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<strong>Benefits</strong>-the choice is inmy hands.2013SOUTHWEST AIRLINESANNUAL ENROLLMENT


Table of ContentsImportant Enrollment Information............................................................5Eligibility Documentation.........................................................................5Eligibility Chart.......................................................................................6<strong>Benefits</strong>Plus Summary.............................................................................7Health Savings Account............................................................................8<strong>Benefits</strong>Plus 2013 Monthly Medical Contributions.......................................9<strong>Benefits</strong>Plus 2013 Medical Program Options Comparison Chart...................10<strong>Benefits</strong>Plus Prescription Coverage..........................................................12<strong>Benefits</strong>Plus Dental Program...................................................................13<strong>Benefits</strong>Plus Vision Program...................................................................13Regular Plan….......................................................................................14Flexible Spending Accounts.....................................................................16Life Insurance........................................................................................18Optional Accidental Death & Dismemberment (AD&D) Insurance.................20Beneficiary Designation.........................................................................20Long Term Disability (LTD) Insurance........................................................21<strong>Benefits</strong>Plus Voluntary <strong>Benefits</strong>.............................................................22ClearSkies/Employee Assistance Program................................................23Wellness Programs................................................................................23Important Phone Numbers and Websites....................................back page2013 ANNUAL ENROLLMENT 3


2013 SOUTHWEST AIRLINESAnnual EnrollmentOctober 25, 2012 - November 14, 2012 Closes at 11:59 P.M. Central TimeImportant note: The online enrollment system will be closed onSaturday, November 10, 2012 from 6:00 a.m. - 7:00 p.m. Central Time.BIG CHANGES:Employee benefit options have been redesigned for2013 to give you more choices.READ CLOSELY:This Annual Enrollment guide provides an overview of theinformation and tools that you need to understand thesechoices and select the options that will work best for youand your family. The benefits described in this 2013 AnnualEnrollment guide will be effective January 1, 2013.Please read all of the information in this guide and besure to call or e-mail the <strong>Benefits</strong> Team if you havequestions.ASK QUESTIONS:Health & Welfare <strong>Benefits</strong>Monday – Friday 8:00 a.m. – 5:00 p.m. Central Time1-800-551-1211askbenefits@wnco.comADDITIONAL INFORMATION—SUMMARY OF BENEFITS COVERAGE:As an Employee, the health benefits available toyou represent a significant component of yourcompensation package. They also provide importantprotection for you and your family in the case ofillness or injury. The Southwest Airlines Co. WelfareBenefit Plan offers a series of health coverage options.Choosing a health coverage option is an importantdecision. To help you make an informed choice, yourplan makes available a Summary of <strong>Benefits</strong> andCoverage (SBC) for each option, that summarizesimportant information in a standard format to helpyou compare across options. SBCs are available onthe online enrollment tool as well as at <strong>SWA</strong>Life>My<strong>Benefits</strong>><strong>Benefits</strong> Information and Resources>Summaryof <strong>Benefits</strong> Coverage. A paper copy is also available,free of charge, by e-mailing askbenefits@wnco.com orcalling 1-800-551-1211.42013 ANNUAL ENROLLMENT


IMPORTANT ENROLLMENT INFORMATIONYOU MUST ENROLL ONLINE. To enroll, go to <strong>SWA</strong>Life>About Me >My <strong>Benefits</strong> and click on the AnnualEnrollment link. For detailed step-by-step instructions onhow to enroll, please refer to the 2013 Online EnrollmentUser guide included in this packet.ENROLL EARLY! Annual Enrollment begins on October25 and ends on November 14 at 11:59 p.m. Central Time.Late enrollments, changes, or corrections will not beaccepted. The online enrollment system will be closedon Saturday, November 10, 2012 from 6:00 a.m. - 7:00p.m. Central Time.YOU MUST SAVE YOUR ELECTIONS, when you completethe online enrollment process.REVIEW THE BENEFITS CONFIRMATION STATEMENT.You are not enrolled until you see the <strong>Benefits</strong> ConfirmationStatement on the computer screen and receive it in yourCompany e-mail inbox. It is your responsibility to carefullyreview the <strong>Benefits</strong> Confirmation Statement to confirmthat it matches your selections and print a copy of your<strong>Benefits</strong> Confirmation Statement for your records.DEADLINE-ELIGIBLITY DOCUMENTATION REQUIRED.December 31, 2012 is the deadline to submit forms anddocumentation for newly enrolled Family Members.FLEXIBLE SPENDING ACCOUNT ELECTIONS DO NOTCARRY OVER YEAR-TO-YEAR. If you would like to enrollin the Health Care Flexible Spending Account or theDependent Care Flexible Spending Account then you mustmake affirmative elections during Annual Enrollment.REGISTRATION REQUIREMENT WHEN CHANGING FROMTHE REGULAR PLAN TO BENEFITSPLUS (OR FROMBENEFITSPLUS TO THE REGULAR PLAN). Reminder:There are two programs available for benefits coverage—<strong>Benefits</strong>Plus and the Regular Plan. If you would like toswitch coverage from the Regular Plan to <strong>Benefits</strong>Plusor from <strong>Benefits</strong>Plus to the Regular Plan, you mustcontact Health & Welfare <strong>Benefits</strong> before using the onlineenrollment tool so that you can be registered with thedesired program. You will be required to complete a<strong>Benefits</strong> Request for Program Change Form. You mustallow 24 hours to process your <strong>Benefits</strong> Request forProgram Change Form before you enroll in the desiredprogram using the online enrollment tool. Note: If youswitch from the <strong>Benefits</strong>Plus program to the Regular Plan,you and your family members over the age of 19 may besubject to a three-month pre-existing condition limitation.AUTOMATIC ENROLLMENT IF YOU DO NOT ELECT 2013OPTIONS. Choice Plus PPO and Choice EPO are beingcombined to form the Choice Plus Plan, and Medical PlanC is being renamed Choice Plan C, all effective January 1,2013. If you do not make an election online during AnnualEnrollment and you are currently enrolled in these optionsthen, effective January 1, 2013 you will be automaticallyenrolled as follows:2012 Election Defaults to 2013 ElectionChoice Plus PPO Choice Plus PlanChoice EPO Choice Plus PlanMedical Plan C Choice Plan CELIGIBILITY DOCUMENTATIONSouthwest offers benefit coverage in the Medical, Dental,Vision and Life Insurance programs to eligible dependentsprovided that you submit all required documentation uponenrollment and at any time upon request. To enroll a newFamily Member for coverage effective January 1, 2013,you must complete a Family Member DocumentationForm and provide required documentation no later thanDecember 31, 2012. If your documentation is not receivedprior to this deadline, then the family member will not beeligible for coverage in 2013.INSTRUCTIONS FOR SUBMITTING DOCUMENTATION:1. Obtain Family Member Documentation Form throughthe online enrollment tool.2. Complete the Family Member Documentation Form –including your dependent’s social security number.3. Review the eligibility chart, gather all requireddocuments and write your Employee ID number oneach document.4. Ask questions!5. Deliver, fax, or e-mail the documentation to:Health & Welfare <strong>Benefits</strong>1st Floor of Headquarters inthe People DepartmentFAX: 214-792-4216askbenefits@wnco.com6. Confirm receipt with Health & Welfare <strong>Benefits</strong>.7. Keep a copy of documentation and proof of submissionfor your records.8. Be prepared to provide additional information if neededupon request.2013 ANNUAL ENROLLMENT 5


ELIGIBILITY CHARTSouthwest Airlines and its third party administrators may audit dependent eligibility at any time. It is each Employee’sresponsibility to provide any and all information requested. Falsifying eligibility documentation, claims, or otherwiseattempting to obtain benefits or coverage inappropriately could result in denial of claims, termination of benefits, and otherdisciplinary measures, up to and including termination of employment.Family Member Description Required DocumentationSpouseYour lawful Spouse (if not legally separated from you, theEmployee) who qualifies as a Spouse for purposes of theInternal Revenue Code of 1986 (as in effect on January 1,2004).1. Copy of Marriage Certificate issued by a governmental agency (certified translated copy ifin a foreign language);2. Social Security Number;3. And ONE document from the options below:Option 1Page 1 of your current year’s filed Federal tax return that lists your Spouse and filing status.Option 2Page 1 of your previous year’s filed Federal tax return that lists your Spouse and filing statusAND a copy of your current year IRS Form 4868 requesting a filing extension.Option 3One item from the list below.• Joint Ownership Document - examples include: mortgage statement, credit card statement,car note, bank statement, school taxes, or utility bills dated any time in the last threemonths listing you and your Spouse• Rental/lease agreement, deed, or property tax statement/appraisals dated anytime in thelast 12 months listing you and your Spouse• Homeowner’s insurance policy currently in effect listing you and your Spouse• Auto insurance policy currently in effect listing you and your Spouse• Automobile registration currently in effect listing you and your Spouse**If you were married within the last 12 months, then you only need to submit a copy of yourMarriage Certificate and do not need to submit the documents listed in the options.Marriage License alone is not adequate.Natural Child Your natural child up to age 26. 1. Copy of Birth Certificate issued by a governmental agency, Hospital Birth Record (fornewborns), or other legal document establishing parentage. (Employee must be listed on thebirth certificate, hospital birth record or other legal document).2. Social Security NumberStepchildLegally AdoptedChild (or Child Placedfor Adoption)Child for WhomYou Have a LegalObligationDisabled ChildCommitted PartnerRegistered Partner(Passes Only)Your stepchild, up to age 26 and who is a child of your currentSpouse by a previous union.Your legally-adopted child, including child placed for adoptionup to age 26.Child for whom you (or, alternatively, you and your Spouse)have been appointed by a court of competent jurisdiction asthe person(s) having custody of the child and the sole legalright and obligation to provide support and medical care forthe child, but only if the child resides in your household ona permanent basis and the child’s parents are deceased, orthe parental rights of the child’s parents are permanentlyterminated, or the Plan Administrator determines, in its solediscretion, that the child’s parents are totally disabled andfinancially unable to provide any support or care for the child.Your disabled child up to the age of 26 is covered under theeligibilty guidelines described above. Your disabled child overage 25 may be eligible for continued coverage.Your Committed Partner must satisfy all of the requirementsas stated in the Committed Partner Policy.Your eligible Committed Partner may only be enrolled in<strong>Benefits</strong>Plus, as well as the Dental Plan and the Vision Plan.You may enroll in the Committed Partner Program for MedicalCoverage and/or Passes at any time during the calendar year.You may find the Committed Partner Enrollment Packet on<strong>SWA</strong>LIfe>About Me>Launch Self Service>My <strong>Benefits</strong>><strong>Benefits</strong>Information and Resources>Information and Forms.Your Registered Partner must satisfy all of the requirementsstated in the Registered Partner Policy and you must completethe appropriate paperwork.You may find the Registered Partner Enrollment Packet on<strong>SWA</strong>Life>About Me>Launch Self-Service>My <strong>Benefits</strong>><strong>Benefits</strong>Information and Resources>Information and Forms.1. Copy of Birth Certificate issued by a governmental agency or other legal documentestablishing parentage. Employee’s Spouse must be listed on birth certificate or other legaldocument.2. Social Security Number.1. Copy of Adoption (or Adoption Placement) Orders proving legal obligation and issued by aCourt or other legal authority.2. Social Security Number.1. Copy of Birth Certificate issued by a governmental agency;2. Court Documentation proving your custody and the sole legal right and obligation to providesupport and medical care for the child; proof the child lives in your household on a permanentbasis; proof the child’s parents are deceased or have had their parental rights permanentlyterminated (or proof the child’s parents are totally disabled and financially unable to provide anysupport or care for the child); and3. Social Security Number.For disabled children over age 25, a physician’s statement showing proof of incapacity isrequired. Contact Health & Welfare <strong>Benefits</strong> for the appropriate forms.See the Southwest Airlines Co. Committed Partner <strong>Benefits</strong> Policy for required proof of eligibility(available at www.swalife.com or upon request from the Health & Welfare <strong>Benefits</strong>).See the Southwest Airlines Co. Committed Partner <strong>Benefits</strong> Policy for required proof of eligibility(available at www.swalife.com or upon request from the Health & Welfare <strong>Benefits</strong>).62013 ANNUAL ENROLLMENT


BENEFITSPLUS summaryEffective January 1, 2013, there will be three optionsfor medical coverage available under the <strong>Benefits</strong>Plusprogram designed to give you the ability to makechoices that best fit your family’s needs. All <strong>Benefits</strong>Plusprograms will be administered by UnitedHealthcare in2013. All Employees will receive new insurance ID cardsin early January.Choice Plus Plan: The <strong>Benefits</strong>Plus EPO and PPOoptions are being combined to form the Choice PlusPlan. The Choice Plus Plan offers network benefits andnon-network benefits, although it pays more for servicesprovided by network providers. It includes copays foroffice visits and generic drugs and pays a percentage ofthe costs for other medical care as well as non-genericdrugs.Choice Plan C: Medical Plan C is being renamed ChoicePlan C. Modifications include but are not limited to:• Employees will pay monthly contributions (seeMedical Monthly Contributions chart).• The Out-of-pocket maximum for Employee coveragewill decrease while the Out-of-pocket maximum forFamily coverage will increase.• Generic and non-preferred prescription drugscoinsurance remains unchanged, however theamount the Employee pays for preferred brandprescriptions will increase.Health Savings Plan (HSP): The Health Savings Plan(HSP): The Health Savings Plan is a new medical optionthat offers low monthly contributions, but notablyhigher deductible and higher coinsurance requirements.Employees in the Health Savings Plan are responsiblefor the full cost of all healthcare expenses (other thanqualified preventive care) until the higher deductible andcoinsurance are satisfied.The Health Savings Plan has:• The option to contribute to a tax-advantagedHealth Savings Account (HSA).See below for more details• Lower monthly upfront contributions compared tothe other <strong>Benefits</strong>Plus options. The amount savedon monthly contributions can be contributed to aHealth Savings Account.• Higher deductibles compared to the other<strong>Benefits</strong>Plus options. The deductible in the HealthSavings Plan works differently than the deductiblesin the other <strong>Benefits</strong>Plus medical options. With“Employee Only” coverage in the Health Savings Plan,the Employee will be subject to the “Employee Only”deductible of $1,500. With any other coverage levelbesides “Employee Only” (including any CommittedPartner coverage), the “Family” deductible of $3,000must be met. Unlike the other <strong>Benefits</strong>Plus options,there is no deductible for individual Family members.There is only one deductible for the entire Familythat is significantly higher than the other <strong>Benefits</strong>Plusoptions.• Out-of-Pocket maximums. Your Out-of-pocketmaximum is the maximum amount you pay duringa calendar year for covered charges. The Out-ofpocketmaximum is applied to you and each coveredDependent you add to coverage. Once you havepaid your deductible, and in addition, reached thecoinsurance annual Out-of-pocket maximum, theHealth Savings Plan will cover 100% of all eligibleexpenses for the reminder of the calendar year. TheOut-of-pocket maximum excludes deductibles.• A unique prescription drug benefit. Under theHealth Savings Plan, certain <strong>Benefits</strong>Plus preventive prescriptiondrugs are covered at 80% before the deductible ismet. For a list of these preventive prescriptions, goto <strong>SWA</strong>Life on About Me>My <strong>Benefits</strong>>Informationand Forms. For all other prescriptions, the Employeeis responsible for the full cost until the medicaldeductible is met.• Coverage for eligible benefits on the autismspectrum, including Applied Behavioral Analysis(ABA) Therapy. This coverage is only availableunder the Health Savings Plan option. Treatmentassociated with autism may be covered, includingspeech therapy, occupational therapy, and physicaltherapy subject to any plan coverage limitations.<strong>Benefits</strong> may be denied or shortened for persons notprogressing in goal-directed rehabilitation services orif rehabilitation goals were previously met. <strong>Benefits</strong>under this section are not available for maintenance/preventive manipulative treatment. All servicesunder this benefit for both in and out-of-networkproviders require pre-notification or coverage willbe denied. To access benefits for autism coverageand to meet the pre-notification requirement, callClear Skies at 1-800-742-8911.2013 ANNUAL ENROLLMENT 7


health savings accountA Health Savings Account (HSA) is only available underthe <strong>Benefits</strong>Plus Health Savings Plan option.If you enroll in the Health Savings Plan, you will havethe option, if you meet IRS requirements, of openinga Health Savings Account (HSA) to save money forqualified health care expenses. You may choose to openan HSA with any bank. If you open your account withOptumHealth Bank, then the amount that you choose tosave can be withheld from your paycheck before taxesand direct deposited to your HSA. If you open an HSAwith another bank, you may make contributions directly(for example, by personal check) but payroll deductionswill not be available to you.The amount in your HSA is yours to use for qualifiedmedical expenses, including your deductible under theHealth Savings Plan. You do not lose amounts in yourHSA at the end of the year or when your employmentwith Southwest ends. It’s your money! You may alsochoose for amounts in your HSA to earn interest andgrow tax-free for use on qualified medical expenses inthe future.How to Open a Health Savings Account (HSA):To participate in the HSA, you will need to personallyopen your own account. You can either (i) choose tohave Southwest deduct your HSA contributions directlyfrom your paycheck, in which case you must openyour own account with OptumHealth Bank (see detailsbelow), or (ii) choose to make direct contributions (forexample, by personal check) to your HSA in which caseyou may open a Health Savings Account with the bankof your choice.To open a Health Savings Account with OptumHealthBank, you must go to www.OptumHealthBank.comto complete the bank’s online application includingSouthwest Airlines’ Group Number 199409. Your electedpre-tax payroll contributions will not begin until youopen your account with OptumHealth Bank.Note: You must open an HSA and have funds in yourHSA before you can use your account to pay forqualified medical expenses. You may only use your HSAto pay for medical expenses incurred after the account isopened.HSA Eligibility: Most Southwest Employees will beeligible to open a Health Savings Account; however,federal tax law limits participation in a Health SavingsAccount in some circumstances. Make sure youunderstand these limitations before you make yourelections.These eligibility requirements only apply to the HealthSavings Account—not the Health Savings Plan option.If you enroll in the Health Savings Plan intending toopen a Health Savings Account, but then determine youare not eligible for the Health Savings Account, you willnot be able to change to another medical option untilAnnual Enrollment for 2014.To be eligible to open a Health Savings Account (HSA):• You may ONLY have medical coverage under aneligible high deductible health plan (HDHP)—theSouthwest Health Savings Plan.o You may not have coverage under a spouse’snon-HDHP.o You may not be enrolled in Medicare (Part A orB), TRICARE or TRICARE for Life, even assecondary coverage. (If you are eligible forMedicare, but not enrolled, then you are eligibleto contribute to an HSA.)o You must not have received VeteranAdministration (VA) <strong>Benefits</strong> within threemonths of making any contribution to yourHealth Savings Account.• You may not be claimed as a dependent on someoneelse’s tax return.• You, and your spouse (if any), may not contribute toa Health Care Flexible Spending Account (includingSouthwest’s Health Care Flexible Spending Account).However, you may contribute to a Dependent CareFlexible Spending Account.Note: Although a Committed Partner can be coveredunder the Health Savings Plan, under federal tax rules,the Committed Partner’s medical expenses usually willnot constitute qualified medical expenses that can bepaid or reimbursed out of a Health Savings Account.82013 ANNUAL ENROLLMENT


<strong>Benefits</strong>Plus 2013 Monthlymedical ContributionsYou may enroll in medical, dental, and vision options independently of each other and each option selected has itsown monthly contribution as shown in the charts below.For example, you may elect Employee + Family coverage for medical, Employee Only coverage for dental, and Employee+ Spouse for vision. By carefully choosing the options that are the best fit for your family, you can structure your benefitsto minimize your monthly contributions.If you select NO COVERAGE for medical, then you will receive a $50.00 credit in your paycheck each month ($60.00 foreligible <strong>SWA</strong> to <strong>SWA</strong> no coverage election).<strong>Benefits</strong>plusMedical Monthly ContributionsFulltime EmployeesChoice Plus Plan Choice Plan C Health Savings PlanEE ONLY $49.00 $20.00 $5.00EE + SPOUSEEE + COMMITTED PARTNER$150.00 $70.00 $9.00EE + CHILDREN $133.00 $66.00 $7.00EE + FAMILYEE + COMMITTED PARTNER + CHILDREN$221.00 $113.00 $11.00<strong>SWA</strong> EE + <strong>SWA</strong> EE $98.00 $40.00 $9.00<strong>SWA</strong> EE + <strong>SWA</strong> FAMILY $182.00 $86.00 $11.00<strong>Benefits</strong>plusMedical Monthly ContributionsParttime EmployeesChoice Plus Plan Choice Plan C Health Savings PlanEE ONLY $49.00 $20.00 $5.00EE + SPOUSEEE + COMMITTED PARTNER$510.85 $455.15 $406.34EE + CHILDREN $377.30 $329.60 $290.94EE + FAMILYEE + COMMITTED PARTNER + CHILDREN$842.16 $767.75 $695.29<strong>SWA</strong> EE + <strong>SWA</strong> EE $98.00 $40.00 $9.00<strong>SWA</strong> EE + <strong>SWA</strong> FAMILY $426.30 $349.60 $294.942013 ANNUAL ENROLLMENT 9


2013 benefitsplusMEDICAL Programoptions COMPARISONB e n e f i t s P l u sCHOICE PLUS (5)Annual DeductibleCo-Pays/Services Performed by Physician(non-surgical do not apply towards deductible orOut-of-pocket maximum)Network: $300/Per Person; $750/Family(does not apply to Out-of-pocket maximum)100% After appropriate copay or coinsurance.In Network:Non-Network: $600/Per Person; $1,500/FamilyConvenience Care Clinic; $15 (2)Office Visit $25; Specialist $40; Urgent Care $40;Emergency Room $150Other Services after annual deductible 15% coinsuranceNon-Network: 60% coverage, no co-payGeneral Level of Benefit Coverage(inpatient and outpatient)Network Provider: 85%; Non-Network Provider: 60%(after annual deductible)Preventive Care (no deductible)(Adult and Children)Network Provider: 100%Non-Network Provider: 100% of Reasonable and CustomaryNewborn Care (inpatient)Includes: circumcision, room and board, generalnursing care, and Doctor’s fees.Network Provider: 85%; Non-Network Provider: 60%(after annual deductible)PrescriptionsSee chart on page 12 for more information.Infertility Treatment(Pre-treatment authorization required by UHC)Applied Behavorial Analysis (ABA)TherapyClearSkies Employee Assistance Program(EAP)Services (1) : 50% coinsurance after $500 separate lifetime deductible (infertility treatment only), Employeeand spouse combined; $10,000 lifetime maximum — You and your Spouse/Committed Partner combinedPrescription Drugs:• Network Provider: 50% coinsurance, $5,000 lifetime maximum—You and your Spouse/Committed Partner combined• Non-Network Provider: No CoverageNo CoverageNetwork Provider: Up to five appointments per person, per issue with ClearSkies at no charge.Non-Network: no coverageMental, Emotional, Behavioral andChemical Abuse/Dependency <strong>Benefits</strong>Prenotified (3)Prescription Drugs are covered under thePrescription Drug Card Program.Network: Outpatient/Inpatient 85%Non-Network: Outpatient/Inpatient 60%(after annual deductible)Annual Out-of-Pocket Maximum(excludes deductibles and all copays exceptemergency room copays)Lifetime Maximum(combined Medical and Mental Health andChemical Dependency)Network: $3,200 per person; $6,400 familyNon-Network: $6,400 per person; $12,800 family(excludes deductibles)No Limit(1) Charges for all prescription drugs and infertility treatment will not apply to the Choice Plus Plan annual out-of-pocket maximum or annual medical deductible. Certain provider andcoverage limitations apply to infertility treatment. You must contact Unitedhealthcare prior to receiving infertility treatment.(2) List of Convenience Care Clinics available at www.myuhc.com.102013 ANNUAL ENROLLMENT


B e n e f i t s P l u sCHOICE PLAN C (5) HEALTH SAVINGS PLAN (HSP) (6)Network: $800/Per Person; $2,000/FamilyNon-Network: $1,500/Per Person; $3,750/Family(does not apply to Out-of-pocket maximum)Network/Non-Network - $1,500/Employee Only - $3,000/Family (6)(does not apply to Out-of-pocket maximum)Co-pays not availableCo-pays not availableNetwork Provider: 80%;Non-Network Provider: 60%(after annual deductible)Network Provider: 80%Non-Network provider: 60%(after annual deductible)Network Provider: 100%Non-Network Provider: 100% of Reasonable andCustomaryNetwork Provider: 100%Non-Network Provider: 100%of Reasonable and CustomaryNo CoverageNetwork Provider: 80%; Non-Network Provider: 60%(after annual deductible)See chart on page 12 for more information.See chart on page 12 for more information.No CoverageNo CoverageNo CoverageNetwork Provider: Up to five appointments per person,per issue with ClearSkies at no charge.Non-Network: no coverageNetwork Provider: 80%Non-Network provider: 60%(after annual deductible)Network Provider: Up to five appointments per person, perissue with ClearSkies at no charge.Non-Network: no coverageNetwork: Outpatient/Inpatient 80%Non-Network: Outpatient/Inpatient 60%(after annual deductible)Network: Outpatient/Inpatient 80%Non-Network: Outpatient/Inpatient 60%(after annual deductible)Network: $4,000 per person; $8,000 familyNon-Network: $6,000 per person; $12,000 family(excludes deductibles)Network: $4,500/per person - $9,000/per familyNon-Network: $6,750/per person - $13,500/per family(excludes deductibles)No LimitNo Limit(3) Refer to the Summary Plan Description on <strong>SWA</strong>Life>About Me for prenotification rules for each medical plan.(4) List of Specified Preventive medications may be found at <strong>SWA</strong>LIfe>About Me>My <strong>Benefits</strong>.(5) For the Choice Plus Plan and Choice Plan C, when an individual in a family meets the individual deductible, coinsurance applies. When the family deductible amount ismet, the rest of the family will receive benefits. One participant can never incur deductible expenses above the individual limit. Family deductible may be reached with anycombination of expense incurred by any Family Member.(6) For the HSP, if you have anything other than Employee Only coverage, then you will be subject to the entire family deductible before any Family Member receives abenefits.2013 ANNUAL ENROLLMENT 11


BENEFITSPLUS PRESCRIPTION COVERAGEWhen you enroll in a <strong>Benefits</strong>Plus medical option you are automatically enrolled in the corresponding prescription coverage.Described below are the amounts the Employee is required to pay for prescription coverage.<strong>Benefits</strong>Plus PrescriptionChoice Plus Plan Choice Plan C Health Savings Plan90 Day Retail/30 Day Retail 30 Day Retail 30 Day RetailMail Order90 Day Retail/Mail Order90 Day Retail/Mail OrderAdministrator Catamaran Catamaran Catamaran Catamaran OptumRx OptumRxGeneric $10 $2510%($10 min/$35 max)7%($25min/$88 max)20% 20%Preferred Brand25%($25 min/$50 max)20%($45 min/$125 max)25%($25 up to $100)20%($63 up to $250)20% 20%Non-PreferredBrand45%($40 up to $150)45%($60 up to $375)45%($40 up to $150)45%($125 up to $375)20% 20%Specialty Drug25%($20-$150)90 day not available25%($20-$150)90 day not available 20% 90 day not availablePreventiveMedications (appliesto HSP Plan only)Diabetic TestingSuppliesN/A N/A N/A N/ACovered at 100%by planCovered at 100%by planDeductible (annual) $0.00 $0.00InfertilityMedications50% with $5,000lifetime maximumCovered at 100%by plan$50 separate annualdeductibleCovered at 100%by plan$50 separate annualdeductible20%(deductible waivedfor core list ofmedications)20%(deductible waivedfor core list ofmedications)20% 90 day not available$1,500/$3,000(Combined w/HealthPlan Deductible)$1,500/$3,000(Combined w/HealthPlan Deductible)122013 ANNUAL ENROLLMENT


BENEFITSPLUS dental programThe Southwest dental program is administered by Delta Dental and is separate from your medical program. You may go toany dentist that you choose; however, you will have lower coinsurance requirements if you select a network provider. To print adental ID card or locate a network provider go to www.deltadentalins.com/southwest.If you select NO COVERAGE for dental, then you will receive an $8.50 credit in your paycheck each month.<strong>Benefits</strong>plusDental Monthly ContributionsFulltime EmployeesParttime EmployeesBasic Optional BasicOptionalEE ONLY $1.00 $10.00 $1.00 $10.00EE + SPOUSEEE + COMMITTED PARTNER$3.00 $26.00 $31.02 $56.52EE + CHILDREN $3.00 $30.00 $37.02 $65.82EE + FAMILYEE + COMMITTED PARTNER + CHILDREN$5.00 $42.00 $61.04 $103.04<strong>SWA</strong> EE + <strong>SWA</strong> EE $2.00 $20.00 $2.00 $20.00<strong>SWA</strong> EE + <strong>SWA</strong> FAMILY $4.00 $40.00 $38.02 $75.82BENEFITSPLUS vision programEyeMed Vision Care will be the new vision programprovider effective January 1, 2013. The vision programis an insured plan (not self-insured by Southwest) andSouthwest has negotiated lower rates compared toprior years. EyeMed Vision Care offers an expansivenetwork of doctors and vision care centers includingpopular convenient retail locations (e.g., LensCrafters,Sears, Target Optical, Pearl Vision, JCPenney Optical).For a comprehensive summary of vision benefits andnetwork providers go to www.strata-g.com/eyemed/swa. If you elect vision coverage, a vision ID card willbe mailed in January 2013 to your home address onrecord. As a general matter, you may only enroll inthe vision program if you are enrolled in <strong>Benefits</strong>Plus.Although some collectively bargained work groups havethe option to enroll in the Vision Program through theRegular Plan.<strong>Benefits</strong>PlusVision Monthly ContributionsEE ONLY $4.92EE + SPOUSEEE + COMMITTED PARTNER$9.35EE + CHILDREN $9.84EE + FAMILYEE + COMMITTED PARTNER + CHILDRENFulltime andParttime Employees$14.472013 ANNUAL ENROLLMENT 13


egular planREGISTRATION REQUIREMENT WHEN CHANGINGFROM THE REGULAR PLAN TO BENEFITSPLUS (ORFROM BENEFITSPLUS TO THE REGULAR PLAN):Reminder: There are two programs available for benefitscoverage—<strong>Benefits</strong>Plus and the Regular Plan. If youwould like to switch coverage from the Regular Plan to<strong>Benefits</strong>Plus or from <strong>Benefits</strong>Plus to the Regular Plan,you must contact Health & Welfare <strong>Benefits</strong> before usingthe online enrollment tool so that you can be registeredwith the desired program. You will be required tocomplete a <strong>Benefits</strong> Request for Program Change Form.You must allow 24 hours to process your <strong>Benefits</strong>Request for Program Change Form before you enroll inthe desired program using the online enrollment tool.Note: If you switch from the <strong>Benefits</strong>Plus program tothe Regular Plan, you and your family members over theage of 19 may be subject to a three-month pre-existingcondition limitation.Effective January 1, 2013, UnitedHealthcare willadminister the Regular Plan (not Blue Cross Blue Shieldof Texas). You will receive a new medical ID card inJanuary 2013.HEALTH CARE REFORM REQUIRED LEGAL NOTICE:The Southwest Airlines Co. Funded Welfare BenefitPlan believes the Regular Plan Benefit Program is a“grandfathered health plan” under the Patient Protectionand Affordable Care Act (the “Affordable Care Act”). Aspermitted by the Affordable Care Act, a grandfatheredhealth plan can preserve certain basic health coveragethat was already in effect when that law was enacted.Being a grandfathered health plan means that coverageunder the Regular Plan Benefit Program may not includecertain consumer protections of the Affordable CareAct that apply to the <strong>Benefits</strong>Plus program options, forexample, the requirement for the provision of preventivehealth services without any cost sharing. However,grandfathered health plans must comply with certainother consumer protections in the Affordable CareAct, for example, the elimination of lifetime limits onbenefits. Questions regarding which protections applyand which protections do not apply to a grandfatheredhealth plan and what might cause a plan to changefrom grandfathered health plan status can be directedto Health & Welfare <strong>Benefits</strong> by e-mailing askbenefits@wnco.com or phoning 1-800-551-1211. You may alsocontact the Employee <strong>Benefits</strong> Security Administration,U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a tablesummarizing which protections do and do not apply tograndfathered health plan.IMPORTANT INFORMATION TO CONSIDER ABOUT THEREGULAR PLAN: The Regular Plan either does notoffer, or offers but limits, many of the benefits that maybe available under <strong>Benefits</strong>Plus. You should carefullyreview these limitations before selecting this option.• Preventive services such as physicals, mammograms,and colonoscopies are not covered.• Basic medical and dental coverage is available but itis more limited than under <strong>Benefits</strong>Plus.• Mail order prescriptions are not available.• The Vision Program is only offered to some workgroups under the Regular Plan.• You may not enroll in the Flexible Spending Accountprograms (i.e., Health Care Flexible Spending Accountand Dependent Care Flexible Spending Account).• Optional Life Insurance is limited to the amount equalto your Basic Life Insurance• Spouse Life Insurance is limited to a maximum of$10,000.• Child Life Insurance is limited to a maximum of$1,000 for each child less than six months of age, or$5,000 for each child six months of age or older.• Optional Accidental Death and DismembermentInsurance (AD&D) is limited to the amount equal toyour Basic Life Insurance.• You may not enroll in optional Accidental Death &Dismemberment coverage for Family.• Long Term Disability is not automatically provided bySouthwest when enrolled in the Regular Plan.• The new voluntary benefit programs (i.e., auto/home/pet/supplemental hospital insurance) are onlyavailable under <strong>Benefits</strong>Plus and are not availableunder the Regular Plan.• Committed partner benefits are not offered in theRegular Plan.142013 ANNUAL ENROLLMENT


Regular PlanMonthly ContributionsMedical Dental VisionFulltime Parttime Fulltime Parttime Fulltime ParttimeEE ONLY $0 $0 $0 $0 $3.83 $3.83EE + SPOUSEEE + COMMITTED PARTNER$0 $572.76 $0 $28.00 $7.28 $7.28EE + CHILDREN $0 $400.93 $0 $33.60 $7.67 $7.67EE + FAMILYEE + COMMITTED PARTNER + CHILDREN$0 $973.69 $0 $56.00 $11.27 $$11.27<strong>SWA</strong> EE + <strong>SWA</strong> EE $0 $0 $0 $0 $7.28 $7.28<strong>SWA</strong> EE + <strong>SWA</strong> FAMILY $0 $400.93 $0 $33.60 $11.27 $11.27You are automatically enrolled in prescription drug coverage administered by OptumRx when you enroll in the RegularPlan. Preferred brand, non-preferred and specialty medications are available in either a 30 day or 90 day retail supply (nomail order option). You may refer to the chart below for the schedule of prescription benefits.Regular PlanPrescription ChartDeductible (annual)GenericPreferred BrandNon-Preferred BrandSpecialty DrugDiabetic Testing SuppliesPreventive Medications$200/$300(Combined w/Health PlanDeductible)Covered at 100%(after deductible)20%(after deductible)20%(after deductible)20%(after deductible)20%(after deductible)N/AInfertilityN/A2013 ANNUAL ENROLLMENT 15


flexible spending accountsIf you are electing <strong>Benefits</strong>Plus Choice Plus Plan or Choice Plan C medical options then you may choose to participate inthe Health Care Flexible Spending Account program.If you are electing <strong>Benefits</strong>Plus Choice Plus Plan, Choice Plan C, or the Health Savings Plan medical option then you maychoose to participate in the Dependent Care Flexible Spending Account program.All flexible spending programs are administered by UnitedHealthcare.Expenses Eligible forReimbursementHealth Care FlexibleSpending AccountDependent Care FlexibleSpending AccountWhat is this benefit used for? Qualified medical expenses ONLY. Qualified dependent day care expenses ONLY.Choice Plus Plan YES YESChoice Plan C YES YESCan be elected if enrolled in theHealth Savings Plan Option?NOYESTo participate in the flexible spending account programs, you must make an election each year. Your 2012 electionswill not rollover to 2013. If you choose to participate, then you must determine the amount that you would like tocontribute annually and elect this contribution amount during Annual Enrollment. The annual contribution amount willbe prorated across your paychecks throughout the year. Your monthly flexible spending account contribution(s) will bewithheld from your paychecks before taxes. Amounts contributed to flexible spending accounts do not carry-over fromyear-to-year. Both flexible spending accounts operate as use-it-or-lose-it programs. If you don’t use all your FlexibleSpending Account contributions by December 31st, then the remaining balance is forfeited. You have until March 31stof the following year to file claims, but the eligible expenses must be incurred by December 31st of the prior year.162013 ANNUAL ENROLLMENT


HEALTH CARE FLEXIBLE SPENDING ACCOUNT: The Health Care Flexible Spending Account is a way for you to savemoney tax-free to use on eligible healthcare expenses, including co-pays and coinsurance, for you and members of yourfamily that qualify as dependents for federal income tax purposes.For a complete and current detailed listing of eligible healthcare expenses and ineligible expenses you may go towww.irs.gov and review Publication 502. As a result of healthcare reform, effective January 1, 2013, the maximumamount that you may contribute to a Health Care Flexible Spending Account in 2013 is $2,500. The minimum amountyou may contribute for the year is $120.The Health Care Flexible Spending Account program is different than the Health Savings Account (HSA). You maynot participate in the Health Care Flexible Spending Account if you are enrolled in the <strong>Benefits</strong>Plus Health SavingsPlan medical option. The chart below reflects the differences:Comparison ChartMedical Program RequirementMust be Used by Year End?(“Use it or Lose it”)Health Care FlexibleSpending Account<strong>Benefits</strong>Plus Choice Plus Planand Choice Plan C ONLYYESHealth Savings Account<strong>Benefits</strong>Plus Health Savings Plan (HSP) ONLYNOAnnual Contribution Limit? $2,500$3,250 Employee Only Coverage$6,450 Family Coverage(Family Coverage includes: Employee + Spouse/Committed Partner, Employee + Children)Roll-over option when Terminate or Retire? NO YESQualified Medical Expenses only? YES YESPre-Tax Contributions? YES YES*Can be elected if enrolled in the <strong>Benefits</strong>PlusHealth Savings Plan Option?NOYES* Pre-tax payroll contributions can only be made to a Health Savings Account with OptumHealth Bank. If you open yourHealth Savings Account with another bank, contributions cannot be pre-tax payroll deducted, although they may beconsidered a tax deduction when filing your annual tax return. Consult your tax advisor for details.DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT: The Dependent Care Flexible Spending Account allows you toset aside money each year from your pay to reimburse yourself for eligible expenses for the child or adult daycare orother qualifying care of your family members that qualify as a dependent for federal income tax purposes. For 2013,you may contribute any amount from an annual minimum of $120 up to annual maximum of $5,000 (or $2,500 if youare married and filing separate tax returns) to pay for eligible dependent care expenses. If you do not have child oradult daycare or other qualifying care expenses, then you should not enroll in the Dependent Care Flexible SpendingAccount. If you enroll in the Dependent Care Flexible Spending Account in error, contributions will not be refunded.2013 ANNUAL ENROLLMENT 17


LIFE INSURANCESouthwest offers a choice of life insurance options to help provide for your family in the event of your death. The LifeInsurance program is an insured product and, effective January 1, 2013, will be provided by MetLife (not The Standard). Thetransition to MetLife will offer additional benefit levels and lower rates.EMPLOYEE BASIC LIFE INSURANCE: As an Employee at Southwest you automatically receive Basic Life Insurance coverageat no cost to you. Basic life insurance is equal to your base annual pay up to a maximum of $50,000.EMPLOYEE OPTIONAL LIFE INSURANCE: You may elect Optional Life Insurance coverage in addition to Basic Life Insurancecoverage. Effective January 1, 2013, if you are enrolled in <strong>Benefits</strong>Plus, then you may purchase Optional Life Insurance up toten times your base annual pay (increased from six times in 2012) and if you are enrolled in the Regular Plan, then you maypurchase Optional Life Insurance up to a maximum of $50,000. This means that at the time of your death, your beneficiary willreceive a cash payout from MetLife that is equal to the level of coverage you selected. The cost of your premium depends onyour age as of December 31 of the Plan Year.Age Bandsthat determine premium level<strong>Benefits</strong>PlusOptional Life Insurance Premiums< 25 $.023 per $1,000 of coverage25-29 $.023 per $1,000 of coverage30-44 $.028 per $1,000 of coverage45-49 $.051 per $1,000 of coverage50-54 $.079 per $1,000 of coverage55-59 $.147 per $1,000 of coverage60-64 $.255 per $1,000 of coverage65-69 $.493 per $1,000 of coverage70+ $.793 per $1,000 of coverageSPOUSE/COMMITTED PARTNER LIFE INSURANCE: Southwest offers this life insurance option to help provide for your familyin the event of the death of your Spouse/Committed Partner. You may elect the Spouse/Committed Partner Life Insurancecoverage level of your choice and upon the death of your Spouse/Committed Partner you or the beneficiary will receive a cashpayout from MetLife in that amount. If you are enrolled in <strong>Benefits</strong>Plus, then coverage level choices for Spouse/CommittedPartner <strong>Benefits</strong>Plus are $10,000, $20,000, $30,000, $50,000, $100,000, $150,000, or $250,000. If you are enrolled in theRegular Plan, then you may only purchase Spouse Life Insurance at the $10,000 coverage level and you may not purchaseCommitted Partner Life Insurance.Age Bandsthat determine premium level<strong>Benefits</strong>PlusSpouse/Committed PartnerInsurance Premiums< 25 $.04 per $1,000 of coverage25-29 $.04 per $1,000 of coverage30-44 $.05 per $1,000 of coverage45-49 $.09 per $1,000 of coverage50-54 $.14 per $1,000 of coverage55-59 $.26 per $1,000 of coverage60-64 $.45 per $1,000 of coverage65-69 $.87 per $1,000 of coverage70+ $1.40 per $1,000 of coverage182013 ANNUAL ENROLLMENT


LIFE INSURANCE (continued)CHILD LIFE INSURANCE: Southwest offers this life insurance option to help provide for unexpected expenses that may arisein the event of your child’s death. If you are enrolled in <strong>Benefits</strong>Plus, then you may elect Child Life Insurance coverage in theamount of $10,000 with a monthly premium of $.50 or $20,000 with a monthly premium of $1.00. If you are enrolled in theRegular Plan, then you may elect Child Life Insurance coverage for a monthly premium of $.26 and your coverage level will be$1,000 for each child less than six months of age and $5,000 for each child six months of age or older.Upon the death of your eligible child you will receive a cash payout from MetLife in the amount of coverage you chose.Eligible children include any children from live birth up to age 25 that qualify as an: unmarried child; disabled child; fosterchild; child placed with you for adoption; or child living in your home as your grandchild, your stepchild, or the child ofyour Spouse.IMPORTANT NOTE ABOUT CHILD LIFE INSURANCE:A number of Employees are paying for Child Life Insurancewho DO NOT have an eligible child.Removing a child as a dependent for benefits coverageDOES NOT stop the child life insurance deductions. Youmust also go through the Online Annual EnrollmentTool to remove child life insurance coverage. It is yourresponsibility to remove the child from coverage.Statement of Health (SOH) Requirements: To increase Optional Life Insurance and/or Spouse/Committed PartnerLife Insurance from the level you selected for 2012, you and/or your Spouse/Committed Partner must complete aStatement of Health (SOH) with MetLife after you complete the Annual Enrollment process. It is your responsibility tocomplete this step following enrollment. Your coverage level(s) will not be increased if you do not submit the SOH(s) inaccordance with MetLife’s requirements.To make the transition process to MetLife a little easier, for the 2013 Annual Enrollment period, the SOH will be a shortform consisting of only five questions. Responses to the short form will determine if you and/or your Spouse/CommittedPartner need to complete the long form and/or be required to submit a medical exam. Any increase in Optional LifeInsurance and/or Spouse/Committed Partner Life Insurance will be suspended until MetLife approves or denies yourincreased coverage. You will receive a notification from MetLife once a determination has been made.Statement of Health Process: If you increase Optional Life Insurance and/or Spouse/Committed Partner Life Insurance,then a web link for the Statement of Health will be e-mailed to your Company e-mail address within five business days.The SOH must be completed within thirty days of when the e-mail is delivered to your Company e-mail address. If notcompleted, then your 2012 life insurance elections will carry-over to 2013 and your new elections will not take effect.Age 70 Limitations: MetLife limits Optional Life Insurance, Spouse/Committed Partner Life Insurance, and AccidentalDeath and Dismemberment coverage for individuals over age 70; therefore, effective January 1 of the year you or yourSpouse will reach age 70, as applicable, your coverage amount for the applicable program will be reduced by 50%(regardless of whether your election rolls over or you affirmatively elect a coverage level during Annual Enrollment) andyour premiums will be adjusted accordingly.2013 ANNUAL ENROLLMENT 19


optional accidental death anddismemberment (ad&D) insuranceSouthwest offers the option to purchase Accidental Death and Dismemberment (AD&D) Insurance as part of the lifeinsurance program to help provide for your family in the event of accidental death or dismemberment. You may electAD&D Insurance coverage level of your choice and (i) upon the death of you or your Family Member you will receive acash payout from MetLife equal to your coverage level, and (ii) upon the dismemberment of you or your Family Memberyou will receive a cash payout from MetLife that is equal to a percentage of your coverage level subject to certain limits.If you are enrolled in <strong>Benefits</strong>Plus, you may purchase AD&D Insurance coverage up to ten times your annual base pay(increased from six times in 2012). If you are in the Regular Plan, then you may purchase AD&D Insurance up to yourlevel of Basic Life Insurance.For the first time in 2013, if you are enrolled in <strong>Benefits</strong>Plus, in addition to an Employee Only Coverage option, youwill have the option to purchase Employee + Family Coverage. The Employee + Family option is not available toEmployees enrolled in the Regular Plan.You may review your applicable monthly premium rates for AD&D Insurance in the online Annual Enrollment tool.beneficiary designationUpdating your Beneficiary Designation: It is very important that MetLife have up to date beneficiary designations forLife Insurance and Accidental Death and Dismemberment Insurance. This ensures that MetLife can timely distributethe cash payments in the event of a death or dismemberment under the Life Insurance or Optional Accidental Deathand Dismemberment Insurance programs. If you would like to update your beneficiary designations, access the MetLifewebsite at www.metlife.com/mybenefits. Once registered on the MetLife website, you may change your beneficiarydesignation during Annual Enrollment or at any other time you would like to update this information.202013 ANNUAL ENROLLMENT


long term disability insurance (ltd)The Long Term Disability Insurance program is an insured product and, effective January 1, 2013, will be provided byCIGNA (not Aetna). Southwest offers you the opportunity to purchase Long Term Disability Insurance to help providefor you and your family in the event that you become disabled and cannot work for an extended period of time. Pilotsare not eligible but may elect long term disability coverage through <strong>SWA</strong>PA.CIGNA is offering reduced rates for coverage in 2013. You can go to the online Annual Enrollment tool to calculate your2013 premiums.Transition to CIGNA: The coverage option you currently have under the Aetna Long Term Disability program willautomatically transfer to the Cigna Long Term Disability program if you do not make a new election. If you becomedisabled January 1 or later, your claim will be actively managed by Cigna’s Long Term Disability claims unit. If youcurrently have an active claim or become disabled prior to January 1, 2013, Aetna’s claims unit will continue to manageyour claim until you return to work.Southwest will continue to offer the following long-term disability coverage options:BASIC LONG TERM DISABILITY INSURANCE: If you are enrolled in <strong>Benefits</strong>Plus, you will be automatically enrolledin Basic Long Term Disability Insurance at no cost to you. If you have a qualifying disability, you would receive fortypercent of your base salary. Basic Long Term Disability Insurance is not available if you are enrolled in the Regular Plan.OPTIONAL LONG TERM DISABILITY INSURANCE: If you are enrolled in <strong>Benefits</strong>Plus or the Regular Plan and you wouldlike to purchase Optional Long Term Disability Insurance, depending on your work group, you may purchase coveragethat would provide you with up to sixty percent of your base salary. If you are enrolled in <strong>Benefits</strong>Plus, then you maychoose whether you would like to purchase this as a taxable benefit (your premiums will be deducted on an after-taxbasis, a portion of the benefit you receive from the insurance carrier will be subject to tax) or a non-taxable benefit (yourpremiums will be deducted on an after-tax basis, the benefit you receive from the insurance carrier will not be subject totax). If you are enrolled in the Regular Plan then your Optional Long Term Disability Insurance is a non-taxable benefit(your premiums will be deducted on an after-tax basis, the benefit you receive from the insurance carrier will not besubject to tax).If you need additional information about selecting the Long Term Disability Insurance option that is best for your family,please contact Health & Welfare <strong>Benefits</strong>.2013 ANNUAL ENROLLMENT 21


enefitsplus voluntary benefitsNEW FOR 2013! Southwest expanded the insurance programs available to Employees that enroll in <strong>Benefits</strong>Plus. Younow have the choice to purchase Supplemental Hospital Insurance, Auto Insurance, Homeowners Insurance, and/orPet Insurance. All premiums are paid through payroll deductions.SUPPLEMENTAL HOSPITAL INSURANCE: During Annual Enrollment, Southwest Employees who enroll in <strong>Benefits</strong>Pluswill have the option of enrolling in Supplemental Hospital Insurance Plan effective January 1, 2013. Supplemental HospitalInsurance is an insured product provided by Combined Worksite Solutions. Southwest offers this option to Employeesenrolled in the <strong>Benefits</strong>Plus program to provide an additional cash resource in the event that you or a qualified familymember is hospitalized. There are no health questions or medical exams required to purchase this insurance.Numerous exclusions apply to Supplemental Hospital Insurance including, but not limited to: (i) an individual that ispregnant as of the coverage effective date will not be eligible for a Supplemental Hospital Insurance benefit for days inthe hospital in connection with maternity and (ii) treatment for being overweight, gastric bypass or stapling, intestinalbypass, and any related procedures, including complications is also excluded. For a complete list of exclusions you mayreview details in the materials from Combined Worksite Solutions that are posted on <strong>SWA</strong>Life>About Me>My <strong>Benefits</strong>>Information and Forms.If you purchase supplemental Hospital Insurance, you will be eligible for up to $2,500 in payments per year for you andeach qualified family member. Upon your or a qualified family member’s initial confinement to the hospital, you willreceive $750. For each additional day in a regular hospital room during the year, you will receive an additional $250 perday up to three days. For each additional day in an ICU hospital room during the year, you will receive an additional$250 per day up to four days.Note: Supplemental Hospital Insurance does not replace coverage that you have under your <strong>Benefits</strong>Plus medicaloption. Supplemental Hospital Insurance benefits are paid directly to you in cash to help you cover costs that may ariseduring your time in the hospital. You could use the money to pay deductibles or coinsurance in connection with yourhospital stay or you could use the money to pay for any other need (e.g., your mortgage).<strong>Benefits</strong>plusSupplemental HospitalInsurance ProgramMonthly Premium RatesEE ONLY $11.44EE + SPOUSEEE + COMMITTED PARTNER$26.72EE + CHILDREN $25.42EE + FAMILYEE + COMMITTED PARTNER + FAMILYAUTO/HOME INSURANCE: Effective January 1, 2013, Southwest Employees who enroll in <strong>Benefits</strong>Plus will have the optionof purchasing auto or homeowners insurance at discounted rates. The Auto/Home Insurance program is an insuredproduct provided by MetLife Auto & Home (although note that home insurance is not offered in Florida or Massachusetts).Southwest used its sizable purchasing power to give Employees enrolled in the <strong>Benefits</strong>Plus program the opportunityto purchase Auto Insurance and/or Homeowners Insurance at discounted rates. January 1, 2013, Employees enrolledin <strong>Benefits</strong>Plus may call MetLife to request a quote and enroll. MetLife Auto & Home will obtain quotes from multipleinsurance companies to determine your proposed rate. Additional information will be provided soon!PET INSURANCE: Effective January 1, 2013, Southwest Employees who enroll in <strong>Benefits</strong>Plus will have the option topurchase pet insurance at discounted rates. The Pet Insurance program is an insured product provided by VeterinaryPet Insurance (VPI). Southwest used its sizable purchasing power to give Employees enrolled in the <strong>Benefits</strong>Plusprogram the opportunity to purchase Pet Insurance at discounted rates. VPI policies cover wellness care as well assignificant medical incidents. Pet Insurance offers you the chance to manage the risk associated with your pet’s medicalissues. Additional information will be provided soon!$39.68222013 ANNUAL ENROLLMENT


clear skiesemployee assistance programClearSkies Employee Assistance Program is a confidential program available to all Southwest Employees and familymembers from the day you join the Company. You do not have to be covered through one of the medical programs tobe eligible. Southwest offers you the ClearSkies program so that you have a confidential resource to help you and yourfamily deal with any personal problem that may affect your health, family life, or work including relationships, financialconcerns, alcohol, drugs, stress, depression, and emotional distress. When you contact ClearSkies at 1-800-742-8911, alicensed counselor will assess your situation, determine what assistance is needed, and provide you possible resourcesfor treatment. You may also access ClearSkies via the web at www.liveandworkwell.com and use pin number: swa737.wellness programsSouthwest encourages you and your family to live well! In the coming months you will see more opportunities toparticipate in Wellness Programs including fitness challenges, fitness center discounts, weight management programs,and more! Additional information is online at <strong>SWA</strong>Life>AboutMe>MyWellness.2013 ANNUAL ENROLLMENT 23


IMPORTANT PHONE NUMBERS AND WEB SITESWould you like to check the status of a claim or the services that are available to you? The chart below lists web sites and phonenumbers for your benefit administrators and providers. You may also access these from <strong>SWA</strong>Life>AboutMe.BENEFIT PROGRAM NAME & PHONE NUMBER WEB SITEMedical ProgramsChOIce Plus Plan, Choice Plan C,Health Savings Plan,and ReguLAr PlanUnitedHealthcare (UHC)877-246-0857Group # 199409Find a Network Provider if not a member of UHC:www.myuhc.com/groups/nhswaTo become a UHC member: Enter your Social Securitynumber and desired password for access towww.myuhc.comPrescription drug programChoice Plus plan and choice Plan cCatamaran800-451-3101To find Network pharmacies in your areaWalgreensHealth.comPrescription drug programhealth savings planand regular planOptum Rx877-246-0857To find Network pharmacies in your areawww.myuhc.comFlexible Spending Accountshealth care FLEXIBLE spending account(available for Choice Plan Plus and Choice Plan C)dependent care FLEXIBLE spending account(Available for choice pLus plan, CHoice Plan C, andHealth Savings Plan)UnitedHealthcare (UHC)877-311-7849www.myuhc.comYou must be enrolled in myuhc.com. Enter yourSocial Security number and desired password forinstant access.health savings account (HSA)Health savings plan (HSP) onlyOptumHealth Bank800-791-9361www.optumhealthbank.comYou must provide a group number when opening anaccount: 199409Clearskiesemployee assistance plan (EAP) and Mental healthchemical dependencyOptumHealth Behavioral Solutions800-742-8911Find a Providerwww.liveandworkwell.comUse Pin Number: swa737life eventslive and work wellLife EventsOptumHealth Behavioral Solutions(United Behavioral Health)800-538-8310Provides information for EAP, MHCD and Life Eventswww.liveandworkwell.comUse Pin Number: swa737dental programDelta Dental866-204-5502Find a Network Dentist and Print ID Cardwww.deltadentalins.com/southwestvision programEyeMed Vision Care855-219-4451http://www.strata-g.com/eyemed/swaLong term disability PROGRAMCigna888-873-2127www.cigna.comlife insuranceMetLifeCall Center: 866-492-6983Claims: 800-638-6420 #2Statement of Health: 800-638-6420 #1www.metlife.com/mybenefitssupplementAL hospital insuranceBENEFITSPLUSCombined Worksite Solutions800-964-7096Web site coming January 1. 2013commuter benefitsWage Works877-924-3967www.getwageworks.com/southwestPlease note: The web site addresses included in this publication are accurate as of the printing of this piece.However, it is possible for site addresses to change from time to time.

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