Northrop Grumman Executive Health Plan Matrix
EX-10.6 3 dex106.htm NORTHROP GRUMMAN EXECUTIVE MEDICAL PLAN BENEFIT MATRIX Northrop Grumman Executive Medical Plan Benefit Matrix
Exhibit 10.6
Northrop Grumman Executive Health Plan Matrix
| Plan Feature | Benefit | |
| Eligibility | Employee + Spouse & Dependents | |
| Medical Plan | Premium PPO Plan administered by Blue Cross Blue Shield of Illinois | |
| Coverage | 100% coverage, for all eligible plan expenses | |
| Annual Deductible | No annual deductible | |
| Co-payment/Co-insurance | No co-payment/No co-insurance | |
| Preventive Care Coverage | $500 annual maximum per covered individual | |
| Prescription Drug Coverage | Covered under Medical Plan | |
| Annual Deductible | No annual deductible | |
| Coverage - retail 30 - day supply | 100% coverage, when network pharmacy is utilized | |
| Coverage – mail order 90 – day supply | 100% coverage, when network pharmacy is utilized | |
| Vision and Hearing Coverage | $500 vision/ $500 per ear per plan year - per covered individual | |
| Acupuncture and Acupressure | $1,300 acupuncture/$1,300 acupressure – per person, per plan year | |
| Chiropractic Care | 20 visits per benefit plan year | |
| Physical Therapy | 50 visits per benefit plan year (in and out-of-network combined) | |
| Speech Therapy | 50 visits per benefit plan year (in and out-of-network combined) | |
| Occupational Therapy | 50 visits per benefit plan year (in and out-of-network combined) | |
| Mental Health Coverage Pre-approval is required for both In-Network and Out-of-Network benefits | In-Network: In-patient - 100% coverage – Annual benefit maximum: 60 days Out-patient - 100% coverage – Annual benefit maximum: 60 visits Out-of-Network In-patient 100% coverage – Annual benefit maximum: 60 days Out-patient. 100% coverage - Annual benefit maximum – 60 visits | |
| Mental Health Maximums | Combined Lifetime Limits - included in $2 million per person Medical lifetime maximum | |
| Health Plan Lifetime Maximums | $2,000,000.00 per covered individual, including mental health benefits | |
| Dental Plan | Premium PPO Plan administered by Delta Dental | |
| Annual maximum | $4,000 per person – per benefit plan year | |
| Coverage | 100% coverage, for all eligible plan expenses up to annual maximum | |
| Annual Deductible | No annual deductible | |
| Co-payment/Co-insurance | No co-payment/No co-insurance | |
| Life Insurance Coverage | Company-paid life insurance 3x Annual base salary up to a maximum of $2 million | |
| Accidental Death & Dismemberment (AD&D) Coverage | Company-paid accidental death & dismemberment insurance – 6 x Annual base salary up to a maximum of $1 million | |
| Long-Term Disability (LTD) | Company-paid basic LTD benefit of 75% of your monthly base salary, up to a maximum monthly benefit of $25,000 |
Effective 9/1/2004
