Caso N° 4 Despacho Anticipado con Diferencia de Sellos 120

The Federal Government has special eligibility rules for HSAs, as described below (these requirements differ from Boeing health care plan eligibility rules). You may be eligible to set up an HSA if you

n Are covered by a high-deductible health care plan, such as the PPO+Account. n Are not claimed as a dependent on someone else’s tax return (except your spouse’s).

n Are not covered by another health care plan such as your spouse’s health care plan (unless it is a high-

deductible health care plan).

– A health flexible spending account, including your spouse’s flexible spending account (unless it is a “limited use” spending account designed to work with an HSA).

– Medicare. – TRICARE.

– Veterans Affairs medical benefits (used during the past three months). You will have to certify that you meet the HSA eligibility requirements when you enroll. If your spouse is enrolled in a high-deductible health care plan, it may affect how much you can contribute to your HSA.

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Contributing to Your Aetna HSA

The amount Boeing will contribute to your account is based on the coverage level you elect. The contribution will be equally divided among your paychecks for the year.

You can make your own optional contributions to your Aetna HSA through payroll deductions. The amount you contribute is subject to Federal limits. You can change your contribution amount at any time during the year, for any reason. Even if you decide not to contribute, you still will receive Boeing’s contribution.

The amount Boeing contributes to your HSA will change each year. Contribution amounts are shown below.

2012 Annual Aetna HSA Contributions*

Coverage level: contributes:Boeing contribute up to:Employee can

Total maximum contributions (from Boeing and employee):

Employee only $1,000 $2,050** $3,050 Employee + spouse or child(ren) $1,750 $4,400** $6,150 Employee + spouse

and child(ren) $2,500 $3,650** $6,150

* Contributions are subject to Federal limits and are adjusted annually. The contribution limits shown here are for 2010; 2012 limits are not known at this time, but will apply to the Aetna HSA on January 1, 2012.

** Employees who are age 55 or older (or will turn 55 in 2012) can contribute up to an additional $1,000 as a “catch‑up” contribution in 2012.

2013 and 2014 Boeing Annual Aetna HSA Contributions

Coverage level: Boeing contributes:

Employee only $700

Employee + spouse or child(ren) $1,250 Employee + spouse and child(ren) $1,750

Important HSA Information

The Aetna HSA is not subject to ERISA (the PPO+Account medical coverage is subject to ERISA).

Because Boeing does not sponsor or endorse the Aetna HSA, there are some differences between it and medical plans sponsored by Boeing:

n Your Aetna HSA will not offer COBRA continuation rights (unlike the PPO medical coverage, which may be

continued through COBRA). However, the HSA is your account and it is portable, which means you can maintain it with Aetna after you leave Boeing, or you can move it to another qualified HSA. You also can continue making contributions to your HSA after you leave Boeing, provided you are enrolled in a high- deductible health care plan and meet all other contribution requirements.

n Aetna sponsors and administers the HSA; neither Boeing nor the Employee Benefit Plans Committee will

have any involvement in HSA administration or claim issues.

n Please keep in mind the HSA is your personal account with Aetna. As a result, Boeing cannot sponsor or

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Traditional Medical Plan

Prescription Drug Program

The following changes apply to the prescription drug program:

n Prescription drugs purchased at a retail participating pharmacy will be covered as follows:

– 90 percent generic ($5 minimum; $25 maximum).

– 80 percent brand formulary ($15 minimum; $75 maximum). – 70 percent brand nonformulary ($30 minimum; no maximum).

n Prescription drugs purchased through the mail-order program will be covered as follows:

– $10 copayment generic.

– $40 copayment brand formulary. – $70 copayment brand nonformulary. – 90-day supply

n Generic Incentive Program

– To encourage the use of generic drugs, if a brand-name drug is purchased when a generic equivalent is available—whether you or your physician requests the brand-name drug—you will pay the generic coinsurance/copayment plus the cost difference between the brand-name and generic drug.

n Pharmacy Management—Specialty Care Pharmacy

– Specialty medications are typically injectable medications administered by the patient or a health care professional, and they often require special handling. Newly prescribed medications may be purchased at any participating retail pharmacy for up to two times. After that, the plan will cover these prescriptions only if they are purchased through the service representative’s specialty care pharmacy. The specialty care pharmacy program will not apply to medications ordered and billed through a physician’s office.

Preventive Care and Routine Physicals

For network preventive care services and supplies, benefits will be paid as described below.

n 100 percent (deductible does not apply) up to a $500 annual maximum for all preventive care, including

routine physical examinations, related laboratory and X-ray charges as well as childhood and adult

immunizations as recommended by the U.S. Preventive Care Task Force guidelines. Covered expenses that exceed the $500 maximum will be subject to the deductible and coinsurance.

n 100 percent (deductible does not apply) with no annual maximum for routine Pap tests, mammograms,

prostate screenings, and colorectal screenings (including colonoscopies) as recommended by the physician.

n 100 percent (deductible does not apply) with no annual maximum for preventive care for children to age 2;

includes immunizations according to the U.S. Preventive Care Task Force guidelines and as recommended by the physician.