2018 Benefits Summary

This benefit summary reflects the most common version of the LM HealthWorks Plan. Your plan design may differ slightly. Please refer to your Collective Bargaining Agreement (CBA) or the Lockheed Martin Employee Service Center (LMESC) Online for your specific benefit plan design.

HealthFund

Employee or SpouseDeposit Earned by Completing Healthy Actions *
Employee $ 1,000
Spouse $ 600

* The HealthFund is an account set up for you by Lockheed Martin to help offset your deductible and/or certain covered out-of-pocket expenses. You (and your enrolled Spouse) may add to your HealthFund by completing a Well-Being Assessment and other Healthy Actions. Click here to learn more.

In addition to the amounts listed above, pregnant members may earn another $150 by registering in the Beginning Right Maternity Management Program. Click here to learn more.

Any unused HealthFund balance rolls over at year-end as long as you continue to be enrolled as the subscriber in the LM HealthWorks Plan.

Medical Plan

 In NetworkOut of Network*

Annual Deductible

All Coverage Levels

In-network and out-of-network are not combined; they do not cross apply.

$1,000 per person, up to a $3,000 maximum (no more than $1,000 per person) $2,250 per person, up to a $6,750 maximum (no more than $2,250 per person)

Medical Out-of-Pocket Maximum

All Coverage Levels

In-network and out-of-network are not combined; they do not cross apply.

Prescription drugs and preventive care expenses do not count toward the out-of-pocket maximum. In addition, amounts over Reasonable & Customary (R&C) and non-covered services do not accumulate to the out-of-pocket maximum.

$2,500 per person, up to a $6,000 maximum (no more than $2,500 per person) $7,250 per person, up to a $16,750 maximum (no more than $7,250 per person)

Preventive Care

Routine physicals, immunizations,
and related lab fees.
In NetworkOut of Network*

Adults, age 18 and older
Routine physical exam, immunizations, flu shots 1 physical exam per year.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Colorectal Screenings
For all members age 50 and over: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years).

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Gynecological
1 routine GYN exam per year with 1 pap smear and related lab fees.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Hearing Exams
Covered only as part of routine physical exam.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Mammograms
Routine mammogram.
1 baseline age 35-40.
1 annual mammogram age 40+.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Prostate Specific Antigen (PSA) Test and Digital Rectal Exam (DRE)
1 annual (PSA and DRE) exam for males ages 40 to 75; not covered age 76 and over.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Vision Screenings
Covered only as part of routine physical exam.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Well Child Care
Routine immunizations, flu shots.
7 exams in first year of life.
13th - 24th month - 3 exams.
25th - 36th month - 3 exams.
1 exam per year thereafter to age 18.

Plan pays 100%,
deductible waived

Plan pays 100% up to Reasonable & Customary (R&C), deductible waived

Physician Office Visits

 In NetworkOut of Network*

Non-surgical, internists, general physician, family practitioner or pediatrician.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Walk-in Clinic
Immunizations and routine consults performed by Nurse Practitioners outside of traditional office visit setting.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Aexcel®-Designated Providers

 In NetworkOut of Network*

Specialty Care/Office Visits.

Plan pays 90%, after deductible
You pay 10%, after deductible

Not applicable

Non-Aexcel®-Designated Providers

 In NetworkOut of Network*

Specialty Care/Office Visits.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Prescription Drug Coverage

 In NetworkOut of Network*

Retail (Up to a 30-day supply) First 3 purchases of any medication.*

Generic

You pay 10%**, up to $25 maximum, for each prescription or refill

Plan pays 50%, no deductible
You pay 50%, no deductible

Retail (Up to a 30-day supply) First 3 purchases of any medication.*

Brand Name

Preferred brand name. (listed on formulary)

You pay 30%, up to $75 maximum, for each prescription or refill, no deductible

Plan pays 50%, no deductible
You pay 50%, no deductible

Retail (Up to a 30-day supply) First 3 purchases of any medication.*

Brand Name

Non-preferred brand name. (not listed on formulary)

You pay 50%, up to $175 maximum, for each prescription or refill, no deductible

Plan pays 50%, no deductible
You pay 50%, no deductible

Mail Order (Up to a 90-day supply)

Generic

You pay 10%, up to $50 maximum, for each prescription or refill, no deductible

No Coverage

Mail Order (Up to a 90-day supply)

Brand Name

Preferred brand name. (listed on formulary)

You pay 30%, up to $150 maximum, for each prescription or refill, no deductible

No Coverage

Mail Order (Up to a 90-day supply)

Brand Name

Non-preferred brand name. (not listed on formulary)

You pay 50%, up to $350 maximum, for each prescription or refill, no deductible

No Coverage

*After the third purchase of a long-term medication, you pay an additional co-payment of up to $25 per additional fill of that medication at retail. To avoid this cost, use the Express Scripts mail order pharmacy service.

**You pay 0% for in-network generic prescription contraceptive medications that are covered at 100% as part of the Affordable Care Act.

Prescription Drug Out-of-Pocket Maximum

 In NetworkOut of Network*

All Coverage Levels

Amounts over the Reasonable & Customary (R&C) and non-covered medications do not accumulate to the out-of-pocket maximum

$2,000 per person, up to $4,000 maximum (no more than $2,000 per person)

No maximum

Diagnostic X-ray and Lab

 In NetworkOut of Network*

Performed as part of physician office visit and billed by physician, covered same as physician office visits.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Performed in outpatient hospital or other outpatient facility setting, including independent lab.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Complex Imaging Services

 In NetworkOut of Network*

MRA/MRS, MRI, CT Scan, PET Scan. Precertification required for outpatient services.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Emergency Medical Care

 In NetworkOut of Network*

Emergency Room

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 80%, after deductible
You pay 20%, after deductible

Non-emergency use of an Emergency Room

Plan pays 50%, after deductible
You pay 50%, after deductible

Plan pays 50%, after deductible
You pay 50%, after deductible

Ambulance

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 80%, after deductible
You pay 20%, after deductible

Urgent Care Facility

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Non-urgent use of an Urgent Care Facility

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Maternity

 In NetworkOut of Network*

OB Visits
Hospital/facility delivery charges are covered under Hospital Services.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Mental Health

 In NetworkOut of Network*

Inpatient services; no maximum inpatient days per year; Precertification required.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient services; no visit maximum for medically necessary care; Precertification required (generally not required for outpatient therapy visits).

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Hospital Services

 In NetworkOut of Network*

Inpatient
Inpatient surgery expenses, room & board & misc. fees, physician expenses, routine nursery care, prescription drugs, and all inpatient care; Precertification required.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Bariatric Surgery, Cardiac Care, Orthopedic Care
Inpatient and outpatient.
Precertification required.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 90%, after deductible
You pay 10%, after deductible if services performed in Institute of Quality (IOQ) facility

Plan pays 60%, after deductible
You pay 40%, after deductible

Second Surgical Opinion

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient Hospital Expenses
Hospital and other facilities.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient Surgery Performed in Office Setting

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Substance Abuse

 In NetworkOut of Network*

Inpatient rehabilitation and detoxification in a hospital or treatment facility; no maximum inpatient days per year; Precertification required.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient services in an office or other outpatient setting; no visit maximum for medically necessary care; Precertification required (generally not required for outpatient therapy visits).

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Other Services

 In NetworkOut of Network*

Allergy Testing and Treatment
Office Visit.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Allergy Injections

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Autism/Pervasive Development Delays
Covers diagnosis and outpatient short-term rehabilitation.
Limited to 60 visits per year, combined for speech, physical and occupational therapies. Short-Term Rehabilitation at an outpatient hospital setting is included in the 60 visits maximum.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Chiropractic Care
All visits/services at a chiropractor count toward 20 visit annual maximum.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Contraceptive Devices, Implants and Injections
Plan covers associated office visit for injection of Depo-Provera and Lunell, Diaphragm fitting, and cervical cap and IUD devices.

Plan pays 100%, deductible waived

Plan pays 60%, after deductible
You pay 40%, after deductible

Convalescent Facility/Skilled Nursing Facility
Semi-private room rate. Prior hospital confinement not required. Precertification required; up to 120 days per calendar year (combined in-network and out-of-network limit).

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Durable Medical Equipment
Precertification required for amounts in excess of $5,000.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Hearing Aids
Limited to $1,000 per ear every 3 years.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Home Health Care
Prior hospital confinement not required. Each visit by a Home Health Aide of up to 4 hours equals 1 visit. Each visit by a Nurse or Therapist equals 1 visit. Limited to 120 visits per year (Home Health Care and Private Duty Nurse visits combined); Precertification required for some services.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Inpatient Hospice Care; Precertification required.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Inpatient Hospice Lifetime Maximum.

Unlimited

Unlimited

Outpatient Hospice Care.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient Hospice Lifetime Maximum.

Unlimited

Unlimited

Infertility
Covers diagnosis and treatment of underlying cause only.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Mouth, Jaws, Teeth
Oral surgery procedures; Precertification required. Covers accident related injury to teeth, and medical in nature oral and jaw surgery.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Organ and Tissue Transplants
Requires preauthorization by National Medical Excellence.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 90%, after deductible
You pay 10%, after deductible if services performed in Institute of Quality (IOQ) facility

Plan pays 60%, after deductible
You pay 40%, after deductible

Outpatient Short-Term Rehabilitation
Limited to 60 visits per year, combined for speech, physical and occupational therapies. Short-Term Rehabilitation at an outpatient hospital setting is included in the 60 visits maximum. Includes coverage for Autism/Pervasive Developmental Delays.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Private Duty Nursing (PDN)
Outpatient care provided by a Registered Nurse or LPN, if member’s condition requires skilled nursing care and visiting nursing care is not adequate; Precertification required. Limited to 120 visits per year (Home Health Care and Private Duty Nurse visits combined).PDN maximum: 1 shift equals up to 8 hours.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Prosthetic Devices
(Artificial limbs, breast prosthesis)
Precertification required for amounts in excess of $5,000.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Sexual Disorders
Excludes treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling that do not have a physiological or organic basis.

Plan pays 80%, after deductible
You pay 20%, after deductible

Plan pays 60%, after deductible
You pay 40%, after deductible

Precertification Penalty

 In NetworkOut of Network*

Inpatient Hospital
Precertification required for treatment facilities, skilled nursing facilities and inpatient mental health / substance abuse.

Precertification required;
provider responsible - no penalty

You are responsible for precertification;
$500 penalty for failure to precertify

Outpatient Hospital
Precertification required for home health care, private duty nursing and some other outpatient services; generally not required for outpatient therapy visits.

Precertification required;
provider responsible - no penalty

You are responsible for precertification;
$300 penalty for failure to precertify

Lifetime Maximum

 In NetworkOut of Network*

Lifetime Maximum

No maximum.

 

Pre-existing Conditions

 In NetworkOut of Network*

Pre-existing Conditions

No restrictions

No restrictions

Dependent Limiting Age

Plan covers eligible dependent children from birth to age 26.

Claims Administrator Information

Medical Administered by:

Aetna
P.O. Box 981106
El Paso, TX 79998-1106

Prescription Administered by:

Express Scripts, Inc.
P.O. Box 14711
Lexington, KY 40512

Out-of-Area Plan Definition

In some locations in the United States, employees may have limited or no access to a provider network. If the medical claims administrator determines you reside in one of these locations, you are eligible for out-of-area benefits. Once the determination is made, it will be valid for the remainder of the year. Out-of-area coverage is the same as out-of-network coverage except that the plan reimbursement is generally 80% (not 65%) of the reasonable and customary charge* (after the deductible) for most covered medical expenses. The deductibles and out-of-pocket maximums are the same as the in-network deductibles and out-of-pocket maximums. If you receive medical care from a network provider, covered expenses are reimbursed at the in-network level.

* The reasonable and customary charge is the charge most often made for a given health care service or supply in a geographical area. Benefits paid by the LM HealthWorks Plan for out-of-network or out-of-area care are based on reasonable and customary charges.

This document is not intended as a summary plan description or plan document. If there is any conflict between this summary and the official plan documents, the official plan documents will govern.

Disclaimer:

The information provided in this "Benefits Summary" is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Consult the formal plan documents to determine governing plan provisions, including procedures, exclusions and limitations relating to the plan. While this information is believed to be accurate as of the plan effective date (January 1, 2018), it is subject to change.

* Benefits paid by the LM HealthWorks Plan for out-of-network and out-of-area care are based on Reasonable and Customary charges. Reasonable and Customary charges are those most often made for a given health care service or supply in a geographical area.

Please note that plan provisions and eligibility for union represented employees are based on the terms of the collective bargaining agreement.

This document is not intended as a summary plan description or plan document. If there is any conflict between this summary and the official plan documents, the official plan documents will govern.

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