|
Delaware
|
7373 | 26-2634160 | ||
|
(State or other jurisdiction
of
incorporation or organization) |
(Primary Standard Industrial
Classification Code Number) |
(I.R.S. Employer
Identification Number) |
|
Matthew E. Kaplan
Debevoise & Plimpton LLP 919 Third Avenue New York, New York 10022 (212) 909-6000 |
Douglas S. Manya
Booz Allen Hamilton Inc. 8283 Greensboro Drive McLean, Virginia 22102 (703) 902-5000 |
Rachel W. Sheridan
Jason M. Licht Latham & Watkins LLP 555 Eleventh Street, NW Suite 1000 Washington, D.C. 20004 (202) 637-2200 |
|
Large accelerated filer
o
|
Accelerated filer o | Non-accelerated filer x | Smaller reporting company o |
| (Do not check if a smaller reporting company) |
|
The
information in this prospectus is not complete and may be
changed. These securities may not be sold until the registration
statement filed with the Securities and Exchange Commission is
effective. This prospectus is not an offer to sell these
securities and it is not soliciting an offer to buy these
securities in any state or jurisdiction where the offer or sale
is not permitted.
|
| Per Share | Total | |||||||
|
Initial public offering price
|
$ | $ | ||||||
|
Underwriting discounts and commissions
|
$ | $ | ||||||
|
Proceeds, before expenses, to us
|
$ | $ | ||||||
| Morgan Stanley | Barclays Capital |
| BofA Merrill Lynch | Credit Suisse |
| BB&T Capital Markets | Lazard Capital Markets | Raymond James |
ii
ii
1
9
16
36
38
39
40
42
44
48
52
84
103
111
139
144
149
153
159
161
164
167
169
170
171
F-1
i
ii
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F-36
F-39
F-41
II-5
1
2
Superior Talent Base.
We have a highly
educated talent base, and a significant percentage of our people
hold government security clearances. We are able to renew and
grow this talent base because of our commitment to professional
development, our position as a leader in our markets, the high
quality of our work and the appeal of our culture.
Focus on Talent Development.
We continually
develop our talent base by providing our people with the
opportunity to work on important and complex problems,
facilitating broad engagement at all levels of seniority and
encouraging the development of substantive skills through
continuing education.
Assessment System that Promotes
Collaboration.
We use our
360-degree
assessment process to help promote and enforce the consistency
of our collaborative culture, core values and ethics.
Core Values.
Our core values, which are a key
component of our success, are: client service, diversity,
excellence, entrepreneurship, teamwork, professionalism,
fairness, integrity, respect and trust.
Our Approach to Client Service.
Over the
70 years that we have been serving the
U.S. government, we have cultivated relationships of trust
with, and developed a comprehensive understanding of, our
clients, which, together with our deep domain knowledge and
capabilities, enable us to anticipate, identify and address
their specific needs.
Partnership-Style Culture and Compensation
System.
We have a deeply ingrained culture of
teamwork and collaboration, and we manage our company as a
single profit center with a partner-style compensation system
that focuses on the success of the institution over the success
of the individual.
3
Expand Our Business Base.
We intend to deepen
our existing client relationships, continue to help our clients
rapidly respond to change and broaden our client base by
leveraging our collaborative culture, our expertise and our
reputation as a trusted partner and an industry leader.
Capitalize on Our Strengths in Emerging
Areas.
We will continue to leverage our deep
domain expertise and broad capabilities to help our clients
address emerging issues, including cyber, government efficiency
and procurement, transformation of the healthcare system and
Systems Engineering & Integration, or SE&I.
Continue to Innovate.
We will continue to
invest significant resources in our efforts to identify
near-term
developments and long-term trends that may present significant
challenges or opportunities for our clients. We continue to
invest in many initiatives at various stages of development, and
are currently focused on cloud computing, advanced analytics,
and the deployment of specialized services and capabilities in
the financial sector, among others.
4
(1)
Represents %, %
and % of the total voting power in
our company, respectively, excluding shares of common stock with
respect to which Carlyle has received a voting proxy pursuant to
new irrevocable proxy and tag-along agreements. See
Certain Relationships and Related Party
Transactions Related Person Transactions
Irrevocable Proxy and Tag-Along Agreements.
(2)
Guarantor of the senior credit facilities and mezzanine credit
facility.
(3)
Refers to our senior secured loan facilities providing for a
$125.0 million Tranche A term facility,
$585.0 million Tranche B term facility,
$350.0 million Tranche C term facility and
$245.0 million revolving credit facility. As of
June 30, 2010, we had $1,018.6 million outstanding
under our senior credit facilities.
(4)
Refers to our $550.0 million mezzanine term loan facility.
As of June 30, 2010, on a pro forma as adjusted basis after
giving effect to (i) this offering and the use of the net
proceeds therefrom, which is based on the midpoint of the price
range set forth on the cover page of this prospectus, and
(ii) the repayment of $85.0 million of indebtedness
outstanding under our mezzanine credit facility, we would have
had
$ million
of debt outstanding under our mezzanine credit facility.
5
6
Class A common stock offered by us
shares
shares
The underwriters have a
30-day
option to purchase an
additional
shares of Class A common stock from us.
Proposed New York Stock Exchange symbol
BAH
Use of proceeds
We estimate that our net proceeds from the offering, after
deducting underwriting discounts and commissions and estimated
offering expenses payable by us, will be approximately
$ million, based on the
midpoint of the price range set forth on the cover page of this
prospectus. We intend to use the net proceeds from this offering
to repay $ million of
indebtedness outstanding under our mezzanine credit facility and
pay a related prepayment penalty of
$ million. See
Use of Proceeds. Certain of the underwriters of this
offering or their affiliates are lenders under our senior credit
facilities and mezzanine credit facility. Accordingly, certain
of the underwriters may receive net proceeds from this offering
in connection with the repayment of our mezzanine credit
facility. See Underwriting.
Risk factors
See Risk Factors and other information included in
this prospectus for a discussion of factors you should carefully
consider before deciding whether to invest in shares of our
Class A common stock.
Dividend policy
We do not expect to pay dividends on our Class A common
stock for the foreseeable future.
Conflicts of interest
We intend to use certain of the net proceeds of this offering to
retire a portion of the mezzanine credit facility under which an
affiliate of Credit Suisse Securities (USA) LLC is a lender.
Since Credit Suisse Securities (USA) LLCs affiliate will
receive at least 5% of the net proceeds of this offering in
connection with this repayment, Credit Suisse Securities (USA)
LLC, a member of the Financial Industry Regulatory Authority, or
FINRA, may be deemed to have a conflict of interest
with us under FINRAs NASD Conduct Rule 2720.
Accordingly, this offering will be conducted in compliance with
the requirements of such rule. See
Underwriting Conflicts of Interest.
7
shares of Class A
common stock reserved for issuance under our Equity Incentive
Plan, including shares issuable upon the exercise of outstanding
stock options;
shares of Class A
common stock reserved for issuance under our Officers
Rollover Stock Plan upon the exercise of outstanding stock
options related to outstanding shares of our Class E
special voting common stock and our mandatory repurchase of
those shares in connection with such exercise; and
shares of Class A
common stock issuable upon transfer of outstanding Class B
non-voting common stock and Class C restricted common stock.
reflects a -for-1 split of our
outstanding common stock to be effected prior to the completion
of this offering. The stock split will be effected to reduce the
per share price of our Class A common stock to a more
customary level for an initial public offering and an initial
listing on a national securities exchange;
gives effect to amendments to our certificate of incorporation
and bylaws to be adopted prior to the completion of this
offering and the related elimination of our Class D merger
rolling common stock and Class F non-voting restricted
common stock prior to the completion of this offering;
assumes the issuance
of shares of Class A
common stock in this offering;
assumes that the initial public offering price of our
Class A common stock will be
$ per share, which is the
midpoint of the price range set forth on the cover page of this
prospectus;
assumes that the underwriters will not exercise their
over-allotment option; and
presents indebtedness outstanding under our senior credit
facilities and our mezzanine credit facility as of any
particular date net of unamortized discount.
8
9
10
Predecessor
The Company
Pro Forma
Fiscal Year Ended
Fiscal Year Ended
Fiscal Year Ended
Three Months Ended June 30,
March 31, 2008
March 31, 2009(1)
March 31, 2010
2009
2010
(As adjusted)
(Unaudited)
(Unaudited)
(As adjusted)
(In thousands, except share and per share data)
$
270,484
$
(61,711
)
$
10,011
(10,991
)
(6,568
)
(14,829
)
(372,560
)
(3,025
)
(2,406
)
$
226,874
$
277,344
$
368,323
$
100,996
$
121,545
$
97,001
$
30,014
$
41,661
$
221,213
$
(68,279
)
$
(6,202
)
Predecessor
The Company
As of March 31,
As of March 31,
As of June 30,
2008
2009
2010
2009
2010
N/A
(10)
$
7,278,782
$
9,012,923
$
7,503,772
$
9,488,823
18,822
21,614
23,315
22,492
23,848
The Company
As of June 30, 2010
Pro Forma as
Actual
Pro Forma(11)
Adjusted(11)
(Unaudited)
(Unaudited)
(In thousands)
$
300,611
648,622
3,015,262
1,542,063
552,676
(1)
See Selected Historical Consolidated Financial and Other
Data and Managements Discussion and Analysis
of Financial Condition and Results of Operation
Results of Operations for further information regarding
our unaudited pro forma condensed consolidated results of
operations.
(2)
Basic earnings per share for the Company has been computed using
the weighted average number of shares of Class A common
stock, Class B non-voting common stock and Class C
restricted common stock outstanding during the period. The
Companys diluted earnings per share has been computed
using the weighted average number of shares of Class A
common stock, Class B non-voting common stock and
Class C restricted common stock including the dilutive
effect of outstanding common stock options and other stock-based
awards. The weighted average number of Class E special
voting common stock has not been included in the calculation of
either basic earnings per share or diluted earnings per share
due to the terms of such common stock.
Basic earnings per share for the Predecessor has been computed
using the weighted average number of shares of Class A
common stock outstanding during the period. The
Predecessors diluted earnings per share has been computed
using the weighted average number of shares of Class A
common stock including the dilutive effect of outstanding
stock-based awards.
(3)
Reflects
a -for-1
split of our outstanding common stock to be effected prior to
the completion of this offering.
(4)
Pro forma earnings per share for fiscal 2010 and the three
months ended June 30, 2010 gives effect to the net
reduction in interest expense related to the repayment of
$85.0 million of indebtedness under our
mezzanine credit facility on August 2, 2010, as if such
repayment had occurred on April 1, 2009 and 2010,
respectively.
(5)
Includes shares
of Class A common stock offered by us in this offering.
(6)
Pro forma as adjusted earnings per share for fiscal 2010 and the
three months ended June 30, 2010 gives effect to the net
reduction in interest expense related to (i) the repayment
of $85.0 million of indebtedness under our mezzanine credit
facility on August 2, 2010, and (ii) the use of the
net proceeds from the sale of
shares of Class A common stock in this offering at an
assumed offering price of $ , the
midpoint of the range set forth on the cover page of this
prospectus, to repay borrowings under our mezzanine credit
facility, as if each had occurred on April 1, 2009 and
2010, respectively.
(7)
Reflects the payment of special dividends in the aggregate
amount of $114.9 million and $497.5 million to holders
of record of our Class A common stock, Class B
non-voting common stock, and Class C restricted common
stock as of July 29, 2009 and December 8, 2009,
respectively.
(8)
Adjusted EBITDA
represents net income before
income taxes, net interest and other expense and depreciation
and amortization and before certain other items, including:
(i) certain stock option-based and other equity-based
compensation expenses, (ii) transaction costs, fees, losses
and expenses, (iii) the impact of the application of
purchase accounting and (iv) any extraordinary, unusual or
non-recurring items. We prepare Adjusted EBITDA to eliminate the
impact of items we do not consider indicative of ongoing
operating performance due to their inherent unusual,
extraordinary or non-recurring nature or because they result
from an event of a similar nature.
We utilize and discuss Adjusted EBITDA because our management
uses this measure for business planning purposes, including to
manage the business against internal projected results of
operations and measure the performance of the business
generally. We view Adjusted EBITDA as a measure of our core
operating business because it excludes the impact of the items
described above on our results of operations as these items are
generally not operational in nature. Adjusted EBITDA also
provides another basis for comparing period to period results by
excluding potential differences caused by non-operational and
unusual, extraordinary or non-recurring items. We also present
Adjusted EBITDA in this prospectus as a supplemental performance
measure because we believe that this measure provides investors
and securities analysts with important supplemental information
with which to evaluate our performance and to enable them to
assess our performance on the same basis as management.
Adjusted EBITDA as discussed in this prospectus may vary from
and may not be comparable to similarly titled measures presented
by other companies in our industry. Adjusted EBITDA is different
from the term EBITDA as it is commonly used, and
Adjusted EBITDA also varies from (i) the measure
Consolidated EBITDA discussed in this prospectus
under Managements Discussion and Analysis of
Financial Condition and Results of Operations
Liquidity and Capital Resources Indebtedness
and (ii) the measures EBITDA and Bonus
EBITDA discussed in this prospectus under Executive
Compensation. Adjusted EBITDA is not a recognized
measurement under GAAP and when analyzing our performance,
investors should (i) evaluate each adjustment in our
reconciliation of net income to Adjusted EBITDA and the
explanatory footnotes regarding those adjustments and
(ii) use Adjusted EBITDA in addition to, and not as an
alternative to, operating income or net income as a measure of
operating results, each as defined under GAAP.
12
Predecessor
The Company
Pro Forma
Three Months
Fiscal Year Ended
Fiscal Year Ended
Fiscal Year Ended
Ended June 30,
March 31, 2008
March 31, 2009
March 31, 2010
2009
2010
(As adjusted)
(Unaudited)
(Unaudited)
(As adjusted)
(In thousands)
$
17,874
$
(49,441
)(a)
$
25,419
$
8,425
$
28,169
62,693
(25,831
)
23,575
7,547
19,916
1,808
141,673
150,560
36,379
40,660
33,079
106,335
95,763
24,003
19,384
35,013
82,019
68,517
24,242
13,344
5,301
19,512
3,415
72
3,077
1,074
400
71,106
$
226,874
$
277,344
$
368,323
$
100,996
$
121,545
(a)
Represents loss from continuing operations.
(b)
Includes $57.8 million and $40.6 million in pro forma
2009 and fiscal 2010, respectively, of amortization of
intangible assets resulting from the acquisition. Includes
$10.1 million and $7.2 million in the three months
ended June 30, 2009 and 2010, respectively, of amortization
of intangible assets resulting from the acquisition.
(c)
Reflects (i) $35.0 million of expense in fiscal 2008
for stock rights under the Predecessors Officer Stock
Rights Plan, which were accounted for as liability awards, and
(ii) $70.5 million and $49.3 million of stock-based
compensation expense in pro forma 2009 and fiscal 2010,
respectively, and $16.6 million and $9.5 million of
stock-based compensation expense in the three months ended
June 30, 2009 and 2010, respectively, for new options for
Class A common stock and restricted shares, in each case,
issued in connection with the acquisition under the
Officers Rollover Stock Plan established in connection
with the acquisition. Expense is based on vesting schedules from
three to five years, which is dependent on whether officers were
classified as retirement or non-retirement eligible at the time
of the acquisition. Also reflects $11.5 million and
$19.2 million of stock-based compensation expense in pro
forma 2009 and fiscal 2010, respectively, and $7.7 million and
$3.8 million of stock-based compensation expense in the
three months ended June 30, 2009 and 2010, respectively,
for Equity Incentive Plan Class A common stock options
issued in connection with the acquisition under the Equity
Incentive Plan established in connection with the acquisition.
(d)
Fiscal 2008 and pro forma 2009 reflect charges related to the
acquisition, including legal, tax and accounting expenses.
Fiscal 2010 reflects costs related to the modification of our
credit facilities, the establishment of the Tranche C term
loan facility under our senior credit facilities and the
related payment of special dividends. See Acquisition and
Recapitalization Transaction. The three months ended
June 30, 2010 reflects certain external administrative and
other expenses incurred in connection with this offering.
(e)
Reflects adjustments resulting from the application of purchase
accounting in connection with the acquisition not otherwise
included in depreciation and amortization.
(f)
Reflects loss from discontinued operations.
Adjusted Net Income
represents net income
before: (i) certain stock option-based and other
equity-based compensation expenses, (ii) transaction costs,
fees, losses and expenses, (iii) the impact of the
application of purchase accounting, (iv) adjustments
related to the amortization of intangible assets,
(v) amortization or write-off of debt issuance costs and
write-off of original issue discount, or OID, and
13
(vi) any extraordinary, unusual or non-recurring items, in
each case net of the tax effect calculated using an assumed
effective tax rate. We prepare Adjusted Net Income to eliminate
the impact of items, net of tax, we do not consider indicative
of ongoing operating performance due to their inherent unusual,
extraordinary or non-recurring nature or because they result
from an event of a similar nature.
We utilize and discuss Adjusted Net Income because our
management uses this measure for business planning purposes,
including to manage the business against internal projected
results of operations and measure the performance of the
business generally. We view Adjusted Net Income as a measure of
our core operating business because it excludes the items
described above, net of tax, which are generally not operational
in nature. We also present Adjusted Net Income in this
prospectus as a supplemental performance measure because we
believe that this measure provides investors and securities
analysts with important supplemental information with which to
evaluate our performance, long-term earnings potential and to
enable them to assess our performance on the same basis as
management.
Adjusted Net Income as discussed in this prospectus may vary
from and may not be comparable to similarly titled measures
presented by other companies in our industry. Adjusted Net
Income is not a recognized measurement under GAAP and when
analyzing our performance, investors should (i) evaluate
each adjustment in our reconciliation of net income to Adjusted
Net Income and the explanatory footnotes regarding those
adjustments and (ii) use Adjusted Net Income in addition
to, and not as an alternative to, operating income or net income
as a measure of operating results, each as defined under GAAP.
The Company
Three Months
Fiscal Year Ended
Ended June 30,
March 31, 2010
2009
2010
(Unaudited)
(Unaudited)
(As adjusted)
(In thousands)
$
25,419
$
8,425
$
28,169
68,517
24,242
13,344
3,415
72
1,074
400
40,597
10,120
7,158
5,700
1,219
1,913
(47,721
)
(14,392
)
(8,995
)
$
97,001
$
30,014
$
41,661
(a)
Reflects $49.3 million of stock-based compensation expense
in fiscal 2010 and $16.6 million and $9.5 million of
stock-based compensation expense in the three months ended
June 30, 2009 and 2010, respectively, for new options for
Class A common stock and restricted shares, in each case,
issued in connection with the acquisition under the
Officers Rollover Stock Plan established in connection
with the acquisition. Expense is based on vesting schedules from
three to five years, which is dependent on whether officers were
classified as retirement or non-retirement eligible at the time
of the acquisition. Also reflects $19.2 million of
stock-based compensation expense in fiscal 2010 and
$7.7 million and $3.8 million of stock-based
compensation expense in the three months ended June 30,
2009 and 2010, respectively, for Equity Incentive Plan
Class A common stock options issued in connection with the
acquisition under the Equity Incentive Plan established in
connection with the acquisition.
(b)
Fiscal 2010 reflects costs related to the modification of our
credit facilities, the establishment of the Tranche C term
loan facility under our senior credit facilities and the related
payment of special dividends. See Acquisition and
Recapitalization Transaction. The three months ended
June 30, 2010 reflects certain external administrative and
other expenses incurred in connection with this offering.
(c)
Reflects adjustments resulting from the application of purchase
accounting in connection with the acquisition.
(d)
Reflects amortization of intangible assets resulting from the
acquisition.
(e)
Reflects taxes on adjustments at an assumed marginal tax rate of
40%. See Managements Discussion and Analysis of
Financial Condition and Results of Operations
Factors and Trends Affecting Our Results of
Operations Income Taxes and our consolidated
financial statements and related footnotes included in this
prospectus.
14
Free Cash Flow
represents (i) net cash
provided by operating activities of continuing operations after
(ii) purchases of property and equipment, each as presented
in our consolidated statements of cash flows. We utilize and
discuss Free Cash Flow because our management uses this measure
for business planning purposes, to measure the cash generating
ability of our operating business after the impact of cash used
to purchase property and equipment, and to measure our liquidity
generally. We also present Free Cash Flow in this prospectus as
a supplemental liquidity measure because we believe that this
measure provides investors and securities analysts with
important supplemental information with which to evaluate our
liquidity and to enable them to assess our liquidity on the same
basis as management.
Free Cash Flow as discussed in this prospectus may vary from and
may not be comparable to similarly titled measures presented by
other companies in our industry. Free Cash Flow is not a
recognized measurement under GAAP and when analyzing our
liquidity, investors should use Free Cash Flow in addition to,
and not as an alternative to, cash flows, as defined under GAAP,
as a measure of liquidity.
The following table reconciles net cash provided by operating
activities of continuing operations to Free Cash Flow:
The Company
Three Months
Fiscal Year Ended
Ended June 30,
March 31, 2010
2009
2010
(Unaudited)
(Unaudited)
(As adjusted)
(In thousands)
$
270,484
$
(61,711
)
$
10,011
(49,271
)
(6,568
)
(16,213
)
$
221,213
$
(68,279
)
$
(6,202
)
(9)
We define backlog to include funded backlog, unfunded backlog
and priced options. Funded backlog represents the revenue value
of orders for services under existing contracts for which
funding is appropriated or otherwise authorized less revenue
previously recognized on those contracts. Unfunded backlog
represents the revenue value of orders for services under
existing contracts for which funding has not been appropriated
or otherwise authorized. Priced contract options represent 100%
of the revenue value of all future contract option periods under
existing contracts that may be exercised at our clients
option and for which funding has not been appropriated or
otherwise authorized. Backlog is given as of the end of each
period presented. See Risk Factors Risks
Relating to Our Business We may not realize the full
value of our backlog, which may result in lower than expected
revenue, Managements Discussion and Analysis
of Financial Condition and Results of Operations
Factors and Trends Affecting Our Results of
Operations Sources of Revenue Contract
Backlog and Business Backlog.
(10)
Not available because we began to separately track information
on priced options on April 1, 2008.
(11)
Pro forma balance sheet data gives effect to the repayment of
$85.0 million of indebtedness under our mezzanine credit
facility on August 2, 2010 and the payment of the related
prepayment penalty of $2.6 million, as if such payments had
occurred on June 30, 2010. Pro forma as adjusted balance
sheet data gives effect to (i) the repayment of
$85.0 million of indebtedness under our mezzanine credit
facility on August 2, 2010 and the payment of the related
prepayment penalty of $2.6 million, and (ii) the use
of the net proceeds from the sale
of shares of our Class A
common stock in this offering at an assumed initial public
offering price of $ per share, the
midpoint of the range set forth on the cover of this prospectus,
to repay borrowings under our mezzanine credit facility and pay
a related prepayment penalty as described in Use of
Proceeds, as if each had occurred on June 30, 2010.
Each $1.00 increase (decrease) in the assumed public offering
price of $ per share would increase
(decrease) the pro forma as adjusted amount of each of cash and
cash equivalents, working capital, total assets, long-term debt,
net of current portion and stockholders equity by
approximately $ million, assuming that
the number of shares offered by us, as set forth on the cover
page of this prospectus, remains the same, and after deducting
estimated underwriting discounts and commissions and estimated
offering expenses payable by us. We may also increase or
decrease the number of shares we are offering. Each increase
(decrease) of 1.0 million shares in the number of shares
offered by us, assuming the offering price remains the same,
would increase (decrease) the pro forma as adjusted amount of
each of cash and cash equivalents, working capital, total
assets, long-term debt, net of current portion, and
stockholders equity by approximately
$ million. The information
discussed above is illustrative only and will adjust based on
the actual public offering price and other terms of this
offering determined at pricing.
15
budgetary constraints affecting U.S. government spending
generally, or specific agencies in particular, and changes in
available funding;
a shift in expenditures away from agencies or programs that we
support;
reduced U.S. government outsourcing of functions that we
are currently contracted to provide, including as a result of
increased insourcing;
changes in U.S. government programs that we support or
related requirements;
16
U.S. government shutdowns (such as that which occurred
during government fiscal year 1996) or weather-related
closures in the Washington, DC area (such as that which occurred
in February 2010) and other potential delays in the
appropriations process;
U.S. government agencies awarding contracts on a
technically acceptable/lowest cost basis in order to reduce
expenditures;
delays in the payment of our invoices by government payment
offices; and
changes in the political climate and general economic
conditions, including a slowdown or unstable economic conditions
and responses to conditions, such as emergency spending, that
reduce funds available for other government priorities.
the Federal Acquisition Regulation, or the FAR, and agency
regulations supplemental to the FAR, which regulate the
formation, administration and performance of
U.S. government contracts. Specifically, FAR 52.203-13
requires contractors to establish a Code of Business Ethics and
Conduct, implement a comprehensive internal control system, and
report to the government when the contractor has credible
evidence that a principal, employee, agent, or subcontractor, in
connection with a government contract, has violated certain
federal criminal law, violated the civil False Claims Act or has
received a significant overpayment;
the False Claims Act and False Statements Act, which impose
civil and criminal liability for presenting false or fraudulent
claims for payments or reimbursement, and making false
statements to the U.S. government, respectively;
the Truth in Negotiations Act, which requires certification and
disclosure of cost and pricing data in connection with the
negotiation of a contract, modification or task order;
laws, regulations and executive orders restricting the use and
dissemination of information classified for national security
purposes and the export of certain products, services and
technical data, including requirements regarding any applicable
licensing of our employees involved in such work; and
17
the Cost Accounting Standards and Cost Principles, which impose
accounting requirements that govern our right to reimbursement
under certain cost-based U.S. government contracts and
require consistency of accounting practices over time.
the necessity to expend resources, make financial commitments
(such as procuring leased premises) and bid on engagements in
advance of the completion of their design, which may result in
unforeseen difficulties in execution, cost overruns and, in the
case of an unsuccessful competition, the loss of committed costs;
the substantial cost and managerial time and effort spent to
prepare bids and proposals for contracts that may not be awarded
to us;
the ability to accurately estimate the resources and costs that
will be required to service any contract we are awarded;
the expense and delay that may arise if our competitors protest
or challenge contract awards made to us pursuant to competitive
bidding, and the risk that any such protest or challenge could
result in the resubmission of bids on modified specifications,
or in termination, reduction, or modification of the awarded
contract; and
any opportunity cost of bidding and winning other contracts we
might otherwise pursue.
18
19
20
Funded Backlog.
Funded backlog represents the
revenue value of orders for services under existing contracts
for which funding is appropriated or otherwise authorized less
revenue previously recognized on these contracts.
Unfunded Backlog.
Unfunded backlog represents
the revenue value of orders for services under existing
contracts for which funding has not been appropriated or
otherwise authorized.
Priced Options.
Priced contract options
represent 100% of the revenue value of all future contract
option periods under existing contracts that may be exercised at
our clients option and for which funding has not been
appropriated or otherwise authorized.
21
our ability to transition employees from completed projects to
new assignments and to hire and assimilate new employees;
our ability to forecast demand for our services and thereby
maintain headcount that is aligned with demand;
our ability to manage attrition; and
our need to devote time and resources to training, business
development and other non-chargeable activities.
22
divert sales from us by winning very large-scale government
contracts, a risk that is enhanced by the recent trend in
government procurement practices to bundle services into larger
contracts;
force us to charge lower prices in order to win or maintain
contracts;
seek to hire our employees; or
adversely affect our relationships with current clients,
including our ability to continue to win competitively awarded
engagements where we are the incumbent.
23
lose revenue due to adverse client reaction;
be required to provide additional services to a client at no
charge;
24
receive negative publicity, which could damage our reputation
and adversely affect our ability to attract or retain
clients; or
suffer claims for substantial damages.
our ability to satisfy obligations to lenders may be impaired,
resulting in possible defaults on and acceleration of our
indebtedness;
25
our ability to obtain additional financing for refinancing of
existing indebtedness, working capital, capital expenditures,
product and service development, acquisitions, general corporate
purposes, and other purposes may be impaired;
a substantial portion of our cash flow from operations could be
dedicated to the payment of the principal and interest on our
debt;
we may be increasingly vulnerable to economic downturns and
increases in interest rates;
our flexibility in planning for and reacting to changes in our
business and the industry may be limited; and
we may be placed at a competitive disadvantage relative to other
firms in our industry.
26
impaired objectivity;
unfair access to non-public information; or
the ability to set the ground rules for another
procurement for which the contractor competes.
we may not be able to identify suitable acquisition candidates
at prices we consider attractive;
we may not be able to compete successfully for identified
acquisition candidates, complete acquisitions or accurately
estimate the financial effect of acquisitions on our business;
future acquisitions may require us to issue common stock or
spend significant cash, resulting in dilution of ownership or
additional debt leverage;
we may have difficulty retaining an acquired companys key
employees or clients;
we may have difficulty integrating acquired businesses,
resulting in unforeseen difficulties, such as incompatible
accounting, information management, or other control systems,
and greater expenses than expected;
acquisitions may disrupt our business or distract our management
from other responsibilities;
as a result of an acquisition, we may incur additional debt and
we may need to record write-downs from future impairments of
intangible assets, each of which could reduce our future
reported earnings; and
we may have difficulty integrating personnel from the acquired
company with our people and our core values.
27
terminate existing contracts, with short notice, for convenience
as well as for default;
reduce orders under or otherwise modify contracts;
for contracts subject to the Truth in Negotiations Act, reduce
the contract price or cost where it was increased because a
contractor or subcontractor furnished cost or pricing data
during negotiations that was not complete, accurate and current;
for some contracts, (i) demand a refund, make a forward
price adjustment or terminate a contract for default if a
contractor provided inaccurate or incomplete data during the
contract negotiation process and (ii) reduce the contract
price under certain triggering circumstances, including the
revision of price lists or other documents upon which the
contract award was predicated;
terminate our facility security clearances and thereby prevent
us from receiving classified contracts;
cancel multi-year contracts and related orders if funds for
contract performance for any subsequent year become unavailable;
decline to exercise an option to renew a multi-year contract or
issue task orders in connection with ID/IQ contracts;
claim rights in solutions, systems and technology produced by
us, appropriate such work-product for their continued use
without continuing to contract for our services and disclose
such work-product to third parties, including other
U.S. government agencies and our competitors, which could
harm our competitive position;
prohibit future procurement awards with a particular agency due
to a finding of organizational conflicts of interest based upon
prior related work performed for the agency that would give a
contractor an unfair advantage over competing contractors, or
the existence of conflicting roles that might bias a
contractors judgment;
subject the award of contracts to protest by competitors, which
may require the contracting federal agency or department to
suspend our performance pending the outcome of the protest and
may also result in a requirement to resubmit offers for the
contract or in the termination, reduction or modification of the
awarded contract; and
suspend or debar us from doing business with the
U.S. government.
revise its procurement practices or adopt new contract laws,
rules and regulations, such as cost accounting standards,
organizational conflicts of interest and other rules governing
inherently governmental functions at any time;
28
reduce, delay or cancel procurement programs resulting from U.S.
government efforts to improve procurement practices and
efficiency;
limit the creation of new government-wide or agency-specific
multiple award contracts;
face restrictions or pressure from government employees and
their unions regarding the amount of services the
U.S. government may obtain from private contractors;
award contracts on a technically acceptable/lowest cost basis in
order to reduce expenditures, and we may not be the lowest cost
provider of services;
change the basis upon which it reimburses our compensation and
other expenses or otherwise limit such reimbursements; and
at its option, terminate or decline to renew our contracts.
29
30
any cause of reduction or delay in U.S. government funding
(e.g., changes in presidential administrations that delay timing
of procurements);
fluctuations in revenue earned on existing contracts;
commencement, completion or termination of contracts during a
particular period;
a potential decline in our overall profit margins if our other
direct costs and subcontract revenue grow at a faster rate than
labor-related revenue;
strategic decisions by us or our competitors, such as changes to
business strategy, strategic investments, acquisitions,
divestitures, spin offs and joint ventures;
a change in our contract mix to less profitable contracts;
31
changes in policy or budgetary measures that adversely affect
U.S. government contracts in general;
variable purchasing patterns under U.S. government GSA
schedules, blanket purchase agreements, which are agreements
that fulfill repetitive needs under GSA schedules, and ID/IQ
contracts;
changes in demand for our services and solutions;
fluctuations in our staff utilization rates;
seasonality associated with the U.S. governments
fiscal year;
an inability to utilize existing or future tax benefits,
including those related to our NOLs or stock-based compensation
expense, for any reason, including a change in law;
alterations to contract requirements; and
adverse judgments or settlements in legal disputes.
quarterly variations in our operating results;
32
changes in contract revenue and earnings estimates or
publication of research reports by analysts;
speculation in the press or investment community;
investor perception of us and our industry;
strategic actions by us or our competitors, such as significant
contracts, acquisitions or restructurings;
actions by institutional stockholders or other large
stockholders, including future sales;
our relationship with U.S. government agencies;
changes in U.S. government spending;
changes in accounting principles; and
general economic market conditions.
33
establishment of a classified Board, with staggered terms;
granting to the Board the sole power to set the number of
directors and to fill any vacancy on the Board;
limitations on the ability of stockholders to remove directors
if a group, as defined under Section 13(d)(3)
of the Exchange Act, ceases to own more than 50% of our voting
common stock;
granting to the Board the ability to designate and issue one or
more series of preferred stock without stockholder approval, the
terms of which may be determined at the sole discretion of the
Board;
a prohibition on stockholders from calling special meetings of
stockholders;
the establishment of advance notice requirements for stockholder
proposals and nominations for election to the Board at
stockholder meetings;
requiring approval of two-thirds of stockholders to amend the
bylaws; and
prohibiting our stockholders from acting by written consent if a
group ceases to own more than 50% of our voting
common stock.
34
35
any issue that compromises our relationships with the
U.S. government or damages our professional reputation;
changes in U.S. government spending and mission priorities
that shift expenditures away from agencies or programs that we
support;
the size of our addressable markets and the amount of
U.S. government spending on private contractors;
failure to comply with numerous laws and regulations;
our ability to compete effectively in the competitive bidding
process and delays caused by competitors protests of major
contract awards received by us;
the loss of GSA schedules or our position as prime contractor on
GWACs;
changes in the mix of our contracts and our ability to
accurately estimate or otherwise recover expenses, time and
resources for our contracts;
our ability to generate revenue under certain of our contracts
and our ability to realize the full value of our backlog;
changes in estimates used in recognizing revenue;
any inability to attract, train or retain employees with the
requisite skills, experience and security clearances;
an inability to hire enough employees to service our clients
under existing contracts;
an inability to effectively utilize our employees and
professionals;
failure by us or our employees to obtain and maintain necessary
security clearances;
the loss of members of senior management or failure to develop
new leaders;
misconduct or other improper activities from our employees or
subcontractors;
increased competition from other companies in our industry;
failure to maintain strong relationships with other contractors;
inherent uncertainties and potential adverse developments in
legal proceedings, including litigation, audits, reviews and
investigations, which may result in materially adverse
judgments, settlements or other unfavorable outcomes;
internal system or service failures and security breaches;
risks related to our indebtedness and credit facilities which
contain financial and operating covenants;
36
the adoption by the U.S. government of new laws, rules and
regulations, such as those relating to organizational conflicts
of interest issues;
an inability to utilize existing or future tax benefits,
including those related to our NOLs and stock-based compensation
expense, for any reason, including a change in law;
variable purchasing patterns under U.S. government GSA
schedules, blanket purchase agreements and
ID/IQ
contracts; and
other risks and factors listed under Risk Factors
and elsewhere in this prospectus.
37
38
39
on an actual basis;
on a pro forma basis to give effect to the repayment of
$85.0 million of indebtedness under our mezzanine credit
facility on August 2, 2010 and the payment of the related
prepayment penalty of $2.6 million; and
on a pro forma as adjusted basis to give effect to (i) the
sale by us of shares of our
Class A common stock in this offering at the initial public
offering price of $ per share (and
after deducting estimated underwriting discounts and commissions
and offering expenses payable by us) and the use of the net
proceeds therefrom as described in Use of
Proceeds and (ii) the repayment of
$85.0 million of indebtedness under our mezzanine credit
facility on August 2, 2010 and the payment of the related
prepayment penalty of $2.6 million.
40
(1)
Debt reflects (i) long-term debt of $1,542.1 million,
(ii) current portion of long-term debt of
$21.9 million and (iii) the deferred payment
obligation of $80.0 million.
Long-term debt, net of current portion includes borrowings under
our senior credit facilities and our mezzanine credit facility.
For a description of these facilities, see Description of
Certain Indebtedness. Loans under our senior credit
facilities and our mezzanine credit facility were issued with
original issue discount and are presented net of unamortized
discount of $18.5 million as of June 30, 2010.
The $80.0 million deferred payment obligation is comprised
of a $16.6 million deferred payment obligation balance as
of June 30, 2010, and contingent tax claims in the amount
of $63.4 million related to the deferred payment
obligation, but does not include $4.4 million of accrued
interest related to the deferred payment obligation. See
The Acquisition and Recapitalization
Transaction The Acquisition The
Merger.
(2)
Pro forma debt and retained earnings also reflects the impact of
charges for acceleration of original issue discount and the
write-off of a portion of deferred financing costs related to
the repayment of $85.0 million of indebtedness under our
mezzanine credit facility on August 2, 2010.
Pro forma as adjusted debt and retained earnings also reflects
the impact of charges for acceleration of original issue
discount and the write-off of certain deferred financing costs
related to (i) the repayment of $85.0 million of
indebtedness under our mezzanine credit facility on
August 2, 2010 and (ii) the use of net proceeds from
the sale of shares of
our Class A common stock in this offering at an assumed
offering price of $ ,
the midpoint of the range set forth on the cover page of this
prospectus, to repay borrowings under our mezzanine credit
facility.
(3)
A $1.00 increase (decrease) in the assumed initial public
offering price of $ per share
would increase (decrease) each of additional paid-in capital,
total stockholders equity and total capitalization by
$ , assuming the number of shares
offered by us remains the same and after deducting estimated
underwriting discounts and commission and estimated offering
expenses payable by us. We may also increase or decrease the
number of shares we are offering. Each increase (decrease) of
1.0 million shares in the number of shares offered by us,
assuming the offering price remains the same, would increase
(decrease) the pro forma as adjusted amount of each of
additional paid-in capital, total stockholders equity and
total capitalization by approximately
$ million. The pro forma as
adjusted information discussed above is illustrative only and
will adjust based on the actual public offering price and other
terms of this offering determined at pricing.
41
Per Share
42
43
44
entry into our senior credit facilities, and the incurrence of
$125.0 million of term loans under the Tranche A term
facility of the senior credit facilities and $585.0 million
under the Tranche B term facility under our senior credit
facilities;
entry into our mezzanine credit facility, and the incurrence of
$550.0 million of term loans thereunder; and
an equity contribution from Coinvest of approximately
$956.5 million.
45
for a period of three years following the Closing Date (subject
to certain exceptions), Spin Co. agreed that it and its
subsidiaries would not (i) provide, sell, or offer to sell
or advertise certain types of consulting services provided by
the government business, (ii) assist, advise, engage or
participate in providing such services to certain scheduled
competitors of Booz Allen Hamilton, (iii) have certain
interests in such competitors, (iv) knowingly permit its
names to be used by such competitors in connection with
providing any services other than permitted services or
(v) provide any services of any type to a scheduled list of
direct competitors or their subsidiaries or successors;
for a period of three years following the Closing Date (subject
to certain exceptions), Booz Allen Hamilton agreed that it and
its subsidiaries would not (i) provide, sell, or offer to
sell or advertise any services other than certain types of
consulting services (including cyber-security services) provided
by the government business, (ii) assist or advise certain
scheduled competitors of Spin Co. in providing services other
than such consulting services provided by the government
business, (iii) have certain interests in such competitors,
or (iv) knowingly permit its names to be used by such
competitors in connection with providing any services other than
such consulting services provided by the government business;
for a period of three years following the Closing Date, Booz
Allen Hamilton and Spin Co. agreed not to solicit or attempt to
solicit any client or business relation of the other party to
cease or adversely change their business relationship with the
other party or its subsidiaries;
for a period of three years following the Closing Date, Booz
Allen Hamilton and Spin Co. agreed not to hire or attempt to
hire any person who was at Closing an officer, director,
employee, consultant or agent of the other party (subject to
certain exceptions);
until the earlier of the fifth anniversary of the Closing Date
or a change in control of the other party, Booz Allen Hamilton
and Spin Co. agreed that they and their subsidiaries would not,
in the case of Spin Co., hire or attempt to hire any person who
was or is a stockholder of Booz Allen Hamilton (other than a
commercial partner); and in the case of Booz Allen Hamilton,
hire or attempt to hire any person who was, on or prior to the
Closing Date, a commercial partner, or is then, a stockholder of
Spin Co. (subject to certain exceptions); and
for a period of three years following the Closing Date, Spin Co.
agreed that it and its subsidiaries would not directly or
indirectly acquire a competitor of Booz Allen Hamilton.
46
47
48
Predecessor
The Company
Pro Forma
Four Months
Eight Months
Fiscal Year
Fiscal Year
Ended
Ended
Ended
Ended
Three Months
Fiscal Year Ended March 31,
July 31,
March 31,
March 31,
March 31,
Ended June 30,
2006
2007
2008
2008
2009
2009(1)
2010
2009
2010
(Unaudited)
(Unaudited)
(As adjusted)
(As adjusted)
(As adjusted)
(Unaudited)
(Unaudited)
(As adjusted)
(As adjusted)
(As adjusted)
(In thousands, except share and per share data)
$
2,902,513
$
3,209,211
$
3,625,055
$
1,409,943
$
2,941,275
$
4,351,218
$
5,122,633
$
1,229,459
$
1,341,929
1,572,817
1,813,295
2,028,848
722,986
1,566,763
2,296,335
2,654,143
638,690
677,095
820,951
815,421
935,459
401,387
756,933
1,158,320
1,361,229
329,681
356,286
409,576
421,921
474,188
726,929
505,226
723,827
811,944
184,734
200,419
22,284
27,879
33,079
11,930
79,665
106,335
95,763
24,003
19,384
2,825,628
3,078,516
3,471,574
1,863,232
2,908,587
4,284,817
4,923,079
1,177,108
1,253,184
76,885
130,695
153,481
(453,289
)
32,688
66,401
199,554
52,351
88,745
1,995
2,955
2,442
734
4,578
5,312
1,466
515
312
(966
)
(1,481
)
(2,319
)
(1,044
)
(98,068
)
(146,803
)
(150,734
)
(36,371
)
(40,353
)
392
146
(1,931
)
(54
)
(128
)
(182
)
(1,292
)
(523
)
(619
)
78,306
132,315
151,673
(453,653
)
(60,930
)
(75,272
)
48,994
15,972
48,085
39,399
55,921
62,693
(56,109
)
(22,147
)
(25,831
)
23,575
7,547
19,916
38,907
76,394
88,980
(397,544
)
(38,783
)
$
(49,441
)
25,419
8,425
28,169
(30,409
)
(57,611
)
(71,106
)
(848,371
)
$
8,498
$
18,783
$
17,874
$
(1,245,915
)
$
(38,783
)
$
25,419
$
8,425
$
28,169
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
(
4)
$
$
49
Predecessor
The Company
As of March 31,
As of March 31,
As of June 30,
2006
2007
2008
2009
2010
2010
(Unaudited)
(Unaudited)
(As adjusted)
(As adjusted)
(Unaudited)
(As adjusted)
(As adjusted)
(In thousands)
$
31,233
$
3,272
$
7,123
$
420,902
$
307,835
$
300,611
724,470
789,275
1,113,656
789,308
584,248
648,622
1,422,983
1,482,453
1,891,375
3,182,249
3,062,223
3,015,262
1,220,502
1,546,782
1,542,063
271,090
272,068
313,065
1,060,343
509,583
552,676
(1)
The table below presents the pro forma adjustments attributable
to the acquisition. The pro forma adjustments are described in
the accompanying footnotes and are based upon available
information and certain assumptions that we believe are
reasonable.
Four Months
Eight Months
Ended
Ended
Pro Forma
July 31,
March 31,
Pro Forma
Fiscal Year Ended
2008
2009
Adjustments
March 31, 2009
(As adjusted)
(As adjusted)
(In thousands, except share and per share data)
$
1,409,943
$
2,941,275
$
4,351,218
722,986
1,566,763
$
6,586
(a)
2,296,335
401,387
756,933
1,158,320
726,929
505,226
(508,328
)(b)
723,827
11,930
79,665
14,740
(c)
106,335
1,863,232
2,908,587
4,284,817
(453,289
)
32,688
66,401
734
4,578
5,312
(1,044
)
(98,068
)
(47,691
)(d)
(146,803
)
(54
)
(128
)
(182
)
(453,653
)
(60,930
)
(75,272
)
(56,109
)
(22,147
)
52,425
(e)
(25,831
)
(397,544
)
(38,783
)
$
(49,441
)
(848,371
)
$
(1,245,915
)
$
(38,783
)
(a)
Reflects additional stock-based compensation expense associated
with options issued in exchange for stock rights under the stock
rights plan that existed prior to the closing of the acquisition
for $6.6 million (see Note 17 to our consolidated
financial statements for additional information on our
stock-based compensation).
50
(b)
Consists of the following adjustments:
(c)
Reflects amortization expense of intangible assets established
as part of purchase accounting and depreciation expense
associated with the fair value of fixed assets associated with
the acquisition accounted for as a business combination for
$14.7 million.
(d)
Consists of the following adjustments:
(e)
Reflects tax effect of the cumulative pro forma adjustments.
(2)
Basic earnings per share for the Company has been computed using
the weighted average number of shares of Class A common
stock, Class B non-voting common stock and Class C
restricted common stock outstanding during the period. The
Companys diluted earnings per share has been computed
using the weighted average number of shares of Class A
common stock, Class B non-voting common stock and
Class C restricted common stock including the dilutive
effect of outstanding common stock options and other stock-based
awards. The weighted average number of Class E special
voting common stock has not been included in the calculation of
either basic earnings per share or diluted earnings per share
due to the terms of such common stock.
Basic earnings per share for the Predecessor has been computed
using the weighted average number of shares of Class A
common stock outstanding during the period. The
Predecessors diluted earnings per share has been computed
using the weighted average number of shares of Class A
common stock including the dilutive effect of outstanding
stock-based awards.
(3)
Reflects a -for-1 split of our common stock to be
effected prior to the completion of this offering.
(4)
Reflects the payment of special dividends in the aggregate
amount of $114.9 million and $497.5 million to holders
of record of our Class A common stock, Class B
non-voting common stock, and Class C restricted common
stock as of July 29, 2009 and December 8, 2009,
respectively.
51
AND RESULTS OF OPERATIONS
52
budgeting constraints increasing pressure on the
U.S. government to control spending while pursuing numerous
important policy initiatives, which may result in a slowdown in
the growth rate of U.S. government spending in certain areas;
changes in the level and mix of U.S. government spending,
such as the U.S. governments increased spending in
recent years on homeland security, cyber, advanced technology
analytics, intelligence and defense-related programs and
healthcare;
cost cutting and efficiency initiatives and other efforts to
streamline the U.S. defense and intelligence infrastructure,
including the initiatives recently announced by the Secretary of
Defense;
increased insourcing by the U.S. government of work that
was traditionally performed by outside contractors, including at
the Department of Defense;
specific efficiency initiatives by the U.S. government such
as the Base Realignment and Closure Program and efforts to
rebalance the U.S. defense forces in accordance with the
2010 Quadrennial Defense Review, as well as general efforts to
improve procurement practices and efficiencies, such as the
actions recently announced by the Office of Management and
Budget regarding IT procurement practices;
U.S. government agencies awarding contracts on a
technically acceptable/lowest cost basis, which could have a
negative impact on our ability to win certain contracts;
restrictions by the U.S. government on the ability of
federal agencies to use lead system integrators, in response to
cost, schedule and performance problems with large defense
acquisition programs where contractors were performing the lead
system integrator role;
increasingly complex requirements of the Department of Defense
and the U.S. Intelligence Community, including
cyber-security, and focus on reforming existing government
regulation of various sectors of the economy, such as financial
regulation and healthcare;
efforts by the U.S. government to address organizational
conflicts of interest and related issues and the impact of those
efforts on us and our competitors; and
increased competition from other government contractors and
market entrants seeking to take advantage of the trends
identified above.
Cost-reimbursable contracts.
Cost-reimbursable
contracts provide for the payment of allowable costs incurred
during performance of the contract, up to a ceiling based on the
amount that has been funded, plus a fee. We generate revenue
under two general types of cost-reimbursable contracts:
cost-plus-fixed-fee and cost-plus-award-fee contracts, both of
which reimburse allowable costs and include a fixed
53
contract fee. The fixed fee under each type of cost-reimbursable
contract is generally payable upon completion of services in
accordance with the terms of the contract, and
cost-plus-fixed-fee contracts offer no opportunity for payment
beyond the fixed fee. Cost-plus-award-fee contracts also provide
for an award fee that varies within specified limits based upon
the clients assessment of our performance against a
predetermined set of criteria, such as targets for factors like
cost, quality, schedule, and performance.
Time-and-materials
contracts.
Under a
time-and-materials
contract, we are paid a fixed hourly rate for each direct labor
hour expended, and we are reimbursed for allowable material
costs and allowable
out-of-pocket
expenses. To the extent our actual direct labor and associated
costs vary in relation to the fixed hourly billing rates
provided in the contract, we will generate more or less profit,
or could incur a loss.
Fixed-price contracts.
Under a fixed-price
contract, we agree to perform the specified work for a
pre-determined
price. To the extent our actual costs vary from the estimates
upon which the price was negotiated, we will generate more or
less profit, or could incur a loss. Some fixed-price contracts
have a performance-based component, pursuant to which we can
earn incentive payments or incur financial penalties based on
our performance. Fixed-price level of effort contracts require
us to provide a specified level of effort, over a stated period
of time, for a fixed price.
Predecessor
The Company
Three Months
Fiscal
Pro Forma
Fiscal
Ended June 30,
2008
2009
2010
2009
2010
47
%
50
%
50
%
52
%
51
%
44
%
39
%
38
%
38
%
36
%
9
%
11
%
12
%
10
%
13
%
(1)
Includes both cost-plus-fixed-fee and cost-plus-award fee
contracts.
(2)
Includes fixed-price level of effort contracts.
54
Funded Backlog.
Funded backlog represents the
revenue value of orders for services under existing contracts
for which funding is appropriated or otherwise authorized less
revenue previously recognized on these contracts.
Unfunded Backlog.
Unfunded backlog represents
the revenue value of orders for services under existing
contracts for which funding has not been appropriated or
otherwise authorized.
Priced Options.
Priced contract options
represent 100% of the revenue value of all future contract
option periods under existing contracts that may be exercised at
our clients option and for which funding has not been
appropriated or otherwise authorized.
55
The Company
As of March 31,
As of June 30,
2009
2010
2009
2010
(In millions)
$
2,392
$
2,528
$
2,214
$
2,618
1,968
2,453
2,057
2,576
2,919
4,032
3,233
4,295
$
7,279
$
9,013
$
7,504
$
9,489
(1)
Reflects a reduction by management to the revenue value of
orders for services under two existing single award ID/IQ
contracts based on an established pattern of funding under these
contracts by the U.S. government.
(2)
Amounts shown reflect 100% of the undiscounted revenue value of
all priced options.
56
57
58
59
60
61
62
63
64
Predecessor
The Company
Four
Eight
Pro Forma
Fiscal Year
Months
Months
Fiscal
Fiscal Year
Ended
Ended
Ended
Year Ended
Ended
Three Months
March 31,
July 31,
March 31,
Pro Forma
March 31,
March 31,
Ended June 30,
2008
2008
2009
Adjustments
2009
2010
2009
2010
(As adjusted)
(As adjusted)
(As adjusted)
(Unaudited)
(Unaudited)
(As adjusted)
(In thousands)
$
3,625,055
$
1,409,943
$
2,941,275
$
4,351,218
$
5,122,633
$
1,229,459
$
1,341,929
2,028,848
722,986
1,566,763
$
6,586
(a)
2,296,335
2,654,143
638,690
677,095
935,459
401,387
756,933
1,158,320
1,361,229
329,681
356,286
474,188
726,929
505,226
(508,328
)(b)
723,827
811,944
184,734
200,419
33,079
11,930
79,665
14,740
(c)
106,335
95,763
24,003
19,384
3,471,574
1,863,232
2,908,587
4,284,817
4,923,079
1,177,108
1,253,184
153,481
(453,289
)
32,688
66,401
199,554
52,351
88,745
2,442
734
4,578
5,312
1,466
515
312
(2,319
)
(1,044
)
(98,068
)
(47,691
)(d)
(146,803
)
(150,734
)
(36,371
)
(40,353
)
(1,931
)
(54
)
(128
)
(182
)
(1,292
)
(523
)
(619
)
151,673
(453,653
)
(60,930
)
(75,272
)
48,994
15,972
48,085
62,693
(56,109
)
(22,147
)
52,425
(e)
(25,831
)
23,575
7,547
19,916
88,980
(397,544
)
(38,783
)
$
(49,441
)
25,419
8,425
28,169
(71,106
)
(848,371
)
$
17,874
$
(1,245,915
)
$
(38,783
)
$
25,419
$
8,425
$
28,169
(a)
Reflects additional stock-based compensation expense associated
with options issued in exchange for stock rights under the stock
rights plan that existed prior to the closing of the acquisition
for $6.6 million (see Note 17 to our consolidated
financial statements for additional information on our
stock-based compensation).
(b)
Consists of the following adjustments:
(c)
Reflects amortization expense of intangible assets established
as part of purchase accounting and depreciation expense
associated with the fair value of fixed assets associated with
the acquisition accounted for as a business combination for
$14.7 million.
65
(d)
Consists of the following adjustments:
(e)
Reflects tax effect of the cumulative pro forma adjustments.
Revenue increased 9.1% over the three months ended June 30,
2009 driven primarily by the deployment during the three months
ended June 30, 2010 of approximately 1,200 net
additional consulting staff against funded backlog. Net
additional consulting staff reflects newly hired consulting
staff net of consulting staff attrition during the twelve months
ended June 30, 2010.
Operating income as a percentage of revenue increased to 6.6% in
the three months ended June 30, 2010 from 4.3% in the three
months ended June 30, 2009. The increase in operating
margin reflects a reduction in the cost of revenue as a
percentage of revenue driven by a decrease in
acquisition-related expenses and cost efficiencies across our
overhead base primarily related to lower indirect labor costs.
Income from continuing operations before taxes increased to
$48.1 million for the three months ended June 30, 2010
from $16.0 million for the three months ended June 30,
2009 due to an increase in operating income of
$36.4 million partially offset by a decrease in interest
income and an increase in interest expense.
Revenue increased 17.7% over pro forma 2009 driven primarily by
the deployment during fiscal 2010 of approximately
1,500 net additional consulting staff against funded
backlog. Net additional consulting staff reflects newly hired
consulting staff net of consulting staff attrition during fiscal
2010.
Operating income for fiscal 2010 as a percentage of revenue
increased to 3.9% in fiscal 2010 from 1.5% in pro forma 2009.
The increase in operating margin reflects a reduction in the
cost of revenue as a percentage of revenue driven by a decrease
in acquisition-related expenses and cost efficiencies across our
overhead base primarily related to lower indirect labor costs.
Operating income reflects (i) a $3.1 million reduction
in reserves for costs in excess of funding appropriated under
existing contracts, (ii) recognition of $3.6 million
of profits earned but unrecorded under existing contracts
following a comprehensive contract review and
(iii) recognition of $2.1 million of profits earned
under a contract that was terminated at the request of our
counterparty and with our consent.
Income from continuing operations before taxes for fiscal 2010
was $49.0 million compared to a loss of $75.3 million
for pro forma 2009 due to an increase in operating income of
$133.2 million partially offset by a decrease in interest
income and an increase in interest expense.
66
67
68
69
70
71
72
73
74
75
76
operating expenses, including salaries;
working capital requirements to fund the growth of our business;
capital expenditures which primarily relate to the purchase of
computers, business systems, furniture and leasehold
improvements to support our operations; and
debt service requirements for borrowings under our senior credit
facilities and mezzanine credit facility.
77
Predecessor
The Company
Twelve Months
Four Months
Eight Months
Twelve Months
Ended
Ended
Ended
Ended
Three Months
March 31,
July 31,
March 31,
March 31,
Ended June 30,
2008
2008
2009
2010
2009
2010
(Unaudited)
(Unaudited)
(In thousands)
$
43,791
$
(26,548
)
$
180,709
$
270,484
$
(61,711
)
$
10,011
(38,527
)
(162,976
)
(1,660,518
)
(10,991
)
(6,568
)
(14,829
)
(1,413
)
211,112
1,900,711
(372,560
)
(3,025
)
(2,406
)
$
3,851
$
21,588
$
420,902
$
(113,067
)
$
(71,304
)
$
(7,224
)
78
79
Consolidated Total Leverage Ratio
the ratio
of total leverage as of the last day of the quarter (defined as
the aggregate principal amount of all funded debt, less cash,
cash equivalents and permitted liquid investments) to the
preceding four quarters Consolidated EBITDA
(as defined in the credit agreements governing the credit
facilities). For the period ended March 31, 2010, this
ratio was required to be less than or equal to 5.75 to 1.0 to
comply with our senior credit facilities, and less than 6.9 to
1.0 to comply with our mezzanine credit facility. As of
March 31, 2010, we were in compliance with our consolidated
total leverage ratio. For the period ended June 30, 2010,
this ratio was required to be less than or equal to 5.5 to 1.0
to comply with our senior credit facilities, and less than 6.6
to 1.0 to comply with our mezzanine credit facility. As of
June 30, 2010, we were in compliance with our consolidated
total leverage ratio with a ratio of 3.34. The ratios for the
period ending September 30, 2010 will remain unchanged from
those in effect for the period ended June 30, 2010.
Effective December 31, 2010, these ratios will decrease to
5.0 to 1.0 for our senior credit facilities and 6.0 to 1.0 for
our mezzanine credit facility.
80
Consolidated Net Interest Coverage Ratio
the
ratio of the preceding four quarters Consolidated
EBITDA (as defined in our senior credit facilities) to net
interest expense for the preceding four quarters (defined as
cash interest expense, less the sum of cash interest income and
one-time financing fees (to the extent included in consolidated
interest expense)). For the period ended March 31, 2010,
this ratio was required to be greater than or equal to 1.7 to
1.0 to comply with our senior credit facilities. As of
March 31, 2010, we were in compliance with our consolidated
net interest coverage ratio. For the period ended June 30,
2010, this ratio was required to be greater than or equal to 1.8
to 1.0 to comply with our senior credit facilities. As of
June 30, 2010, we were in compliance with our consolidated
net interest coverage ratio with a ratio of 3.04. The ratio for
the period ending September 30, 2010 will remain unchanged
from the ratio in effect for the period ended June 30,
2010. Effective December 31, 2010, this ratio will increase
to 1.9 to 1.0.
81
Payments Due by Period
Less Than
1 to 3
3 to 5
More Than
Total
1 Year
Years
Years
5 Years
(In thousands)
$
1,587,850
$
21,850
$
56,200
$
81,200
$
1,428,600
287,676
74,447
106,777
69,886
36,566
812,118
141,677
279,989
272,898
117,554
63,435
63,435
54,351
6,976
29,422
17,953
100,178
18,573
40,154
41,451
13,319
13,319
$
2,918,927
$
263,523
$
512,542
$
496,707
$
1,646,155
(a)
See Note 11 to our consolidated financial statements for
additional information regarding debt and related matters.
(b)
Does not reflect the repayment of $85.0 million of
indebtedness under our mezzanine credit facility on
August 2, 2010.
(c)
Includes $17.6 million deferred payment obligation balance,
plus current and future interest accruals.
(d)
Reflects liabilities to holders of stock options issued under
our Officers Rollover Stock Plan related to the reduction
in the exercise price of such options as a result of the July
2009 dividend and the December 2009 dividend.
(e)
Includes $62.4 million of tax liabilities offset by amounts
owed under the deferred payment obligation. The remainder is
related to other tax liabilities.
82
83
84
85
86
87
Deepen Our Existing Client Relationships.
The
complex and evolving nature of the challenges our clients face
requires the application of different core competencies and
capabilities. Our approach to client service and collaborative
culture enables us to effectively cross-sell and deploy multiple
services to existing clients. We plan to leverage our
comprehensive understanding of our clients needs and our
track record of successful performance to grow our client
relationships and expand the scope of the services we provide to
our existing clients.
Help Clients Rapidly Respond to Change.
We
will continue to help our clients formulate rapid and dynamic
responses to the frequent and sometimes sudden changes that they
face by leveraging: the scope and scale of our domain expertise,
our broad capabilities and our one-firm culture, which allow us
to effectively and efficiently allocate our resources and deploy
our intellectual capital.
88
Broaden Our Client Base.
We intend to
capitalize on our scale, the scope of our domain expertise and
core capabilities, and our reputation as a trusted long-term
partner to grow our client base. We believe that growing demand
for the types of services we provide and our ongoing business
initiatives will enable us to leverage our reputation as a
trusted partner and industry leader to cultivate new client
relationships across all agencies and departments of the
U.S. government. We will also continue to build on our
current cyber-security related work in the commercial market as
permitted under the terms of our non-competition agreement with
Spin Co. We will explore new opportunities as those
opportunities become available in the commercial market upon
termination of those contractual restrictions on July 31,
2011, particularly to the extent that we are able to leverage
our core competencies, such as our domain expertise in energy,
transportation, health and finance, and our functional
capabilities, such as cyber and analytics.
Cyber.
Network-enabled technology now forms
the backbone of our economy, infrastructure and national
security, and recent national policies and initiatives in this
area, including CNCI, are creating new cyber-related
opportunities. We have been focused on cyber and predecessor
areas, such as information assurance, since 1999. We are
currently involved in cyber-related initiatives for our defense,
intelligence and civil clients and cyber-security initiatives
for commercial clients. We are focused on further developing our
cyber capabilities to position our company as a leader across
the broad and growing range of areas requiring cyber-related
services.
Government Efficiency and Procurement.
We are
focused on helping the U.S. government achieve operating
and budgetary efficiencies driven by the need to control
spending while simultaneously pursuing numerous policy
initiatives. In addition, recent U.S. government reforms in
the procurement area may allow us to leverage our status as a
large, objective service provider to win additional assignments
to the extent that we are able to address organizational
conflicts of interest and similar concerns more easily than our
competitors.
Ongoing Healthcare Transformation.
We expect
recent and ongoing developments in the healthcare market, such
as the passage of the Affordable Care Act of 2010 and the Health
Information Technology for Economic and Clinical Health Act of
2009, to increase demand for our healthcare consulting
capabilities. We have been serving healthcare-oriented clients
in the U.S. government since the late 1980s. In 2002,
we began a focused expansion of our healthcare consulting
business, and the current scale of that business, together with
our technology-related capabilities, provide us with a strong
platform from which to address our clients increased focus
on the interoperability of healthcare IT platforms, healthcare
policy, and payment and caregiver reforms.
Systems Engineering &
Integration.
Our clients are increasingly
utilizing SE&I services to help them manage every phase of
the development and integration of increasingly sophisticated
information technology, communications and mission
systems ranging from satellite and space systems to
air traffic control and naval systems. Many SE&I
engagements require the application of requisite competencies
across the entire range of agencies or departments involved in a
particular program. Through the application of our matrix, we
have developed deep cross-market knowledge and a combination of
engineering, acquisition, management and leadership expertise.
We plan to leverage this knowledge and expertise to bid on
large-scale SE&I contracts.
89
our assurance and resilience services area, which generated
approximately $450 million of revenue in fiscal 2010 and
which began in 1999 with our efforts to anticipate the
challenges posed to federal agencies by IT
proliferation; and
our healthcare consulting services area, which generated
approximately $280 million of revenue in fiscal 2010 and
began in the late 1980s with IT work for the Department of
Health and Human Services, and expanded rapidly in 2002 as the
result of an internal analysis of potential long-term trends
which could affect federal health agencies.
90
Relationship
Length
(Years)
70
60
25+
20+
20+
15+
15+
15+
15+
10+
(1)
Includes predecessor organizations.
91
U.S. Army.
For 60 years, we have
addressed challenges for the U.S. Army at the strategic,
operational and tactical levels by bringing experienced people,
high quality processes and advanced technologies together. We
work with our U.S. Army clients to help sustain their land
combat capabilities while responding to current demands and
preparing for future needs. Recent examples of the services that
we have provided include enhancing field intelligence systems,
delivering rapid response solutions to counter improvised
explosive devices, infusing lifecycle sustainment capabilities
to improve distribution and delivery of material, and employing
systems and consulting methods to help expand care and support
for soldiers and their families. Our clients include Army
Headquarters, Army Material Command (AMC), Forces Command
(FORSCOM), Training and Doctrine Command (TRADOC), and many
Program Executive Offices, Direct Reporting Units and Army
Service Component Commands.
U.S. Navy/Marine Corps.
We have supported
the U.S. Navy for 70 years. We employ a
multidimensional approach that analyzes and balances people,
processes, technology, and infrastructure to meet their missions
of equipping global forces for greater flexibility, mobility and
efficiency, sustaining results while reducing costs and
integrating new technology. Our clients include the Office of
the Secretary of the Navy, Chief of Naval Operations, the
Commandant of the Marine Corps to the Office of Naval
Intelligence and U.S. Navy/Marine Corps operating commands
and systems commands, as well as the Joint Program Executive
Offices (PEO) and individual PEOs such as Naval Air Systems
Command (NAVAIR), Naval Seas Systems Command (NAVSEA),
U.S. Marine Corps Systems Command, and Space and Naval
Warfare (SPAWAR).
U.S. Air Force/NASA/Aerospace.
We provide
integrated strategy and technical services to the U.S. Air
Force. Our skilled strategists and technology experts bring
diverse capabilities to assignments that include weapons
analysis, capability-based planning and aircraft systems
engineering. We also support the space industry in applying new
technologies, integrating space operations, and using strategies
to address the technical issues, cost, schedule and risk of
space systems. Our clients include Air Combat Command, Air Force
Space Command, Air Force Materiel Command, Air Mobility Command,
Air Force Cyber Command, Air Force Pacific Command, NASA, the
Defense Information Systems Agency (DISA), the National
Reconnaissance Office (NRO) and the National
Geospatial-Intelligence Agency (NGA).
Joint Staff and Combatant Commands.
We provide
mission-critical support to the Office of the Secretary of
Defense, the Joint Staff, the Combatant Commands (COCOMs), and
other U.S. government departments and agencies during the
planning and mission execution phases to meet global mission
requirements ranging from integrated intelligence, surveillance
and reconnaissance (ISR) to space and global strike operations.
Our clients include most major organizations within the Office
of the Secretary of Defense and the Department of Defenses
agencies, as well as the Pacific Command, Northern Command,
Central Command, Southern Command, European Command, Strategic
Command, Special Operations Command, and Transportation Command.
92
U.S. Intelligence Agencies.
We provide
critical support in strategic planning, policy development,
program development and execution, information sharing,
architecture, and program management for research and
development projects as well as support to reform initiatives
flowing from the Intelligence Reform and Terrorism Protection
Act. We help clients improve the processes and substance of
intelligence information provided to the executive and
legislative branches of the U.S. government for policy
development and operational decision making.
Joint Staff and Unified Combatant Commands.
We
deliver comprehensive intelligence analysis, including providing
all-source intelligence analysis and open-source intelligence
analysis conducted in high intensity environments. We also
provide data collection management and analytical systems
intelligence training services, and provide intellectual capital
and best practices for intelligence activities.
Military Intelligence.
We provide consulting
services, integrated intelligence and information operations
mission support, and a range of counterintelligence services to
the U.S. Army, U.S. Air Force, U.S. Navy, Marine
Corps, and Defense Intelligence Agency.
Financial Services.
We provide support to all
major U.S. government finance and treasury organizations
charged with the collection, management and protection of the
U.S. financial system, including the Department of the
Treasury, Internal Revenue Service and other agencies of the
Department of the Treasury, Office of the Comptroller of the
Currency, Federal Deposit Insurance Corporation, Federal Reserve
Board and Banks, the SEC, and Pension Benefit Guaranty
Corporation. We create innovative approaches to some of their
most challenging problems, including bank receivership, payment
channel modernization, cyber initiatives and fraud detection.
Health.
We support government clients on
innovative projects that help achieve public health missions,
including entitlement reform, developing a national health
information network, mitigating risk to populations, improving
government infrastructure, and facilitating an international
public-private sector dialogue on international health issues.
Our clients include the Department of Health and Human Services
and its agencies, including the U.S. Food and Drug
Administration, National Institutes of Health, Centers for
Disease Control and Prevention (CDC), the Centers for Medicare
and Medicaid Services, the Department of Defense Military Health
System and Department of Veterans Affairs.
Energy, Transportation and Environment.
We
support clients in the transportation, energy and environment
sectors which have control over our national infrastructure. We
support our clients efforts to maintain and build
infrastructure that is efficient, effective and sustainable. Our
services include strategy, operations, technology and
engineering. Our clients include the Departments of Energy,
Transportation, and Interior and their component agencies, and
the Environmental Protection Agency. We also support the
Department of Defense in major environmental and infrastructure
programs in the United States and Europe.
Justice and Homeland Security.
We support the
U.S. governments homeland security mission and
operations in the areas of intelligence (analysis, information
sharing, and risk assessment), operations (coordination,
contingency planning, and decision support), strategy,
technology and management
93
(program management and information technology tools), emergency
management and response planning, and border, cargo and
transportation security. We support law enforcement missions and
operations in counterterrorism, intelligence and
counterintelligence, and traditional criminal areas (narcotics,
white collar crime, organized crime, and violent crime).
Business of Government.
We help agencies
effectively and efficiently manage the business processes that
support government in its provision of services to its citizens,
spanning management, personnel, budget operations, information
technology and telecommunications. Our clients include the
General Services Administration, Office of Management and
Budget, Office of Personnel Management, the Congress, and
Courts. We also support public sector grant-making agencies,
from health and education, to labor and homeland and economic
security, serving clients such as the Departments of
Agriculture, Homeland Security, Commerce, Education, Labor, and
Housing and Urban Development, as well as the National Science
Foundation. In addition, we serve our U.S. government
clients abroad in helping them resolve systemic global
development needs. Our clients include the U.S. Agency for
International Development, the Department of State, Millennium
Challenge Corporation, and the World Bank.
Strategy and change management
, helping clients formulate
business strategies to meet their mission, and transforming key
elements within organizations such as people, processes,
technology and physical infrastructure;
Organization and process improvement
, redesigning an
organizations structure to fit its mission and strategy,
aligning its business purpose, and improving operations and
performance through business process reengineering, knowledge
management, strategic sourcing, shared services and lean six
sigma methodologies; and
Human capital, learning and communications
, helping
clients build new capabilities and increasing workforce
performance through competency identification and development of
learning programs, designing programs to better manage the
workforce for high performance, and building stakeholder
understanding and buy-in.
Business analytics
, enabling our clients to optimize
decisions regarding resources through financial and economic
analysis, financial stewardship and accountability and
disciplined contract strategy and program controls;
Intelligence and operations analytics
, providing a full
spectrum of intelligence analysis, innovative all-source
analysis, analytic training and counter-intelligence services to
meet persistent challenges and guard against new threats;
94
Mission and performance analytics
, enhancing our
clients ability to weigh alternative futures and make
sound decisions that are supported by rigorous methods,
including capabilities based assessments, modeling and
simulation, policy analysis, threat, vulnerability and risk
analysis and war-games; and
Advanced analytics
, developing capabilities to exploit
very large amounts of information through the use of advanced
mathematical techniques to gain insights, create foresight and
make predictions to support fact-based decision making for our
clients.
Cyber technologies
, enabling clients to execute their
missions in cyberspace with trusted and secure networks,
systems, and information and delivering solutions for full life
cycle support, information exchange, collaboration,
transportation, and information storage;
SE&I
, developing, acquiring, testing and integrating
complex systems, integrated acquisition management, program and
technical integration, and program and organizational leadership
design;
Systems development
, designing and deploying information
technology solutions, including software development to automate
business processes, improve client service, solve mission
requirements, and share information effectively and
securely; and
Strategic technology and innovation
, identifying and
incubating advanced technologies, innovation processes, and
innovation management critical to the achievement of our
clients goals.
Acquisition and program management
, enabling clients to
originate, plan, and execute programs of all types and
complexity across the entire program or product lifecycle,
including program and project management, acquisition and life
cycle services and program integration;
Infrastructure
, developing sustainable strategies and
executing plans to solve complex challenges across the many
natural and man-made infrastructure environments to facilitate a
safe, efficient, effective and sustainable project;
Mission and industry expertise
, supporting clients across
planning and policy development, capability development and
management, conceptual and operational requirements, and mission
readiness and operational support; and
Supply chain and logistics
, formulating and executing
supply chain strategies and mission-specific logistics solutions
to optimize material, data and human capital flows designed to
achieve our clients targets for cost, readiness and
operational performance.
95
We developed a methodology that dramatically improves the
design, cost and management of major weapons programs that we
refer to as Design for Affordability, and worked
closely with the U.S. Navy to achieve significant cost
reductions. Launched in 2004, the first Virginia-class submarine
cost more than $3.2 billion to build, which exceeded
estimates provided to U.S. Navy officials for this class of
over 30 boats. The Chief of Naval Operations subsequently
set a target cost of $2 billion per submarine as a
condition for increasing production from one to two boats per
year starting in 2012. Electric Boat, the prime contractor,
engaged us as a subcontractor to develop a comprehensive
strategy for permanently reducing costs to $2 billion per
boat. Our Design for Affordability methodology achieved positive
results, which led to the U.S. Navy directly hiring us to
extend our methodology across other parts of the submarine value
chain in the areas of operations and sustainability. The Design
for Affordability methodology utilizes our operations, strategy
and organization and analytics capabilities, and we can apply
this methodology to help the U.S. government achieve
cost-savings in other large acquisition programs such as those
for aircraft and combat vehicles.
We are working with a major client in the U.S. Intelligence
Community on cloud computing. We are employing cloud
technologies to store, manage, and perform advanced analytics on
massive volumes of data to identify patterns that reveal larger
trends, yield new insights, and ultimately capture cyber
actors behavior. In support of our client, we utilize our
technology and analytics capabilities to analyze huge stores of
historical data in the cloud and build statistical models to
understand the behavior, intent, and potential future targets of
adversaries attempting to conduct attacks or crimes in
cyberspace. Improved cyber analysis using cloud technologies is
highly useful for government agencies striving to better share
information and integrate intelligence.
We worked with the CDC to improve its process for ordering,
distributing and managing the U.S.s supply of
publicly-funded childhood vaccines through the Vaccines for
Children program, a $3 billion-dollar-a-year initiative
that reaches half of all American children. The CDC mission was
to respond more effectively to public health crises such as
disease outbreaks, vaccine shortages, natural disasters and
disruptions of the vaccine supply. We utilized our strategy and
organization, operations and technology capabilities and
leveraged our expertise in supply chain management, information
management and change management to redesign the CDCs
procurement and storage process to allow them to ship inventory
in hours instead of weeks. We helped the CDC integrate 64
grantees with formerly separate supply and distribution systems
into a single, centrally managed supply chain that has shipped
millions of doses of vaccines and realized $496 million in
overall one-time savings with the potential for recurring annual
savings.
Definite contracts call for the performance of specified
services or the delivery of specified products. The
U.S. government procures services and solutions through
single award, definite contracts that
96
specify the scope of services that will be delivered and
identify the contractor that will provide the specified
services. When an agency recognizes a need for services or
products, it develops an acquisition plan, which details the
means by which it will procure those services or products.
During the acquisition process, the agency may release a request
for information to determine if qualified bidders exist, a draft
request for a proposal to allow industry to comment on the scope
of work and acquisition strategy, and finally a formal request
for a proposal. Following the evaluation of submitted proposals,
the agency will award the contract to the winning bidder.
Indefinite contract vehicles provide for the issuance by the
client of orders for services or products under the terms of the
contract. Indefinite contracts are formally known as indefinite
delivery, indefinite quantity or ID/IQ contracts, and are often
referred to as contract vehicles or ordering contracts. ID/IQ
contracts may be awarded to one contractor (single award) or
several contractors (multiple award). Under a multiple award
ID/IQ contract, there is no guarantee of work as contract
holders must compete for individual work orders. ID/IQ contracts
will often include pre-established labor categories and rates,
and the ordering process is streamlined (usually taking less
than a month from recognition of a need to an established order
with a contractor). ID/IQ contracts often have
multi-year
terms and unfunded ceiling amounts, thereby enabling but not
committing the U.S. government to purchase substantial
amounts of products and services from one or more contractors in
a streamlined procurement process.
¡
GWACs and GSA schedules are ID/IQ contracts that are open to all
U.S. government agencies. Contract holders compete for
individual task orders under both types of ID/IQ contract
vehicles. Prices (labor rates) are pre-established under GSA
schedules, while prices under GWACs may be pre-established or
determined by task order proposal. Agencies may solicit
companies directly under GSA schedules and, under GWACs, must
work through the agency that operates the GWAC or receive a
delegation of authority to use the GWAC. GSA schedules are
administered by the General Services Administration and support
a wide range of products and services. GWACs are used to procure
IT products and services and are administered by the agency
soliciting the services or products, with permission from the
Office of Management and Budget.
97
Number of
% of
Pro
% of
% of
Task Orders
Fiscal
Total
Forma
Total
Fiscal
Total
as of
Expiration
2008
Revenue
2009
Revenue
2010
Revenue
March 31, 2010
Date
(Revenue in millions)
$
187.8
5
%
$
245.6
6
%
$
351.7
7
%
494
9/30/12
$
330.2
9
%
$
334.5
8
%
$
257.7
5
%
326
7/30/10
$
242.8
7
%
$
243.8
6
%
$
216.5
4
%
287
10/28/14
$
279.4
8
%
$
339.1
7
%
$
368.2
7
%
$
1,040.2
29
%
$
1,163.0
27
%
$
1,194.1
23
%
Number of
% of
Task Orders
Fiscal
Total
as of
Expiration
2010
Revenue
March 31, 2010
Date
(Revenue in millions)
$
376.0
7
%
335
1/8/2013
$
817.1
16
%
907
$
957.8
19
%
961
Funded Backlog.
Funded backlog represents the
revenue value of orders for services under existing contracts
for which funding is appropriated or otherwise authorized less
revenue previously recognized on these contracts.
Unfunded Backlog.
Unfunded backlog represents
the revenue value of orders for services under existing
contracts for which funding has not been appropriated or
otherwise authorized.
Priced Options.
Priced contract options
represent 100% of the revenue value of all future contract
option periods that may be exercised at our clients option
and for which funding has not been appropriated or otherwise
authorized.
98
The Company
As of March 31,
As of June 30,
2009
2010
2009
2010
(In millions)
$
2,392
$
2,528
$
2,214
$
2,618
1,968
2,453
2,057
2,576
2,919
4,032
3,233
4,295
$
7,279
$
9,013
$
7,504
$
9,489
(1)
Reflects a reduction by management to the revenue value of
orders for services under two existing single award ID/IQ
contracts based on an established pattern of funding under these
contracts by the U.S. government.
(2)
Amounts shown reflect 100% of the undiscounted revenue value of
all priced options.
99
100
FAR, and agency regulations supplemental thereto, which regulate
the formation, administration and performance of
U.S. government contracts;
the Truth in Negotiations Act, which requires certification and
disclosure of cost and pricing data in connection with the
negotiation of a contract, modification or task order;
the Procurement Integrity Act, which regulates access to
competitor bid and proposal information and certain internal
government procurement sensitive information, and our ability to
provide compensation to certain former government procurement
officials;
post government employment laws and regulations, which restrict
the ability of a contractor to recruit, hire, and deploy former
employees of the U.S. government;
laws, regulations and executive orders restricting the use and
dissemination of information classified for national security
purposes and the export of certain products, services and
technical data, including requirements regarding any applicable
licensing of our employees involved in such work; and
the Cost Accounting Standards and FAR Cost Principles, which
impose accounting requirements that govern our right to
reimbursement under certain cost-based U.S. government
contracts and require consistency of accounting practices over
time.
101
102
66
Chairman of the Board, President and Chief Executive Officer
60
Executive Vice President, Chief Financial Officer, Chief
Administrative Officer and Director
63
Executive Vice President, General Counsel and Secretary
42
Executive Vice President, Chief Strategy
and Talent Officer
62
Executive Vice President
59
Executive Vice President
44
Executive Vice President
45
Executive Vice President
53
Executive Vice President
64
Executive Vice President
67
Executive Vice President
52
Executive Vice President
45
Director
38
Director
58
Director
75
Director
69
Director
Operating and management experience;
Understanding of government contracting;
Core business skills, including financial and strategic
planning; and
Deep understanding of our company, its history and culture.
103
Finance, financial reporting, compliance and controls expertise;
Understanding of government contracting; and
Core business skills, including financial and strategic planning.
104
Operating experience;
Understanding of government contracting;
Core business skills, including financial and strategic
planning;
Public company directorship and committee experience; and
Expertise in finance, financial reporting, compliance and
controls and global businesses.
Operating experience;
Understanding of government contracting;
Core business skills, including financial and strategic
planning; and
Expertise in finance, financial reporting, compliance and
controls and global businesses.
Operating experience;
Understanding of government contracting;
Core business skills, including financial and strategic
planning; and
Experience in finance, financial reporting, compliance and
controls and global businesses.
105
Operating and risk management experience, relevant to the
oversight of operational risk management;
Core business skills, including financial and strategic planning;
Understanding of government contracting;
Expertise in strategic planning and executive compensation; and
Public company directorship and committee experience.
Operating and risk management experience, relevant to the
oversight of operational risk management;
Core business skills, including financial and strategic planning;
Understanding of government contracting;
Expertise in finance, financial reporting, compliance and
controls and global businesses; and
Public company directorship and audit committee experience.
106
107
108
Fees Earned or
Option
Stock
Paid in Cash
Awards
Awards
Other(2)
Total
($)
($)(1)
($)
($)
($)
100,000(3
)
55,610
57(3
)
14,450
170,117
100,000(4
)
55,610
(4
)
28,889
184,499
(1)
This column represents the grant date fair value of the options
granted to our directors in fiscal 2010. The aggregate fair
value of the awards was computed in accordance with FASB ASC
Topic 718 based on the probable outcome of the performance
conditions using the valuation methodology and assumptions set
forth in Note 17 to our financial statements for the fiscal
year ended March 31, 2010, which are incorporated by
reference herein, modified to exclude any forfeiture assumptions
related to service-based vesting conditions. The amounts in this
column do not reflect the value, if any, that ultimately may be
realized by the director.
Option Awards
Equity Incentive
Plan Awards:
Number of
Number of
Number of
Securities
Securities
Securities
Underlying
Underlying
Underlying
Unexercised
Unexercised
Unexercised
Option
Option
Options
Options
Unearned
Exercise
Expiration
Exercisable
Unexercisable
Options
Price ($)
Date
200
267
(a)
355
(b)
60.77
05/07/2019
178
(c)
60.77
05/07/2019
200
267
(a)
355
(b)
60.77
05/07/2019
178
(c)
60.77
05/07/2019
(a)
The options vest and become exercisable, subject to the
continued service of the director, ratably on June 30,
2009, 2010, 2011, 2012 and 2013. All service-vesting options
fully vest and become exercisable immediately prior to the
effective date of certain change in control events.
(b)
The options vest and become exercisable, subject to the
continued service of the director, ratably on June 30,
2009, 2010, 2011, 2012 and 2013 based on achievement of EBITDA
performance goals, with the ability to catch up on
missed goals if (x) the missed performance goal was at
least 90% of target level and (y) cumulative EBITDA
performance reaches the target cumulative levels during the
five-year vesting period. In addition, any unvested performance
options at the time of a change in control event vest
immediately prior to the effective date of the event if Carlyle
achieves a specified internal rate of return as a result of the
event or the investment proceeds to Carlyle are at least a
specified multiple of their invested capital.
109
(c)
The options vest and become exercisable, subject to the
continued service of the director, ratably on June 30,
2009, 2010, 2011, 2012 and 2013 based on achievement of
cumulative cash flow performance goals, with the ability to
catch up on missed goals if cumulative achievement
reaches the target cumulative levels during the five-year
vesting period. In addition, any unvested performance options at
the time of a change in control event vest immediately prior to
the effective date of event if Carlyle achieves a specified
internal rate of return as a result of the event or the
investment proceeds to Carlyle are at least a specified multiple
of their invested capital.
(2)
On July 27, 2009, our Board approved a special dividend of
$10.87 per share paid on July 29, 2009 to holders of our
Class A common stock, Class B non-voting common stock
and Class C restricted common stock as of July 29,
2009. In addition, on December 7, 2009, our Board approved
a special dividend of $46.42 per share paid on December 11,
2009 to holders of record of Class A common stock,
Class B non-voting common stock and Class C restricted
common stock as of December 8, 2009. The amount set forth
in the table reflects the dividends received by
Messrs. Odeen and Rossotti with respect to their unvested
Class A restricted common stock. Messrs. Odeen and
Rossotti also received dividends of $9,841 and $19,682,
respectively, on the restricted stock granted for fiscal 2010
that vested prior to the December 8, 2009 dividend record
date, which amounts are not compensation and therefore are not
reflected in the Director Compensation Table.
(3)
Mr. Odeen elected to receive half of his compensation in
the form of restricted stock, and was granted 424 shares of
restricted Class A common stock in lieu of $50,000 of the
cash payment. The shares of restricted stock awarded for
services performed in fiscal 2010 vested in equal installments
on September 30, 2009 and March 31, 2010. The grant
date fair market value of the shares was $50,057, based on the
$118.06 value of our stock on the May 7, 2009 grant date.
Mr. Odeen also received a grant of 212 shares of stock
in fiscal 2010 in lieu of half of his cash compensation for
services as a director in fiscal 2009. These shares were vested
immediately on grant and are not reflected in the Director
Compensation Table as they were paid with respect to his
services performed during fiscal 2009.
(4)
Mr. Rossotti elected to receive his entire compensation in
the form of restricted stock, and was granted 847 shares of
restricted Class A common stock in lieu of the cash
payment. The shares of restricted stock awarded for services
performed in fiscal 2010 vested in equal installments on
September 30, 2009 and March 31, 2010. The grant date
fair market value of the shares was $99,997, based on the
$118.06 value of our stock on the May 7, 2009 grant date.
Mr. Rossotti also received a grant of 424 shares of
stock in fiscal 2010 in lieu of his cash compensation for
services as a director in fiscal 2009. These shares were vested
immediately on grant and are not reflected in the Director
Compensation Table as they were paid with respect to his
services performed during fiscal 2009.
110
attract, motivate and retain executives of outstanding ability
to meet and exceed the demands of our clients;
focus management on optimizing stockholder value and fostering
an ownership culture;
create appropriate rewards for outstanding performance and
penalties for under-performance; and
provide competitive rewards and foster collaboration by:
rewarding executives for their contribution to our overall
performance and financial success and, at the same time,
recognizing the spirit and culture of collaboration that has
defined us throughout our history; and
determining and allocating incentives based on our performance
as a whole while measuring individual performance over the long
term to facilitate long-term investment and resource allocation.
111
cash compensation, a portion of which is paid as base salary,
designed to reflect the requirements of the marketplace in order
to attract and keep our executive talent, and a portion of which
is short-term cash incentive compensation (consisting of annual
cash bonuses), designed to reward our executive officers for
annual improvements in key areas of our operational and
financial performance;
long-term equity incentive plans, designed to reward our
executive officers for growing our company over the long term
and aligning our executive officers interests with our
stockholders;
retirement benefits, designed to build financial security for
our executive officers and promote a long-term career with our
company, including a defined contribution 401(k) plan, company
contributions to the defined contribution 401(k) plan and annual
cash payments to supplement the contribution in cases where the
IRS retirement contribution limits are reached, a lump-sum
retirement payment and employer-paid retiree healthcare; and
executive benefits, including enhanced health and welfare
benefits, financial counseling and club memberships.
112
113
$
295,317
97,266
7,262
$
399,845
$
337,000
114
115
Ownership Guideline:
5x base salary
3x base salary
116
117
118
Change in
Pension Value
and
Nonqualified
Non-Equity
Deferred
Option
Incentive Plan
Compensation
All Other
Year
Salary
Bonus
Awards
Compensation
Earnings
Compensation
Total
(1)
($)
($)
($)(2)
($)(3)
($)(4)
($)(5)
($)
2010
1,162,500
1,559,145
32,694
1,474,503
4,228,842
2010
825,000
1,106,490
69,700
1,062,115
3,063,305
2010
1,050,000
1,408,260
42,085
1,394,506
3,894,851
2010
1,050,000
1,408,260
50,985
1,298,793
3,808,038
2010
1,050,000
1,525,434
1,408,260
28,277
122,353
4,134,324
(1)
Year reflects fiscal 2010 April 1, 2009 to
March 31, 2010.
(2)
This column represents the grant date fair value of the options
granted in fiscal 2010 at the time of Mr. McConnells
rehiring. Options are generally granted only on hire or
promotion. See Compensation Discussion and
Analysis Elements of Compensation
Long-term Equity Incentive Plans. The aggregate fair value
of the awards was computed in accordance with FASB ASC Topic 718
based on the probable outcome of the performance conditions
using the valuation methodology and assumptions set forth in
Note 17 to our financial statements for the fiscal year
ended March 31, 2010, which are incorporated by reference
herein, modified to exclude any forfeiture assumptions related
to service-based vesting conditions. The amounts in this column
do not reflect the value, if any, that ultimately may be
realized by Mr. McConnell.
(3)
This column reflects bonuses under our annual performance bonus
plan, which provides awards based on the achievement of a
corporate performance objective. Awards under the annual
performance bonus plan are paid in cash. The annual performance
bonus plan is described more fully at Compensation
Discussion and Analysis Elements of
Compensation Cash Compensation.
(4)
This column reflects the change in value over fiscal 2009 of the
retiree medical and cash retirement benefit for each of our
named executive officers.
119
(5)
The table below describes the elements included in All Other
Compensation.
Dividends
and Related
Payments
on Unvested
Non-Qualified
Restricted
Qualified
Company
Stock and
Company
Retirement
Executive
Tax
Vested Stock
Club
Financial
Contributions
Contributions
Medical Plan
Gross
Options
Membership
Counseling
to 401(k)
to Employee
Contributions
Ups
Other
Total
($)(a)
($)
($)
($)
($)
($)
($)(b)
($)(c)
($)
927,758
33,753
15,000
32,377
392,371
34,677
8,628
29,939
1,474,503
675,348
32,481
3,040
32,377
264,629
34,677
3,215
16,348
1,062,115
927,758
11,795
15,000
32,377
349,790
34,677
4,998
18,111
1,394,506
837,255
13,510
10,000
32,377
349,790
34,677
3,729
17,455
1,298,793
0
0
7,166
32,377
22,000
34,677
4,787
21,346
122,353
(a)
On July 27, 2009, our Board approved a special dividend of
$10.87 per share paid on July 29, 2009 to holders of record
of our Class A common stock, Class B non-voting common
stock and Class C restricted common stock as of
July 29, 2009. In addition, on December 7, 2009, our
Board approved a special dividend of $46.42 per share paid on
December 11, 2009 to holders of record as of
December 8, 2009 of our Class A common stock,
Class B non-voting common stock and Class C restricted
common stock. In connection with these dividends and based on
their equity holdings, our named executive officers received
these dividend payments with respect to unvested Class C
restricted common stock. Dividends on vested shares are not
included because they are not considered compensation. In
addition, in accordance with the terms of the Officers
Rollover Stock Plan, the exercise price of outstanding stock
options was reduced by the reduction in value of our common
stock as a result of each of the dividends. For any stock option
with an exercise price less than the amount of the adjustment,
the exercise price was reduced to the par value of our
Class A common stock ($0.01), and the option-holder was
granted a right to receive a cash payment, in the same calendar
year as the year the related option is required to be exercised,
equal to the difference between the amount of the special
dividend and the amount by which the related options
exercise price was reduced. Amounts earned or paid in fiscal
2010 are included in this column. Amounts earned or paid with
respect to vested options are set forth in the Nonqualified
Deferred Compensation Table below.
(b)
Includes tax
gross-ups
relating to life insurance coverage and milestone anniversary
awards.
(c)
Includes: medical, dental, supplemental medical, life insurance,
accident insurance, personal excess liability coverage, estate
planning and milestone anniversary awards.
120
All
Other
All Other
Estimated Future Payouts
Stock
Option
Grant Date
Estimated Future Payouts
Under Equity Incentive
Awards;
Awards:
Exercise or
Fair Value
Under Non-Equity Incentive
Plan Awards
Number of
Number of
Base Price
of Stock
Plan Awards(1)
Max
Shares or
Securities
of Option
and Option
Grant
Threshold
Target
Max
Threshold
Target
($)
Stock
Underlying
Awards
Awards
Date
($)
($)
($)
($)
($)
(H)
Units
Options
($/Sh)
($)
06/29/09
1,046,250
06/29/09
742,500
06/29/09
945,000
06/29/09
945,000
06/29/09
945,000
05/07/09
27,500
(2)
118.06
(3)
1,525,434
(1)
Reflects target bonus levels for fiscal 2010 under our annual
performance bonus plan, which provides awards based on the
achievement of a corporate performance objective. Awards under
the annual performance bonus plan are paid in cash. The annual
performance bonus plan is described more fully at
Compensation Discussion and Analysis Elements
of Compensation Cash Compensation. Non-equity
incentive plan awards have no minimum threshold or maximum cap
payouts. The actual bonuses paid under the plan for fiscal 2010
are reflected in the Summary Compensation Table.
(2)
On May 7, 2009, upon rejoining our company,
Mr. McConnell received one-time awards of time-vesting and
performance-vesting stock options under our Equity Incentive
Plan. See Executive Compensation Plans, below, for a
description of our Equity Incentive Plan.
One-third of the options are service-vesting options, which vest
and become exercisable, subject to the continued employment of
the named executive officer, ratably over three years.
Two-thirds of the options are performance options, which vest
and become exercisable, subject to the continued employment of
the named executive officer, ratably over three years based on
achievement of EBITDA and cumulative cash flow performance
goals, with the ability to catch up on missed goals
if cumulative achievement reaches the target cumulative levels
during the three-year vesting period. In the case of an option
that vests based on EBITDA performance, the missed performance
goal must be at least 90% of the target level to be eligible for
catch up.
All service-vesting options become fully vested and exercisable
immediately prior to the effective date of certain change in
control events. Any unvested performance options at the time of
such a change in control event vest immediately prior to the
effective date of event if Carlyle achieves a specified internal
rate of return or the investment proceeds to Carlyle are at
least a specified multiple of their invested capital.
For purposes of the options, internal rate of return
means the internal rate of return realized by Carlyle on its
invested capital as a result of the proceeds realized, or deemed
realized, by Carlyle on its capital, calculated without
reduction for any taxes and after giving effect to the vesting
of any awards granted under the Equity Incentive Plan.
(3)
Reflects the exercise price on the grant date. The exercise
price has been adjusted to $60.77 to reflect the two
extraordinary dividends paid in fiscal 2010. See
Compensation Discussion and Analysis Elements
of Compensation Long-term Equity Incentive
Plans.
121
Option Awards
Stock Awards
Equity
Incentive
Plan
Market
Awards:
Value of
Number of
Number of
Number of
Number of
Shares or
Securities
Securities
Securities
Shares or
Units of
Underlying
Underlying
Underlying
Option
Units of
Stock That
Unexercised
Unexercised
Unexercised
Exercise
Option
Stock That
Have Not
Options
Options
Unearned
Price
Expiration
Have Not
Vested
Exercisable
Unexercisable
Options
($)
Date
Vested(5)
($)(6)
10,445.3333
1,337,316
2,799
3,734
(1)
4,853.55
(2)
42.71
11/19/2018
2,613.45
(3)
42.71
11/19/2018
13,895.154
(4)
0.01
08/29/2010
11,910.132
(4)
0.01
08/29/2011
7,940.088
(4)
0.01
08/29/2012
7,940.088
(4)
0.01
08/29/2013
5,955.066
(4)
0.01
08/29/2014
7,082.0000
906,708
3,699
4,934
(1)
6,413.55
(2)
42.71
11/19/2018
3,453.45
(3)
42.71
11/19/2018
11,579.295
(4)
0.01
08/29/2010
9,925.11
(4)
0.01
08/29/2011
6,616.74
(4)
0.01
08/29/2012
6,616.74
(4)
0.01
08/29/2013
4,962.555
(4)
0.01
08/29/2014
10,445.3333
1,337,316
2,799
3,734
(1)
4,853.55
(2)
42.71
11/19/2018
2,613.45
(3)
42.71
11/19/2018
13,895.154
(4)
0.01
08/29/2010
11,910.132
(4)
0.01
08/29/2011
7,940.088
(4)
0.01
08/29/2012
7,940.088
(4)
0.01
08/29/2013
5,955.066
(4)
0.01
08/29/2014
8,993.3333
1,154,416
2,799
3,734
(1)
4,853.55
(2)
42.71
11/19/2018
2,613.45
(3)
42.71
11/19/2018
13,627.9395
(4)
0.01
08/29/2010
11,681.0910
(4)
0.01
08/29/2011
7,787.3940
(4)
0.01
08/29/2012
7,787.3940
(4)
0.01
08/29/2013
5,840.5455
(4)
0.01
08/29/2014
9,167
(7)(8)
11,916.45
(9)
60.77
05/07/2019
6,416.55
(8)
60.77
05/07/2019
(1)
The options vest and become exercisable, subject to the
continued employment of the named executive officer, ratably on
June 30, 2009, 2010, 2011, 2012 and 2013. All
service-vesting options fully vest and become exercisable
immediately prior to the effective date of certain change in
control events.
(2)
The options vest and become exercisable, subject to the
continued employment of the named executive officer, ratably on
June 30, 2009, 2010, 2011, 2012 and 2013 based on
achievement of EBITDA performance goals, with the ability to
catch up on missed goals if (x) the missed
performance goal was at least 90% of target level and
(y) cumulative EBITDA performance reaches the target
cumulative levels during the five-year vesting period. In
addition, any unvested performance options at the time of a
change in control event vest immediately prior to the effective
date of the event if Carlyle achieves a specified
122
internal rate of return as a result of the event or the
investment proceeds to Carlyle are at least a specified multiple
of its invested capital.
(3)
The options vest and become exercisable, subject to the
continued employment of the named executive officer, ratably on
June 30, 2009, 2010, 2011, 2012 and 2013 based on
achievement of cumulative cash flow performance goals, with the
ability to catch up on missed goals if cumulative
achievement reaches the target cumulative levels during the
five-year vesting period. In addition, any unvested performance
options at the time of a change in control event vest
immediately prior to the effective date of event if Carlyle
achieves a specified internal rate of return as a result of the
event or the investment proceeds to Carlyle are at least a
specified multiple of its invested capital.
(4)
One third of the options are currently vested. The remaining
options vest in equal annual installments on June 30, 2010
and 2011. To the extent the options become vested, they become
exercisable as set forth below (all vested options must be
exercised within 60 days following the annual exercise
dates unless a named executive officer receives written consent
from the administrator, in which case such options may be
exercised through the end of the year in which they vest):
June 30
June 30
June 30
June 30
June 30
2010
2011
2012
2013
2014
50
%
50
%
50
%
20
%
20
%
10
%
20
%
20
%
30
%
30
%
June 30
June 30
June 30
June 30
June 30
2010
2011
2012
2013
2014
$
575,870.35
$
493,603.16
$
329,068.77
$
329,068.77
$
246,801.58
$
471,594.55
$
404,223.90
$
269,482.60
$
269,482.60
$
202,111.95
$
575,870.35
$
493,603.16
$
329,068.77
$
329,068.77
$
246,801.58
$
563,305.16
$
482,832.99
$
321,888.66
$
321,888.66
$
241,416.50
(5)
Our Class C restricted common stock vests in equal annual
installments on June 30, 2010 and 2011.
(6)
Market value has been determined based on the fair market value
of our stock on March 31, 2010 of $128.03.
123
(7)
The options vest and become exercisable, subject to the
continued employment of the named executive officer, ratably on
June 30, 2010, 2011 and 2012. All service-vesting options
fully vest and become exercisable immediately prior to the
effective date of certain change in control events.
(8)
The options vest and become exercisable, subject to the
continued employment of the named executive officer, ratably on
June 30, 2010, 2011 and 2012 based on achievement of
cumulative cash flow performance goals, with the ability to
catch up on missed goals if cumulative achievement
reaches the target cumulative levels during the three-year
vesting period. In addition, any unvested performance options at
the time of a change in control event vest immediately prior to
the effective date of event if Carlyle achieves a specified
internal rate of return as a result of the event or the
investment proceeds to Carlyle are at least a specified multiple
of its invested capital.
(9)
The options vest and become exercisable, subject to the
continued employment of the executive officer, ratably on
June 30, 2010, 2011 and 2012 based on achievement of EBITDA
performance goals, with the ability to catch up on
missed goals if (x) the missed performance goal was at
least 90% of target level and (y) cumulative EBITDA
performance reaches the target cumulative levels during the
three-year vesting period. In addition, any unvested performance
options at the time of a change in control event vest
immediately prior to the effective date of the event if Carlyle
achieves a specified internal rate of return as a result of the
event or the investment proceeds to Carlyle are at least a
specified multiple of its invested capital.
Option Awards
Stock Awards
Number of Shares
Value Realized on
Number of Shares
Value Realized on
Acquired on
Exercise
Acquired on
Vesting
Exercise(1)
($)(2)
Vesting(1)
($)(3)
11,910.1320
1,425,064
5,222.6667
650,953
9,925.1100
1,180,536
3,541.0000
441,350
11,910.1320
1,425,064
5,222.6667
650,953
11,681.0910
1,396,513
4,496.6667
560,465
(1)
Fractional shares are paid in cash.
(2)
Option Award ($) value realized is based on fair market value
less exercise cost at time of exercise.
(3)
Stock Award ($) value realized is based on fair market value on
June 30, 2009.
124
Present Value of
Payments
Number of
Accumulated
During Last
Years Credited
Benefits
Fiscal Year
Service (#)
($)(1)
($)
Officers Retirement Plan
31.5
315,000
Officers Retirement Plan
14.4
144,000
Officers Retirement Plan
28.0
280,000
Officers Retirement Plan
17.5
175,000
Officers Retirement Plan
12.1
121,000
(1)
The present value of accumulated benefits has been calculated in
a manner consistent with our reporting of the Retired
Officers Bonus Plan under Statement of Financial
Accounting Standards No. 87, using the Accumulated Benefit
Obligation with the exception of the retirement rate
assumptions. The amounts shown above reflect an assumption that
each participant collects his benefit at the earliest age at
which an unreduced benefit is available.
Executive
Registrant
Aggregate
Aggregate
Aggregate
Contributions
Contributions
Earnings in
Withdrawals/
Balance at
in Last FY
in Last FY(1)
Last FY
Distributions
Last FYE(2)
($)
($)
($)
($)
($)
Officers Rollover Stock Plan
329,345
276
329,069
Officers Rollover Stock Plan
269,621
138
269,483
Officers Rollover Stock Plan
329,345
276
329,069
Officers Rollover Stock Plan
322,027
138
321,889
Officers Rollover Stock Plan
(1)
Registrant contributions represent, for each vested stock option
issued under the Officers Rollover Stock Plan held by the
named executive officer on the record date with respect to each
dividend declared in fiscal 2010, the difference between the
value of the dividend paid and the amount by which the exercise
price of the stock option was reduced. Amounts in this column
are included in the All Other Compensation column of
the Summary Compensation Table.
(2)
None of the amounts in this column would have been reported in
our Summary Compensation Table in prior years.
125
126
Equity With
Death and
Continued
Accelerated
Retirement
Disability
Perquisites and
Severance Pay
Vesting
Plan Benefits:
Benefits
Benefits
Total
($)(1)
($)(2)
($)(7)
($)
($)
($)
8,394,179
2,096,875
(3)
10,491,054
79,587
(4)
296,198
(5)
375,785
1,162,500
296,198
(5)
1,458,698
315,000
338,348
(6)
653,348
9,349,848
296,198
(9)
9,646,046
6,758,979
2,068,750
(3)
8,827,729
106,438
(4)
494,673
(5)
601,111
825,000
494,673
(5)
1,319,673
144,000
543,393
(6)
687,393
8,021,801
494,673
(9)
8,516,474
8,394,179
2,087,500
(3)
10,481,679
84,803
(4)
389,278
(5)
474,081
1,050,000
389,278
(5)
1,439,278
280,000
434,809
(6)
714,809
9,349,848
389,278
(9)
9,739,126
8,067,459
2,087,500
(3)
10,154,959
85,064
(4)
424,849
(5)
509,913
1,050,000
424,849
(5)
1,474,849
175,000
471,467
(6)
646,467
9,023,129
424,849
(9)
9,447,978
2,087,500
(3)
2,087,500
70,736
(4)
275,004
(5)
345,740
1,050,000
275,004
(5)
1,325,004
120,900
315,995
(6)
436,895
1,849,650
275,004
(9)
2,124,654
127
(1)
Each named executive officer is eligible for transition pay
equal to one months base pay per year of service as an
officer up to a maximum of twelve months base pay. An
additional amount equal to a pro rata portion of the named
executive officers annual incentive compensation for the
year in which the termination occurs may be paid upon
termination at the discretion of the Board.
(2)
This column includes the value of the equity with accelerated
vesting calculated using $128.03, the fair market value of our
common stock on March 31, 2010, and the value of the
deferred cash payment due to the named executive officers as a
result of the special dividends paid on July 29, 2009 and
December 11, 2009, as described in footnote 4 to the
Outstanding Equity at Fiscal Year-End Table above.
(3)
Each named executive officer has a $2 million life
insurance policy. If the death was accidental, an additional
$1.5 million would be paid. Survivors also receive one
months base pay.
(4)
Includes present value of disability insurance payments that
cover up to 60% of base salary and bonus with a maximum benefit
of $25,000 per month ($300,000/year). The amounts in this column
were calculated by valuing the benefit as a standard annuity
benefit based on the incidence of disability, using assumptions
consistent with FAS 87/106 accounting for our other benefit
programs and, for the assumption of a rate of disability, the
1977 Social Security Disability Index table.
(5)
Amount includes actuarial present value of retiree medical
benefits. The present value of accumulated benefits has been
calculated in a manner consistent with our reporting of the
Retired Officers Welfare Plan under Statement of Financial
Accounting Standards No. 106, using the Accumulated
Postretirement Benefit Obligation with an adjustment made to
retirement age assumptions as required by SEC regulations.
(6)
Amount includes actuarial present value of up to $4,000 per year
for financial counseling assistance and retiree medical
benefits. The amounts in this column that represent the present
value of the financial counseling allowance were calculated with
the same assumptions we use to disclose our Retired
Officers Bonus Plan, consistent with FAS 87, with an
adjustment to the rate of retirement; the valuation is based on
the discounted value of the full $4,000. The amounts in the
column that represent the actuarial present value of retiree
medical benefits were calculated as described in
footnote 5 above.
(7)
Benefits under the Officers Retirement Plan. This amount
has been calculated using the methodology and assumptions
described in footnote 1 to the Pension Benefits Table
above.
(8)
Whether a termination of employment is deemed a company approved
departure is determined at the discretion of our Compensation
Committee.
(9)
Reflects the present value of the guaranteed benefits and cash
payment of the actuarial cost of the officers benefits
under the officers retiree medical plan, assuming that the
plan was terminated during the five years following a change in
control.
128
129
130
June 30,
June 30,
June 30,
June 30,
June 30,
June 30,
2009
2010
2011
2012
2013
2014
60
%
20
%
20
%
50
%
20
%
20
%
10
%
20
%
20
%
30
%
30
%
131
June 30,
June 30,
June 30,
June 30,
June 30,
2011
2012
2013
2014
2015
20
%
20
%
20
%
20
%
20
%
25
%
25
%
25
%
25
%
33
%
33
%
34
%
Cause or competitive activity:
If an
officers employment is terminated for cause or if the
officer engages in competitive activity (each as defined in the
Officers Rollover Stock Plan) during or following
termination of employment, then all unvested options will
immediately be forfeited and we will have the right to convert
vested but unexercised options into the right to receive upon
exercise a cash payment equal to the excess, if any, of:
in the case of options (other than the excess options),
(i) the lower of (a) fifty percent (50%) (or, in the
case of a termination after June 30, 2016, ninety percent
(90%)) of the fair market value of the shares subject thereto
and (b) the cost over (ii) the per share
exercise price, and
in the case of excess options, (i) the fair market value of
the shares subject thereto over (ii) the per share exercise
price.
Without cause, disability or company-approved
departure:
In the event that an executive
officers employment is terminated without cause or by
reason of disability or through a company-approved departure,
then unvested options will continue to vest as otherwise
provided and any not previously expired or exercised options
held by the officer can be exercised on the applicable exercise
date. However, we will have the right to convert any portion of
any unexercised options into the right to receive upon vesting
and exercise a cash payment equal to the excess, if any, of:
in the case of options (other than the excess options),
(i) in our discretion, (a) the fair market value of
the shares subject to the options as of the date of termination,
or (b) the cost, over (ii) the per share exercise
price for the shares, and
in the case of excess options, (i) the fair market value of
the shares subject thereto over (ii) the per share exercise
price.
Death:
In the event that an officers
employment is terminated by reason of death, any unvested
portion of any options held by the officer (or his or her
personal representative or person empowered under the deceased
officers will or the then applicable laws (eligible
representative)) and not previously expired or exercised,
will immediately vest in full and any vested options held by the
officer
132
(or his or her eligible representative) not previously expired
or exercised, will be exercisable by the eligible representative
during the calendar year following the year of the
officers death or, if earlier, at the time that the option
would have otherwise been required to be exercised. We will have
the right to convert all or any portion of any unexercised
options into the right to receive upon vesting and exercise a
cash payment equal to the excess, if any, of:
in the case of options (other than the excess options),
(i) in our discretion, (a) the fair market value of
the shares subject to the option as of the date of termination,
or (b) the cost, over (ii) the per share exercise
price for the shares, and
in the case of excess options, (i) the fair market value of
the shares subject thereto, over (ii) the per share
exercise price, which in each case, will be paid to the
officers eligible representative during the calendar year
following the year of the officers death or, if earlier,
at the time the new option would have otherwise been required to
be exercised.
Termination for any Other Reason:
In the event
an officers employment is terminated for any reason other
than those set forth above, any vested option not previously
exercised or expired will be exercisable on the applicable
exercise date. All unvested options will be immediately
forfeited and canceled effective as of the date of termination.
We will have the right to convert all or any portion of any
vested but unexercised options into the right to receive upon
exercise a cash payment equal to the excess, if any, of
in the case of options (other than the excess options),
(i) the lower of (a) the fair market value of the
shares subject thereto and (b) the cost, over (ii) the
per share exercise price, and
in the case of excess options, (i) the fair market value of
the shares subject thereto over (ii) the per share exercise
price.
Cause or Competitive Activity:
If an
officers employment is terminated for cause or if the
officer engages in competitive activity each as defined in the
Officers Rollover Stock Plan after such termination, then
Common Stock:
the purchase price for any
shares of common stock (other than shares acquired pursuant to
the Officers Rollover Stock Plan that are designated as
excess rollover shares pursuant to an exchange agreement entered
into between the shareholder and our company or are received on
the exercise of an excess option) will equal
until June 30, 2016, the lower of (x) fifty percent
(50%) of fair market value and (y) the cost and
after June 30, 2016, ninety percent (90%) of fair market
value.
Unvested Restricted Stock:
the purchase price
per share for any unvested restricted stock will equal the lower
of (i) the exercise price of the 2008 stock rights with
respect to which the restricted stock was granted plus any
withholding taxes paid by the officer relating to the surrender
of 2008 stock rights or the grant of the shares of restricted
stock and minus any dividends paid on the restricted stock or
(ii) fifty percent (50%) of the fair market value.
133
Without Cause, Disability, Death or Company Approved
Departure:
If an officers employment is
terminated without cause or by reason of the officers
death or disability or company approved departure, then, the
purchase price for any shares of common stock (other than excess
rollover shares) will equal, in the administrators
discretion, either (x) the fair market value of the shares
as of the repurchase date or (y) the cost.
Termination for any Other Reason:
If an
officer is terminated for any other reason than those described
above, then the purchase price for any shares of common stock
(other than excess rollover shares) will equal, in our
companys discretion, either (x) the fair market value
of the shares as of the date of the repurchase or (y) the
cost.
134
135
136
137
Number of
Securities to Be
Issued Upon
Number of Securities Remaining
Exercise of
Weighted-Average
Available for Future Issuance
Outstanding
Exercise Price of
Under Equity Compensation
Options, Warrants
Outstanding Options,
Plans (Excluding Securities
and Rights
Warrants and Rights
Reflected in Column (a))
(a)
(b)
(c)
2,641,080.7335
(1)
$
23.74
759,953
N/A
2,641,080.7335
(1)
$
23.74
759,953
(1)
Upon the exercise of all outstanding options, we will issue
2,640,821 shares of Class A common stock and will redeem
259.7335 fractional shares for cash.
138
139
140
141
Shares of
Partial
Class A
Repayment
Deferred
Gross Cash
Common
of Deferred
Payment
Received at
Stock
Payment
Escrow
Obligation
Closing
Received
Obligation
Percentage
Percentage
($)
(#)(1)
($)
(%)
(%)
$
30,963,618
180,178
$
3,049,845
3.02
%
3.04
%
$
6,867,181
$
698,923
0.69
%
0.70
%
$
22,117,104
106,885
$
2,178,461
2.16
%
2.17
%
$
11,058,800
18,705
$
1,089,230
1.08
%
1.08
%
$
3,487,591
$
344,923
0.34
%
0.34
%
$
2,411,507
2,290
$
299,538
0.30
%
0.30
%
$
2,757,101
$
317,692
0.31
%
0.32
%
$
1,412,668
$
181,538
0.18
%
0.18
%
$
3,668,814
$
363,077
0.36
%
0.36
%
$
1,796,103
$
226,923
0.22
%
0.23
%
$
4,515,771
954
$
444,769
0.44
%
0.44
%
$
16,835,098
$
1,270,769
1.26
%
1.27
%
(1)
Does not reflect -for-1 split of
our outstanding common stock to be effected prior to the
completion of this offering.
142
143
144
145
Consolidated
Total Leverage
Ratio
5.50:1.00
5.00:1.00
5.00:1.00
4.50:1.00
4.50:1.00
4.25:1.00
4.25:1.00
4.00:1.00
4.00:1.00
3.75:1.00
Consolidated
Net Interest
Coverage Ratio
1.80:1.00
1.90:1.00
1.90:1.00
2.00:1.00
2.00:1.00
2.10:1.00
2.10:1.00
2.20:1.00
2.20:1.00
2.30:1.00
146
147
Consolidated Total
Leverage Ratio
6.60:1.00
6.00:1.00
6.00:1.00
5.40:1.00
5.40:1.00
5.10:1.00
5.10:1.00
4.80:1.00
4.80:1.00
4.50:1.00
148
each person, or group of persons, who is known to beneficially
own more than 5% of any class of our common stock;
each of our directors;
each of the named executive officers; and
all of our directors and executive officers as a group.
149
Combined
Combined
Combined
Voting
Voting
Voting
Power
Power
Power
of Shares of
of Shares of
of Shares of
All Classes of
Shares Beneficially
All Classes of
Shares Beneficially
All Classes of
Common
Owned After the
Common
Owned After the
Common
Stock
Offering Assuming the
Stock
Offering Assuming the
Stock
Shares Beneficially
Beneficially
Underwriters Option is
Beneficially
Underwriters Option is
Beneficially
Owned Prior to Offering
Owned
Not Exercised
Owned
Exercised in Full
Owned
Class of
Number of
Percentage
Total
Number of
Percentage
Total
Number of
Percentage
Total
Stock
Shares
of Class
Percentage
Shares
of Class
Percentage
Shares
of Class
Percentage
Class A(2)
9,566,000
89.83
%
79.15
%
Proxy(3)
Class A
Class B
Class C
Class E
Total
Class A(4)(5)
141,288
1.33
%
Class B
Class C
15,668
7.72
%
Class E
104,039
8.42
%
Total
260,995
2.16
%
Class A(5)(6)
28,902
*
Class B
Class C
10,623
5.24
%
Class E
28,122
2.28
%
Total
67,647
**
Class A(5)(7)
138,288
1.30
%
Class B
Class C
15,668
7.72
%
Class E
33,746
2.73
%
Total
187,702
1.55
%
Class A(5)(8)
49,611
*
Class B
Class C
13,490
6.65
%
Class E
33,096
2.68
%
Total
96,197
**
Class A(5)(9)
9,166
*
Class B
Class C
Class E
Total
9,166
**
Class A
Class B
Class C
Class E
Total
Class A
Class B
Class C
Class E
Total
Class A
Class B
Class C
Class E
Total
150
Combined
Combined
Combined
Voting
Voting
Voting
Power
Power
Power
of Shares of
of Shares of
of Shares of
All Classes of
Shares Beneficially
All Classes of
Shares Beneficially
All Classes of
Common
Owned After the
Common
Owned After the
Common
Stock
Offering Assuming the
Stock
Offering Assuming the
Stock
Shares Beneficially
Beneficially
Underwriters Option is
Beneficially
Underwriters Option is
Beneficially
Owned Prior to Offering
Owned
Not Exercised
Owned
Exercised in Full
Owned
Class of
Number of
Percentage
Total
Number of
Percentage
Total
Number of
Percentage
Total
Stock
Shares
of Class
Percentage
Shares
of Class
Percentage
Shares
of Class
Percentage
Class A(11)
1,226
*
Class B
Class C
Class E
Total
1,226
**
Class A(12)
6,157
*
Class B
Class C
Class E
Total
6,157
**
Class A
467,982
4.36
%
Class B
Class C
82,958
40.90
%
Class E
336,150
27.22
%
Total
887,090
7.29
%
*
Represents beneficial ownership of less than 1%.
**
Represents voting power of less than 1%.
(1)
Carlyle Partners V US, L.P. is the managing member of Explorer
Coinvest LLC. TC Group V US, L.P. is the sole general partner of
Carlyle Partners V US, L.P. TC Group V US, L.L.C. is the sole
general partner of TC Group V US, L.P. TC Group Investment
Holdings, L.P. is the managing member of TC Group V US, L.L.C.
TCG Holdings II, L.P. is the sole general partner of TC Group
Investment Holdings, L.P. DBD Investors V, L.L.C. is the
sole general partner of TCG Holdings II, L.P. and, in such
capacity, exercises investment discretion and control of the
shares beneficially owned by Explorer Coinvest LLC. DBD
Investors V, L.L.C. is managed by a three-person managing
board, and all board action relating to the voting or
disposition of these shares requires approval of a majority of
the board. The members of the managing board are William E.
Conway, Jr., Daniel A. DAniello and David M. Rubenstein,
all of whom disclaim beneficial ownership of these shares.
(2)
Excludes shares of common stock owned by other parties to the
current stockholders agreement prior to the offering of which
Coinvest may be deemed to share beneficial ownership and
Coinvest disclaims beneficial ownership of such shares.
(3)
Reflects
shares of common stock over which Coinvest holds a voting proxy
with respect to certain matters pursuant to new irrevocable
proxy and tag-along agreements between Carlyle and a number of
other stockholders, including all of the executive officers. See
Certain Relationships and Related Party
Transactions Irrevocable Proxy and Tag-Along
Agreements.
(4)
Includes 5,598 shares that Dr. Shrader has the right
to acquire through the exercise of options. Dr. Shrader
shares investment power and voting power with his wife,
Mrs. Janice W. Shrader, for 135,690 shares in the
Ralph W. Shrader Revocable Trust.
(5)
Excludes shares of common stock owned by other parties to the
current stockholders agreement prior to the offering and the
amended and restated stockholders agreement after the offering
of which the executive officer may be deemed to share beneficial
ownership. The executive officer disclaims beneficial ownership
of such excluded shares. All shares owned by the executive
officer are subject to an irrevocable proxy and tag-along
agreement with Carlyle. See Certain Relationships and
Related Party Transactions Related Person
Transactions Irrevocable Proxy and Tag-Along
Agreements.
151
(6)
Includes 7,398 shares that Mr. Strickland has the
right to acquire through the exercise of options.
Mr. Strickland has sole investment power and voting power
for 21,504 shares in the Samuel Strickland Revocable Trust.
(7)
Includes 5,598 shares that Mr. Appleby has the right
to acquire through the exercise of options.
(8)
Includes 5,598 shares that Mr. Garner has the right to
acquire through the exercise of options.
(9)
Includes 9,166 shares that Mr. McConnell has the right
to acquire through the exercise of options.
(10)
Does not include shares of common stock held by Explorer
Coinvest LLC, an affiliate of Carlyle. Messrs Clare,
Fujiyama and Holt are directors of Booz Allen Holding and
Managing Directors of Carlyle. Such persons disclaim beneficial
ownership of the shares held by Explorer Coinvest LLC.
(11)
Includes 199 shares that Mr. Odeen has the right to
acquire through the exercise of options.
(12)
Includes 199 shares that Mr. Rossotti has the right to
acquire through the exercise of options.
(13)
Includes 83,544 shares that the directors and executive
officers, in aggregate, have the right to acquire through the
exercise of options.
152
shares
of Class A common stock, par value $0.01 per share;
shares
of Class B non-voting common stock, par value $0.01 per
share;
shares
of Class C restricted common stock, par value $0.01 per
share; and
shares
of Class E special voting common stock, par value $0.03 per
share.
As of June 30,
2010
10,266,161
305,313
202,827
1,404,881
12,179,182
153
enhance the likelihood of continuity and stability in the
composition of our Board;
discourage some types of transactions that may involve an actual
or threatened change in control of our company;
discourage certain tactics that may be used in proxy fights;
154
ensure that our Board will have sufficient time to act in what
our Board believes to be the best interests of us and our
stockholders; and
encourage persons seeking to acquire control of our company to
first consult with our Board to negotiate the terms of any
proposed business combination or offer.
before that time, the board of directors of the corporation
approved either the business combination or the transaction
which resulted in the stockholder becoming an interested
stockholder;
upon consummation of the transaction which resulted in the
stockholder becoming an interested stockholder, the interested
stockholder owned at least 85% of the voting stock of the
corporation outstanding at the time the transaction commenced,
excluding for purposes of determining the number of shares
outstanding those shares owned by persons who are directors and
also officers and by employee stock plans in which employee
participants do not have the right to determine confidentially
whether shares held subject to the plan will be tendered in a
tender or exchange offer; or
at or after that time, the business combination is approved by
the board of directors and authorized at an annual or special
meeting of stockholders, and not by written consent, by the vote
of at least
66
2
/
3
%
of the outstanding voting stock that is not owned by the
interested stockholder.
any merger or consolidation of the corporation with the
interested stockholder;
any sale, lease, exchange, mortgage, transfer, pledge or other
disposition of 10% or more of the assets of the corporation
involving the interested stockholder;
subject to specified exceptions, any transaction that results in
the issuance or transfer by the corporation of any stock of the
corporation to the interested stockholder;
any transaction involving the corporation that has the effect of
increasing the proportionate share of the stock of any class or
series of the corporation beneficially owned by the interested
stockholder; or
any receipt by the interested stockholder of the benefit of any
loans, advances, guarantees, pledges or other financial benefits
provided by or through the corporation.
any entity or person beneficially owning 15% or more of the
outstanding voting stock of the corporation; and
any entity or person affiliated with or controlling or
controlled by the entity or person.
155
156
any breach of the directors duty of loyalty;
acts or omissions not in good faith or which involve intentional
misconduct or a knowing violation of the law;
under Section 174 of the Delaware General Corporation Law
(unlawful dividends); or
any transaction from which the director derives an improper
personal benefit.
157
158
offer, pledge, sell, contract to sell, sell any option or
contract to purchase, purchase any option or contract to sell,
grant any option, right or warrant to purchase, lend, or
otherwise transfer or dispose of, directly or indirectly, any
shares of our common stock or any securities convertible into or
exercisable or exchangeable for our common stock;
enter into any swap or other arrangement that transfers to
another, in whole or in part, any of the economic consequences
of ownership of our common stock; or
make any demand for or exercise any right with respect to, the
registration of any shares of our common stock or any security
convertible into or exercisable or exchangeable for our common
stock;
during the last 17 days of the
180-day
restricted period we issue an earnings release, or material news
or a material event relating to us occurs; or
prior to the expiration of the
180-day
restricted period, we announce that we will release earnings
results during the
16-day
period beginning on the last day of the
180-day
restricted period,
159
during the last 17 days of the
180-day
restricted period we issue an earnings release, or material news
or a material event relating to us occurs; or
prior to the expiration of the
180-day
restricted period, we announce that we will release earnings
results during the
16-day
period beginning on the last day of the
180-day
restricted period, in which case these restrictions will
continue to apply until the expiration of the
180-day
period beginning on the issuance of the earnings release or the
occurrence of the material news or material event.
the person is not an affiliate of the company and has not been
an affiliate of the company at any time during the three months
preceding such a sale; and
the person has beneficially owned the shares proposed to be sold
for at least one year, including the holding period of any prior
owner other than an affiliate.
160
an individual who is neither a citizen nor a resident of the
United States;
a corporation that is not created or organized in or under the
laws of the United States, any state thereof, or the District of
Columbia;
an estate that is not subject to U.S. federal income tax on
income from
non-U.S. sources
which is not effectively connected with the conduct of a trade
or business within the United States; or
a trust unless (i) it is subject to the primary supervision
of a court within the United States and one or more United
States persons have the authority to control all of its
substantial decisions or (ii) it has in effect a valid
election under applicable U.S. Treasury regulations to be
treated as a United States person.
161
we are or have been a United States real property holding
corporation for U.S. federal income tax purposes at
any time during the shorter of (i) the five year period
ending on the date of such sale, exchange or disposition and
(ii) such
Non-U.S. Holders
holding period with respect to our common stock, and certain
other conditions are met;
such gain is effectively connected with the conduct of a trade
or business in the United States by such
Non-U.S. Holder,
in which event such
Non-U.S. Holder
generally will be subject to U.S. federal income tax on a
net income basis in substantially the same manner as a
U.S. holder (except as provided by an applicable tax
treaty) and, if it is a corporation, may also be subject to a
branch profits tax at the rate of 30% (or a lower rate if
provided by an applicable tax treaty); or
such
Non-U.S. Holder
is an individual who is present in the United States for
183 days or more in the taxable year of such sale, exchange
or disposition and certain other conditions are met.
162
163
Number of
Shares
Incorporated
164
Paid by Us
Total
No
Full
No
Full
Exercise
Exercise
Exercise
Exercise
$
$
$
$
$
$
$
$
offer, pledge, sell, contract to sell, sell any option or
contract to purchase, purchase any option or contract to sell,
grant any option, right or warrant to purchase, lend, or
otherwise transfer or dispose of, directly or indirectly, any
shares of our common stock or any securities convertible into or
exercisable or exchangeable for our common stock;
enter into any swap or other arrangement that transfers to
another, in whole or in part, any of the economic consequences
of ownership of our common stock; or
make any demand for or exercise any right with respect to, the
registration of any shares of our common stock or any security
convertible into or exercisable or exchangeable for our common
stock;
during the last 17 days of the
180-day
restricted period we issue an earnings release, or material news
or a material event relating to us occurs; or
prior to the expiration of the
180-day
restricted period, we announce that we will release earnings
results during the
16-day
period beginning on the last day of the
180-day
restricted period,
165
during the last 17 days of the
180-day
restricted period we issue an earnings release, or material news
or a material event relating to us occurs; or
prior to the expiration of the
180-day
restricted period, we announce that we will release earnings
results during the
16-day
period beginning on the last day of the
180-day
restricted period, in which case these restrictions will
continue to apply until the expiration of the
180-day
period beginning on the issuance of the earnings release or the
occurrence of the material news or material event.
the sale by us of shares to the underwriters in connection with
the offering;
transactions by any person other than us relating to shares of
Class A common stock or other securities convertible or
exchangeable into Class A common stock acquired in open
market transactions after the completion of the offering of the
shares, provided that no filing under Section 16(a) of the
Exchange Act, reporting a reduction in beneficial ownership of
shares of Class A common stock, shall be required or shall
be voluntarily made during the
180-day
restricted period; or
the transfer of shares of Class A common stock or any
security convertible or exchangeable into shares of Class A
common stock as a bona fide gift, as a distribution to general
or limited partners, stockholders or members of our
stockholders, or by will or intestate succession to a member of
the immediate family of our stockholders.
166
167
168
169
170
171
Page
F-2
F-3
F-4
F-5
F-6
F-8
F-1
Booz Allen Hamilton Holding Corporation
McLean, Virginia
June 18, 2010
F-2
F-3
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
(As adjusted)
(As adjusted)
(As adjusted)
(As adjusted)
(Unaudited)
(Unaudited)
(In thousands, except per share data)
$
3,625,055
$
1,409,943
$
2,941,275
$
5,122,633
$
1,229,459
$
1,341,929
2,028,848
722,986
1,566,763
2,654,143
638,690
677,095
935,459
401,387
756,933
1,361,229
329,681
356,286
474,188
726,929
505,226
811,944
184,734
200,419
33,079
11,930
79,665
95,763
24,003
19,384
3,471,574
1,863,232
2,908,587
4,923,079
1,177,108
1,253,184
153,481
(453,289
)
32,688
199,554
52,351
88,745
2,442
734
4,578
1,466
515
312
(2,319
)
(1,044
)
(98,068
)
(150,734
)
(36,371
)
(40,353
)
(1,931
)
(54
)
(128
)
(1,292
)
(523
)
(619
)
151,673
(453,653
)
(60,930
)
48,994
15,972
48,085
62,693
(56,109
)
(22,147
)
23,575
7,547
19,916
88,980
(397,544
)
(38,783
)
25,419
8,425
28,169
(71,106
)
(848,371
)
$
17,874
$
(1,245,915
)
$
(38,783
)
$
25,419
$
8,425
$
28,169
$
50.64
$
(181.28
)
$
(3.67
)
$
2.39
$
0.80
$
2.62
$
43.33
$
(181.28
)
$
(3.67
)
$
2.19
$
0.76
$
2.33
$
10.17
$
(568.13
)
$
(3.67
)
$
2.39
$
0.80
$
2.62
$
8.70
$
(568.13
)
$
(3.67
)
$
2.19
$
0.76
$
2.33
F-4
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
(As adjusted)
(Unaudited)
(Unaudited)
(As adjusted)
(As adjusted)
(As adjusted)
(In thousands)
$
17,874
$
(1,245,915
)
$
(38,783
)
$
25,419
$
8,425
$
28,169
71,106
848,371
33,079
11,930
79,665
95,763
24,003
19,384
3,106
5,700
1,219
1,913
1,480
2,505
575
744
(1,915
)
(552
)
35,013
511,653
62,059
71,897
24,812
15,660
166
(39,988
)
(54,236
)
(22,147
)
19,837
6,255
17,585
(181,365
)
(19,765
)
(33,675
)
(92,386
)
(69,174
)
23,385
(35,934
)
(70,781
)
21,303
(14,429
)
1,243
1,437
(6,236
)
(4,717
)
(26,030
)
150
(3,286
)
(7,008
)
(1,859
)
(327
)
(6,491
)
15,672
2,798
2,570
2,627
280
(3,742
)
(133
)
(3,003
)
(7,913
)
(44,050
)
99,094
33,760
(57,693
)
(88,764
)
72,654
57,054
7,186
110,265
(592
)
(12,534
)
10,604
(10,633
)
3,947
2,039
73,036
(7,220
)
1,177
2,483
(239
)
(22
)
2,716
(4,036
)
10,499
(8,190
)
(6,648
)
321
(4,630
)
21,793
1,849
6,139
1,015
1,418
13,611
(26,582
)
9,647
12,189
1,762
7,269
43,791
(26,548
)
180,709
270,484
(61,711
)
10,011
115,650
(160,368
)
159,441
(186,916
)
180,709
270,484
(61,711
)
10,011
(35,179
)
(9,314
)
(36,835
)
(49,271
)
(6,568
)
(16,213
)
(1,623,683
)
(3,348
)
(153,662
)
38,280
1,384
(38,527
)
(162,976
)
(1,660,518
)
(10,991
)
(6,568
)
(14,829
)
(68,516
)
58,323
(107,043
)
(104,653
)
(1,660,518
)
(10,991
)
(6,568
)
(14,829
)
18,891
956,500
1,002
(612,401
)
(15,543
)
(16,422
)
(4,761
)
(251,050
)
(16,100
)
(3,025
)
(5,463
)
227,534
1,240,300
346,500
(45,039
)
(15,808
)
(78,000
)
1,915
552
1,334
1,503
(1,413
)
211,112
1,900,711
(372,560
)
(3,025
)
(2,406
)
(5,908
)
128,712
(7,321
)
339,824
1,900,711
(372,560
)
(3,025
)
(2,406
)
3,851
21,588
420,902
(113,067
)
(71,304
)
(7,224
)
3,272
7,123
420,902
420,902
307,835
$
7,123
$
28,711
$
420,902
$
307,835
$
349,598
$
300,611
$
1,448
$
720
$
82,879
$
126,744
$
30,393
$
35,444
$
19,841
$
42,336
$
34
$
5,474
$
464
$
215
F-5
Predecessor
Retained
Accumulated
Stock
Additional
Earnings
Other
Total
Redeemable
Subscription
Paid-In
(Accumulated
Comprehensive
Stockholders
Common Stock
Receivable
Capital
Deficit)
Income (Loss)
Equity
(In thousands, except share data)
$
242,963
$
$
$
16,024
$
(15,800
)
$
243,187
28,881
28,881
242,963
44,905
(15,800
)
272,068
17,874
17,874
42,831
42,831
(217
)
(217
)
(15,543
)
(15,543
)
17,216
17,216
178
(178
)
(10,081
)
(10,081
)
15,800
15,800
(26,883
)
(26,883
)
287,645
62,384
(36,964
)
313,065
(1,245,915
)
(1,245,915
)
5,479
5,479
(52
)
(52
)
(16,422
)
(16,422
)
854,494
854,494
180,985
(180,985
)
(846
)
(846
)
(87,007
)
(87,007
)
(134,874
)
22,252
(112,622
)
$
1,312,181
$
(87,007
)
$
$
(1,499,442
)
$
(15,558
)
$
(289,826
)
F-6
The Company
Class B
Class C
Class E
(Accumulated
Accumulated
Class A
Non-Voting
Restricted
Special Voting
Additional
Deficit)
Other
Total
Common Stock
Common Stock
Common Stock
Common Stock
Paid-In
Retained
Comprehensive
Stockholders
Shares
Amount
Shares
Amount
Shares
Amount
Shares
Amount
Capital
Earnings
Income (Loss)
Equity
(In thousands, except share data)
$
$
$
$
$
$
$
$
564,187
6
235,020
2
202,827
2
1,480,288
45
79,814
79,869
9,567,500
95
956,405
956,500
(38,783
)
(38,783
)
698
698
(38,085
)
62,059
62,059
10,131,687
101
235,020
2
202,827
2
1,480,288
45
1,098,278
(38,783
)
698
1,060,343
1,907
158,696
2
(145,700
)
(5
)
1,337
1,334
(34,408
)
(34,408
)
25,419
25,419
(4,516
)
(4,516
)
20,903
71,897
71,897
(612,401
)
(612,401
)
1,915
1,915
10,292,290
$
103
235,020
$
2
202,827
$
2
1,334,588
$
40
$
526,618
$
(13,364
)
$
(3,818
)
$
509,583
8,983
70,293
2
1,000
1,002
35,181
1
1,502
1,503
552
552
(70,293
)
(1
)
70,293
1
(3,875
)
(3,875
)
28,169
28,169
82
82
28,251
15,660
15,660
10,266,161
$
103
305,313
$
3
202,827
$
2
1,404,881
$
42
$
541,457
$
14,805
$
(3,736
)
$
552,676
F-7
1.
OVERVIEW
F-8
2.
SUMMARY
OF SIGNIFICANT ACCOUNTING POLICIES
F-9
F-10
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
2008
2008
2009
2010
2009
$
842,593
$
876,280
$
883,311
$
980,095
$
952,244
55,175
41,253
42,614
38,216
42,855
$
897,768
$
917,533
$
925,925
$
1,018,311
$
995,099
$
187,096
$
244,024
$
234,412
$
344,678
$
231,609
9,443
8,813
9,419
9,419
11,632
$
196,539
$
252,837
$
243,831
$
354,097
$
243,241
$
3,625,951
$
1,423,865
$
2,912,610
$
5,121,895
$
1,225,612
(896
)
(13,922
)
28,665
738
3,847
$
3,625,055
$
1,409,943
$
2,941,275
$
5,122,633
$
1,229,459
$
90,175
$
(389,497
)
$
(55,770
)
$
24,681
$
6,791
(1,195
)
(8,047
)
16,987
738
1,634
$
88,980
$
(397,544
)
$
(38,783
)
$
25,419
$
8,425
$
19,069
$
(1,237,868
)
$
(55,770
)
$
24,681
$
6,791
(1,195
)
(8,047
)
16,987
738
1,634
$
17,874
$
(1,245,915
)
$
(38,783
)
$
25,419
$
8,425
$
51.32
$
(177.61
)
$
(5.28
)
$
2.32
$
0.64
$
43.92
$
(177.61
)
$
(5.28
)
$
2.12
$
0.61
$
(0.68
)
$
(3.67
)
$
1.61
$
0.07
$
0.16
$
(0.59
)
$
(3.67
)
$
1.61
$
0.07
$
0.15
$
50.64
$
(181.28
)
$
(3.67
)
$
2.39
$
0.80
$
43.33
$
(181.28
)
$
(3.67
)
$
2.19
$
0.76
$
10.85
$
(564.46
)
$
(5.28
)
$
2.32
$
0.64
$
9.29
$
(564.46
)
$
(5.28
)
$
2.12
$
0.61
$
(0.68
)
$
(3.67
)
$
1.61
$
0.07
$
0.16
$
(0.59
)
$
(3.67
)
$
1.61
$
0.07
$
0.15
$
10.17
$
(568.13
)
$
(3.67
)
$
2.39
$
0.80
$
8.70
$
(568.13
)
$
(3.67
)
$
2.19
$
0.76
F-11
F-12
F-13
F-14
F-15
3.
EARNINGS
PER SHARE
F-16
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
$
88,980
$
(397,544
)
$
(38,783
)
$
25,419
$
8,425
$
28,169
17,874
(1,245,915
)
(38,783
)
25,419
8,425
28,169
1,757,000
2,193,000
10,131,687
10,209,918
10,132,071
10,274,748
235,020
235,020
235,020
266,690
202,827
202,827
202,827
202,827
1,757,000
2,193,000
10,569,534
10,647,765
10,569,918
10,744,265
296,338
975,073
585,834
1,351,297
2,053,338
2,193,000
10,569,534
11,622,838
11,155,752
12,095,562
$
50.64
$
(181.28
)
$
(3.67
)
$
2.39
$
0.80
$
2.62
$
43.33
$
(181.28
)
$
(3.67
)
$
2.19
$
0.76
$
2.33
$
10.17
$
(568.13
)
$
(3.67
)
$
2.39
$
0.80
$
2.62
$
8.70
$
(568.13
)
$
(3.67
)
$
2.19
$
0.76
$
2.33
4.
BUSINESS
COMBINATION
F-17
$
1,009,589
141,219
40,289
(489,611
)
(245,000
)
(145,417
)
311,069
163,600
190,200
1,163,129
$
1,827,998
Fiscal Year Ended
March 31, 2009
$
4,351,218
(49,441
)
$
(4.68
)
$
(4.68
)
F-18
5.
GOODWILL
AND OTHER INTANGIBLE ASSETS
As of March 31, 2009
As of March 31, 2010
As of June 30, 2010
Gross
Net
Gross
Net
Gross
Net
Carrying
Accumulated
Carrying
Carrying
Accumulated
Carrying
Carrying
Accumulated
Carrying
Value
Amortization
Value
Value
Amortization
Value
Value
Amortization
Value
$
160,800
$
43,613
$
117,187
$
160,800
$
83,405
$
77,395
$
160,800
$
90,379
$
70,421
2,800
710
2,090
2,800
1,515
1,285
2,800
1,699
1,101
$
163,600
$
44,323
$
119,277
$
163,600
$
84,920
$
78,680
$
163,600
$
92,078
$
71,522
$
190,200
$
$
190,200
$
190,200
$
$
190,200
$
190,200
$
$
190,200
$
353,800
$
44,323
$
309,477
$
353,800
$
84,920
$
268,880
$
353,800
$
92,078
$
261,722
F-19
$
28,645
16,364
12,549
8,450
4,225
8,447
$
78,680
6.
ACCOUNTS
RECEIVABLE
March 31,
June 30,
2009
2010
2010
(Unaudited)
$
460,215
$
437,256
$
453,362
467,358
583,182
543,755
(1,648
)
(2,127
)
(2,191
)
925,925
1,018,311
994,926
13,051
17,072
17,446
$
938,976
$
1,035,383
$
1,012,372
F-20
7.
PROPERTY
AND EQUIPMENT
March 31,
2009
2010
$
66,748
$
82,759
34,077
43,824
10,164
20,693
66,883
79,501
177,872
226,777
(35,329
)
(90,129
)
$
142,543
$
136,648
8.
ACCOUNTS
PAYABLE AND OTHER ACCRUED EXPENSES
March 31,
June 30,
2009
2010
2010
(Unaudited)
$
184,394
$
257,418
$
235,084
56,774
93,317
102,242
2,663
3,362
5,382
$
243,831
$
354,097
$
342,708
9.
ACCRUED
COMPENSATION AND BENEFITS
March 31,
June 30,
2009
2010
2010
(Unaudited)
$
135,566
$
146,035
$
33,557
74,614
89,200
107,794
104,249
119,912
125,028
29,980
29,998
39,025
$
344,409
$
385,145
$
305,404
10.
DEFERRED
PAYMENT OBLIGATION
F-21
11.
DEBT
March 31,
June 30,
2009
2010
2010
(Unaudited)
$
119,708
$
110,829
$
107,830
571,260
566,811
565,709
345,790
345,054
690,968
1,023,430
1,018,593
544,759
545,202
545,320
1,235,727
1,568,632
1,563,913
(15,225
)
(21,850
)
(21,850
)
$
1,220,502
$
1,546,782
$
1,542,063
F-22
F-23
Payments Due By March 31,
Total
2011
2012
2013
2014
2015
Thereafter
112,500
$
12,500
$
15,625
$
21,875
$
62,500
$
$
576,225
5,850
5,850
5,850
5,850
5,850
546,975
349,125
3,500
3,500
3,500
3,500
3,500
331,625
550,000
550,000
$
1,587,850
$
21,850
$
24,975
$
31,225
$
71,850
$
9,350
$
1,428,600
12.
DEFERRED
FINANCING COSTS
F-24
13.
INCOME
TAXES
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
(Unaudited)
(Unaudited)
$
93,374
$
(1,414
)
$
$
2,664
$
676
$
1,851
9,307
(459
)
1,074
616
480
102,681
(1,873
)
3,738
1,292
2,331
(37,566
)
(44,996
)
(16,133
)
18,004
5,386
15,709
(2,422
)
(9,240
)
(6,014
)
1,833
869
1,876
(39,988
)
(54,236
)
(22,147
)
19,837
6,255
17,585
$
62,693
$
(56,109
)
$
(22,147
)
$
23,575
$
7,547
$
19,916
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
2008
2008
2009
2010
$
53,086
$
(158,779
)
$
(21,326
)
$
17,148
8,541
(6,889
)
(2,651
)
2,913
738
1,321
2,552
97,048
328
12,511
509
962
$
62,693
$
(56,109
)
$
(22,147
)
$
23,575
F-25
March 31,
2009
2010
$
21,677
$
36,655
26,148
47,461
15,503
844
11,087
28,728
243,430
141,472
10,056
42,379
3,091
640
8,960
328,541
309,590
(10,056
)
(42,379
)
318,485
267,211
116,687
122,733
122,845
106,106
1,509
241,041
228,839
$
77,444
$
38,372
F-26
March 31,
2009
2010
$
86,690
$
87,867
1,077
100
(1,885
)
$
87,867
$
85,982
14.
EMPLOYEE
BENEFIT PLANS
F-27
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
(Unaudited)
(Unaudited)
$
1,894
$
755
$
2,325
$
2,682
$
670
$
841
1,568
666
1,395
2,269
567
642
$
3,462
$
1,421
$
3,720
$
4,951
$
1,237
$
1,483
Predecessor
Officer Medical Plan
Retired Officers Bonus Plan
Fiscal Year
Four Months
Fiscal Year
Four Months
Ending
Ending
Ending
Ending
March 31,
July 31,
March 31,
July 31,
2008
2008
2008
2008
6.25
%
6.50
%
6.25
%
6.50
%
N/A
N/A
N/A
N/A
The Company
Officer Medical Plan
Retired Officers Bonus Plan
March 31,
March 31,
2009
2010
2009
2010
6.50
%
5.75
%
6.50
%
5.75
%
N/A
N/A
N/A
N/A
2008
2009
2010
11.0
%
7.5
%
8.0
%
5.0
%
5.0
%
5.0
%
2013
2015
2017
F-28
1% Increase
1% Decrease
$
828
$
(676
)
$
6,357
$
(5,271
)
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
2008
2008
2009
2010
$
26,624
$
32,605
$
32,157
$
35,577
1,894
755
2,325
2,682
1,569
666
1,395
2,270
3,609
(1,518
)
797
6,673
(1,091
)
(351
)
(1,097
)
(1,747
)
$
32,605
$
32,157
$
35,577
$
45,455
$
$
$
$
1,091
351
1,097
1,747
(1,091
)
(351
)
(1,097
)
(1,747
)
$
$
$
$
F-29
Officer
Medical Plan
Benefits
$
1,641
1,870
2,143
2,398
2,758
19,623
15.
OTHER
LONG-TERM LIABILITIES
March 31,
2009
2010
$
4,790
$
10,255
4,770
11,289
27,432
87
292
$
9,647
$
49,268
F-30
16.
STOCKHOLDERS
EQUITY
March 31,
June 30
2009
2010
2010
10,131,687
10,292,290
10,266,161
235,020
235,020
305,313
202,827
202,827
202,827
1,480,288
1,334,588
1,404,881
12,049,822
12,064,725
12,179,182
F-31
17.
STOCK-BASED
COMPENSATION
F-32
Percentage of New Options to be Exercised
As of June 30,
2009
2010
2011
2012
2013
2014
60
%
20
%
20
%
50
%
20
%
20
%
10
%
20
%
20
%
30
%
30
%
Percentage of New Options to be Exercised
As of June 30,
2011
2012
2013
2014
2015
20
%
20
%
20
%
20
%
20
%
25
%
25
%
25
%
25
%
33
%
33
%
34
%
F-33
F-34
The Company
Eight Months Ended March 31, 2009
Rollover Stock Plan
Rollover Stock Plan
New Options
New Options
Equity Incentive
(Retirement)
(Non-Retirement)
Plan
0.0
%
0.0
%
0.0
%
33.6
%
36.0
%
40.0
%
2.76
%
3.26
%
2.50
%
2.98
5.29
7.02
F-35
Fiscal Year Ended March 31, 2010
Rollover Stock Plan
Rollover Stock Plan
New Options
New Options
Equity Incentive
(Retirement)
(Non-Retirement)
Plan
0.0
%
0.0
%
0.0
%
33.6
%
36.0
%
40.0
%
2.76
%
3.26
%
2.56
%
2.98
5.29
7.03
Three Months Ended June 30, 2010
Rollover Stock Plan
Rollover Stock Plan
New Options
New Options
Equity Incentive
(Retirement)
(Non-Retirement)
Plan
0.0
%
0.0
%
0.0
%
33.6
%
36.0
%
40.1
%
2.76
%
3.26
%
2.61
%
2.98
5.29
7.02
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Three Months
Three Months
Ended
Ended
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
June 30,
June 30,
2008
2008
2009
2010
2009
2010
$
35,013
$
$
20,479
$
23,652
$
8,263
$
4,527
35,013
20,479
23,652
8,263
4,527
511,653
41,580
48,245
16,549
11,133
511,653
41,580
48,245
16,549
11,133
$
35,013
$
511,653
$
62,059
$
71,897
$
24,812
$
15,660
F-37
Weighted
Average
Number of
Exercise
Options
Price
728,542
$
16.23
728,542
$
0.01
*
145,708
0.01
*
582,834
0.01
*
582,834
751,750
$
16.79
751,750
0.01
*
751,750
751,750
F-38
Weighted
Average
Number of
Exercise
Options
Price
1,190,000
$
100.00
1,190,000
$
42.71
*
203,000
77.04
*
73,507
43.82
12,996
42.71
*
1,306,497
170,000
128.03
35,181
42.71
1,441,316
*
Reflects adjustment for $10.87 dividend issued July 27,
2009, and $46.42 dividend issued December 11, 2009.
Aggregate
Weighted
Intrinsic
Number of
Average
Value on
Options
Fair Value
Grant Date
(In thousands)
903
$
125.42
$
56,627
679
126.11
42,814
224
**
728,542
$
100.00
$
61,032
728,542
242,847
42.71
*
10,370
*
485,695
242,847
42.71
10,370
242,848
751,750
$
100.00
$
62,553
751,750
751,750
751,750
F-40
Aggregate
Weighted
Intrinsic
Number of
Average
Value on
Options
Fair Value
Grant Date
(In thousands)
1,190,000
$
100.00
$
1,190,000
203,000
$
77.04
*
$
236,889
42.71
*
73,507
43.82
1,082,604
170,000
$
128.03
$
264,217
45.35
988,387
*
Reflects adjustment for $10.87 dividend issued July 27,
2009, and $46.42 dividend issued December 11, 2009.
**
224 outstanding rights remaining as of July 31, 2008, were
exchanged as a part of the Merger Transaction.
Weighted
Weighted
Average
Number of
Average
Remaining
Options
Options
Exercise Price
Contractual Life
Exercisable
(In thousands)
(In years)
(In thousands)
1,335
$
0.01*
2.56
97
1,307
$
47.98*
8.72
134
*
Reflects adjustment for $10.87 dividend issued July 27,
2009, and $46.42 dividend issued December 11, 2009.
Weighted
Weighted
Average
Number of
Average
Remaining
Options
Options
Exercise Price
Contractual Life
Exercisable
(In thousands)
(In years)
(In thousands)
1,335
$
0.01
2.34
340
1,441
$
57.55
8.62
453
18.
FAIR
VALUE MEASUREMENTS
19.
RELATED-PARTY
TRANSACTIONS
F-42
Transition
Services
Collaboration
Agreement
Agreement
$
2,918
$
725
$
1,806
$
93
$
303
$
73
$
1,318
$
$
458
$
17
$
1,256
$
$
12,608
$
15,044
$
15,772
$
12,013
$
3,226
$
486
$
2,096
$
793
$
1,491
$
401
$
1,136
$
537
$
150
$
50
$
252
$
31
20.
COMMITMENTS
AND CONTINGENCIES
F-43
Operating
Operating
Lease
Sublease
Payments
Income
$
74,447
$
801
59,001
320
47,776
39,642
30,244
36,566
$
287,676
$
1,121
F-44
21.
BUSINESS
SEGMENT INFORMATION
F-45
22.
UNAUDITED
QUARTERLY FINANCIAL DATA
2009 Quarters
Predecessor
The Company
One Month
Two Months
Ended
Ended
July 31,
September 30,
First
2008
2008
Third
Fourth
(In thousands, except per share amounts)
$
1,072,986
$
336,957
$
693,425
$
1,091,557
$
1,156,293
(257,561
)
(195,728
)
15,744
17,576
(632
)
(257,562
)
(196,091
)
(7,167
)
(18,097
)
(35,666
)
(1,058,437
)
(187,478
)
(15,932
)
(11,492
)
(11,359
)
$
(594.96
)
$
(87.48
)
$
(1.54
)
$
(1.11
)
$
(1.10
)
$
(594.96
)
$
(87.48
)
$
(1.54
)
$
(1.11
)
$
(1.10
)
2010 Quarters
First
Second
Third
Fourth
(As adjusted, in thousands, except per share amounts)
$
1,229,459
$
1,279,257
$
1,261,353
$
1,352,564
52,351
57,938
40,712
48,553
15,972
21,262
2,696
9,064
8,425
10,810
1,294
4,890
$
0.80
$
1.02
$
0.12
$
0.46
$
0.76
$
0.95
$
0.11
$
0.41
(1)
Earnings per share are computed independently for each of the
quarters presented and therefore may not sum to the total for
the fiscal year.
(2)
Amounts are shown as adjusted for certain
adjustments to the allocation of the effective tax rate among
the quarters.
23.
SUPPLEMENTAL
FINANCIAL INFORMATION
Predecessor
The Company
Fiscal Year
Four Months
Eight Months
Fiscal Year
Ended
Ended
Ended
Ended
March 31,
July 31,
March 31,
March 31,
2008
2008
2009
2010
$
4,170
$
4,364
$
1,959
$
1,648
7,116
1,038
2,082
1,371
(6,922
)
(3,443
)
(2,393
)
(892
)
$
4,364
$
1,959
$
1,648
$
2,127
F-46
24.
DISCONTINUED
OPERATIONS
March 31,
July 31,
2008
2008
$
1,147,612
$
438,567
926,957
300,652
315,537
1,142,880
(94,882
)
(1,004,965
)
16,165
2,741
(1,894
)
(855
)
14,271
1,886
(80,611
)
(1,003,079
)
9,505
154,708
$
(71,106
)
$
(848,371
)
F-47
25.
SUBSEQUENT
EVENTS
F-48
Morgan
Stanley
Barclays Capital
BofA
Merrill Lynch
Credit Suisse
Item 13.
Other
Expenses of Issuance and Distribution.
$
21,390
$
30,500
$
250,000
$
600,000
$
4,200,000
$
1,200,000
$
25,000
$
5,000
$
50,000
$
6,381,890
Item 14.
Indemnification
of Directors and Officers.
II-1
II-2
Item 15.
Recent
Sales of Unregistered Securities.
II-3
Item 16.
Exhibits
and Financial Statement Schedules.
Exhibit
1
.1
Form of Underwriting Agreement
2
.1**
Agreement and Plan of Merger, dated as of May 15, 2008, by
and among Booz Allen Hamilton Inc., Booz Allen Hamilton Holding
Corporation (formerly known as Explorer Holding Corporation),
Booz Allen Hamilton Investor Corporation (formerly known as
Explorer Investor Corporation), Explorer Merger Sub Corporation
and Booz & Company Inc.
2
.2**
Spin Off Agreement, dated as of May 15, 2008, by and among
Booz Allen Hamilton Inc., Booz & Company Holdings,
LLC, Booz & Company Inc., Booz & Company
Intermediate I Inc. and Booz & Company
Intermediate II Inc.
2
.3**
Amendment to the Agreement and Plan of Merger and the Spin Off
Agreement, dated as of July 30, 2008, by and among Booz
Allen Hamilton Inc., Booz Allen Hamilton Investor Corporation
(formerly known as Explorer Investor Corporation), Explorer
Merger Sub Corporation, Booz & Company Holdings, LLC,
Booz & Company Inc., Booz & Company
Intermediate I Inc. and Booz & Company
Intermediate II Inc.
3
.1*
Form of Second Amended and Restated Certificate of Incorporation
of Booz Allen Hamilton Holding Corporation
3
.2
Form of Second Amended and Restated Bylaws of Booz Allen
Hamilton Holding Corporation
4
.1**
Guarantee and Collateral Agreement, among Booz Allen Hamilton
Investor Corporation (formerly known as Explorer Investor
Corporation), Explorer Merger Sub Corporation as the Initial
Borrower, Booz Allen Hamilton Inc., as the Surviving Borrower,
and the Subsidiary Guarantors party thereto, in favor of Credit
Suisse, as Collateral Agent, dated as of July 31, 2008
4
.2**
Guarantee Agreement, among Booz Allen Hamilton Investor
Corporation (formerly known as Explorer Investor Corporation),
Explorer Merger Sub Corporation as the Initial Borrower, Booz
Allen Hamilton Inc., as the Surviving Borrower, and the
Subsidiary Guarantors party thereto, and Credit Suisse, as
Administrative Agent, dated as of July 31, 2008
4
.3
Form of Amended and Restated Stockholders Agreement
4
.4
Form of Irrevocable Proxy and Tag-Along Agreement
4
.5
Form of Stock Certificate
5
.1*
Opinion of Debevoise & Plimpton LLP
10
.1**
Credit Agreement, among Booz Allen Hamilton Investor Corporation
(formerly known as Explorer Investor Corporation), Explorer
Merger Sub Corporation, as the Initial Borrower, Booz Allen
Hamilton Inc., as the Surviving Borrower, the several lenders
from time to time parties thereto, Credit Suisse AG, Cayman
Islands Branch (formerly known as Credit Suisse), as
Administrative Agent and Collateral Agent, Credit Suisse AG,
Cayman Islands Branch (formerly known as Credit Suisse), as
Issuing Lender, Banc of America Securities LLC and Credit Suisse
Securities (USA) LLC, as Joint Lead Arrangers, and Banc of
America Securities LLC, Credit Suisse Securities (USA) LLC,
Barclays Capital, Goldman Sachs Credit Partners L.P., and Morgan
Stanley Senior Funding, Inc., as Joint Bookrunners and Sumitomo
Mitsui Banking Corporation, as Co-Manager, dated as of
July 31, 2008
10
.2**
First Amendment to Credit Agreement, dated as of
December 8, 2009
10
.3**
Mezzanine Credit Agreement, among Booz Allen Hamilton Investor
Corporation (formerly known as Explorer Investor Corporation),
Explorer Merger Sub Corporation, as the Initial Borrower, Booz
Allen Hamilton Inc., as the Surviving Borrower, the several
lenders from time to time parties thereto, Credit Suisse, as
Administrative Agent, and Credit Suisse Securities (USA) LLC,
Banc of America Securities LLC and Lehman Brothers Inc., as
Joint Lead Arrangers and Joint Bookrunners, dated as of
July 31, 2008
10
.4**
First Amendment to Mezzanine Credit Agreement, dated as of
July 23, 2009
10
.5**
Second Amendment to Mezzanine Credit Agreement, dated as of
December 7, 2009
10
.6**
Management Agreement, among Booz Allen Hamilton Holding
Corporation (formerly known as Explorer Holding Corporation),
Booz Allen Hamilton Inc., and TC Group V US, LLC, dated as of
July 31, 2008.
10
.7
Amended and Restated Equity Incentive Plan of Booz Allen
Hamilton Holding Corporation
II-4
Exhibit
10
.8**
Booz Allen Hamilton Holding Corporation Officers Rollover
Stock Plan
10
.9**
Form of Booz Allen Hamilton Holding Corporation Rollover Stock
Option Agreement
10
.10**
Form of Stock Option Agreement under the Equity Incentive Plan
of Booz Allen Hamilton Holding Corporation
10
.11**
Form of Stock Option Agreement under the Equity Incentive Plan
of Booz Allen Hamilton Holding Corporation
10
.12**
Form of Subscription Agreement
10
.13**
Form of Restricted Stock Agreement for Directors under the
Equity Incentive Plan of Booz Allen Hamilton Holding
Corporation
10
.14
Form of Restricted Stock Agreement for Employees under the
Equity Incentive Plan of Booz Allen Hamilton Holding
Corporation
10
.15
Booz Allen Hamilton Holding Corporation Annual Incentive
Plan
10
.16*
Booz Allen Hamilton Holding Corporation Officers
Retirement Plan
10
.17
Officers Comprehensive Medical and Dental Plans
10
.18
Retired Officers Comprehensive Medical and Dental
Plans
10
.19
Excess ECAP Payment Program
10
.20
Group Variable Universal Life Insurance
10
.21**
Group Personal Excess Liability Insurance
10
.22
Annual Performance Program
10
.23
Form of Booz Allen Hamilton Holding Corporation Director and
Officer Indemnification Agreement
21
.1**
List of Subsidiaries
23
.1*
Consent of Debevoise & Plimpton LLP (included in
Exhibit 5.1)
23
.2
Consent of Ernst & Young LLP, Independent Auditors
24
.1**
Powers of Attorney
*
To be filed by amendment.
**
Previously filed.
Indicates management compensation plan.
Item 17.
Undertakings.
II-6
By:
President, Chief Executive Officer and Director (Principal
Executive Officer)
September 30, 2010
Executive Vice President, Chief Financial Officer, Chief
Administrative Officer and Director (Principal Financial and
Accounting Officer)
September 30, 2010
Director
September 30, 2010
Director
September 30, 2010
Director
Director
September 30, 2010
Director
September 30, 2010
CG Appleby
Attorney-in-Fact
II-7
Exhibit
1
.1
Form of Underwriting Agreement
2
.1**
Agreement and Plan of Merger, dated as of May 15, 2008, by
and among Booz Allen Hamilton Inc., Booz Allen Hamilton Holding
Corporation (formerly known as Explorer Holding Corporation),
Booz Allen Hamilton Investor Corporation (formerly known as
Explorer Investor Corporation), Explorer Merger Sub Corporation
and Booz & Company Inc.
2
.2**
Spin Off Agreement, dated as of May 15, 2008, by and among
Booz Allen Hamilton Inc., Booz & Company Holdings,
LLC, Booz & Company Inc., Booz & Company
Intermediate I Inc. and Booz & Company
Intermediate II Inc.
2
.3**
Amendment to the Agreement and Plan of Merger and the Spin Off
Agreement, dated as of July 30, 2008, by and among Booz
Allen Hamilton Inc., Booz Allen Hamilton Investor Corporation
(formerly known as Explorer Investor Corporation), Explorer
Merger Sub Corporation, Booz & Company Holdings, LLC,
Booz & Company Inc., Booz & Company
Intermediate I Inc. and Booz & Company
Intermediate II Inc.
3
.1*
Form of Second Amended and Restated Certificate of Incorporation
of Booz Allen Hamilton Holding Corporation
3
.2
Form of Second Amended and Restated Bylaws of Booz Allen
Hamilton Holding Corporation
4
.1**
Guarantee and Collateral Agreement, among Booz Allen Hamilton
Investor Corporation (formerly known as Explorer Investor
Corporation), Explorer Merger Sub Corporation as the Initial
Borrower, Booz Allen Hamilton Inc., as the Surviving Borrower,
and the Subsidiary Guarantors party thereto, in favor of Credit
Suisse, as Collateral Agent, dated as of July 31, 2008
4
.2**
Guarantee Agreement, among Booz Allen Hamilton Investor
Corporation (formerly known as Explorer Investor Corporation),
Explorer Merger Sub Corporation as the Initial Borrower, Booz
Allen Hamilton Inc., as the Surviving Borrower, and the
Subsidiary Guarantors party thereto, and Credit Suisse, as
Administrative Agent, dated as of July 31, 2008
4
.3
Form of Amended and Restated Stockholders Agreement
4
.4
Form of Irrevocable Proxy and Tag-Along Agreement
4
.5
Form of Stock Certificate
5
.1*
Opinion of Debevoise & Plimpton LLP
10
.1**
Credit Agreement, among Booz Allen Hamilton Investor Corporation
(formerly known as Explorer Investor Corporation), Explorer
Merger Sub Corporation, as the Initial Borrower, Booz Allen
Hamilton Inc., as the Surviving Borrower, the several lenders
from time to time parties thereto, Credit Suisse AG, Cayman
Islands Branch (formerly known as Credit Suisse), as
Administrative Agent and Collateral Agent, Credit Suisse AG,
Cayman Islands Branch (formerly known as Credit Suisse), as
Issuing Lender, Banc of America Securities LLC and Credit Suisse
Securities (USA) LLC, as Joint Lead Arrangers, and Banc of
America Securities LLC, Credit Suisse Securities (USA) LLC,
Barclays Capital, Goldman Sachs Credit Partners L.P., and Morgan
Stanley Senior Funding, Inc., as Joint Bookrunners and Sumitomo
Mitsui Banking Corporation, as Co-Manager, dated as of
July 31, 2008
10
.2**
First Amendment to Credit Agreement, dated as of
December 8, 2009
10
.3**
Mezzanine Credit Agreement, among Booz Allen Hamilton Investor
Corporation (formerly known as Explorer Investor Corporation),
Explorer Merger Sub Corporation, as the Initial Borrower, Booz
Allen Hamilton Inc., as the Surviving Borrower, the several
lenders from time to time parties thereto, Credit Suisse, as
Administrative Agent, and Credit Suisse Securities (USA) LLC,
Banc of America Securities LLC and Lehman Brothers Inc., as
Joint Lead Arrangers and Joint Bookrunners, dated as of
July 31, 2008
10
.4**
First Amendment to Mezzanine Credit Agreement, dated as of
July 23, 2009
10
.5**
Second Amendment to Mezzanine Credit Agreement, dated as of
December 7, 2009
10
.6**
Management Agreement, among Booz Allen Hamilton Holding
Corporation (formerly known as Explorer Holding Corporation),
Booz Allen Hamilton Inc., and TC Group V US, LLC, dated as of
July 31, 2008.
10
.7
Amended and Restated Equity Incentive Plan of Booz Allen
Hamilton Holding Corporation
Exhibit
10
.8**
Booz Allen Hamilton Holding Corporation Officers Rollover
Stock Plan
10
.9**
Form of Booz Allen Hamilton Holding Corporation Rollover Stock
Option Agreement
10
.10**
Form of Stock Option Agreement under the Equity Incentive Plan
of Booz Allen Hamilton Holding Corporation
10
.11**
Form of Stock Option Agreement under the Equity Incentive Plan
of Booz Allen Hamilton Holding Corporation
10
.12**
Form of Subscription Agreement
10
.13**
Form of Restricted Stock Agreement for Directors under the
Equity Incentive Plan of Booz Allen Hamilton Holding
Corporation
10
.14
Form of Restricted Stock Agreement for Employees under the
Equity Incentive Plan of Booz Allen Hamilton Holding
Corporation
10
.15
Booz Allen Hamilton Holding Corporation Annual Incentive
Plan
10
.16*
Booz Allen Hamilton Holding Corporation Officers
Retirement Plan
10
.17
Officers Comprehensive Medical and Dental Plans
10
.18
Retired Officers Comprehensive Medical and Dental
Plans
10
.19
Excess ECAP Payment Program
10
.20
Group Variable Universal Life Insurance
10
.21**
Group Personal Excess Liability Insurance
10
.22
Annual Performance Program
10
.23
Form of Booz Allen Hamilton Holding Corporation Director and
Officer Indemnification Agreement
21
.1**
List of Subsidiaries
23
.1*
Consent of Debevoise & Plimpton LLP (included in
Exhibit 5.1)
23
.2
Consent of Ernst & Young LLP, Independent Registered
Public Accounting Firm
24
.1**
Powers of Attorney
*
To be filed by amendment.
**
Previously filed.
Indicates management compensation plan.
|
c/o
|
Morgan Stanley & Co. Incorporated | |
|
|
1585 Broadway | |
|
|
New York, New York 10036 | |
|
|
||
|
c/o
|
Barclays Capital Inc. | |
|
|
745 Seventh Avenue | |
|
|
New York, New York 10019 |
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
|
Very truly yours,
Booz Allen Hamilton Holding Corporation |
||||
| By: | ______________________ | |||
| Name: | ||||
| Title: | ||||
31
|
|
||||||||
| By: | Morgan Stanley & Co. Incorporated | |||||||
|
|
||||||||
|
By:
|
||||||||
|
|
Name: | |||||||
|
|
Title: | |||||||
|
|
||||||||
| By: | Barclays Capital Inc. | |||||||
|
|
||||||||
|
By:
|
||||||||
|
|
Name: | |||||||
|
|
Title: | |||||||
32
| Number of Firm Shares | ||
| Underwriter | To Be Purchased | |
|
Morgan Stanley & Co. Incorporated
|
||
|
Barclays Capital Inc.
|
||
|
Merrill Lynch, Pierce, Fenner & Smith Incorporated
|
||
|
Credit Suisse Securities (USA) LLC
|
||
|
Stifel Nicolaus & Company, Incorporated
|
||
|
BB&T Capital Markets, a division of Scott & Stringfellow, LLC
|
||
|
Lazard Capital Markets LLC
|
||
|
Raymond James & Associates, Inc.
|
||
|
|
||
|
Total:
|
||
|
|
I-1
| 1. | Preliminary Prospectus issued [date] | |
| 2. | [Any free writing prospectuses filed by the Company under Rule 433(d) of the Securities Act to be identified] | |
| 3. | [Any free writing prospectus containing a description of terms that does not reflect final terms, if the Time of Sale Prospectus does not include a pricing sheet, to be indentified] | |
| 4. | [Any orally communicated pricing information to be included on Schedule II if a pricing term sheet is not used] |
II-1
III-1
|
c/o
|
Morgan Stanley & Co. Incorporated | |
|
|
1585 Broadway | |
|
|
New York, New York 10036 | |
|
|
||
|
c/o
|
Barclays Capital Inc. | |
|
|
745 Seventh Avenue | |
|
|
New York, New York 10019 |
A-1
A-2
| Very truly yours, | |||
|
(Name)
|
|||
|
|
|||
|
(Address)
|
|||
A-3
| By: | ||||
| Name: | Samuel R. Strickland | |||
| Title: |
Executive Vice President, Chief Financial Officer
and Chief Administrative Officer |
|||
B-1
| Page | ||||||
|
|
||||||
|
ARTICLE I
|
MEETINGS OF STOCKHOLDERS | 1 | ||||
|
|
||||||
|
Section 1.01
|
Annual Meetings | 1 | ||||
|
Section 1.02
|
Special Meetings | 1 | ||||
|
Section 1.03
|
Participation in Meetings by Remote Communication | 1 | ||||
|
Section 1.04
|
Notice of Meetings; Waiver of Notice | 1 | ||||
|
Section 1.05
|
Proxies | 2 | ||||
|
Section 1.06
|
Voting Lists | 3 | ||||
|
Section 1.07
|
Quorum | 3 | ||||
|
Section 1.08
|
Voting | 3 | ||||
|
Section 1.09
|
Adjournment | 3 | ||||
|
Section 1.10
|
Organization; Procedure; Inspection of Elections | 4 | ||||
|
Section 1.11
|
Stockholder Action by Written Consent | 5 | ||||
|
Section 1.12
|
Notice of Stockholder Proposals and Nominations | 5 | ||||
|
|
||||||
|
ARTICLE II
|
BOARD OF DIRECTORS | 10 | ||||
|
|
||||||
|
Section 2.01
|
General Powers | 10 | ||||
|
Section 2.02
|
Number and Term of Office | 10 | ||||
|
Section 2.03
|
Regular Meetings | 10 | ||||
|
Section 2.04
|
Special Meetings | 11 | ||||
|
Section 2.05
|
Notice of Meetings; Waiver of Notice | 11 | ||||
|
Section 2.06
|
Quorum; Voting | 11 | ||||
|
Section 2.07
|
Action by Telephonic Communications | 11 | ||||
|
Section 2.08
|
Adjournment | 11 | ||||
|
Section 2.09
|
Action Without a Meeting | 12 | ||||
|
Section 2.10
|
Regulations | 12 | ||||
|
Section 2.11
|
Resignations of Directors | 12 | ||||
|
Section 2.12
|
Removal of Directors | 12 | ||||
|
Section 2.13
|
Vacancies and Newly Created Directorships | 12 | ||||
|
Section 2.14
|
Director Fees and Expenses | 13 | ||||
|
Section 2.15
|
Reliance on Accounts and Reports, etc | 13 | ||||
|
|
||||||
|
ARTICLE III
|
COMMITTEES | 13 | ||||
|
|
||||||
|
Section 3.01
|
Designation of Committees | 13 | ||||
|
Section 3.02
|
Members and Alternate Members | 13 | ||||
|
Section 3.03
|
Committee Procedures | 14 | ||||
|
Section 3.04
|
Meetings and Actions of Committees | 14 | ||||
|
Section 3.05
|
Resignations and Removals | 14 | ||||
i
| Page | ||||||
|
|
||||||
|
Section 3.06
|
Vacancies | 15 | ||||
|
|
||||||
|
ARTICLE IV
|
OFFICERS | 15 | ||||
|
|
||||||
|
Section 4.01
|
Officers | 15 | ||||
|
Section 4.02
|
Election | 15 | ||||
|
Section 4.03
|
Compensation | 15 | ||||
|
Section 4.04
|
Removal and Resignation; Vacancies | 15 | ||||
|
Section 4.05
|
Authority and Duties of Officers | 16 | ||||
|
Section 4.06
|
President | 16 | ||||
|
Section 4.07
|
Vice Presidents | 16 | ||||
|
Section 4.08
|
Secretary | 16 | ||||
|
Section 4.09
|
Treasurer | 17 | ||||
|
Section 4.10
|
Security | 18 | ||||
|
|
||||||
|
ARTICLE V
|
CAPITAL STOCK | 18 | ||||
|
|
||||||
|
Section 5.01
|
Certificates of Stock | 18 | ||||
|
Section 5.02
|
Facsimile Signatures | 18 | ||||
|
Section 5.03
|
Lost, Stolen or Destroyed Certificates | 18 | ||||
|
Section 5.04
|
Transfer of Stock | 19 | ||||
|
Section 5.05
|
Registered Stockholders | 19 | ||||
|
Section 5.06
|
Transfer Agent and Registrar | 19 | ||||
|
|
||||||
|
ARTICLE VI
|
INDEMNIFICATION | 20 | ||||
|
|
||||||
|
Section 6.01
|
Indemnification | 20 | ||||
|
Section 6.02
|
Advance of Expenses | 20 | ||||
|
Section 6.03
|
Procedure for Indemnification | 21 | ||||
|
Section 6.04
|
Burden of Proof | 21 | ||||
|
Section 6.05
|
Contract Right; Non-Exclusivity; Survival | 21 | ||||
|
Section 6.06
|
Insurance | 22 | ||||
|
Section 6.07
|
Employees and Agents | 22 | ||||
|
Section 6.08
|
Interpretation; Severability | 22 | ||||
|
|
||||||
|
ARTICLE VII
|
OFFICES | 23 | ||||
|
|
||||||
|
Section 7.01
|
Registered Office | 23 | ||||
|
Section 7.02
|
Other Offices | 23 | ||||
|
|
||||||
|
ARTICLE VIII
|
GENERAL PROVISIONS | 23 | ||||
|
|
||||||
|
Section 8.01
|
Dividends | 23 | ||||
|
Section 8.02
|
Reserves | 23 | ||||
|
Section 8.03
|
Execution of Instruments | 23 | ||||
ii
| Page | ||||||
|
|
||||||
|
Section 8.04
|
Voting as Stockholder | 24 | ||||
|
Section 8.05
|
Fiscal Year | 24 | ||||
|
Section 8.06
|
Seal | 24 | ||||
|
Section 8.07
|
Books and Records; Inspection | 24 | ||||
|
Section 8.08
|
Electronic Transmission | 24 | ||||
|
|
||||||
|
ARTICLE IX
|
AMENDMENT OF BYLAWS | 24 | ||||
|
|
||||||
|
Section 9.01
|
Amendment | 24 | ||||
iii
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
| Section 1. | Board Representation . |
2
3
| Section 2. | Restrictions on Transfer . |
4
| Section 3. | Leadership Team . |
| Section 4. | Bring-Along Rights . |
5
6
7
| Section 5. | Permitted Transfers . |
| Section 6. | Registration Rights |
8
9
10
| Section 7. | Indemnification . |
11
12
| Section 8. | Rights to Repurchase Securities held by Management Stockholders . |
13
14
15
| Section 9. | Rights to Repurchase Securities held by Other Stockholders |
16
17
| Section 10. | [Reserved]. |
| Section 11. | Conversion of Company Non Voting Common Stock and Company Restricted Common Stock; Repurchase of Company Special Voting Stock. |
| Section 12. | Section 280G Payments |
18
| Section 13. | Termination . |
| Section 14. | Certain Definitions . |
19
20
21
22
23
24
| Defined Term | Location of Definition | |
|
Accountants
|
Section 12(a) | |
|
Agreement
|
Preamble | |
|
BAH
|
Recitals | |
|
Board
|
Section 1(a) | |
|
Bring-Along Notice
|
Section 4(b) | |
|
Bring-Along Right
|
Section 4(a) | |
|
Buyer
|
Recitals | |
|
Code
|
Section 12(a) | |
|
Company
|
Preamble | |
|
Demand Registration
|
Section 6(a) | |
|
Directors
|
Section 1(a) | |
|
Direct Competitive Activity
|
Section 9(a) | |
|
Disability Notice
|
Section 8(d) | |
|
Down-Round Preemptive Right
|
Section 10(a) | |
|
Equity Securities
|
Section 10(b) | |
|
Executive Directors
|
Section 1(a) | |
|
Executive Stockholder
|
Section 3(a) | |
|
Financing Agreements
|
Section 8(d) | |
|
Foreclosed Securities
|
Section 2 | |
|
Foreclosure Transferee
|
Section 2 | |
|
Initial Carlyle Stockholder
|
Preamble | |
|
IPO
|
Recitals | |
|
Lender
|
Section 2 | |
|
Management Securities Call Notice
|
Section 8(a) | |
|
Management Securities Call Right
|
Section 8(a) | |
|
Management Securities Purchase Price
|
Section 8(b) | |
|
Merger
|
Preamble | |
|
Merger Agreement
|
Preamble | |
|
Merger Sub
|
Recitals | |
|
Newco
|
Section 9(a) | |
|
Newco 2
|
Section 9(a) | |
|
Individual Stockholders
|
Preamble | |
|
Other Stockholder Securities Call Notice
|
Section 9(a) | |
|
Other Stockholder Securities Call Right
|
Section 9(a) | |
|
Other Stockholder Securities Purchase Price
|
Section 9(b) | |
|
Payments
|
Section 12(a) | |
|
Permitted Transfer
|
Section 5(a) | |
|
Permitted Transferee
|
Section 5(a) | |
|
Piggyback Registration
|
Section 6(b) | |
|
Registration Request
|
Section 6(a) |
25
| Defined Term | Location of Definition | |
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Repurchase Date
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Section 8(b) | |
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Repurchase Disability
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Section 8(d) | |
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Securities Act
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Section 2 | |
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Third Party Purchaser
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Section 4(a) | |
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Third Party Terms
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Section 4(b) | |
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Unaffiliated Directors
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Section 1(a) | |
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280G Regulations
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Section 12(b) |
| Section 15. | Effectiveness . |
| Section 16. | Miscellaneous . |
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| (i) | If to any Carlyle Stockholder, addressed to such Carlyle Stockholder, c/o The Carlyle Group, at: |
| (ii) | If to any Individual Stockholder, to the address set forth on such Stockholders signature page hereto. |
| (iii) | If to the Company: |
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BOOZ ALLEN HAMILTON HOLDING CORPORATION
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EXPLORER COINVEST LLC
By: Carlyle Partners V US, L.P., its managing member By: TC Group V US, L.P., its general partner By: TC Group V US, L.L.C., its general partner By: TC Group Investment Holdings, L.P., its managing member By: TCG Holdings II, L.P., its general partner |
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BOOZ ALLEN HAMILTON HOLDING CORPORATION
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| Title | ||||
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| 1 | Note : To the extent that any individuals execute this Agreement within New York State, this Agreement will need to be revised to conform with New Yorks power of attorney requirements. |
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| (i) | If to the Carlyle Stockholder, addressed to the Carlyle Stockholder, c/o The Carlyle Group, at: |
| (ii) | If to the Individual Stockholder, to the address set forth on the Individual Stockholders signature page hereto |
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EXPLORER COINVEST LLC
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| By: | Carlyle Partners V US, L.P., its managing member | |||
| By: | TC Group V US, L.P., its general partner | |||
| By: | TC Group V US, L.L.C., its general partner | |||
| By: | TC Group Investment Holdings, L.P., its managing member | |||
| By: | TCG Holdings II, L.P., its general partner | |||
| By: | ||||
| Name: | ||||
| Title: | ||||
| Date: | ||||
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Date:
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INDIVIDUAL STOCKHOLDER
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| Name: | ||||
| Address: | ||||
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If the Individual Stockholder is not a natural person:
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| By: | ||||
| Name: | ||||
| Title: | ||||
| CUSIP 099502 10 6 |
as tenants in common
as tenants by the entireties
as joint tenants with right
of survivorship and not as
tenants in common
Custodian
(Cust)
(Minor)
under Uniform Gifts to Minors
Act
(State)
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For value received,
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hereby sell, assign and transfer unto | |||
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PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE |
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Shares | |
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| of the common stock represented by the within Certificate, and do hereby irrevocably | ||
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constitute and appoint
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| Attorney to transfer the said stock on the books of the within-named Corporation with full power of substitution in the premises. | ||
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Dated,
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NOTICE:
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THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH
THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE, IN
EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT, OR
ANY CHANGE WHATEVER.
|
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| Section 14.1 Changes in Company Common Stock; Disposition of Assets and Corporate Events . |
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Name of Recipient:
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«Name» | |
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Total Number of Shares of Restricted Stock:
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«Shares» | |
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Grant Date:
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«Date» | |
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Vesting Schedule:
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Restricted Stock will vest and become exercisable in three equal installments on each of June 30, [ ], [ ] and [ ] (each, the Vesting Date ). |
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BOOZ ALLEN HAMILTON
HOLDING CORPORATION |
RECIPIENT | |||||||
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By
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Name: | |||||||
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Title: | |||||||
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| 1 | For employees employed in California, add the following: ; provided that, for purposes of this Agreement, clauses (a) and (b) of the definition of Competitive Activity shall be deleted. |
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BENEFIT PLAN
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What Your Plan
Covers and How Benefits are Paid |
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Prepared Exclusively for
Booz Allen Hamilton |
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Officers Comprehensive Medical and
Dental Choice Plans
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Preface
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1 | |||
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Coverage for You and Your Dependents
|
1 | |||
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Health Expense Coverage
|
1 | |||
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Treatment Outcomes of Covered Services
|
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When Your Coverage Begins
|
2 | |||
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Who Can Be Covered
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2 | |||
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Employees
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Eligible Classes
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Obtaining Coverage for Dependents
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How and When to Enroll
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3 | |||
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Initial Enrollment in the Plan
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How and When to Enroll
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3 | |||
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Initial Enrollment in the Plan
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Late Enrollment
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Special Enrollment Periods
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When Your Coverage Begins
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5 | |||
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Your Effective Date of Coverage
|
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Your Dependents Effective Date of Coverage
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How Your Medical Plan Works
|
7 | |||
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Common Terms
|
7 | |||
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About Your Comprehensive Medical Plan
|
7 | |||
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Using the Plan
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Cost Sharing
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Emergency and Urgent Care
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8 | |||
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In Case of a Medical Emergency
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Coverage for Emergency Medical Conditions
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In Case of an Urgent Condition
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Coverage for an Urgent Condition
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Follow-Up Care After Treatment of an
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Emergency or Urgent Medical Condition
|
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Requirements For Coverage
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10 | |||
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What The Plan Covers
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11 | |||
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Comprehensive Medical Plan
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11 | |||
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Wellness
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11 | |||
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Routine Physical Exams
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Preventative Health Care Services Expenses
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Routine Cancer Screenings
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Early Intervention Services
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||||
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Family Planning Services
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||||
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Bone Mineral Density Measurement or Test,
|
||||
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Drug and Devices
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Vision Care Services
|
||||
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Limitations
|
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Hearing Exam
|
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Physician Services
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15 | |||
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Physician Visits
|
||||
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Surgery
|
||||
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Anesthetics
|
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Hospital Expenses
|
15 | |||
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Room and Board
|
||||
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Other Hospital Services and Supplies
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Outpatient Hospital Expenses
|
||||
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Coverage for Emergency Medical Conditions
|
||||
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Coverage for Urgent Conditions
|
||||
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Alternatives to Hospital Stays
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17 | |||
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Outpatient Surgery and Physician Surgical
|
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Services
|
||||
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Birthing Center
|
||||
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Ambulatory Care
|
||||
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Home Health Care
|
||||
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Private Duty Nursing
|
||||
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Skilled Nursing Facility
|
||||
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Hospice Care
|
||||
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Other Covered Health Care Expenses
|
21 | |||
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Acupuncture
|
||||
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Ambulance Service
|
||||
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Diagnostic and Preoperative Testing
|
22 | |||
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Outpatient Diagnostic Lab Work and
|
||||
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Radiological Services
|
||||
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Outpatient Preoperative Testing
|
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Durable Medical and Surgical Equipment (DME)
|
23 | |||
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Experimental or Investigational Treatment
|
23 | |||
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Pregnancy Related Expenses
|
24 | |||
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Prescription Drugs
|
24 | |||
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Prosthetic Devices
|
25 | |||
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Hearing Aids
|
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Benefits After Termination of Coverage
|
||||
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Short-Term Rehabilitation Therapy Services
|
26 | |||
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Cardiac and Pulmonary Rehabilitation Benefits
|
||||
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Outpatient Cognitive Therapy, Physical Therapy,
|
||||
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Occupational Therapy and Speech Therapy
|
||||
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Rehabilitation Benefits
|
||||
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Reconstructive or Cosmetic Surgery and Supplies
|
27 | |||
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Reconstructive Breast Surgery
|
||||
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Specialized Care
|
29 | |||
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Chemotherapy
|
||||
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Radiation Therapy Benefits
|
||||
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Outpatient Infusion Therapy Benefits
|
||||
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Diabetic Equipment, Supplies and Education
|
30 | |||
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Treatment of Infertility
|
31 | |||
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Advanced Reproductive Technology (ART)
|
||||
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Benefits
|
||||
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Jaw Joint Disorder Treatment
|
33 | |||
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Enteral Formulas
|
34 | |||
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Treatment of Mental Disorders
|
||||
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Alcoholism and Substance Abuse
|
||||
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Oral and Maxillofacial Treatment (Mouth, Jaws and
Teeth)
|
35 | |||
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Medical Plan Exclusions
|
36 | |||
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Your Pharmacy Benefit
|
37 | |||
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How the Pharmacy Plan Works
|
37 | |||
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Getting Started: Common Terms
|
37 | |||
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Accessing Pharmacies and Benefits
|
38 | |||
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Accessing Network Pharmacies and Benefits
|
|
Emergency Prescriptions
|
||||
|
Availability of Providers
|
||||
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Cost Sharing for Network Benefits
|
||||
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When You Use an Out-of-Network Pharmacy
|
||||
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Cost Sharing for Out-of-Network Benefits
|
||||
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Pharmacy Benefit
|
39 | |||
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Retail Pharmacy Benefits
|
||||
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Mail Order Pharmacy Benefits
|
||||
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Self-Injectable Drugs Specialty Pharmacy
|
||||
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Network Benefits
|
||||
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Other Covered Expenses
|
||||
|
Pharmacy Benefit Limitations
|
||||
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Pharmacy Benefit Exclusions
|
||||
|
How Your Aetna Dental Plan Works
|
44 | |||
|
Understanding Your Aetna Dental Plan
|
44 | |||
|
Getting Started: Common Terms
|
44 | |||
|
About the comprehensive Dental Plan
|
44 | |||
|
Getting an Advance Claim Review
|
45 | |||
|
When to Get an Advance Claim Review
|
||||
|
What The Plan Covers
|
45 | |||
|
Comprehensive Dental Plan
|
||||
|
Schedule of Benefits for the Comprehensive
|
||||
|
Dental Plan
|
||||
|
Dental Care Schedule
|
||||
|
Comprehensive Dental Expense Coverage Plan
|
||||
|
Rules and Limits That Apply to the Dental Plan
|
48 | |||
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Replacement Rule
|
||||
|
Tooth Missing but Not Replaced Rule
|
||||
|
Alternate Treatment Rule
|
||||
|
Coverage for Dental Work Begun Before You
|
||||
|
Are Covered by the Plan
|
||||
|
Coverage for Dental Work Completed After
|
||||
|
Termination of Coverage
|
||||
|
Jaw Joint Disorder Treatment Rule
|
||||
|
What The Comprehensive Dental Plan Does Not
|
||||
|
Cover
|
49 | |||
|
When Coverage Ends
|
51 | |||
|
When Coverage Ends For Employees
|
||||
|
Your Proof of Prior Medical Coverage
|
||||
|
When Coverage Ends for Dependents
|
||||
|
Continuation of Coverage
|
52 | |||
|
Continuing Health Care Benefits
|
||||
|
Handicapped Dependent Children
|
||||
|
Extension of Benefits
|
53 | |||
|
Coverage for Health Benefits
|
||||
|
COBRA Continuation of Coverage
|
54 | |||
|
Continuing Coverage through COBRA
|
||||
|
Who Qualifies for COBRA
|
||||
|
Disability May Increase Maximum Continuation
to 29 Months
|
||||
|
Determining Your Premium Payments for
|
||||
|
Continuation Coverage
|
||||
|
When You Acquire a Dependent During a
|
||||
|
Continuation Period
|
||||
|
When Your COBRA Continuation Coverage
|
||||
|
Ends
|
||||
|
Conversion from a Group to an Individual Plan
|
||||
|
Converting to an Individual Medical Insurance
|
||||
|
Policy
|
56 | |||
|
Eligibility
|
||||
|
Features of the Conversion Policy
|
||||
|
Limitations
|
||||
|
Electing an Individual Conversion Policy
|
||||
|
Your Premiums and Payments
|
||||
|
When an Individual Policy Becomes Effective
|
||||
|
Coordination of Benefits What Happens When
There is More Than One Health Plan
|
59 | |||
|
When Coordination of Benefits Applies
|
59 | |||
|
Which Plan Pays First
|
59 | |||
|
How Coordination of Benefits Work
|
60 | |||
|
Right To Receive And Release Needed
|
||||
|
Information
|
||||
|
Facility of Payment
|
||||
|
Right of Recovery
|
||||
|
When You Have Medicare Coverage
|
61 | |||
|
Which Plan Pays First
|
61 | |||
|
How Coordination With Medicare Works
|
61 | |||
|
General Provisions
|
63 | |||
|
Type of Coverage
|
63 | |||
|
Physical Examinations
|
63 | |||
|
Legal Action
|
63 | |||
|
Confidentiality
|
63 | |||
|
Additional Provisions
|
63 | |||
|
Assignments
|
64 | |||
|
Misstatements
|
64 | |||
|
Incontestability
|
64 | |||
|
Recovery of Overpayments
|
64 | |||
|
Health Coverage
|
||||
|
Reporting of Claims
|
65 | |||
|
Payment of Benefits
|
65 | |||
|
Records of Expenses
|
65 | |||
|
Contacting Aetna
|
65 | |||
|
Reinstatement after Your Dental Coverage
|
||||
|
Terminates
|
66 | |||
|
Effect of Benefits Under Other Plans
|
66 | |||
|
Effect of An Health Maintenance Organization
|
||||
|
Plan (HMO Plan) On Coverage
|
||||
|
Effect of Prior Coverage Transferred Business
|
66 | |||
|
Glossary *
|
68 |
| * | Defines the Terms Shown in Bold Type in the Text of This Document. |
|
Group Policyholder:
|
Booz Allen Hamilton | |
|
Group Policy Number:
|
GP-800105 | |
|
Effective Date:
|
January 1, 2010 | |
|
Issue Date:
|
December 21, 2009 | |
|
Booklet-Certificate Number:
|
1 |
|
|
||
|
Ronald A. Williams
|
||
|
Chairman, Chief Executive Officer and President
|
||
|
|
||
|
Aetna Life Insurance Company
|
||
|
(A Stock Company)
|
1
|
When Your Coverage Begins
|
Who Can Be Covered | |
|
(GR-9N 29-005-01-NY)
|
||
|
|
How and When to Enroll | |
|
|
||
|
|
When Your Coverage Begins |
| | You will need to be in an eligible class, as defined below; and | |
| | You will need to meet the eligibility date criteria described below. |
| | You are a regular full-time employee, as defined by your employer. |
| | Your legal spouse; or | |
| | Your domestic partner who meets the rules set by your employer; and | |
| | Your dependent children. |
2
| | Unmarried; and | |
| | Under 23 years of age; not working full time, and who can qualify as dependents under the provision of the IRS. |
| | Your biological children; | |
| | Your stepchildren; | |
| | Your legally adopted children; | |
| | Your foster children, including any children placed with you for adoption; | |
| | Any children for whom you are responsible under court order; | |
| | Your grandchildren in your court-ordered custody; and | |
| | Any other child who lives with you in a parent-child relationship. |
| | Both an employee and a dependent; or | |
| | A dependent of more than one employee. |
3
| | You did not enroll yourself or your dependent when you first became eligible or during any subsequent annual enrollments because, at that time: |
| | You or your dependents were covered under other creditable coverage ; and | ||
| | You refused coverage and stated, in writing, at the time you refused coverage that the reason was that you or your dependents had other creditable coverage , but such written statement is required only if your employer requires the statement and gives you notice of the requirement, and the notice explains the consequence of failing to provide such statement; and |
| | You or your dependents are no longer eligible for other creditable coverage because of one of the following: |
| | The end of your employment; | ||
| | A reduction in your hours of employment (for example, moving from a full-time to part-time position); | ||
| | The ending of the other plans coverage; | ||
| | Death; | ||
| | Divorce or legal separation; | ||
| | Employer contributions toward that coverage have ended; | ||
| | COBRA coverage ends; | ||
| | the employers decision to stop offering the group health plan to the eligible class to which you belong; | ||
| | cessation of a dependents status as an eligible dependent as such is defined under this Plan; or | ||
| | you or your dependents have reached the lifetime maximum of another Plan for all benefits under that Plan. |
| | You will need to enroll yourself or a dependent for coverage within 31 days of when other creditable coverage ends. Evidence of termination of creditable coverage must be provided to Aetna . If you do not enroll during this time, you will need to wait until the next annual enrollment period. |
| | You did not enroll when you were first eligible for coverage; and | |
| | You later acquire a dependent, as defined under the plan, through marriage, birth, adoption, or placement for adoption; and | |
| | You elect coverage for yourself and your dependent within 31 days of acquiring the dependent. |
4
| | You did not enroll them when they were first eligible; and | |
| | You later elect coverage for them within 31 days of a court order requiring you to provide coverage. |
| | The child meets the plans definition of an eligible dependent on the date he or she is placed for adoption; and | |
| | You request coverage for the child in writing within 31 days of the placement. | |
| | Proof of placement will need to be presented to Aetna prior to the dependent enrollment. | |
| | Any coverage limitations for a pre-existing condition will not apply to a child placed with you for adoption provided that the placement occurs on or after the effective date of your coverage. |
| | The child meets the plans definition of an eligible dependent; and | |
| | You request coverage for the child in writing within 31 days of the court order. |
| | The date you are eligible for coverage; | |
| | If you are considered a late enrollee, on the first day of the first calendar month following the end of the late entrant enrollment period during which you elect coverage. |
5
6
|
How Your Medical Plan Works
(GR-9N 08-005 01 NY) |
Common Terms | |
|
|
||
|
|
Accessing Providers |
| | Definitions you need to know; | |
| | How to access care, including procedures you need to follow; | |
| | What expenses for services and supplies are covered and what limits may apply; | |
| | What expenses for services and supplies are not covered by the plan; | |
| | How you share the cost of your covered services and supplies; and | |
| | Other important information such as eligibility, complaints and appeals, termination, continuation of coverage, and general administration of the plan. |
| | Unless otherwise indicated, you refers to you and your covered dependents. | |
| | Your health plan pays benefits only for services and supplies described in this Booklet-Certificate as covered expenses that are medically necessary . | |
| | This Booklet-Certificate applies to coverage only and does not restrict your ability to receive health care services that are not or might not be covered benefits under this health plan. | |
| | Store this Booklet-Certificate in a safe place for future reference. |
| | When you need medical care, you can directly access physicians, hospitals and other health care providers of your choice for covered services and supplies under the plan. |
7
| | You will receive notification of what the plan has paid toward your covered expenses . It will indicate any amounts you owe towards your deductible, payment percentage or other non-covered expenses you have incurred. You may elect to receive this notification by e-mail, or through the mail. Call or e-mail Member Services if you have questions regarding your statement. |
| | You must satisfy any applicable deductibles before the plan begins to pay benefits. | |
| | After you satisfy any applicable deductible , you will be responsible for any applicable coinsurance for covered expenses that you incur. You will be responsible for your coinsurance up to the coinsurance limit applicable to your plan. | |
| | Your coinsurance will be based on the recognized charge . If the health care provider you select charges more than the recognized charge , you will be responsible for any expenses above the recognized charge . | |
| | Once you satisfy the coinsurance limit , the plan will pay 100% of the covered expenses that apply toward the limit for the rest of the Calendar Year. Certain designated out-of-pocket expenses may not apply to the coinsurance limit . Refer to your Schedule of Benefits section for information on what expenses do not apply to the limit and specific dollar limits that apply to your plan. | |
| | The plan will pay for covered expenses , up to the maximums shown in the What the Plan Covers or Schedule of Benefit sections. You are responsible for any expenses incurred over the maximum limits outlined in the What the Plan Covers or Schedule of Benefits sections. |
| | An emergency medical condition ; or | |
| | An urgent condition . |
| | Seek the nearest emergency room, or dial 911 or your local emergency response service for medical and ambulatory assistance. If possible, call your physician provided a delay would not be detrimental to your health. | |
| | After assessing and stabilizing your condition, the emergency room should contact your physician to obtain your medical history to assist the emergency physician in your treatment. | |
| | If you are admitted to an inpatient facility, notify your physician as soon as reasonably possible. | |
| | Please refer to the Schedule of Benefits for specific details about the plan. |
8
9
| 1. | The service or supply or prescription drug must be covered by the plan. For a service or supply or prescription drug to be covered, it must: |
| | Be included as a covered expense in this Booklet-Certificate; | ||
| | Not be an excluded expense under this Booklet-Certificate. Refer to the Exclusions sections of this Booklet-Certificate for a list of services and supplies that are excluded; | ||
| | Not exceed the maximums and limitations outlined in this Booklet-Certificate. Refer to the What the Plan Covers section and the Schedule of Benefits for information about certain expense limits; and | ||
| | Be obtained in accordance with all the terms, policies and procedures outlined in this Booklet-Certificate. |
| 2. | The service or supply or prescription drug must be provided while coverage is in effect. See the Who Can Be Covered, How and When to Enroll, When Your Coverage Begins, When Coverage Ends and Continuation of Coverage sections for details on when coverage begins and ends. |
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What The Plan Covers
(GR-9N 11-005 01 NY) |
Wellness | |
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Physician Services | |
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Hospital Expenses | |
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Other Medical Expenses |
| | Radiological services, X-rays, lab and other tests given in connection with the exam; and | |
| | Immunizations for infectious diseases and the materials for administration of immunizations as recommended by the Advisory Committee on Immunization Practices of the Department of Health and Human Services, Center for Disease Control; and | |
| | Testing for Tuberculosis. |
| | An initial hospital check up and well child visits in accordance with the prevailing clinical standards of the American Academy of Pediatric Physicians. |
| | Services which are covered to any extent under any other part of this plan; | |
| | Services which are for diagnosis or treatment of a suspected or identified illness or injury ; | |
| | Exams given during your stay for medical care; | |
| | Services not given by a physician or under his or her direction; | |
| | Psychiatric, psychological, personality or emotional testing or exams; |
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| | A medical history; | |
| | a complete physical examination; | |
| | developmental assessment; | |
| | anticipatory guidance; | |
| | appropriate immunizations; | |
| | laboratory tests. |
| | Services which are covered to any extent under any other part of the plan; | |
| | Services for diagnosis or treatment of a suspected or identified illness or disease; | |
| | Medicines or drugs; | |
| | Appliances, equipment or supplies; | |
| | Premarital exams; dental exams; hearing exams; or exams related in any way to employment. |
| | Upon recommendation of a physician , a mammogram at any age for females having a history of breast cancer or who have a first degree relative with a prior history of breast cancer; | |
| | A single baseline mammogram for covered females aged 35 through 39; and | |
| | An annual mammogram for covered females aged 40 or older. |
| | Standard diagnostic tests, including but not limited to a digital rectal exam and one prostate specific antigen (PSA) test per calendar year, at any age for males having a prior history of prostate cancer; and | |
| | An annual standard diagnostic examination, including but not limited to a digital rectal examination and a prostate specific antigen test for males age 50 or more who are asymptomatic and for males age 40 or more with a family history of prostate cancer or other prostate cancer risk factors. |
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| | Until September 1 of the calendar year in which the child attains the age of 3 years; if the child is born between January 1 and August 31 of that calendar year. | |
| | Until January 2 of the calendar year following the calendar year the child attains the age of 3 years; if the child is born between September 1 and December 31 of the preceding calendar year. |
| | Speech and language therapy given in connection with a speech impairment resulting from a congenital abnormality, disease or injury. | |
| | Occupational or physical therapy expected to result in significant improvement of a body function impaired by a congenital abnormality, disease or injury. | |
| | Clinical psychological tests or treatment. | |
| | Skilled nursing services, on a part-time or intermittent basis, given by an R.N. or by an L.P.N. |
| | Contraceptive drugs and contraceptive devices prescribed by a physician provided they have been approved by the Federal Drug Administration; | |
| | Related outpatient services such as: |
| | Consultations; | ||
| | Exams; | ||
| | Procedures; and | ||
| | Other medical services and supplies. |
| | Charges for services which are covered to any extent under any other part of the Plan or any other group plans sponsored by your employer; and | |
| | Charges incurred for contraceptive services while confined as an inpatient. |
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| | Voluntary sterilization. | |
| | Voluntary termination of pregnancy. |
| | Routine eye exam: The plan covers expenses for a complete routine eye exam that includes refraction and glaucoma testing. A routine eye exam does not include a contact lens exam. The plan covers charges for one routine eye exam in any Calendar Year. |
| | A physician certified as an otolaryngologist or otologist; or | |
| | An audiologist who: |
| | Is legally qualified in audiology; or | ||
| | Holds a certificate of Clinical Competence in Audiology from the American Speech and Hearing Association (in the absence of any applicable licensing requirements); and | ||
| | Performs the exam at the written direction of a legally qualified otolaryngologist or otologist. |
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| | Immunizations for infectious disease; | |
| | Allergy testing, treatment and injections; and | |
| | Charges made by a qualified physician for a second surgical opinion on the need for surgery; and a second medical opinion by an appropriate specialist (including, but not limited to a specialist affiliated with a specialty care center for the treatment of cancer) in the event of a positive or negative diagnosis of cancer; or a recurrence or cancer; or a recommendation of a course of treatment for cancer. The opinion may be rendered by either a network or a non-network specialist. |
| | Performing your surgical procedure; | |
| | Pre-operative and post-operative visits; and | |
| | Consultation with another physician to obtain a second opinion prior to the surgery. |
| | Services of the hospitals nursing staff; | |
| | Admission and other fees; | |
| | General and special diets; and | |
| | Sundries and supplies. |
| | Ambulance services. | |
| | Physicians and surgeons. | |
| | Operating, cytoscopic and recovery rooms. | |
| | Intensive or special care facilities and equipment. |
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| | Administration of blood and blood products, but not the cost of the blood or blood products. | |
| | Radiation therapy, chemotherapy. | |
| | Speech therapy, physical therapy and occupational therapy. | |
| | Oxygen and oxygen therapy. | |
| | Radiological services, electrocardiographs, electroencephalographs, laboratory testing and diagnostic services. | |
| | Medications, sera, biological and vaccines. | |
| | Intravenous (IV) preparations, visualizing dyes. | |
| | Discharge planning. | |
| | Dressings and casts. |
| | Covered services and supplies provided by the outpatient department of a hospital; | |
| | Hospital services rendered within 24 hours after an accidental injury; and | |
| | X-ray and lab test in the outpatient department of the hospital, to the extent such services would be provided if an inpatient. |
| | Use of emergency room facilities; | |
| | Emergency room physicians services; | |
| | Hospital nursing staff services; and | |
| | Radiologists and pathologists services. |
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| | Use of emergency room facilities; | |
| | Use of urgent care facilities; | |
| | Physicians services; | |
| | Nursing staff services; and | |
| | Radiologists and pathologists services. |
| | An office-based surgical facility of a physician or dentist ; | |
| | A surgery center ; or | |
| | The outpatient department of a hospital . |
| | The surgery can be performed adequately and safely only in a surgery center or hospital and | |
| | The surgery is not normally performed in a physician s or dentists office. |
| | Services and supplies provided by the hospital , surgery center on the day of the procedure; | |
| | The operating physicians services for performing the procedure, related pre- and post-operative care, and administration of anesthesia; and | |
| | Services of another physician for related post-operative care and administration of anesthesia. This does not include a local anesthetic. |
| | The services of a physician or other health care provider who renders technical assistance to the operating physician . | |
| | A stay in a hospital . | |
| | Facility charges for office based surgery. |
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| | Prenatal care; | |
| | Delivery; and | |
| | Postpartum care within 48 hours after a vaginal delivery and 96 hours after a Cesarean delivery. |
| | In connection with a pregnancy for which pregnancy related expenses are not included as a covered expense. |
| | Related to and necessary for treatment or diagnosis of your illness or injury ; | |
| | Ordered by a physician ; | |
| | In the case of physical therapy, furnished for the same illness or injury for which you were hospitalized or for surgery (care must start no later than 6 months after discharge from the hospital or surgery and is limited to 365 days following surgery or discharge from the hospital ). |
| | The charges are made by a home health care agency ; and | |
| | The care is given under a home health care plan ; and | |
| | The care is given to you in your home while you are homebound. |
| | Part-time or intermittent care by a R . N . or by a L . P . N . | |
| | Part-time intermittent home health aide services provided in conjunction with and in direct support of patient care. | |
| | Physical, occupational and speech therapy. | |
| | Medical supplies, prescription drugs and medications and lab services by or for a home health care agency to the extent they would have been covered under this plan if you been confined in a hospital or skilled nursing facilit y (as defined in Title XVIII of the Social Security Act). |
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| | Services or supplies that are not part of the Home Health Care Plan. |
| | Services of a person who usually lives with you, or who is a member of your or your spouses or your domestic partners family. |
| | Transportation. |
| | Services that are for custodial care . |
| | A change in your medication; |
| | Treatment of an urgent or emergency medical condition by a physician ; |
| | The onset of symptoms indicating a need for emergency treatment; |
| | Surgery; |
| | An inpatient stay . |
| | Nursing care that does not require the education, training and technical skills of a R.N. or L.P.N. |
| | Nursing care assistance for daily life activities, such as: |
| | Transportation; | ||
| | Meal preparation; | ||
| | Vital sign charting; | ||
| | Companionship activities; | ||
| | Bathing; | ||
| | Feeding; | ||
| | Personal grooming; | ||
| | Dressing; | ||
| | Toileting; and | ||
| | Getting in/out of bed or a chair. |
| | Nursing care provided for skilled observation. |
| | Nursing care provided while you are an inpatient in a hospital or health care facility, provided the care can adequately be provided by the facilitys general nursing staff, if it were fully staffed. |
| | A service provided solely to administer oral medicine, except where law requires a R.N. or L.P.N. to administer medicines. |
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| | Room and board , up to the semi-private room rate . The plan will cover up to the private room rate if it is needed due to an infectious illness or a weak or compromised immune system; | |
| | Use of special treatment rooms; | |
| | Radiological services and lab work; | |
| | Physical, occupational, or speech therapy; | |
| | Oxygen and other gas therapy; | |
| | Other medical services and general nursing services usually given by a skilled nursing facility (this does not include charges made for private or special nursing, or physicians services); and | |
| | Medical supplies. |
| | Charges made for the treatment of: |
| | Drug addiction; | ||
| | Alcoholism; | ||
| | Senility; | ||
| | Mental retardation; or | ||
| | Any other mental illness; and |
| | Daily room and board charges over the semi private rate . |
| | Room and Board and other services and supplies furnished during a stay for pain control and other acute and chronic symptom management; and | |
| | Services and supplies furnished to you on an outpatient basis. |
| | Part-time or intermittent nursing care by a R.N. or L.P.N. for up to eight hours a day; |
| | Part-time or intermittent home health aide services to care for you up to eight hours a day. |
| | Medical social services under the direction of a physician . These include but are not limited to: |
| | Assessment of your social, emotional and medical needs, and your home and family situation; | ||
| | Identification of available community resources; and | ||
| | Assistance provided to you to obtain resources to meet your assessed needs. |
| | Physical and occupational therapy; and |
| | Consultation or case management services by a physician ; |
| | Medical supplies. |
| | Prescription drugs; |
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| | Dietary counseling; and |
| | Psychological counseling. |
| | A physician for a consultation or case management; |
| | A physical or occupational therapist; |
| | A home health care agency for: |
| | Physical and occupational therapy; | ||
| | Part time or intermittent home health aide services for your care up to eight hours a day; | ||
| | Medical supplies; | ||
| | Prescription drugs ; | ||
| | Psychological counseling; and | ||
| | Dietary counseling. |
| | Daily room and board charges over the semi-private room rate . |
| | More than 5 visits for bereavement counseling. | |
| | Funeral arrangements. | |
| | Pastoral counseling. | |
| | Financial or legal counseling. This includes estate planning and the drafting of a will. | |
| | Homemaker or caretaker services. These are services which are not solely related to your care. These include, but are not limited to: sitter or companion services for either you or other family members; transportation; maintenance of the house. |
| | Respite care. This is care furnished during a period of time when your family or usual caretaker cannot attend to your needs. |
| | As a form of anesthesia in connection with a covered surgical procedure; and |
| | To treat an illness, injury or to alleviate chronic pain. |
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| | If an ambulance service is not required by your physical condition; or |
| | If the type of ambulance service provided is not required for your physical condition; or |
| | By any form of transportation other than a professional ambulance service. |
| | The test are related to your surgery, and the surgery takes place in a hospital or surgery center ; |
| | Reservations for a bed or for an operating room were made prior to the tests: |
| | The test are completed within 7 days before your surgery; | ||
| | The test are performed on an outpatient basis; | ||
| | The test would be covered if you were an inpatient in a hospital ; | ||
| | The test are not repeated in or by the hospital or surgery center where the surgery will be performed; | ||
| | Test results appear in your medical record kept by the hospital or surgery center where the surgery is performed. |
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| | If your tests indicate that surgery should not be performed because of your physical condition, the plan will pay for the test, however surgery will not be covered. |
| | Long term care is planned; and |
| | The equipment cannot be rented or is likely to cost less to purchase than to rent. |
| | The replacement is needed because of a change in your physical condition; and |
| | It is likely to cost less to replace the item than to repair the existing item or rent a similar item. |
| | Made to withstand prolonged use; |
| | Made for and mainly used in the treatment of an illness or injury ; |
| | Suited for use in the home; |
| | Not normally of use to people who do not have an illness or injury ; |
| | Not for use in altering air quality or temperature; and |
| | Not for exercise or training. |
| | You have been diagnosed with cancer or a condition likely to cause death within one year or less; |
| | Standard therapies have not been effective or are inappropriate; |
| | Aetna determines, based on at least two documents of medical and scientific evidence, that you would likely benefit from the treatment; |
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| | There is an ongoing clinical trial. You are enrolled in a clinical trial that meets these criteria: |
| | The drug, device, treatment or procedure to be investigated has been granted investigational new drug (IND) or Group c/treatment IND status; | ||
| | The clinical trial has passed independent scientific scrutiny and has been approved by an Institutional Review Board that will oversee the investigation; | ||
| | The clinical trial is sponsored by the National Cancer Institute (NCI) or similar national organization (such as the Food & Drug Administration or the Department of Defense) and conforms to the NCI standards; | ||
| | The clinical trial is not a single institution or investigator study unless the clinical trial is performed at an NCI-designated cancer center; and | ||
| | You are treated in accordance with protocol. |
| | 48 hours after a vaginal delivery; and | |
| | 96 hours after a cesarean section. | |
| | A shorter stay, if the attending physician , with the consent of the mother, discharges the mother or newborn earlier. |
| | any outpatient prescription drug covered or excluded from coverage under Aetnas prescription drug plan in accordance with the prescription drug coverage and exclusions sections of this Booklet-Certificate or any separately issued Booklet-Certificate. |
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| | Sildenafil Citrate, phentolamine, apomorphine and alprostadil in oral, and topical (which includes, but is not limited to gels, creams, ointments and patches) forms; or any other form, internally or externally, are covered; regardless of medical necessity . Coverage includes: any prescription drug in oral or topical form, that is in a similar or identical class; has a similar or identical mode of action; or exhibits similar, or identical outcomes. | |
| | Coverage is limited to 6 pills, or other form; determined cumulatively among all forms for unit amounts; determined by Aetna to be similar in cost to: oral forms, per 30 day supply. |
| | Internal body part or organ; or | |
| | External body part. |
| | The replacement is needed because of a change in your physical condition; or normal growth or wear and tear; or | |
| | It is likely to cost less to buy a new one than to repair the existing one; or | |
| | The existing one cannot be made serviceable. |
| | An artificial arm, leg, hip, knee or eye; | |
| | Eye lens; | |
| | An external breast prosthesis and the first bra made solely for use with it after a mastectomy; | |
| | A breast implant after a mastectomy; | |
| | Ostomy supplies, urinary catheters and external urinary collection devices; | |
| | Speech generating device; | |
| | A cardiac pacemaker and pacemaker defibrillators; and | |
| | A durable brace that is custom made and fitted for you. |
| | Orthopedic shoes, therapeutic shoes, foot orthotics, or other devices to support the feet, unless required for the treatment of or to prevent complications of diabetes; or if the orthopedic shoe is an integral part of a covered leg brace; or | |
| | Trusses, corsets, and other support. |
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| | The prescription for the hearing aid was written; and | |
| | The hearing aid was ordered. |
| | A licensed or certified physical, occupational or speech therapist; | |
| | A hospital , skilled nursing facility , or hospice facility ; | |
| | A home health care agency ; or | |
| | A physician . |
| | Cardiac rehabilitation benefits are available as part of an inpatient hospital stay . A limited course of outpatient cardiac rehabilitation is covered when following angioplasty, cardiovascular surgery, congestive heart failure or myocardial infarction. | |
| | Pulmonary rehabilitation benefits are available as part of an inpatient hospital stay . A limited course of outpatient pulmonary rehabilitation is covered for the treatment of reversible pulmonary disease states. |
| | Physical therapy is covered for non-chronic conditions and acute illnesses and injuries , provided the therapy expects to significantly improve, develop or restore physical functions lost or impaired as a result of an acute illness , injury or surgical procedure. Physical therapy does not include educational training or services designed to develop physical function. | |
| | Occupational therapy (except for vocational rehabilitation or employment counseling) is covered for non-chronic conditions and acute illnesses and injuries , provided the therapy expects to significantly improve, develop or restore physical functions lost or impaired as a result of an acute illness , injury or surgical procedure, or to relearn skills to significantly improve independence in the activities of daily living. Occupational therapy does not include educational training or services designed to develop physical function. |
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| | Speech therapy is covered for non-chronic conditions and acute illnesses and injuries and expected to restore the speech function or correct a speech impairment resulting from illness or injury ; or for delays in speech function development as a result of a gross anatomical defect present at birth. Speech function is the ability to express thoughts, speak words and form sentences. Speech impairment is difficulty with expressing ones thoughts with spoken words. | |
| | Cognitive therapy associated with physical rehabilitation is covered when the cognitive deficits have been acquired as a result of neurologic impairment due to trauma, stroke, or encephalopathy, and when the therapy is part of a treatment plan intended to restore previous cognitive function. |
| | Details the treatment, and specifies frequency and duration; and | |
| | Provides for ongoing reviews and is renewed only if continued therapy is appropriate. | |
| | Allows therapy services, provided in your home, if you are homebound . |
| | Therapies for the treatment of delays in development, unless resulting from acute illness or injury, or congenital defects amenable to surgical repair (such as cleft lip/ palate), are not covered. | |
| | Any services which are covered expenses in whole or in part under any other group plan sponsored by an employer; | |
| | Any services unless provided in accordance with a specific treatment plan; | |
| | Services for the treatment of delays in speech development, unless resulting from: illness; injury ; or congenital defect; | |
| | Services provided during a stay in a hospital , skilled nursing facility , or hospice facility except as stated above ; | |
| | Services not performed by a physician or under the direct supervision of a physician ; | |
| | Treatment covered as part of the Spinal Manipulation Treatment. This applies whether or not benefits have been paid under that section; | |
| | Services provided by a physician or physical, occupational or speech therapist who resides in your home; or who is a member of your family, or a member of your spouses family; or your domestic partner; | |
| | Special education to instruct a person whose speech has been lost or impaired, to function without that ability. This includes lessons in sign language. |
| | Surgery to correct the result of an accidental injury provided the surgery occurs no more than 24 months after the injury . For a covered child, surgery will be covered up to age 18 or up to 24 months after the injury , whichever period is longer. Injuries that occur during surgical procedures or medical treatments are not considered accidental injuries, even if unplanned or unexpected. | |
| | Surgical implantation or attachment of covered prosthetic devices. | |
| | Surgery to correct a gross anatomical defect present at birth. The surgery will be covered if the defect results in severe facial disfigurement or significant functional impairment of a body part; and the purpose of the surgery is to improve function. |
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| | You or your dependent is at least 18 years old; and | ||
| | You or your dependent have met criteria for the diagnosis of true transsexualism including: |
| | A life-long sense of belonging to the opposite sex and of having been born into the wrong sex, often since childhood; | ||
| | A sense of estrangement from ones own body; so that any evidence of ones own biological sex is regarded as repugnant; | ||
| | A desire to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; | ||
| | A stable transsexual orientation evidenced by a desire to be rid of ones genitals; and to live in society as a member of the other sex for at least 2 years; (i.e. not limited to periods of stress); | ||
| | There is no sexual arousal from cross-dressing; | ||
| | There is an absence of physical inter-sex of genetic abnormality; and | ||
| | This is not due to another biological, chromosomal or associated psychiatric disorder; such as schizophrenia. |
| | You or your dependent must have completed a recognized program of transgender identity treatment; as evidenced by all of the following: |
| | Has successfully lived and worked within the desired gender role full-time for at least 12 months (so-called real-life experience); without periods of returning to the original gender; | ||
| | Unless medically contraindicated, has received at least 12 months of continuous hormonal sex change therapy recommended by a behavioral health provider ; and carried out by an endocrinologist (which can be simultaneous with the real-life experience); | ||
| | A behavioral health provider who has been acquainted with you or your dependent for at least 18 months recommends sex change surgery documented in the form of a written comprehensive evaluation; | ||
| | A second concurring recommendation by another qualified behavioral health provider must be documented in the form of a written expert opinion; as long as one of the two behavioral health provider s possess a doctoral degree (e.g., Ph.D., Ed.D., D.Sc., D.S.W., Psy.D., or M.D.); | ||
| | Psychotherapy is not an absolute requirement for surgery unless the behavioral health provider s initial assessment leads to a recommendation for psychotherapy that specifies the goals of treatment, estimates its frequency and duration throughout the real life experience (usually a minimum of 3 months); | ||
| | For genital surgical sex change; you or your dependent has undergone a urological examination for the purpose of identifying and perhaps treating abnormalities of the genitourinary tract; since genital surgical sex change includes the invasion of, and the alteration of; the genitourinary tract (urological examination is not required for persons not undergoing genital change); and |
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| | You or your dependent have demonstrated an understanding of the proposed male-to-female or female-to-male sex change surgery with its attendant costs, required lengths of hospitalization, likely complications, and post surgical rehabilitation requirements of the planned surgery. |
| | The covered person has obtained precertification from Aetna . |
| | Charges made by a physician for: |
| | Performing the surgical procedure; and | ||
| | Pre-operative and post-operative hospital , office and home visits. |
| | Charges made by a hospital for inpatient and outpatient services (including outpatient surgery). Room and board charges in excess of the hospital s semi-private rate will not be covered; unless a private room is ordered by your physician and precertification has been obtained. | |
| | Charges made by a Skilled Nursing Facility for inpatient services and supplies. Room and board charges in excess of the hospital s semi-private rate will not be covered. | |
| | Charges made for the administration of anesthetics. | |
| | Charges for outpatient diagnostic laboratory and x-rays. | |
| | Charges for blood transfusion and the cost of unreplaced blood and blood products. Also included are the charges for collecting, processing and storage of self-donated blood after the surgery has been scheduled. |
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| | A free-standing facility; | |
| | The outpatient department of a hospital ; or | |
| | A physician in his/her office or in your home. |
| | The pharmaceutical when administered in connection with infusion therapy and any medical supplies, equipment and nursing services required to support the infusion therapy; | |
| | Professional services; | |
| | Total parenteral nutrition (TPN); | |
| | Chemotherapy; | |
| | Drug therapy (includes antibiotic and antivirals); | |
| | Pain management (narcotics); and | |
| | Hydration therapy (includes fluids, electrolytes and other additives). |
| | Enteral nutrition; | |
| | Blood transfusions |
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| | Insulin; | |
| | Insulin pumps and accessories; | |
| | Syringes; | |
| | Injections aids for the visually impaired; | |
| | Test strips for glucose monitoring and visual reading and urine testing strips | |
| | Blood glucose monitors, including those for the visually impaired | |
| | Lancets; | |
| | Insulin infusion devices; | |
| | Oral agents for controlling blood sugar; | |
| | Cartridges for the visually impaired; | |
| | Prescribed oral medications whose primary purpose is to influence blood sugar; | |
| | Alcohol swabs; | |
| | Injectable glucagons; | |
| | Glucagon emergency kits; | |
| | Self-management training provided by a licensed health care provider certified in diabetes self-management training; and | |
| | Foot care to minimize the risk of infection. | |
| | Any additional equipment and related supplies as may be medically necessary for the treatment of diabetes. |
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| | Ovulation induction; | |
| | Artificial insemination; | |
| | Ultrasound; | |
| | Post-coital test; | |
| | Hysterosalpinogram; | |
| | Laparoscopy; | |
| | Sono-hysterogram; | |
| | Blood tests; | |
| | Endometrial biopsy; | |
| | Hysteroscopy; | |
| | Semen analysis; | |
| | Testis biopsy; and | |
| | Prescription drugs. |
| | Purchases of donor sperm and any charges for the storage of any sperm; | |
| | The purchase of donor eggs and any charges associated with care of the donor required for donor egg retrieval, transfers or gestational carriers; | |
| | Charges associated with cryopreservation, or storage of cryopreserved embryos, including but not limited to office visits, hospital charges, ultrasounds and lab tests; | |
| | Reversal of elective sterilization; | |
| | Sex change procedures; | |
| | Cloning; | |
| | Gestational carrier programs (surrogate parenting) for you or the gestational carrier; | |
| | Prescription drugs used for the treatment of an excluded treatment or procedure, including injectable medications; | |
| | Home ovulation prediction kits; | |
| | In-vitro fertilization; gamete intrafallopian tube transfers; zygote intrafallopian tube transfers; and intracytoplasmic sperm injection; | |
| | Frozen embryo transfers; including thawing; | |
| | Procedures deemed experimental in accordance with the standards of the American Society for Reproductive Medicine; | |
| | Services and supplies obtained without precertification . |
| | A condition that is a demonstrated cause of infertility has been recognized by a gynecologist or infertility specialist. | |
| | The procedures are not performed during an inpatient stay in a hospital , or any other facility. | |
| | FSH levels are less than, or equal to, 19miU on day 3 of the menstrual cycle. |
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| | The infertility is not caused by voluntary sterilization of either one of the partners (with or without surgical reversal), or a hysterectomy. | |
| | A successful pregnancy cannot be attained through less costly treatment for which coverage is available under this Plan. |
| | In-vitro fertilization (IVF); | |
| | Zygote intra-fallopian transfer (ZIFT); | |
| | Gamete intra-fallopian transfer (GIFT); | |
| | Cryopreserved embryo transfers; | |
| | Intracytoplasmic sperm injection (ICSI); or ovum microsurgery; | |
| | Care associated with a donor IVF program. This includes fertilization and culture; | |
| | Charges for obtaining the sperm of a covered partner are covered if both the man and the woman are covered by the plan. |
| | Precertified by Aetnas Infertility Care Management Unit. |
| | purchases of donor sperm and any charges for storage of any sperm; | |
| | the purchase of donor eggs and any charges associated with the care of the donor required for donor egg retrievals, transfers or gestational carriers; | |
| | charges associated with cryopreservation, or storage of cryopreserved embryos, including but not limited to, office visits, hospital charges, ultrasounds and lab tests; | |
| | Reversal of elective sterilization; | |
| | Charges for or related to artificial insemination; | |
| | Gestational carrier programs (surrogate parenting) for you or the gestational carrier; | |
| | Prescription drugs, including injectable infertility medications; | |
| | Home ovulation prediction kits; | |
| | Frozen embryo transfers, including thawing; | |
| | Services and supplies obtained without the necessary referrals, or claims authorizations from the Infertility Unit or the Patient Management Unit. |
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| | Of the jaw joint itself, such as temporomandibular joint dysfunction (TMJ) syndrome; or | |
| | Involving the relationship between the jaw joint and related muscles and nerves such as myofacial pain dysfunction (MPD). |
| | inherited diseases of amino acid or organic acid metabolism; | |
| | Crohns disease; | |
| | gastroesophageal reflux with failure to thrive; | |
| | disorders of gastrointestinal motility; | |
| | multiple, severe food allergies. |
| | There is a written treatment plan prescribed and supervised by a behavioral health provider ; | |
| | The plan includes follow-up treatment; and | |
| | The plan is for a condition that can favorably be changed. |
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| | Non-surgical treatment of infections or diseases of the mouth, jaw joints or supporting tissues. |
| | Treat a fracture, dislocation, or wound. | |
| | Cut out cysts, tumors, or other diseased tissues. | |
| | Cut into gums and tissues of the mouth. This is only covered when not done in connection with the removal, replacement or repair of teeth. | |
| | Alter the jaw, jaw joints, or bite relationships by a cutting procedure when appliance therapy alone cannot result in functional improvement. |
| (a) | Natural teeth damaged, lost, or removed; or | |
| (b) | Other body tissues of the mouth fractured or cut |
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| | The first denture or fixed bridgework to replace lost teeth; | |
| | The first crown needed to repair each damaged tooth; and | |
| | An in-mouth appliance used in the first course of orthodontic treatment after the injury . |
| | Cosmetic services and plastic surgery: any treatment, surgery (cosmetic or plastic), service or supply to alter, the shape or appearance of the body whether or not for psychological or emotional reasons, unless medically necessary . But this exclusion will not apply to (i) R econstructive Services and Specialized Care Services under What the Plan Covers section; (ii) removal of bony impacted teeth, bone fractures, removal of tumors and orthodontogentic cysts; or covered dental services or supplies to treat congenital defects or anomalies (including cleft lip or cleft palate) of covered dependent children. |
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| | Definitions you need to know; | |
| | How to access network pharmacies and procedures you need to follow; | |
| | What prescription drug expenses are covered and what limits may apply; | |
| | What prescription drug expenses are not covered by the plan; | |
| | How you share the cost of your covered prescription drug expenses; and | |
| | Other important information such as eligibility, complaints and appeals, termination, and general administration of the plan. |
| | Unless otherwise indicated, you refers to you and your covered dependents. | |
| | Your prescription drug plan pays benefits only for prescription drug expenses described in this Booklet- Certificate as covered expenses that are medically necessary . | |
| | This Booklet-Certificate applies to coverage only and does not restrict your ability to receive prescription drugs that are not or might not be covered benefits under this prescription drug plan. | |
| | Store this Booklet-Certificate in a safe place for future reference. |
| | Covered expenses are subject to cost sharing requirements as described in the Cost Sharing sections of this coverage and in your Schedule of Benefits. |
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| | You will be responsible for the copayment for each prescription or refill as specified in the Schedule of Benefits . The copayment is payable directly to the network pharmacy at the time the prescription is dispensed. | |
| | After you pay the applicable copayment , if any, you will be responsible for any applicable coinsurance for covered expenses that you incur. Your coinsurance is based on the negotiated charge . You will not have to pay any balance bills above the negotiated charge for the covered expense . |
| | You will be responsible for any applicable coinsurance for covered expenses that you incur. Your coinsurance share is based on the recognized charge . If the out-of-network pharmacy charges more than the recognized charge, you will be responsible for any expenses above the recognized charge . |
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| | Diabetic needles and syringes. | |
| | Test strips for glucose monitoring and/or visual reading. | |
| | Diabetic test agents. | |
| | Lancets/lancing devices. | |
| | Alcohol swabs. |
| | Urofollitropin, menotropin, human chorionic gonadotropin and progesterone. |
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| | Administration or injection of any drug. | |
| | Any charges in excess of the benefit, dollar, day, or supply limits stated in this Booklet-Certificate. |
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| | Have been granted treatment investigational new drug (IND); or Group c/ treatment IND status; or | |
| | Are being studied at the Phase III level in a national clinical trial sponsored by the National Cancer Institute; and | |
| | Aetna determines, based on available scientific evidence, are effective or show promise of being effective for the illness. |
| | Any charges for the administration or injection of prescription drugs or injectable insulin and other injectable drugs covered by Aetna ; | |
| | Injectable agents, except insulin; | |
| | Needles and syringes, except for diabetic needles and syringes; | |
| | Unless medically necessary, injectable drugs if an alternative oral drug is available. |
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How Your Aetna Dental Plan Works
(GR-9N 16-005-01) |
Common Terms | |||
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What the Plan Covers | |||
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Rules that Apply to the Plan | |||
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What the Plan Does Not Cover |
| | Definitions you need to know; | |
| | How to access care, including procedures you need to follow; | |
| | What services and supplies are covered and what limits may apply; | |
| | What services and supplies are not covered by the plan; | |
| | How you share the cost of your covered services and supplies; and | |
| | Other important information such as eligibility, complaints and appeals, termination, continuation of coverage and general administration of the plan. |
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| | The services and supplies must be medically necessary . | |
| | The services and supplies must be covered by the plan. | |
| | You must be covered by the plan when you incur the expense. |
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| | A charge is made for an unlisted service given for the dental care of a specific condition; and | |
| | The list includes one of more services that, under standard practices, are separately suitable for the dental care of that condition. |
| | Preventive | |
| | Diagnostic | |
| | Restorative | |
| | Oral surgery | |
| | Endodontics | |
| | Periodontics |
| | Pregnancy; | |
| | Coronary artery disease/cardiovascular disease; | |
| | Cerebrovascular disease; or | |
| | Diabetes |
| | One additional prophylaxis (cleaning) per year. | |
| | Scaling and root planing, (4 or more teeth); per quadrant; | |
| | Scaling and root planing (limited to 1-3 teeth); per quadrant; | |
| | Full mouth debridement; | |
| | Periodontal maintenance (one additional treatment per year); and | |
| | Localized delivery of antimicrobial agents. (Not covered for pregnancy) |
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| | While you were covered by the plan, you had a tooth (or teeth) extracted after the existing denture or bridge was installed. As a result, you need to replace or add teeth to your denture or bridge. | |
| | The present crown, inlay and onlay, veneer, complete denture, removable partial denture, fixed partial denture (bridge), or other prosthetic service was installed at least 5 years before its replacement and cannot be made serviceable. | |
| | You had a tooth (or teeth) extracted while you were covered by the plan. Your present denture is an immediate temporary one that replaces that tooth (or teeth). A permanent denture is needed, and the temporary denture cannot be used as a permanent denture. Replacement must occur within 12 months from the date that the temporary denture was installed. |
| | The dentures, bridges or other prosthetic services are needed to replace one or more natural teeth that were removed while you were covered by the plan; and | |
| | The tooth that was removed was not an abutment to a removable or fixed partial denture installed during the prior 5 years. The extraction of a third molar does not qualify. Any such appliance or fixed bridge must include the replacement of an extracted tooth or teeth. |
| | Customarily used nationwide for treatment, and | |
| | Deemed by the dental profession to be appropriate for treatment of the condition in question. The service or supply must meet broadly accepted standards of dental practice, taking into account your current oral condition. |
| | An appliance, or modification of an appliance, if an impression for it was made before you were covered by the plan; | |
| | A crown, bridge, or cast or processed restoration, if a tooth was prepared for it before you were covered by the plan; or | |
| | Root canal therapy, if the pulp chamber for it was opened before you were covered by the plan. |
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| | Inlays; | |
| | Onlays; | |
| | Crowns; | |
| | Removable bridges; | |
| | Cast or processed restorations; | |
| | Dentures; | |
| | Fixed partial dentures (bridges); and | |
| | Root canals. |
| | For a denture: the impressions from which the denture will be made were taken. | |
| | For a root canal: the pulp chamber was opened. | |
| | For any other item: the teeth which will serve as retainers or supports, or the teeth which are being restored: |
| | Must have been fully prepared to receive the item; and | ||
| | Impressions have been taken from which the item will be prepared. |
| | Diagnosis; | |
| | Applicable therapy; | |
| | Other non-surgical treatment. |
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| | It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material; or | |
| | The tooth is an abutment to a covered partial denture or fixed bridge. |
| | Under any other part of this plan; or | |
| | Under any other plan of group benefits provided by the policyholder. |
| | Scaling of teeth; and | |
| | Cleaning of teeth. |
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| | The plan is discontinued; | |
| | You voluntarily stop your coverage; | |
| | The group policy ends; | |
| | You are no longer eligible for coverage; | |
| | You do not make any required contributions; | |
| | You become covered under another plan offered by your employer; | |
| | You have exhausted your overall maximum lifetime benefit under your medical plan, if your plan contains such a maximum benefit; or | |
| | Your employment stops. This will be either the date you stop active work, or the day before the first premium due date that occurs after you stop active work. However, if premium payments are made on your behalf, your coverage may continue until stopped by your employer as described below: |
| | If you are not at work due to illness or injury , your coverage may continue, but not beyond the end of the next policy month after the policy month in which your absence started. A policy month is defined in the group policy on file with your employer. | ||
| | If you are not at work due to temporary lay-off or leave of absence, your coverage will stop on your last full day of active work before the start of the lay-off or leave of absence. |
| | You are no longer eligible for dependents coverage; | |
| | You do not make the required contribution toward the cost of dependents coverage; | |
| | Your own coverage ends for any of the reasons listed under When Coverage Ends for Employees (other than exhaustion of your overall maximum lifetime benefit, if included); | |
| | Your dependent is no longer eligible for coverage. In this case, coverage ends at the end of the calendar month when your dependent no longer meets the plans definition of a dependent; or | |
| | Your dependent becomes eligible for comparable benefits under this or any other group plan offered by your employer. |
| | The date this plan no longer allows coverage for domestic partners. | |
| | The date of termination of the domestic partnership. In that event, you should provide your Employer with a completed and signed Declaration of Termination of Domestic Partnership. |
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| | The date coverage would otherwise terminate; and | |
| | The date you are sent notice by first class mail by your employer of the right to continue; |
| | The end of an 18 month period which starts on the date coverage would otherwise terminate. | |
| | The end of a 29 month period which starts on the date your coverage would otherwise terminate; but only if, prior to the end of the above 18 months period, you provide notice to your employer that you have been determined to be disabled under Title II or XVI of the Social Security Act on the date your coverage would have otherwise terminated, except for this continuation. If you are no longer determined to be so disabled, you must notify your employer within 30 days of such determination. In that case, coverage will cease at the start of the month that begins more than 31 days after the date of the final determination that you are no longer so disabled. | |
| | The date you become eligible for like group coverage, including coverage for any preexisting condition. | |
| | The end of the period for which any required contributions have been made. | |
| | Discontinuance of the coverage involved as to employees of the eligible class of which you were a member. | |
| | The date you become enrolled in benefits under Medicare. |
| | You were covered at the time of your death, | |
| | Your coverage, at the time of your death, is not being continued after your employment has ended, as provided in the When Coverage Ends section; | |
| | A request is made for continued coverage within 31 days after your death; and | |
| | Payment is made for the coverage. |
| | The end of the 12 month period following your death; | |
| | He or she no longer meets the plans definition of dependent; | |
| | Dependent coverage is discontinued under the group contract; |
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| | He or she becomes eligible for comparable benefits under this or any other group plan; or | |
| | Any required contributions stop; and | |
| | For your spouse, the date he or she remarries. |
| | he or she is not able to earn his or her own living because of mental retardation or a physical handicap which started prior to the date he or she reaches the maximum age for dependent children under your plan; and | |
| | he or she depends chiefly on you for support and maintenance. |
| | Cessation of the handicap. | |
| | Failure to give proof that the handicap continues. | |
| | Failure to have any required exam. | |
| | Termination of Dependent Coverage as to your child for any reason other than reaching the maximum age under your plan. |
| | You are not able to work at your own occupation and you cannot work at any occupation for pay or profit. | |
| | Your dependent is not able to engage in most normal activities of a healthy person of the same age and gender. |
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| | You are no longer totally disabled, or become covered under any other group plan with like benefits. | |
| | Your dependent is no longer totally disabled, or he or she becomes covered under any other group plan with like benefits. |
| | Complete and submit an application for continued health coverage, which is an election notice of your intent to continue coverage. | |
| | Submit your application within 60 days of the qualifying event, or within 60 days of your employers notice of this COBRA continuation right, if later. | |
| | Agree to pay the required premiums. |
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| Qualifying Event Causing Loss | Covered Persons Eligible to | |||
| of Health Coverage | Elect Continuation | Maximum Continuation Periods | ||
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Your active employment ends for
reasons other than gross misconduct |
You and your dependents | 18 months | ||
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Your working hours are reduced
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You and your dependents | 18 months | ||
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Your marriage is annulled, you
divorce or legally separate and are
no longer responsible for
dependent coverage
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Your dependents | 36 months | ||
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You become entitled to benefits
under Medicare
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Your dependents | 36 months | ||
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Your covered dependent children
no longer qualify as dependents under the plan |
Your dependent children | 36 months | ||
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You die
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Your dependents | 36 months | ||
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You are a retiree eligible for health
coverage and your former employer
files for bankruptcy
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You and your dependents | 18 months |
| | Have the right to extend coverage beyond the initial 18 month maximum continuation period. | |
| | Qualify for an additional 11 month period, subject to the overall COBRA conditions. | |
| | Must notify your employer within 60 days of the disability determination status and before the 18 month continuation period ends. | |
| | Must notify the employer within 30 days after the date of any final determination that you or a covered dependent is no longer disabled. | |
| | Are responsible to pay the premiums after the 18 th month, through the 29 th month. |
| | For the 18 or 36 month periods, premiums may never exceed 102 percent of the plan costs. | |
| | During the 18 through 29 month period, premiums for coverage during an extended disability period may never exceed 150 percent of the plan costs. |
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| | He or she meets the definition of an eligible dependent, | |
| | Your employer is notified about your dependent within 31 days of eligibility, and | |
| | Additional premiums for continuation are paid on a timely basis. |
| | You or your covered dependents reach the maximum COBRA continuation period the end of the 18, 29 or 36 months. (Coverage for a newly acquired dependent who has been added for the balance of a continuation period would end at the same time your continuation period ends, if he or she is not disabled nor eligible for an extended maximum). | |
| | You or your covered dependents do not pay required premiums. | |
| | You or your covered dependents become covered under another group plan that does not restrict coverage for pre-existing conditions. If your new plan limits pre-existing condition coverage, the continuation coverage under this plan may remain in effect until the pre-existing clause ceases to apply or the maximum continuation period is reached under this plan. | |
| | The date your employer no longer offers a group health plan. | |
| | The date you or a covered dependent becomes enrolled in benefits under Medicare. This does not apply if it is contrary to the Medicare Secondary Payer Rules or other federal law. | |
| | You or your dependent dies. |
| | At the termination of employment. | |
| | When loss of coverage under the group plan occurs. | |
| | When loss of dependent status occurs. | |
| | At the end of the maximum health coverage continuation period. |
| | You terminate your employment; | |
| | You are no longer in an eligible class; | |
| | Your dependent no longer qualifies as an eligible dependent; | |
| | Any continuation coverage required under federal or state law has ended; or | |
| | You retire and there is no medical coverage available. |
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| | You only; or | |
| | You and all dependents who are covered under the group plan at the time your coverage ended; or | |
| | Your covered dependents, if you should die before you retire. |
| | Required by law or regulation for group conversion purposes in your or your dependents states of residence; and | |
| | Offered by Aetna when you or your dependents apply under your employers conversion plan. |
| | Plan I: Hospital room and board expense benefits of $130 per day. The maximum duration is 30 days. Miscellaneous hospital expense benefits to a maximum of $1,300. Surgical operation expense benefits according to a $1,400 maximum benefits schedule. | |
| | Plan II: Hospital room and board expense benefits of $230 per day. The maximum duration is 30 days. Miscellaneous hospital expense benefits to a maximum of $2,300. Surgical operation expense benefits according to a $2,400 maximum benefits schedule. | |
| | Plan III: Hospital room and board expense benefits of $330 per day. The maximum duration is 70 days. Miscellaneous hospital expense benefits to a maximum of $3,300. Surgical operation expense benefits according to a $3,500 maximum benefits schedule. |
| | Plan IV: Major medical expense benefits providing: (a) a $330 per day hospital room and board benefit; (b) surgical expense benefits according to a $4,500 maximum benefits schedule; (c) a $200,000 maximum benefit for all sicknesses and injuries; (d) a deductible of $1,000; (e) an 80% benefit percentage, with a coinsurance limit of $2,000; and (f) an annual restoration benefit of $5,000. |
| | Reduce its benefits by any like benefits payable under your group plan after coverage ends (for example: if benefits are paid after coverage ends because of a disability extension of benefits); | |
| | Not guarantee renewal under selected conditions described in the policy; | |
| | Require a statement that Aetna may ask for data about your coverage under any other plan. This may be asked for on any premium due date for the individual policy. If you do not give the data, expenses covered under the individual policy may be reduced by expenses which are covered or provided under those plans. |
| | You or your dependents are eligible for Medicare. Covered dependents not eligible for Medicare may apply for individual coverage even if you are eligible for Medicare. | |
| | Coverage under the plan has been in effect for less than three months. |
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| | A lifetime maximum benefit under this plan has been reached. For example: |
| | If a covered dependent reaches the group plans lifetime maximum benefit, the covered dependent will not have the right to convert. If you or your dependents have remaining benefits, you are eligible to convert. | ||
| | If you have reached your lifetime maximum, you will not be able to convert. However, if a dependent has a remaining benefit, he or she is eligible to convert. |
| | You or your covered dependents become eligible for any other medical coverage under this plan. | |
| | You apply for individual coverage in a jurisdiction where Aetna cannot issue or deliver an individual conversion policy. | |
| | You or your covered dependents are eligible for, or have benefits available under, another plan that, in addition to the converted policy, would either match benefits or result in over insurance. Examples include: |
| | Any other hospital or surgical expense insurance policy; | ||
| | Any hospital service or medical expense indemnity corporation subscriber contract; | ||
| | Any other group contract; or | ||
| | Any statute, welfare plan or program. |
| | Get a copy of the Notice of Conversion Privilege and Request form from your employer. | |
| | Complete and send the form to Aetna at the specified address. |
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|
Coordination of Benefits What Happens When There is
More Than One Health Plan
|
When Coordination of Benefits Applies | |
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(GR-9N 33-005-01-NY)
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Getting Started Important Terms | |
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Which Plan Pays First | |
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How Coordination of Benefits Works |
| | A plan with no rules for coordination with other benefits will be deemed to pay its benefits before a plan which contains such rules. | |
| | A plan which covers a person as other than a dependent will be deemed to pay its benefits before a plan which covers the person as a dependent. |
| 1. | Except in the case of a dependent child whose parents are divorced or separated; the plan which covers the person as a dependent of a person whose birthday comes first in a calendar year will be primary to the plan which covers a person as a dependent of a person whose birthday comes later in the year; however: |
| (a) | if both parents have the same birthday, the benefits of the plan which covered the parent longer are determined before those of the plan which covered the other parent for a shorter period of time; | ||
| (b) | if the other plan does not have the rules described above, but instead has a rule based on the gender of the parent, and if, as a result, the plans do not agree on the order of benefit, the rule in the other plan will determine the order of benefits. |
| 2. | In the case of a dependent child whose parents are divorces or separated: |
| (a) | If there is a court decree which makes one parent financially responsible for the health care expenses with respect to the child and the entity obligated to pay or provide the benefits of that parent has actual knowledge of those terms, the benefits of that plan which covers the child as a dependent of such parent shall be determined before the benefits of any other plan which covers the child as a dependent child. | ||
| (b) | If there is no such court decree, the order of benefits is: |
| | The plan of the custodial parent; | ||
| | The plan of the spouse of the custodial parent ; | ||
| | The plan of the non custodial parent ; and then |
| 3. | Active Employee or Retired or Laid off Employee. The plan that covers a person as an employee who is neither laid off nor retired or as a dependent of an active employee, is the primary plan. The plan covering that same person as a retired or laid off employee or as a dependent of a retired or laid off employee is the |
59
| secondary plan. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule is ignored. This rule will not apply if the Non-Dependent or Dependent rules above determine the order of benefits. | |||
| 4. | Longer or Shorter Length of Coverage. The plan that covered the person as an employee, member, subscriber longer is primary. | ||
| 5. | If the preceding rules do not determine the primary plan, the allowable expenses shall be shared equally between the plans meeting the definition of plan under this provision. In addition, This Plan will not pay more than it would have paid had it been primary. |
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|
When You Have Medicare Coverage
|
Which Plan Pays First | |
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(GR-9N 33-020-01)
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How Coordination with Medicare Works | |
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What is Not Covered |
| | Covered under it by reason of age, disability, or | |
| | End Stage Renal Disease; or | |
| | Not covered under it because you: |
| 1. | Refused it; | ||
| 2. | Dropped it; or | ||
| 3. | Failed to make a proper request for it. |
| | Solely due to age if the plan is subject to the Social Security Act requirements for Medicare with respect to working aged (i.e., generally a plan of an employer with 20 or more employees); | |
| | Due to diagnosis of end stage renal disease, but only during the first 30 months of such eligibility for Medicare benefits. This provision does not apply if, at the start of eligibility, you were already eligible for Medicare benefits, and the plans benefits were payable on a secondary basis; | |
| | Solely due to any disability other than end stage renal disease; but only if the plan meets the definition of a large group health plan as outlined in the Internal Revenue Code (i.e., generally a plan of an employer with 100 or more employees). |
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| | This Booklet-Certificate applies to coverage only, and does not restrict your ability to receive health care services that are not, or might not be, covered. | |
| | You cannot receive multiple coverage under the plan because you are connected with more than one employer. | |
| | This document describes the main features of the plan. Additional provisions are described elsewhere in the group policy. If you have any questions about the terms of the plan or about the proper payment of benefits, contact your employer or Aetna . | |
| | Your employer hopes to continue the plan indefinitely but, as with all group plans, the plan may be changed or discontinued with respect to your coverage. |
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| | The benefits due under this group insurance policy; | |
| | The right to receive payments due under this group insurance policy; or | |
| | Any claim you make for damages resulting from a breach or alleged breach, of the terms of this group insurance policy. |
| | No statement made by the Policyholder or you or your dependent shall be the basis for voiding coverage or denying coverage or be used in defense of a claim unless it is in writing after it has been in force for 2 years from its effective date. | |
| | No statement made by the Policyholder shall be the basis for voiding this Policy after it has been in force for 2 years from its effective date. | |
| | No statement made by you, an eligible employee or your dependent shall be used in defense of a claim for loss incurred or starting after coverage as to which claim is made has been in effect for 2 years. |
| | To require the return of the overpayment; or | |
| | To reduce by the amount of the overpayment, any future benefit payment made to or on behalf of that person or another person in his or her family. |
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| | Names of physicians , dentists and others who furnish services. | |
| | Dates expenses are incurred. | |
| | Copies of all bills and receipts. |
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| | If the HMO Plan provides medical coverage, you will be excluded from medical expense coverage (except Vision Care, if any,) on the date of your coverage under such HMO Plan. | |
| | If the HMO Plan provides dental coverage, you will be excluded from dental expense coverage on the date of your coverage under such HMO Plan. |
| | Live in an HMO Plan enrollment area and choose to change coverage during an open enrollment period, coverage will take effect on the group policy anniversary date after the open enrollment period. There will be no rules for waiting periods or preexisting conditions. | |
| | Live in an HMO Plan enrollment area and choose to change coverage when there is not an open enrollment period, coverage will take effect only if and when Aetna gives its written consent. | |
| | Move from an HMO Plan enrollment area or if the HMO discontinues and you choose to change coverage within 31 days of the move or the discontinuance, coverage will take effect on the date you elect such coverage. There will be no restrictions for waiting periods or preexisting conditions. If you choose to change coverage after 31 days, coverage will take effect only if and when Aetna gives its written consent. |
| | The end of a 90 day period; and | |
| | The date the person is not confined. |
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| | Hospitals ; | |
| | Psychiatric hospitals ; | |
| | Residential treatment facilities ; | |
| | Psychiatric physicians ; | |
| | Psychologists; | |
| | Social workers; | |
| | Psychiatric nurses; | |
| | Addictionologists; and | |
| | Other alcoholism, drug abuse and mental health providers or groups, involved in the delivery of health care or ancillary services. |
| | Meets licensing standards. | |
| | Is set up, equipped and run to provide prenatal care, delivery and immediate postpartum care. | |
| | Charges for its services. | |
| | Is directed by at least one physician who is a specialist in obstetrics and gynecology. |
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| | Has a physician or certified nurse midwife present at all births and during the immediate postpartum period. | |
| | Extends staff privileges to physicians who practice obstetrics and gynecology in an area hospital . | |
| | Has at least 2 beds or 2 birthing rooms for use by patients while in labor and during delivery. | |
| | Provides, during labor, delivery and the immediate postpartum period, full-time skilled nursing services directed by an R.N. or certified nurse midwife. | |
| | Provides, or arranges with a facility in the area for, diagnostic X-ray and lab services for the mother and child. | |
| | Has the capacity to administer a local anesthetic and to perform minor surgery. This includes episiotomy and repair of perineal tear. | |
| | Is equipped and has trained staff to handle emergency medical conditions and provide immediate support measures to sustain life if: |
| | Complications arise during labor; or | ||
| | A child is born with an abnormality which impairs function or threatens life. |
| | Accepts only patients with low-risk pregnancies. | |
| | Has a written agreement with a hospital in the area for emergency transfer of a patient or a child. Written procedures for such a transfer must be displayed and the staff must be aware of them. | |
| | Provides an ongoing quality assurance program. This includes reviews by physicians who do not own or direct the facility. | |
| | Keeps a medical record on each patient and child. |
| | Health coverage issued on a group or individual basis; | |
| | Medicare; | |
| | Medicaid; | |
| | Health care for members of the uniformed services; | |
| | A program of the Indian Health Service or tribal organization; |
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| | A state health benefits risk pool; | |
| | The Federal Employees Health Benefit Plan (FEHBP); | |
| | A public health plan (any plan established by a State, the government of the United States, or any subdivision of a State or of the government of the United States, or a foreign country); | |
| | Any health benefit plan under Section 5(e) of the Peace Corps Act; and | |
| | The State Childrens Health Insurance Program (S-Chip). |
| | by whom they are prescribed; | |
| | by whom they are recommended; or | |
| | by whom they are performed. |
| | Any dentist; | |
| | Group; | |
| | Organization; | |
| | Dental facility; or | |
| | Other institution or person. |
| | Occurs unexpectedly; | |
| | Requires immediate diagnosis and treatment in order to stabilize the condition; and | |
| | Is characterized by symptoms such as severe pain and bleeding. |
70
| | Intoxicating alcohol or drug; | |
| | Alcohol or drug-dependent factors; or | |
| | Alcohol in combination with drugs; |
| | Made to withstand prolonged use; | |
| | Made for and mainly used in the treatment of a illness or injury ; | |
| | Suited for use in the home; | |
| | Not normally of use to people who do not have a illness or injury ; | |
| | Not for use in altering air quality or temperature; and | |
| | Not for exercise or training. |
| | Is prescribed; and supervised; by a physician; and | |
| | Is for a mental disorder that can be favorably changed. |
| | Placing your health in serious jeopardy; or | |
| | In the case of a behavioral condition, placing the health of such person, or others, in serious jeopardy; or | |
| | Serious impairment to bodily function; or | |
| | Serious dysfunction of a body part or organ; or | |
| | Serious disfigurement of such person; or | |
| | In the case of a pregnant woman, serious jeopardy to the health of the fetus. |
71
| | There are insufficient outcomes data available from controlled clinical trials published in the peer-reviewed literature to substantiate its safety and effectiveness for the illness or injury involved; or | |
| | Approval required by the FDA has not been granted for marketing; or | |
| | A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental or investigational, or for research purposes; or | |
| | It is a type of drug, device or treatment that is the subject of a Phase I or Phase II clinical trial or the experimental or research arm of a Phase III clinical trial, using the definition of phases indicated in regulations and other official actions and publications of the FDA and Department of Health and Human Services; or | |
| | The written protocol or protocols used by the treating facility, or the protocol or protocols of any other facility studying substantially the same drug, device, procedure, or treatment, or the written informed consent used by the treating facility or by another facility studying the same drug, device, procedure, or treatment states that it is experimental or investigational, or for research purposes. |
| | Due to an illness or injury which makes leaving the home medically contraindicated; or | |
| | Because the act of transport would be a serious risk to your life or health. |
| | You do not often travel from home because of feebleness or insecurity brought on by advanced age (or otherwise); or | |
| | You are wheelchair bound but could safely be transported via wheelchair accessible transportation. |
| | Mainly provides skilled nursing and other therapeutic services. | |
| | Is associated with a professional group (of at least one physician and one R.N .) which makes policy. | |
| | Has full-time supervision by a physician or an R.N . | |
| | Keeps complete medical records on each person. | |
| | Has an administrator. | |
| | Meets licensing standards. |
72
| | Prescribed in writing by the attending physician ; and | |
| | An alternative to a hospital or skilled nursing facility stay. |
| | Has hospice care available 24 hours a day. | |
| | Meets any licensing or certification standards established by the jurisdiction where it is located. | |
| | Provides: |
| | Skilled nursing services; | ||
| | Medical social services; and | ||
| | Psychological and dietary counseling. |
| | Provides, or arranges for, other services which include: |
| | Physician services; | ||
| | Physical and occupational therapy; | ||
| | Part-time home health aide services which mainly consist of caring for terminally ill people; and | ||
| | Inpatient care in a facility when needed for pain control and acute and chronic symptom management. |
| | Has at least the following personnel: |
| | One physician; | ||
| | One R.N.; and | ||
| | One licensed or certified social worker employed by the agency. |
| | Establishes policies about how hospice care is provided. | |
| | Assesses the patients medical and social needs. | |
| | Develops a hospice care program to meet those needs. | |
| | Provides an ongoing quality assurance program. This includes reviews by physicians , other than those who own or direct the agency. | |
| | Permits all area medical personnel to utilize its services for their patients. | |
| | Keeps a medical record on each patient. | |
| | Uses volunteers trained in providing services for non-medical needs. | |
| | Has a full-time administrator. |
| | Is established by and reviewed from time to time by a physician attending the person, and appropriate personnel of a hospice care agency ; | |
| | Is designed to provide palliative and supportive care to terminally ill persons, and supportive care to their families; and | |
| | Includes an assessment of the persons medical and social needs; and a description of the care to be given to meet those needs. |
73
| | Mainly provides inpatient hospice care to terminally ill persons. | |
| | Charges patients for its services. | |
| | Meets any licensing or certification standards established by the jurisdiction where it is located. | |
| | Keeps a medical record on each patient. | |
| | Provides an ongoing quality assurance program including reviews by physicians other than those who own or direct the facility. | |
| | Is run by a staff of physicians. At least one staff physician must be on call at all times. | |
| | Provides 24-hour-a-day nursing services under the direction of an R.N . | |
| | Has a full-time administrator. |
| | Is primarily engaged in providing, by or under the continuous supervision of physicians , to inpatients, diagnostic services and therapeutic services for diagnostic, treatment and care of injured and sick persons; | |
| | Has organized departments of medicine and major surgery; | |
| | Has a requirement that every patient must be under the care of a physician or dentist; | |
| | Provides 24 hour nursing service by or under the supervision of a registered professional nurse (R.N.); | |
| | If located in New York State, has in effect a hospitalization review plan applicable to all patients which meets at least the standards set forth in Section 1861k of U.S. Public Law 89-97 (42 USCA 1395x(k)); | |
| | Is duly licensed by the agency responsible for licensing such hospitals; | |
| | Makes charges; and | |
| | Is not, other than incidentally, a place for rest, a place primarily for the treatment of tuberculosis, a place for the aged, a place for drug addicts, alcoholics, or a place for convalescent, custodial, educational or rehabilitative care. |
| | For a woman who is 21 or more but less than 35 years of age: 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or | |
| | For a woman who is 35 years of age or older, but less than 45: 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination. |
74
| | An unexpected or reasonably unforeseen occurrence or event; or | |
| | The reasonable unforeseeable consequences of a voluntary act by the person. | |
| | An act or event must be definite as to time and place. |
| | A Temporomandibular Joint (TMJ) dysfunction or any similar disorder of the jaw joint; or | |
| | A Myofacial Pain Dysfunction (MPD); or | |
| | Any similar disorder in the relationship between the jaw joint and the related muscles and nerves. |
| | Are furnished mainly to maintain, rather than to improve, a level of physical, or mental function; and | |
| | Provide a surrounding free from exposures that can worsen the persons physical or mental condition. |
75
| a) | In accordance with generally accepted standards of medical or dental practice; | |
| b) | Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patients illness , injury or disease; and | |
| c) | Not primarily for the convenience of the patient, physician , other health care or dental provider ; and | |
| d) | Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patients illness , injury , or disease. |
| | Alcoholism and substance abuse. | |
| | Bipolar disorder. | |
| | Major depressive disorder. | |
| | Obsessive compulsive disorder. | |
| | Panic disorder. | |
| | Pervasive Mental Developmental Disorder (Autism). | |
| | Psychotic depression. | |
| | Schizophrenia. |
76
| | The service or supply involved; and | |
| | The class of employees to which you belong. |
| | 8 hours in a row a night; and | |
| | 5 nights a week. |
| | Arise out of (or in the course of) any work for pay or profit; or | |
| | Result in any way from an illness that does. |
| | Is covered under any type of workers compensation law; and | |
| | Is not covered for that illness under such law. |
| | Arise out of (or in the course of) any work for pay or profit; or | |
| | Result in any way from an injury which does. |
| | Arises out of (or in the course of) any activity in connection with employment or self-employment whether or not on a full time basis; or | |
| | Results in any way from an injury or illness that does. |
77
| | Receives no medical treatment; services; or supplies; for a disease or injury ; and | |
| | Neither takes any medication, nor has any medication prescribed, for a disease or injury . |
| | Medical service or supply; or | |
| | Dental service or supply; |
| | Of the teeth; or | ||
| | Of the bite; or | ||
| | Of the jaws or jaw joint relationship; |
| | The installation of a space maintainer; or | |
| | A surgical procedure to correct malocclusion. |
| | It is carried out in a hospital ; psychiatric hospital or residential treatment facility ; on less than a full-time inpatient basis. | |
| | It is in accord with accepted medical practice for the condition of the person. | |
| | It does not require full-time confinement. | |
| | It is supervised by a psychiatric physician who weekly reviews and evaluates its effect. | |
| | Day care treatment and night care treatment are considered partial confinement treatment . |
78
| | Has an M.D. or D.O. degree; | |
| | Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices; and | |
| | Provides medical services which are within the scope of his or her license or certificate. |
| | Is properly licensed or certified to provide medical care under the laws of the jurisdiction where he or she practices; | |
| | Provides medical services which are within the scope of his or her license or certificate; | |
| | Under applicable insurance law is considered a physician for purposes of this coverage; | |
| | Has the medical training and clinical expertise suitable to treat your condition; | |
| | Specializes in psychiatry, if your illness or injury is caused, to any extent, by alcohol abuse, substance abuse or a mental disorder; and | |
| | A physician is not you or related to you. |
| | An injectable drug prescribed to be self-administered or administered by any other person except one who is acting within his or her capacity as a paid healthcare professional. Covered injectable drugs include injectable insulin. |
79
| | Mainly provides a program for the diagnosis, evaluation, and treatment of alcoholism, substance abuse or mental disorders. | |
| | Is not mainly a school or a custodial, recreational or training institution. | |
| | Provides infirmary-level medical services. Also, it provides, or arranges with a hospital in the area for, any other medical service that may be required. | |
| | Is supervised full-time by a psychiatric physician who is responsible for patient care and is there regularly. | |
| | Is staffed by psychiatric physicians involved in care and treatment. | |
| | Has a psychiatric physician present during the whole treatment day. | |
| | Provides, at all times, psychiatric social work and nursing services. | |
| | Provides, at all times, skilled nursing services by licensed nurses who are supervised by a full-time R.N. | |
| | Prepares and maintains a written plan of treatment for each patient based on medical, psychological and social needs. The plan must be supervised by a psychiatric physician . | |
| | Makes charges. | |
| | Meets licensing standards. |
| | Specializes in psychiatry; or | |
| | Has the training or experience to do the required evaluation and treatment of alcoholism, substance abuse or mental disorders. |
| | On-site licensed Behavioral Health Provider 24 hours per day/7 days a week. | |
| | Provides a comprehensive patient assessment (preferably before admission, but at least upon admission). | |
| | Is admitted by a Physician . | |
| | Has access to necessary medical services 24 hours per day/7 days a week. | |
| | If the member requires detoxification services, must have the availability of on-site medical treatment 24 hours per day/7 days a week, which must be actively supervised by an attending Physician . | |
| | Provides living arrangements that foster community living and peer interaction that are consistent with developmental needs. | |
| | Offers group therapy sessions with at least an RN or Masters-Level Health Professional. | |
| | Has the ability to involve family/support systems in therapy (required for children and adolescents; encouraged for adults). | |
| | Provides access to at least weekly sessions with a Psychiatrist or psychologist for individual psychotherapy. | |
| | Has peer oriented activities. |
80
| | Services are managed by a licensed Behavioral Health Provider who, while not needing to be individually contracted, needs to (1) meet the Aetna credentialing criteria as an individual practitioner, and (2) function under the direction/supervision of a licensed psychiatrist (Medical Director). | |
| | Has individualized active treatment plan directed toward the alleviation of the impairment that caused the admission. | |
| | Provides a level of skilled intervention consistent with patient risk. | |
| | Meets any and all applicable licensing standards established by the jurisdiction in which it is located. | |
| | Is not a Wilderness Treatment Program or any such related or similar program, school and/or education service. | |
| | Ability to assess and recognize withdrawal complications that threaten life or bodily functions and to obtain needed services either on site or externally. | |
| | 24-hours perday/7 days a week supervision by a physician with evidence of close and frequent observation. | |
| | On-site, licensed Behavioral Health Provider , medical or substance abuse professionals 24 hours per day/7 days a week. |
| | Has, on-site licensed Behavioral Health Provider 24 hours per day. | |
| | Provides a comprehensive patient assessment. | |
| | Provides living arrangements that foster community living and peer interaction that are consistent with developmental needs. | |
| | Offers group therapy sessions. | |
| | Has the ability to involve family/support systems in therapy. | |
| | Provides access to at least weekly sessions with a Psychiatrist or psychologist for individual psychotherapy. | |
| | Has peer oriented activities. | |
| | Is managed by a licensed Behavioral Health Provider who functions under the direction and supervision of a psychiatric physician. | |
| | Has individualized active treatment plan directed toward the alleviation of the impairment that caused the admission. | |
| | Provides a level of skilled intervention consistent with patient risk. | |
| | Provides active discharge planning initiated upon admission to the program. | |
| | Meets any and all applicable licensing standards established by the jurisdiction in which it is located. |
81
| | The services require medical or paramedical training. | |
| | The services are rendered by an R.N. or L.P.N. within the scope of his or her license. | |
| | The services are not custodial. |
| | Meets licensing standards. | |
| | Is set up, equipped and run to provide general surgery. | |
| | Charges for its services. | |
| | Is directed by a staff of physicians . At least one of them must be on the premises when surgery is performed and during the recovery period. | |
| | Has at least one certified anesthesiologist at the site when surgery requiring general or spinal anesthesia is performed and during the recovery period. | |
| | Extends surgical staff privileges to: |
| | Physicians who practice surgery in an area hospital; and | ||
| | Dentists who perform oral surgery. |
| | Has at least 2 operating rooms and one recovery room. | |
| | Provides, or arranges with a medical facility in the area for, diagnostic x-ray and lab services needed in connection with surgery. |
82
| | Does not have a place for patients to stay overnight. | |
| | Provides, in the operating and recovery rooms, full-time skilled nursing services directed by an R.N. | |
| | Is equipped and has trained staff to handle emergency medical conditions . |
| | A physician trained in cardiopulmonary resuscitation; and | |
| | A defibrillator; and | |
| | A tracheotomy set; and | |
| | A blood volume expander. | |
| | Has a written agreement with a hospital in the area for immediate emergency transfer of patients. | |
| | Written procedures for such a transfer must be displayed and the staff must be aware of them. | |
| | Physicians who do not own or direct the facility. | |
| | Keeps a medical record on each patient. |
| | The onset of or change in a illness ; or | |
| | The diagnosis of a illness ; or | |
| | An injury . | |
| | The condition, while not needing an emergency admission , is severe enough to require confinement as an inpatient in a hospital within 2 weeks from the date the need for the confinement becomes apparent. |
| | A freestanding medical facility that meets all of the following requirements. |
| | Provides unscheduled medical services to treat an urgent condition if the persons physician is not reasonably available. | ||
| | Routinely provides ongoing unscheduled medical services for more than 8 consecutive hours. | ||
| | Makes charges. | ||
| | Is licensed and certified as required by any state or federal law or regulation. | ||
| | Keeps a medical record on each patient. | ||
| | Provides an ongoing quality assurance program. This includes reviews by physicians other than those who own or direct the facility. | ||
| | Is run by a staff of physicians . At least one physician must be on call at all times. | ||
| | Has a full-time administrator who is a licensed physician . |
83
| | A physician s office, but only one that: |
| | Has contracted with Aetna to provide urgent care; and | ||
| | Is, with Aetna s consent, included in the directory as a network urgent care provider . |
| | It is not the emergency room or outpatient department of a hospital . |
| | Is severe enough to require prompt medical attention to avoid serious deterioration of your health; | |
| | Includes a condition which would subject you to severe pain that could not be adequately managed without urgent care or treatment; | |
| | Does not require the level of care provided in the emergency room of a hospital; and | |
| | Requires immediate outpatient medical care that cannot be postponed until your physician becomes reasonably available. |
84
| | the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory; or | |
| | the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington D.C. 20210. |
| (1) | reconstruction of the breast on which a mastectomy has been performed; | |
| (2) | surgery and reconstruction of the other breast to produce a symmetrical appearance; | |
| (3) | prostheses; and | |
| (4) | treatment of physical complications of all stages of mastectomy, including lymphedemas. |
| | The date you are required to make any contribution and you fail to do so. | |
| | The date your Employer determines your approved FMLA leave is terminated. | |
| | The date the coverage involved discontinues as to your eligible class. However, coverage for health expenses may be available to you under another plan sponsored by your Employer. |
|
BENEFIT PLAN
|
What Your Plan
Covers and How Benefits are Paid |
|
|
|
||
|
Prepared Exclusively for
Booz Allen Hamilton |
|
Preface
|
1 | |||
|
Coverage for You and Your Dependents
|
1 | |||
|
Health Expense Coverage
|
1 | |||
|
Treatment Outcomes of Covered Services
|
||||
|
When Your Coverage Begins
|
3 | |||
|
Who Can Be Covered
|
3 | |||
|
Employees
|
||||
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Eligible Classes
|
||||
|
Obtaining Coverage for Dependents
|
||||
|
How and When to Enroll
|
4 | |||
|
Initial Enrollment in the Plan
|
||||
|
Special Enrollment Periods
|
||||
|
When Your Coverage Begins
|
5 | |||
|
Your Effective Date of Coverage
|
||||
|
Your Dependents Effective Date of Coverage
|
||||
|
How Your Medical Plan Works
|
6 | |||
|
Common Terms
|
6 | |||
|
About Your Comprehensive Medical Plan
|
6 | |||
|
Using the Plan
|
||||
|
Cost Sharing
|
||||
|
Emergency and Urgent Care
|
7 | |||
|
In Case of a Medical Emergency
|
||||
|
Coverage for Emergency Medical Conditions
|
||||
|
In Case of an Urgent Condition
|
||||
|
Coverage for an Urgent Condition
|
||||
|
Follow-Up Care After Treatment of an
|
||||
|
Emergency or Urgent Medical Condition
|
||||
|
Requirements For Coverage
|
9 | |||
|
Clinical Review Criteria Requests
|
||||
|
What The Plan Covers
|
11 | |||
|
Comprehensive Medical Plan
|
11 | |||
|
Wellness
|
11 | |||
|
Routine Physical Exams
|
||||
|
Preventative Health Care Services Expenses
|
||||
|
Routine Cancer Screenings
|
||||
|
Early Intervention Services
|
||||
|
Family Planning Services
|
||||
|
Bone Mineral Density Measurement or Test,
|
||||
|
Drug and Devices
|
||||
|
Vision Care Services
|
||||
|
Limitations
|
||||
|
Hearing Exam
|
||||
|
Physician Services
|
14 | |||
|
Physician Visits
|
||||
|
Surgery
|
||||
|
Anesthetics
|
||||
|
Hospital Expenses
|
15 | |||
|
Room and Board
|
||||
|
Other Hospital Services and Supplies
|
||||
|
Outpatient Hospital Expenses
|
||||
|
Coverage for Emergency Medical Conditions
|
||||
|
Coverage for Urgent Conditions
|
||||
|
Alternatives to Hospital Stays
|
17 | |||
|
Outpatient Surgery and Physician Surgical
|
||||
|
Services
|
||||
|
Birthing Center and Physician Services
|
||||
|
Ambulatory Care
|
||||
|
Home Health Care
|
||||
|
Private Duty Nursing
|
||||
|
Hospice Care
|
||||
|
Other Covered Health Care Expenses
|
21 | |||
|
Acupuncture
|
||||
|
Ambulance Service
|
||||
|
Diagnostic and Preoperative Testing
|
22 | |||
|
Outpatient Diagnostic Lab Work and
|
||||
|
Radiological Services
|
||||
|
Outpatient Preoperative Testing
|
||||
|
Durable Medical and Surgical Equipment (DME)
|
23 | |||
|
Experimental or Investigational Treatment
|
23 | |||
|
Pregnancy Related Expenses
|
24 | |||
|
Prescription Drugs
|
24 | |||
|
Prosthetic Devices
|
25 | |||
|
Hearing Aids
|
||||
|
Benefits After Termination of Coverage
|
||||
|
Short-Term Rehabilitation Therapy Services
|
26 | |||
|
Cardiac and Pulmonary Rehabilitation Benefits
|
||||
|
Outpatient Cognitive Therapy, Physical Therapy,
|
||||
|
Occupational Therapy and Speech Therapy
|
||||
|
Rehabilitation Benefits
|
||||
|
Reconstructive or Cosmetic Surgery and Supplies
|
28 | |||
|
Reconstructive Breast Surgery
|
||||
|
Specialized Care
|
30 | |||
|
Chemotherapy
|
||||
|
Radiation Therapy Benefits
|
||||
|
Outpatient Infusion Therapy Benefits
|
||||
|
Diabetic Equipment, Supplies and Education
|
31 | |||
|
Treatment of Infertility
|
32 | |||
|
Advanced Reproductive Technology (ART)
|
||||
|
Benefits
|
||||
|
Jaw Joint Disorder Treatment
|
34 | |||
|
Enteral Formulas
|
34 | |||
|
Alcoholism and Substance Abuse
|
||||
|
Oral and Maxillofacial Treatment (Mouth, Jaws and
Teeth)
|
35 | |||
|
Medical Plan Exclusions
|
36 | |||
|
Your Pharmacy Benefit
|
37 | |||
|
How the Pharmacy Plan Works
|
37 | |||
|
Getting Started: Common Terms
|
37 | |||
|
Accessing Pharmacies and Benefits
|
38 | |||
|
Accessing Network Pharmacies and Benefits
|
||||
|
Emergency Prescriptions
|
||||
|
Availability of Providers
|
||||
|
Cost Sharing for Network Benefits
|
||||
|
When You Use an Out-of-Network Pharmacy
|
|
Cost Sharing for Out-of-Network Benefits
|
||||
|
Pharmacy Benefit
|
39 | |||
|
Retail Pharmacy Benefits
|
||||
|
Mail Order Pharmacy Benefits
|
||||
|
Self-Injectable Drugs Specialty Pharmacy
|
||||
|
Network Benefits
|
||||
|
Other Covered Expenses
|
||||
|
Pharmacy Benefit Limitations
|
||||
|
Pharmacy Benefit Exclusions
|
||||
|
How Your Aetna Dental Plan Works
|
43 | |||
|
Understanding Your Aetna Dental Plan
|
43 | |||
|
Getting Started: Common Terms
|
43 | |||
|
Getting an Advance Claim Review
|
43 | |||
|
When to Get an Advance Claim Review
|
||||
|
What The Plan Covers
|
44 | |||
|
Comprehensive Dental Plan
|
||||
|
Schedule of Benefits for the Comprehensive
|
||||
|
Dental Plan
|
||||
|
Dental Care Schedule
|
||||
|
Comprehensive Dental Expense Coverage Plan
|
||||
|
Comprehensive Dental Expense Coverage
|
||||
|
Rules and Limits That Apply to the Dental Plan
|
46 | |||
|
Replacement Rule
|
||||
|
Tooth Missing but Not Replaced Rule
|
||||
|
Alternate Treatment Rule
|
||||
|
Coverage for Dental Work Begun Before You
|
||||
|
Are Covered by the Plan
|
||||
|
Coverage for Dental Work Completed After
|
||||
|
Termination of Coverage
|
||||
|
Jaw Joint Disorder Treatment Rule
|
||||
|
What The Comprehensive Dental Plan Does Not
|
||||
|
Cover
|
48 | |||
|
When Coverage Ends
|
50 | |||
|
When Coverage Ends For Retirees
|
||||
|
Your Proof of Prior Medical Coverage
|
||||
|
When Coverage Ends for Dependents
|
||||
|
Continuation of Coverage
|
51 | |||
|
Continuing Health Care Benefits
|
||||
|
Handicapped Dependent Children
|
||||
|
Extension of Benefits
|
52 | |||
|
Coverage for Health Benefits
|
||||
|
COBRA Continuation of Coverage
|
53 | |||
|
Continuing Coverage through COBRA
|
||||
|
Who Qualifies for COBRA
|
||||
|
Disability May Increase Maximum Continuation
to 29 Months
|
||||
|
Determining Your Premium Payments for
|
||||
|
Continuation Coverage
|
||||
|
When You Acquire a Dependent During a
Continuation Period
|
||||
|
When Your COBRA Continuation Coverage
Ends
|
||||
|
Conversion from a Group to an Individual Plan
|
||||
|
Converting to an Individual Medical Insurance
Policy
|
55 | |||
|
Eligibility
|
||||
|
Features of the Conversion Policy
|
||||
|
Limitations
|
||||
|
Electing an Individual Conversion Policy
|
||||
|
Your Premiums and Payments
|
||||
|
When an Individual Policy Becomes Effective
|
||||
|
Coordination of Benefits What Happens When
There is More Than One Health Plan
|
58 | |||
|
When Coordination of Benefits Applies
|
58 | |||
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Getting Started Important Terms
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58 | |||
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Which Plan Pays First
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59 | |||
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How Coordination of Benefits Work
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60 | |||
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Right To Receive And Release Needed
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Information
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Facility of Payment
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Right of Recovery
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When You Have Medicare Coverage
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62 | |||
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Which Plan Pays First
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62 | |||
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How Coordination With Medicare Works
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62 | |||
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General Provisions
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64 | |||
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Type of Coverage
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64 | |||
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Physical Examinations
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64 | |||
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Legal Action
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64 | |||
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Confidentiality
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64 | |||
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Additional Provisions
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64 | |||
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Assignments
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65 | |||
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Misstatements
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65 | |||
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Incontestability
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65 | |||
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Recovery of Overpayments
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65 | |||
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Health Coverage
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Payment of Benefits
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66 | |||
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Records of Expenses
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66 | |||
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Contacting Aetna
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66 | |||
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Reinstatement after Your Dental Coverage
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Terminates
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66 | |||
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Effect of Benefits Under Other Plans
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67 | |||
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Effect of An Health Maintenance Organization
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Plan (HMO Plan) On Coverage
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Effect of Prior Coverage Transferred Business
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67 | |||
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Glossary *
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69 |
| * | Defines the Terms Shown in Bold Type in the Text of This Document. |
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Group Policyholder:
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Booz Allen Hamilton | |
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Group Policy Number:
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GP-800105 | |
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Effective Date:
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January 1, 2010 | |
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Issue Date:
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December 22, 2009 | |
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Booklet-Certificate Number:
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| Who Can Be Covered | ||
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How and When to Enroll | |
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When Your Coverage Begins |
| | You will need to be in an eligible class, as defined below; and | |
| | You will need to meet the eligibility date criteria described below. |
| | You are a retired employee of an employer participating in this plan, and you: |
| | Retired before the effective date of this plan and were covered under the prior plan for health care coverage on the day before you retired; or | ||
| | Were covered under this plan or another plan sponsored by your employer on the day before you retired; and | ||
| | Retire under your employers IRS-qualified retirement plan. |
| | Your legal spouse; or | |
| | Your domestic partner who meets the rules set by your employer; and | |
| | Your dependent children. |
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| | Unmarried; and | |
| | Under 23 years of age; not working full time, and who can qualify as dependents under the provision of the IRS. |
| | Your biological children; | |
| | Your stepchildren; | |
| | Your legally adopted children; | |
| | Your foster children, including any children placed with you for adoption; | |
| | Any children for whom you are responsible under court order; | |
| | Your grandchildren in your court-ordered custody; and | |
| | Any other child who lives with you in a parent-child relationship. |
| | Both an employee and a dependent; or | |
| | A dependent of more than one employee. |
| | The child meets the plans definition of an eligible dependent on the date he or she is placed for adoption; and | |
| | You request coverage for the child in writing within 31 days of the placement. | |
| | Proof of placement will need to be presented to Aetna prior to the dependent enrollment. | |
| | Any coverage limitations for a pre-existing condition will not apply to a child placed with you for adoption provided that the placement occurs on or after the effective date of your coverage. |
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| | The child meets the plans definition of an eligible dependent; and | |
| | You request coverage for the child in writing within 31 days of the court order. |
| | The date you are eligible for coverage |
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How Your Medical Plan Works
(GR-9N 08-005 01 NY) |
Common Terms | |
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Accessing Providers | |
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Precertification |
| | Definitions you need to know; | |
| | How to access care, including procedures you need to follow; | |
| | What expenses for services and supplies are covered and what limits may apply; | |
| | What expenses for services and supplies are not covered by the plan; | |
| | How you share the cost of your covered services and supplies; and | |
| | Other important information such as eligibility, complaints and appeals, termination, continuation of coverage, and general administration of the plan. |
| | Unless otherwise indicated, you refers to you and your covered dependents. | |
| | Your health plan pays benefits only for services and supplies described in this Booklet-Certificate as covered expenses that are medically necessary . | |
| | This Booklet-Certificate applies to coverage only and does not restrict your ability to receive health care services that are not or might not be covered benefits under this health plan. | |
| | Store this Booklet-Certificate in a safe place for future reference. |
| | When you need medical care, you can directly access physicians, hospitals and other health care providers of your choice for covered services and supplies under the plan. |
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| | You may have to pay the provider or facility and submit a claim to receive reimbursement from the plan. You will be responsible for completing and submitting claim forms for reimbursement of covered expenses you paid directly to the provider. Aetna will reimburse you for a covered expense up to the reasonable charge , less any cost sharing required by you. | |
| | You will receive notification of what the plan has paid toward your covered expenses . It will indicate any amounts you owe towards your deductible, payment percentage or other non-covered expenses you have incurred. You may elect to receive this notification by e-mail, or through the mail. Call or e-mail Member Services if you have questions regarding your statement. |
| | You must satisfy any applicable deductibles before the plan begins to pay benefits. |
| | An emergency medical condition ; or | |
| | An urgent condition . |
| | Seek the nearest emergency room, or dial 911 or your local emergency response service for medical and ambulatory assistance. If possible, call your physician provided a delay would not be detrimental to your health. | |
| | After assessing and stabilizing your condition, the emergency room should contact your physician to obtain your medical history to assist the emergency physician in your treatment. | |
| | If you are admitted to an inpatient facility, notify your physician as soon as reasonably possible. | |
| | If you seek care in an emergency room for a non-emergency condition (one that does not meet the criteria above), your benefits will be reduced. Please refer to the Schedule of Benefits for specific details about the plan. |
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| 1. | The service or supply or prescription drug must be covered by the plan. For a service or supply or prescription drug to be covered, it must: |
| | Be included as a covered expense in this Booklet-Certificate; | ||
| | Not be an excluded expense under this Booklet-Certificate. Refer to the Exclusions sections of this Booklet-Certificate for a list of services and supplies that are excluded; | ||
| | Not exceed the maximums and limitations outlined in this Booklet-Certificate. Refer to the What the Plan Covers section and the Schedule of Benefits for information about certain expense limits; and | ||
| | Be obtained in accordance with all the terms, policies and procedures outlined in this Booklet-Certificate. |
| 2. | The service or supply or prescription drug must be provided while coverage is in effect. See the Who Can Be Covered, How and When to Enroll, When Your Coverage Begins, When Coverage Ends and Continuation of Coverage sections for details on when coverage begins and ends. | |
| 3. | The service or supply or prescription drug must be medically necessary . To meet this requirement, the medical or dental services, supply or prescription drug must be provided by a physician , or other health care provider or dental provider , exercising prudent clinical judgment, to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness , injury , disease or its symptoms. The provision of the service or supply must be: |
| (a) | In accordance with generally accepted standards of medical or dental practice; | ||
| (b) | Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patients illness , injury or disease; and | ||
| (c) | Not primarily for the convenience of the patient, physician or dental provider or other health care provider; | ||
| (d) | And not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patients illness , injury , or disease. |
| | Persons name; address; and telephone number. | |
| | A request for the clinical review criteria; which Aetna would utilize in making a coverage determination involving a specific condition, treatment or device. |
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What The Plan Covers
(GR-9N 11-005 01 NY) |
Wellness | |
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Physician Services | |
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Hospital Expenses | |
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Other Medical Expenses |
| | Radiological services, X-rays, lab and other tests given in connection with the exam; and | |
| | Immunizations for infectious diseases and the materials for administration of immunizations as recommended by the Advisory Committee on Immunization Practices of the Department of Health and Human Services, Center for Disease Control; and | |
| | Testing for Tuberculosis. |
| | An initial hospital check up and well child visits in accordance with the prevailing clinical standards of the American Academy of Pediatric Physicians. |
| | Services which are covered to any extent under any other part of this plan; | |
| | Services which are for diagnosis or treatment of a suspected or identified illness or injury ; | |
| | Exams given during your stay for medical care; | |
| | Services not given by a physician or under his or her direction; | |
| | Psychiatric, psychological, personality or emotional testing or exams; |
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| | A medical history; | |
| | a complete physical examination; | |
| | developmental assessment; | |
| | anticipatory guidance; | |
| | appropriate immunizations; | |
| | laboratory tests. |
| | Services which are covered to any extent under any other part of the plan; | |
| | Services for diagnosis or treatment of a suspected or identified illness or disease; | |
| | Medicines or drugs; | |
| | Appliances, equipment or supplies; | |
| | Premarital exams; dental exams; hearing exams; or exams related in any way to employment. |
| | Upon recommendation of a physician , a mammogram at any age for females having a history of breast cancer or who have a first degree relative with a prior history of breast cancer; | |
| | A single baseline mammogram for covered females aged 35 through 39; and | |
| | An annual mammogram for covered females aged 40 or older. |
| | Standard diagnostic tests, including but not limited to a digital rectal exam and one prostate specific antigen (PSA) test at any age for males having a prior history of prostate cancer; and | |
| | An annual standard diagnostic examination, including but not limited to a digital rectal examination and a prostate specific antigen test for males age 50 or more who are asymptomatic and for males age 40 or more with a family history of prostate cancer or other prostate cancer risk factors. |
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| | Until September 1 of the calendar year in which the child attains the age of 3 years; if the child is born between January 1 and August 31 of that calendar year. | |
| | Until January 2 of the calendar year following the calendar year the child attains the age of 3 years; if the child is born between September 1 and December 31 of the preceding calendar year. |
| | Speech and language therapy given in connection with a speech impairment resulting from a congenital abnormality, disease or injury. | |
| | Occupational or physical therapy expected to result in significant improvement of a body function impaired by a congenital abnormality, disease or injury. | |
| | Clinical psychological tests or treatment. | |
| | Skilled nursing services, on a part-time or intermittent basis, given by an R.N. or by an L.P.N. |
| | Voluntary sterilization. | |
| | Voluntary termination of pregnancy. |
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| | Routine eye exam: The plan covers expenses for a complete routine eye exam that includes refraction and glaucoma testing. A routine eye exam does not include a contact lens exam. The plan covers charges for one routine eye exam in any Calendar Year. |
| | A physician certified as an otolaryngologist or otologist; or | |
| | An audiologist who: |
| | Is legally qualified in audiology; or | ||
| | Holds a certificate of Clinical Competence in Audiology from the American Speech and Hearing Association (in the absence of any applicable licensing requirements); and | ||
| | Performs the exam at the written direction of a legally qualified otolaryngologist or otologist. |
| | Immunizations for infectious disease, | |
| | Allergy testing, treatment and injections; and | |
| | Charges made by a qualified physician for a second surgical opinion on the need for surgery; and a second medical opinion by an appropriate specialist (including, but not limited to a specialist affiliated with a specialty care center for the treatment of cancer) in the event of a positive or negative diagnosis of cancer; or a recurrence or cancer; or a recommendation of a course of treatment for cancer. The opinion may be rendered by either a network or a non-network specialist. |
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| | Performing your surgical procedure; | |
| | Pre-operative and post-operative visits; and | |
| | Consultation with another physician to obtain a second opinion prior to the surgery. |
| | Services of the hospitals nursing staff; | |
| | Admission and other fees; | |
| | General and special diets; and | |
| | Sundries and supplies. |
| | Ambulance services. | |
| | Physicians and surgeons. | |
| | Operating, cytoscopic and recovery rooms. | |
| | Intensive or special care facilities and equipment. | |
| | Administration of blood and blood products, but not the cost of the blood or blood products. | |
| | Radiation therapy, chemotherapy. | |
| | Speech therapy, physical therapy and occupational therapy. | |
| | Oxygen and oxygen therapy. | |
| | Radiological services, electrocardiographs, electroencephalographs, laboratory testing and diagnostic services. | |
| | Medications, sera, biological and vaccines. | |
| | Intravenous (IV) preparations, visualizing dyes. | |
| | Discharge planning. | |
| | Dressings and casts. |
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| | Covered services and supplies provided by the outpatient department of a hospital; | |
| | Hospital services rendered within 24 hours after an accidental injury; and | |
| | X-ray and lab test in the outpatient department of the hospital, to the extent such services would be provided if an inpatient. |
| | Use of emergency room facilities; | |
| | Emergency room physicians services; | |
| | Hospital nursing staff services; and | |
| | Radiologists and pathologists services. |
| | Use of emergency room facilities; | |
| | Use of urgent care facilities; | |
| | Physicians services; |
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| | Nursing staff services; and | |
| | Radiologists and pathologists services. |
| | An office-based surgical facility of a physician or dentist ; | |
| | A surgery center ; or | |
| | The outpatient department of a hospital . |
| | The surgery can be performed adequately and safely only in a surgery center or hospital and | |
| | The surgery is not normally performed in a physician s or dentists office. |
| | Services and supplies provided by the hospital , surgery center on the day of the procedure; | |
| | The operating physicians services for performing the procedure, related pre- and post-operative care, and administration of anesthesia; and | |
| | Services of another physician for related post-operative care and administration of anesthesia. This does not include a local anesthetic. |
| | The services of a physician or other health care provider who renders technical assistance to the operating physician . | |
| | A stay in a hospital . | |
| | Facility charges for office based surgery. |
| | Prenatal care; | |
| | Delivery; and | |
| | Postpartum care within 48 hours after a vaginal delivery and 96 hours after a Cesarean delivery. |
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| | For the services of a physician who renders technical assistance to the operating physician . | |
| | In connection with a pregnancy for which pregnancy related expenses are not included as a covered expense. |
| | Related to and necessary for treatment or diagnosis of your illness or injury ; | |
| | Ordered by a physician ; | |
| | In the case of physical therapy, furnished for the same illness or injury for which you were hospitalized or for surgery (care must start no later than 6 months after discharge from the hospital or surgery and is limited to 365 days following surgery or discharge from the hospital ). |
| | The charges are made by a home health care agency ; and | |
| | The care is given under a home health care plan ; and | |
| | The care is given to you in your home while you are homebound. |
| | Part-time or intermittent care by a R . N . or by a L . P . N . | |
| | Part-time intermittent home health aide services provided in conjunction with and in direct support of patient care. | |
| | Physical, occupational and speech therapy. | |
| | Medical supplies, prescription drugs and medications and lab services by or for a home health care agency to the extent they would have been covered under this plan if you been confined in a hospital or skilled nursing facility (as defined in Title XVIII of the Social Security Act). |
| | Services or supplies that are not part of the Home Health Care Plan. | |
| | Services of a person who usually lives with you, or who is a member of your or your spouses or your domestic partners family. | |
| | Transportation | |
| | Services that are for custodial care . |
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| | A change in your medication; | |
| | Treatment of an urgent or emergency medical condition by a physician ; | |
| | The onset of symptoms indicating a need for emergency treatment; | |
| | Surgery; | |
| | An inpatient stay . |
| | Nursing care that does not require the education, training and technical skills of a R.N. or L.P.N. | |
| | Nursing care assistance for daily life activities, such as: |
| | Transportation; | ||
| | Meal preparation; | ||
| | Vital sign charting; | ||
| | Companionship activities; | ||
| | Bathing; | ||
| | Feeding; | ||
| | Personal grooming; | ||
| | Dressing; | ||
| | Toileting; and | ||
| | Getting in/out of bed or a chair. |
| | Nursing care provided for skilled observation. | |
| | Nursing care provided while you are an inpatient in a hospital or health care facility, provided the care can adequately be provided by the facilitys general nursing staff, if it were fully staffed. | |
| | A service provided solely to administer oral medicine, except where law requires a R.N. or L.P.N. to administer medicines. |
| | Room and board , up to the semi-private room rate . The plan will cover up to the private room rate if it is needed due to an infectious illness or a weak or compromised immune system; | |
| | Use of special treatment rooms; | |
| | Radiological services and lab work; | |
| | Physical, occupational, or speech therapy; | |
| | Oxygen and other gas therapy; | |
| | Other medical services and general nursing services usually given by a skilled nursing facility (this does not include charges made for private or special nursing, or physicians services); and |
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| | Medical supplies. | |
| | The stay must start during a Convalescent Period. A convalescent period starts on the first day of your stay if you: |
| | Had a hospital stay of at least three days in a row; while covered under this plan for treatment of an illness or injury; | ||
| | Start your stay in a skilled nursing facility within 14 days after your discharge from the hospital ; | ||
| | Need skilled nursing facility services to recover from the condition that caused the hospital stay; and | ||
| | Further hospitalization would otherwise be necessary . |
| | Charges made for the treatment of: |
| | Drug addiction; | ||
| | Alcoholism; | ||
| | Senility; | ||
| | Mental retardation; or | ||
| | Any other mental illness; and |
| | Daily room and board charges over the semi private rate . |
| | Room and Board and other services and supplies furnished during a stay for pain control and other acute and chronic symptom management; and | |
| | Services and supplies furnished to you on an outpatient basis. |
| | Part-time or intermittent nursing care by a R.N. or L.P.N. for up to eight hours a day; | |
| | Part-time or intermittent home health aide services to care for you up to eight hours a day. | |
| | Medical social services under the direction of a physician . These include but are not limited to: |
| | Assessment of your social, emotional and medical needs, and your home and family situation; | ||
| | Identification of available community resources; and | ||
| | Assistance provided to you to obtain resources to meet your assessed needs. |
| | Physical and occupational therapy; and | |
| | Consultation or case management services by a physician ; | |
| | Medical supplies. |
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| | Prescription drugs; | |
| | Dietary counseling; and | |
| | Psychological counseling. |
| | A physician for a consultation or case management; | |
| | A physical or occupational therapist; | |
| | A home health care agency for: |
| | Physical and occupational therapy; | ||
| | Part time or intermittent home health aide services for your care up to eight hours a day; | ||
| | Medical supplies; | ||
| | Prescription drugs ; | ||
| | Psychological counseling; and | ||
| | Dietary counseling. |
| | Daily room and board charges over the semi-private room rate . | |
| | More than 5 visits for bereavement counseling. | |
| | Funeral arrangements. | |
| | Pastoral counseling. | |
| | Financial or legal counseling. This includes estate planning and the drafting of a will. | |
| | Homemaker or caretaker services. These are services which are not solely related to your care. These include, but are not limited to: sitter or companion services for either you or other family members; transportation; maintenance of the house. | |
| | Respite care. This is care furnished during a period of time when your family or usual caretaker cannot attend to your needs. |
| | As a form of anesthesia in connection with a covered surgical procedure; and | |
| | To treat an illness, injury or to alleviate chronic pain. |
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| | If an ambulance service is not required by your physical condition; or | |
| | If the type of ambulance service provided is not required for your physical condition; or | |
| | By any form of transportation other than a professional ambulance service. |
| | The test are related to your surgery, and the surgery takes place in a hospital or surgery center ; | |
| | Reservations for a bed or for an operating room were made prior to the tests: |
| | The test are completed within 7 days before your surgery; | ||
| | The test are performed on an outpatient basis; | ||
| | The test would be covered if you were an inpatient in a hospital ; | ||
| | The test are not repeated in or by the hospital or surgery center where the surgery will be performed; | ||
| | Test results appear in your medical record kept by the hospital or surgery center where the surgery is performed. |
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| | If your tests indicate that surgery should not be performed because of your physical condition, the plan will pay for the test, however surgery will not be covered. |
| | Long term care is planned; and | |
| | The equipment cannot be rented or is likely to cost less to purchase than to rent. |
| | The replacement is needed because of a change in your physical condition; and | |
| | It is likely to cost less to replace the item than to repair the existing item or rent a similar item. |
| | Made to withstand prolonged use; | |
| | Made for and mainly used in the treatment of an illness or injury ; | |
| | Suited for use in the home; | |
| | Not normally of use to people who do not have an illness or injury ; | |
| | Not for use in altering air quality or temperature; and | |
| | Not for exercise or training. |
| | You have been diagnosed with cancer or a condition likely to cause death within one year or less; | |
| | Standard therapies have not been effective or are inappropriate; | |
| | Aetna determines, based on at least two documents of medical and scientific evidence, that you would likely benefit from the treatment; |
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| | There is an ongoing clinical trial. You are enrolled in a clinical trial that meets these criteria: |
| | The drug, device, treatment or procedure to be investigated has been granted investigational new drug (IND) or Group c/treatment IND status; | ||
| | The clinical trial has passed independent scientific scrutiny and has been approved by an Institutional Review Board that will oversee the investigation; | ||
| | The clinical trial is sponsored by the National Cancer Institute (NCI) or similar national organization (such as the Food & Drug Administration or the Department of Defense) and conforms to the NCI standards; | ||
| | The clinical trial is not a single institution or investigator study unless the clinical trial is performed at an NCI-designated cancer center; and | ||
| | You are treated in accordance with protocol. |
| | 48 hours after a vaginal delivery; and | |
| | 96 hours after a cesarean section. | |
| | A shorter stay, if the attending physician , with the consent of the mother, discharges the mother or newborn earlier. |
| | any outpatient prescription drug covered or excluded from coverage under Aetnas prescription drug plan in accordance with the prescription drug coverage and exclusions sections of this Booklet-Certificate or any separately issued Booklet-Certificate. |
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| | Sildenafil Citrate, phentolamine, apomorphine and alprostadil in oral, and topical (which includes, but is not limited to gels, creams, ointments and patches) forms; or any other form, internally or externally, are covered; regardless of medical necessity . Coverage includes: any prescription drug in oral or topical form, that is in a similar or identical class; has a similar or identical mode of action; or exhibits similar, or identical outcomes. | |
| | Coverage is limited to 6 pills, or other form; determined cumulatively among all forms for unit amounts; determined by Aetna to be similar in cost to: oral forms, per 30 day supply. |
| | Internal body part or organ; or | |
| | External body part. |
| | The replacement is needed because of a change in your physical condition; or normal growth or wear and tear; or | |
| | It is likely to cost less to buy a new one than to repair the existing one; or | |
| | The existing one cannot be made serviceable. |
| | An artificial arm, leg, hip, knee or eye; | |
| | Eye lens; | |
| | An external breast prosthesis and the first bra made solely for use with it after a mastectomy; | |
| | A breast implant after a mastectomy; | |
| | Ostomy supplies, urinary catheters and external urinary collection devices; | |
| | Speech generating device; | |
| | A cardiac pacemaker and pacemaker defibrillators; and | |
| | A durable brace that is custom made and fitted for you. |
| | Orthopedic shoes, therapeutic shoes, foot orthotics, or other devices to support the feet, unless required for the treatment of or to prevent complications of diabetes; or if the orthopedic shoe is an integral part of a covered leg brace; or | |
| | Trusses, corsets, and other support. |
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| | The prescription for the hearing aid was written; and | |
| | The hearing aid was ordered. |
| | A licensed or certified physical, occupational or speech therapist; | |
| | A hospital , skilled nursing facility , or hospice facility ; | |
| | A home health care agency ; or | |
| | A physician . |
| | Cardiac rehabilitation benefits are available as part of an inpatient hospital stay . A limited course of outpatient cardiac rehabilitation is covered when following angioplasty, cardiovascular surgery, congestive heart failure or myocardial infarction. | |
| | Pulmonary rehabilitation benefits are available as part of an inpatient hospital stay . A limited course of outpatient pulmonary rehabilitation is covered for the treatment of reversible pulmonary disease states. |
| | Physical therapy is covered for non-chronic conditions and acute illnesses and injuries , provided the therapy expects to significantly improve, develop or restore physical functions lost or impaired as a result of an acute illness , injury or surgical procedure. Physical therapy does not include educational training or services designed to develop physical function. | |
| | Occupational therapy (except for vocational rehabilitation or employment counseling) is covered for non-chronic conditions and acute illnesses and injuries , provided the therapy expects to significantly improve, develop or restore physical functions lost or impaired as a result of an acute illness , injury or surgical procedure, or to relearn skills to significantly improve independence in the activities of daily living. Occupational therapy does not include educational training or services designed to develop physical function. |
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| | Speech therapy is covered for non-chronic conditions and acute illnesses and injuries and expected to restore the speech function or correct a speech impairment resulting from illness or injury ; or for delays in speech function development as a result of a gross anatomical defect present at birth. Speech function is the ability to express thoughts, speak words and form sentences. Speech impairment is difficulty with expressing ones thoughts with spoken words. | |
| | Cognitive therapy associated with physical rehabilitation is covered when the cognitive deficits have been acquired as a result of neurologic impairment due to trauma, stroke, or encephalopathy, and when the therapy is part of a treatment plan intended to restore previous cognitive function. |
| | Details the treatment, and specifies frequency and duration; and | |
| | Provides for ongoing reviews and is renewed only if continued therapy is appropriate. | |
| | Allows therapy services, provided in your home, if you are homebound . |
| | Therapies for the treatment of delays in development, unless resulting from acute illness or injury, or congenital defects amenable to surgical repair (such as cleft lip/palate), are not covered. | |
| | Any services which are covered expenses in whole or in part under any other group plan sponsored by an employer; | |
| | Any services unless provided in accordance with a specific treatment plan; | |
| | Services for the treatment of delays in speech development, unless resulting from: illness; injury ; or congenital defect; | |
| | Services provided during a stay in a hospital , skilled nursing facility , or hospice facility except as stated above ; | |
| | Services not performed by a physician or under the direct supervision of a physician ; | |
| | Treatment covered as part of the Spinal Manipulation Treatment. This applies whether or not benefits have been paid under that section; | |
| | Services provided by a physician or physical, occupational or speech therapist who resides in your home; or who is a member of your family, or a member of your spouses family; or your domestic partner; | |
| | Special education to instruct a person whose speech has been lost or impaired, to function without that ability. This includes lessons in sign language. |
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| | Surgery to correct the result of an accidental injury provided the surgery occurs no more than 24 months after the injury . For a covered child, surgery will be covered up to age 18 or up to 24 months after the injury , whichever period is longer. Injuries that occur during surgical procedures or medical treatments are not considered accidental injuries, even if unplanned or unexpected. | |
| | Surgical implantation or attachment of covered prosthetic devices. | |
| | Surgery to correct a gross anatomical defect present at birth. The surgery will be covered if the defect results in severe facial disfigurement or significant functional impairment of a body part; and the purpose of the surgery is to improve function. |
| | You or your dependent is at least 18 years old; and | ||
| | You or your dependent have met criteria for the diagnosis of true transsexualism including: |
| | A life-long sense of belonging to the opposite sex and of having been born into the wrong sex, often since childhood; | ||
| | A sense of estrangement from ones own body; so that any evidence of ones own biological sex is regarded as repugnant; | ||
| | A desire to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; | ||
| | A stable transsexual orientation evidenced by a desire to be rid of ones genitals; and to live in society as a member of the other sex for at least 2 years; (i.e. not limited to periods of stress); | ||
| | There is no sexual arousal from cross-dressing; | ||
| | There is an absence of physical inter-sex of genetic abnormality; and | ||
| | This is not due to another biological, chromosomal or associated psychiatric disorder; such as schizophrenia. |
| | You or your dependent must have completed a recognized program of transgender identity treatment; as evidenced by all of the following: |
| | Has successfully lived and worked within the desired gender role full-time for at least 12 months (so-called real-life experience); without periods of returning to the original gender; | ||
| | Unless medically contraindicated, has received at least 12 months of continuous hormonal sex change therapy recommended by a behavioral health provider ; and carried out by an endocrinologist (which can be simultaneous with the real-life experience); |
28
| | A behavioral health provider who has been acquainted with you or your dependent for at least 18 months recommends sex change surgery documented in the form of a written comprehensive evaluation; | ||
| | A second concurring recommendation by another qualified behavioral health provider must be documented in the form of a written expert opinion; as long as one of the two behavioral health provider s possess a doctoral degree (e.g., Ph.D., Ed.D., D.Sc., D.S.W., Psy.D., or M.D.); | ||
| | Psychotherapy is not an absolute requirement for surgery unless the behavioral health provider s initial assessment leads to a recommendation for psychotherapy that specifies the goals of treatment, estimates its frequency and duration throughout the real life experience (usually a minimum of 3 months); | ||
| | For genital surgical sex change; you or your dependent has undergone a urological examination for the purpose of identifying and perhaps treating abnormalities of the genitourinary tract; since genital surgical sex change includes the invasion of, and the alteration of; the genitourinary tract (urological examination is not required for persons not undergoing genital change); and | ||
| | You or your dependent have demonstrated an understanding of the proposed male-to-female or female-to-male sex change surgery with its attendant costs, required lengths of hospitalization, likely complications, and post surgical rehabilitation requirements of the planned surgery. |
| | The covered person has obtained precertification from Aetna . |
| | Charges made by a physician for: |
| | Performing the surgical procedure; and | ||
| | Pre-operative and post-operative hospital , office and home visits. |
| | Charges made by a hospital for inpatient and outpatient services (including outpatient surgery). Room and board charges in excess of the hospital s semi-private rate will not be covered; unless a private room is ordered by your physician and precertification has been obtained. | |
| | Charges made by a Skilled Nursing Facility for inpatient services and supplies. Room and board charges in excess of the hospital s semi-private rate will not be covered. | |
| | Charges made for the administration of anesthetics. | |
| | Charges for outpatient diagnostic laboratory and x-rays. | |
| | Charges for blood transfusion and the cost of unreplaced blood and blood products. Also included are the charges for collecting, processing and storage of self-donated blood after the surgery has been scheduled. |
29
| | A free-standing facility; | |
| | The outpatient department of a hospital ; or | |
| | A physician in his/her office or in your home. |
| | The pharmaceutical when administered in connection with infusion therapy and any medical supplies, equipment and nursing services required to support the infusion therapy; | |
| | Professional services; | |
| | Total parenteral nutrition (TPN); | |
| | Chemotherapy; | |
| | Drug therapy (includes antibiotic and antivirals); | |
| | Pain management (narcotics); and | |
| | Hydration therapy (includes fluids, electrolytes and other additives). |
| | Enteral nutrition; | |
| | Blood transfusions |
30
| | Insulin; | |
| | Insulin pumps and accessories; | |
| | Syringes; | |
| | Injections aids for the visually impaired; | |
| | Test strips for glucose monitoring and visual reading and urine testing strips | |
| | Blood glucose monitors, including those for the visually impaired | |
| | Lancets; | |
| | Insulin infusion devices; | |
| | Oral agents for controlling blood sugar; | |
| | Cartridges for the visually impaired; | |
| | Prescribed oral medications whose primary purpose is to influence blood sugar; | |
| | Alcohol swabs; | |
| | Injectable glucagons; | |
| | Glucagon emergency kits; | |
| | Self-management training provided by a licensed health care provider certified in diabetes self-management training; and | |
| | Foot care to minimize the risk of infection. | |
| | Any additional equipment and related supplies as may be medically necessary for the treatment of diabetes. |
31
| | Ovulation induction; | |
| | Artificial insemination; | |
| | Ultrasound; | |
| | Post-coital test; | |
| | Hysterosalpinogram; | |
| | Laparoscopy; | |
| | Sono-hysterogram; | |
| | Blood tests; | |
| | Endometrial biopsy; | |
| | Hysteroscopy; | |
| | Semen analysis; | |
| | Testis biopsy; and | |
| | Prescription drugs. |
| | Purchases of donor sperm and any charges for the storage of any sperm; | |
| | The purchase of donor eggs and any charges associated with care of the donor required for donor egg retrieval, transfers or gestational carriers; | |
| | Charges associated with cryopreservation, or storage of cryopreserved embryos, including but not limited to office visits, hospital charges, ultrasounds and lab tests; | |
| | Reversal of elective sterilization; | |
| | Sex change procedures; | |
| | Cloning; | |
| | Gestational carrier programs (surrogate parenting) for you or the gestational carrier; | |
| | Prescription drugs used for the treatment of an excluded treatment or procedure, including injectable medications; | |
| | Home ovulation prediction kits; | |
| | In-vitro fertilization; gamete intrafallopian tube transfers; zygote intrafallopian tube transfers; and intracytoplasmic sperm injection; | |
| | Frozen embryo transfers; including thawing; | |
| | Procedures deemed experimental in accordance with the standards of the American Society for Reproductive Medicine; | |
| | Services and supplies obtained without precertification . |
32
| | A condition that is a demonstrated cause of infertility has been recognized by a gynecologist or infertility specialist. | |
| | The procedures are not performed during an inpatient stay in a hospital , or any other facility. | |
| | FSH levels are less than, or equal to, 19miU on day 3 of the menstrual cycle. | |
| | The infertility is not caused by voluntary sterilization of either one of the partners (with or without surgical reversal), or a hysterectomy. | |
| | A successful pregnancy cannot be attained through less costly treatment for which coverage is available under this Plan. |
| | In-vitro fertilization (IVF); | |
| | Zygote intra-fallopian transfer (ZIFT); | |
| | Gamete intra-fallopian transfer (GIFT); | |
| | Cryopreserved embryo transfers; | |
| | Intracytoplasmic sperm injection (ICSI); or ovum microsurgery; | |
| | Care associated with a donor IVF program. This includes fertilization and culture; | |
| | Charges for obtaining the sperm of a covered partner are covered if both the man and the woman are covered by the plan. |
| | Precertified by Aetnas Infertility Care Management Unit. |
| | purchases of donor sperm and any charges for storage of any sperm; | |
| | the purchase of donor eggs and any charges associated with the care of the donor required for donor egg retrievals, transfers or gestational carriers; | |
| | charges associated with cryopreservation, or storage of cryopreserved embryos, including but not limited to, office visits, hospital charges, ultrasounds and lab tests; | |
| | Reversal of elective sterilization; | |
| | Charges for or related to artificial insemination; | |
| | Gestational carrier programs (surrogate parenting) for you or the gestational carrier; | |
| | Prescription drugs, including injectable infertility medications; | |
| | Home ovulation prediction kits; | |
| | Frozen embryo transfers, including thawing; | |
| | Services and supplies obtained without the necessary referrals, or claims authorizations from the Infertility Unit or the Patient Management Unit. |
33
| | Of the jaw joint itself, such as temporomandibular joint dysfunction (TMJ) syndrome; or | |
| | Involving the relationship between the jaw joint and related muscles and nerves such as myofacial pain dysfunction (MPD). |
| | inherited diseases of amino acid or organic acid metabolism; | |
| | Crohns disease; | |
| | gastroesophageal reflux with failure to thrive; | |
| | disorders of gastrointestinal motility; | |
| | multiple, severe food allergies. |
34
| | Non-surgical treatment of infections or diseases of the mouth, jaw joints or supporting tissues. |
| | Treat a fracture, dislocation, or wound. | |
| | Cut out cysts, tumors, or other diseased tissues. | |
| | Cut into gums and tissues of the mouth. This is only covered when not done in connection with the removal, replacement or repair of teeth. | |
| | Alter the jaw, jaw joints, or bite relationships by a cutting procedure when appliance therapy alone cannot result in functional improvement. |
| (a) | Natural teeth damaged, lost, or removed; or | |
| (b) | Other body tissues of the mouth fractured or cut due to injury . |
| | The first denture or fixed bridgework to replace lost teeth; | |
| | The first crown needed to repair each damaged tooth; and | |
| | An in-mouth appliance used in the first course of orthodontic treatment after the injury . |
35
| | Cosmetic services and plastic surgery: any treatment, surgery (cosmetic or plastic), service or supply to alter, the shape or appearance of the body whether or not for psychological or emotional reasons, unless medically necessary . But this exclusion will not apply to (i) Reconstructive Services and Specialized Care Services under What the Plan Covers section; (ii) removal of bony impacted teeth, bone fractures, removal of tumors and orthodontogentic cysts; or covered dental services or supplies to treat congenital defects or anomalies (including cleft lip or cleft palate) of covered dependent children. |
36
| | Definitions you need to know; | |
| | How to access network pharmacies and procedures you need to follow; | |
| | What prescription drug expenses are covered and what limits may apply; | |
| | What prescription drug expenses are not covered by the plan; | |
| | How you share the cost of your covered prescription drug expenses; and | |
| | Other important information such as eligibility, complaints and appeals, termination, and general administration of the plan. |
| | Unless otherwise indicated, you refers to you and your covered dependents. | |
| | Your prescription drug plan pays benefits only for prescription drug expenses described in this Booklet-Certificate as covered expenses that are medically necessary . | |
| | This Booklet-Certificate applies to coverage only and does not restrict your ability to receive prescription drugs that are not or might not be covered benefits under this prescription drug plan. | |
| | Store this Booklet-Certificate in a safe place for future reference. |
| | Covered expenses are subject to cost sharing requirements as described in the Cost Sharing sections of this coverage and in your Schedule of Benefits. |
37
38
| | After you pay the applicable copayment , if any, you will be responsible for any applicable coinsurance for covered expenses that you incur. Your coinsurance is based on the negotiated charge . You will not have to pay any balance bills above the negotiated charge for the covered expense . |
39
| | Diabetic needles and syringes. | |
| | Test strips for glucose monitoring and/or visual reading. | |
| | Diabetic test agents. | |
| | Lancets/lancing devices. | |
| | Alcohol swabs. |
40
| | Administration or injection of any drug. | |
| | Any charges in excess of the benefit, dollar, day, or supply limits stated in this Booklet-Certificate. |
| | Have been granted treatment investigational new drug (IND); or Group c/treatment IND status; or | |
| | Are being studied at the Phase III level in a national clinical trial sponsored by the National Cancer Institute; and | |
| | Aetna determines, based on available scientific evidence, are effective or show promise of being effective for the illness. |
41
| | Any charges for the administration or injection of prescription drugs or injectable insulin and other injectable drugs covered by Aetna ; | |
| | Injectable agents, except insulin; | |
| | Needles and syringes, except for diabetic needles and syringes; | |
| | Unless medically necessary, injectable drugs if an alternative oral drug is available. |
42
|
How Your Aetna Dental Plan Works
(GR-9N 16-005-01) |
Common Terms
What the Plan Covers Rules that Apply to the Plan What the Plan Does Not Cover |
| | Definitions you need to know; | |
| | How to access care, including procedures you need to follow; | |
| | What services and supplies are covered and what limits may apply; | |
| | What services and supplies are not covered by the plan; | |
| | How you share the cost of your covered services and supplies; and | |
| | Other important information such as eligibility, complaints and appeals , termination, continuation of coverage and general administration of the plan. |
43
| | The services and supplies must be medically necessary . | |
| | The services and supplies must be covered by the plan. | |
| | You must be covered by the plan when you incur the expense. |
| | A charge is made for an unlisted service given for the dental care of a specific condition; and | |
| | The list includes one of more services that, under standard practices, are separately suitable for the dental care of that condition. |
44
| | Preventive | |
| | Diagnostic | |
| | Restorative | |
| | Oral surgery | |
| | Endodontics | |
| | Periodontics |
| | Pregnancy; | |
| | Coronary artery disease/cardiovascular disease; | |
| | Cerebrovascular disease; or | |
| | Diabetes |
| | One additional prophylaxis (cleaning) per year. | |
| | Scaling and root planing, (4 or more teeth); per quadrant; | |
| | Scaling and root planing (limited to 1-3 teeth); per quadrant; | |
| | Full mouth debridement; | |
| | Periodontal maintenance (one additional treatment per year); and | |
| | Localized delivery of antimicrobial agents. (Not covered for pregnancy) |
45
46
| | While you were covered by the plan, you had a tooth (or teeth) extracted after the existing denture or bridge was installed. As a result, you need to replace or add teeth to your denture or bridge. | |
| | The present crown, inlay and onlay, veneer, complete denture, removable partial denture, fixed partial denture (bridge), or other prosthetic service was installed at least 5 years before its replacement and cannot be made serviceable. | |
| | You had a tooth (or teeth) extracted while you were covered by the plan. Your present denture is an immediate temporary one that replaces that tooth (or teeth). A permanent denture is needed, and the temporary denture cannot be used as a permanent denture. Replacement must occur within 12 months from the date that the temporary denture was installed. |
| | The dentures, bridges or other prosthetic services are needed to replace one or more natural teeth that were removed while you were covered by the plan; and | |
| | The tooth that was removed was not an abutment to a removable or fixed partial denture installed during the prior 5 years. The extraction of a third molar does not qualify. Any such appliance or fixed bridge must include the replacement of an extracted tooth or teeth. |
| | Customarily used nationwide for treatment, and | |
| | Deemed by the dental profession to be appropriate for treatment of the condition in question. The service or supply must meet broadly accepted standards of dental practice, taking into account your current oral condition. |
| | An appliance, or modification of an appliance, if an impression for it was made before you were covered by the plan; | |
| | A crown, bridge, or cast or processed restoration, if a tooth was prepared for it before you were covered by the plan; or | |
| | Root canal therapy, if the pulp chamber for it was opened before you were covered by the plan. |
47
| | Inlays; | |
| | Onlays; | |
| | Crowns; | |
| | Removable bridges; | |
| | Cast or processed restorations; | |
| | Dentures; | |
| | Fixed partial dentures (bridges); and | |
| | Root canals. |
| | For a denture: the impressions from which the denture will be made were taken. | |
| | For a root canal: the pulp chamber was opened. | |
| | For any other item: the teeth which will serve as retainers or supports, or the teeth which are being restored: |
| | Must have been fully prepared to receive the item; and | ||
| | Impressions have been taken from which the item will be prepared. |
| | Diagnosis; | |
| | Applicable therapy; | |
| | Other non-surgical treatment. |
| | Orthodontic treatment; | |
| | Crown, bridges and dentures; | |
| | Treatment of periodontal disease; | |
| | Implants; | |
| | Root canal therapy. |
48
| | It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material; or | |
| | The tooth is an abutment to a covered partial denture or fixed bridge. |
| | Under any other part of this plan; or | |
| | Under any other plan of group benefits provided by the policyholder. |
49
| | Scaling of teeth; and | |
| | Cleaning of teeth. |
| | The plan is discontinued; | |
| | You voluntarily stop your coverage; | |
| | The group policy ends; | |
| | You are no longer eligible for coverage; | |
| | You do not make any required contributions; | |
| | You become covered under another plan offered by your employer; | |
| | You have exhausted your overall maximum lifetime benefit under your medical plan, if your plan contains such a maximum benefit. |
| | You are no longer eligible for dependents coverage; | |
| | You do not make the required contribution toward the cost of dependents coverage; | |
| | Your own coverage ends for any of the reasons listed under When Coverage Ends for Employees (other than exhaustion of your overall maximum lifetime benefit, if included); | |
| | Your dependent is no longer eligible for coverage. In this case, coverage ends at the end of the calendar month when your dependent no longer meets the plans definition of a dependent; or | |
| | Your dependent becomes eligible for comparable benefits under this or any other group plan offered by your employer. |
| | The date this plan no longer allows coverage for domestic partners. | |
| | The date of termination of the domestic partnership. In that event, you should provide your Employer with a completed and signed Declaration of Termination of Domestic Partnership. |
50
| | You were covered at the time of your death, | |
| | Your coverage, at the time of your death, is not being continued after your employment has ended, as provided in the When Coverage Ends section; | |
| | A request is made for continued coverage within 31 days after your death; and | |
| | Payment is made for the coverage. |
| | The end of the 12 month period following your death; | |
| | He or she no longer meets the plans definition of dependent; | |
| | Dependent coverage is discontinued under the group contract; | |
| | He or she becomes eligible for comparable benefits under this or any other group plan; or | |
| | Any required contributions stop; and | |
| | For your spouse, the date he or she remarries. |
| | The date coverage would otherwise terminate; and | |
| | The date you are sent notice by first class mail by your employer of the right to continue; |
51
| | The end of an 18 month period which starts on the date coverage would otherwise terminate. | |
| | The end of a 29 month period which starts on the date your coverage would otherwise terminate; but only if, prior to the end of the above 18 months period, you provide notice to your employer that you have been determined to be disabled under Title II or XVI of the Social Security Act on the date your coverage would have otherwise terminated, except for this continuation. If you are no longer determined to be so disabled, you must notify your employer within 30 days of such determination. In that case, coverage will cease at the start of the month that begins more than 31 days after the date of the final determination that you are no longer so disabled. | |
| | The date you become eligible for like group coverage, including coverage for any preexisting condition. | |
| | The end of the period for which any required contributions have been made. | |
| | Discontinuance of the coverage involved as to employees of the eligible class of which you were a member. | |
| | The date you become enrolled in benefits under Medicare. |
| | he or she is not able to earn his or her own living because of mental retardation or a physical handicap which started prior to the date he or she reaches the maximum age for dependent children under your plan; and | |
| | he or she depends chiefly on you for support and maintenance. |
| | Cessation of the handicap. | |
| | Failure to give proof that the handicap continues. | |
| | Failure to have any required exam. | |
| | Termination of Dependent Coverage as to your child for any reason other than reaching the maximum age under your plan. |
52
| | You are no longer totally disabled, or become covered under any other group plan with like benefits. |
| | Your dependent is no longer totally disabled, or he or she becomes covered under any other group plan with like benefits. |
| | Complete and submit an application for continued health coverage, which is an election notice of your intent to continue coverage. | |
| | Submit your application within 60 days of the qualifying event, or within 60 days of your employers notice of this COBRA continuation right, if later. | |
| | Agree to pay the required premiums. |
53
| Qualifying Event Causing Loss | Covered Persons Eligible to | |||
| of Health Coverage | Elect Continuation | Maximum Continuation Periods | ||
|
Your active employment ends for
reasons other than gross misconduct |
You and your dependents | 18 months | ||
|
Your working hours are reduced
|
You and your dependents | 18 months | ||
|
Your marriage is annulled, you
divorce or legally separate and are no longer responsible for
dependent coverage
|
Your dependents | 36 months | ||
|
You become entitled to benefits
under Medicare
|
Your dependents | 36 months | ||
|
Your covered dependent children
no longer qualify as dependents under the plan |
Your dependent children | 36 months | ||
|
You die
|
Your dependents | 36 months | ||
|
You are a retiree eligible for health
coverage and your former employer
files for bankruptcy
|
You and your dependents | 18 months |
| | Have the right to extend coverage beyond the initial 18 month maximum continuation period. | |
| | Qualify for an additional 11 month period, subject to the overall COBRA conditions. | |
| | Must notify your employer within 60 days of the disability determination status and before the 18 month continuation period ends. | |
| | Must notify the employer within 30 days after the date of any final determination that you or a covered dependent is no longer disabled. | |
| | Are responsible to pay the premiums after the 18 th month, through the 29 th month. |
| | For the 18 or 36 month periods, premiums may never exceed 102 percent of the plan costs. |
| | During the 18 through 29 month period, premiums for coverage during an extended disability period may never exceed 150 percent of the plan costs. |
| | He or she meets the definition of an eligible dependent, | |
| | Your employer is notified about your dependent within 31 days of eligibility, and | |
| | Additional premiums for continuation are paid on a timely basis. |
54
| | You or your covered dependents reach the maximum COBRA continuation period the end of the 18, 29 or 36 months. (Coverage for a newly acquired dependent who has been added for the balance of a continuation period would end at the same time your continuation period ends, if he or she is not disabled nor eligible for an extended maximum). | |
| | You or your covered dependents do not pay required premiums. | |
| | You or your covered dependents become covered under another group plan that does not restrict coverage for pre-existing conditions. If your new plan limits pre-existing condition coverage, the continuation coverage under this plan may remain in effect until the pre-existing clause ceases to apply or the maximum continuation period is reached under this plan. | |
| | The date your employer no longer offers a group health plan. | |
| | The date you or a covered dependent becomes enrolled in benefits under Medicare. This does not apply if it is contrary to the Medicare Secondary Payer Rules or other federal law. | |
| | You or your dependent dies. |
| | At the termination of employment. | |
| | When loss of coverage under the group plan occurs. | |
| | When loss of dependent status occurs. | |
| | At the end of the maximum health coverage continuation period. |
| | You terminate your employment; | |
| | You are no longer in an eligible class; | |
| | Your dependent no longer qualifies as an eligible dependent; | |
| | Any continuation coverage required under federal or state law has ended; or | |
| | You retire and there is no medical coverage available. |
| | You only; or | |
| | You and all dependents who are covered under the group plan at the time your coverage ended; or | |
| | Your covered dependents, if you should die before you retire. |
55
| | Required by law or regulation for group conversion purposes in your or your dependents states of residence; and | |
| | Offered by Aetna when you or your dependents apply under your employers conversion plan. |
| | Plan I: Hospital room and board expense benefits of $130 per day. The maximum duration is 30 days. Miscellaneous hospital expense benefits to a maximum of $1,300. Surgical operation expense benefits according to a $1,400 maximum benefits schedule. | |
| | Plan II: Hospital room and board expense benefits of $230 per day. The maximum duration is 30 days. Miscellaneous hospital expense benefits to a maximum of $2,300. Surgical operation expense benefits according to a $2,400 maximum benefits schedule. | |
| | Plan III: Hospital room and board expense benefits of $330 per day. The maximum duration is 70 days. Miscellaneous hospital expense benefits to a maximum of $3,300. Surgical operation expense benefits according to a $3,500 maximum benefits schedule. |
| | Plan IV: Major medical expense benefits providing: (a) a $330 per day hospital room and board benefit; (b) surgical expense benefits according to a $4,500 maximum benefits schedule; (c) a $200,000 maximum benefit for all sicknesses and injuries; (d) a deductible of $1,000; (e) an 80% benefit percentage, with a coinsurance limit of $2,000; and (f) an annual restoration benefit of $5,000. |
| | Reduce its benefits by any like benefits payable under your group plan after coverage ends (for example: if benefits are paid after coverage ends because of a disability extension of benefits); | |
| | Not guarantee renewal under selected conditions described in the policy; | |
| | Require a statement that Aetna may ask for data about your coverage under any other plan. This may be asked for on any premium due date for the individual policy. If you do not give the data, expenses covered under the individual policy may be reduced by expenses which are covered or provided under those plans. |
| | You or your dependents are eligible for Medicare. Covered dependents not eligible for Medicare may apply for individual coverage even if you are eligible for Medicare. | |
| | Coverage under the plan has been in effect for less than three months. | |
| | A lifetime maximum benefit under this plan has been reached. For example: |
| | If a covered dependent reaches the group plans lifetime maximum benefit, the covered dependent will not have the right to convert. If you or your dependents have remaining benefits, you are eligible to convert. | ||
| | If you have reached your lifetime maximum, you will not be able to convert. However, if a dependent has a remaining benefit, he or she is eligible to convert. |
| | You or your covered dependents become eligible for any other medical coverage under this plan. | |
| | You apply for individual coverage in a jurisdiction where Aetna cannot issue or deliver an individual conversion policy. |
56
| | You or your covered dependents are eligible for, or have benefits available under, another plan that, in addition to the converted policy, would either match benefits or result in over insurance. Examples include: |
| | Any other hospital or surgical expense insurance policy; | ||
| | Any hospital service or medical expense indemnity corporation subscriber contract; | ||
| | Any other group contract; or | ||
| | Any statute, welfare plan or program. |
| | Get a copy of the Notice of Conversion Privilege and Request form from your employer. | |
| | Complete and send the form to Aetna at the specified address. |
57
|
Coordination of Benefits What
Happens When There is More
Than One Health Plan
|
When Coordination of Benefits Applies
Getting Started Important Terms |
|||
|
|
||||
|
(GR-9N 33-005-01-NY)
|
Which Plan Pays First | |||
|
|
||||
|
|
How Coordination of Benefits Works |
| | If a covered person is confined in a private hospital room, the difference between the cost of a semi-private room in the hospital and the private room (unless the patients stay in the private room is medically necessary in terms of generally accepted medical practices, or one of the Plans routinely provides coverage of hospital private rooms) is not an allowable expense. |
58
| | Group or nongroup, blanket, or franchise health insurance policies issued by insurers, including health care service contractors; | |
| | Other prepaid coverage under service plan contracts, or under group or individual practice; | |
| | Uninsured arrangements of group or group-type coverage; | |
| | Labor-management trustee plans, labor organization plans, employer organization plans, or employee benefit organization plans; | |
| | Medical benefits coverage in a group, group-type, and individual automobile no-fault and traditional automobile fault type contracts; | |
| | Medicare or other governmental benefits; | |
| | Other group-type contracts. Group type contracts are those which are not available to the general public and can be obtained and maintained only because membership in or connection with a particular organization or group. |
| | A plan with no rules for coordination with other benefits will be deemed to pay its benefits before a plan which contains such rules. | |
| | A plan which covers a person as other than a dependent will be deemed to pay its benefits before a plan which covers the person as a dependent. |
| 1. | Except in the case of a dependent child whose parents are divorced or separated; the plan which covers the person as a dependent of a person whose birthday comes first in a calendar year will be primary to the plan which covers a person as a dependent of a person whose birthday comes later in the year; however: |
| (a) | if both parents have the same birthday, the benefits of the plan which covered the parent longer are determined before those of the plan which covered the other parent for a shorter period of time; | ||
| (b) | if the other plan does not have the rules described above, but instead has a rule based on the gender of the parent, and if, as a result, the plans do not agree on the order of benefit, the rule in the other plan will determine the order of benefits. |
59
| 2. | In the case of a dependent child whose parents are divorces or separated: |
| (a) | If there is a court decree which makes one parent financially responsible for the health care expenses with respect to the child and the entity obligated to pay or provide the benefits of that parent has actual knowledge of those terms, the benefits of that plan which covers the child as a dependent of such parent shall be determined before the benefits of any other plan which covers the child as a dependent child. | ||
| (b) | If there is no such court decree, the order of benefits is: |
| | The plan of the custodial parent; | ||
| | The plan of the spouse of the custodial parent ; | ||
| | The plan of the non custodial parent ; and then |
| 3. | Active Employee or Retired or Laid off Employee. The plan that covers a person as an employee who is neither laid off nor retired or as a dependent of an active employee, is the primary plan. The plan covering that same person as a retired or laid off employee or as a dependent of a retired or laid off employee is the secondary plan. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule is ignored. This rule will not apply if the Non-Dependent or Dependent rules above determine the order of benefits. | ||
| 4. | Longer or Shorter Length of Coverage. The plan that covered the person as an employee, member, subscriber longer is primary. | ||
| 5. | If the preceding rules do not determine the primary plan, the allowable expenses shall be shared equally between the plans meeting the definition of plan under this provision. In addition, This Plan will not pay more than it would have paid had it been primary. |
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When You Have Medicare Coverage
|
Which Plan Pays First | |||
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(GR-9N 33-020-01)
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How Coordination with Medicare Works | |||
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What is Not Covered |
| | Covered under it by reason of age, disability, or | |
| | End Stage Renal Disease; or | |
| | Not covered under it because you: |
| 1. | Refused it; | ||
| 2. | Dropped it; or | ||
| 3. | Failed to make a proper request for it. |
| | Solely due to age if the plan is subject to the Social Security Act requirements for Medicare with respect to working aged (i.e., generally a plan of an employer with 20 or more employees); | |
| | Due to diagnosis of end stage renal disease, but only during the first 30 months of such eligibility for Medicare benefits. This provision does not apply if, at the start of eligibility, you were already eligible for Medicare benefits, and the plan s benefits were payable on a secondary basis; | |
| | Solely due to any disability other than end stage renal disease; but only if the plan meets the definition of a large group health plan as outlined in the Internal Revenue Code (i.e., generally a plan of an employer with 100 or more employees). |
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| | This Booklet-Certificate applies to coverage only, and does not restrict your ability to receive health care services that are not, or might not be, covered. | |
| | You cannot receive multiple coverage under the plan because you are connected with more than one employer. | |
| | This document describes the main features of the plan. Additional provisions are described elsewhere in the group policy . If you have any questions about the terms of the plan or about the proper payment of benefits, contact your employer or Aetna . | |
| | Your employer hopes to continue the plan indefinitely but, as with all group plans, the plan may be changed or discontinued with respect to your coverage. |
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| | The benefits due under this group insurance policy; | |
| | The right to receive payments due under this group insurance policy; or | |
| | Any claim you make for damages resulting from a breach or alleged breach, of the terms of this group insurance policy. |
| | No statement made by the Policyholder or you or your dependent shall be the basis for voiding coverage or denying coverage or be used in defense of a claim unless it is in writing after it has been in force for 2 years from its effective date. | |
| | No statement made by the Policyholder shall be the basis for voiding this Policy after it has been in force for 2 years from its effective date. | |
| | No statement made by you, an eligible employee or your dependent shall be used in defense of a claim for loss incurred or starting after coverage as to which claim is made has been in effect for 2 years. |
| | To require the return of the overpayment; or | |
| | To reduce by the amount of the overpayment, any future benefit payment made to or on behalf of that person or another person in his or her family. |
65
| | Names of physicians , dentists and others who furnish services. | |
| | Dates expenses are incurred. | |
| | Copies of all bills and receipts. |
66
| | If the HMO Plan provides medical coverage, you will be excluded from medical expense coverage (except Vision Care, if any,) on the date of your coverage under such HMO Plan. | |
| | If the HMO Plan provides dental coverage, you will be excluded from dental expense coverage on the date of your coverage under such HMO Plan. |
| | Live in an HMO Plan enrollment area and choose to change coverage during an open enrollment period, coverage will take effect on the group policy anniversary date after the open enrollment period. There will be no rules for waiting periods or preexisting conditions. | |
| | Live in an HMO Plan enrollment area and choose to change coverage when there is not an open enrollment period, coverage will take effect only if and when Aetna gives its written consent. | |
| | Move from an HMO Plan enrollment area or if the HMO discontinues and you choose to change coverage within 31 days of the move or the discontinuance, coverage will take effect on the date you elect such coverage. There will be no restrictions for waiting periods or preexisting conditions. If you choose to change coverage after 31 days, coverage will take effect only if and when Aetna gives its written consent. |
| | The end of a 90 day period; and | |
| | The date the person is not confined. |
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| | The calendar year in which you become covered under any Comprehensive Medical Plan section of this plan; or | |
| | The last 3 months of the calendar year right before the year your coverage takes effect. |
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| | Hospitals ; | |
| | Psychiatric hospitals ; | |
| | Residential treatment facilities ; | |
| | Psychiatric physicians ; | |
| | Psychologists; | |
| | Social workers; | |
| | Psychiatric nurses; | |
| | Addictionologists; and | |
| | Other alcoholism, drug abuse and mental health providers or groups, involved in the delivery of health care or ancillary services. |
| | Meets licensing standards. | |
| | Is set up, equipped and run to provide prenatal care, delivery and immediate postpartum care. | |
| | Charges for its services. | |
| | Is directed by at least one physician who is a specialist in obstetrics and gynecology. |
69
| | Has a physician or certified nurse midwife present at all births and during the immediate postpartum period. | |
| | Extends staff privileges to physicians who practice obstetrics and gynecology in an area hospital . | |
| | Has at least 2 beds or 2 birthing rooms for use by patients while in labor and during delivery. | |
| | Provides, during labor, delivery and the immediate postpartum period, full-time skilled nursing services directed by an R.N. or certified nurse midwife. | |
| | Provides, or arranges with a facility in the area for, diagnostic X-ray and lab services for the mother and child. | |
| | Has the capacity to administer a local anesthetic and to perform minor surgery. This includes episiotomy and repair of perineal tear. | |
| | Is equipped and has trained staff to handle emergency medical conditions and provide immediate support measures to sustain life if: |
| | Complications arise during labor; or | ||
| | A child is born with an abnormality which impairs function or threatens life. |
| | Accepts only patients with low-risk pregnancies. | |
| | Has a written agreement with a hospital in the area for emergency transfer of a patient or a child. Written procedures for such a transfer must be displayed and the staff must be aware of them. | |
| | Provides an ongoing quality assurance program. This includes reviews by physicians who do not own or direct the facility. | |
| | Keeps a medical record on each patient and child. |
| | Coinsurance limit is the maximum out-of-pocket amount you are responsible to pay for coinsurance for covered expenses during your calendar year. Once you satisfy the coinsurance limit , the plan will pay 100% of the covered expenses that apply toward the limit for the rest of the calendar year. |
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| | Health coverage issued on a group or individual basis; | |
| | Medicare; | |
| | Medicaid; | |
| | Health care for members of the uniformed services; | |
| | A program of the Indian Health Service or tribal organization; | |
| | A state health benefits risk pool; | |
| | The Federal Employees Health Benefit Plan (FEHBP); | |
| | A public health plan (any plan established by a State, the government of the United States, or any subdivision of a State or of the government of the United States, or a foreign country); | |
| | Any health benefit plan under Section 5(e) of the Peace Corps Act; and | |
| | The State Childrens Health Insurance Program (S-Chip). |
| | by whom they are prescribed; | |
| | by whom they are recommended; or | |
| | by whom they are performed. |
| | Any dentist ; | |
| | Group; | |
| | Organization; |
71
| | Dental facility; or | |
| | Other institution or person. |
| | Occurs unexpectedly; | |
| | Requires immediate diagnosis and treatment in order to stabilize the condition; and | |
| | Is characterized by symptoms such as severe pain and bleeding. |
| | Intoxicating alcohol or drug; | |
| | Alcohol or drug-dependent factors; or | |
| | Alcohol in combination with drugs; |
| | Made to withstand prolonged use; | |
| | Made for and mainly used in the treatment of a illness or injury ; | |
| | Suited for use in the home; | |
| | Not normally of use to people who do not have a illness or injury ; | |
| | Not for use in altering air quality or temperature; and | |
| | Not for exercise or training. |
72
| | Placing your health in serious jeopardy; or | |
| | In the case of a behavioral condition, placing the health of such person, or others, in serious jeopardy; or | |
| | Serious impairment to bodily function; or | |
| | Serious dysfunction of a body part or organ; or | |
| | Serious disfigurement of such person; or | |
| | In the case of a pregnant woman, serious jeopardy to the health of the fetus. |
| | There are insufficient outcomes data available from controlled clinical trials published in the peer-reviewed literature to substantiate its safety and effectiveness for the illness or injury involved; or | |
| | Approval required by the FDA has not been granted for marketing; or | |
| | A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental or investigational , or for research purposes; or | |
| | It is a type of drug, device or treatment that is the subject of a Phase I or Phase II clinical trial or the experimental or research arm of a Phase III clinical trial, using the definition of phases indicated in regulations and other official actions and publications of the FDA and Department of Health and Human Services; or | |
| | The written protocol or protocols used by the treating facility, or the protocol or protocols of any other facility studying substantially the same drug, device, procedure, or treatment, or the written informed consent used by the treating facility or by another facility studying the same drug, device, procedure, or treatment states that it is experimental or investigational , or for research purposes. |
| | Due to an illness or injury which makes leaving the home medically contraindicated; or | |
| | Because the act of transport would be a serious risk to your life or health. |
| | You do not often travel from home because of feebleness or insecurity brought on by advanced age (or otherwise); or | |
| | You are wheelchair bound but could safely be transported via wheelchair accessible transportation. |
73
| | Mainly provides skilled nursing and other therapeutic services. | |
| | Is associated with a professional group (of at least one physician and one R.N. ) which makes policy. | |
| | Has full-time supervision by a physician or an R.N. | |
| | Keeps complete medical records on each person. | |
| | Has an administrator. | |
| | Meets licensing standards. |
| | Prescribed in writing by the attending physician ; and | |
| | An alternative to a hospital or skilled nursing facility stay . |
| | Has hospice care available 24 hours a day. | |
| | Meets any licensing or certification standards established by the jurisdiction where it is located. | |
| | Provides: |
| | Skilled nursing services ; | ||
| | Medical social services; and | ||
| | Psychological and dietary counseling. |
| | Provides, or arranges for, other services which include: |
| | Physician services; | ||
| | Physical and occupational therapy; | ||
| | Part-time home health aide services which mainly consist of caring for terminally ill people; and | ||
| | Inpatient care in a facility when needed for pain control and acute and chronic symptom management. |
| | Has at least the following personnel: |
| | One physician ; | ||
| | One R.N. ; and | ||
| | One licensed or certified social worker employed by the agency. |
| | Establishes policies about how hospice care is provided. | |
| | Assesses the patients medical and social needs. | |
| | Develops a hospice care program to meet those needs. | |
| | Provides an ongoing quality assurance program. This includes reviews by physicians , other than those who own or direct the agency. | |
| | Permits all area medical personnel to utilize its services for their patients. | |
| | Keeps a medical record on each patient. | |
| | Uses volunteers trained in providing services for non-medical needs. | |
| | Has a full-time administrator. |
74
| | Is established by and reviewed from time to time by a physician attending the person, and appropriate personnel of a hospice care agency ; | |
| | Is designed to provide palliative and supportive care to terminally ill persons, and supportive care to their families; and | |
| | Includes an assessment of the persons medical and social needs; and a description of the care to be given to meet those needs. |
| | Mainly provides inpatient hospice care to terminally ill persons. | |
| | Charges patients for its services. | |
| | Meets any licensing or certification standards established by the jurisdiction where it is located. | |
| | Keeps a medical record on each patient. | |
| | Provides an ongoing quality assurance program including reviews by physicians other than those who own or direct the facility. | |
| | Is run by a staff of physicians . At least one staff physician must be on call at all times. | |
| | Provides 24-hour-a-day nursing services under the direction of an R.N. | |
| | Has a full-time administrator. |
| | Is primarily engaged in providing, by or under the continuous supervision of physicians , to inpatients, diagnostic services and therapeutic services for diagnostic, treatment and care of injured and sick persons; | |
| | Has organized departments of medicine and major surgery; | |
| | Has a requirement that every patient must be under the care of a physician or dentist; | |
| | Provides 24 hour nursing service by or under the supervision of a registered professional nurse (R.N.); | |
| | If located in New York State, has in effect a hospitalization review plan applicable to all patients which meets at least the standards set forth in Section 1861k of U.S. Public Law 89-97 (42 USCA 1395x(k)); | |
| | Is duly licensed by the agency responsible for licensing such hospitals; | |
| | Makes charges; and | |
| | Is not, other than incidentally, a place for rest, a place primarily for the treatment of tuberculosis, a place for the aged, a place for drug addicts, alcoholics, or a place for convalescent, custodial, educational or rehabilitative care. |
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| | For a woman who is 21 or more but less than 35 years of age : 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or | |
| | For a woman who is 35 years of age or older, but less than 45 : 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination. |
| | An unexpected or reasonably unforeseen occurrence or event; or | |
| | The reasonable unforeseeable consequences of a voluntary act by the person. | |
| | An act or event must be definite as to time and place. |
| | A Temporomandibular Joint (TMJ) dysfunction or any similar disorder of the jaw joint; or | |
| | A Myofacial Pain Dysfunction (MPD); or | |
| | Any similar disorder in the relationship between the jaw joint and the related muscles and nerves. |
76
| | Are furnished mainly to maintain, rather than to improve, a level of physical, or mental function; and | |
| | Provide a surrounding free from exposures that can worsen the persons physical or mental condition. |
| a) | In accordance with generally accepted standards of medical or dental practice; | |
| b) | Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patients illness , injury or disease; and | |
| c) | Not primarily for the convenience of the patient, physician , other health care or dental provider ; and | |
| d) | Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patients illness , injury , or disease. |
| | Alcoholism and substance abuse. | |
| | Bipolar disorder. | |
| | Major depressive disorder. | |
| | Obsessive compulsive disorder. | |
| | Panic disorder. | |
| | Pervasive Mental Developmental Disorder (Autism). | |
| | Psychotic depression. | |
| | Schizophrenia. |
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| | The service or supply involved; and | |
| | The class of employees to which you belong. |
| | 8 hours in a row a night; and | |
| | 5 nights a week. |
| | Arise out of (or in the course of) any work for pay or profit; or | |
| | Result in any way from an illness that does. |
| | Is covered under any type of workers compensation law; and | |
| | Is not covered for that illness under such law. |
| | Arise out of (or in the course of) any work for pay or profit; or | |
| | Result in any way from an injury which does. |
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| | Arises out of (or in the course of) any activity in connection with employment or self-employment whether or not on a full time basis; or | |
| | Results in any way from an injury or illness that does. |
| | Receives no medical treatment; services; or supplies; for a disease or injury ; and | |
| | Neither takes any medication, nor has any medication prescribed, for a disease or injury . |
| | Medical service or supply; or | |
| | Dental service or supply; |
| | Of the teeth; or | ||
| | Of the bite; or | ||
| | Of the jaws or jaw joint relationship; |
| | The installation of a space maintainer; or | |
| | A surgical procedure to correct malocclusion. |
| | It is carried out in a hospital ; psychiatric hospital or residential treatment facility ; on less than a full-time inpatient basis. | |
| | It is in accord with accepted medical practice for the condition of the person. | |
| | It does not require full-time confinement. | |
| | It is supervised by a psychiatric physician who weekly reviews and evaluates its effect. | |
| | Day care treatment and night care treatment are considered partial confinement treatment . |
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| | Has an M.D. or D.O. degree; | |
| | Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices; and | |
| | Provides medical services which are within the scope of his or her license or certificate. |
| | Is properly licensed or certified to provide medical care under the laws of the jurisdiction where he or she practices; | |
| | Provides medical services which are within the scope of his or her license or certificate; | |
| | Under applicable insurance law is considered a physician for purposes of this coverage; | |
| | Has the medical training and clinical expertise suitable to treat your condition; | |
| | Specializes in psychiatry, if your illness or injury is caused, to any extent, by alcohol abuse, substance abuse or a mental disorder; and | |
| | A physician is not you or related to you. |
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| | An injectable drug prescribed to be self-administered or administered by any other person except one who is acting within his or her capacity as a paid healthcare professional. Covered injectable drugs include injectable insulin. |
| | Mainly provides a program for the diagnosis, evaluation, and treatment of alcoholism, substance abuse or mental disorders . | |
| | Is not mainly a school or a custodial, recreational or training institution. | |
| | Provides infirmary-level medical services. Also, it provides, or arranges with a hospital in the area for, any other medical service that may be required. | |
| | Is supervised full-time by a psychiatric physician who is responsible for patient care and is there regularly. | |
| | Is staffed by psychiatric physicians involved in care and treatment. | |
| | Has a psychiatric physician present during the whole treatment day. | |
| | Provides, at all times, psychiatric social work and nursing services. | |
| | Provides, at all times, skilled nursing services by licensed nurses who are supervised by a full-time R.N. | |
| | Prepares and maintains a written plan of treatment for each patient based on medical, psychological and social needs. The plan must be supervised by a psychiatric physician . | |
| | Makes charges. | |
| | Meets licensing standards. |
| | Specializes in psychiatry; or | |
| | Has the training or experience to do the required evaluation and treatment of alcoholism, substance abuse or mental disorders . |
| | On-site licensed Behavioral Health Provider 24 hours per day/7 days a week. | |
| | Provides a comprehensive patient assessment (preferably before admission, but at least upon admission). | |
| | Is admitted by a Physician . | |
| | Has access to necessary medical services 24 hours per day/7 days a week. | |
| | If the member requires detoxification services, must have the availability of on-site medical treatment 24 hours per day/7days a week, which must be actively supervised by an attending Physician . |
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| | Provides living arrangements that foster community living and peer interaction that are consistent with developmental needs. | |
| | Offers group therapy sessions with at least an RN or Masters-Level Health Professional. | |
| | Has the ability to involve family/support systems in therapy (required for children and adolescents; encouraged for adults). | |
| | Provides access to at least weekly sessions with a Psychiatrist or psychologist for individual psychotherapy. | |
| | Has peer oriented activities. | |
| | Services are managed by a licensed Behavioral Health Provider who, while not needing to be individually contracted, needs to (1) meet the Aetna credentialing criteria as an individual practitioner, and (2) function under the direction/supervision of a licensed psychiatrist (Medical Director). | |
| | Has individualized active treatment plan directed toward the alleviation of the impairment that caused the admission. | |
| | Provides a level of skilled intervention consistent with patient risk. | |
| | Meets any and all applicable licensing standards established by the jurisdiction in which it is located. | |
| | Is not a Wilderness Treatment Program or any such related or similar program, school and/or education service. | |
| | Ability to assess and recognize withdrawal complications that threaten life or bodily functions and to obtain needed services either on site or externally. | |
| | 24-hours perday/7 days a week supervision by a physician with evidence of close and frequent observation. | |
| | On-site, licensed Behavioral Health Provider , medical or substance abuse professionals 24 hours per day/7 days a week. |
| | Has, on-site licensed Behavioral Health Provider 24 hours per day. | |
| | Provides a comprehensive patient assessment. | |
| | Provides living arrangements that foster community living and peer interaction that are consistent with developmental needs. | |
| | Offers group therapy sessions. | |
| | Has the ability to involve family/support systems in therapy. | |
| | Provides access to at least weekly sessions with a Psychiatrist or psychologist for individual psychotherapy. | |
| | Has peer oriented activities. | |
| | Is managed by a licensed Behavioral Health Provider who functions under the direction and supervision of a psychiatric physician . | |
| | Has individualized active treatment plan directed toward the alleviation of the impairment that caused the admission. | |
| | Provides a level of skilled intervention consistent with patient risk. | |
| | Provides active discharge planning initiated upon admission to the program. | |
| | Meets any and all applicable licensing standards established by the jurisdiction in which it is located. |
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| | It is licensed to provide, and does provide, the following on an inpatient basis for persons convalescing from illness or injury : |
| | Professional nursing care by an R.N. , or by a L.P.N. directed by a full-time R.N. ; and | ||
| | Physical restoration services to help patients to meet a goal of self-care in daily living activities. |
| | Provides 24 hour a day nursing care by licensed nurses directed by a full-time R.N. | |
| | Is supervised full-time by a physician or an R.N. | |
| | Keeps a complete medical record on each patient. | |
| | Has a utilization review plan. | |
| | Is not mainly a place for rest, for the aged, for drug addicts, for alcoholics, for mental retardates, for custodial or educational care, or for care of mental disorder s. | |
| | Charges patients for its services. | |
| | An institution or a distinct part of an institution that meets all of the following requirements: |
| | It is licensed or approved under state or local law. | ||
| | Is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. |
| | Qualifies as a skilled nursing facility under Medicare or as an institution accredited by : |
| | The Joint Commission on Accreditation of Health Care Organizations; | ||
| | The Bureau of Hospitals of the American Osteopathic Association; or | ||
| | The Commission on the Accreditation of Rehabilitative Facilities |
| | Institutions which provide only: |
| | Minimal care; | ||
| | Custodial care services; | ||
| | Ambulatory; or | ||
| | Part-time care services. |
| | Institutions which primarily provide for the care and treatment of alcoholism, substance abuse or mental disorders . |
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| | The services require medical or paramedical training. | |
| | The services are rendered by an R.N. or L.P.N. within the scope of his or her license. | |
| | The services are not custodial. |
| | Meets licensing standards. | |
| | Is set up, equipped and run to provide general surgery. | |
| | Charges for its services. | |
| | Is directed by a staff of physicians . At least one of them must be on the premises when surgery is performed and during the recovery period. | |
| | Has at least one certified anesthesiologist at the site when surgery requiring general or spinal anesthesia is performed and during the recovery period. |
| | Extends surgical staff privileges to: |
| | Physicians who practice surgery in an area hospital ; and | ||
| | Dentists who perform oral surgery. |
| | Has at least 2 operating rooms and one recovery room. | |
| | Provides, or arranges with a medical facility in the area for, diagnostic x-ray and lab services needed in connection with surgery. |
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| | Does not have a place for patients to stay overnight. | |
| | Provides, in the operating and recovery rooms, full-time skilled nursing services directed by an R.N. | |
| | Is equipped and has trained staff to handle emergency medical conditions . |
| | A physician trained in cardiopulmonary resuscitation; and | |
| | A defibrillator; and | |
| | A tracheotomy set; and | |
| | A blood volume expander. | |
| | Has a written agreement with a hospital in the area for immediate emergency transfer of patients. | |
| | Written procedures for such a transfer must be displayed and the staff must be aware of them. | |
| | Physician s who do not own or direct the facility. | |
| | Keeps a medical record on each patient. |
| | The onset of or change in a illness ; or | |
| | The diagnosis of a illness ; or | |
| | An injury . | |
| | The condition, while not needing an emergency admission , is severe enough to require confinement as an inpatient in a hospital within 2 weeks from the date the need for the confinement becomes apparent. |
| | A freestanding medical facility that meets all of the following requirements. |
| | Provides unscheduled medical services to treat an urgent condition if the persons physician is not reasonably available. | ||
| | Routinely provides ongoing unscheduled medical services for more than 8 consecutive hours. | ||
| | Makes charges. | ||
| | Is licensed and certified as required by any state or federal law or regulation. | ||
| | Keeps a medical record on each patient. | ||
| | Provides an ongoing quality assurance program. This includes reviews by physicians other than those who own or direct the facility. | ||
| | Is run by a staff of physicians . At least one physician must be on call at all times. | ||
| | Has a full-time administrator who is a licensed physician . |
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| | A physician s office, but only one that: |
| | Has contracted with Aetna to provide urgent care; and | ||
| | Is, with Aetna s consent, included in the directory as a network urgent care provider . |
| | It is not the emergency room or outpatient department of a hospital . |
| | Is severe enough to require prompt medical attention to avoid serious deterioration of your health; | |
| | Includes a condition which would subject you to severe pain that could not be adequately managed without urgent care or treatment; | |
| | Does not require the level of care provided in the emergency room of a hospital; and | |
| | Requires immediate outpatient medical care that cannot be postponed until your physician becomes reasonably available. |
86
| | the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory; or | |
| | the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington D.C. 20210. |
| (1) | reconstruction of the breast on which a mastectomy has been performed; | |
| (2) | surgery and reconstruction of the other breast to produce a symmetrical appearance; | |
| (3) | prostheses; and | |
| (4) | treatment of physical complications of all stages of mastectomy, including lymphedemas. |
|
POLICY WITH RIDERHOLDER
|
CITIZENS BANK OF RHODE ISLAND, AS TRUSTEE OF THE STRATEGIC GROUP UNIVERSAL LIFE TRUST | |
|
|
||
|
INSURER
|
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | |
|
|
||
|
EFFECTIVE DATE
|
JANUARY 1, 1998 | |
|
|
||
|
STATE OF ISSUE
|
RHODE ISLAND | |
|
|
||
|
POLICY WITH RIDER
NUMBER
|
002 |
|
|
|
|
| President | Secretary |
| | The right to assign the certificate with rider. | ||
| | The right to change the Owner or any Beneficiary. | ||
| | The right to fully surrender the insurance. | ||
| | The right to make withdrawals. | ||
| | The right to make loans. | ||
| | The right to increase or decrease the Selected Face Amount. | ||
| | The right to allocate net premiums among the Guaranteed Principal Account and the divisions of the Separate Account. | ||
| | The right to transfer values among the Guaranteed Principal Account and the divisions of the Separate Account. | ||
| | The right to change the Death Benefit Option. |
| Page No. | ||||
|
Part 1.
The Basics Of This Policy With Rider
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1 | |||
|
The Parties Involved
|
1 | |||
|
Insurer
|
1 | |||
|
Policy With Riderholder
|
1 | |||
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Employer
|
1 | |||
|
Owner
|
1 | |||
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Insured
|
1 | |||
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Beneficiary
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1 | |||
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Irrevocable Beneficiary
|
1 | |||
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Group Life Insurance Certificates With Riders
|
1 | |||
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Dates Certificate Date, Certificate Anniversary Date,
Certificate Year, Rider Add-On Date, Issue Date,
Paid-Up Certificate Date, Monthly Calculation Date,
Valuation Date, Valuation Period, Valuation Time
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2 | |||
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Entire Contract
|
2 | |||
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Eligibility
|
3 | |||
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Effective Date
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3 | |||
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Termination of The Policy With Rider
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3 | |||
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Discontinuance of Policy With Rider
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3 | |||
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Continuation Of Insurance
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4 | |||
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Representations And Contestability
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4 | |||
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Misstatement Of Age
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4 | |||
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Meaning Of In Force
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4 | |||
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Home Office
|
5 | |||
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Part 2.
Premium Payments
|
5 | |||
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Minimum Initial Premium
|
5 | |||
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Modal Term
|
5 | |||
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Modal Term Premium
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5 | |||
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Premium Flexibility And Premium Notices
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6 | |||
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Where To Pay Premiums
|
6 | |||
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Right To Refund Premiums
|
6 | |||
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Part 3.
Accounts, Values, And Charges
|
6 | |||
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Net Premium
|
6 | |||
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Allocation Of Net Premiums
|
6 | |||
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The Separate Account
|
7 | |||
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Changes In The Separate Account
|
7 | |||
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Accumulation Units
|
8 | |||
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Purchase And Sale Of Accumulation Units
|
8 | |||
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Account Value Of Certificate With Rider
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8 | |||
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Variable Account Value Of Certificate With Rider
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8 | |||
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Fixed Account Value Of Certificate With Rider
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9 | |||
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The Guaranteed Principal Account
|
9 | |||
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Interest On Fixed Account Value
|
9 | |||
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Monthly Charges
|
10 | |||
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Grace Period And Termination
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11 | |||
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Part 4.
Life Benefits
|
11 | |||
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Certificate With Rider Ownership
|
11 | |||
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Rights Of Owner
|
11 | |||
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Assignment
|
11 | |||
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Changing The Owner Or Beneficiary
|
12 | |||
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Transfers Of Values
|
12 | |||
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The Certificate With Riders Share In Dividends
|
12 | |||
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Certificate With Rider Is Participating
|
12 | |||
| Page No. | ||||
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How Dividends May Be Used
|
13 | |||
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Dividend After Death
|
13 | |||
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Surrendering The Certificate With Rider And Making
Withdrawals
|
13 | |||
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Right To Surrender
|
13 | |||
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Cash Surrender Value
|
13 | |||
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Making Withdrawals
|
13 | |||
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How We Pay
|
14 | |||
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Borrowing On The Certificate With Rider
|
15 | |||
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Right To Make Loans
|
15 | |||
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Effect Of Loan
|
15 | |||
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Maximum Loan Available
|
15 | |||
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Interest
|
16 | |||
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Certificate With Rider Debt Limit
|
17 | |||
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Repayment Of Certificate With Rider Debt
|
17 | |||
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Other Borrowing Rules
|
17 | |||
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Reinstating The Certificate With Rider
|
18 | |||
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When Reinstatement Can Be Made
|
18 | |||
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Requirements To Reinstate
|
18 | |||
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Changes In the Selected Face Amount
|
18 | |||
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Increases In The Selected Face Amount
|
18 | |||
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Limitations On Increases
|
18 | |||
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Evidence Of Increases
|
18 | |||
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Decreases In The Selected Face Amount
|
19 | |||
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Right To Amend
|
19 | |||
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Amending The Certificate With Rider
|
19 | |||
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Reports To Owner
|
19 | |||
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Annual Report
|
19 | |||
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Illustrative Report
|
19 | |||
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Part 5.
The Death Benefit
|
20 | |||
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Amount Of Death Benefit
|
20 | |||
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Death Benefit Options
|
20 | |||
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Minimum Face Amount
|
20 | |||
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Changes In The Death Benefit Option
|
21 | |||
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When We Pay
|
21 | |||
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Interest On Death Benefit
|
21 | |||
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Suicide Exclusion
|
21 | |||
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Part 6.
Payment Options
|
22 | |||
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Availability Of Options
|
22 | |||
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Minimum Amounts
|
22 | |||
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Description Of Options
|
22 | |||
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Electing A Payment Option
|
27 | |||
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Effective Date And Payment Dates
|
27 | |||
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Withdrawals And Changes
|
27 | |||
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Income Protection
|
27 | |||
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Part 7.
Notes On Our Computations
|
28 | |||
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Net Investment Factor
|
28 | |||
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Accumulation Unit Value
|
28 | |||
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Adjustments Of Units And Values
|
28 | |||
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Basis Of Computation
|
28 | |||
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Method Of Computing Values
|
29 | |||
|
Any Riders and Endorsements For This Policy With
Rider Follow Page 29
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MassMutual
The Blue Chip Company SM Massachusetts Mutual Life Insurance Company Springfield, MA 01111-0001 |
| | Executing a Participation Agreement; and | ||
| | Meeting the conditions for participation that are specified in that Agreement. This includes applying for insurance under the policy for certain of the employers employees who meet eligibility requirements established by the Employer. |
| Example: | Debbie is named as primary (first) Beneficiary. Anne and Scott are named as Beneficiaries in the secondary class. If Debbie is alive when the Insured dies, she receives the death benefit. But if Debbie is dead and Anne and Scott are alive when the Insured dies, Anne and Scott receive the death benefit. |
1
| Example: | The Certificate Date is June 10, 19X1. The first Certificate Anniversary Date is June 10, 19X2. The period from June 10, 19X1 through June 9, 19X2 is a Certificate Year. |
2
| | This policy with rider and the application for it; | ||
| | The applications for the certificates with riders; and | ||
| | Any rider(s) attached to any certificates with riders issued under this policy with rider. |
| | The word policy with rider as it applies to a certificate with rider shall mean certificate with rider; | ||
| | The words Policy Date as they apply to a certificate with rider shall mean Certificate Date; and | ||
| | The words Policy Anniversary Date as they apply to a certificate with rider shall mean Certificate Anniversary Date. |
| | the Policy With Riderholder gives us 30 days written notice requesting that the policy with rider be discontinued; or | ||
| | we give the Policy With Riderholder written notice of discontinuance at least 30 days prior to the date we discontinue the policy with rider. |
3
| | The account value less any certificate with rider debt is sufficient to cover the monthly charges due on each Monthly Calculation Date; and | ||
| | Certificate with rider debt does not exceed the account value; and | ||
| | The certificate with rider is not fully surrendered. |
4
| | The amount and timing of premium payments. | ||
| | Any withdrawals or transfers of values. | ||
| | Any changes in any riders. | ||
| | Any changes in the Selected Face Amount. | ||
| | Any outstanding certificate with rider debt. | ||
| | Any changes in the Death Benefit Option. | ||
| | The monthly charges deducted from the account value. | ||
| | The interest earned on the fixed account value. | ||
| | The net investment experience of the Separate Account for the certificate with rider. |
5
6
7
| Example: | The amount applied is $550. The date of purchase is June 10, 19X4. The accumulation unit value on that date is $10. The number of units purchased would be 55 ($550 divided by $10 = 55). If instead, the unit value was $11, then the amount applied would purchase 50 units ($550 divided by $11 = 50). |
| | The net premiums allocated to the Separate Account for the certificate with rider; | ||
| | Any amounts transferred into the Separate Account for the certificate with rider from the Guaranteed Principal Account; | ||
| | Any amounts transferred and withdrawn from the Separate Account for the certificate with rider; | ||
| | Any monthly charges deducted from the Separate Account for the certificate with rider; and |
8
| | The net investment experience of the Separate Account for the certificate with rider. |
| | The net premiums allocated to the Guaranteed Principal Account for the certificate with rider; plus | ||
| | Any amounts transferred into the Guaranteed Principal Account for the certificate with rider from the Separate Account; less | ||
| | Any amounts transferred and withdrawn from the Guaranteed Principal Account for the certificate with rider; and less | ||
| | Any monthly charges deducted from the Guaranteed Principal Account for the certificate with rider. |
9
| | The date we receive the initial premium for the Certificate; | ||
| | The Monthly Calculation Date; and | ||
| | The date we receive the amount of premium needed to prevent termination in accordance with the Grace Period And Termination provision in this Part. |
| 1. | Administrative Charge. The amount of this charge will be determined by us. In no case, however, will it be greater than the maximum charge shown in the Other Information section of the Schedule Page of the certificate with rider. | |
| 2. | Mortality Charge. The amount of this charge will be determined by us. The maximum monthly mortality charges for each $1,000 of insurance that requires a charge are shown in the Table Of Maximum Monthly Mortality Charges of the certificate with rider. | |
| We have the right to charge less than the maximum charges shown in the Table. Any change in these charges will apply to all individuals who are in the same class. The amount of insurance that requires a charge is determined as follows. This computation is made as of the date the charge is deducted. All amounts are computed as of that date. |
| a. | We compute the certificate with riders account value after all additions and deductions other than the deduction of the mortality charge. | ||
| b. | We determine the amount of benefit under the Death Benefit Option in effect (as discussed in the Death Benefit Options provision in Part 5). The Minimum Face Amount used here is based on the account value computed in (a) above. | ||
| c. | We divide the amount of benefit determined in (b) above by an amount equal to 1 plus the monthly equivalent (expressed as a decimal fraction) of the minimum annual interest rate for the Guaranteed Principal Account shown in the Basis Of |
10
| Computation section on the Schedule Page of the certificate with rider. | |||
| d. | We subtract the account value, as computed in (a) above, from the amount determined in (c) above. The result is the amount of insurance that requires a charge. |
| 3. | Rider Charge. The monthly charges for any rider are shown in a table of charges for that rider. |
11
| | Transfers of values between divisions of the Separate Account. These transfers will be made by selling all or part of the accumulation units in a division and applying the value of the units sold to purchase units in any other division. | ||
| | Transfers of values from one or more divisions of the Separate Account to the Guaranteed Principal Account. These transfers will be made by selling all or part of the accumulation units in a division and applying the value of the units sold to the Guaranteed Principal Account. | ||
| | Transfers of values from the Guaranteed Principal Account to one or more divisions of the Separate Account. These transfers will be made by applying all or part of the value in the Guaranteed Principal Account to purchase accumulation units in one or more divisions of the Separate Account. |
12
13
| | The minimum amount of a withdrawal is $500; | ||
| | A withdrawal charge of up to 2% of the amount of the withdrawal, but not more than $25, will be deducted from the amount of the withdrawal; and | ||
| | An amount equal to certificate with rider debt plus one plus the number of Monthly Calculation Dates remaining in the Modal Term multiplied by the most recent monthly charge made for the certificate with rider must remain in the Guaranteed Principal Account; and | ||
| | The maximum total withdrawal amount cannot exceed the account value less certificate with rider debt less one plus the number of Monthly Calculation Dates remaining in the Modal Term multiplied by the most recent monthly charge made for the certificate with rider. |
| Example: | The Owner makes a withdrawal without furnishing us satisfactory evidence of insurability. Just before the withdrawal, the certificate with rider has a Selected Face Amount of $50,000 and an account value of $20,000. The Minimum Face Amount Percentage for the current Certificate Year is 200%. Under Death Benefit Option A, the amount of insurance that requires a charge is $50,000 minus $20,000, or $30,000. If you make a withdrawal of $5,000, the account value would be reduced to $15,000. The amount of insurance that requires a charge would otherwise be increased to $35,000 ($50,000 - $15,000). However, the Selected Face Amount will be reduced instead to $45,000 and the amount of insurance that requires a charge will remain $30,000. (For simplicity, in this example the minimum annual interest rate is assumed to be zero.) |
14
| | The New York Stock Exchange (or its successor) is closed, except for normal weekend or holiday closings, or trading is restricted; or | ||
| | The Securities and Exchange Commission (or its successor) determines that a state of emergency exists; or | ||
| | The Securities and Exchange Commission (or its successor) permits us to delay payment for the protection of our certificate with rider owners; or | ||
| | We are permitted by state law to delay such payment. |
15
| | 90% of the certificate with riders account value on that date; less | ||
| | Any outstanding certificate with rider debt; less | ||
| | Interest on the loan being made and on any outstanding certificate debt to the next Certificate Anniversary Date; less | ||
| | An amount equal to one plus the number of Monthly Calculation Dates remaining in the Modal Term multiplied by the most recent monthly charge made for the certificate with rider. |
| Example: | You have a loan of $1,000. The interest due on the Certificate Anniversary Date is $60. If it is not paid on that date, we will add it to the existing loan. The loan will then be $1,060 and interest will be charged on this amount from then on. |
| 1. | A fixed loan interest rate of 6% per year; and | |
| 2. | An adjustable loan rate. Such an annual rate is set by us. This rate may change from year to year. Each year we will set the rate that will apply for the next Certificate Year. |
| | The Monthly Average Corporates yield shown in Moodys Corporate Bond Yield Averages, as published by Moodys Investors Service, Inc., or any successor to that Service; or | ||
| | If that Monthly Average is no longer published, a substantially similar average, established by regulation issued by the insurance supervisory official of the state where this policy with rider was delivered. |
16
| Example: | A Certificate Year begins on June 10, 19X1. The calendar month ending two months before that date is March. The loan interest rate for the Certificate Year beginning June 10, 19X1 will not be greater than the Published Monthly Average for March, 19X1. However, if the Basis Of Computations annual interest rate (plus 1%) is higher than the Average, then that rate (plus 1%) will be the maximum loan interest rate for that Certificate Year. |
| | The New York Stock Exchange (or its successor) is closed, except for normal weekend or holiday closings, or trading is restricted; or |
17
| | The Securities and Exchange Commission (or its successor) determines that a state of emergency exists; or | ||
| | The Securities and Exchange Commission (or its successor) permits us to delay payment for the protection of our certificate with rider owners; or | ||
| | We are permitted by state law to delay such payment. |
| | The date 15 days after a written request for such change has been received and approved by us; or | ||
| | The requested effective date of the change. |
18
| | The date 15 days after a written request for such change has been received and approved by us; or | ||
| | The requested effective date of the change. |
19
| | We add the part of any monthly charge that applies to a period beyond the date of death; and | ||
| | We deduct: |
| | Any certificate with rider debt outstanding on the date of death; and | ||
| | Any unpaid monthly charges to the date of death. |
| | The Selected Face Amount in effect on the date of death; and | ||
| | The Minimum Face Amount in effect on the date of death. |
| | The Selected Face Amount in effect on the date of death plus the certificate with riders account value on the date of death; and | ||
| | The Minimum Face Amount in effect on the date of death. |
20
| | The date 15 days after a written request for such change has been received and approved by us; or | ||
| | The requested effective date of the change. |
| | The New York Stock Exchange (or its successor) is closed, except for normal weekend or holiday closings, or trading is restricted; or | ||
| | The Securities and Exchange Commission (or its successor) determines that a state of emergency exists; or | ||
| | The Securities and Exchange Commission (or its successor) permits us to delay payment for the protection of our certificate with rider owners; or | ||
| | We are permitted by state law to delay such payment. |
21
22
| Monthly | ||||
| Years | Payment | |||
|
|
||||
|
1
|
$ | 84.47 | ||
|
2
|
42.86 | |||
|
3
|
28.99 | |||
|
4
|
22.06 | |||
|
5
|
17.91 | |||
|
6
|
15.14 | |||
|
7
|
13.16 | |||
|
8
|
11.68 | |||
|
9
|
10.53 | |||
|
10
|
9.61 | |||
|
11
|
8.86 | |||
|
12
|
8.24 | |||
|
13
|
7.71 | |||
|
14
|
7.26 | |||
|
15
|
6.87 | |||
| 16 | $ | 6.53 | ||
| 17 | 6.23 | |||
| 18 | 5.96 | |||
| 19 | 5.73 | |||
| 20 | 5.51 | |||
| 21 | 5.32 | |||
| 22 | 5.15 | |||
| 23 | 4.99 | |||
| 24 | 4.84 | |||
| 25 | 4.71 | |||
| 26 | 4.59 | |||
| 27 | 4.47 | |||
| 28 | 4.37 | |||
| 29 | 4.27 | |||
| 30 | 4.18 | |||
23
| (1) | Payments for life only. No specific number of payments is guaranteed. Payments stop when the named person dies. | |
| (2) | Payments guaranteed for amount applied. Payments stop when they equal the amount applied or when the named person dies, whichever is later. | |
| (3) | Payments guaranteed for 5, 10 or 20 years. Payments stop at the end of the selected guaranteed period or when the named person dies, whichever is later. |
| Payments | Payments Guaranteed For | |||||||||||||||||||
| For Life | Amount | 5 | 10 | 20 | ||||||||||||||||
| Age* | Only | Applied | Years | Years | Years | |||||||||||||||
|
|
||||||||||||||||||||
|
40
|
$ | 3.30 | $ | 3.25 | $ | 3.29 | $ | 3.28 | $ | 3.27 | ||||||||||
|
45
|
3.47 | 3.41 | 3.46 | 3.45 | 3.43 | |||||||||||||||
|
50
|
3.69 | 3.60 | 3.68 | 3.67 | 3.62 | |||||||||||||||
|
55
|
3.96 | 3.83 | 3.95 | 3.93 | 3.85 | |||||||||||||||
|
60
|
4.31 | 4.13 | 4.30 | 4.27 | 4.14 | |||||||||||||||
|
|
||||||||||||||||||||
|
65
|
4.77 | 4.49 | 4.75 | 4.70 | 4.44 | |||||||||||||||
|
70
|
5.41 | 4.96 | 5.38 | 5.26 | 4.77 | |||||||||||||||
|
75
|
6.30 | 5.56 | 6.21 | 5.96 | 5.07 | |||||||||||||||
|
80
|
7.50 | 6.31 | 7.30 | 6.77 | 5.30 | |||||||||||||||
|
85
|
9.16 | 7.29 | 8.72 | 7.64 | 5.43 | |||||||||||||||
| * | Age on birthday nearest due date of the first payment. Monthly payment rates for ages not shown will be furnished on request. Monthly payment rates for ages over 85 are the same as those for 85. |
24
| (1) | Payments for two lives only. No specific number of payments is guaranteed. Payments stop when both named persons have died. | |
| (2) | Payments guaranteed for 10 years. Payments stop at the end of 10 years, or when both named persons have died, whichever is later. |
| Age* | 55 | 60 | 65 | 70 | 75 | 80 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
55
|
$ | 3.53 | $ | 3.64 | $ | 3.72 | $ | 3.80 | $ | 3.85 | $ | 3.89 | ||||||||||||
|
60
|
3.64 | 3.78 | 3.91 | 4.03 | 4.12 | 4.18 | ||||||||||||||||||
|
65
|
3.72 | 3.91 | 4.10 | 4.27 | 4.42 | 4.54 | ||||||||||||||||||
|
70
|
3.80 | 4.03 | 4.27 | 4.52 | 4.76 | 4.97 | ||||||||||||||||||
|
75
|
3.85 | 4.12 | 4.42 | 4.76 | 5.11 | 5.44 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
80
|
3.89 | 4.18 | 4.54 | 4.97 | 5.44 | 5.92 | ||||||||||||||||||
|
85
|
3.91 | 4.23 | 4.63 | 5.12 | 5.71 | 6.36 | ||||||||||||||||||
| Age* | 55 | 60 | 65 | 70 | 75 | 80 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
55
|
$ | 3.52 | $ | 3.63 | $ | 3.71 | $ | 3.79 | $ | 3.84 | $ | 3.88 | ||||||||||||
|
60
|
3.63 | 3.77 | 3.90 | 4.02 | 4.11 | 4.17 | ||||||||||||||||||
|
65
|
3.71 | 3.90 | 4.09 | 4.26 | 4.41 | 4.53 | ||||||||||||||||||
|
70
|
3.79 | 4.02 | 4.26 | 4.51 | 4.75 | 4.94 | ||||||||||||||||||
|
75
|
3.84 | 4.11 | 4.41 | 4.75 | 5.08 | 5.38 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
80
|
3.88 | 4.17 | 4.53 | 4.94 | 5.38 | 5.82 | ||||||||||||||||||
|
85
|
3.90 | 4.22 | 4.61 | 5.08 | 5.62 | 6.19 | ||||||||||||||||||
| * | Age on birthday nearest the due date of the first payment. Monthly payment rates for ages not shown will be furnished on request. Monthly payment rates for ages over 85 are the same as those for 85. |
25
| Age* | 55 | 60 | 65 | 70 | 75 | 80 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
55
|
$ | 3.80 | $ | 3.94 | $ | 4.10 | $ | 4.28 | $ | 4.47 | $ | 4.66 | ||||||||||||
|
60
|
3.94 | 4.11 | 4.30 | 4.51 | 4.73 | 4.96 | ||||||||||||||||||
|
65
|
4.10 | 4.30 | 4.52 | 4.77 | 5.05 | 5.33 | ||||||||||||||||||
|
70
|
4.28 | 4.51 | 4.77 | 5.08 | 5.42 | 5.77 | ||||||||||||||||||
|
75
|
4.47 | 4.73 | 5.05 | 5.42 | 5.85 | 6.30 | ||||||||||||||||||
|
80
|
4.66 | 4.96 | 5.33 | 5.77 | 6.30 | 6.88 | ||||||||||||||||||
|
85
|
4.86 | 5.19 | 5.61 | 6.13 | 6.77 | 7.51 | ||||||||||||||||||
| * | Age on birthday nearest the due date of the first payment. Monthly payment rates for ages not shown will be furnished on request. Monthly payment rates for ages over 85 are the same as those for 85. |
26
27
| | A equals: |
| | the net asset value per share of each Fund held by a Division for the current Valuation Period; plus | ||
| | any dividend per share declared on behalf of such Fund that has an ex-dividend date within the current Valuation Period; less | ||
| | the cumulative charge or credit for taxes reserved which is determined by us to have resulted from the operation or maintenance of the Division; and |
| | B equals: |
| | the net asset value per share of the Fund held by the Division for the immediately preceding Valuation Period; and |
| | C equals: |
| | the cumulative unpaid charge for the net investment factor asset charge shown on the Schedule Page of the certificate with rider. |
| | The maximum monthly mortality charges; | ||
| | The minimum annual interest earned on the fixed account value of the certificate with rider; and | ||
| | The minimum payments under Payment Options C, E, and F. |
28
29
| | As a direct result of accidental bodily injury independently of all other causes; and | ||
| | Within 180 days after the injury was received; and | ||
| | While the certificate and this rider were in force. |
| | The loss is a direct result of accidental bodily injury independently of all other causes; and | ||
| | The loss occurred within 180 days after the injury was received; and | ||
| | The loss occurred while the certificate and this rider were in force; and |
Page 1
| | An accidental death benefit is not payable by this coverage for the same accident. |
| | both hands; or | ||
| | both feet; or | ||
| | sight of both eyes; or | ||
| | one hand and sight of one eye; or | ||
| | one foot and sight of one eye; or | ||
| | one hand and one foot. |
| | one hand or one foot; or | ||
| | sight of one eye. |
| Suicide Suicide, while the Insured is sane or insane. | ||
| War War, declared or undeclared, or any act of war. | ||
| Military Service Service in the military forces of any country at war or in any civilian noncombatant unit serving with those forces. War includes undeclared war and any act of war. Country includes any international organization or group of countries. | ||
| Aviation Travel in, or descent from or with, any kind of aircraft aboard which the Insured is a pilot or crew member or is giving or receiving any training. Crew member includes anyone who has any duty aboard the aircraft. |
Page 2
| | On the Certificate Anniversary Date after the Insureds 65th birthday; or | ||
| | Upon the termination of the certificate for any reason. |
|
|
|
|
|
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|
President
|
Secretary |
Page 3
| | Any Monthly Calculation Date after the Insured has been totally disabled for six months during the continuance of total disability; and | |
| | Any Monthly Calculation Date during the first six months of total disability. |
| | Total disability directly caused by any willfully and intentionally self-inflicted injury; or | |
| | Total disability caused by war while the Insured is in the military forces of any country at war or in any civilian noncombatant unit service with those forces. War includes undeclared war and any act of war. Country includes any international organization or group of countries. |
| | The waiver benefits after the increase would exceed our published limits for such benefits. |
Page 1
| | The Insured does not meet our underwriting requirements for the additional waiver benefits. | |
| | A higher rating would apply to the additional waiver benefits rather than to the existing waiver benefits. |
| | Is caused by sickness or injury; and | |
| | Begins while this rider and the certificate are in force; and | |
| | Begins before the Certificate Anniversary Date after the Insureds 65th birthday; and | |
| | For the first 24 months of any period of total disability, prevents the Insured from performing substantially all the duties of the Insureds occupation; and | |
| | After total disability has continued for 24 months, prevents the Insured from engaging in any occupation the Insured is qualified to perform. |
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| | The Insured is totally disabled; and | |
| | Total disability began while this rider and the certificate were in force; and | |
| | Total disability began before the Certificate Anniversary Date after the Insureds 65th birthday; and | |
| | Total disability has continued for six months. |
| | The Certificate Anniversary Date after the Insureds 65th birthday; and | |
| | Termination of the certificate. |
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| | The Insured is no longer totally disabled; or |
| | Satisfactory proof of continued total disability is not given to us as required; or |
| | The Insured refuses or fails to have an examination we require; or |
| | The day before the Certificate Anniversary Date after the Insureds 65th birthday or, if later, the date two years from the day that total disability began. |
| | Termination of the certificate for any reason; or | |
| | The Certificate Anniversary Date after the Insureds 65th birthday if the Insured is not totally disabled on that Date; or | |
| | If the Insured is totally disabled as of the Certificate Anniversary Date after the Insureds 65th birthday, the date two years from the day that total disability began. |
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President
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Secretary |
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| | The death benefit payable upon the death of the Insured under the base certificate; over | ||
| | The certificate account value. |
| | The amount payable upon the death of the Insured under any life insurance rider that does not provide level or increasing coverage for at least two years after the Acceleration Date; and | ||
| | The amount of any insurance provided under the certificate on the life of someone other than the Insured; and | ||
| | The amount of benefit under any accidental death or accidental death and dismemberment benefit rider. |
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| | 75% of the Eligible Amount; and | ||
| | $250,000 minus the total amount accelerated under all other policies issued on the life of the Insured by us and any of our affiliates. |
| | Interest at the annual interest rate we have declared for certificates in this class; and | ||
| | A fee of not more than $250. |
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| 1. | We must receive at our Home Office: |
| a. | The Owners written request for payment of an accelerated death benefit under the certificate; | ||
| b. | The Insureds written authorization to release medical records to us; and | ||
| c. | The written consent to this request of any assignee and any irrevocable beneficiary under the certificate. |
| 2. | We must receive proof, satisfactory to us, that the Insured has a terminal illness. |
| | Is first diagnosed by a legally qualified physician after the Issue Date of the certificate; and | ||
| | With reasonable medical certainty, will result in the death of the Insured within 12 months from the date diagnosed; and | ||
| | Is not curable by any means available to the medical profession. |
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| This rider will end automatically on the date: | ||
| 1. | An accelerated benefit payment is made; or | |
| 2. | The certificate terminates for any reason; or | |
| 3. | The certificate is changed to a different certificate on which this rider is not available; or | |
| 4. | Two years before coverage under the certificate is scheduled to mature or terminate. | |
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By:
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/s/ Ann M. Nagle | Title: | Assistant Vice President | |||||||
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| Applicant: | Citizens Bank of Rhode Island as Trustee of the Strategic Group Universal Life Trust |
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Date:
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January 30, 1998 | By | /s/ Ann M. Nagle | |||||||
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(Signature or authorized officer) | |||||||||
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Ann M. Nagle Assistant Vice President | |||||||||
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(Print name & title) | |||||||||
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Date:
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Licensed Resident Agent | |||||||||
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Booz Allen Hamilton Holding Corporation
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