COBRA coverage within the same 60-day period. You may do this

as long as you contact the Boeing Service Center and elect COBRA coverage before the end of the 60 days.





6-4 Coverage End Dates and Continuation of Coverage Health Care Plans | 2009 Edition | A86320W

If you decline COBRA enrollment, then change your mind and elect COBRA coverage before the end of

the 60-day enrollment period, your COBRA coverage will start the day you contact the Boeing Service

Center and enroll in COBRA. Your coverage period will be measured from the date of your qualifying

event. For example, assume you terminate employment on December 31 and decline COBRA enrollment

on January 15. Then, on February 20, you enroll in COBRA. In this case, your COBRA coverage will be

effective February 20, but your COBRA coverage period will be measured from December 31, the date of

your COBRA qualifying event.

If the Boeing Service Center determines that you or your dependent is not eligible for COBRA coverage,

you will receive a notice stating the reasons for ineligibility.

Pay for COBRA Coverage

The Boeing Service Center will notify you of the amount you and your covered dependents must pay for

COBRA coverage.

If the cost of coverage changes for similarly situated active employees or dependents, the cost of COBRA

coverage also will change.

You have an initial 45-day grace period from the date of your election to pay the first premium. You also

must pay for any months of continued health care coverage since the date your active coverage ended.

After the first payment, your COBRA coverage payments are due by the first of each month. (You have a

31-day grace period, beginning on the first day of the month, in which to make each payment. Payments

must be postmarked within the 31-day grace period.)

If you submit only a partial payment (but not significantly less than the full amount), the Boeing Service

Center will bill you for the remaining amount and allow you 31 days to pay it.

It is important that you make timely payments for your COBRA coverage. If you fail to make a payment

as described above, coverage will end automatically on the last day of the month for which coverage was

paid. You will not be allowed to reinstate coverage that has been terminated because timely payments were

not made.



When COBRA Coverage Begins

Generally, COBRA coverage begins when your active coverage ends, except in special circumstances

described under “Elect COBRA Coverage,” earlier in this section.



When You Can Change COBRA Coverage

As a COBRA participant, you have the same opportunity as an active employee to

• Choose different health care plans during annual enrollment.

• Add or drop covered dependents during annual enrollment.

• Enroll eligible dependents under special enrollment and qualified status change rules. (For example, you

may add a new dependent acquired through marriage, entering a same-gender domestic partnership,

birth, or adoption.)

For more information, see “Special Enrollment Events” and “Qualified Status Changes,” in Section 1.



Can I add a new dependent to my COBRA coverage?

Yes. You may add a child born to you or placed with you for adoption while you are covered through COBRA.

That child will have all of the COBRA rights as if he or she had been a covered dependent under your active

coverage. Any other dependent you add to your COBRA coverage will have only the rights to your then-current

COBRA coverage period; the new dependent will not be able to extend coverage if a secondary qualifying

event occurs.









Health Care Plans | 2009 Edition | A86320W Coverage End Dates and Continuation of Coverage 6-5

How Long COBRA Coverage Can Continue and How Much It Costs

Generally, COBRA coverage may last for up to 18 or 36 months, depending on the event that caused you

or your dependent to lose coverage and whether or not any secondary event occurs during the COBRA

coverage period. These COBRA coverage periods and the events that determine them are shown here.

If you are covered by a fully insured health plan, you may be eligible for additional continuation of your

coverage under your state’s insurance regulations beyond the Federal COBRA continuation requirements.

Contact your health plan directly to determine what options are available to you after your Federal COBRA

coverage ends.

If the cost of coverage changes for similarly situated active employees or dependents, the cost of COBRA

coverage will change.



COBRA Coverage Periods and Qualifying Events

Maximum Length of COBRA Coverage and

Qualifying Event Qualified Beneficiaries Cost of COBRA Coverage

Your employment ends, except layoff • You 18 months at 102%

• Your spouse or same-

gender domestic partner*

• Your dependent child*

Your hours are reduced • You 18 months at 102%

• Your spouse or same-

gender domestic partner*

• Your dependent child*

You are laid off • You 18 months; the active contribution amount for

• Your spouse or same- the first 3 months, then 102%

gender domestic partner*

• Your dependent child*

You die • Your spouse or same- 36 months; for nonoccupational death, the

gender domestic partner* active contribution amount for the first 12

• Your dependent child* months, then 102%; for occupational death,

the active contribution amount for 36 months

Divorce, legal separation, or dissolution • Your spouse or same- 36 months at 102%

of domestic partnership gender domestic partner*

• Your dependent child*

A dependent child loses eligibility Your dependent child* 36 months at 102%

A covered individual becomes disabled • You 29 months; 18 months at 102%, then 150%

and • Your spouse or same- for you and your dependents if the disabled

• Is determined by the Social Security gender domestic partner* person is covered; if the disabled person is not

Administration to have been disabled • Your dependent child* covered, 102%

for the purposes of Social Security at

any time during the first 60 days of

COBRA coverage, and

• Provides notification of the

determination within 60 days after

it is granted and during the first

18 months of COBRA coverage









6-6 Coverage End Dates and Continuation of Coverage Health Care Plans | 2009 Edition | A86320W

COBRA Coverage Periods and Qualifying Events (continued)

Qualifying Event Qualified Beneficiaries Maximum Length of COBRA Coverage and

Cost of COBRA Coverage

You go on an approved medical leave of • You 6 months of continued active coverage, then

absence**,†,†† • Your spouse or same- 24 months of COBRA coverage

gender domestic partner* For the first 24 months of COBRA coverage,

• Your dependent child* you contribute the active medical contribution

for you only and 100% for your covered

dependents, as well as 100% for your and your

dependents’ dental coverage

You go on an approved medical leave of • You 6 months of continued active coverage, then

absence and you • Your spouse or same- 29 months of COBRA coverage

• Are determined by the Social Security gender domestic partner* For the first 24 months of COBRA coverage,

Administration to have been disabled • Your dependent child* you contribute the active medical contribution

for the purposes of Social Security at for you only and 100% for your covered

any time during the first 60 days of dependents, as well as 100% for your and your

COBRA coverage, and dependents’ dental coverage

• Provide notification of the For the last 5 months, you contribute 150% for

determination within 60 days after medical and dental coverage for you and your

it is granted and during the first 18 dependents if the disabled person is covered,

months of COBRA coverage**,†,†† otherwise 102%

You go on an approved nonmedical • You 3 months of continued active coverage, then

leave of absence†,†† • Your spouse or same- 21 months of COBRA coverage at 100%

gender domestic partner*

• Your dependent child*

You go on an approved Uniformed • You USERRA Continuation Coverage: 24 months

Services Employment and • Your spouse or same- provided your uniformed services leave

Reemployment Rights Act (USERRA) gender domestic partner* continues in accordance with USERRA; the

leave†† • Your dependent child* first 3 months of coverage are provided at the

Note: Coverage continuation during active contribution amount, with the remaining

USERRA leave is not considered COBRA 21 months at 100% of the active rate

coverage. However, your COBRA If your leave is associated with the

continuation period runs concurrently September 11, 2001, terrorist attacks on the

with your USERRA continuation period. United States or subsequent military action

related to those attacks, including the war

with Iraq, USERRA continuation coverage

is available for up to 60 months during a

temporary period. This coverage will be

continued at the active contribution level for

the duration of your uniformed services leave.

You go on an approved leave of • You Servicemember Family Leave Continuation

absence under the FMLA to care for • Your spouse or same- Coverage: 24 months provided your service

a family member injured in the line of gender domestic partner* family leave continues in accordance with

military duty (Servicemember Family • Your dependent child* the FMLA; the first 6 months of coverage are

Leave)‡ provided at the active contribution amount,

Note: Coverage continuation during with the remaining 18 months at 100% of the

Servicemember Family Leave is not active rate.

considered COBRA coverage. However,

your COBRA continuation period runs

concurrently with your Servicemember

Family Leave continuation period.



‡

Updated: January 2010

Health Care Plans | 2009 Edition | A86320W Coverage End Dates and Continuation of Coverage 6-7

COBRA Coverage Periods and Qualifying Events (continued)

Qualifying Event Qualified Beneficiaries Maximum Length of COBRA Coverage and

Cost of COBRA Coverage

You go on an approved union-related • You 3 months of continued active coverage, then

leave of absence†† • Your spouse or same- coverage will be continued at 100% for the

gender domestic partner* duration of your union-related leave

• Your dependent child*

* For more information, see “Secondary COBRA Qualifying Events,” in this section.

** A medical leave of absence is a leave that is due to an illness, an accidental injury (on or off the job), or a pregnancy-related condition. Two medical

leaves of absence that are separated by fewer than 30 days of continuous work are considered one leave of absence, unless the second leave is

entirely due to unrelated conditions.

†

The Family and Medical Leave Act of 1993 (FMLA) applies to family and medical leaves at locations with 50 or more employees within a 75-mile

radius. This Federal law requires that employees on family or medical leave have the same rights and privileges as do active employees. The

continuation rules and employee contributions generally are more generous than required by the law. However, in a situation where these rules do not

provide the required coverage, the Company will comply with Federal law.

††

Contact the Boeing Service Center through Boeing TotalAccess for information about medical, nonmedical, USERRA, and union leaves.



Note: If your qualifying event is the end of employment or a reduction of your hours of employment, and

you become entitled to Medicare benefits less than 18 months before the qualifying event, COBRA

continuation coverage for your dependents who lose coverage as a result of the qualifying event may

continue until 36 months after the date of your Medicare entitlement.

In addition, note that different rules apply when more than one qualifying event occurs. Contact the Boeing

Service Center through Boeing TotalAccess for additional information.

Secondary COBRA Qualifying Events‡

If your spouse or same-gender domestic partner or dependent child experiences a secondary COBRA

qualifying event during your 18- or 29-month COBRA period, he or she may continue COBRA coverage

for up to a total of 36 months from the date you lost active coverage because of termination of employment

or a reduction in your hours. During this extension period, COBRA coverage will cost 102 percent of the

cost of coverage.

A secondary COBRA qualifying event occurs when your dependent loses coverage because one of these

events occurs during your 18- or 29-month COBRA period:

• You die.

• You divorce, you become legally separated, or your domestic partnership is dissolved.

• Your dependent child loses eligibility under plan rules.

To qualify for this extended COBRA coverage, your dependent must be a “qualified beneficiary.” That is,

your dependent must have been covered while you were an active employee and continuously enrolled

under your COBRA coverage. If your child is born, adopted, or placed with you for adoption during your

period of COBRA coverage, he or she must have been enrolled within 120 days and continuously covered

since birth, adoption, or placement for adoption.









‡

Updated: January 2011

6-8 Coverage End Dates and Continuation of Coverage Health Care Plans | 2009 Edition | A86320W

When COBRA Coverage Ends

COBRA coverage ends on the earliest date in which any of the following events occurs:

• The 18-, 29-, or 36-month COBRA period expires.

• The Company no longer provides group health coverage to any employees.

• The COBRA coverage premium is not paid within 31 days of the due date (except during the initial

45-day grace period).

• You become covered, after electing COBRA coverage, under another group health plan that contains no

applicable exclusion or preexisting condition limit.

• The last day of the month following the month in which you receive a Social Security determination that

you no longer are disabled after your COBRA coverage has been extended beyond 18 months (but not

less than 31 days after you receive the determination).

• The last day of the month in which your dependent who is not a qualified beneficiary ceases to be an

eligible dependent as defined by the plan.

• You or your dependent becomes covered by Medicare (under Part A or Part B, with or without Part D) or

a Medicare Advantage plan after the date COBRA coverage is elected.

Once COBRA coverage ends, it cannot be reinstated.



What events must be reported?

You or your dependent must call the Boeing Service Center through Boeing TotalAccess when you or your

COBRA-covered dependent becomes covered under another group health plan or Medicare, when Social

Security disability benefits end, or when your dependent who is not a qualified beneficiary no longer meets the

plan’s eligibility requirements.







Convert Your Coverage to an Individual Policy

If medical coverage ends, you or your covered dependents may convert coverage to an individual group

medical conversion policy offered by the service representative for your medical plan, if available.

Individual policy benefits will not be the same as under this plan, however, so be sure to read the

application materials carefully.

To convert to an individual policy, complete a conversion application and submit it to the service

representative by the later of the following:

• 31 days after your Company-sponsored coverage ends.

• 31 days after the date the Boeing Service Center provides written notice of your conversion rights if

notice is sent within 90 days of the date your Company-sponsored coverage ends.

You will be billed for the applicable rate, which generally is higher than the group rate. Conversion

applications are available from the service representative.

No evidence of insurability will be required.

You or your covered dependents may be able to convert your COBRA coverage at the end of the 18-, 29-,

or 36-month COBRA coverage period.









Health Care Plans | 2009 Edition | A86320W Coverage End Dates and Continuation of Coverage 6-9

Plan Administration and Legal Rights Section 7

Your Rights and Responsibilities

What Rights You Have Under Federal Law

The Employee Retirement Income Security Act of 1974, as amended (ERISA), provides you with certain

rights and protections. These rights are explained here.

Receive Information About Your Plan and Benefits

You have the right to

• Examine, without charge, at the Plan Administrator’s office and other specified locations, such as work

sites and union halls, all documents governing the Plan, including insurance contracts and collective

bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with

the Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security

Administration.

• Obtain copies of documents governing Plan operation, including insurance contracts, collective bargaining

agreements, copies of the latest annual report (Form 5500 Series), and updated summary plan descriptions

by writing to the Plan Administrator. The Plan Administrator may charge you a reasonable fee for copies.

• Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to

furnish each participant with a copy of this summary annual report.

Continue Group Health Plan Coverage

You have the right to continue health care coverage for yourself, your spouse, your same-gender domestic

partner, or your dependents under the Plan if you lose coverage because of a qualifying event. You or your

dependents may have to pay for such coverage. This summary plan description and documents that govern

the Plan explain the rules for COBRA continuation coverage rights.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for Plan participants, ERISA imposes duties on the people who are

responsible for operating the Plan (known as fiduciaries).

The fiduciaries have a duty to operate the Plan prudently and in the interest of you and other Plan

participants and beneficiaries.

No one, including your employer, your union, or any other person, may fire you or otherwise

discriminate against you in any way to prevent you from obtaining a Plan benefit or exercising your

rights under ERISA.

Enforce Your Rights

If your eligibility or a Plan benefit claim is denied or ignored, in whole or in part, you have the right to

• Know why this was done.

• Obtain copies of documents relating to the decision without charge.

• Appeal any denial—all within certain time schedules. (See Section 5, “Claims and Appeals.”)

You can take steps to enforce your rights under ERISA. For instance

• If you request a copy of Plan documents or the latest annual report and you do not receive it within

30 days, you may file suit in Federal court. In such a case, the court may require the Plan Administrator

to provide the materials and pay you up to $110 a day until you receive them, unless the materials were

not sent because of reasons beyond the Plan Administrator’s control.

• If your eligibility or Plan benefit claim is denied or ignored, in whole or in part, you may file suit in state

or Federal court after you exhaust your appeal rights.

• In addition, if you disagree with the Plan’s decision or lack of decision concerning the qualified status of

a medical child support order, you may file suit in Federal court.



Health Care Plans | 2009 Edition | A86320W Plan Administration and Legal Rights 7-1

• If Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights,

you may seek assistance from the Department of Labor or you may file suit in Federal court.

The court will decide who should pay court costs and legal fees. If you are successful, the court may order

the person you have sued to pay these costs and fees; if you lose, the court may order you to pay these costs

and fees—for example, if it finds your claim is frivolous.

Receive Assistance With Your Questions

If you have any questions about

• Your Plan, contact the Plan Administrator.

• This statement or your rights under ERISA, or if you need assistance obtaining documents from the

Plan Administrator, contact the nearest office of the Employee Benefits Security Administration, U.S.

Department of Labor (see your telephone directory for the number), or write to

Division of Technical Assistance and Inquiries

Employee Benefits Security Administration

U.S. Department of Labor

200 Constitution Avenue NW

Washington, DC 20210

You also can obtain certain publications about your rights and responsibilities under ERISA from the

Employee Benefits Security Administration on the World Wide Web (http://askebsa.dol.gov/) or by calling

the hot line at 1-866-444-EBSA (1-866-444-3272).



Your Responsibilities Under the Plan

As a participant in the Plan, you must

• Submit any claim for Plan benefits in accordance with Plan rules.

• Inform the Boeing Service Center through Boeing TotalAccess of any change in

– Your marital or domestic partnership status.

– The status of your eligible children, as defined by Plan rules.

– Your address or the address of your eligible dependents.

• Provide any information or documentation requested by the Boeing Service Center, health plan service

representative, or Plan Administrator.

• Abide by Plan rules.





How the Plan Is Administered

The Boeing Company Board of Directors has designated the Employee Benefit Plans Committee

(“Committee”) to be the Plan Administrator. This Committee is composed of Company employees who are

appointed to their positions by the Board of Directors.



Plan Administrator’s Rights

Notwithstanding any other provision in the Plan, and to the full extent permitted under ERISA and the

Internal Revenue Code, the Plan Administrator has the exclusive right, power, and authority, in its sole and

absolute discretion, to

• Administer, apply, construe, and interpret the Plan and all related Plan documents.

• Decide all matters and questions arising in connection with entitlement to benefits and the nature, type,

form, amount, and duration of benefits.

• Amend the Plan.

• Establish rules and procedures to be followed by participants and beneficiaries in filing applications for

benefits and in other matters required to administer the Plan.

• Prescribe forms for filing benefit claims and for annual and other enrollment materials.

• Receive all applications for benefits and make all determinations of fact necessary to establish the right

of the applicant to benefits under the provisions of the Plan, including the amount of such benefits.





7-2 Plan Administration and Legal Rights Health Care Plans | 2009 Edition | A86320W

• Appoint accountants, attorneys, actuaries, consultants, and other persons (who may be employees of the

Company) for advice, counsel, and reports to make determinations of benefits or eligibility.

• Delegate its administrative duties and responsibilities to persons or entities of its choice such as the

Boeing Service Center, the service representatives, and employees of the Company.

All decisions that the Plan Administrator (or any duly authorized designees) makes with respect to any

matter arising under the Plan and any other Plan documents are final and binding. If any part of this Plan is

held to be invalid, the remaining provisions will continue in force.



Company’s Right to Amend, Modify, and Terminate the Plan

Although the Company currently intends to continue the Plan, the Company reserves the right to change,

modify, amend, or terminate the Plan at any time and for any reason for employees, former employees,

retirees, and their dependents. If the Plan is terminated and any Plan assets remain, they will be used to

pay Plan benefits and administrative expenses.

Any Plan assets that remain after all Plan obligations are met will revert to the Company to the extent

permitted under the applicable insurance contract or trust agreement. If the insurance contract or trust

agreement provides that Plan assets may not revert to the Company, remaining assets will be used to pay

other benefits as permitted under applicable law.



Who Pays for This Plan

Company contributions primarily pay the cost of coverage under this Plan. Employee contributions, if any,

pay a small portion of the cost of coverage and are determined by the provisions of the applicable collective

bargaining agreement. Employee contributions are fixed for each benefit year. You may obtain current

employee contribution information by visiting the Your Benefits Resources web site or calling the Boeing

Service Center through Boeing TotalAccess.

The Company pays the full cost of the Plan in excess of employee contributions, including any costs that

are higher or lower than expected. Any claims experience dividends, refunds, or other adjustments in

premiums, fees, or other Plan costs related to benefits provided under the Plan will be used to reduce the

amount of Company contributions.

How the VEBA Trust Fund Works

The Company has established a Voluntary Employees’ Beneficiary Association (VEBA) trust for The

Boeing Company Employee Health Benefit Plan (Plan 626). The VEBA trust is a tax-exempt trust that was

established solely to provide benefits to Plan participants as allowed under Federal law. All or part of your

health care benefits may be provided through this trust.

The VEBA trust holds Plan contributions, funds medical and dental benefits, and pays administrative

expenses authorized by the Plan Administrator. Assets that are held in the VEBA trust are considered Plan

assets and are protected under ERISA.

The Company may establish a minimum contribution to be made under the Plan for each year. There is no

assurance the Company will establish an annual minimum contribution. This minimum contribution will be

used to provide benefits and pay covered expenses under the Plan and trust. The Company will notify

participants each year that the Company commits to make a minimum contribution.

Necessary and proper covered expenses for Plan administration will be paid from VEBA trust assets,

except for covered expenses that the Company is required by law or chooses to pay.



How Benefits Are Paid

The service representatives administer benefit payments in accordance with the provisions of the

applicable administrative agreements and insurance contracts.

If a benefit is payable to a person who is legally disabled, incapacitated, or otherwise unable to manage his

or her affairs, the Plan Administrator, at its discretion, may direct payment of that benefit to another person,

including a guardian or legal representative of that person. If a payment is made under these circumstances,

the Committee and the Plan will have no further liability for that claim.





Health Care Plans | 2009 Edition | A86320W Plan Administration and Legal Rights 7-3

Right to Recover Overpayments

If an incorrect amount is paid to you or on your behalf, any remaining payments may be adjusted, including

withholding funds from future reimbursements, to correct the error. The Plan Administrator, Boeing

Service Center, and service representatives also may take other action that they determine is necessary or

appropriate to correct any such error.

Any employee who knowingly, and with intent to defraud or deceive, gives false, incomplete, or misleading

information during enrollment, when filing a claim, or in any other respect under this Plan may be subject

to discipline, up to and including discharge. The Plan reserves the right to recover from employees any

overpayment of claims or costs of coverage.

No Contract of Employment

Nothing in this Plan, including the receipt of benefits, is to be construed as a contract of employment, and

nothing in the Plan gives any employee the right to be retained in the employ of the Company or to

interfere with the rights of the Company to discharge any employee at any time.

Plan Information

Plan Document The Boeing Company Master Welfare Plan

Plan Name and Number The Boeing Company Employee Health Benefit Plan (Plan 626)

Plan Sponsor The Boeing Company

100 North Riverside

MC 5002-8421

Chicago, IL 60606-1596

Employer Identification Number 91-0425694

Plan Year Calendar-year basis (January 1 through December 31)

Plan Administrator Employee Benefit Plans Committee

100 North Riverside

MC 5002-8421

Chicago, IL 60606-1596

312-544-2297

Agent for Service of Legal Process Employee Benefit Plans Committee

The Boeing Company

c/o United States Corporation Company of Illinois

33 North La Salle Street

Chicago, IL 60602

Legal process also may be served on the Plan Trustee or Plan Administrator

Type of Plan Health and welfare benefit plan that provides medical and dental benefits

Type of Administration This Plan is administered according to the terms of the applicable

administrative agreements and insurance contracts with the service

representatives for each benefit coverage

Collective Bargaining Agreement The Plan is maintained pursuant to collective bargaining agreements; a

copy of such agreement or agreements may be obtained by participants and

beneficiaries upon written request to the Plan Administrator and is available

for examination by participants and beneficiaries

Contributions Employer and employee contributions, as applicable, based on the collective

bargaining agreements

Funding The Boeing Company VEBA Master Trust

Plan Trustee JPMorgan Chase Bank

c/o Global Investor Services

3 MetroTech Center, Fifth Floor

Brooklyn, NY 11245

718-242-1857

Claim Administrators Various health insurance issuers (called service representatives); see Section 9





7-4 Plan Administration and Legal Rights Health Care Plans | 2009 Edition | A86320W

Other Groups That the Plan Covers

The Boeing Company Employee Health Benefit Plan (Plan 626) includes other medical and dental benefit

plans. Those plans provide benefits—which differ from those described in this booklet—for the following

employee groups:

Certain nonunion employees of the Company

Autometric, Inc. and Affiliated Companies

The Boeing Company

Eligible employees of the Company who are represented by

International Association of Fire-Fighters

Local No. I-17

International Association of Firefighters, AFL-CIO

Local No. I-66 (Washington)

Local No. I-66 (Kansas)

International Association of Machinists and Aerospace Workers, AFL-CIO

Aerospace Industrial District Lodge No. 751

District Lodge No. 24

District Lodge No. 70

Space and Rocket City Lodge No. 2766

International Brotherhood of Electrical Workers, AFL-CIO

Local No. 271

International Brotherhood of Teamsters

Local No. 174

Local No. 795

International Union of Operating Engineers

Local No. 286

Local No. 286W

International Union, Security, Police and Fire Professionals of America and Certain Affiliated

Amalgamated Locals

Local No. 2

Local No. 5

Local No. 255

International Union, United Automobile, Aerospace and Agricultural Implement Workers of America

Local No. 1069

Society of Professional Engineering Employees in Aerospace

Wichita Engineering Unit

The employee groups participating in Plan 626 change from time to time. You may obtain an updated list

by contacting the Plan Administrator.









Health Care Plans | 2009 Edition | A86320W Plan Administration and Legal Rights 7-5

Definitions Section 8

annual deductible

The amount of money that you pay for covered services and supplies before your plan begins to pay for

covered expenses. The annual deductible does not apply to some services and supplies, as described in

applicable sections.

annual enrollment period

A period of time designated by the Company each year when you may add or change your benefit elections

for yourself and/or your eligible dependents.

benefit year

The 12-month period that each plan uses to calculate the annual deductible, annual out-of-pocket

maximum, and other benefit limits. The benefit year for this health care plan is July 1, 2009, through

December 31, 2009. Beginning January 1, 2010, the benefit year for this health care plan is January 1

through December 31.

CCP

See coordinated care plan (CCP).

COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.

coinsurance

The percentage of the covered charge that you and the plan each pay.

Company-sponsored plan

A group health care plan provided by the Company (or a subsidiary or affiliate) for employees and

dependents. This includes the plans described in this booklet. (To find out whether a particular plan is

sponsored by the Company, contact the Boeing Service Center through Boeing TotalAccess.)

coordinated care plan (CCP)

A type of medical plan, as described in “Medical Plan Options,” in Section 1.

copayment

A fixed dollar amount that you pay toward the cost of a particular covered service such as a network office

visit. You generally pay the copayment at the time the service is received.

covered charge

The provider’s charge for a covered service or supply, up to the service representative’s maximum

allowance. The amount of the covered charge depends on whether you see a network provider or

nonnetwork provider.

• For a network provider, the service representative determines the amount of the covered charge for a

particular service or supply under any applicable agreement between the service representative and the

provider.

• For a nonnetwork provider, the covered charge is based on the usual and customary charge for the

covered service or supply. This plan does not recognize any portion of a provider’s charge that exceeds

the usual and customary charge; you are responsible for these excess charges.

covered dependent

Your spouse, same-gender domestic partner, or child who has met the eligibility conditions for the plan and

who is currently enrolled in the plan.

covered service

Any medically necessary treatment, procedure, or supply that the plan will accept for payment under terms

of the plan, subject to any deductible, coinsurance, copayment, or payment limitation of the plan.



Health Care Plans | 2009 Edition | A86320W Definitions 8-1

dentist

A legally qualified dentist who is practicing within the scope of his or her license.

dependent

See eligible dependent and covered dependent.

EAP

See Employee Assistance Program.

eligible dependent

Your spouse, same-gender domestic partner, or child who has met the eligibility conditions for enrollment

in this plan, as described in Section 1.

eligible employee

An employee who qualifies for benefits under the plan by meeting the conditions described in Section 1.

emergency

The sudden, unexpected onset of serious illness or severe injury that could result in (or a prudent person

would have reason to believe could result in) death, permanent damage to or impairment of bodily function,

or loss of limb use if not treated immediately.

For mental health coverage, a situation also is considered an emergency when there is imminent danger to

yourself or others, or you are medically compromised as a result of mental illness or substance abuse.

Employee Assistance Program (EAP)

A counseling and consultation service, available to certain employee groups, that can help you or your

covered dependents address personal issues and concerns on a confidential basis. The role of the EAP is to

provide initial assessment, referrals, and short-term therapy. EAP counselors can help you identify your

problem, develop a plan of action, and locate the right professionals for ongoing care, if needed.

EPO

See exclusive provider organization (EPO).

ERISA

The Employee Retirement Income Security Act of 1974, as amended.

exclusive provider organization (EPO)

A type of medical plan, as described in “Medical Plan Options,” in Section 1.

experimental or investigational service or supply

For the Traditional Medical Plan, a service or supply that meets at least one of these criteria. The service or

supply

• Requires approval by the U.S. Food and Drug Administration or other government agency that has not

been granted when the service or supply is ordered.

• Has been classified by the national Blue Cross and Blue Shield Association as experimental or

investigational.

• Is under clinical investigation by health professionals.

• Is not generally recognized by the medical profession as tested and accepted medical practice.

However, a service or supply will not be considered experimental or investigational if it is part

of an approved clinical trial. An approved clinical trial is one that meets all criteria in either

Category 1 or 2 below.

Category 1:

The trial has been approved by the National Institutes of Health, Food and Drug Administration,

Department of Veterans Affairs, or a research center approved by the plan’s service representative.

• The trial has been reviewed and approved by a qualified institutional review board.

• The facility and personnel have sufficient experience or training to provide the treatment or

use the supplies.



8-2 Definitions Health Care Plans | 2009 Edition | A86320W

Category 2:

• The trial is to treat a condition that is too rare to qualify for approval under Category 1.

• The trial has been reviewed and approved by a qualified institutional review board.

• The facility and personnel have sufficient experience or training to provide the treatment or

use the supplies.

• Available clinical or preclinical data provide reasonable expectation that the trial treatment will be at

least as effective as noninvestigational therapy.

• There is no therapy clearly superior to the trial treatment.

explanation of benefits

A statement from a health care service representative that lists which services and supplies the plan

covered, how much it paid toward those services and supplies, and any amount for which you may be

responsible. This statement also provides notice when a benefit is denied and when additional information

is needed to process a claim.

health care

A general term that means both medical and dental care (for purposes of the descriptions in this booklet).

health maintenance organization (HMO)

A type of medical plan, as described in “Medical Plan Options,” in Section 1.

HMO

See health maintenance organization (HMO).

licensed professional

For the Preferred Dental Plan, an individual legally authorized to perform services as defined in his or her

license, including, but not limited to, denturist, hygienist, and radiology technician.

maximum allowable fee (Preferred Dental Plan)

The maximum dollar amount that will be allowed toward reimbursement for any service provided for a

covered dental benefit.

medically necessary service or supply

A service or supply that meets the following criteria in accordance with the plan and as determined by the

service representative. A service or supply is medically necessary if it is

• Required to diagnose or treat the patient’s illness, injury, or condition and the condition could not have

been diagnosed or treated without it.

• Consistent with the symptom or diagnosis and the treatment of the condition.

• The most appropriate service or supply that is essential to the patient’s needs.

• Appropriate as good medical practice.

• Professionally and broadly accepted as the usual, customary, and effective means of diagnosing or

treating the illness, injury, or condition.

• Unable to be provided safely to the patient as an outpatient (for an inpatient service or supply).

A service or supply may be medically necessary in part only. The fact the service or supply is furnished,

prescribed, recommended, or approved by a physician does not, by itself, make it medically necessary.

mental illness

A disorder (including an eating disorder) that exhibits signs, symptoms, history, and other characteristics

congruent with those required for a mental disorder diagnosis in the Diagnostic and Statistical Manual of

Mental Disorders, 4th edition (DSM-IV).

network provider

Any health care professional, institution, facility, agency, or other provider that has a contract with a service

representative to provide services at negotiated rates.







Health Care Plans | 2009 Edition | A86320W Definitions 8-3

nonnetwork provider

Any health care professional, institution, facility, agency, or other provider that does not have a contract

with a service representative to provide services at negotiated rates.

nonparticipating pharmacy

A retail pharmacy that does not have a contract with the service representative to provide prescription drugs

at discounted prices.

nurse

A person duly licensed as a registered nurse (R.N.) in the area where his or her services are performed who

is practicing within the scope of such license.

participant

Any eligible employee or eligible dependent who has fulfilled the requirements for participation described

in Section 1, who continues to fulfill these eligibility requirements, and who has not terminated

participation in the plan.

participating pharmacy

A retail pharmacy that participates in the service representative’s network of pharmacies to provide

prescription drugs at negotiated, discounted prices.

PCP

See primary care provider (PCP).

physician

A person licensed as a medical physician (M.D.) or physician of osteopathy (D.O.) who is duly licensed to

prescribe and administer all drugs and to perform surgery.

plan benefit

The portion of the covered charge that the plan pays.

prepaid dental plan

A Company-sponsored dental plan that provides dental care through a network of dentists. This plan

requires participants to select a primary care provider in advance and receive covered services (other than

orthodontia) through that dentist.

primary care provider (PCP)

A physician or other medical professional who serves as a first point of contact within the plan’s network of

contracted physicians, hospitals, and other medical specialists. This physician or medical professional is

referred to as a primary care provider, and he or she coordinates all care and referrals for you within a

plan’s network.

principal support

Refers to you and/or your current or former spouse providing more than half the financial support for your

child. (In determining this, you can exclude any scholarships for study at a regular educational institution

unless the child is not your natural child, adopted child, or stepchild.) In most cases, if you claim the child

as a dependent on your annual Federal taxes, then you provide principal support for the purposes of

eligibility for these plans.

If you have never been married to the other parent of your child, then you must provide more than half the

support for your child, regardless of the other parent’s support. If you are divorced from the other parent of

your child, special rules apply; contact your tax adviser. You also may want to review Internal Revenue

Service Publication 502, Medical and Dental Expenses.

provider

A general term for a physician, hospital, health care facility, dentist, or other medical professional or

specialist that delivers health care treatment and/or services within the scope of his or her license.









8-4 Definitions Health Care Plans | 2009 Edition | A86320W

psychologist

A person duly licensed as a clinical psychologist in the area where his or her services are performed who is

practicing within the scope of such license.

service area

The geographical area designated by the Plan that determines eligibility for a health care plan and the

network level of coverage.

service representative

An agent that the Company has contracted with to make benefit determinations and administer benefit

payments under the plans described in this booklet. See Section 9 for a list of service representatives.

The Company may change a service representative at any time.

substance abuse

An alcohol- or drug-related disorder that exhibits signs, symptoms, history, and other characteristics

congruent with those required for a substance-related disorder diagnosis in the Diagnostic and Statistical

Manual of Mental Disorders, 4th edition (DSM-IV).

usual and customary charge (Traditional Medical Plan)

The maximum charge for a covered service or supply the service representative will consider for

reimbursement from a nonnetwork provider. The service representative may refer to this as the “maximum

reimbursable charge,” “maximum allowable charge,” “reasonable and customary charge,” “allowed

amount,” or a similar term.

The usual and customary charge is the least of

• The provider’s actual charge for the service or supply,

• The provider’s normal charge for a similar service or supply, or

• A predetermined percentile (negotiated between each carrier and plan sponsor) of charges made by

providers of a comparable service or supply in the geographic area where it is received.

To determine if a charge exceeds the usual and customary charge for medical services or supplies in

situations involving unusual or complicated services or supplies, the nature and severity of the injury or

sickness may be considered.

The service representative uses a database of provider charges to determine the usual and customary charge

in an area. Information about the database and percentile used to determine the usual and customary charge

can be obtained by contacting the service representative.

If you use a nonnetwork provider, you pay any charges above the usual and customary amount.

usual and customary charge (Scheduled Dental Plan)

The maximum charge for a covered service or supply the service representative will consider for

reimbursement from a nonnetwork provider. The service representative refers to this as the “maximum

allowable fee.”

The usual and customary charge is the lesser of

• The provider’s actual charge for the service or supply, or

• The provider’s filed fee for the service or supply or, in the absence of a filed fee, the service

representative’s predetermined maximum allowable fee for the service or supply based on factors

including the provider’s contracting status and charges made by other providers in the geographic area

where it is received.

Information about the method of determining the maximum allowable fee can be obtained by contacting

the service representative.

If you use a nonnetwork provider, you pay any charges above the usual and customary amount.









Health Care Plans | 2009 Edition | A86320W Definitions 8-5

Contacts Section 9

Where to Get More Information*

If you have questions about . . . Contact . . . At . . .

Eligibility and enrollment for all Boeing Service Center for Web site: Your Benefits Resources, through Boeing

medical and dental plans Health and Insurance Plans TotalAccess

• Medical and dental plan • Boeing Web: https://my.boeing.com

options • World Wide Web: www.boeing.com/express

• Plan comparisons Telephone: through Boeing TotalAccess

• Cost of coverage • General: 1-866-473-2016

• Network providers • TTY/TDD: 1-800-755-6363

• Boeing TotalAccess hours of service

– Automated telephone system: self-service

applications are available 24 hours a day, seven

days a week

– Representatives available Monday through Friday

from 7 a.m. to 8 p.m. Central time

You must have your BEMS ID number (or Social

Security number) and Boeing TotalAccess password

to use Boeing TotalAccess on the World Wide Web or

by telephone

Mailing address: 100 Half Day Road

P.O. Box 1466

Lincolnshire, IL 60069-1466

COBRA information for all Boeing Service Center for Same as for eligibility and enrollment, above

medical and dental plans Health and Insurance Plans

• Notification of COBRA event

• Enrollment in COBRA coverage

• COBRA payments

Health and wellness information BoeingWellness, the Web site: www.boeingwellness.com

• Resources for medical Boeing-Mayo Clinic site

conditions and treatments

• Information on drugs and

supplements

• Health programs

• Work site programs

Case management* OptumHealth Telephone: 1-866-203-9167

Mailing address: 300 One Market Pointe Drive

Suite 110

Bloomington, MN 55435-MN045









*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Contacts 9-1

Where to Get More Information (continued)**

If you have questions about . . . Contact . . . At . . .

Traditional Medical Plan BlueCross BlueShield of Telephone:

• Medical coverage Illinois (BCBSIL) • Through Boeing TotalAccess (above) or direct:

• Precertification 1-888-802-8776

• Medical claims • Network provider information:

• Customer service 1-800-810-2583

• Medical ID cards and • Medical review program:

replacement cards 1-800-981-3546

Mailing address: P.O. Box 805107

Chicago, IL 60680-4112

Web site: www.bcbsil.com/boeing

Mental health and substance ValueOptions Telephone: 1-800-892-1411

abuse program for Traditional (Boeing Helpline) TTY/TDD: 1-800-855-2880

Medical Plan participants Clinical Appeals: P.O. Box 6065

• Coverage Cypress, CA 90630

• Referrals Administrative Appeals:

• Claims P.O. Box 1290

• Customer service Latham, NY 12110

Web site: www.valueoptions.com

Prescription drug program for Medco Health Solutions, Telephone: 1-800-841-2797

Traditional Medical Plan, Inc. Mailing addresses:

Selections Plan (Washington), • Appeals: Medco Health Appeals

Selections Plus Plan (Oregon and Attn: Appeals

Kansas) participants* 8111 Royal Ridge Parkway

• Participating pharmacies Irving, TX 75063

• Claims • Retail pharmacy:

• Mail-order prescriptions P.O. Box 14711

• Refills Lexington, KY 40512

• Mail-order (Medco By Mail):

P.O. Box 650022

Dallas, TX 75265-0022

Web site: www.medco.com

Vision care program for Vision Service Plan (VSP) Telephone: 1-800-877-7195

Traditional Medical Plan Mailing addresses:

participants • Claims: P.O. Box 997105

• Coverage Sacramento, CA 95899-7105

• Claims • Appeals: VSP Member Appeals

• Customer service 3333 Quality Drive

Rancho Cordova, CA 95670

Web site: www.vsp.com









*Updated: January 2010

**Updated: January 2011

9-2 Contacts Health Care Plans | 2009 Edition | A86320W

Where to Get More Information (continued)*

If you have questions about . . . Contact . . . At . . .

PPO+Account Aetna Telephone: 1-800-221-7371

• Medical coverage Mailing addresses:

• Mental health and substance • Claims: Aetna Claims

abuse coverage P.O. Box 14089

• Precertification Lexington, KY 40512-4089

• Prescription drug coverage • Appeals: Aetna

• Medical claims Attn: National Account CRT

P.O. Box 14463

• Customer service

Lexington, KY 40512-4463

• Medical cards and

replacement cards Web site: www.aetna.com

• Health Savings Account

CCP/HMO plans/EPO plan Select Network Plan EPO Telephone: 1-888-802-8766

• Medical coverage Available in Washington Mailing address: P.O. Box 805107

• Precertification Chicago, IL 60680-4112

• Medical claims Web site: www.bcbsil.com/boeing

• Prescription drug coverage

Selections Plus CCP Telephone: 1-888-802-8766

and claims

Available in Oregon Mailing address: P.O. Box 805107

• Vision coverage and claims

(Portland area) Chicago, IL 60680-4112

• Customer service

Web site: www.bcbsil.com/boeing

• Medical ID cards and

replacement cards Group Health Cooperative Telephone: 206-901-4636 or 1-888-901-4636

HMO Mailing addresses:

Available in Washington • Claims: P.O. Box 34585

Seattle, WA 98124

• Appeals: P.O. Box 34593

Seattle, WA 98124

Web site: www.ghc.org

Kaiser Permanente HMO Telephone: 1-800-464-4000

Available in California Mailing address: P.O. Box 7102

Pasadena, CA 91109-7102

Web site: www.kaiserpermanente.org

Select Health HMO Telephone: 1-800-538-5038

Available in Utah Mailing address: P.O. Box 30192

Salt Lake City, UT 84130-0192

Web site: www.selecthealth.org

Kaiser Permanente HMO Telephone: 1-800-813-2000

Available in Oregon Mailing address: Kaiser Northwest

(Portland area) 500 NE Multnomah Street

Suite 100

Portland, OR 97232

Web site: www.kaiserpermanente.org









*Updated: January 2011

Health Care Plans | 2009 Edition | A86320W Contacts 9-3

Where to Get More Information (continued)

If you have questions about . . . Contact . . . At . . .

Preferred Dental Plan Washington Dental Service Telephone: 1-877-521-2101

• Dental coverage Available in all locations Mailing addresses:

• Predetermination • Claims: P.O. Box 75983

• Dental claims Seattle, WA 98175-0983

• Customer service • Appeals: Attn: Claim Appeal Representation

9706 Fourth Avenue NE

Seattle, WA 98115

Web site: www.deltadentalwa.com/boeing

Scheduled Dental Plan Aetna Life Insurance Telephone: 1-800-221-7371

• Dental coverage Company Mailing address: P.O. Box 14089

• Predetermination Available in all locations Lexington, KY 40512-4089

• Dental claims

• Customer service

Prepaid dental plan DeltaCare Telephone: 1-877-289-5114

• Dental coverage Available in Oregon and Mailing address: Delta Dental/Washington

• Predetermination Washington Dental Service

• Dental claims P.O. Box 75983

• Customer service Seattle, WA 98175-0983

• Dental ID cards and Web site: www.deltadentalwa.com/boeing

replacement cards









9-4 Contacts Health Care Plans | 2009 Edition | A86320W