US Airways Attachment B to the August 14

US Airways Attachment B to the August 14, 2002 Amendment to the 1999 Agreement
National PPO - Plan Design Summary
Eligible Actives, Inactives & Pre-65 Retirees

Health and Welfare Plans

New Medical/Dental Plan Design Effective January 1, 2003

For all eligible active and inactive employees, pre-Medicare eligible retirees (i.e. prior to age 65) and eligible dependents who are in-network for the selected Third Party Administrator (TPA), medical coverage will be in accordance with the attached PPO Plan Design Summary and the following;

For all eligible active and inactive employees, pre-Medicare eligible retirees (i.e. prior to age 65) and eligible dependents who are out-of-network for the selected TPA, medical coverage will be in accordance with the attached Indemnity Plan Design Summary and the following;

For all eligible Medicare-eligible retirees (i.e. after age 65) and eligible dependents, medical coverage will be in accordance with the attached Indemnity Plan Design Summary, and the following;

For all eligible active and inactive employees, retirees, and their eligible dependents, dental coverage will be in accordance with the attached Managed Dental Plan Design Summary and the following:

Reasonable and Customary (R&C) standard provided for in the out-of-network and out-of-access portions of the medical and dental plans will be updated based on the Third Party Administrator’s (TPA’s) regular schedule but not less frequently than every six months at the 90^th percentile of charges.
For purposes of Lifetime Maximums, there will be no carryover of charges from existing plans (i.e. fresh start.)
The Company will use the TPA’s standard definition of access for defining when a participant is considered to be out-of-network with respect to the medical and dental plans. The out-of-network medical and dental plans will provide benefits at the in-network level, subject to R&C.
The company will adopt the protocols of the selected TPA regarding transition of care. Care while traveling abroad will be covered under the plan on an in-network basis for emergency and urgent care.
Spouses will be eligible for benefits under the medical/dental plan, subject to a non-duplication method of coordination.
In selecting a vendor to administer its medical and dental plans, US Airways will make every effort to cause the least disruption to current provider access.
Employee contributions will be in accordance with the attached contribution charts.

Changes to Flexible Spending Account

Increase maximum medical/dental care expense reimbursement of the Flexible Spending Account Program under Letter of Agreement #24 to the lesser of $7,500 or the maximum amount permitted under the law. US Airways will implement effective January 1, 2003.

Benefits	Option 1		Option 2		Option 3
Benefits	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Annual Deductible ^{(1) (2)}
Single	$300	$600	$150	$300	$150	$300
Family	$600	$1,200	$300	$600	$300	$600
Coinsurance	80%	60%	90%	70%	100%	80%
Annual Out-of-Pocket Maximum ^{(1) (2) (3)}
Single	$2,000	$4,000	$1,000	$2,000	N/A	$2,000
Family	$4,000	$8,000	$2,000	$4,000	N/A	$4,000
Lifetime Maximum ⁽⁴⁾	Unlimited	$1,000,000	Unlimited	$1,000,000	Unlimited	$1,000,000
Medical Office Services
Office Visits	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Subject to deductible & coinsurance	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Subject to deductible & coinsurance	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Subject to deductible & coinsurance
Physical Exams	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered
Well-Child Care	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered
Gynecological Exams	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Annual well woman exams not covered except for pap smears & mammograms Visits related to illness subject to deductible & coinsurance	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Annual well woman exams not covered except for pap smears & mammograms Visits related to illness subject to deductible & coinsurance	100% after $15 copay for primary care physicians and $25 copay for specialists⁽¹⁾	Annual well woman exams not covered except for pap smears & mammograms Visits related to illness subject to deductible & coinsurance
X-ray & Lab Tests	100% if performed in physician office as part of office visit, otherwise subject to deductible & coinsurance	Subject to deductible & coinsurance	100% if performed in physician office as part of office visit, otherwise subject to deductible & coinsurance	Subject to deductible & coinsurance	100% if performed in physician office as part of office visit, otherwise subject to deductible	Subject to deductible & coinsurance
Immunizations	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered	100% after $15 copay ⁽¹⁾	Not covered
Inpatient Hospital Services ⁽⁵⁾
Days of Care	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible Unlimited number of days	Subject to deductible & coinsurance Unlimited number of days
Room Allowance (Semi-private room covered; private room only when medically necessary)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Intensive & Cardiac Care	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Supplies & Services	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Surgery	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Physician Visits	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Outpatient Hospital Services
Surgery	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
X-ray & Lab Tests	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Pre-admission Testing	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Emergency Room Care ⁽⁶⁾	Covered in full after $100 copay ^{(1) (6)} (waived if admitted)		Covered in full after $100 copay ^{(1) (6)} (waived if admitted)		Covered in full after $100 copay ^{(1) (6)} (waived if admitted)
Maternity Care
Obstetric Services (including office visits)	100% after $25 copay (initial visit only) ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay (initial visit only) ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay (initial visit only) ⁽¹⁾	Subject to deductible & coinsurance
Hospital Charges (including newborn nursery care)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Mental Health Care ⁽⁷⁾
Inpatient Care ⁽⁵⁾	Subject to deductible & coinsurance Coinsurance level is 80%	Subject to deductible & coinsurance Coinsurance level is 60% 30 day maximum per year	Subject to deductible & coinsurance Coinsurance level is 90%	Subject to deductible & coinsurance Coinsurance level is 70% 30 day maximum per year	Subject to deductible & coinsurance Coinsurance level is 100%	Subject to deductible & coinsurance Coinsurance level is 80% 30 day maximum per year
Outpatient Care	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year
Chemical Dependency ⁽⁷⁾
Inpatient Care ⁽⁵⁾	Subject to deductible & coinsurance Coinsurance level is 80%	Subject to deductible & coinsurance Coinsurance level is 60% 30 day maximum per year	Subject to deductible & coinsurance Coinsurance level is 90%	Subject to deductible & coinsurance Coinsurance level is 70% 30 day maximum per year	Subject to deductible & coinsurance Coinsurance level is 100%	Subject to deductible & coinsurance Coinsurance level is 80% 30 day maximum per year
Outpatient Care	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year	100% after $15 copay ⁽¹⁾ No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% 30 visit maximum per year
Other Coverage
Durable Medical Equipment	100% up to $500 ⁽¹⁾per year then subject to deductible & coinsurance	Subject to deductible & coinsurance	100% up to $500 ⁽¹⁾per year then subject to deductible & coinsurance	Subject to deductible & coinsurance	100% up to $500 ⁽¹⁾per year then subject to deductible	Subject to deductible & coinsurance
Physical & Speech Therapy (20 combined in and out of network maximum per year)	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance
Chiropractic Care	100% after $25 copay ⁽¹⁾ (20 visit maximum per year)	Not covered	100% after $25 copay ⁽¹⁾ (20 visit maximum per year)	Not covered	100% after $25 copay ⁽¹⁾ (20 visit maximum per year)	Not covered
Home Health Care	100% when medically necessary (100 visit maximum per year)	Not covered	100% when medically necessary (100 visit maximum per year)	Not covered	100% when medically necessary (100 visit maximum per year)	Not covered
Hospice Care	100% up to $10,000	Not covered	100% up to $10,000	Not covered	100% up to $10,000	Not covered
Skilled Nursing Care (60 day combined in and out of network maximum per year)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible	Subject to deductible & coinsurance
Second Surgical Opinion	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance	100% after $25 copay ⁽¹⁾	Subject to deductible & coinsurance
Dental Care	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible	Covered only when the result of accidental injury then subject to the deductible & coinsurance
Vision Care	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered
Hearing Care	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered
Prescription Drug Coverage ⁽⁸⁾
Retail Copay ⁽¹⁾ (34-day supply)
Generic	100% after $10 copay	Not covered	100% after $10 copay	Not covered	100% after $10 copay	Not covered
Brand formulary	100% after $20 copay	Not covered	100% after $20 copay	Not covered	100% after $20 copay	Not covered
Brand nonformulary	100% after $30 copay	Not covered	100% after $30 copay	Not covered	100% after $30 copay	Not covered
Mail Order Copay ⁽¹⁾ (90-day supply)
Generic	100% after $20 copay	Not covered	100% after $20 copay	Not covered	100% after $20 copay	Not covered
Brand formulary	100% after $40 copay	Not covered	100% after $40 copay	Not covered	100% after $40 copay	Not covered
Brand nonformulary	100% after $60 copay	Not covered	100% after $60 copay	Not covered	100% after $60 copay	Not covered
Coordination of Benefits	Nonduplication		Nonduplication		Nonduplication

Notes:

Indexing of dollar amounts for deductibles and copays will not occur. Separate deductible applies for medical and mental health/chemical dependency.

Out-of network expenses can be applied toward satisfaction of in-network deductibles and out-of-pocket maximums. In-network expenses can be applied toward satisfaction of out-of-network deductibles and out-of-pocket maximums.

Does not include deductible or copays. Separate for medical and mental health/chemical dependency.

Combined medical and mental health/chemical dependency maximum.

Network physicians required to notify plan and obtain approval for all inpatient hospital admissions (medical and mental health/chemical dependency.) Member responsible for notification and obtaining authorization for all out-of-network inpatient hospital admission. $250 penalty for non-notification.

For non-emergency use of Emergency Room – coinsurance level reduced to 50%.

Mental Health and Chemical Dependency services may be carved-out and administered by a TPA.

Prescription drug coverage may be carved-out and administered by a TPA.

Benefits	Option 1	Option 2	Option 3
Annual Deductible ⁽¹⁾
Single	$300	$150	$150
Family	$600	$300	$300
Coinsurance	80%	90%	100%
Annual Out-of-Pocket Maximum ^{(1) (2)}
Single	$2,000	$1,000	N/A
Family	$4,000	$2,000	N/A
Lifetime Maximum ⁽³⁾	Unlimited	Unlimited	Unlimited
Medical Office Services
Office Visits	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Physical Exams	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Well-Child Care	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Gynecological Exams	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
X-ray & Lab Tests	100% if performed in physician office as part of office visit, otherwise subject to deductible & coinsurance	100% if performed in physician office as part of office visit, otherwise subject to deductible & coinsurance	100% if performed in physician office as part of office visit, otherwise subject to deductible
Immunizations	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Inpatient Hospital Services ⁽⁴⁾
Days of Care	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible & coinsurance Unlimited number of days	Subject to deductible Unlimited number of days
Room Allowance (Semi-private room covered; private room only when medically necessary)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Intensive & Cardiac Care	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Supplies & Services	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Surgery	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Physician Visits	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Outpatient Hospital Services
Surgery	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
X-ray & Lab Tests	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Pre-admission Testing	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Emergency Room Care ⁽⁵⁾	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Maternity Care
Obstetric Services (including office visits)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Hospital Charges (including newborn nursery care)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Mental Health Care ⁽⁶⁾
Inpatient Care ⁽⁴⁾	Subject to deductible & coinsurance Coinsurance level is 80%	Subject to deductible & coinsurance Coinsurance level is 90%	Subject to deductible & coinsurance Coinsurance level is 100%
Outpatient Care	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit
Chemical Dependency ⁽⁶⁾
Inpatient Care ⁽⁴⁾	Subject to deductible & coinsurance Coinsurance level is 80%	Subject to deductible & coinsurance Coinsurance level is 90%	Subject to deductible & coinsurance Coinsurance level is 100%
Outpatient Care	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit	Subject to deductible & coinsurance Coinsurance level is 50% No visit limit
Other Coverage
Durable Medical Equipment	100% up to $500 ⁽¹⁾per year then Subject to deductible & coinsurance	100% up to $500 ⁽¹⁾per year then Subject to deductible & coinsurance	100% up to $500 ⁽¹⁾per year then Subject to deductible
Physical & Speech Therapy (20 visit maximum per year)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Chiropractic Care (20 visit maximum per year)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Home Health Care (100 visit maximum per year)	100% when medically necessary	100% when medically necessary	100% when medically necessary
Hospice Care	100% up to $10,000	100% up to $10,000	100% up to $10,000
Skilled Nursing Care (60 day maximum per year)	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Second Surgical Opinion	Subject to deductible & coinsurance	Subject to deductible & coinsurance	Subject to deductible
Dental Care	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible & coinsurance	Covered only when the result of accidental injury then subject to the deductible
Vision Care	Not covered	Not covered	Not covered
Hearing Care	Not covered	Not covered	Not covered
Prescription Drug Coverage ⁽⁷⁾
Retail Copay ⁽¹⁾ (34-day supply)
Generic	100% after $10 copay	100% after $10 copay	100% after $10 copay
Brand formulary	100% after $20 copay	100% after $20 copay	100% after $20 copay
Brand nonformulary	100% after $30 copay	100% after $30 copay	100% after $30 copay
Mail Order Copay ⁽¹⁾ (90-day supply)
Generic	100% after $20 copay	100% after $20 copay	100% after $20 copay
Brand formulary	100% after $40 copay	100% after $40 copay	100% after $40 copay
Brand nonformulary	100% after $60 copay	100% after $60 copay	100% after $60 copay
Coordination of Benefits	Carve-out	Carve-out	Carve-out

Notes:

Indexing of dollar amounts for deductibles and prescription drug copays will not occur. Separate deductible applies for medical and mental health/chemical dependency.

Does not include deductible. Separate for medical and mental health/chemical dependency.

Combined medical and mental health/chemical dependency maximum.

Member responsible for notification and obtaining authorization for all inpatient hospital admission (medical and mental health/chemical dependency) - $250 penalty for non-notification.

For non-emergency use of Emergency Room- coinsurance level reduced to 50%.

Mental Health and Chemical Dependency services may be carved-out and administered by a TPA.

Prescription drug coverage may be carved-out and administered by a TPA.

Benefits	In-Network	Out-of-Network
Deductible	$0	$50/$100 family
Coinsurance
Preventive	100%	80% of R&C
Minor	80%	50% of R&C
Major	50%	50% of R&C
Orthodontia	50%	No coverage
Maximum
Annual Maximum	$1,500	$1,000
Lifetime Ortho Maximum	$2,000	No coverage

Notes:

If participant resides outside of network area, provide reimbursement based on R&C and paid at the in-network level and orthodontia benefit of 50% to $2,000 lifetime maximum.