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Retiree Benefits Guide for Transworld Airlines, Inc. Retirees About This Guide

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Retiree Benefits Guide for Transworld Airlines, Inc. Retirees About This Guide Retiree Benefits Guide for TransWorld Airlines, Inc. Retirees About This Guide In connection with the bankruptcy proceedings of Trans World Airlines, Inc., American Airlines, Inc. and TWA Airlines LLC agreed with the Official Retirees' Committee to provide TWA retiree medical, dental and life benefits. This Health & Life Benefits Guide for Retirees of TWA (Guide) contains the legal plan documents and the summary plan descriptions (SPDs) for the TransWorld Airlines, Inc. Retiree Health and Life Benefits Plan (TWA Retiree Plan) The provisions of this Guide apply to and the American Airlines, Inc. Retiree Dental Insurance Plan eligible retirees of TWA (who were on (RDIP) as they pertain to TWA retiree coverages. The TWA the United States payroll), spouses, Retiree Plan includes the TWA Retiree Medical Benefits and the dependents and surviving spouses TWA Retiree Life Insurance Benefit. who were covered under the benefit program for TWA Retirees effective In our efforts to provide you with full multimedia access to January 1, 2002. American Airlines, benefits information, American Airlines, Inc. has created online Inc. reviews all benefit plans annually, versions of the plans and SPDs. If there is any discrepancy and coverage, as well as between the online version and this Guide, then the plan contribution/premium amounts, may documents contained in this Guide, plus the official notices of be adjusted periodically. changes to the plans will govern. In the event of a conflict between the plan provisions in this Guide and the provisions contained in any insurance policy(ies), the insurance policy (for fully insured programs) shall govern in all cases. The Company expects to continue these plans and programs, but reserves the right to alter, amend, modify or terminate any of the plans or programs described in this Guide, or any part thereof, at its sole discretion. Changes to the plans generally will not affect claims for services or supplies received before the change, and you will receive updates and notices of changes. The Benefits Strategy Committee (BSC), under the authority granted by the Chief Executive Officer of American Airlines, Inc., has the sole authority to create, adopt, amend and/or terminate benefit plans. The Pension Benefits Administration Committee (PBAC), under the sole authority granted to it by the BSC, has the sole authority to make certain amendments to benefit plans. The BSC and PBAC, in consultations with actuaries, consultants, Employee Relations, Human Resources and the Legal Department, have the discretion to adopt such rules, forms, procedures and amendments determined necessary for the administration of employee benefit plans according to their terms, applicable law and regulation, or to further the objectives of the employee welfare plans. The BSC and/or PBAC may act by a majority of its members present during a meeting at which at least half the members are present, or by a unanimous written decision taken without a meeting and filed with the Chair of the PBAC. All benefit plans offered to employees or retirees of any AMR affiliated company are under the jurisdiction of the BSC and the PBAC of American Airlines, Inc. Only BSC and PBAC are authorized to change the plans. From time to time, you may receive updated information concerning plan changes. Neither this Guide nor updated materials are contracts or assurances of compensation, employment or benefits of any kind. i Table of Contents ABOUT THIS GUIDE ................................................................................................................. I TABLE OF CONTENTS............................................................................................................ II BENEFITS-AT-A-GLANCE....................................................................................................... 1 ELIGIBILITY.............................................................................................................................. 2 TWA Retiree Plan Eligibility...................................................................................................................2 Retiree Dental Plan (RDIP) Eligibility ....................................................................................................3 Retiree Life Insurance Benefit Eligibility ................................................................................................3 Retiree Long-Term Care Insurance Plan Eligibility................................................................................3 Dependent Eligibility ..............................................................................................................................3 Incapacitated Child............................................................................................................................................. 4 Qualified Medical Child Support Order (QMCSO).............................................................................................. 4 Parents and Grandchildren ................................................................................................................................ 4 When Children's Eligibility Ends......................................................................................................................... 4 Retirees Married To Employees or Retirees .........................................................................................4 Eligibility During Disability......................................................................................................................5 Eligibility After Age 65............................................................................................................................5 Dependents of Deceased Retirees........................................................................................................5 Coverage for Your Spouse................................................................................................................................. 5 Coverage for Your Children................................................................................................................................ 5 ENROLLMENT AND LIFE EVENTS......................................................................................... 7 Enrollment .............................................................................................................................................7 Contributions Toward Coverage......................................................................................................................... 7 When Coverage Begins.........................................................................................................................7 Life Events — Under Age 65 Participants .............................................................................................7 Marital Status Changes ...................................................................................................................................... 7 Dependent Status Changes ............................................................................................................................... 8 Other Life Event Changes .................................................................................................................................. 8 When Coverage Ends ...........................................................................................................................8 TWA RETIREE MEDICAL BENEFITS...................................................................................... 9 Overview................................................................................................................................................9 How the Plan Works ..............................................................................................................................9 Under Age 65 Option.......................................................................................................................................... 9 Key Plan Provisions - Under Age 65 Option................................................................................................. 12 How the Plan Works ............................................................................................................................13 Age 65 and Over Option (formerly known as the TWA Medicare Supplement Plan) ...................................... 13 Key Plan Provisions – Age 65 and Over Option........................................................................................... 14 Covered Expenses for the TWA Retiree Plan (both the Under Age 65 and the Age 65 and Over Options) ...............................................................................................................................................15 Covered Mental Health and Chemical Dependency Care ............................................................................... 20 Excluded Expenses .............................................................................................................................21 CheckFirst for Pre-Determination of Benefits ......................................................................................24 QuickReview for Hospital Pre-Authorization........................................................................................25 Prescription Drug Benefits...................................................................................................................26 Retail Prescription
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