Financial Statements

EX-10.4 5 v51970exv10w4.htm EX-10.4 exv10w4

Exhibit 10.4

Northrop Grumman Executive Health Plan Matrix



	Plan Feature			Benefit
	Eligibility			Employee + Spouse & Eligible Dependents
	Medical Plan			Premium PPO Plan administered by Anthem Blue Cross Blue Shield
	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			No limits as long as procedures fall under Anthem’s Guidelines
	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			20 visits [combined] — per person, per plan year
	Chiropractic Care			40 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 Inpatient treatment must be pre-authorized by Value Options(800) 982-8161 Mental Health Maximums			Mental health is 100% covered (in and out-of-network combined) Unlimited office visits (in and out-of-network) 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

	Eligibility			Employee
	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 monthly base salary, up to a maximum monthly benefit of $25,000
	Executive Physicals			$2,000/year allowance for executive physical — coverage under Perquisite Program (covers employee only)

Effective 07/01/08