Basic Indemnity Plan

Boeing Basic Indemnity Plan

No Personal Care Provider (PCP) required
Nationwide network of providers for services not covered by Medicare
Benefits for preventive care without copay or coinsurance

Coverage at a Glance

Deductible:	$1,000 individual; $3,000 family
Annual OOP Max:	$2,000 individual; $4,000 family
Lifetime Max:	$1,500,000; $2,000,000 individual
Copay:	$50 emergency room only
Coinsurance:	10%
Network(s):	Preferred Provider Organization (PPO)

	Preventive Care
	Hospital Services
	Emergency Room
	Mental Health
	Substance Abuse
	Alternative Care
	Prescription benefits
	Vision

Basic Features

Deductibles:	$1,000 individual $3,000 family
Annual OOP Max:	$2,000 individual $4,000 family
Lifetime Max:	$1,500,000; $2,000,000 individual
Coinsurance:	10%
Preventive Care:	100% network Not subject to deductible
Office Visits:	90%-95% Subject to deductible
Diagnostic x-ray and Laboratory Services:	90% - 95% (unless specified otherwise) Subject to deductible
Hospital Services:	90% - 95% Subject to deductible
Emergency Room:	90% - 95% after $50 copay Subject to deductible Emergency room treatment is paid at the network level when the condition meets the definition of a medical emergency. Refer to the Summary Plan Description below for more information.
Mental Health:	90% - 95% inpatient and outpatient services Refer to Benefit Summary below
Substance Abuse:	90% - 95% inpatient and outpatient services Refer to Benefit Summary below
Alternative care:	90% - 95%. Subject to deductible. Limited to a combined total of 26 spinal and extremity manipulation visits per benefit year. Alternative care under the Basic Indemnity Plan includes services received by acupuncturists and chiropractors only. Naturopaths, naturopathic services and massage therapists are not covered under the plan.
Prescriptions:	Generic: $5 retail copay; $10 mail-order copay Brand-name formulary: $20 retail copay; $40 mail-order copay Non-formulary: $35 retail copay; $70 mail-order copay Not subject to deductible Prescription medications are covered through a prescription program managed by Medco. Contact Medco at 1 (800) 841-2797 or visit the Medco Web site to learn more.
Vision:	Routine vision care services are covered through Vision Service Plan (VSP) for certain unions. Contact VSP at 1(800) 877-7195 or visit the VSP Web site to learn more.

Benefit Summary

To view, save, or print a copy of the Benefit Summary, you will require Adobe® Acrobat® Reader. If you do not have Acrobat® Reader, you can download a free copy from Adobe®.

Summary Plan Description

For specific benefit information, refer to the Summary Plan Description located on The Boeing Company Web site.

This information is provided as confirmation of benefits available under the Basic Indemnity Plan for Boeing employees, early retirees, and their families and should not be construed as a guarantee of coverage for any services. The final determination on all claims is made upon their submittal to the plan.