Benefits at a Glance
This page summarizes the current terms of certain employee benefit plans and programs available to Honeywell employees. Honeywell’s formal employee plan documents govern the terms and conditions of the plans. The information provided in this presentation and oral and written statements made by a supervisor or human resources representative cannot change the terms and condition of the written plans. Honeywell has reserved the right to modify, change, and revise the terms and conditions of the Company’s employee benefits plans, as well as the right to terminate the plans (subject to applicable collective bargaining agreements). Honeywell has also reserved the right to change the premiums charged to employees and other cost sharing features of the Company’s employee benefit plans (subject to applicable collective bargaining agreements). The information provided in this presentation is not a guarantee of the future availability or design of the Company’s employee benefits.
Annual Deductibles and Out-of-Pocket Maximums
| Service | In Network | Out of Network |
| Deductible – Individual | An upfront $1,500 deductible per covered member will apply. | An upfront $3,000 deductible per covered member will apply. |
| Deductible – Family | An upfront $3,000 deductible per family will apply. | An upfront $6,000 deductible per family will apply. |
| Individual Out-of- Pocket Maximum | $2,500 per year for Employees with annualized base pay of $50,000 or less; $4,000 per year for Employees with annualized base pay of more than $50,000. | $8,000 |
| Family Out-of-Pocket Maximum | $5,000 per year for Employees with annualized base pay of $50,000 or less; $8,000 per family with a per individual max of $7,900 for Employees with annualized base pay of more than $50,000. | $16,000 |
| Lifetime Maximum | None | None |
Preventive Care
| Service | In Network | Out of Network |
| Periodic physicals for adults | Covered at 100% for annual well visit and preventive services. | Not covered |
| Well-child care (including routine exams, injections and immunizations) | Covered at 100% for annual well visit and preventive services. | Not covered |
| Annual Preventive Mammograms, Prostate Screenings and Pap Smears | Covered at 100% for annual well visit and preventive services. | Not covered |
| Annual Preventive Colonoscopies, Endoscopies and Sigmoidoscopies | Covered at 100% for annual well visit and preventive services. | Not covered |
| Preventive Lab & X-ray | Covered at 100% for annual well visit and preventive services. | Not covered |
Physician Office and Physician’s Staff Services
| Service | In Network | Out of Network |
| Primary Care Office Visit | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Waived if preventive.
For Cigna Staff participants: In-network office visits out of the Cigna Staff model are covered at 70% after deductible |
Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Specialist Office Visit | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Waived if preventive.
For Cigna Staff participants: In-network office visits out of the Cigna Staff model are covered at 70% after deductible |
Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached |
| Office or home visits (including allergy injections) | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached.
For Cigna Staff participants: In-network visits out of the Cigna Staff model are covered at 70% after deductible |
Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
X-ray and Laboratory Services
| Service | In Network | Out of Network |
| Diagnostic X-ray and laboratory, including CAT Scan, MRI | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Preventive X-ray and laboratory | Covered at 100% for annual well visit and preventive services. | Not covered |
Inpatient Hospital Services
| Service | In Network | Out of Network |
| Anesthesiologist | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Inpatient physical, occupational and speech therapy | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Other Necessary Services and Supplies | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Physician/Surgeon Services | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Semi-private Room and Board | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
Outpatient Hospital Services
| Service | In Network | Out of Network |
| Chemotherapy | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Colonoscopy, Endoscopy and Sigmoidoscopy | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Waived if preventive. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Dialysis | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Infusion Therapy | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Other Medically Necessary Services and Supplies | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Physicians’ and Surgeons’ Charges | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Pre-Admission Testing | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Surgery (including services and supplies) | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
Emergency Care
| Service | In Network | Out of Network | |
| Emergency Care for a life-threatening condition (See Covered Services & Supplies section for an explanation of what constitutes Emergency Care.) | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | All out-of-network Emergency claims will be paid at the in-network benefit level. | |
| Non-Emergency Care | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. | |
| Ambulance for emergencies (to the nearest facility providing adequate care) | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | All out-of-network Emergency claims will be paid at the in-network benefit level. | |
| Ambulance transportation from one facility to another if medically necessary | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. If precertification is approved by both facilities, then benefit is paid at the in-network level. | |
| Air Ambulance if medically necessary | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Not covered if not medically necessary. | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Not covered if not medically necessary. |
Maternity Care
| Service | In Network | Out of Network | |
| Office visits for Prenatal & Postnatal care | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Waived if preventive. | For Cigna Staff participants: In-network visits out of the Cigna Staff model are covered at 70% after deductible | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Birth Center (including certified Nurse-Midwife), where available | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. | |
| Delivery | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
Other Services
| Service | In Network | Out of Network |
| Blood and blood transfusions (including administrative fees for collection) | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Durable Medical Equipment | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Injury to sound, natural teeth by an external force | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Organ Transplants | If the health plans network transplant program is utilized the deductible applies; then the plan pays 100%. If the health plans network transplant program is not utilized, the deductible applies; then the plan pays 80%. After deductible; plan pays 100% after out-of-pocket is reached. Plan pays up to a maximum of $100 per night for food and lodging and coach airfare for two people to a center of excellence. | The deductible applies; then the plan pays 50%. After deductible; plan pays 100% after out-of-pocket is reached. |
| Orthogenetic Surgery | Upfront deductible applies; then plan pays 80% after deductible to repair or correct a severe facial deformity or disfigurement that orthodontics alone cannot correct. Plan pays 100% after out-of- pocket maximum is reached. See Section 5.B. for details. | Upfront deductible applies; then plan pays 50% after deductible to repair or correct a severe facial deformity or disfigurement that orthodontics alone cannot correct. Plan pays 100% after out-of-pocket maximum is reached. See Section 5.B. for details. |
| Overseas Coverage | Emergency, Urgent Care and other conditions which require immediate treatment are covered at the In-network benefit level. Other covered services paid at Out-of- Network benefit level; preventive care is excluded. | Emergency, Urgent Care and other conditions which require immediate treatment are covered at the In- network benefit level. Other covered services paid at Out-of-Network benefit level; preventive care is excluded. |
| Prosthetics | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Urgent Care | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | All out-of-network Emergency facility claims will be paid at the in-network benefit level. |
Other Services - Limits combined for In-network and Out- of network
| Service | In Network | Out of Network |
| Chiropractic Care | Deductible applies; then plan pays 80% after deductible; plan pays 100% after out- of-pocket maximum is reached to a maximum of 30 visits per calendar year (on a combined in-network and out-of- network basis). | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of 30 visits per calendar year (on a combined in-network and out-of-network basis). |
| Home Health Care | BCBS - Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 120 visits per calendar year. | BCBS - Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 40 visits per calendar year. |
| Home Health Care | Cigna – Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 120 days per calendar year | Cigna – Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 40 days per calendar year. |
| Hospice | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached up to 180 days. | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached up to 180 days. |
| Orthotics | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of one per calendar year (except for individuals with diabetes, in which case this limit will not be imposed). The following items are excluded: arch supports, lifts, inserts, wedges, soles, and those available over the counter. | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of one per calendar year (except for individuals with diabetes, in which case this limit will not be imposed). The following items are excluded: arch supports, lifts, inserts, wedges, soles, and those available over the counter. |
| Outpatient Physical Therapy | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 30 visits per calendar year. | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached. To a maximum of 30 visits per calendar year. |
| Outpatient speech and/or occupational therapy | Deductible applies; then plan pays 80% after deductible; plan pays 100% after out- of-pocket maximum is reached to a maximum of 30 visits per calendar year. | Deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of 30 visits per calendar year. |
| Private Duty Nursing | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached limited to outpatient care given by a licensed nurse (RN, LPN or LVN) for professional nursing services at the direction of a doctor. | Not Covered |
| Skilled Nursing/Extended Care Facility | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of 120 days per calendar year. | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached to a maximum of 120 days per calendar year. |
| Temporomandibular Joint (TMJ) Dysfunction | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached for services received in an Inpatient or Outpatient facility. All treatment must be pre-approved. | Upfront deductible applies; then plan pays 50% after deductible; plan pays 100% after out-of-pocket maximum is reached for services received in an Inpatient or Outpatient facility. All treatment must be pre-approved. |
Mental Health/Substance Abuse
| Service | In Network | Out of Network |
| Inpatient | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
| Outpatient | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. |
Prescription Drugs
| Service | In Network | Out of Network |
| Prescription Drugs dispensed at network pharmacies | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Generic Preventive medications at mail order are provided at no cost. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. No mail order available. |
| Mail-Order Maintenance Prescription Drugs | Upfront deductible applies; then plan pays 80% after deductible; plan pays 100% after out-of-pocket maximum is reached. Generic Preventive medications at mail order are provided at no cost. | Upfront deductible applies; then plan pays 50% of Maximum Reimbursable Charge after deductible; plan pays 100% after out-of-pocket maximum is reached. No mail order available. |
