Read 255172-United Health Care text version

Total Compensation

UnitedHealthcare Coordinated Care Plan

Supplement to the Health Care Plans Your Health and Welfare Plans

Nonrepresented Salaried Employees / 2000 Edition

Health and Welfare

Plan Highlights

This description of the UnitedHealthcare coordinated care plan and accompanying mental health and chemical dependency, prescription drug, and vision care programs, is a supplement to the current edition Health Care Plans booklet for nonrepresented salaried employees of The Boeing Company. Under the UnitedHealthcare coordinated care plan, you may choose any legally qualified physician or hospital each time you need health care services. However, when you have your network primary care physician coordinate your care, you receive the highest benefits under the plan. The plan is available to you if you live in the network service area (St. Louis and the surrounding counties). Refer to your Health Care Plans booklet for information regarding · Eligibility and enrollment provisions, including contribution information. · Termination of coverage provisions. · Special disclosure and other general plan information.

This supplement and the current edition Health Care Plans booklet for nonrepresented salaried employees comprise the plan document and the summary plan description for the UnitedHealthcare coordinated care plan and accompanying mental health and chemical dependency, prescription drug, and vision care programs.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition 1

Table of Contents

UnitedHealthcare Coordinated Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . Network Service Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Your Primary Care Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Using Your Primary Care Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referrals for Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7 7 7 7

When a Referral Is Not Required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 How Medical Expenses Are Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Network Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Nonnetwork Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Coverage for a Child Who Does Not Reside With You . . . . . . . . . . . . . . . . . 9 Coverage When You Are Traveling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Network Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Payment Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Copayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Annual Copayment Maximum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Lifetime Maximum Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Covered Network Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Preventive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Physician Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Hospital Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Emergency/Urgent Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Hospital Alternatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Medical Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 How to File a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Nonnetwork Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Payment Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Calendar Year Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Coinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Stop-Loss Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Lifetime Maximum Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Other Health Care Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Reasonable and Customary Allowances. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Advance Estimate of Reasonable and Customary Allowance . . . . . . . 16 Special Provisions for Nonnetwork Care . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Preadmission Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Continued Stay Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Medical Case Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Covered Nonnetwork Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . 18 Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Christian Science Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition 3

Emergency Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to File a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noncovered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Assessment/Referral Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Payment Provisions With Assessment/Referral . . . . . . . . . . . . . . . . . . . . . . . . . Payment Provisions Without Assessment/Referral . . . . . . . . . . . . . . . . . . . . . . . Calendar Year Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Coinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental Health Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chemical Dependency Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lifetime Limit for Chemical Dependency Treatment . . . . . . . . . . . . . . . . . . . . . How to File a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maximum Quantity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to Fill a Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Local Participating Pharmacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nonparticipating Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ordering Drugs by Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preauthorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Voluntary Formulary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Covered Drugs and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noncovered Drugs and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 18 18 19 22 22 22 23 23 23 23 23 24 25 25 25 25 25 26 26 26 27 27 27

Mental Health and Chemical Dependency Program . . . . . . . . . . . . . . . . . . . 22

Prescription Drug Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Vision Care Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 How to Get Vision Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Avesis Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-Avesis Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Ways to Get Vision Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noncovered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29 29 29 31

Review, Appeal, and Accelerated Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Claim Review and Appeal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Accelerated Appeal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UnitedHealthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ValueOptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Merck-Medco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Avesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eligibility Review and Appeal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33 33 33 34 34 35

4

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Coordination of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Exhibits

Exhibit 1: Vision Benefits Payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Exhibit 2: Where to Get Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

5

6

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

UnitedHealthcare Coordinated Care Plan

The UnitedHealthcare coordinated care plan is offered to employees who live in the network service area. Under this plan, you may choose any legally qualified physician or hospital each time you need health care services. You may · Use a primary care physician from the plan's network to coordinate all of your medical care, or · Make your own arrangements for medical care without going through your primary care physician. UnitedHealthcare is the service representative for this coordinated care plan. Boeing may change the service representative at any time.

Network Service Area

The plan's network service area is St. Louis and the surrounding counties. The personalized Enrollment Worksheet you receive from the Boeing Service Center as a newly eligible employee or during the annual enrollment period will indicate whether you live within the network service area and are eligible to enroll in the plan.

Your Primary Care Physician

When you enroll in this plan, you must choose a primary care physician from the list of network physicians (internists, family practice or general practice physicians, or pediatricians). You may not choose a specialist as a primary care physician. You may have one primary care physician for all family members or different primary care physicians for each family member. Call the service representative or the Boeing Service Center for specific rules regarding the selection of primary care physicians for family members. Exhibit 2 on page 42 lists the telephone numbers for the service representative and the Boeing Service Center.

Using Your Primary Care Physician

If you have all medical care coordinated through your primary care physician and you use network providers, the plan will pay the greatest level of benefits. Here is some other information you need to know about primary care physicians: · Your primary care physician is required to obtain approval from the service representative before providing or authorizing certain services such as surgery and inpatient hospital care. · Services that the plan limits or excludes are limited or excluded even if your primary care physician recommends them.

Referrals for Treatment

When your primary care physician determines you need the services of a specialist, he or she will issue a referral to the specialist. The referral will authorize the number of visits you may schedule within a specific period of time. Although some primary care physicians may make a referral by telephone, generally it will be on a written form provided by the plan's service representative with copies for the specialist, the service representative, and you.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

7

For certain ongoing treatment, such as prenatal and postnatal visits, allergy shots, some cancer therapy, and dialysis, your primary care physician may issue a referral for a longer period of time. You need to know the following additional information about referrals: · If your primary care physician is a member of an association of private practice physicians, a physician's hospital organization, or a member of a physician's group practice, you may be required to receive care from specialists who belong to the same association or medical group. Your provider directory will indicate primary care physicians who belong to such a group. · For some types of specialty care, your primary care physician may be required to make referrals only to certain providers in the plan's network. For example, only certain hospitals within the plan's network are authorized to perform transplants. · In some cases, your primary care physician's referral may require approval from the plan's service representative or from the association or medical group to which the primary care physician belongs. · If your primary care physician refers you to a specialist who is not in the network, the primary care physician must have approval from the service representative. The plan's service representative can give you more information about any of these situations.

When a Referral Is Not Required

You are not required to obtain a referral from your primary care physician for · An annual well-woman exam, but you must select an obstetrician/gynecologist from the plan's network, and in some cases, from the same medical group as your primary care physician. · Up to 15 chiropractic care visits in a calendar year (but you must select a chiropractor from the plan's chiropractic network). · Emergency care. You also do not need a referral from your primary care physician for mental health and chemical dependency care or routine vision care. These services are covered under separate programs and are discussed in other sections of this supplement.

How Medical Expenses Are Paid

Network Benefits

The plan pays the greatest level of benefits (100 percent after applicable copayments) when you obtain covered medical services and supplies through your primary care physician and you use network providers. Additional network payment provisions and network benefits are described beginning on page 9. Occasionally, a primary care physician might recommend services or supplies that the plan does not cover. The plan will not pay for such services or supplies, even if your primary care physician recommends them. Certain services are covered only with prior plan approval or when you use network providers specified by the plan. If your primary care physician coordinates your care and refers you to nonnetwork providers after receiving prior approval from the plan, benefits will be paid at the network payment level.

Nonnetwork Benefits

If you live in the network service area and obtain covered medical services or supplies from network or nonnetwork providers without going through your primary care physician, or if you fail to notify your primary care physician as required in connection with emergency treatment, your benefit coverage will be much lower. In general, the plan pays 60 percent of reasonable and customary charges after you pay a $500 calendar year deductible per person. Additional nonnetwork payment provisions and nonnetwork benefits are described beginning on page 14.

8 UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Coverage for a Child Who Does Not Reside With You

If your dependent child lives away from home (for example, your child boards at college or lives with your former spouse), contact the service representative for information about available coverage. (See Exhibit 2 on page 42 for the service representative's telephone number.)

Coverage When You Are Traveling

The plan covers treatment for illnesses or injuries that occur while you are traveling (business or personal) outside the network service area. If you or a dependent will be out of the network service area for an extended period of time, check with the Boeing Service Center to see what options are available to you for continuing care. In a medical emergency, get treatment as soon as possible, just as you would if you were in the network service area. Then call your primary care physician as instructed on your health care identification card. For an unexpected urgent need that is not an emergency, call your primary care physician or other appropriate number on your health care identification card. The plan will not reimburse nonemergency services if you do not call and get approval before incurring an expense. The treating physician or hospital may require you to pay at the time of the service. If so, add your Social Security number to the bill for proper identification, and then send the bill to the service representative at the address on your health care identification card with a note to explain the circumstances. If you used an emergency room, it is helpful to send a copy of the emergency room report. You do not need a claim form. If you are sent on a business trip of more than 90 days, contact UnitedHealthcare to see what options are available to you for continuing care. (See Exhibit 2 on page 42 for UnitedHealthcare's telephone number.)

Network Benefits

Payment Provisions

When you obtain health care services through your primary care physician or as otherwise required by the plan for network benefits, benefits are generally paid at 100 percent after the applicable copayments, as described below.

Copayments

For covered medical expenses, you pay the following copayments: · $10 copayment per office visit to a primary care physician. (The office visit copayment does not apply if the sole purpose of a visit is to receive the preventive care services described on page 10.) · $10 copayment per office visit to a specialist when referred by your primary care physician. There are two exceptions: · For pregnancy, you pay a copayment for the first prenatal visit. The plan covers in full all other prenatal and postnatal visits for that pregnancy. If you change physicians during the term of the pregnancy, you must pay a copayment for the first visit to the new physician. · You do not pay the office visit copayment if the sole purpose of a visit is to receive an allergy shot. · $50 copayment for treatment of an emergency illness or injury in an emergency room. If the patient is admitted to the hospital as an inpatient from the emergency room, the $50 copayment does not apply. The plan will pay nonnetwork benefits if the illness or injury is not a true emergency. (See the definition of "emergency" on page 39.) All of the above copayments are on a per patient, per visit basis. For example, if you take two children for an office visit to a pediatrician, you pay a $10 copayment for each child.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition 9

Different payment provisions apply to mental health and chemical dependency services, prescription drugs, and vision care services, as described in other sections of this supplement.

Annual Copayment Maximum

Your copayments for covered expenses in a calendar year will not be more than · $750 for one person, or · $1,500 for a family. The service representative does not keep a cumulative total of the copayments you make for network services in a calendar year. Although it is unlikely you would reach the copayment maximum in a calendar year, you should keep your own records of the copayments you make for yourself and each family member. If you reach the individual or family copayment maximum, notify the service representative. After verifying the information, the plan will pay 100 percent of covered medical expenses obtained through the primary care physician or as otherwise required by the plan for the rest of the calendar year for you or your family. Amounts you pay for mental health and chemical dependency, prescription drugs, vision care, and dental care do not count toward your annual copayment maximum under this plan.

Lifetime Maximum Benefit

There is no lifetime maximum benefit for services obtained in and through the network.

Covered Network Services and Supplies

The plan pays benefits for the following preventive care services and supplies and for the medically necessary treatment of illness, injury, and pregnancy, when obtained according to plan provisions. The exclusions listed under "Noncovered Services and Supplies," beginning on page 19, apply to network benefits.

Preventive Care

With the exception of an annual well-woman exam, all preventive care services must be obtained through your network primary care physician. Your primary care physician will advise you of the preventive care services that are medically indicated for you based on your age, sex, and medical history. Generally, the following services are available: · Pediatric examinations and well-baby care. · Immunizations in accordance with accepted medical practice. (The plan does not pay for immunizations required or recommended by third parties for employment, flight clearance, summer camp, insurance, foreign travel, and so forth.) · Health assessments and examinations. · Periodic mammograms. · Well-woman exam. Once each calendar year, the plan allows a woman to obtain a well-woman exam from a network obstetrician/gynecologist with no referral from her primary care physician. Refer to your provider directory or call the service representative to determine whether you must select your obstetrician/gynecologist from your primary care physician's association or medical group. · Vision screening from an ophthalmologist or optometrist (except eye refraction exams that are covered under the vision care program described beginning on page 29).

Physician Services

The plan covers the services of a licensed physician for the medically necessary diagnosis or treatment of nonoccupational accidental injuries, illnesses, or other covered conditions.

10

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Physician services also are covered for · Preventive care, as described on page 10. · Injectable legend drugs administered in a physician's office that are used to treat a covered condition. (Preventive injections and immunizations are not covered except as noted under the preventive care benefit described on page 10.) Medical devices (including contraceptive injections, devices, and implants) dispensed by a physician are covered. · An eye examination (including refraction) if performed because of another medical condition such as diabetes, glaucoma, or cataracts. (Routine eye examinations are covered under the vision care program described beginning on page 29.)

Hospital Services and Supplies

The plan covers the following inpatient hospital services and supplies: · Room and board for services provided in a ward, semiprivate room, operating room, intensive care unit, or other special care unit. · Professional services including services of attending physicians, anesthesiologists, pathologists, radiologists, and nurses. Private duty nursing is covered only when approved by the plan's service representative in advance. · Supplies for treatment, including whole blood or blood components, oxygen, ordinary casts, splints, dressings, and prescription drugs and medicines used while in the hospital. Following childbirth, mothers and newborns may stay in the hospital for 48 hours following a normal delivery or for 96 hours following a cesarean section, unless a shorter stay is authorized by the attending health care provider in consultation with the mother.

Emergency/Urgent Care

Emergency Care--The plan covers emergency treatment under network benefit provisions no matter when or where the emergency occurs and whether or not you use a network hospital, provided you call your primary care physician as described below. See page 39 for the definition of an emergency. Some examples of medical emergencies are · Severe shortness of breath. · Pain or severe squeezing sensation in the chest. · Sudden paralysis or slurred speech. · Seizure or loss of consciousness. · Convulsions. · Poisoning or suspected overdose of medication. · Broken bone. · Severe burn. · Extreme bleeding. · Severe cut. In an emergency, take whatever action is required to obtain medical care. If the circumstances allow you to call your primary care physician first, do so. If you cannot call your primary care physician in advance, call 911 (or your local number for emergency medical assistance if 911 is not available in your area) or take the patient to the nearest emergency room. After the patient is stabilized, call your primary care physician as directed on your health care identification card. If you obtain medical treatment for an illness or injury that is not an emergency without a referral or authorization from your primary care physician, you must pay for the services and file a claim for reimbursement under the nonnetwork payment provisions.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

11

Urgent Care--Examples of medical conditions that may require urgent care, but not emergency care are · High fever. · Severe vomiting. · Intense pain. · Sprains. When the need for care is urgent, call your primary care physician or the number on your health care identification card before receiving care. Your physician may suggest you go to his or her office, an urgent care facility, or an emergency room. These same guidelines apply if you are out of the network service area.

Hospital Alternatives

The plan covers the following hospital alternatives: · Convalescent and long-term illness care facility services. · Home health care services including skilled nursing care and other services provided by a network home health care agency (excluding custodial services such as meal preparation, personal comfort items, housekeeping, and other services that are not treatment of the medical condition). · Hospice care. A hospice program provides a group of interdisciplinary services designed to meet the physical, psychological, spiritual, and social needs of dying persons and their families. Services include pain control and supportive medical, nursing, mental health, and other health services. Services may be provided by the following network providers: · A hospital. · A skilled nursing facility or a similar institution. · A home health care agency. · A hospice facility. · Any other facility or agency licensed to provide hospice care services. · Outpatient hospital or ambulatory surgical center services and supplies. · Skilled nursing facility care (except for custodial care and conditions of senile deterioration, mental retardation, and mental illness).

Medical Services and Supplies

The plan covers the following medical services and supplies: · Anesthesia. · Autologous blood donation (elective harvesting and storage of blood from the member in anticipation of surgery). · Chiropractic services. You may obtain services from any chiropractor in the plan's chiropractic network without a referral from your primary care physician. You pay a $10 copayment per visit for up to 15 visits in a calendar year. (The 15-visit limit is a combined limit for services received from chiropractors that are/are not providers in the plan's chiropractic network.) Covered services include the initial diagnostic lab work and X-rays. · Consumable supplies, as follows: · Diabetic supplies, including lancets, test strips, and alcohol swabs. · Catheters, including indwelling, intermittent, and external. · Ostomy supplies. · Irrigation kits.

12 UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

·

· · ·

·

·

·

· · ·

·

·

· Jobst pressure garments for burn victims. · Jobst full-length stockings for vascular problems. Dental services (limited). The following limited dental services are covered when approved in advance by the plan: · Hospital charges in connection with dental treatment when hospitalization is required due to a concurrent medical condition. · Treatment of sound natural teeth injured in an accident while covered by this plan, provided the treatment is received within 12 months of the accident. · Treatment of temporomandibular joint (TMJ) syndrome. Diagnostic services, laboratory services, and X-ray exams. Family planning services, including counseling, vasectomy, and tubal ligation. Genetic counseling and procedures necessary to determine the existence of gender-linked genetic disorders. (Amniocentesis, ultrasound, or any other procedures used solely for sex determination of a fetus are not covered.) Hearing aid services. The plan covers one otological and audiometric exam from an audiologist, and one standard hearing device per ear during a three-year benefit period. Hearing exams require a $10 copayment per visit. You do not need a referral from your primary care physician for hearing services, but you must obtain hearing services from a network provider. Infertility diagnosis and treatment. The plan covers services for the diagnosis and treatment of infertility, except for drugs, injectables, and procedures that bypass (such as in vitro fertilization), rather than treat, a functional abnormality. Medical equipment. The plan covers the use of certain durable medical equipment such as hospital beds and wheelchairs. The list of covered medical equipment changes over time. Contact your primary care physician or the plan's service representative to determine whether a certain piece of durable medical equipment is covered. Also, see the "personal comfort and convenience items or services" information on page 20 for a list of equipment the plan currently does not cover. Nutritional evaluation. The plan covers nutritional evaluation and counseling if your primary care physician determines that diet is a part of your medical treatment. Orthopedic and prosthetic devices, including replacement when due to a change in physical condition or wear and tear. Orthotics or other supportive devices of the feet when prescribed for treatment of an injury or other medical condition of the foot, including braces, splints, insoles, and foot supports constructed of acrylic, plastic, or metal, as well as impression casts required for the fitting of these devices. The device must be intended for wear at all times that shoes are worn and not just for specific activities. The plan does not cover shoes, or supports that are available without prescription. Physical therapy, speech therapy, and occupational therapy if the plan's service representative determines the services are restorative and significant improvement can be expected in a short period of time, such as within two months. Post-mastectomy benefits. Following a mastectomy, the plan covers · Reconstruction of the breast on which the mastectomy was performed. · Surgery and reconstruction of the other breast to produce a symmetrical appearance. · Prosthesis and treatment of physical complication of all stages of mastectomy, including lymphedemas.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

13

· Transplant benefits. The plan pays covered expenses for human bone marrow, cornea, kidney, liver, pancreas, heart, and heart/lung transplants, provided the transplant is · Recommended by your network primary care physician. · Approved by the plan. · Performed at a facility selected by the health plan. The plan does not cover experimental or investigational transplants. If the selected transplant facility is out of the network service area, the plan pays transportation expenses for the recipient and one family member to and from the center. (The IRS considers payment of some transportation expenses to be taxable income.) When the recipient is covered by this plan, the plan considers covered expenses of the recipient and the donor, whether or not the donor is covered by this plan. The plan considers expenses for the following services to obtain a donor organ: · Compatibility testing of deceased donors and of live donors who are blood relatives of a recipient. · Surgery and hospital expenses for removing the organ from a live donor. · Acquisition cost of an organ from a deceased donor. · Transportation services. · Ambulance for emergency transportation to and from the nearest hospital able to provide appropriate care. · Nonemergency use of an ambulance when recommended by your primary care physician and approved in advance by the plan's service representative. · Transportation to and from a provider outside of the network service area only when the plan's service representative determines special treatment is not available in the network service area. · Transportation expenses (to and from the transplant center for a live donor; to the transplant center for an organ from a deceased donor) in connection with a covered transplant when the donor is not in the transplant center area.

How to File a Claim

When you obtain care from your network primary care physician or from a network provider referred by your primary care physician, you generally do not need to file claim forms. If you receive emergency care outside the network service area, you must pay for the service and file a claim form for reimbursement. Claim forms are available from the plan's service representative. See Exhibit 2 on page 42 for the service representative's address and telephone number.

Nonnetwork Benefits

When you or your dependents obtain medical services without a referral from your primary care physician when the plan requires a referral, you · Pay a larger share of the cost. · Assume responsibility for several plan provisions that, if not followed properly, can increase your out-of-pocket expenses. (See "Special Provisions for Nonnetwork Care" on page 16.)

14

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Payment Provisions

When you seek medical services without going through your primary care physician or as otherwise required for network benefits, you and the plan will pay covered expenses as shown in the following table. Refer also to the subsequent paragraphs for a more complete description of plan provisions.

Nonnetwork Payment Provisions Plan Feature Calendar year deductible You pay the first covered expenses up to... Coinsurance Then the plan pays... And you pay... Stop-loss limit After you pay the $500 deductible and $3,000 in coinsurance, the plan pays... Lifetime maximum benefit 100% of covered expenses over $8,000 in a calendar year, up to the plan lifetime maximum benefit $1,500,000 60% of the next $7,500 of covered expenses in a calendar year ($4,500) 40% of the next $7,500 of covered expenses in a calendar year ($3,000) $500 For Each Person

Calendar Year Deductible

Before the plan begins paying benefits during a calendar year, you must satisfy a deductible of $500 per person; there is no family deductible maximum. Covered expenses incurred in the last quarter of the calendar year that are applied to the deductible also are applied to the deductible for the next calendar year. Payments you make for expenses above the reasonable and customary allowance, for noncovered services and supplies, and any penalty you pay for inpatient hospital services obtained without preadmission certification are not applied toward the deductible. See pages 16 and 17 for information about preadmission certification.

Coinsurance

Coinsurance means you and the plan each pay part of the cost of covered health care services. After you pay the deductible, the plan pays 60 percent and you pay 40 percent of reasonable and customary charges for covered nonnetwork services and supplies, up to stop-loss limits (described below). Different coinsurance provisions apply to mental health and chemical dependency treatment. (See "Mental Health and Chemical Dependency Program," beginning on page 22, for details.)

Stop-Loss Limit

The stop-loss limit is the point at which you stop paying your part of coinsurance and the plan begins to pay 100 percent of covered medical expenses for the rest of the calendar year, up to the plan lifetime maximum benefit. The stop-loss limit is $3,000 per person; there is no family stop-loss limit. Payments you make for the calendar year deductible, expenses above the reasonable and customary allowance, expenses for noncovered services and supplies, and any penalty you pay for inpatient hospital services that you obtain without preadmission certification are not applied toward the stop-loss limit.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

15

Lifetime Maximum Benefit

The plan pays a lifetime maximum benefit of $1,500,000 per person for covered nonnetwork medical expenses.

Other Health Care Expenses

Amounts you pay for mental health and chemical dependency treatment, prescription drugs, and vision care do not apply to the calendar year deductible, stop-loss limit, or $1,500,000 lifetime maximum benefit. (See pages 22 through 31 for information about the separate mental health and chemical dependency, prescription drug, and vision care programs.)

Reasonable and Customary Allowances

Like most medical plans, this plan pays benefits based on reasonable and customary allowances for covered expenses. The plan's service representative determines the reasonable and customary allowance based on the 90th percentile of the charges for the same or similar services within a geographic area. Generally, this means that 90 percent of the physicians who perform a service in a geographic area charge the reasonable and customary amount or less. Fewer than 10 percent of the physicians charge more than the reasonable and customary allowance. If the charges submitted to the plan are more than the reasonable and customary allowance for a particular service, the plan will pay your benefit based only on its reasonable and customary allowance for that service. You must pay any amount that exceeds the reasonable and customary allowance.

Advance Estimate of Reasonable and Customary Allowance

You can avoid incurring a charge that exceeds the reasonable and customary allowance by taking the following steps: · Ask ahead of time what the charge will be (for example, when you make an appointment). · If the proposed charge is more than $200, ask your physician to complete an Advance Reasonable and Customary Estimation form describing the service. You can get the form from the service representative. · Submit the completed Advance Reasonable and Customary Estimation form to the service representative. The service representative will tell you if the charge is within the reasonable and customary allowance for that service. If the charge is more than the reasonable and customary allowance, you will be told how much it exceeds the allowance. You may then want to discuss the matter with your physician or find a physician who charges less.

Special Provisions for Nonnetwork Care

When you live in a network service area and decide to manage your own medical care without going through your primary care physician, you must follow these special benefit provisions.

Preadmission Certification

Preadmission certification is not required for hospital admissions outside the United States. A separate preadmission process is required for mental health and chemical dependency treatments (see page 22). If your physician recommends an overnight hospital stay for you or a covered family member, you are responsible for getting preadmission certification. Under preadmission certification, a medical reviewer must certify the need for hospitalization. This is another way of ensuring that you obtain the most appropriate medical care at a reasonable cost. To begin the certification process, the patient, a family member, or the physician must call the telephone number on your health care identification card before any nonemergency admission. After receiving the required information, a qualified medical reviewer will match the patient's diagnosis with the physician's treatment plan. Based on nationally accepted criteria and the

16 UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

information that the physician presents, the medical reviewer will decide whether the hospital is the best place to provide treatment for the patient. If the medical reviewer determines that the patient's condition can be treated just as well elsewhere (for example, in a physician's office or an outpatient surgical center), hospitalization will be judged unnecessary and inappropriate. Hospital preadmission review for childbirth is not required for a mother or newborn for the first 48 hours following a normal delivery or 96 hours following a cesarean section. If the nonemergency hospitalization is certified as necessary and appropriate, the plan will pay normal nonnetwork benefits for hospital services. However, if certification is not requested on a timely basis, or if it is requested but is not approved and you incur inpatient hospital expenses, then the plan will reduce covered expenses for room and board charges by 20 percent before calculating the benefit. The penalty you pay as a result of the reduction in room and board benefits will not exceed $750 per hospitalization. The plan will not apply the penalty you pay to your calendar year deductible or stoploss limit. In an emergency situation (as defined on page 39), the patient can and should be admitted to the hospital without delay. Then, the patient, a family member, the physician, or the hospital must call the telephone number on your health care identification card as soon as reasonably possible. (Remember, the plan covers emergency treatment under network benefit provisions no matter when or where the emergency occurs, provided you call your primary care physician as instructed on your identification card.)

Continued Stay Review

Once the patient has been admitted to the hospital, the need to stay there also is certified. You do not have to do anything to initiate the continued stay review. Instead, the medical reviewer will monitor the patient's time in the hospital. The medical reviewer will notify you in writing when, in the medical reviewer's opinion, further hospitalization becomes unnecessary. You should understand that the medical reviewer's notice does not necessarily mean you are considered well. Rather, the notice indicates that any additional care can be provided in a convalescent and long-term illness care facility, by a hospice program, in the physician's office, or at home. Normally, this notice is advisory and will not affect your benefits. However, if care becomes custodial in nature, the plan will no longer cover such a stay.

Medical Case Management

The plan offers medical case management as a service to a patient who has an illness or injury that requires rehabilitation or other long-term health care support. You do not pay for medical case management services. While your decision to participate is entirely voluntary, medical case management can result in improved services for your benefit dollar. During the preadmission certification process described on page 16 and above, the medical reviewer will become aware of any potential need for long-term care and will refer the case to a medical case manager for evaluation. If the evaluation shows that medical case management could be beneficial, the medical case manager will contact the patient (or responsible family member) regarding participation. At no charge to you, medical case management provides personal counseling by experienced health care professionals. These medical case managers work with the physician evaluating, among other things, diagnosis and expectations for recovery, plan of care, and alternative forms of treatment. If the patient needs special medical supplies and equipment, physical therapy and rehabilitation, outpatient treatment, and the like, the medical case manager will help arrange for them. The idea is to improve the quality of care and reduce its cost by minimizing the time spent in the hospital.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

17

If the patient's physician and medical case manager prescribe alternative forms of treatment that are not normally covered by the plan, the plan's service representative must approve the alternative before the patient incurs the expense. To request medical case management, contact the service representative at the telephone number shown on your health care identification card or in Exhibit 2 on page 42.

Covered Nonnetwork Services and Supplies

You and your dependents are entitled only to covered services and supplies that the plan determines to be medically necessary, whether or not you use your primary care physician to manage your health care. Unless stated otherwise, the list of covered network services and supplies (shown beginning on page 10) as well as the list of exclusions (shown under "Noncovered Services and Supplies" beginning on page 19) also apply to nonnetwork benefits. When you choose to receive services without a referral from your primary care physician, the plan will not pay for preventive care services, transplant benefits, or hearing aid benefits. You are responsible for obtaining preadmission certification for inpatient hospital stays and must pay up to an additional $750 if you fail to do so. In addition, the plan places special limits on chiropractic care and skilled nursing facility care. The following special coverage provisions apply to nonnetwork benefits.

Acupuncture

The plan covers acupuncture only under nonnetwork benefit provisions (no network benefits are available) and only when services are provided by a person licensed to practice acupuncture.

Christian Science Treatment

The plan covers treatment by a Christian Science practitioner, nurse, and sanatorium only under nonnetwork benefit provisions (no network benefits are available). The practitioner, nurse, and sanatorium must be authorized as such by the Mother Church, the First Church of Christ, Scientist, of Boston, Massachusetts.

Emergency Care

If you use the hospital emergency room for a nonemergency situation, the plan pays nonnetwork benefits. If you use the hospital emergency room for a true emergency (as defined on page 39), the plan pays covered expenses based on network benefit provisions whether or not you use a network hospital. See page 11 for details about emergency care.

Skilled Nursing Facility

The plan pays nonnetwork benefits for services received in a nonnetwork skilled nursing facility (except for custodial care and conditions of senile deterioration, mental retardation, and mental illness). Admission to the facility must be within 14 days after release from a hospital stay of at least three days or within 14 days of a previous confinement in a nursing home.

How to File a Claim

When you obtain nonnetwork services (either network provider services obtained without a referral from your primary care physician or nonnetwork provider services, including emergency services), you generally must pay for the services and then file a claim for reimbursement. Claim forms are available from the plan's service representative. Complete the claim form and attach an itemized bill that clearly identifies the patient, dates of service, types of services, and the charges. If the patient is your dependent and you are not identified on the bill as a Boeing employee, add your name and Social Security number to the bill. Submit the claim as instructed on the form, being sure to retain a copy of all itemized bills for your records.

18

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Noncovered Services and Supplies

The plan does not cover the following services and supplies, whether obtained through network providers or through nonnetwork providers, except as specifically noted: · Services and supplies the plan's service representative determines are not medically necessary and appropriate for the therapeutic treatment of an illness, injury, or pregnancy, except for certain preventive care and hospice care as authorized by the service representative. · Expenses in excess of reasonable and customary charges as determined by the plan's service representative. · All surgery and other health care that the plan's service representative determines to be experimental or investigational. The plan will consider medical and scientific literature in making its decision and will deny coverage for procedures or treatment that · Does not conform to accepted medical practice. · Is not proven to be effective for a particular medical condition. · Has failed to be completely assessed by the scientific community. · Has not been granted the required approval by a governmental agency when the services are provided. · Medical and surgical services for the treatment or control of obesity, unless medically necessary. · Commercial weight loss programs. · Treatment of injury or illness arising out of the course of employment. · Cosmetic surgery or other surgical procedure that is primarily for the purpose of altering appearance. However, surgery that restores a normal bodily function or surgery that is medically necessary is covered. · Replacement or repair of lost, stolen, or willfully damaged artificial limbs, eyes, and braces for the arm, leg, back, or neck. · Physical therapy, speech therapy, or occupational therapy if not restorative or if the plan's service representative determines that continued therapy will not show evidence of significant continued improvement. · Vocational or educational testing and/or therapy. · Naturopathy or hypnotherapy. · Routine trimming of nails, calluses, or corns unless medically necessary. · Acupuncture, except as described on page 18 under "Covered Nonnetwork Services and Supplies." · Christian Science services, except as described on page 18 under "Covered Nonnetwork Services and Supplies." · Custodial or domiciliary care, rest cures, or transportation for such care. · Skilled nursing care for conditions of senile deterioration, mental retardation, or mental illness. · Care for conditions that state or local law requires to be treated in a public facility. · Services or supplies to the extent they are covered under any federal, state, or other government plan, except where required by law. · Confinement, surgical, medical, or other treatment, services, or supplies received in or from a U.S. Government hospital, except as required by law. · Any accident or illness covered by a workers' compensation law. · Costs associated with the collection, preparation, or storage of sperm for artificial insemination, including donor fees. · Artificial insemination, in vitro fertilization, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer, or similar procedures, which bypass, rather than treat, a functional abnormality.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition 19

· Amniocentesis, ultrasound, or any other procedures when used solely for sex determination of a fetus, except that genetic counseling and procedures necessary to determine the existence of genderlinked genetic disorders are covered. · Sex change surgery, presurgery counseling, or hormone therapy. · Tuboplasty or reversal of voluntary sterilization. · Physical exams, immunizations, or diagnostic testing required or necessitated by third persons, such as for employment, flight clearance, summer camp, insurance, foreign travel, and so forth. · Court-ordered treatment or hospitalization, unless the order is being sought by a network physician or unless the plan would normally cover it without the court order. · Over-the-counter disposable or consumable supplies except as described under "Medical Services and Supplies" beginning on page 12. · Services for which no charge is made or for which you are not, in the absence of this plan, legally obligated to pay. · Special medical reports not directly related to treatment. · Appearances in court or at a hearing. · Dental or orthodontia services except as specifically listed under "Medical Services and Supplies" on page 13. · Radial keratotomy, vision therapy, eye exams, lenses, or frames for the correction of vision deficiencies. (See "Vision Care Program," beginning on page 29, for exam, frame, and lens benefits.) · Hearing aid care, services or supplies for · Replacement batteries or any other ancillary equipment obtained after the hearing aid is purchased. · Repairs, servicing, or altering of hearing aid equipment. · Expenses incurred for a hearing aid after the termination of coverage, except for hearing aids ordered before termination and delivered within 30 days after termination. · Outpatient prescription drugs. (See "Prescription Drug Program," beginning on page 25, for prescription drug benefits). · Diabetic supplies, except those noted under "Medical Services and Supplies" on page 12. · Treatment and testing for mental health or chemical dependency. (See "Mental Health and Chemical Dependency Program," beginning on page 22.) · Expenses that you are not legally obligated to pay. · Personal comfort and convenience items or services, including, but not limited to · Television, telephone charges, guest meals, or cots for overnight guests while an inpatient. · Meal preparation or housekeeping services in connection with home health care. · Assistance in daily living activities such as eating, bathing, dressing, and services primarily for rest, domiciliary, or custodial care. · Bathtub chairs, safety grab bars, stair gliders, elevators, over-the-bed tables, saunas, or exercise equipment. · Hygienic or self-help items or equipment. · Environmental control equipment such as air purifiers, humidifiers, or electrostatic machines. · Institutional equipment such as air-fluidized beds or diathermy machines. · Equipment used for athletic activities, including braces and splints. · Items not generally accepted by the medical profession as being therapeutically effective, such as auto-tilt chairs, paraffin bath units, or whirlpool baths.

20

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

· Charges by a physician, nurse or other medical practitioner who is a close relative or who lives with the covered individual. In addition, the plan will not pay benefits under nonnetwork provisions for the following services and supplies: · Preventive care. (See page 10 for a description of preventive care services that are available through your network primary care physician.) · Transplant benefits. (See page 14 for transplant benefits that are available through network providers.) · Hearing aid benefits. (See page 13 for a description of hearing aid benefits that are available through network providers.) · Medical expenses incurred to the extent the provider gives a discount, credit, or reduction to the covered individual. · Routine trimming of nails, calluses, or corns. (These services may be covered under network benefits when recommended by your primary care physician as necessary due to a concurrent medical condition.) · Nutritional evaluations or counseling sessions.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

21

Mental Health and Chemical Dependency Program

ValueOptions is the service representative for the mental health and chemical dependency program. Boeing may change the service representative at any time. The payment provisions and maximums described in this section apply to the combination of mental health and chemical dependency treatment, except as specifically noted.

Assessment/Referral Process

To receive the greatest benefits from the program, you must begin all nonemergency treatment for mental health and chemical dependency by completing a confidential assessment/referral process. You must receive treatment from a ValueOptions network provider in order to receive network benefits. All network providers are responsible for having ValueOptions review the care for medical necessity. To initiate the assessment/referral process, call · The ValueOptions telephone number listed on your health care identification card, or · Your local Boeing Employee Assistance Program (EAP). In an emergency, obtain the necessary emergency care and then call (or have a family member or your provider call) within 48 hours of receiving the emergency care to initiate the assessment/ referral process. Once you have started the assessment/referral process, the mental health case manager or EAP will provide ongoing support and management for your treatment. Use the assessment referral program to begin mental health or chemical dependency treatment.

Payment Provisions With Assessment/ Referral

When you follow the assessment/referral process, the following payment provisions apply to treatment of mental health or chemical dependency, or a combination of the two: · You do not pay a calendar year deductible. · The program pays 100 percent of certified inpatient care. · You pay a $10 copayment for each certified outpatient visit; then, the program pays 100 percent. See "Lifetime Limit for Chemical Dependency Treatment" on page 23 for additional chemical dependency benefit limits.

Payment Provisions Without Assessment/ Referral

If you choose to see a nonnetwork provider, there is no case management through ValueOptions and the following payment provisions apply.

22

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Calendar Year Deductible

You must pay a calendar year deductible of the first $500 of reasonable and customary charges for covered mental health or chemical dependency services. One deductible satisfies the deductible requirement for both mental health and chemical dependency services for the individual; there is no family deductible limit for mental health and chemical dependency coverage. This deductible is separate from the UnitedHealthcare coordinated care plan deductible.

Coinsurance

You and the program pay reasonable and customary expenses as follows.

Mental Health Treatment

After you pay the deductible, the program pays · 60 percent of inpatient hospital care, including partial hospitalization for up to 20 days per calendar year. Each two days of partial hospitalization reduces the 20 days of inpatient hospital care by one day. · 60 percent of an intensive outpatient care program for treatment of mental illness (if available in your area). Each four days of intensive outpatient care reduces the 20 days available for inpatient hospital treatment of mental illness by one day. · 60 percent of outpatient care for up to 20 visits per calendar year. You pay all charges that the program does not pay.

Chemical Dependency Treatment

After you pay the deductible, the program pays · 60 percent of inpatient hospital care. The maximum benefit payable is $200 per day for up to 20 days per calendar year. · 60 percent of outpatient care for up to 20 visits per calendar year. · 60 percent of an intensive outpatient care program for treatment of chemical dependency (if available in your area). The maximum benefit payable is $2,400. Each four days of intensive outpatient care reduces the 20 days available for inpatient hospital treatment of chemical dependency by one day. You pay all charges that the program does not pay. See "Lifetime Limit for Chemical Dependency Treatment," below, for additional chemical dependency benefit limits.

Lifetime Limit for Chemical Dependency Treatment

Each covered person is eligible for two courses of chemical dependency treatment in a lifetime, whether or not that person uses the assessment/referral process. In addition, nonnetwork provider services are limited to a $10,000 lifetime maximum. A course of treatment may include some or all of the following: · A period of detoxification, if necessary. · A period of intensive treatment. · Aftercare for a period of one year from the end of intensive treatment. If a person suffers a relapse while participating in a course of treatment, further treatment will be considered a continuation of the same course of treatment.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

23

The following events are considered to be a course of treatment under the program: · Completion of intensive care (with or without detoxification) and the one-year aftercare program. · Detoxification, without continued treatment after detoxification. · Partial completion of the intensive phase of treatment (with or without detoxification). · Completion of the intensive phase of treatment, but not the one-year aftercare program. If a person suffers a relapse after ending any one of these courses of treatment, any new treatment is considered a second course of treatment under this program.

How to File a Claim

When you follow the assessment/referral process and receive care from a ValueOptions network provider, no claim forms are necessary. However, when you obtain care without a referral from ValueOptions or your EAP, you generally must pay for the services and then file a claim for reimbursement. Claim forms are available from ValueOptions. (See Exhibit 2 on page 42 for ValueOptions' telephone number and address.) Complete the claim form and attach an itemized bill that clearly identifies the patient, dates of service, types of services, and the charges. If the patient is your dependent and you are not identified on the bill as a Boeing employee, add your name and Social Security number to the bill. Submit the claim as instructed on the form, being sure to retain a copy of all itemized bills for your records.

24

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Prescription Drug Program

The prescription drug program offers benefits through two options: a local participating pharmacy option and a mail service option. PAID Prescriptions, L.L.C., is the service representative for the participating pharmacy option. Merck-Medco Rx Services is the service representative for the mail service option. Boeing may change the service representative at any time.

Copayments

You must pay the copayment amounts listed below for each prescription or refill you order from a local participating pharmacy or by mail. · Generic drug--$5 copayment. · Brand-name drug when required by the physician or where there is no generic equivalent-- $15 copayment. · Brand-name drug at your request when a generic equivalent is available--$5 copayment plus the difference in retail cost between the brand-name drug and the service representative's scheduled price for the generic equivalent. If the generic drug does not have a scheduled price or your physician has requested that only a brand-name drug be used, you pay only a $15 copayment. A brand-name drug can cost as much as 80 to 90 percent more than the generic equivalent drug. When you request a brand-name drug that is not required by your physician, you will pay much more for your prescription.

Maximum Quantity

The maximum drug quantity the program will allow for one copayment is a · 30-day supply when purchased from a local participating pharmacy. · 90-day supply when purchased through the mail service option.

How to Fill a Prescription

Local Participating Pharmacy

For short-term prescription drug needs, use a local participating pharmacy. Call PAID Prescriptions to find participating pharmacies in your area. (See Exhibit 2 on page 42 for PAID Prescriptions' telephone number). Take your health care identification card and the prescription to the pharmacy. If the prescription is for a dependent, you will need to know the dependent's date of birth. The pharmacist will automatically fill your prescription with a generic drug, if available, unless your physician has specifically stated that only a brand-name drug should be used. Pay the pharmacy the applicable copayment (see "Copayments" above). The program will pay the balance of the cost.

Nonparticipating Pharmacy

In most cases, no program benefits are available when you use a nonparticipating pharmacy. There are two exceptions: · You have an emergency outside of your pharmacy's normal hours, or · You are traveling and are either unable to locate a participating pharmacy or are outside of the United States.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

25

In these situations, you must pay the full cost of the prescription and file a claim for reimbursement on a PAID Prescriptions claim form. Claim forms are available upon request from PAID Prescriptions. (See Exhibit 2 on page 42 for PAID Prescriptions' telephone number and address.)

Ordering Drugs by Mail

The mail service option allows you to purchase up to a 90-day supply of maintenance medications prescribed by your physician. You pay only one copayment for each prescription or refill (see "Copayments" on page 25). Merck-Medco Rx Services generally will deliver your prescription by U.S. mail or United Parcel Service within 14 days of your order. To order a prescription by mail, follow these steps: · Ask your physician to prescribe up to a 90-day supply of your prescription, plus necessary refills. For example, for a year's supply at one tablet a day, have the prescription written for 90 tablets plus three refills, rather than 30 tablets with eleven refills. · Obtain an order form from Merck-Medco Rx Services. (See Exhibit 2 on page 42 for MerckMedco's telephone number, address, and web site address.) · Mail the original prescription, the order form, and your check, money order, or your authorization to charge your VISA or Mastercard account to Merck-Medco Rx Services in the preaddressed envelope. · To order a refill of a prescription currently on file at Merck-Medco Rx Services, call Merck-Medco or order through their web site. (See Exhibit 2 on page 42 for the telephone number and web site address.) When ordering drugs by mail, keep in mind that · The pharmacist will fill your prescription with a generic drug unless your physician has directed otherwise. · If you request a brand-name drug when your physician does not require it, the pharmacist will charge you the $5 copayment plus the difference in retail cost between the brand-name drug and the service representative's scheduled price for the generic equivalent. If the generic drug does not have a scheduled price or your physician has requested that only a brand-name drug be used, you pay only a $15 copayment. · Some controlled substances are subject to special limitations. The pharmacist will tell you if your prescription cannot be filled as written. · The pharmacist may not dispense some prescriptions in a 90-day supply because they come in a prepackaged form. · The mail order option can save you multiple copayments for some drugs.

New Employees

If you need a prescription drug before you receive your health care identification card, you may use a participating pharmacy by providing the pharmacist your Social Security number and your group number for prescription drug benefits. If you do not know your group number, contact PAID Prescriptions at the telephone number listed in Exhibit 2 on page 42. You also may have your prescription filled through the mail service option.

Preauthorization

The program requires certain drugs to be approved for medical necessity before they can be dispensed. Because this list changes from time to time, it is not included in this supplement. The pharmacist will contact your physician to determine the medical necessity for the prescription. The pharmacist will issue the prescription when it is approved, or notify you if it is not approved.

26 UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Voluntary Formulary

A formulary is a list of cost-effective, commonly prescribed medications from which your physician may prescribe when appropriate. You are not limited to using the drugs listed in the formulary, but you and your physician will help to control costs when you do. A copy of the formulary is included when your health care identification card is issued. You also may get a copy from PAID Prescriptions to take to your physician at your next visit.

Covered Drugs and Services

The program covers prescriptions that meet all of the following qualifications: · The prescription is written by a physician or dentist who is licensed to prescribe drugs. · The prescription is dispensed by a licensed pharmacy. · The drug is a legend drug, which means that federal law requires it to bear the legend, "Caution: Federal Law Prohibits Dispensing Without a Prescription," or it meets one of the following requirements: · Any compound medication for which at least one ingredient is a legend drug. · Oral or injectable insulin dispensed only with a physician's written prescription. · Syringes in conjunction with a prescription for injectable insulin. (Diabetic supplies are not covered under the Prescription Drug Program; however, lancets, test strips, and alcohol swabs are covered under the UnitedHealthcare coordinated care plan, as described on page 12.) Note that you pay a copayment for each item, or the full cost of the item if it costs less than the copayment.

Noncovered Drugs and Services

The program does not cover the following drugs and services, except as specifically noted: · Any drug that is not medically necessary, except the program covers birth control pills regardless of medical necessity. · The part of a single purchase of a drug that exceeds a · 30-day supply from a PAID Prescriptions participating pharmacy. · 90-day supply under the mail service option. · Drugs or injectable insulin purchased in a quantity greater than prescribed by the physician, or more than one year after the date of the prescription. · Drugs or injectable insulin provided by a hospital, convalescent and long-term illness care facility, or a similar facility while confined. · Drugs given to the patient by the physician who prescribes them. · Drugs labeled "Caution--Limited by Federal Law to Investigational Use" or drugs used as an experiment. · Drugs prescribed for treatment of sickness covered by workers' compensation, occupational disease law, or similar laws, or injury if it arises out of or in the course of employment. · Healing devices, immunization agents, blood or blood plasma, health or beauty aids, birth control devices or supplies, or delivery charges; however, medical devices (including contraceptive injections, devices, and implants) dispensed by a physician are covered under the UnitedHealthcare coordinated care plan, as described on page 11. · Drugs, supplements, or supplies purchased over the counter.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

27

· Prescriptions from a nonparticipating pharmacy with the following exceptions: · You have an emergency outside of your pharmacy's normal hours. · You are traveling and unable to locate a participating pharmacy or you are outside of the United States. · For covered prescriptions from a nonparticipating pharmacy, cost in excess of what the program would have paid if you had used a participating pharmacy. · Anorexiants. · Drugs whose sole purpose is to promote or stimulate hair growth (e.g., minoxidil or Rogaine). · Lost or misplaced prescription drugs.

28

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Vision Care Program

Vision care services are offered through Avesis Incorporated, the service representative. Boeing may change the service representative at any time. The program pays a scheduled amount for the following vision benefits: · One eye exam every year, and · In a two-year period, either · Two sets of frames and lenses or two pairs of contact lenses, or · One set of frames and lenses and one pair of contact lenses.

How to Get Vision Services

You may obtain services from an Avesis provider or from a provider who is not in the Avesis network; however, you will almost always pay less when you use an Avesis provider. The vision maximum benefits listed in Exhibit 1 on page 30 cover the exam, eyeglass lenses, and many styles of frames when obtained through Avesis. You are free to select from any of the Avesis provider's frames and pay the difference between the program's maximum benefit and the wholesale price of the frames, if higher. When you obtain services from a non-Avesis provider, you must pay the difference between the program's maximum benefit and the retail cost of the frames and lenses. A directory of Avesis providers is available from Avesis; call Avesis at the telephone number listed in Exhibit 2 on page 43.

Avesis Provider

Present your health care identification card to an Avesis provider to identify yourself as covered under the program. Avesis will pay the program's maximum benefits for the exam and/or lenses and frames. You will pay any cost in excess of the program's maximum benefits based on wholesale costs. You do not have to file a claim form when you use an Avesis provider.

Non-Avesis Provider

You pay the full cost of the service. You then must send the paid bill and a claim form to Avesis for reimbursement up to the program's maximum benefits. Claim forms are available from Avesis. (See Exhibit 2 on page 43 for Avesis's telephone number and address.)

Other Ways to Get Vision Care

If you obtain your vision exam from a non-Avesis provider, you may take the eyeglass prescription to an Avesis provider to get your lenses and frames. After you have used your vision benefit within a two-year benefit period, you can save money on any additional vision services during that period by using Avesis providers. · Avesis providers will discount additional exams and eyeglasses not covered by the program. · Most Avesis providers will replace lost or damaged contact lenses for the wholesale cost plus a dispensing fee of $10 per lens.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

29

Exhibit 1

Vision Benefits Payable

Vision benefits are payable as follows. Service Vision exam Frames Lenses (per pair) Single vision Bifocal Trifocal Progressive Lenticular Contact lenses* (per pair) Standard hard/soft Disposable Semihard and gas permeable Hard/soft for astigmatism Extended wear and bifocal Maximum Benefit $30 $25 You Pay With Avesis $0 Charges over $25 You Pay With Non-Avesis Retail charges over $30 Retail charges over $25 Retail charges over $50 Retail charges over $60 Retail charges over $70 Retail charges over $70 Retail charges over $130 Retail charges over $60 Retail charges over $60 Retail charges over $60 Retail charges over $60 Retail charges over $60

$50 $60 $70 $70 $130

$0 $0 $0 Charges over $70 Charges over $70

$60 $60 $60 $60 $60

Lens wholesale cost only** Lens wholesale cost only** Lens wholesale cost plus $15** Lens wholesale cost plus $40** Lens wholesale cost plus $65**

*The program will pay $125 per contact lens following cataract surgery when visual acuity is not correctable to 20/70 in the better eye. **The fitting fee includes six months of follow-up care and a lens kit.

30

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Noncovered Services and Supplies

The program does not cover the following services and supplies: · High power lenses. (You may obtain certain high power lenses through Avesis by paying the laboratory's wholesale cost plus $12.) · Oversize lenses (larger than 65-millimeter box measurement). · Lens options (e.g., special coatings). · Tinted lenses other than Rose #1 and Rose #2 tints. · Medical or surgical treatments of the eye. (These may be covered as a medical expense.) · Special procedures, such as services or materials for orthoptics and visual training. · Nonprescription glasses or nonprescription sunglasses. · Replacement or repair of broken or lost glasses. · Routine eye exams required by a governmental body or as a condition of employment. · Services or materials provided under workers' compensation or similar laws. · More than one benefit within a vision benefit period. (If you have used your benefit for a vision benefit period, you can still get a discount for additional services from Avesis, including services for lost, stolen, or broken eyeglasses or contact lenses.) · Any other treatment or service that is covered as a medical expense under the UnitedHealthcare coordinated care plan, even if it is not specifically mentioned above.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

31

Review, Appeal, and Accelerated Appeal Procedures

The Plan has established procedures for review and appeal of denied claims or eligibility to participate under the UnitedHealthcare coordinated care plan and the mental health and chemical dependency (ValueOptions), prescription drug (Merck-Medco), and vision care (Avesis) programs described in this supplement. In addition, these service representatives have established accelerated appeal procedures that provide for prompt review of complaints regarding treatment decisions, performance of medical procedures, quality of medical services or supplies, access to care, or administration of plan benefits under the coordinated care plan and accompanying programs. The addresses and telephone numbers of all service representatives are listed in Exhibit 2 on pages 42 and 43.

Claim Review and Appeal Procedures

Your initial claim for reimbursement of covered medical, mental health, chemical dependency, prescription drug, or vision care expenses is considered a claim for benefits. When you receive services from network (or participating) providers under the Plan, you generally do not need to submit a claim for benefits. The network provider will submit a claim to the appropriate service representative on your behalf and the service representative will pay the network provider directly. You will receive an Explanation of Benefits form in the mail each time a claim is processed. When you receive services from a nonnetwork (or nonparticipating) provider, you generally must pay the provider's bill and submit a claim to the appropriate service representative for reimbursement. See pages 14, 18, 24, 26, and 29 for additional information about how to submit a claim under the UnitedHealthcare coordinated care plan, mental health and chemical dependency program, prescription drug program, and vision care program. When you submit a claim for benefits, the service representative will respond within 90 days of receiving the claim. If special circumstances require more time, the review period may be extended up to an additional 90 days. You will be notified in writing of this extension. If your claim is denied, you will be notified in writing and given the specific reasons for the denial and advised of your appeal rights. Often, you can resolve questions about a denied claim without a formal appeal. If you think a benefit has been denied in error, the issue often can be resolved by calling the service representative's claim office and discussing the situation. If the claim is not resolved through an informal review process, you may file a formal appeal seeking review of that decision. You or a person you appoint may appeal any denial or partial denial by writing to the service representative identified on the claim denial notice within 60 days after receiving the denial or partial denial of plan benefits. You must indicate the reason for your appeal and may include any information or documents that you believe are relevant to the claim. The service representative will review the appeal and render a decision. In reviewing your appeal, the service representative will apply the terms of the plan and will, as appropriate, use its discretion in interpreting the terms of the plan. The service representative will notify you of its decision within 60 days after receiving your appeal. If special circumstances require more time, the review period may be extended up to an additional 60 days. You will be notified in writing of this extension. The service representative will provide you with its final decision in writing and will indicate the specific plan provision upon which the decision is based. If you have not received any notification after 120 days, you should consider your claim to be denied.

32

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Accelerated Appeal Procedures

If you have a concern or question regarding the provision of health services or benefits (including treatment decisions, performance of medical procedures, quality of medical services or supplies, access to care, or administration of plan benefits), you may contact the service representative for an accelerated appeal at the telephone number or address shown in Exhibit 2 on pages 42 and 43.

UnitedHealthcare

You or your representative has the right to request an accelerated appeal by writing to UnitedHealthcare for a first-level review. A designated representative will contact you in writing to acknowledge receipt of the accelerated request within 10 working days. UnitedHealthcare will perform an investigation of the accelerated request within 20 working days after receipt of the request. If the investigation cannot be completed within 20 working days, you will be notified in writing on or before the 20th working day that a decision will be reached within 30 working days. You will receive a written notice of the resolution within 15 working days. You also have a right to a second-level review. Upon receipt of a request for a second-level review, UnitedHealthcare will submit the accelerated appeal request to a grievance advisory panel consisting of · Other plan participants. · Representatives of UnitedHealthcare that were not involved in the circumstances giving rise to the accelerated appeal request or in any subsequent investigation or determination of the request. · A majority of appropriate clinical peers in the same or similar specialty as would typically manage the case being reviewed when the accelerated appeal request involves an adverse determination. These clinical peers will not have been involved in the circumstances giving rise to the accelerated appeal request or in any subsequent investigation or determination of the request. A second-level review by the grievance advisory panel will follow the same time frames as a first-level review. If you or your representative (i.e., physician or other provider) disagrees with the decision of noncertification of an admission or continued stay, the decision may be appealed. Case information is discussed within one business day with a medical director or second-level reviewer specializing in an appropriate or related area to the diagnosis or procedure in question. If necessary, the medical director is available to discuss the case with the attending physician. An expedited appeal is conducted when the treatment is ongoing or imminent and when not obtaining services would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function. In an expedited appeal, the reviewer tells your physician the decision by telephone. If your expedited appeal is denied, the reviewer sends written documentation within one business day. Recommendations of available alternative levels of care, options to receive the criteria in writing, and the standard appeal process are described in the documentation.

ValueOptions

In the event ValueOptions makes a decision that a mental health or chemical dependency treatment is not medically necessary and you want to appeal, two levels of accelerated appeal are available. A letter is sent to you and the treating provider and facility, if applicable, after each level of appeal, stating the ValueOptions Peer Advisor's decision and rationale for that decision, as well as additional appeal rights.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

33

If a ValueOptions Peer Advisor determines that care is not medically necessary, your treating provider or facility, you, or your representative may immediately request a Level I Appeal. This level of appeal offers the provider an opportunity to review your clinical condition with a ValueOptions Peer Advisor who has not already been involved in the case. Because the care is concurrent, the Level I Appeal must be requested immediately. The appeal will be completed within one business day of the request and letters of notification will be mailed within one business day of the decision. When the Level I Appeal review is complete, the Peer Advisor will verbally inform your provider of the decision, including the length of authorization, the level of care authorized, and any alternatives/ recommendations that can be authorized. Your provider also will be informed of the Level II Appeal procedure, if appropriate. If you are discharged prior to a request or completion of a Level I Appeal, your treating provider and/or you have the right to request a Retrospective Appeal. A complete medical record must accompany the request. A ValueOptions Peer Advisor will review the record to determine medical necessity of the days that were noncertified as a result of the peer review decision. The review will occur within seven calendar days of the request, and letters of notification will be mailed within one business day of the decision. If the determination of no medical necessity is upheld after a Level I Appeal review, your treating provider or facility, you, or your representative has the right to request a Level II Appeal. This level of appeal involves a review by a multidisciplinary committee or independent external reviewer who has not previously reviewed the case. If you are in a current course of treatment, the appeal request and the complete medical record must be submitted to ValueOptions as soon as possible. A Level II Appeal will be conducted within seven calendar days of receipt of the required information. External Level II Appeal reviews will be completed within 10 business days of receipt of required information. If you are discharged prior to a request for completion of a Level II Appeal, your treating provider or facility, you, or your representative has the right to request a Retrospective Appeal. A complete medical record must accompany the request. A ValueOptions Peer Advisor not previously involved will review the record to determine medical necessity of the days that were noncertified as a result of the Level I Appeal decision. The retrospective Level II Appeal will be completed according to the same standards that apply to the concurrent Level II Appeal. Letters of notification for all Level II Appeals will be mailed within one business day of the decision.

Merck-Medco

Your physician can submit a request for review of a pharmacy decision on your behalf, in writing, to Merck-Medco's Appeals Decision Committee. The appeal request must include relevant clinical information to support the request. Merck-Medco may require additional information from the physician. Merck-Medco also may conduct research to obtain additional information from online searches, the Merck-Medco Medical Resource Center, or physician specialists. A review decision normally will be made within five working days of the date Merck-Medco receives all requested information. The physician will be notified of the appeal decision by telephone, and you and the physician will be notified in writing.

Avesis

If you are dissatisfied with services received under the vision care program, a request for an accelerated appeal must be submitted, in writing, by you or a participating provider to Avesis Member Services or the Provider Relations Department within 120 days following accrual of a claim or action. The Avesis Grievance Committee will try to resolve an accelerated appeal request made by you or a participating provider within 30 days of receipt of the accelerated appeal request. If a resolution is not

34

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

reached within 30 days, the Grievance Committee will notify you or the participating provider of a 30-day extension from the date the accelerated appeal request is received. If, however, circumstances beyond Avesis's control make it impractical for a decision to be reached within 60 days, you or the participating provider will be advised of the reasons for the delay and the anticipated decision date. The Grievance Committee's decision will be mailed to you or the participating provider within seven working days following the decision.

Eligibility Review and Appeal Procedures

If you believe you have been improperly denied participation in this Plan or you have been improperly denied the ability to make a qualified status change, you may follow the general appeal procedure described in the preceding section. The only difference is that your initial appeal will be made to the Boeing Service Center for Health and Welfare Plans (instead of the service representative). Any appeal must be made within 60 days of the date you or your dependent are denied participation or are denied a qualified status change. For eligibility or participation appeals, you or a person you appoint may request a review by the Boeing Employee Benefit Plans Committee, or its delegate, if the Boeing Service Center denies your appeal. It is the Committee's exclusive right to interpret the terms of the Plan and, exercising its discretion, to determine all questions arising under the Plan. The decisions of the Committee are final and binding. Your request to the Committee must be in writing, and must be made within 60 days after you receive the Boeing Service Center's decision. You must indicate the reasons for your appeal, and you may include any information or documents that you believe are relevant to the appeal. The Committee will advise you of its decision, usually within 60 days of receiving your request. Up to an additional 60 days may be required in special circumstances. You will be notified in writing of this extension. The address of the Boeing Employee Benefit Plans Committee is Employee Benefit Plans Committee, The Boeing Company, 7755 East Marginal Way S., P.O. Box 3707, MC 11-57, Seattle, WA 98124-2207. You may not take legal action against the Company for any claim for benefits or denied participation under this Plan unless you instigate the legal action within two years after the rendering of the services upon which the claim is based or within two years of the date you or your dependent is initially denied participation in the Plan.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

35

Coordination of Benefits

If you or your dependents have medical, dental, or other health coverage in addition to being covered under the UnitedHealthcare coordinated care plan, mental health and chemical dependency program, or vision care program described in this supplement, these rules govern coordination of benefits with your other coverage. Other coverage includes, whether insured or uninsured, another employer's group benefit plan, other 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, such as homeowners or automobile medical payments or personal injury protection. The plan that pays its benefits first is considered the primary plan of coverage and pays its benefits without regard to benefits that may be payable under other plans. When another plan is the primary plan for coverage, the UnitedHealthcare coordinated care plan, mental health and chemical dependency program, and vision care program (only for expenses incurred with non-Avesis providers) pay the difference between the benefits paid by the primary plan and what would have been paid had these Boeing plans/programs been primary. A plan is considered primary if · 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 above rules do not determine which group plan is considered primary, these Boeing plans/ programs apply the following coordination of benefits rules: 1. A plan that covers a person as an employee, retiree, 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 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 parent whose birthday comes first in the calendar year, with secondary coverage being provided through 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 above rules establishes which group plan should pay first, then the plan that has covered the person for the longest period of time is considered the primary plan of coverage.

36

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

6. Continuation coverage provided under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is always secondary to other coverage, except as required by law. 7. If you (or an eligible dependent) are confined to a hospital when you first become covered under this plan, this plan is secondary to any plan already covering you (or your dependent) for the eligible expenses related to that hospital admission. Benefits under the UnitedHealthcare coordinated care plan, mental health and chemical dependency program, and vision care program described in this supplement are not coordinated with benefits paid under any other group plan offered by Boeing. Federal rules govern coordination of benefits with Medicare. Medicare is secondary to coverage 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 UnitedHealthcare coordinated care plan 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 UnitedHealthcare coordinated care plan provides secondary coverage. The service representatives have the right to obtain and release any information or recover any payment they consider necessary to administer these provisions. The exclusion of government benefits and services under the UnitedHealthcare coordinated care plan is described in "Noncovered Services and Supplies" on page 19.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

37

Definitions

Ambulatory Surgical Center An ambulatory surgical center is a licensed public or private facility with an organized medical staff of physicians that is equipped and operated mainly for performing surgery and giving skilled nursing care on an outpatient basis. The facility must have registered nurses on duty when a patient is in the facility and may not provide services or beds for patients to stay overnight. Audiologist An audiologist is any person who · Possesses a master's or doctorate degree in audiology or speech pathology from an accredited university. · Possesses a Certificate of Clinical Competence in Audiology from the American Speech and Hearing Association. · Is qualified in the state in which the service is provided to conduct an audiometric examination and hearing aid evaluation test for measuring hearing acuity and determining and prescribing the type of hearing aid that would best improve the covered person's loss of hearing acuity. When a physician performs the services, the physician is considered an audiologist for purposes of this plan. Center for Chemical Dependency A center for chemical dependency is a hospital, rehabilitative hospital, residential treatment facility, or an outpatient treatment facility licensed by the state in which it operates and accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a "rehabilitative facility" for the purpose of treating chemical dependency. The term does not include institutions primarily engaged in providing custodial, recreational, or social services or any facility engaged primarily in providing mental health services not related to chemical dependency. Chiropractor A chiropractor is a physician of chiropractic (D.C.) licensed as such by the state in which he or she practices and whose scope of practice is the diagnosis and treatment of the subluxations or misalignments of the spinal column and related bones and tissues that produce nerve interference. Christian Science Practitioner A Christian Science practitioner is a person authorized to be a Christian Science practitioner or a Christian Science nurse by the Mother Church, the First Church of Christ, Scientist, of Boston, Massachusetts. Christian Science Sanatorium A Christian Science sanatorium is a facility approved for inpatient care by the Mother Church, the First Church of Christ, Scientist, of Boston, Massachusetts. Confined Confined means a person is admitted as a registered bed patient in a facility upon the recommendation of a physician for medical, mental health, or chemical dependency treatment. Convalescent and Long-Term Illness Care Facility A convalescent and long-term illness care facility is · A ward, a wing, or other especially designated convalescent, chronic disease, or long-stay care unit operated by or under the supervision of a hospital. · A free-standing institution operating under the laws governing convalescent hospitals for convalescent and long-term illness care. Such an institution must have an arrangement with one or more hospitals for the transfer of patients between the hospital and the facility. It must also be equipped to care adequately for convalescing patients or patients not in need of inpatient hospital care. Either facility above must be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or must qualify as an extended care facility under Title XVIII of the Social Security Act of 1965, as amended.

38

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

The term does not include hospitals, rest homes, homes for custodial care, homes for the aged, or alcohol or drug rehabilitation centers. Covered Expense Covered expense means only the expense incurred by a person who is covered by the plan for medical services and supplies that are specifically allowed by the plan for preventive care or for hospice care, or that are · Prescribed by a physician for the therapeutic treatment of injury, illness, or pregnancy. · Medically necessary. · Not in excess of the reasonable and customary charges as determined by the service representative. Custodial Care Custodial care is the type of care or service that, even if ordered by a physician, is primarily for the purpose of · Meeting the personal needs of the patient. · Maintaining a level of function (as opposed to specific medical, surgical, or psychiatric care or services designed to reduce the disability to the extent necessary to enable the patient to live without such care or services). This includes help in walking, bathing, dressing, preparing special diets, feeding, and giving medications that do not require constant attention of trained medical personnel. The plan does not cover custodial care. Dentist A dentist is a doctor of dental surgery or a doctor of dental medicine legally licensed to practice dentistry and to prescribe medications within the scope of that license. Disability or Disabled Disability or disabled means that · An employee cannot perform the material and substantial duties of regular work associated with his or her age and sex due to injury, illness, or pregnancy. · A dependent spouse cannot engage in all the normal activities of other people of the same age and sex and in good health, due to injury, illness, or pregnancy. · Any other covered individual cannot engage in all the normal activities of other people of the same age and sex and in good health, because of injury or illness. Note that the definition of disability is somewhat different for the purposes of Social Security and COBRA. Doctor (See "Physician.") Emergency An emergency is the sudden onset of a medical, surgical, or psychiatric condition manifesting itself by acute symptoms of sufficient severity that in absence of immediate medical attention could reasonably result in · Placing the life of the patient or, by virtue of the patient's psychiatric illness, the life of another individual in jeopardy. · Serious impairment to bodily functions or serious and permanent dysfunction of a bodily organ or part. Home Health Care Agency A home health care agency is a hospital or a nonprofit or public home health care agency that · Primarily provides skilled nursing services and other therapeutic services under the supervision of a physician or a registered graduate nurse. · Is run according to rules established by a group of professional persons. · Maintains clinical records of all patients. · Does not primarily provide custodial care or mental health care and treatment of the mentally ill. In those jurisdictions where licensing by statute exists, the home health care agency must be licensed and run according to the laws that regulate home health care.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

39

Home Health Care Services Home health care services are the care and treatment of a person in his or her home. To qualify, the services must be established and approved in writing by a physician who certifies that the person would require confinement in a hospital or skilled nursing facility if he or she did not have the care and treatment prescribed for home health care. Hospice Facility A hospice facility is an institution or part of an institution that · Primarily provides care for terminally ill patients. · Is accredited by the National Hospice Organization or Medicare. · Fulfills any licensing requirements of the state or locality in which it operates. Hospital A hospital is an institution that meets all of the following criteria: · Maintains full-time, permanent facilities for the bed care of resident patients. · Has a physician in regular attendance. · Provides nursing services by professional registered nurses 24 hours a day, on duty or on call. · Primarily provides diagnostic and therapeutic services for medical and surgical care of injuries, illnesses, or pregnancies. · Maintains surgical facilities (not required when the facility is operated primarily for the treatment of the chronically and mentally ill). · Qualifies as a hospital, a psychiatric hospital, or a tuberculosis hospital and as a provider of services under Medicare, if such institution is accredited as a hospital by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). · Operates lawfully as a hospital in its area. Rest homes, nursing homes, convalescent homes, or homes for the aged are not hospitals under this plan. Medically Necessary Medically necessary care or treatment is medically necessary only if the medical plan or service representative determines that it meets all of the following conditions: · It is appropriate for the symptoms and consistent with the diagnosis. (Appropriate means the type, level, and length of service, and the setting in which the service is provided, are needed to provide safe and adequate care and treatment.) · It is given in accordance with generally accepted medical practice and professionally recognized standards. · It is not generally considered experimental or unproved. · It is specifically allowed by the licensing statutes that apply to the provider who treats the patient. The plan may designate a professional organization as its authorized representative for assessing the necessity and appropriateness of medical care and treatment. Mental Illness or Functional Nervous Disorder A mental illness or functional nervous disorder is a condition that is both · Classified as such in the International Classification of Diseases of the U.S. Department of Health, Education and Welfare (V. Psychoneurotic and Personality Disorders No. 290-315, as amended). · Considered by the medical profession to be amenable to favorable modification. Network Provider A network provider (or "participating provider") is a health care professional, institution, facility, agency, or other organization that has entered into a contract with a service representative to provide medical, mental health and chemical dependency, prescription drug, or vision services or supplies at a predetermined cost according to the agreement between the plan/program and a service representative. The providers qualifying as network or participating providers may change from time to time.

40

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Nurse Nurse means a registered graduate nurse, a licensed practical nurse, or a licensed vocational nurse who has the right to use the abbreviation R.N., L.P.N., or L.V.N. Ophthalmologist An ophthalmologist is any licensed physician of medicine or osteopathy legally qualified to practice medicine, including diagnosis, treatment, and prescribing of lenses to correct conditions of the eye. Optometrist An optometrist is any person legally licensed to practice optometry as defined by the laws of the state in which the service is provided. Participating Provider (See "Network Provider.") Pharmacy A pharmacy is a business licensed to dispense prescription drugs by one or more pharmacists who are licensed under the laws of the state in which the pharmacy is located. The term "pharmacy" includes a hospital pharmacy. Physician Physician means any legally qualified medical physician, surgeon, dentist, osteopath, optometrist, chiropractor, psychologist, or podiatrist practicing within the scope of his or her license. As used in this supplement, the term includes a social worker or counselor holding a graduate degree in counseling or a related field only when under the direction of a legally qualified physician. Prescription Drug A prescription drug is a drug dispensed only with the written prescription of a physician, including · A drug bearing the legend "Caution: Federal law prohibits dispensing without a prescription." · Oral or injectable insulin, needles, and syringes. · A compound medication of which at least one ingredient is a legend drug. · Any other drug that may legally be dispensed only with the written prescription of a physician. Reasonable and Customary Charge For medical care, mental health and chemical dependency treatment, and vision services from nonparticipating providers, a charge will be considered reasonable and customary if it · Is the normal charge made by the provider for the service or supply. · Does not exceed the normal charge made by most providers for the same or similar service or supply in the same geographic area where the service or supply is received. Service Representative A service representative is an agent who has a contract with Boeing to make benefit determinations and administer benefit payments under the plan/programs described in this supplement. A list of service representatives appears in Exhibit 2 on pages 42 and 43. Boeing may change a service representative at any time. Skilled Nursing Care Skilled nursing care is care or services prescribed by a physician and furnished by a licensed registered nurse (R.N.) or licensed practical nurse (L.P.N.). The services may be provided on a continuous basis (as in a hospital or skilled nursing facility) or on an intermittent/ part-time basis. The patient must be under treatment and/or convalescing from an illness or injury that requires ongoing evaluation and adjustment of care. The nature of the service and skills required for safe and effective delivery, rather than the patient's medical condition, determines whether the service is skilled.

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

41

Exhibit 2

Where to Get Information

Boeing Service Center for Health and Welfare Plans Address: 100 Half Day Road P.O. Box 1466 Lincolnshire, IL 60069-1466 Seven days a week, 24 hours a day 1-888-747-2016 1-847-883-0746 (if calling from overseas) 1-800-855-2880 (hearing impaired) Monday through Friday 9 a.m. ­ 8 p.m. (Eastern) 8 a.m. ­ 7 p.m. (Central) 7 a.m. ­ 6 p.m. (Mountain) 6 a.m. ­ 5 p.m. (Pacific) http://resources.hewitt.com/boeing Participant eligibility processing and records UnitedHealthcare of the Midwest, Inc. P.O. Box 419079 St. Louis, MO 63141-9079 1-800-482-7115 314-592-7930 Claim administration and network management ValueOptions 340 Golden Shore Long Beach, CA 90802-4246 1-800-643-4001 Claim administration and network management

Telephone:

Representatives available:

Web site: Services: Address for claims and appeals: Claim questions: Services: Address for claims and appeals: Telephone: Services: Address for claims and appeals:

Coordinated Care Plan Service Representative

Mental Health and Chemical Dependency Program Service Representative

Prescription Drug Program Service Representatives

Local participating pharmacy program PAID Prescriptions, L.L.C. P.O. Box 737 Parsippany, NJ 07054-0737

1-800-841-2797 Claim administration and network management

Telephone: Services: Address for claims and appeals:

Mail service program Merck-Medco Rx Services, Inc. P.O. Box 3918 Spokane, WA 99220-9990

1-800-841-2797 http://www.merck-medco.com Claim administration and network management

Telephone: Web site: Services:

42

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

Exhibit 2 (continued)

Vision Care Program Service Representative Address for claims and appeals: Avesis Incorporated Vision Claims Department P.O. Box 15600 Phoenix, AZ 85060 1-800-828-9341 Claim administration and network management

Telephone: Services:

UnitedHealthcare Coordinated Care Plan Nonrepresented Salaried | 2000 Edition

43

Information

255172-United Health Care

42 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

39573


You might also be interested in

BETA
Print
255172-United Health Care