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Honda Manufacturing of Alabama, LLC June 2005 Your Benefits Guide 39549_SPDtabs 6/30/05 3:03 PM Page 1

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Honda Manufacturing of Alabama, LLC

June 2005

Your Benefits Guide

39549_SPDtabs 6/30/05 3:03 PM Page 1

Table of Contents

Introduction

About Your Health Care Coverage

Medical Plan

Prescription Drug Plan

Dental Plan

Short-Term Disability Plan (non-exempt)

Long-Term Disability Plan

About Your Life Insurance

Life and Accident Insurance Plan

Supplemental Life Insurance Plan

Other Benefit Services and Programs

Administrative Information

13

113137475155576365

Intr

odu

ctio

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69

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Honda Manufacturing of Alabama, LLC

About Your Health CareCoverage

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Health CareTable of Contents

Who’s Eligible for Health Care Coverage

Health Care EnrollmentNew Hire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Annual Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Changes in Dependent Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Qualified Medical Child Support Order . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

When Health Care Coverage Begins

When Health Care Coverage Ends

Benefits While on Leave

Double Coverage for Medical or DentalDetermining Primary Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6How Benefits Coordinate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medical and Dental Plan Rights

Women’s Health and Cancer Rights ActBenefit for Mammograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Medical Plan Administrator

Health Care Continuation — COBRA

Electing COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9When COBRA Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Abo

ut

You

r 33

5

55

6

7

8

88

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Honda Manufacturing of Alabama, LLC

Medical Plan

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Table of Contents

Who’s Eligible 12When Coverage Begins 12How the Medical Plan Works 12Preferred Care 13Non-Preferred Care 13Certification for Inpatient Admissions 14

If You Don’t Certify Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Covered Expenses 15Physician Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Preventive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Vision Care Benefits and Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Spinal, Jaw Joint and Foot Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Outpatient Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Inpatient Hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Emergency Care and Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Maternity and Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Short-Term Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Skilled Nursing Care/Private Duty Nursing . . . . . . . . . . . . . . . . . . . . . . . 18Home Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Treatment of Mouth, Jaws, Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Mental Health Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Substance Dependency Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Associate Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Organ Transplant Centers of Excellence Facilities . . . . . . . . . . . . . . . . . . 22

Expenses Not Covered by the Plan 22Claims 25When Coverage Ends 26

Disability, Layoff and Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . 26If You Die . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Changing to a Personal Policy 26Glossary 27

PlanM

edic

al

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Honda Manufacturing of Alabama, LLC

Prescription Drug Plan

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Table of Contents

Who’s Eligible

When Coverage Begins

Network Pharmacy Benefits

Covered Expenses

Expenses Not Covered by the Plan

Claims

Mail Order Benefits

When Coverage Ends

Drug Plan323232

33

32

32

35

36

Pre

scri

ptio

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Honda Manufacturing of Alabama, LLC

Dental Plan

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Table of Contents

Who’s Eligible

When Coverage Begins

How the Dental Plan Works

BenefitsAllowed Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Negotiated Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Covered Dental ExpensesBasic Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Restorative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Periodontic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Supplemental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Prosthetic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Orthodontia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Expenses Not Covered by the Plan

Claims

Double Coverage

When Coverage Ends

Glossary

Plan38

38

38

38

38

41

42

43

43

44

Den

tal

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Honda Manufacturing of Alabama, LLC

Short-TermDisability Plan

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Table of Contents

Who’s Eligible

When Coverage Begins

How the STD Plan Works

Benefits

What’s Not Covered

Claims

When Coverage Ends

Plan (non-exempt)

48

48

48

4949

48

49

Shor

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rm D

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lity

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Honda Manufacturing of Alabama, LLC

Long-TermDisability Plan

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Table of Contents

Who’s Eligible

When Coverage Begins

How the LTD Plan WorksDisability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

BenefitsHow Long Benefits Are Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If You Return to Limited Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If Your Disability Recurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53If You Die . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Mental Health/Chemical Dependency Limitation . . . . . . . . . . . . . . . . . . . 54

What’s Not Covered

ClaimsProof of Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

When Coverage Ends

Plan

52

52

52

54

54

52

54

Lon

g-Te

rm D

isabi

lity

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Honda Manufacturing of Alabama, LLC

About Your LifeInsurance

39549_SPDtabs 6/30/05 3:03 PM Page 15

Table of Contents

Naming a Beneficiary

BenefitsDuring a Terminal Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Premium Waiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

When Coverage Ends

Claims

How Benefits Are Paid

Changing to a Personal Policy

Life Insurance

55

55

565656

55

Abo

ut Y

our

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Honda Manufacturing of Alabama, LLC

Life and AccidentInsurance Plan

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Table of Contents

Who’s Eligible

Basic Life and Accidental Death &Dismemberment Insurance Coverage

BenefitsCovered Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Additional Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Exclusions and Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

When Coverage Ends

Business Travel Accident Insurance Plan

Insurance Plan

58

58

58

60

61

Life

an

d A

ccid

ent

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Honda Manufacturing of Alabama, LLC

Supplemental LifeInsurance Plan

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Table of Contents

Who’s Eligible

When Coverage Begins

Supplemental Term Life Insurance Coverage

PlanSu

pple

men

al

Life

6464

64

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Honda Manufacturing of Alabama, LLC

Other Benefit Servicesand Programs

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ProgramsTable of Contents

Honda Educational Reimbursement

Honda Adoption Program

6667

Oth

er P

rogr

am

Ser

vice

s

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Honda Manufacturing of Alabama, LLC

AdministrativeInformation

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InformationTable of Contents

Welfare Plans

Family and Medical Leave Act (FMLA)

Health Insurance Portability and Acountability Act (HIPAA)

Continuation Coverage for Associates in the

Uniformed Services

Qualified Domestic Relations Order

Claim Appeals

Statement of RightsYour Rights Under ERISA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Enforce Your Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Plan Documents

Future of the Plans

707171

71

7272

7374

Ad

min

istr

ati

ve

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