ý	ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934

¨	TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934

---

---

---

•	cost cutting and efficiency initiatives, budget reductions, Congressionally mandated automatic spending cuts, and other efforts to reduce U.S. government spending, including automatic sequestration required by the Budget Control Act of 2011 (as subsequently amended);

•

delayed funding of our contracts due to uncertainty relating to and a possible failure of Congressional efforts to approve funding of the U.S. government and to craft a long-term agreement on the U.S. government’s ability to incur indebtedness in excess of its current limits, or changes in the pattern or timing of government funding and spending (including those resulting from or related to cuts associated with sequestration);

•

current and continued uncertainty around the timing, extent, nature, and effect of ongoing Congressional and other U.S. government action to address budgetary constraints, including, but not limited to, Congressional efforts to approve funding of the U.S. government and to craft a long-term agreement on the U.S. government’s ability to incur indebtedness in excess of its current limits and the U.S. deficit;

•	any issue that compromises our relationships with the U.S. government or damages our professional reputation, including negative publicity concerning government contractors in general or us in particular;

•	changes in U.S. government spending, including a continuation of efforts by the U.S. government to decrease spending for management support service contracts, and mission priorities that shift expenditures away from agencies or programs that we support;

•	U.S. government shutdowns due to, among other reasons, a failure by elected officials to fund the government;

•	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, including, but not limited to, the Federal Acquisition Regulation ("FAR"), the False Claims Act, the Defense Federal Acquisition Regulation Supplement and FAR Cost Accounting Standards and Cost Principles;

•	our ability to compete effectively in the competitive bidding process and delays or losses of contract awards caused by competitors’ protests of major contract awards received by us;

•	the loss of General Services Administration Multiple Award schedule contracts, or GSA schedules, or our position as prime contractor on government-wide acquisition contract vehicles, or GWACs;

•	changes in the mix of our contracts and our ability to accurately estimate or otherwise recover expenses, time, and resources for our contracts;

•

continued efforts to change how the U.S. government reimburses compensation related and other expenses or otherwise limit such reimbursements, including recent rules that expand the scope of existing reimbursement limitations, such as a reduction in allowable annual employee compensation to certain contractors as a result of the Bipartisan Budget Act of 2013, and an increased risk of compensation being deemed unallowable or payments being withheld as a result of U.S. government audit, review or investigation;

•	our ability to generate revenue under certain of our contracts;

---

•	our ability to realize the full value of and replenish our backlog and the timing of our receipt of revenue under contracts included in backlog;

•	changes in estimates used in recognizing revenue;

•	an inability to attract, train, or retain employees with the requisite skills, experience, and security clearances;

•	an inability to hire, assimilate, and deploy enough employees to serve our clients under existing contracts;

•	an inability to timely and effectively utilize our employees or manage our cost structure;

•	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, including the improper use or release of our clients’ sensitive or classified information;

•	increased insourcing by various U.S. government agencies due to changes in the definition of “inherently governmental” work, including proposals to limit contractor access to sensitive or classified information and work assignments;

•	increased competition from other companies in our industry;

•	failure to maintain strong relationships with other contractors; or the failure of contractors with which we have entered into a sub- or prime-contractor relationship to meet their obligations to us or our clients;

•	inherent uncertainties and potential adverse developments in legal or regulatory proceedings, including litigation, audits, reviews, and investigations, which may result in materially adverse judgments, settlements, withheld payments, penalties, or other unfavorable outcomes including debarment, as well as disputes over the availability of insurance or indemnification;

•	internal system or service failures and security breaches, including, but not limited to, those resulting from external cyber attacks on our network and internal systems;

•	risks related to changes to our operating structure, capabilities, or strategy intended to address client needs, grow our business or respond to market developments;

•	risks associated with new relationships, clients, capabilities, and service offerings in our U.S. and international businesses;

•	failure to comply with special U.S. government laws and regulations relating to our international operations;

•	risks related to our indebtedness and credit facilities which contain financial and operating covenants;

•	the adoption by the U.S. government of new laws, rules, and regulations, such as those relating to organizational conflicts of interest issues or limits;

•	risks related to completed and future acquisitions, including our ability to realize the expected benefits from such acquisitions;

•	an inability to anticipate or estimate the tax implications of changes in tax law, including the Tax Cuts and Jobs Act (the "2017 Tax Act"), or utilize existing or future tax benefits, including those related to our stock-based compensation expense, for any reason, including as a result of a change in law, such as the 2017 Tax Act;

•	variable purchasing patterns under U.S. government GSA schedules, blanket purchase agreements and indefinite delivery, indefinite quantity, or IDIQ, contracts; and

•	other risks and factors listed under “Item 1A. Risk Factors” and elsewhere in this Annual Report.

---

Item 1.	Business

---

•	77 partners

•	Nearly 28% are veterans, including 17 partners

•	Approximately 84% hold bachelor's degrees; approximately 40% hold master's degrees; and approximately 3% hold doctoral degrees

•	Approximately 69% hold security clearances

---

•	Consulting focuses on the talent and expertise needed to solve client problems and develop mission-oriented solutions for specific domains, business strategies, human capital, and operations through new and innovative approaches. We help clients boost organizational performance, deploy new technologies in smart ways, and change and streamline processes to achieve better outcomes.

•

Analytics focuses on delivering transformational solutions in the areas of decision analytics (including operations research and cost estimation), automation, and data science (including predictive modeling and machine learning) as well as new or emerging areas such as deep learning and artificial intelligence. We pioneer new approaches to apply analytic technology to clients' problems, draft industry-defining publications, and introduce transformative products such as graphics processing unit (GPU) accelerated deep learning software, to the market.

•

Digital Solutions combines the power of modern systems development techniques and cloud platforms with the power of machine learning to transform customer and mission experiences. We blend in-depth client mission understanding and digital technical expertise with a consultative approach. We develop, design, and implement powerful solutions built on contemporary methodologies and modern architectures. We accelerate clients to open, cloud native environments, where capability can be securely developed and deployed at scale, and effort allocated towards data management challenges is redirected to analysis and insights.

•

Engineering delivers engineering services and solutions to define, develop, implement, sustain, and modernize complex physical systems such as the Launch and Test Range System (LTRS) for the U.S. Air Force Space Command or the Flush Air Data Systems (FADS) for NASA. We leverage mature engineering methodologies to solve our clients' most complex problems. We bring a holistic understanding of client needs and technical strategy as well as policy experts to deliver purpose-fit solutions to problems. Our engineering capabilities include external industry standard certifications (e.g., ISO 90001 and AS9100).

•

Cyber focuses on active prevention, detection, and cost effectiveness. Active prevention includes methods of securing platforms and enterprises against cyber attacks; detection is the instrumentation of networks to provide lead indicators of penetrations; and cost effectiveness includes our integrated engineering capabilities. Our cyber capabilities are rooted in our decades of service to the U.S. federal intelligence community and today afford us the opportunity to maintain technical expertise in network security. With decades of mission intelligence combined with the most advanced tools available, we help clients understand the business value of cyber risk management as well as prepare for future cybersecurity needs with a lens toward efficiency and effectiveness.

---

•

Machine Intelligence applies and scales the use of machine learning and artificial intelligence to fundamentally transform how our clients perform their missions and run their organizations in a future where people and increasingly intelligent machines collaborate to solve our hardest problems. We are continuing to develop new capabilities in exciting areas, such as quantum computing and deep learning, to create long-term differentiation and value.

•	Directed Energy technologies use high-energy lasers or high-powered microwaves to efficiently disrupt or damage targets with non-kinetic, speed-of-light engagement. Through our Directed Energy business, we can help clients as a technology maturation agent, integrator, and solutions provider.

•	Moving closer to the center of our clients' core missions

•	Increasing the technical content of our work

•	Attracting and retaining superior talent in diverse areas of expertise

•	Leveraging innovation to deliver complex, differentiated, end-to-end solutions

•	Creating a broad network of external partners and alliances

•	Expanding into the commercial and international markets

•	Backlog growth, which achieved record levels during fiscal 2018

•	Headcount growth and a corresponding shift in our talent portfolio to more technical expertise in disciplines such as systems development, cyber, and analytics

•	Continued strong performance in the global commercial market

•	Execution against our capability focused acquisition strategy, most recently through the acquisition of technology firm, Morphick, Inc., which closed in October 2017, to expand Booz Allen's managed security portfolio and strengthen the firm's capability to help clients counter advanced cyber threats.

---

•	We derived 97% of our revenue from contracts where the end client was an agency or department of the U.S. government.

•	We delivered services under 4,997 contracts and task orders.

•	We derived 91% of our revenue in fiscal 2018 from engagements for which we acted as the prime contractor.

•	The single largest entity that we served in fiscal 2018 was the Navy Marine Corps, which represented approximately 13% of our revenue in that period.

(1)	Includes predecessor organizations.

---

•

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 often referred to as contract vehicles or ordering contracts. IDIQ contracts may be awarded to one contractor (single award) or several contractors (multiple award). Under a multiple award IDIQ contract, there is no guarantee of work as contract holders must compete for individual work orders. IDIQ 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). IDIQ contracts often have multiyear 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.

•

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 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 how it will procure those

---

---

•	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 (including optional 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.

---

---

•

the Federal Acquisition Regulation (the "FAR"), and agency regulations supplemental to the FAR, which regulate the formation, administration, and performance of U.S. government contracts. For example, 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 laws, violated the civil False Claims Act, or has received a significant overpayment;

•	the False Claims Act, which imposes civil and criminal liability for violations, including substantial monetary penalties, for, among other things, presenting false or fraudulent claims for payments or approval;

•	the False Statements Act, which imposes civil and criminal liability for making false statements to the U.S. government;

•	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;

•	laws and regulations restricting the ability of a contractor to provide gifts or gratuities to employees of the U.S. government;

•	post-government employment laws and regulations, which restrict the ability of a contractor to recruit and hire current employees of the U.S. government and deploy former employees of the U.S. government;

•	laws, regulations, and executive orders restricting the handling, use and dissemination of information classified for national security purposes or determined to be “controlled unclassified information” or “for official use only” and the export of certain products, services, and technical data, including requirements regarding any applicable licensing of our employees involved in such work;

•	laws, regulations, and executive orders, including the Anti-Kickback Act, regulating the handling, use, and dissemination of personally identifiable information in the course of performing a U.S. government contract;

•	international trade compliance laws, regulations and executive orders that prohibit business with certain sanctioned entities and require authorization for certain exports or imports in order to protect national security and global stability;

•

laws, regulations, and executive orders governing organizational conflicts of interest that may restrict our ability to compete for certain U.S. government contracts because of the work that we currently perform for the U.S. government or may require that we take measures such as firewalling off certain employees or restricting their future work activities due to the current work that they perform under a U.S. government contract;

•	laws, regulations and executive orders that impose requirements on us to ensure compliance with requirements and protect the government from risks related to our supply chain;

•	laws, regulations and mandatory contract provisions providing protections to employees or subcontractors seeking to report alleged fraud, waste, and abuse related to a government contract;

•	the Contractor Business Systems rule, which authorizes Department of Defense agencies to withhold a portion of our payments if we are determined to have a significant deficiency in our accounting, cost estimating, purchasing, earned value management, material management and accounting, and/or property management system; and

•	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.

---

Item 1A.	Risk Factors

---

•	budgetary constraints, including Congressionally mandated automatic spending cuts, 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 by various U.S. government agencies due to changes in the definition of “inherently governmental” work, including proposals to limit contractor access to sensitive or classified information and work assignments;

•	further efforts to improve efficiency and reduce costs affecting federal government programs;

•	changes or delays in U.S. government programs that we support or related requirements;

•	a continuation of recent efforts by the U.S. government to decrease spending for management support service contracts;

•	U.S. government shutdowns due to, among other reasons, a failure by elected officials to fund the government (such as that which occurred during government fiscal year 2014 and, to a lesser extent, government fiscal year 2018) or weather-related closures in the Washington, D.C. area 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;

•	an inability by the U.S. government to fund its operations as a result of a failure to increase the federal government’s debt ceiling, a credit downgrade of U.S. government obligations or for any other reason; and

•	changes in the political climate and general economic conditions, including a slowdown of the economy or unstable economic conditions and responses to conditions, such as emergency spending, that reduce funds available for other government priorities.

---

•

the FAR, and agency regulations supplemental to the FAR, which regulate the formation, administration, and performance of U.S. government contracts. For example, 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 laws, violated the civil False Claims Act, or has received a significant overpayment;

•	the False Claims Act, which imposes civil and criminal liability for violations, including substantial monetary penalties, for, among other things, presenting false or fraudulent claims for payments or approval;

•	the False Statements Act, which imposes civil and criminal liability for making false statements to the U.S. government;

•	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;

•	laws and regulations restricting the ability of a contractor to provide gifts or gratuities to employees of the U.S. government;

•	post-government employment laws and regulations, which restrict the ability of a contractor to recruit and hire current employees of the U.S. government and deploy former employees of the U.S. government;

---

•	laws, regulations, and executive orders restricting the handling, use and dissemination of information classified for national security purposes or determined to be “controlled unclassified information” or “for official use only” and the export of certain products, services, and technical data, including requirements regarding any applicable licensing of our employees involved in such work;

•	laws, regulations, and executive orders, including the Anti-Kickback Act, regulating the handling, use, and dissemination of personally identifiable information in the course of performing a U.S. government contract;

•	international trade compliance laws, regulations and executive orders that prohibit business with certain sanctioned entities and require authorization for certain exports or imports in order to protect national security and global stability;

•

laws, regulations, and executive orders governing organizational conflicts of interest that may restrict our ability to compete for certain U.S. government contracts because of the work that we currently perform for the U.S. government or may require that we take measures such as firewalling off certain employees or restricting their future work activities due to the current work that they perform under a U.S. government contract;

•	laws, regulations and executive orders that impose requirements on us to ensure compliance with requirements and protect the government from risks related to our supply chain;

•	laws, regulations and mandatory contract provisions providing protections to employees or subcontractors seeking to report alleged fraud, waste, and abuse related to a government contract;

•	the Contractor Business Systems rule, which authorizes Department of Defense agencies to withhold a portion of our payments if we are determined to have a significant deficiency in our accounting, cost estimating, purchasing, earned value management, material management and accounting, and/or property management system; and

•	the FAR 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 not bidding and winning other contracts we might have otherwise pursued.

---

---

•	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 (including optional 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.

---

•	our ability to transition employees from completed projects to new assignments and to hire, assimilate, and deploy new employees;

•	our ability to forecast demand for our services and to maintain and deploy headcount that is aligned with demand, including employees with the right mix of skills and experience to support our projects;

•	our employees’ inability to obtain or retain necessary security clearances;

•	our ability to manage attrition; and

•	our need to devote time and resources to training, business development, and other non-chargeable activities.

---

•	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.

---

---

•	lose revenue due to adverse client reaction;

•	be required to provide additional services to a client at no charge;

•	incur additional costs related to remediation, monitoring and increasing our cybersecurity;

•	lose revenue due to the deployment of internal staff for remediation efforts instead of client assignments;

•	receive negative publicity, which could damage our reputation and adversely affect our ability to attract or retain clients;

•	be unable to successfully market services that are reliant on the creation and maintaining of secure information technology systems to U.S. government, international, and commercial clients;

•	suffer claims by clients or impacted third parties for substantial damages, particularly as a result of any successful network or systems breach and exfiltration of client and/or third party information; or

•	incur significant costs, including fines from government regulators related to complying with applicable federal or state law, including laws pertaining to the security and protection of personal information.

---

---

•	Changes in or interpretations of laws or policies that may adversely affect the performance of our services;

•	Political instability in foreign countries;

•	Imposition of inconsistent or contradictory laws or regulations;

•	Reliance on the U.S. or other governments to authorize us to export products, technology, and services to clients and other business partners;

•	Conducting business in places where laws, business practices, and customs are unfamiliar or unknown; and

•	Imposition of limitations on or increase of withholding and other taxes on payments by foreign subsidiaries or joint ventures.

---

•	impaired objectivity during performance;

•	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 and investment candidates at prices we consider attractive;

•	we may not be able to compete successfully for identified acquisition and investment candidates, complete acquisitions and investments, or accurately estimate the financial effect of acquisitions and investments on our business;

•	future acquisitions and investments 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 company’s key employees or clients;

•	we may have difficulty integrating acquired businesses and investments, resulting in unforeseen difficulties, such as incompatible accounting, information management, or other control systems, and greater expenses than expected;

•	acquisitions and investments may disrupt our business or distract our management from other responsibilities;

•	as a result of an acquisition or investment, 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; we may have difficulty integrating personnel from the acquired company with our people and our core values; and

•	we may not be able to effectively influence the operations of our joint ventures or partnerships, or we may be exposed to certain liabilities if our partners do not fulfill their obligations.

---

•	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 IDIQ 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 contractor’s 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;

•	suspend or debar us from doing business with the U.S. government; and

•	control or prohibit the export of our services.

---

•	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;

•	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;

•	adopt new socio-economic requirements, including setting aside procurement opportunities to small, disadvantaged businesses;

•	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.

---

▪

making it more difficult for us to satisfy our obligations with respect to our Secured Credit Facility, consisting of a $1,094 million term loan facility (“Term Loan A”), a $395 million term loan facility (“Term Loan B” and, together with Term Loan A, the “Term Loans”) and a $500 million Revolving Credit Facility, with a sublimit for letters of credit of $100 million, our $350 million in aggregate principal amount of 5.125% Senior Notes due 2025 (the “Senior Notes”) and our other debt;

---

▪	limiting our ability to obtain additional financing to fund future working capital, capital expenditures, acquisitions or other general corporate requirements;

▪	requiring a substantial portion of our cash flows to be dedicated to debt service payments instead of other purposes, thereby reducing the amount of cash flows available for working capital, capital expenditures, acquisitions and other general corporate purposes;

▪	increasing our vulnerability to general adverse economic and industry conditions

▪	exposing us to the risk of increased interest rates as certain of our borrowings, including under the Secured Credit Facility, are at variable rates of interest;

▪	limiting our flexibility in planning for and reacting to changes in the industry in which we compete;

▪	placing us at a disadvantage compared to other, less leveraged competitors or competitors with comparable debt and more favorable terms and thereby affecting our ability to compete; and

▪	increasing our cost of borrowing.

---

▪	incur additional indebtedness, guarantee indebtedness or issue disqualified stock or preferred stock;

▪	pay dividends on or make other distributions in respect of, or repurchase or redeem, our capital stock;

▪	prepay, redeem or repurchase subordinated indebtedness;

▪	make loans and investments;

▪	sell or otherwise dispose of assets;

▪	incur liens securing indebtedness;

▪	enter into transactions with affiliates;

▪	enter into agreements restricting our subsidiaries’ ability to pay dividends to us or the guarantors or make other intercompany transfers;

▪	consolidate, merge or sell all or substantially all of our or any guarantor’s assets;

▪	designate our subsidiaries as unrestricted subsidiaries; and

▪	enter into certain lines of business.

•	limited in how we conduct our business;

•	unable to raise additional debt or equity financing to operate during general economic or business downturns; or

•	unable to compete effectively or to take advantage of new business opportunities.

---

•	any cause of reduction or delay in U.S. government funding;

•	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;

•	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 IDIQ contracts;

•	changes in demand for our services and solutions;

•	fluctuations in the degree to which we are able to utilize our professionals;

•	seasonality associated with the U.S. government’s fiscal year;

•	an inability to utilize existing or future tax benefits for any reason, including a change in law;

•	alterations to contract requirements; and

•	adverse judgments or settlements in legal disputes.

---

•	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;

•	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.

Item 1B.	Unresolved Staff Comments

Item 2.	Properties

Item 3.	Legal Proceedings

---

---

Item 4.	Mine Safety Disclosures

---

---

---

(1)

On December 12, 2011, the Board of Directors approved a $30.0 million share repurchase program. On January 27, 2015, the Board of Directors approved an increase to our share repurchase authorization from $30.0 million to up to $180.0 million. On January 25, 2017, the Board of Directors approved an increase to our share repurchase authorization from $180.0 million to up to $410.0 million. On November 2, 2017, the Board of Directors approved an increase to our share repurchase authorization from $410.0 million to up to $610.0 million. On May 24, 2018, the Board of Directors approved an increase to our share repurchase authorization from $610.0 million to up to $910.0 million. As of May 24, 2018, taking into effect the increase in the share repurchase authorization, the Company may repurchase up to approximately $493.7 million of additional shares of common stock under its share repurchase program. A special committee of the Board of Directors was appointed to evaluate market conditions and other relevant factors and initiate repurchases under the program from time to time. The share repurchase program may be suspended, modified or discontinued at any time at the Company’s discretion without prior notice.

---

Item 6.	Selected Financial Data

---

(1)

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 Company’s 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. For the purposes of calculating basic and diluted earnings per share, the Company has utilized the two class method, given non-forfeitable dividends declared on unvested Class A Restricted Common Stock. 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.

Item 7.	Management’s Discussion and Analysis of Financial Condition and Results of Operations

---

---

---

•

"Revenue, Excluding Billable Expenses" represents revenue less billable expenses. We use Revenue, Excluding Billable Expenses because it provides management useful information about the Company's operating performance by excluding the impact of costs that are not indicative of the level of productivity of our consulting staff headcount and our overall direct labor, which management believes provides useful information to our investors about our core operations.

•

"Adjusted Operating Income" represents operating income before: (i) adjustments related to the amortization of intangible assets resulting from the acquisition of our Company by The Carlyle Group (the “Carlyle Acquisition”), and (ii) transaction costs, fees, losses, and expenses, including fees associated with debt prepayments. We prepare Adjusted Operating Income 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.

•

"Adjusted EBITDA" represents net income before income taxes, net interest and other expense and depreciation and amortization before certain other items, including transaction costs, fees, losses, and expenses, including fees associated with debt prepayments. “Adjusted EBITDA Margin on Revenue” is calculated as Adjusted EBITDA divided by revenue. "Adjusted EBITDA Margin on Revenue, Excluding Billable Expenses" is calculated as Adjusted EBITDA divided by Revenue, Excluding Billable Expenses. The Company prepares Adjusted EBITDA, Adjusted EBITDA Margin on Revenue, and Adjusted EBITDA Margin on Revenue, Excluding Billable Expenses to eliminate the impact of items it does 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.

•

"Adjusted Net Income" represents net income before: (i) adjustments related to the amortization of intangible assets resulting from the Carlyle Acquisition, (ii) transaction costs, fees, losses, and expenses, including fees associated with debt prepayments, (iii) amortization or write-off of debt issuance costs and write-off of original issue discount, (iv) release of income tax reserves, and (v) re-measurement of deferred tax assets and

---

•	"Adjusted Diluted EPS" represents diluted EPS calculated using Adjusted Net Income as opposed to net income. Additionally, Adjusted Diluted EPS does not contemplate any adjustments to net income as required under the two-class method as disclosed in the footnotes to the consolidated financial statements.

•	"Free Cash Flow" represents the net cash generated from operating activities less the impact of purchases of property and equipment.

---

(a)	Reflects amortization of intangible assets resulting from the Carlyle Acquisition.

(b)	Reflects debt refinancing costs incurred in connection with the refinancing transaction consummated on July 13, 2016.

---

(c)	Reflects the combination of Interest expense and Other income (expense), net from the consolidated statement of operations.

(d)	Release of pre-acquisition income tax reserves assumed by the Company in connection with the Carlyle Acquisition.

(e)	Reflects the provisional income tax benefit associated with the re-measurement of the Company's deferred tax assets and liabilities as a result of the 2017 Tax Act.

(f)

Fiscal 2017 and 2016 reflect the tax effect of adjustments at an assumed effective tax rate of 40%. Beginning in the third quarter of fiscal 2018 with the enactment of the 2017 Tax Act, adjustments are reflected using an assumed effective tax rate of 36.5%, which approximates a blended federal and state tax rate for fiscal 2018, and consistently excludes the impact of other tax credits and incentive benefits realized.

(g)	Excludes an adjustment of approximately $1.9 million, $2.3 million, and $3.5 million of net earnings for fiscal 2018, 2017, and 2016, respectively, associated with the application of the two-class method for computing diluted earnings per share.

•

uncertainty around the timing, extent, nature and effect of Congressional and other U.S. government actions to approve funding of the U.S. government, address budgetary constraints, including caps on the discretionary budget for defense and non-defense departments and agencies, as established by the Bipartisan Budget Control Act of 2011 and subsequently adjusted by the American Tax Payer Relief Act of 2012, the Bipartisan Budget Act of 2013 and the Bipartisan Budget Act of 2015, and address the ability of Congress to determine how to allocate the available budget authority and pass appropriations bills to fund both U.S. government departments and agencies that are, and those that are not, subject to the caps;

•	budget deficits and the growing U.S. national debt increasing pressure on the U.S. government to reduce federal spending across all federal agencies together with associated uncertainty about the size and timing of those reductions;

•

cost-cutting and efficiency initiatives, current and future budget restrictions, continued implementation of Congressionally mandated automatic spending cuts and other efforts to reduce U.S. government spending could cause clients to reduce or delay funding for orders for services or invest appropriated funds on a less consistent or rapid basis or not at all, particularly when considering long-term initiatives and in light of uncertainty around Congressional efforts to approve funding of the U.S. government and to craft a long-term agreement on the U.S. government's ability to incur indebtedness in excess of its current limits and generally in the current political environment, there is a risk that clients will not issue task orders in sufficient volume to reach current contract ceilings, alter historical patterns of contract awards, including the typical increase in the award of task orders or completion of other contract actions by the U.S. government in the period before the end of the U.S. government's fiscal year on September 30, delay requests for new proposals and contract awards, rely on short-term extensions and funding of current contracts, or reduce staffing levels and hours of operation;

•	delays in the completion of future U.S. government’s budget processes, which have in the past and could in the future delay procurement of the products, services, and solutions we provide;

•

changes in the relative mix of overall U.S. government spending and areas of spending growth, with shifts in priorities on homeland security, intelligence, defense-related programs, and healthcare, and continued increased spending on technology and innovation including cybersecurity, Command, Control, Communications, Computers, Intelligence, Surveillance, and Reconnaissance (C4ISR), advanced analytics, systems modernization and integration;

•

legislative and regulatory changes to limitations on the amount of allowable executive compensation permitted under flexibly priced contracts following adoption of interim rules adopted by federal agencies implementing a section of the Bipartisan Budget Act of 2013, which substantially further reduce the amount of allowable executive compensation under these contracts and extend these limitations to a larger segment of our executives and our entire contract base;

---

•	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;

•	increased audit, review, investigation and general scrutiny by U.S. government agencies of government contractors' performance under U.S. government contracts and compliance with the terms of those contracts and applicable laws;

•	the federal focus on refining the definition of “inherently governmental” work, including proposals to limit contractor access to sensitive or classified information and work assignments, which will continue to drive pockets of insourcing in various agencies, particularly in the intelligence market;

•	negative publicity and increased scrutiny of government contractors in general, including us, relating to U.S. government expenditures for contractor services and incidents involving the mishandling of sensitive or classified information, data breaches and cybersecurity;

•	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;

•	increased competition from other government contractors and market entrants seeking to take advantage of certain of the trends identified above, and industry trend towards consolidation, which may result in the emergence of companies that are better able to compete against us;

•	cost-cutting and efficiency and effectiveness efforts by U.S. civilian agencies with a focus on increased use of performance measurement, “program integrity” efforts to reduce waste, fraud and abuse in entitlement programs, and renewed focus on improving procurement practices for and interagency use of IT services, including through the use of cloud based options and data center consolidation;

•	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 cybersecurity, managing federal health care cost growth and focus on reforming existing government regulation of various sectors of the economy, such as financial regulation and healthcare; and

•	increasing small business regulations across the Department of Defense and civilian agency clients continue to gain traction, agencies are required to meet high small business set aside targets, and large business prime contractors are required to subcontract in accordance with considerable small business participation goals necessary for contract award.

---

•

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. As we increase or decrease our spending on allowable costs, our revenue generated on cost-reimbursable contracts will increase, up to the ceiling and funded amounts, or decrease, respectively. We generate revenue under two general types of cost-reimbursable contracts: cost-plus-fixed-fee and cost-plus-award-fee, both of which reimburse allowable costs and provide for a fee. The fee under each type of cost-reimbursable contract is generally payable upon completion of services in accordance with the terms of the contract. 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 client’s 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 billable material costs and billable out-of-pocket expenses inclusive of allocable indirect costs. To the extent our actual direct labor including allocated indirect costs, and associated billable expenses decrease or increase in relation to the fixed hourly billing rates provided in the contract, we will generate more or less profit, respectively, or could incur a loss.

•

Fixed-Price Contracts. Under a fixed-price contract, we agree to perform the specified work for a predetermined price. To the extent our actual direct and allocated indirect costs decrease or increase from the estimates upon which the price was negotiated, we will generate more or less profit, respectively, 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 (i.e., labor hours), over a stated period of time, for a fixed price.

(1)	Includes both cost-plus-fixed-fee and cost-plus-award-fee contracts.

(2)	Includes fixed-price level of effort contracts.

---

•	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 (including optional 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.

---

•	Cost of Revenue. Cost of revenue includes direct labor, related employee benefits, and overhead. Overhead consists of indirect costs, including indirect labor relating to infrastructure, management and administration, and other expenses.

•	Billable Expenses. Billable expenses include direct subcontractor expenses, travel expenses, and other expenses incurred to perform on contracts.

•	General and Administrative Expenses. General and administrative expenses include indirect labor of executive management and corporate administrative functions, marketing and bid and proposal costs, and other discretionary spending.

•	Depreciation and Amortization. Depreciation and amortization includes the depreciation of computers, leasehold improvements, furniture and other equipment, and the amortization of internally developed software, as well as third-party software that we use internally, and of identifiable long-lived intangible assets over their estimated useful lives.

---

---

---

---

---

---

•	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;

•	commitments and other discretionary investments;

•	debt service requirements for borrowings under our Secured Credit Facility and interest payments for the Senior Notes; and

•	cash taxes to be paid.

---

•

An increase in share repurchases over the prior year period of $223.8 million. In fiscal 2018, the Company repurchased a total of 7.3 million shares of Class A Common Stock, including those related to shares withheld to cover Restricted Stock vesting, for $260.4 million and also paid $9.9 million for shares of Class A Common Stock repurchased in fiscal 2017 that settled in fiscal 2018. In fiscal 2017, the Company repurchased a total of 1.3 million shares of Class A Common Stock for $46.5 million.

•	Net borrowings on the Revolving Credit Facility decreased $225.0 million as compared to the prior year period.

•	The above was offset by net proceeds received of $343.3 million from the issuance of the Senior Notes.

---

---

---

(a)	See Note 11 to our consolidated financial statements for additional information regarding debt and related matters.

(b)	Includes $80 million deferred payment obligation balance plus interest due within the next year.

(c)	See Note 20 to our consolidated financial statements for a discussion of the Company's binding and irrevocable pledge to the Booz Allen Foundation.

(d)	Reflects liabilities to holders of stock options issued under the Equity Incentive Plan, as amended, as a result of special dividends paid in November 2013, and February and August 2014.

(e)	Reflects a reserve of $10.2 million for income tax uncertainties created with the acquisition discussed in Note 4 to our consolidated financial statements.

---

---

---

Item 8.	Financial Statements and Supplementary Data

---

---

---

---

---

---

---

---

---

---

---

---

---

•	The Company expects insignificant changes related to recognizing revenue and earnings over time for long-term contracts as work progresses because of the continuous transfer of control to the customer, generally using an input measure (e.g., costs incurred) to reflect progress.

•	The determination of the customer and contract under Topic 606 will not significantly change.

•	Revenue previously deferred for non-federal government arrangements that commenced without a signed, written contract may be recognized under Topic 606 when such arrangements are legally enforceable under applicable laws and regulations.

•

The Company has determined that in its U.S. government contract portfolio, there are certain periods of performance option exercises that will be evaluated as separate performance obligations or new arrangements for accounting purposes due to their distinct nature. For example, these situations may arise when options to renew the period of performance are not exercised within a relatively short period after execution of the base contract and are thus evaluated to be separate and unrelated purchasing decisions by the customer, or when an option exercise is not the continuation of an integrated service, finished deliverable, or a single combined output.

•	The determination of contract transaction price associated with performance-based contracts (i.e., incentive or award-based contracts) will generally be consistent with the Company's current measurement practices for such contracts. The Company's estimates at completion for most fixed price contracts will now include unfunded components.

•

For interim period financial reporting purposes under Topic 606, contract revenue attributable to indirect costs will be recognized using the agreed-upon annual forward-pricing rates established with the U.S. government at the start of each fiscal year. Forward pricing rates are estimated and agreed upon between the Company and the U.S. government and represent indirect contract costs required to execute and administer contract obligations. The impact of any agreed-upon changes, or changes in the estimated annual forward-pricing rates, will be recorded in the interim financial reporting period when such changes are determined. The impact of this change relates to the interim financial reporting period differences between the actual indirect cost incurred and allocated to contracts compared to the estimated amounts allocated to

---

•	Contracts with significant up-front materials are expected to see an increase in the amount of revenue and costs recognized upon the date of the adoption, but the change in profitability is not expected to be significant.

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

Item 9.	Changes in and Disagreements With Accountants on Accounting and Financial Disclosure.

---

---

Item 9B.	Other Information.

Item 10.	Directors, Executive Officers and Corporate Governance.

Item 11.	Executive Compensation.

---

Item 12.	Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters.

(1)	Column (a) includes: 931,162 shares that have been granted as restricted stock units (RSUs) and 2,799,954 shares granted as options under our equity compensation plans. The weighted average price in column (b) does not take into account shares issued pursuant to RSUs.

Item 13.	Certain Relationships and Related Transactions, and Director Independence.

Item 14.	Principal Accounting Fees and Services

Item 15.	Exhibits, Financial Statement Schedules.

(1)	Financial Statements

(2)	Financial Statement Schedules

(3)	Exhibits

---

---

---

---

*	Filed electronically herewith.

†	Management contract or compensatory arrangement.

Item 16.	Form 10-K Summary.

---

---

---

---

---

---

---

---

---

U.S.	Officer Medical and Dental Insurance Plan (the “Plan”)* covers a variety of services and supplies

---

---

•

Professional Services —members have access to reduced rates from natural therapy professionals which include acupuncturists, chiropractors, massage therapists and dietetic counselors. Natural therapy professionals are available to members through direct access. Aetna members will receive at least a 25% discount off the provider’s standard charges for the services rendered from a natural therapy professional who participates in the vendor’s provider network.

•	Products—members have access to discounts on over 2,400 health-related products, including over-the-counter vitamins, herbal and nutritional supplements and natural products. Members will receive at least a 15% discount off the MSRP on all products offered by the vendor as well

---

1)	placing the health of the individual (or, with respect to a pregnant woman, the health of the woman and her unborn child) in serious jeopardy,

2)	serious impairment to bodily functions, or

3)	serious dysfunction of any bodily organ or part. Examples of medical emergencies are: severe chest pains, insulin shock, seizures/convulsions, and severe shortness of breath.

•	Directed by your Physician; or

•	You cannot reach the Physician or covering Physician; or

•	You believe a delay would be detrimental to your health.

---

---

•	You live in the U.S. and are on the U.S. payroll; and

•	You are not covered by another firm-sponsored basic medical plan

•	Full-time employee; or

•	Part-time* employee working on a regular basis.

•	Your spouse or eligible domestic partner** (regardless of gender);

•	Your and your spouse’s or domestic partner’s children who are unmarried, under age 26, not working full-time, and who can qualify as dependents under the provisions of the Internal Revenue Code.

-	Your biological children

-	Your adopted children (as of the date the child is “placed for adoption” which means the assumption and retention of a legal obligation for total or partial support of a child in anticipation of adoption of the child)

-	Your stepchildren

-	Any other child you support who lives with you in a parent-child relationship

•

Your and your spouse’s or domestic partner’s children (as defined above) age 26 or older, if they are primarily supported by you or your spouse or domestic partner and incapable of self- sustaining employment by reasons of mental or physical handicap. The dependent must have become incapable of self-support before age 26. You must give Aetna proof that the child meets these conditions when requested.

•	To be considered a part-time employee working on a regular basis, you must work at least 50% of the standard number of hours per week as defined for your business unit. For example, if the standard number of hours per week for your business unit is 40 hours, you must work at least 20 hours per week to be benefits eligible.

**	If you have completed and signed a “Declaration of Domestic Partnership” and the Declaration is acceptable to the firm, you may cover as your dependent the person who is the “domestic partner” named in your Declaration.

---

1)	Within 31 days after first becoming eligible to enroll;

2)	During the annual open enrollment period;

3)	Within 31 days after a qualified status change; or

4)	You may defer enrollment if you have coverage from your prior employer that extends beyond your initial date of hire with the firm. You may enroll at a future date provided it is within 31 days after the coverage ends.

•	You marry, legally separate (in states where legal separation equals divorce), have your marriage annulled, or get divorced;

•	Your unmarried dependent is no longer eligibility for plan coverage;

•	You have a baby, adopt a child, have a child placed with you for adoption, or have a child live with you that you can claim as a dependent for federal tax purposes;

•	You, your spouse, or your dependent experiences a change in employment status (for example, loss of a job, start of a new job, a strike or lockout, commencement of or return from a leave of absence, or going from full-time to part-time employment or vice versa);

•	You, your spouse, or your dependent(s) move; or

•	Your spouse or dependent(s) dies.

•

If another employer’s medical plan allows for a change in your family member’s coverage (either during that plan’s open enrollment period or due to a mid-year election change permitted under the Internal Revenue Code), you may be able to make a corresponding election change under the Plan. For example, if your spouse elects family coverage during that plan’s open enrollment period, you may drop your coverage under the Plan.

•	If the Plan receives a judgment, decree, or order (including a Qualified Medical Child Support Order, or QMCSO) requiring the Plan to provide accident or health coverage to your child or

---

•	If you, your spouse or a dependent becomes entitled to, or loses entitlement to, coverage under a government institution, Medicare, Medicaid, or state children’s health program, you may make corresponding changes to your benefit elections under the Plan.

•	You did not elect Health Expense Coverage for yourself or any eligible dependent during the Initial Enrollment Period (or during a subsequent late enrollment period) because at that time:

a)	The person was covered under another group health plan or other health insurance coverage; and

b)	You stated, in writing, at the time you refused coverage that the reason for the refusal was because the person had such coverage, but such written statement is required only if the firm requires the statement and gives you notice of the requirement; and the person loses such coverage because:

i)	It was provided under a COBRA continuation provision, and coverage under that provision was exhausted; or

ii)	It was not provided under a COBRA continuation provision, and either the coverage was terminated as a result of loss of eligibility for the coverage, including loss of eligibility as a result of:

-	Legal separation or divorce;

-	Death;

-	Termination of employment;

-	Reduction in the number of hours of employment;

---

-	The employer’s decision to stop offering the group health plan to the Eligible Class to which the employee belongs;

-	Cessation of a dependent’s status as an eligible dependent as such is defined under this Plan;

-	The operation of another Plan’s lifetime maximum on all benefits, if applicable; or

-	Employer contributions toward the coverage were terminated.

•	You elect coverage within 31 days of the date the person loses coverage for one of the above reasons.

•	You, if you are eligible, but not enrolled, and your newly acquired dependents through marriage, birth, adoption, or placement for adoption. However, you must request enrollment for your newly acquired dependent(s) and yourself, if you are not already enrolled, within

•	Your spouse from whom you are separated or divorced, or child who would meet the definition of a dependent, if you are subject to a court order requiring you to provide health expense coverage for such spouse or child. However, you must request enrollment within 31 days of the court order.

1)	In the case of marriage, on the date the completed request for enrollment is received;

2)	In the case of a newborn, on the date of birth;

3)	In the case of adoption, on the date of the child’s adoption or placement for adoption;

4)	In the case of court ordered coverage of a spouse or child, on the date of the court order;

5)	In the case of loss of coverage under COBRA continuation, on the date COBRA continuation ended; and

6)	In the case of loss of coverage for other reasons, the date on which the applicable event occurred.

---

•	You are no longer employed by the firm;

•	You are no longer a part of a Covered Class (see page 6);

•	The Plan ends; or

•	You are covered as a dependent and you lose your dependent status.

---

•	Hospice care—210 days per period of care

•	Hospice care bereavement counseling—5 days

---

---

•	Initial evaluation, which may include medical, surgical, and sexual histories as well as a physical exam, psychological evaluation, and accompanying diagnostic testing;

•	Hormonal and related services for the external augmentation of ovulatory cycles to achieve pregnancy;

•	Subsequent visits, including follow-up exams and diagnostic procedures;

•	Injectable drugs used to treat infertility, payable under the prescription drug benefit.

•	The person shows that she or her spouse has a history of infertility which has lasted at least

•	The person and her spouse has not had voluntary sterilization (with or without surgical reversal); or a hysterectomy.

•	The person’s Physician must certify that all of the necessary tests have been given to find the cause of the infertility; and no less costly treatment will result in pregnancy.

•	Successful pregnancy cannot be attained through less costly treatment for which there is coverage on the plan.

•	Artificial insemination, including analysis and preparation of the semen with which such person is to be inseminated.

•	Implementation of an embryo of such person, but only in connection with in vitro fertilization or other embryo transfer procedures, including:

-	egg retrieval;

-	semen analysis and preparation;

-	embryo culture; embryo transfer;

-	Gamete Intrafallopian Transfer (GIFT);

-	Zygote Intrafallopian Transfer (ZIFT);

-	Intracytoplasmic Sperm Injection (ICSI).

---

•	Surrogate and Gestational Carrier—In both cases, the plan covers only those tests and procedures that are to be performed on the member. In no event will any of these procedures, tests or charges be covered if the person is acting as a surrogate mother and no procedures or tests performed on the carrier will be covered.

•	Purchase of donor sperm

•	Care of donor egg retrievals or transfers

•	Cryopreservation or storage of cryopreserved embryos—except in the case of Testicular Cancer HCPCS Codes S4030 & S4031

•	Prescription drugs including injectable fertility medications—covered through pharmacy benefit

•	Home ovulation predictor kits

•	Gestational carrier programs

•	Detoxification. This means mainly treating the after effects of a specific episode of alcoholism or drug abuse.

•	Maintenance care. This means providing an environment free of alcohol or drugs.

---

1)	The confinement is recommended by a doctor and begins during a convalescent period;

2)	The patient is under the continuing care of a doctor;

3)	The patient receives necessary skilled nursing care, physical rehabilitation services, or both, and;

4)	It is expected that the care received will improve the patient’s condition and facilitate discharge.

•	Drug addiction

•	Chronic brain syndrome

•	Alcoholism

•	Senility

•	Mental retardation

•	Any other mental disorder

---

•	teeth, mouth, jaws, jaw joints; or

•	supporting tissues (this includes bones, muscles, and nerves).

•	Treat a fracture, dislocation, or wound;

•	Cut out teeth partly or completely impacted in the bone of the jaw; teeth that will not erupt through the gum; other teeth that cannot be removed without cutting into bone; the roots of a tooth without removing the entire tooth; 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.

•	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.

1)	The services and supplies will be considered to be furnished on account of the recipient’s sickness or injury.

---

2)	There is an eligible charge limit on the charges for those services and supplies. That limit is the extent to which benefits for charges, services and supplies are not provided by reason of the donor’s coverage under one or more of the following:

a)	the group contract, or any other group or individual contract;

b)	any arrangement of coverage for individuals in a group (whether on an insured or uninsured basis), including any prepayment coverage.

---

1)	Services of the operating Physician for performing the procedure and for related pre- and post-operative care and the administering of an anesthetic;

2)	Services of any other Physician for the administering of an anesthetic; this does not include a local anesthetic.

---

1)	You require intensive nursing care for treatment of an acute sickness or injury; and

2)	You are not in a Hospital or other health care facility that supplies nursing care.

3)	Visiting nursing care by an R.N. or L.P.N. means a visit of not more than 4 hours for the purpose of performing specific skilled nursing tasks.

4)	Breast reconstruction—if elected after the mastectomy for:

a)	Reconstruction of the breast on which a mastectomy has been performed;

b)	Surgery and reconstruction of the other breast to produce a symmetrical appearance;

c)	Prostheses; and

d)	Treatment of physical complications of all stages of mastectomy, including lymphedemas.

5)	Cleft lip/cleft palate—covers charges for oral and facial surgery, obturators, orthodontic appliances, orthodontic treatment, prosthodontic treatment, habilitative speech therapy, otolaryngology treatment and audiological assessment and treatments.

6)	Craniofacial disorders—Covers dependent children to age 18 and includes charges for partially or fully removable dentures or fixed bridgework; replacement of dentures by denture or fixed bridgework when required as a result of structural changes in the mouth or jaw due to growth; prosthodontic treatment such as obturators; speech appliances and feeding appliances, and cleft orthodontic therapy.

---

7)	Diagnostic speech evaluations to find out if, and to what extent, the person’s ability is to speak. Not included are charges for speaking aids or training in their use;

8)	Services given to treat delays in speech development only if resulting from disease, injury or birth defect;

9)	Rehabilitative speech and language therapy to restore or improve a person’s ability to speak if the loss of speech is not caused by a mental disorder.

•	Speech therapy services are considered medically necessary only if there is a reasonable expectation that speech therapy will achieve measurable improvement in the patient’s condition in a reasonable and predictable period of time.

---

•	For in-mouth appliances, crowns, bridgework, dentures, tooth restorations, or any related fitting or adjustment services; whether or not the purpose of such services or supplies is to relieve pain;

•	For root canal therapy;

•	For routine tooth removal (not needing cutting of bone).

•	To remove, repair, replace, restore or reposition teeth lost or damaged in the course of biting or chewing;

•	To repair, replace, or restore fillings, crowns, dentures or bridgework;

•	For non-surgical periodontal treatment;

•	For dental cleaning, in-mouth scaling, planing or scraping;

•	For myofunctional therapy; this is muscle training therapy; or training to correct or control harmful habits.

---

1)	There are insufficient outcomes data available from controlled clinical trials published in the peer reviewed literature to substantiate its safety and effectiveness for the disease or injury involved; or

2)	If required by the FDA, approval has not been granted for marketing; or

3)	A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental, investigational, or for research purposes; or

4)

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, investigational, or for research purposes.

1)	Furnished, paid for, or for which benefits are provided or required by reason of the past or present service of any person in the armed forces of a government.

2)

Furnished, paid for, or for which benefits are provided or required under any law of a government. (This exclusion will not apply to “no fault” auto insurance if it is required by law; provided on other than a group basis; and is included in the definition of Other Plans in the section entitled “If You or Your Dependents Have Other Coverage Excluding Medicare”. In addition, this exclusion will not apply to a plan established by a government for its own employees or their dependents; or Medicare.)

•	Any ear or hearing exam to diagnose or treat a disease or injury;

•	Drugs or medicines;

•	Any hearing care service or supply which is a covered expense in whole or in part under any other part of this Plan or under any other plan of group benefits provided through your Employer;

---

•	Any hearing care service or supply for which a benefit is provided under any workers’ compensation law or any other law of like purpose, whether benefits are payable as to all or only part of the charges;

•	Any hearing care service or supply which does not meet professionally accepted standards;

•	Any service or supply received while the person is not covered;

•	Any exams given while the person is confined in a hospital or other facility for medical care;

•	Any exam required by an employer as a condition of employment, or which an employer is required to provide under a labor agreement or is required by any law of a government.

•	Any private duty nursing care given while the person is an inpatient in a hospital or other health care facility; or

•	Care provided to help a person in the activities of daily life; such as bathing, feeding, personal grooming, dressing, getting in and out of bed or a chair, or toileting; or

•	Care provided solely for skilled observation; or

•	Any service provided solely to administer oral medicines; except where applicable law requires that such medicines be administered by an R.N. or L.P.N.

---

---

---

---

---

---

---

•	Oral exams once every 6 months, including prophylaxis, scaling and cleaning of teeth;

•	Topical application of sodium or stannous fluoride for persons under 19 years of age;

•	X-rays for diagnosis, also other X-rays not to exceed one full mouth series in a 36 month period and one set of bitewings in a 6 month period;

•	First installation of a space maintainer to replace any baby tooth which is lost prematurely;

•	Sealants for dependent children under 14 years of age.

•	Surgical and non-surgical extractions;

•	Fillings;

•	General anesthetics given in connection with covered dental services;

•	Surgical and non-surgical treatment of diseased periodontal structures;

•	Surgical and non-surgical endodontic treatment, including root canal therapy;

•	Injection of antibiotic drugs;

•	Repair or recementing of crowns, inlays, bridgework or dentures;

•	Relining and rebasing of dentures (one per 36 month period);

---

•	For installation of removable dentures to replace one or more natural teeth extracted while the person is covered. This includes adjustments for the 6 month period following the date they were installed;

•	Replacement of an existing removable denture or fixed bridgework by new fixed bridgework, or the adding of teeth to existing fixed bridgework. The “Prosthesis Replacement Rule” (see below) must be met.

•	Inlays, gold fillings, or crowns; this includes precision attachments for dentures;

•	First installation of fixed bridgework to replace one or more natural teeth extracted while the person is covered, including inlays and crowns as abutments;

•	Replacement of an existing removable denture or fixed bridgework by a new denture, or the adding of teeth to a partial removable denture; the “Prosthesis Replacement Rule” must be met.

•	The replacement or addition of teeth is required to replace teeth extracted after the present denture or bridgework was installed. The person must have been covered when the tooth was extracted.

•	The present denture or bridgework is a least 5 years old and cannot be made serviceable.

---

•	The present denture is an immediate temporary one to replace one or more natural teeth extracted while the person is covered and cannot be made permanent. Replacement

•	by a permanent denture is needed. It takes place within 12 months from the date the immediate temporary one was first installed.

•	Care, treatment, services, or supplies that are not prescribed, recommended, or approved by the person’s attending Physician or Dentist. However, the Plan will cover some treatments by a licensed dental hygienist that are supervised by a Dentist. These are scaling of teeth, cleaning of teeth and topical application of fluoride.

•	The replacement of a prosthetic device that is lost, missing or stolen.

•	Any services or supplies which are for orthodontic treatment.

•	Services or supplies to increase vertical dimension. These are dentures, crowns, inlays and onlays, bridgework or any other appliance or service.

---

•	A drug, a device, a procedure, or treatment will be determined Experimental or Investigational if Aetna determines that:

1)	There are insufficient outcomes data available from controlled clinical trials published in the peer reviewed literature to substantiate its safety and effectiveness for the disease or injury involved; or

2)	If required by the FDA, approval has not been granted for marketing; or

3)	A recognized national medical or dental society or regulatory agency has determined, in writing, that it is Experimental, Investigational, or for research purposes; or

4)

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, Investigational, or for research purposes.

•	Those for services of a resident Physician or intern rendered in that capacity.

•	Those that a covered person is not legally obliged to pay.

•

To the extent allowed by the law of the jurisdiction where the group contract is delivered, those for services and supplies furnished, paid for, or for which benefits are provided or required by reason of the past or present service of any person in the armed forces of a government; furnished, paid for, or for which benefits are provided or required under any law of a government. (This exclusion will not apply to “no fault” auto insurance if it is required by law; is provided on other than a group basis; and is included in the definition of Other Plans in the section entitled If You or Your Dependents Have Other Coverage excluding Medicare. In addition, this exclusion will not apply to a plan established by government for its own employees or their dependents; or Medicaid.)

•

Those for plastic surgery, reconstructive surgery, cosmetic surgery, or other services and supplies which improve, alter or enhance appearance, whether or not for psychological or emotional reasons (this includes charges for personalization or characterization of dentures); except to the extent needed to repair an injury. Surgery must be performed in the calendar year of the accident which causes the injury, or in the next calendar year.

---

---

1)	A plan with no rules for coordination with other benefits will be deemed to pay its benefits before a plan which contains such rules.

2)

A plan which covers a person other than as a dependent will be deemed to pay its benefits before a plan which covers the person as a dependent; except that if the person is also a Medicare beneficiary and as a result of the Social Security Act of 1965, as amended, Medicare is: secondary to the plan covering the person as a dependent; and primary to the plan covering the person as other than a dependent; the benefits of a plan which covers the person as a dependent will be determined before the benefits of a plan which covers the person as other than a dependent and is secondary to Medicare.

3)

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 the person as a dependent of a person whose birthday comes later in that calendar year. If both parents have the same birthday, the benefits of a plan which covered one parent longer are determined before those of a plan which covered the other parent for a shorter period of time.

4)	In the case of a dependent child whose parents are divorced or separated:

a)	If there is a court decree which states that the parents shall share joint custody of a dependent child, without stating that one of the parents is responsible for the health care expenses of the child, the order of benefit determination rules specified in (3) above will apply.

---

b)	If there is a court decree which makes one parent financially responsible for the medical, dental or other health care expenses of such child, the benefits of a plan which covers the child as a dependent of such parent will be determined before the benefits of any Other Plan which covers the child as a dependent child.

c)	If there is not such a court decree:

i)	If the parent with custody of the child has not remarried, the benefits of a plan which covers the child as a dependent of the parent with custody of the child will be determined before the benefits of a plan which covers the child as a dependent of the parent without custody.

ii)

If the parent with custody of the child has remarried, the benefits of a plan which covers the child as a dependent of the parent with custody shall be determined before the benefits of a plan which covers that child as a dependent of the stepparent. The benefits of a plan which covers that child as a dependent of the stepparent will be determined before the benefits of a plan which covers that child as a dependent of the parent without custody.

5)	If 1, 2, 3 and 4 above do not establish an order of payment, the plan under which the person has been covered for the longest time will be deemed to pay its benefits first except that:

a)

The benefits of a plan which covers the person on whose expenses claim is based as a laid-off or retired employee; or the dependent of such person; shall be determined after the benefits of any Other Plan which covers such person as an employee who is not laid-off or retired, or a dependent of such person. If the Other Plan does not have a provision regarding laid-off or retired employees and as a result, each plan determines its benefits after the other, then the above paragraph will not apply.

b)

The benefits of a plan which covers the person on whose expenses claim is based under a right of continuation pursuant to federal or state law shall be determined after the benefits of any Other Plan which covers the person other than under such right of continuation. If the Other Plan does not have a provision: regarding right of continuation pursuant to federal or state law and as a result, each plan determines its benefits after the other, then the above paragraph will not apply.

---

---

•	The specific reasons for the denial;

•	The specific references to provisions of the Plan documents that support those reasons;

•	Any additional information you must provide to improve your claim and the reasons why that information is necessary; and

•	The procedures available to you for further review of the claim.

---

•	Certification of health care services

•	Claim payment

•	Plan interpretation

•	Benefit determination

•	Eligibility

---

•	You have exhausted the Aetna Life Insurance Company appeal process for denied claims and you have received a final denial.

•	The final denial was based upon a lack of medical necessity, or the experimental or investigational nature of the proposed service or treatment; and

•	The cost of the service or treatment at issue exceeds $500.00.

---

•

COBRA applies to “qualified beneficiaries” which does not include domestic partners. However, Booz Allen voluntarily offers the same continuation coverage to domestic partners who are eligible to participate in the Plan. References in this notice to “qualified beneficiaries” and “qualifying events” are intended to pertain to domestic partners covered under the Plan. A “domestic partner” will be treated identically to a “spouse” for all relevant purposes, including notice requirements given by the HR Representative.

---

1)	A reduction in your hours of employment; or

2)	The termination of your employment (for reasons other than your gross misconduct).**

1)	The death of your spouse or domestic partner;

2)	The termination of your spouse’s or domestic partner’s employment (for reasons other than the employee’s gross misconduct);

3)	A reduction in your spouse’s or domestic partner’s hours of employment;

4)	Your divorce or legal separation or the end of your domestic partnership; or

5)	Your spouse’s or domestic partner’s entitlement to Medicare (Part A, Part B, or both).

1)	The death of a parent employed by Booz Allen;

2)	The termination of a parent’s employment with Booz Allen (for reasons other than parent’s gross misconduct);

3)	A reduction in a parent’s hours of employment;

---

4)	The parents’ divorce or legal separation or the end of the parent’s domestic partnership;

5)	The child ceases to be a “dependent child” as defined by the Plan; or

6)	The parent who is employed by Booz Allen becomes entitled to Medicare (under Part A, Part B, or both.)

---

1)	The death of the employee;

2)	The dependent ceases to be a “dependent child” as defined by the Plan;

3)	The employee’s entitlement to Medicare (Part A, Part B, or both); or

4)	Divorce or legal separation or end of domestic partnership.

1)	Booz Allen no longer provides group health care coverage to any of its employees;

2)	The premium for COBRA continuation coverage is not paid in a timely manner;

3)	The person receiving COBRA continuation coverage becomes covered under another group health care plan that does not contain any exclusion or limitation with respect to a pre- existing condition (other than an exclusion or limitation with respect to any pre-existing condition that may be disregarded under the law);

---

4)	The person receiving COBRA continuation coverage becomes entitled to Medicare;

5)	If COBRA continuation coverage was extended to up to 29 months due to a Social Security disability determination and a final determination is made that the qualified beneficiary is no longer disabled; or

6)	The end of the COBRA continuation coverage period.

---

•	Reconstruction of the breast on which the mastectomy was performed;

•	Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

•	Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

•

To pay Aetna to the extent the person recovers from a third party via settlement or judgment an amount, which includes an amount or part thereof, already paid by Aetna. The amount recovered from a third party must be for the same services or benefits for which the person incurred expenses, which were already paid by Aetna. The foregoing notwithstanding, however, if the amount recovered through a settlement or judgment is not sufficient to cover all amounts paid by Aetna and the person, the person’s obligation to pay Aetna shall begin only when the person has fully recovered from the third party all amounts paid by the person for the related medical claims and not paid or reimbursed by Aetna.

•	To provide Aetna a lien in the amount of the benefit paid. This lien may be filed with: the third party; his or her agent; or a court that has jurisdiction in the matter.

---

---

---

•	Access their “Protected Health Information” (PHI);

•	Make certain amendments to their PHI;

•	Receive an accounting of certain disclosures of their PHI; and

•	Request restrictions on use or disclosure of their PHI and/or have their PHI communicated through confidential means.

---

•	To receive services in connection with an NME procedure or treatment on an inpatient or outpatient basis; or

•	To travel to and from the facility where treatment is given.

---

•	By whom they are prescribed; or

•	By whom they are recommended; or

•	By whom or by which they are performed.

•	Has a follow-up therapy program directed by a physician on at least a monthly basis; or

•	Includes meetings at least twice a month with organizations devoted to the treatment of alcoholism or drug abuse.

•	Detoxification. This means mainly treating the aftereffects of a specific episode of alcoholism or drug abuse.

•	Maintenance care. This means providing an environment free of alcohol or drugs.

---

•	Mainly provides inpatient facilities for the surgical and medical diagnosis, treatment, and care of injured and sick persons;

•	Is supervised by a staff of Physicians;

•	Provides 24 hour a day R.N. service;

•	Is not mainly a place for rest, for the aged, for drug addicts, for alcoholics, or a nursing home.

---

•	Alcoholism and drug abuse.

•	Schizophrenia.

•	Bipolar disorder.

•	Pervasive Mental Developmental Disorder (Autism).

•	Panic disorder.

•	Major depressive disorder.

•	Psychotic depression.

•	Obsessive compulsive disorder.

•	Be care or treatment, as likely to produce a significant positive outcome as, and no more likely to produce a negative outcome than, any alternative service or supply, both as to the disease or injury involved and the person’s overall health condition;

•	Be a diagnostic procedure, indicated by the health status of the person and be as likely to result in information that could affect the course of treatment as, and no more likely to produce a negative outcome than, any alternative service or supply, both as to the disease or injury involved and the person’s overall health condition; and

•	As to diagnosis, care and treatment be no more costly (taking into account all health expenses incurred in connection with the service or supply) than any alternate service or supply to meet the above tests.

---

•	Information provided on the affected person’s health status;

•	Reports in peer reviewed medical literature;

•	Reports and guidelines published by nationally recognized healthcare organizations that include supporting scientific data;

•	Generally recognized professional standards of safety and effectiveness in the United States for diagnosis, care or treatment;

•	The opinion of health professionals in the generally recognized health specialty involved; and

•	Any other relevant information brought to Aetna’s attention.

•	Those that do not require the technical skills of a medical, mental health or dental professional; or

•	Those furnished mainly for the personal comfort or convenience of the person, any person who cares for him or her, any person who is part of his or her family, any healthcare provider or healthcare facility; or

•	Those furnished solely because of the setting if the service or supply could safely and adequately be furnished in a Physician’s or a dentist’s office or other less costly setting.

•	Arise out of (or in the course of) any work for pay or profit; or

•	Result in any way from a disease that does.

•	Is covered under any type of workers’ compensation law; and

•	Is not covered for that disease 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.

---

•	While the contract remains in effect;

•	While such a pharmacy dispenses a prescription drug under the terms of its contract with Aetna.

•	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.

•	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 per day/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.

•	The onset of or change in a disease; or

•	The diagnosis of a disease; or

---

•	An injury caused by an accident;

•	Provides unscheduled medical services to treat an urgent condition if the person’s 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.

•	Is severe enough to require prompt medical attention to avoid serious deterioration of the covered person’s health;

•	Includes a condition which would subject the covered person 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 the covered person’s physician becomes reasonably available.

---

---

---

---

---

▪	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 employer’s IRS-qualified retirement plan.

▪	Your legal spouse; or

▪	Your domestic partner who meets the rules set by your employer; and

▪	Your dependent children; and

▪	Dependent children of your domestic partner.

---

▪	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 plan’s 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 plan’s 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

---

§	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.

§	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 recognized 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.

▪	The plan contains a deductible carryover feature. Refer to your Schedule of Benefits section for details.

▪	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.

---

▪	Stays in a hospital

▪	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, your benefits will be reduced. Please refer to the Schedule of Benefits for specific details about the plan. No other plan benefits will pay for non-emergency care in the emergency room unless otherwise specified under the plan.

---

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 services, supply or prescription drug must be provided by a physician, or other health care 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 practice;

(b)	Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury or disease; and

(c)	Not primarily for the convenience of the patient, physician 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 patient’s illness, injury, or disease.

---

§	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.

---

▪	1 gynecological exam every 12 months

▪	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.

▪	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 12 consecutive month period.

---

▪	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, but not if solely for your employment;

▪	Allergy testing, treatment and injections; and

▪	Charges made by the physician for supplies, radiological services, x-rays, and tests provided by the physician.

▪	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 hospital’s nursing staff;

▪	Admission and other fees;

---

▪	General and special diets; and

▪	Sundries and supplies.

▪	Ambulance services.

▪	Physicians and surgeons.

▪	Operating and recovery rooms.

▪	Intensive or special care facilities.

▪	Administration of blood and blood products, but not the cost of the blood or blood products.

▪	Radiation therapy.

▪	Speech therapy, physical therapy and occupational therapy.

▪	Oxygen and oxygen therapy.

▪	Radiological services, laboratory testing and diagnostic services.

▪	Medications.

▪	Intravenous (IV) preparations.

▪	Discharge planning.

▪	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;

▪	Nursing staff services; and

▪	Radiologists and pathologists services.

▪	A physician or dentist for professional services;

▪	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 dentist’s office.

▪	Services and supplies provided by the hospital, surgery center on the day of the procedure;

▪	The operating physician’s 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.

▪	In connection with a pregnancy for which pregnancy related expenses are not included as a covered expense.

▪	Is given under a home health care plan;

▪	Is given to you in your home while you are homebound.

▪	Part-time or intermittent care by an R.N. or by an L.P.N. if an R.N. is not available.

▪	Part-time or intermittent home health aid services provided in conjunction with and in direct support of care by an R.N. or an L.P.N.

▪	Physical, occupational, and speech therapy.

▪	Part-time or intermittent medical social services by a social worker when provided in conjunction with, and in direct support of care by an R.N. or an L.P.N.

▪	Medical supplies, prescription drugs and lab services by or for a home health care agency to the extent they would have been covered under this plan if you had a hospital stay.

▪	Care is provided within 10 days of discharge from a hospital or skilled nursing facility as a full-time inpatient; and

▪	Care is needed to transition from the hospital or skilled nursing facility to home care.

---

▪	Services or supplies that are not a 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 spouse’s or your domestic partner's family.

▪	Services of a certified or licensed social worker.

▪	Services for Infusion Therapy.

▪	Transportation.

▪	Services or supplies provided to a minor or dependent adult when a family member or caregiver is not present.

▪	Services that are 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.

▪	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 physician’s services); and

▪	Medical supplies.

▪	You are currently receiving inpatient hospital care, or inpatient subacute care; and

▪	The skilled nursing facility admission will take the place of an admission to, or continued stay in, a hospital or subacute facility; or it will take the place of three or more skilled nursing care visits per week at home; and

▪	There is a reasonable expectation that your condition will improve sufficiently to permit discharge to your home within a reasonable amount of time; and

▪	The illness or injury is severe enough to require constant or frequent skilled nursing care on a 24-hour basis; and

▪	Your stay in a skilled nursing facility:

•	follows a hospital stay of at least three days in a row; and

•	begins within 14 days after your discharge from the hospital; and

•	is necessary to recover from the illness or injury that caused the hospital stay.

▪	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;

▪	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.

▪	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.

---

▪	As a form of anesthesia in connection with a covered surgical procedure; and

▪	To treat an illness, injury or to alleviate chronic pain.

▪	To the first hospital where treatment is given in a medical emergency.

▪	From one hospital to another hospital in a medical emergency when the first hospital does not have the required services or facilities to treat your condition.

▪	From hospital to home or to another facility when other means of transportation would be considered unsafe due to your medical condition.

▪	From home to hospital for covered inpatient or outpatient treatment when other means of transportation would be considered unsafe due to your medical condition. Transport is limited to 100 miles.

▪	When during a covered inpatient stay at a hospital, skilled nursing facility or acute rehabilitation hospital, an ambulance is required to safely and adequately transport you to or from inpatient or outpatient medically necessary treatment.

▪	Ground ambulance transportation is not available; and

▪	Your condition is unstable, and requires medical supervision and rapid transport; and

▪	In a medical emergency, transportation from one hospital to another hospital; when the first hospital does not have the required services or facilities to treat your condition and you need to be transported to another hospital; and the two conditions above are met.

▪	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.

---

▪	Autistic Disorder;

▪	Asperger's Syndrome;

▪	Rett’s Syndrome;

▪	Childhood Disintegrative Disorder; or

▪	Pervasive Developmental Disorder--Not Otherwise Specified;

▪	C.A.T. scans;

▪	Magnetic Resonance Imaging (MRI);

▪	Positron Emission Tomography (PET) Scans; and

▪	Any other outpatient diagnostic imaging service costing over $500.

---

▪	Related to your surgery, and the surgery takes place in a hospital or surgery center;

▪	Completed within 14 days before your surgery;

▪	Performed on an outpatient basis;

▪	Covered if you were an inpatient in a hospital;

▪	Not repeated in or by the hospital or surgery center where the surgery will be performed.

▪	Test results should appear in your medical record kept by the hospital or surgery center where the surgery is performed.

▪	If your tests indicate that surgery should not be performed because of your physical condition, the plan will pay for the tests, 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.

---

▪	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;

▪	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.

---

▪	Internal body part or organ; or

▪	External body part.

▪	A limb or artificial 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 for 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 items; or

▪	The repair or replacement of any device due to neglect, misuse or abuse.

▪	any item listed in the Exclusions section.

---

▪	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; 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. The plan will cover charges in accordance with a treatment plan as determined by your risk level when recommended by a physician. This course of treatment is limited to a maximum of 36 sessions in a 12 week period.

▪	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. This course of treatment is limited to a maximum of 36 hours or a six week period.

▪	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.

▪

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 one’s 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.

▪

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). Examples of non-covered diagnoses include Pervasive Developmental Disorders, Down's Syndrome, and Cerebral Palsy, as they are considered both developmental and/or chronic in nature. This does not apply to physical therapy, occupational therapy or speech therapy provided for the treatment of Autism Spectrum Disorders. Physical therapy, occupational therapy and speech therapy services for the treatment of Autism Spectrum Disorder are not subject to the maximum benefits, if any shown in the Schedule of Benefits applicable to this coverage.

▪	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 provided during a stay in a hospital, skilled nursing facility, or hospice facility except as stated above;

▪	Services provided by a home health care agency;

▪	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 spouse’s 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 needed to improve a significant functional impairment of a body part.

▪	Surgery to correct the result of an accidental injury, including subsequent related or staged surgery, provided that the surgery occurs no more than 24 months after the original injury. For a covered child, the time period for coverage may be extended through age 18.

▪	Surgery to correct the result of an injury that occurred during a covered surgical procedure provided that the reconstructive surgery occurs no more than 24 months after the original injury.

▪	Surgery to correct a gross anatomical defect present at birth or appearing after birth (but not the result of an illness or injury) when

§	the defect results in severe facial disfigurement, or

§	the defect results in significant functional impairment and the surgery is needed 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 one's own body; so that any evidence of one's 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 one's 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 providers 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.

---

▪	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 and blood products;

▪	Dialysis; and

▪	Insulin.

---

▪	Insulin-dependent diabetes;

▪	Insulin-using diabetes;

▪	Gestational diabetes; and

▪	Non-insulin using diabetes

▪	A condition that is a demonstrated cause of infertility which has been recognized by a gynecologist, or an infertility specialist, and your physician who diagnosed you as infertile, and it has been documented in your medical records.

▪	The procedures are done while not confined in a hospital or any other facility as an inpatient.

▪	Your FSH levels are less than, 19 miU 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

▪	Ovulation induction with menotropins is subject to the maximum benefit, if any, shown in the Schedule of Benefits section of this Booklet-Certificate and has a maximum of 6 cycles per lifetime; (where lifetime is defined to include services received, provided or administered by Aetna or any affiliated company of Aetna); and

▪	Intrauterine insemination is subject to the maximum benefit, if any, shown in the Schedule of Benefits section of this Booklet-Certificate and has a maximum of 6 cycles per lifetime; (where lifetime is defined to include services received, provided or administered by Aetna or any affiliated company of Aetna).

▪	In vitro fertilization (IVF);

▪	Zygote intrafallopian transfer (ZIFT);

▪	Gamete intra-fallopian transfer (GIFT);

---

▪	Cryopreserved embryo transfers;

▪	Intracytoplasmic sperm injection (ICSI); or ovum microsurgery.

▪	First exhaust the comprehensive infertility services benefits. Coverage for ART services is available only if comprehensive infertility services do not result in a pregnancy in which a fetal heartbeat is detected;

▪	Be referred by your physician to Aetna's infertility case management unit.

▪	Up to 3 cycles and subject to the maximum benefit, if any, shown in the Schedule of Benefits section of any combination of the following ART services per lifetime (where lifetime is defined to include all ART services received, provided or administered by Aetna or any affiliated company of Aetna) which only include: IVF; GIFT; ZIFT; or cryopreserved embryo transfers;

▪	IVF; Intra-cytoplasmic sperm injection (“ICSI”); ovum microsurgery; GIFT; ZIFT; or cryopreserved embryo transfers subject to the maximum benefit shown on the Schedule of Benefits section while covered under an Aetna plan;

▪	Payment for charges associated with the care of the an eligible covered person under this plan who is participating in a donor IVF program, including fertilization and culture; and

▪	Charges associated with obtaining the spouse's sperm for ART, when the spouse is also covered under this

▪	ART services for a female attempting to become pregnant who has not had at least 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination (for covered persons under 35 years of age), or 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination (for covered persons 35 years of age or older) prior to enrolling in the infertility program;

▪	ART services for couples in which 1 of the partners has had a previous sterilization procedure, with or without surgical reversal;

▪	Reversal of sterilization surgery;

▪	Infertility services for females with FSH levels 19 or greater mIU/ml on day 3 of the menstrual cycle;

▪	The purchase of donor sperm and any charges for the storage of sperm; the purchase of donor eggs and any charges associated with care of the donor required for donor egg retrievals or transfers or gestational carriers (or surrogacy); all charges associated with a gestational carrier program for the covered person or the gestational carrier;

▪	Charges associated with cryopreservation or storage of cryopreserved eggs and embryos (e.g., office, hospital, ultrasounds, laboratory tests, etc.);

▪	Home ovulation prediction kits;

▪	Drugs related to the treatment of non-covered benefits;

▪	Injectable infertility medications, including but not limited to, menotropins, hCG, GnRH agonists, and IVIG;

▪	Infertility Services that are not reasonably likely to result in success;

▪	Ovulation induction and intrauterine insemination services if you are not infertile;

---

▪	Infertility services for couples in which 1 of the partners has had a previous sterilization procedure, with or without surgical reversal;

▪	Reversal of sterilization surgery;

▪	Infertility services for females with FSH levels 19 or greater mIU/ml on day 3 of the menstrual cycle;

▪	The purchase of donor sperm and any charges for the storage of sperm; the purchase of donor eggs and any charges associated with care of the donor required for donor egg retrievals or transfers or gestational carriers (or surrogacy); all charges associated with a gestational carrier program for the covered person or the gestational carrier;

▪	Charges associated with cryopreservation or storage of cryopreserved eggs and embryos (e.g., office, hospital, ultrasounds, laboratory tests, etc.);

▪	Home ovulation prediction kits;

▪	Drugs related to the treatment of non-covered benefits;

▪	Injectable infertility medications, including but not limited to, menotropins, hCG, GnRH agonists, and IVIG;

▪	Infertility Services that are not reasonably likely to result in success;

▪	Ovulation induction and intrauterine insemination services if you are not infertile;

▪	Any ART procedure or services related to such procedures, including but not limited to in vitro fertilization (“IVF”), gamete intra-fallopian transfer (“GIFT”), zygote intra-fallopian transfer (“ZIFT”), and intra-cytoplasmic sperm injection (“ICSI”); or

▪	Any charges associated with care required to obtain ART services (e.g., office, hospital, ultrasounds, laboratory tests, etc.); and any charges associated with obtaining sperm for any ART procedures.

▪	During your hospital stay; or

▪	For surgery. This includes pre- and post-surgical care provided or ordered by the operating physician.

▪	Oral surgery and facial surgery, including pre and post-operative care provided by a physician;

▪	Oral prosthesis treatment, including obturators and orthotic devices, speech and feeding appliances;

▪	Initial installation of dentures, whether fixed or removable, partial or full;

▪	Replacement of dentures by dentures or fixed partial dentures when needed because of structural changes in the mouth or jaw due to growth;

▪	Cleft orthodontic therapy;

▪	Orthodontic, otolaryngology or prosthetic treatment and management;

---

▪	Installation of crowns;

▪	Diagnostic services provided by a physician to determine the extent of loss or impairment in your speaking or hearing ability;

▪	Speech therapy to treat delays in speech development given by a physician. Such therapy is expected to overcome congenital or early acquired handicaps;

▪	Speech therapy provided by a physician, if the therapy is expected to restore or improve your ability to speak. Coverage includes speech aids and training to use the speech aids;

▪	Psychological assessment and counseling;

▪	Genetic assessment and counseling;

▪	Hearing aids;

▪	Audiological assessment, treatment and management, including surgically implanted amplification devices; and

▪	Physical therapy assessment and treatment.

▪	Oral prostheses, dentures or fixed partial dentures that were ordered before your coverage became effective or ordered while you were covered, but installed or delivered more than 60 days after your coverage ended;

▪	Augmentative (assistive) communication systems and usage training. (These aids are used in the special education of a person whose ability to speak or hear has been impaired, including lessons in sign language.)

▪	Heart;

▪	Lung;

▪	Heart/Lung;

▪	Simultaneous Pancreas Kidney (SPK);

▪	Pancreas;

▪	Kidney;

▪	Liver;

▪	Intestine;

▪	Bone Marrow/Stem Cell;

▪	Multiple organs replaced during one transplant surgery;

▪	Tandem transplants (Stem Cell);

▪	Sequential transplants;

▪	Re-transplant of same organ type within 180 days of the first transplant;

▪	Any other single organ transplant, unless otherwise excluded under the plan.

▪	Autologous blood/bone marrow transplant followed by allogenic blood/bone marrow transplant (when not part of a tandem transplant);

▪	Allogenic blood/bone marrow transplant followed by an autologous blood/bone marrow transplant (when not part of a tandem transplant);

▪	Re-transplant after 180 days of the first transplant;

▪	Pancreas transplant following a kidney transplant;

---

▪	A transplant necessitated by an additional organ failure during the original transplant surgery/process;

▪	More than one transplant when not performed as part of a planned tandem or sequential transplant, (e.g., a liver transplant with subsequent heart transplant).

▪	Charges made by a physician or transplant team.

▪	Charges made by a hospital, outpatient facility or physician for the medical and surgical expenses of a live donor, but only to the extent not covered by another plan or program.

▪	Related supplies and services provided by the facility during the transplant process. These services and supplies may include: physical, speech and occupational therapy; bio-medicals and immunosuppressants; home health care expenses and home infusion services.

▪	Charges for activating the donor search process with national registries.

▪	Compatibility testing of prospective organ donors who are immediate family members. For the purpose of this coverage, an “immediate” family member is defined as a first-degree biological relative. These are your biological parents, siblings or children.

▪	Inpatient and outpatient expenses directly related to a transplant.

1.	Pre-transplant evaluation/screening: Includes all transplant-related professional and technical components required for assessment, evaluation and acceptance into a transplant facility’s transplant program;

2.	Pre-transplant/candidacy screening: Includes HLA typing/compatibility testing of prospective organ donors who are immediate family members;

3.

Transplant event: Includes inpatient and outpatient services for all covered transplant-related health services and supplies provided to you and a donor during the one or more surgical procedures or medical therapies for a transplant; prescription drugs provided during your inpatient stay or outpatient visit(s), including bio-medical and immunosuppressant drugs; physical, speech or occupational therapy provided during your inpatient stay or outpatient visit(s); cadaveric and live donor organ procurement; and

4.	Follow-up care: Includes all covered transplant expenses; home health care services; home infusion services; and transplant-related outpatient services rendered within 180 days from the date of the transplant event.

▪	Outpatient drugs including bio-medicals and immunosuppressants not expressly related to an outpatient transplant occurrence;

▪	Services that are covered under any other part of this plan;

▪	Services and supplies furnished to a donor when the recipient is not covered under this plan;

▪	Home infusion therapy after the transplant occurrence;

▪	Harvesting or storage of organs, without the expectation of immediate transplantation for an existing illness;

---

▪	Harvesting and/or storage of bone marrow, tissue or stem cells, without the expectation of transplantation within 12 months for an existing illness;

▪	Cornea (Corneal Graft with Amniotic Membrane) or Cartilage (autologous chondrocyte or autologous osteochondral mosaicplasty) transplants, unless otherwise authorized by Aetna.

▪

Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regimens and supplements, food or food supplements, appetite suppressants and other medications; exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including morbid obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions; except as provided in this Booklet-Certificate.

▪	The treatment must be medically necessary;

▪	There is a written treatment plan prescribed and supervised by a behavioral health provider; and

▪	This Plan includes follow-up treatment.

---

▪	Please refer to the Schedule of Benefits for any copayments/deductibles, maximums and Coinsurance Limit that may apply.

▪	There is a program of therapy prescribed and supervised by a behavioral health provider.

▪	The program of therapy includes either:

•	A follow up program directed by a behavioral health provider on at least a monthly basis; or

•	Meetings at least twice a month with an organization devoted to the treatment of alcoholism or substance abuse.

▪	Treatment in a hospital for the medical complications of substance abuse.

▪	“Medical complications” include detoxification, electrolyte imbalances, malnutrition, cirrhosis of the liver, delirium tremens and hepatitis.

▪	Treatment in a hospital is covered only when the hospital does not have a separate treatment facility section.

---

▪	Please refer to the Schedule of Benefits for any copayments/deductibles, maximums and Coinsurance Limit that may apply.

▪	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.

▪	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.

▪	age 35 but less than 40 for one screening mammogram.

▪	age 40 and over for one screening mammogram every calendar year.

▪	for an annual Pap smear and for annual testing using any FDA-approved gynecologic cytology screening technologies.

---

▪	age 50 and over; and persons age 40 and over who are at high risk for prostate cancer according to the most recent published guidelines of the American Cancer Society, and that occur in connection with an annual exam for screening for cancer of the prostate:

•	a digital rectal exam; and

•	a prostate specific antigen (PSA) test.

▪	in connection with an annual exam for screening of colorectal cancer and provided in accordance with the most recently published recommendations established by the American College of Gastroenterology, in consultation with the American Cancer Society, for the ages, family histories, and frequencies referenced in such recommendations:

•	fecal occult blood test; and

•	flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging.

i.	is under 5 years of age;

ii.	is severely disabled; or

iii.	has a medical condition that requires admission to a hospital or outpatient surgery center and general anesthesia for dental care treatment.

---

▪	up to 48-hours of inpatient care in a hospital following a radical or modified mastectomy;

▪	up to 24-hours of inpatient care in a hospital following a total mastectomy or partial mastectomy with lymph node dissection.

▪	a minimum stay in a hospital of not less than 23-hours following a laparoscopy-assisted vaginal hysterectomy;

▪	a minimum stay in a hospital of not less than 48-hours following a vaginal hysterectomy; or

▪	a shorter hospital stay, if the attending provider, in consultation with the covered person, determines that a shorter length of stay is appropriate.

▪	They are between the ages of birth and 3 years;

▪	They are certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services as eligible for the services under Part H of the Individuals with Disabilities Education Act; and

▪	The services are designed to attain or retain the capacity to function age-appropriately within their environment.

▪	the treatment or studies are part of a Phase II-IV clinical trial for cancer;

▪

the treatment is being provided in a clinical trial approved by the National Cancer Institute (NCI), an NCI cooperative group or center, the FDA as part of an investigational new drug application, the Federal Department of Veterans Affairs, or an institutional review board which has a multiple project assurance contract approved by the office of protection from research risks of the National Cancer Institute;

▪	the treating facility and personnel have the expertise and capability to render the treatment as a result of their experience, training and volume of patients;

▪	there is no clearly superior, non-investigational treatment alternative; and

▪	available clinical or pre-clinical data provide a reasonable expectation that the treatment will be at least as effective as the non-investigational alternative.

---

---

▪	such prescription drugs or supplies are unavailable or illegal in the United States; or

▪	the purchase of such prescription drugs or supplies outside the United States is considered illegal.

▪	Alcoholism or substance abuse rehabilitation treatment on an inpatient or outpatient basis, except to the extent coverage for detoxification or treatment of alcoholism or substance abuse is specifically provided in the What the Medical Plan Covers Section.

▪	Treatment of a covered health care provider who specializes in the mental health care field and who receives treatment as a part of their training in that field.

▪	Treatment of impulse control disorders such as pathological gambling, kleptomania, pedophilia, caffeine or nicotine use.

▪	Treatment of antisocial personality disorder.

▪	Treatment in wilderness programs or other similar programs.

▪	Treatment of mental retardation, defects, and deficiencies. This exclusion does not apply to mental health services or to medical treatment of mentally retarded in accordance with the benefits provided in the What the Plan Covers section of this Booklet-Certificate.

---

▪	Over the counter contraceptive supplies including but not limited to condoms, contraceptive foams, jellies and ointments.

▪	Face lifts, body lifts, tummy tucks, liposuctions, removal of excess skin, removal or reduction of non-malignant moles, blemishes, varicose veins, cosmetic eyelid surgery and other surgical procedures;

▪	Chemical peels, dermabrasion, laser or light treatments, bleaching, creams, ointments or other treatments or supplies to alter the appearance or texture of the skin;

▪	Insertion or removal of any implant that alters the appearance of the body (such as breast or chin implants);

▪	Removal of tattoos;

▪	Repair of piercings and other voluntary body modifications, including removal of injected or implanted substances or devices;

▪	Surgery to correct Gynecomastia;

▪	Breast augmentation; and

▪	Otoplasty.

▪	services of dentists, oral surgeons, dental hygienists, and orthodontists including apicoectomy (dental root resection), root canal treatment, soft tissue impactions, removal of bony impacted teeth, treatment of periodontal disease, alveolectomy, augmentation and vestibuloplasty and fluoride and other substances to protect, clean or alter the appearance of teeth;

▪	dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth; and

▪	non-surgical treatments to alter bite or the alignment or operation of the jaw, including treatment of malocclusion or devices to alter bite or alignment.

▪	Over-the-counter drugs, biological or chemical preparations and supplies that may be obtained without a

▪	Any services related to the dispensing, injection or application of a drug;

▪	Any prescription drug purchased illegally outside the United States, even if otherwise covered under this plan within the United States;

▪	Immunizations related to work;

▪	Needles, syringes and other injectable aids, except as covered for diabetic supplies;

▪	Drugs related to the treatment of non-covered expenses;

▪	Performance enhancing steroids;

---

▪	Injectable drugs if an alternative oral drug is available;

▪	Outpatient prescription drugs;

▪	Self-injectable prescription drugs and medications;

▪	Any prescription drugs, injectables, or medications or supplies provided by the policyholder or through a third party vendor contract with the policyholder; and

▪	Any expenses for prescription drugs, and supplies covered under an Aetna Pharmacy plan will not be covered under this medical expense plan. Prescription drug exclusions that apply to the Aetna Pharmacy plan will apply to the medical expense coverage; and

▪	Charges for any prescription drug for the treatment of erectile dysfunction, impotence, or sexual dysfunction or inadequacy.

▪	Any services or supplies related to education, training or retraining services or testing, including: special education, remedial education, job training and job hardening programs;

▪	Evaluation or treatment of learning disabilities, minimal brain dysfunction, developmental, learning and communication disorders, behavioral disorders, (including pervasive developmental disorders) training or cognitive rehabilitation, regardless of the underlying cause; and

▪	Services, treatment, and educational testing and training related to behavioral (conduct) problems, learning disabilities and delays in developing skills.

▪	Any health examinations required:

•	by a third party, including examinations and treatments required to obtain or maintain employment, or which an employer is required to provide under a labor agreement;

•	by any law of a government;

•	for securing insurance, school admissions or professional or other licenses;

•	to travel;

•	to attend a school, camp, or sporting event or participate in a sport or other recreational activity; and

▪	rest homes;

▪	assisted living facilities;

▪	similar institutions serving as an individual's primary residence or providing primarily custodial or rest care;

▪	health resorts;

▪	spas, sanitariums; or

▪	infirmaries at schools, colleges, or camps.

---

▪	Treatment of calluses, bunions, toenails, hammer-toes, subluxations, fallen arches, weak feet, chronic foot pain or conditions caused by routine activities such as walking, running, working or wearing shoes; and

▪	Shoes (including but not limited to orthopedic shoes), foot orthotics, arch supports, shoe inserts, ankle braces, guards, protectors, creams, ointments and other equipment, devices and supplies, even if required following a covered treatment of an illness or injury.

▪	Any hearing service or supply that does not meet professionally accepted standards;

▪	Hearing exams given during a stay in a hospital or other facility; except as specifically provided in the What the Plan Covers section;

▪	Replacement parts or repairs for a hearing aid; and

▪	Any tests, appliances, and devices for the improvement of hearing (including but not limited to hearing aids and amplifiers), or to enhance other forms of communication to compensate for hearing loss or devices that simulate speech, except as specifically provided in the What the Plan Covers section.

▪	Purchase or rental of exercise equipment, air purifiers, central or unit air conditioners, water purifiers, waterbeds. and swimming pools;

▪	Exercise and training devices, whirlpools, portable whirlpool pumps, sauna baths, or massage devices;

▪	Equipment or supplies to aid sleeping or sitting, including but not limited to non-hospital electric and air beds, water beds, pillows, sheets, blankets, warming or cooling devices, bed tables and reclining chairs;

▪	Equipment installed in your home, workplace or other environment, including but not limited to stair-glides, elevators, wheelchair ramps, or equipment to alter air quality, humidity or temperature;

▪	Other additions or alterations to your home, workplace or other environment, including but not limited to room additions, changes in cabinets, countertops, doorways, lighting, wiring, furniture, communication aids, wireless alert systems, or home monitoring;

▪	Services and supplies furnished mainly to provide a surrounding free from exposure that can worsen your illness

▪	Removal from your home, worksite or other environment of carpeting, hypo-allergenic pillows, mattresses, paint, mold, asbestos, fiberglass, dust, pet dander, pests or other potential sources of allergies or illness; and

▪	Transportation devices, including but not limited to stair-climbing wheelchairs, personal transporters, bicycles, automobiles, vans or trucks, or alterations to any vehicle or transportation device.

▪	Drugs related to the treatment of non-covered benefits;

▪	Injectable infertility medications, including but not limited to menotropins, hCG, GnRH agonists, and IVIG;

▪

Any advanced reproductive technology (“ART”) procedures or services related to such procedures, including but not limited to in vitro fertilization (“IVF”), gamete intra-fallopian transfer (“GIFT”), zygote intra-fallopian transfer (“ZIFT”), and intra-cytoplasmic sperm injection (“ICSI”); Artificial Insemination for covered females attempting to become pregnant who are not infertile as defined by the plan;

---

▪	Infertility services for couples in which 1 of the partners has had a previous sterilization procedure, with or without surgical reversal;

▪	Procedures, services and supplies to reverse voluntary sterilization;

▪	Infertility services for females with FSH levels 19 or greater mIU/ml on day 3 of the menstrual cycle;

▪	The purchase of donor sperm and any charges for the storage of sperm; the purchase of donor eggs and any charges associated with care of the donor required for donor egg retrievals or transfers or gestational carriers or surrogacy; donor egg retrieval or fees associated with donor egg programs, including but not limited to fees for laboratory tests;

▪	Charges associated with cryopreservation or storage of cryopreserved eggs and embryos (e.g., office, hospital, ultrasounds, laboratory tests, etc.); any charges associated with a frozen embryo or egg transfer, including but not limited to thawing charges;

▪	Home ovulation prediction kits or home pregnancy tests;

▪	Any charges associated with care required to obtain ART Services (e.g., office, hospital, ultrasounds, laboratory tests); and any charges associated with obtaining sperm for any ART procedures; and

▪	Ovulation induction and intrauterine insemination services if you are not infertile.

▪	Annual or other charges to be in a physician’s practice;

▪	Charges to have preferred access to a physician’s services such as boutique or concierge physician practices;

▪	Cancelled or missed appointment charges or charges to complete claim forms;

▪	Charges the recipient has no legal obligation to pay; or the charges would not be made if the recipient did not have coverage (to the extent exclusion is permitted by law) including:

•	Care in charitable institutions;

•	Care for conditions related to current or previous military service;

•	Care while in the custody of a governmental authority;

•	Any care a public hospital or other facility is required to provide; or

•	Any care in a hospital or other facility owned or operated by any federal, state or other governmental entity, except to the extent coverage is required by applicable laws.

---

▪	Surgical procedures to alter the appearance or function of the body;

▪	Hormones and hormone therapy;

▪	Prosthetic devices; and

▪	Medical or psychological counseling.

▪	Surgery, drugs, implants, devices or preparations to correct or enhance erectile function, enhance sensitivity, or alter the shape or appearance of a sex organ; and

▪	Sex therapy, sex counseling, marriage counseling or other counseling or advisory services.

▪	Exercise equipment, memberships in health or fitness clubs, training, advice, or coaching;

▪	Drugs or preparations to enhance strength, performance, or endurance; and

▪	Treatments, services and supplies to treat illnesses, injuries or disabilities related to the use of performance- enhancing drugs or preparations.

---

▪	Aromatherapy;

▪	Bio-feedback and bioenergetic therapy;

▪	Carbon dioxide therapy;

▪	Chelation therapy (except for heavy metal poisoning);

▪	Computer-aided tomography (CAT) scanning of the entire body;

▪	Educational therapy;

▪	Gastric irrigation;

▪	Hair analysis;

▪	Hyperbaric therapy, except for the treatment of decompression or to promote healing of wounds;

▪	Hypnosis, and hypnotherapy, except when performed by a physician as a form of anesthesia in connection with covered surgery;

▪	Lovaas therapy;

▪	Massage therapy;

▪	Megavitamin therapy;

▪	Primal therapy;

▪	Psychodrama;

▪	Purging;

▪	Recreational therapy;

▪	Rolfing;

▪	Sensory or auditory integration therapy;

▪	Sleep therapy;

▪	Thermograms and thermography.

▪	Outpatient drugs including bio-medicals and immunosuppressants not expressly related to an outpatient transplant occurrence;

▪	Services and supplies furnished to a donor when recipient is not a covered person;

▪	Home infusion therapy after the transplant occurrence;

▪	Harvesting and/or storage of organs, without the expectation of immediate transplantation for an existing illness;

▪	Harvesting and/or storage of bone marrow, tissue or stem cells without the expectation of transplantation within 12 months for an existing illness;

▪	Cornea (corneal graft with amniotic membrane) or cartilage (autologous chondrocyte or autologous osteochondral mosaicplasty) transplants, unless otherwise precertified by Aetna.

▪	Special supplies such as non-prescription sunglasses and subnormal vision aids;

▪	Vision service or supply which does not meet professionally accepted standards;

▪	Eye exams during your stay in a hospital or other facility for health care;

▪	Eye exams for contact lenses or their fitting;

▪	Eyeglasses or duplicate or spare eyeglasses or lenses or frames;

▪	Replacement of lenses or frames that are lost or stolen or broken;

▪	Acuity tests;

---

▪	Eye surgery for the correction of vision, including radial keratotomy, LASIK and similar procedures;

▪	Services to treat errors of refraction.

▪	Liposuction, banding, gastric stapling, gastric by-pass and other forms of bariatric surgery; surgical procedures medical treatments, weight control/loss programs and other services and supplies that are primarily intended to treat, or are related to the treatment of obesity, including morbid obesity;

▪	Drugs, stimulants, preparations, foods or diet supplements, dietary regimens and supplements, food or food supplements, appetite suppressants and other medications;

▪	Counseling, coaching, training, hypnosis or other forms of therapy; and

▪	Exercise programs, exercise equipment, membership to health or fitness clubs, recreational therapy or other forms of activity or activity enhancement.

---

▪	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

▪	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.

▪	Injectable prescription drug refills will only be covered when obtained through Aetna’s specialty pharmacy network.

---

---

---

▪	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, you will be responsible for any applicable coinsurance for covered expenses that you incur. Your coinsurance amount is determined by applying the applicable coinsurance percentage to the negotiated charge if the prescription is filled at a network pharmacy. When you obtain your prescription drugs through a network pharmacy, you will not be subject to balance billing.

▪	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.

---

▪	Oral Contraceptives.

▪	Diaphragms, 1 per 365 consecutive day period

▪	Injectable contraceptives.

▪	Contraceptive patches.

▪	Contraceptive rings.

▪	Implantable contraceptives and IUDs are covered when obtained from a physician. The physician will provide insertion and removal of the drugs or device.

---

▪	Urofollitropin, menotropin, human chorionic gonadotropin and progesterone.

▪	Sildenafil Citrate, phentolamine, apomorphine and alprostadil in oral, injectable and topical (including but not limited to gels, creams, ointments and patches) forms or any other form used internally or externally. Expenses include any prescription drug in oral or topical form that is 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 as determined by Aetna to be similar in cost to oral forms, per 30 day supply. Mail order and 60 to 90 day supplies are not covered.

▪	Administration or injection of any drug;

▪	Any charges in excess of the benefit, dollar, day, or supply limits stated in this Booklet-Certificate;

▪	Allergy sera and extracts.

---

▪	Over the counter contraceptive supplies including but not limited to:

§	condoms;

§	contraceptive foams;

§	jellies; and

§	ointments;

▪	Services associated with the prescribing, monitoring and/or administration of contraceptives.

§	health and beauty aids;

§	chemical peels;

§	dermabrasion;

§	treatments;

§	bleaching;

§	creams;

§	ointments or other treatments or supplies, to remove tattoos, scars or to alter the appearance or texture of the skin.

▪	stimulants;

▪	preparations;

▪	foods or diet supplements;

▪	dietary regimens and supplements;

▪	food or food supplements;

▪	appetite suppressants; and

▪	other medications.

---

▪	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

▪	infant formulas;

▪	nutritional supplements;

▪	vitamins;

▪	medical foods and other nutritional items, even if it is the sole source of nutrition.

▪	Any charges for the administration or injection of prescription drugs or injectable insulin and other injectable drugs covered by Aetna;

▪	Needles and syringes, except for diabetic needles and syringes;

▪	Injectable drugs if an alternative oral drug is available;

▪	For any refill of a designated self-injectable drug not dispensed by or obtained through the specialty pharmacy network. An updated copy of the list of self-injectable drugs designated by this plan to be refilled by or obtained through the specialty pharmacy network is available upon request. You may also get a copy of the list on Aetna's website at www.aetna.com.

---

▪	Drugs, implants, devices or preparations to correct or enhance erectile function, enhance sensitivity, or change the shape or appearance of a sex organ.

---

▪	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 health plan, if your plan contains such a maximum benefit.

▪	You are no longer eligible for dependents’ coverage;

▪	You do not make your contribution for the cost of dependents’ coverage;

▪	Your own coverage ends for any of the reasons listed under When Coverage Ends for Employees (This does not apply if you use up your lifetime maximum, if included);

▪

Your dependent is no longer eligible for coverage. Coverage ends at the end of the calendar month when your dependent does not meet the plan’s definition of a dependent. However, when a dependent child is a full-time student who is on a medically necessary leave of absence from school, coverage under this plan will remain in force for up to 12 months from the date the dependent ceases to be a full-time student, or until the dependent does not meet the plan's definition of a dependent, whichever occurs first; or

▪	As permitted under applicable federal and state law, your dependent becomes eligible for like 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 a completed and signed Declaration of Termination of Domestic Partnership.

---

▪	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 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 employer’s notice of this COBRA continuation right, if later.

▪	Agree to pay the required premiums.

---

▪	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 18th month, through the 29th 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.

▪	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

---

▪	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.

▪	Required by law or regulation for group conversion purposes in your or your dependent’s states of residence; and

▪	Offered by Aetna when you or your dependents apply under your employer’s conversion plan.

---

▪	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.

▪	Medical coverage under the group contract has been discontinued.

▪	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.

▪	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.

---

1.	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 is not an allowable expense. This does not apply if one of the Plans provides coverage for a private room.

2.	If a person is covered by 2 or more Plans that compute their benefit payments on the basis of reasonable or recognized charges, any amount in excess of the highest of the reasonable or recognized charges for a specific benefit is not an allowable expense.

3.	If a person is covered by 2 or more Plans that provide benefits or services on the basis of negotiated charges, an amount in excess of the highest of the negotiated charges is not an allowable expense.

4.	The amount a benefit is reduced or not reimbursed by the primary plan because a covered person does not comply with the Plan provisions is not an allowable expense. Examples of these provisions are second surgical opinions, precertification of admissions, and preferred provider arrangements.

5.

If all plans covering a person are high deductible plans and the person intends to contribute to a health savings account established in accordance with section 223 of the Internal Revenue Code of 1986, the primary high deductible plan's deductible is not an allowable expense, except as to any health expense that may not be subject to the deductible as described in section 223(c)(2)(C) of the Internal Revenue Code of 1986.

---

▪	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;

▪	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.

▪	The primary plan pays or provides its benefits as if the secondary plan or plans did not exist.

▪

A plan that does not contain a coordination of benefits provision that is consistent with this provision is always primary. There is one exception: coverage that is obtained by virtue of membership in a group that is designed to supplement a part of a basic package of benefits may provide that the supplementary coverage shall be excess to any other parts of the plan provided by the contract holder. Examples of these types of situations are major medical coverages that are superimposed over base plan hospital and surgical benefits, and insurance type coverages that are written in connection with a closed panel plan to provide out-of-network benefits.

▪	A plan may consider the benefits paid or provided by another plan in determining its benefits only when it is secondary to that other plan.

---

1.

Non-Dependent or Dependent. The plan that covers the person other than as a dependent, for example as an employee, member, subscriber or retiree is primary and the plan that covers the person as a dependent is secondary. However, if the person is a Medicare beneficiary and, as a result of federal law, Medicare is secondary to the plan covering the person as a dependent; and primary to the plan covering the person as other than a dependent (e.g. a retired employee); then the order of benefits between the two plans is reversed so that the plan covering the person as an employee, member, subscriber or retiree is secondary and the other plan is primary.

2.	Child Covered Under More than One Plan. The order of benefits when a child is covered by more than one plan is:

A.	The primary plan is the plan of the parent whose birthday is earlier in the year if:

i.	The parents are married or living together whether or not married;

ii.	A court decree awards joint custody without specifying that one party has the responsibility to provide health care coverage or if the decree states that both parents are responsible for health coverage. If both parents have the same birthday, the plan that covered either of the parents longer is primary.

B.

If the specific terms of a court decree state that one of the parents is responsible for the child’s health care expenses or health care coverage and the plan of that parent has actual knowledge of those terms, that plan is primary. If the parent with responsibility has no health coverage for the dependent child’s health care expenses, but that parent’s spouse does, the plan of the parent’s spouse is the primary plan.

C.	If the parents are separated or divorced or are not living together whether or not they have ever been married and there is no court decree allocating responsibility for health coverage, the order of benefits is:

•	The plan of the custodial parent;

•	The plan of the spouse of the custodial parent;

•	The plan of the noncustodial parent; and then

•	The plan of the spouse of the noncustodial parent.

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.

Continuation Coverage. If a person whose coverage is provided under a right of continuation provided by federal or state law also is covered under another plan, the plan covering the person as an employee, member, subscriber or retiree (or as that person’s dependent) is primary, and the continuation coverage is secondary. 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.

5.	Longer or Shorter Length of Coverage. The plan that covered the person as an employee, member, or subscriber longer is primary.

6.	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.

---

---

▪	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).

---

---

▪	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.

▪	In the event of a misstatement of any fact affecting your coverage under the plan, the true facts will be used to determine the coverage in force.

▪	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.

---

▪	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.

---

▪	Names of physicians, dentists and others who furnish services.

▪	Dates expenses are incurred.

▪	Copies of all bills and receipts.

---

▪	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.

▪	A dependent child's eligibility under the prior coverage is a result of his or her status as a full-time student at a postsecondary educational institution; and

▪	Such dependent child is in a period of coverage continuation pursuant to a medically necessary leave of absence from school (or change in full-time student status); and

▪	This plan provides coverage for eligible dependents;

---

▪	The calendar year in which you become covered under any Comprehensive Medical Expense Coverage section of this plan; or

▪	The last 3 months of the calendar year right before the year your coverage takes effect.

---

▪	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.

▪	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;

▪	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 Children’s Health Insurance Program (S-Chip).

---

▪	Routine patient care such as changing dressings, periodic turning and positioning in bed, administering medications;

▪	Care of a stable tracheostomy (including intermittent suctioning);

▪	Care of a stable colostomy/ileostomy;

▪	Care of stable gastrostomy/jejunostomy/nasogastric tube (intermittent or continuous) feedings;

▪	Care of a stable indwelling bladder catheter (including emptying/changing containers and clamping tubing);

▪	Watching or protecting you;

▪	Respite care, adult (or child) day care, or convalescent care;

▪	Institutional care, including room and board for rest cures, adult day care and convalescent care;

▪	Help with the daily living activities, such as walking, grooming, bathing, dressing, getting in or out of bed, toileting, eating or preparing foods;

▪	Any services that a person without medical or paramedical training could be trained to perform; and

▪	Any service that can be performed by a person without any medical or paramedical training.

▪	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 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.

▪	Placing your health in serious jeopardy; or

▪	Serious impairment to bodily function; or

▪	Serious dysfunction of a body part or organ; or

▪	In the case of a pregnant woman, serious jeopardy to the health of the fetus.

▪	There is not enough 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

▪	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.

▪	the treating facility; or

▪	by another facility studying the same:

•	drug;

•	device;

•	procedure; or

•	treatment.

▪	chemical;

▪	proprietary; or

▪	non-proprietary name; and

▪	is accepted by the U.S. Food and Drug Administration as therapeutically the same; and

▪	can be replaced with drugs with the same amount of active ingredient; and

▪	so stated by Medispan or any other publication named by Aetna or consort.

▪	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.

---

▪	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 patient's 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 person's 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, on its premises, inpatient medical, surgical and diagnostic services;

▪	Is supervised by a staff of physicians;

▪	Provides twenty-four (24) hour-a-day R.N. service,

▪	Charges patients for its services;

▪	Is operating in accordance with the laws of the jurisdiction in which it is located; and

▪	Does not meet all of the requirements above, but does meet the requirements of the jurisdiction in which it operates for licensing as a hospital and is accredited as a hospital by the Joint Commission on the Accreditation of Healthcare Organizations.

▪	For a woman who is under 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: 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 alike disorder of the jaw joint; or

▪	A Myofacial Pain Dysfunction (MPD); or

▪	Any alike disorder in the relationship of the jaw joint and the related muscles and nerves.

▪	Are given mainly to maintain, rather than to improve, a level of physical, or mental function; and

▪	Give a surrounding free from exposures that can worsen the person's physical or mental condition.

---

▪	preventing;

▪	evaluating;

▪	diagnosing; or

▪	treating:

•	an illness;

•	an injury;

•	a disease; or

•	its symptoms.

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 patient's illness, injury or disease; and

c)	Not mostly for the convenience of the patient, physician, other health care or dental provider; and

d)	And do not cost more than an alternative service or sequence of services at least as likely to produce the same therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease.

▪	Anorexia/Bulimia Nervosa.

▪	Bipolar disorder.

▪	Major depressive disorder.

▪	Obsessive compulsive disorder.

▪	Panic disorder.

▪	Pervasive developmental disorder (including Autism).

▪	Psychotic disorders/Delusional disorder.

▪	Schizo-affective disorder.

▪	Schizophrenia.

---

▪	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.

▪	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

▪	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.

▪	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.

▪	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

---

▪	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.

▪	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.

▪	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.

▪	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 per day/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.

▪	It is licensed to provide, and does provide, the following on an inpatient basis for persons convalescing from

•	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 disorders.

▪	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.

▪	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.

▪	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.

▪	Provides an ongoing quality assurance program. The program must include reviews by physicians who do not own or direct the facility.

▪	Keeps a medical record on each patient.

▪	The onset of or change in an illness; or

▪	The diagnosis of an 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 person’s 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.

▪	A physician’s office, but only one that has contracted with Aetna to provide urgent care.

▪	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.

---

---

---

▪	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)	all stages of 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.

---

---

---

---

---

---

---

•	you or a family member;

•	any person using a vehicle or watercraft covered under this policy with permission from you or a family member with respect to their legal responsibility arising out of its use;

•	any other person who is a covered person under your Required Primary Underlying Insurance;

•	any person or organization with respect to their legal responsibility for covered acts or omissions of you or a family member; or

•	any combination of the above.

---

•	bodily injury;

•	shock, mental anguish, or mental injury;

•	false arrest, false imprisonment, or wrongful detention;

•	wrongful entry or eviction;

•	malicious prosecution or humiliation; and

•	libel, slander, defamation of character, or invasion of privacy.

•	any motorized land vehicle not designed for or required to be registered for use on public roads;

•	any motorized land vehicle which is in dead storage at your residence;

•	any motorized land vehicle used solely on and to service your residence premises;

•	any motorized land vehicle used to assist the disabled that is not designed for or required to be registered for use on public roads; or

•	golf carts.

---

•	$250,000/$500,000 bodily injury and $100,000 property damage;

•	$300,000/$300,000 bodily injury and $100,000 property damage; or

•	$300,000 single limit each occurrence.

•	$250,000/$500,000 bodily injury and $100,000 property damage;

•	$300,000/$300,000 bodily injury and $100,000 property damage; or

•	$300,000 single limit each occurrence.

•	$250,000/$500,000 bodily injury and $100,000 property damage;

•	$300,000/$300,000 bodily injury and $100,000 property damage; or

•	$300,000 single limit each occurrence.

•	in excess of damages covered by the underlying insurance; or

•	from the first dollar of damage where no underlying insurance is required under this policy and no underlying insurance exists; or

•	from the first dollar of damage where underlying insurance is required under this policy but no coverage is provided by the underlying insurance for a particular occurrence;

---

---

•	not covered by any underlying insurance; or

•	covered by an underlying policy. This will apply to each Defense Coverage as it has been exhausted by payment of claims.

•	all premiums on appeal bonds required in any suit we defend;

•	all premiums on bonds to release attachments for any amount up to the amount of coverage (but we are not obligated to apply for or furnish any bond);

•	all expenses incurred by us;

•	all costs taxed against a covered person;

•	all interest accruing after a judgment is entered in a suit we defend on only that part of the judgment we are responsible for paying. We will not pay interest accruing after we have paid the judgment up to the amount of coverage;

•	all earnings lost by each covered person at our request; up to $25,000;

•	other reasonable expenses incurred by a covered person at our request; and

•	the cost of bail bonds required of a covered person because of a covered loss.

•	the costs for notarizing affidavits or similar documents for law enforcement agencies, financial institutions or similar credit grantors, and credit agencies;

•	the costs for sending certified mail to law enforcement agencies, financial institutions or similar credit grantors, and credit

---

•	the loan application fees for reapplying for loan(s) due to the rejection of the original application because the lender received incorrect credit information;

•	the telephone expenses for calls to businesses, law enforcement agencies, financial institutions or similar credit grantors,

•	earnings lost by you or a family member as a result of time off from work to complete fraud affidavits, meet with law enforcement agencies, credit agencies, merchants, or legal counsel;

•	the reasonable attorney fees incurred with prior notice to us for:

•	the defense of you or a family member against any suit(s) by businesses or their collection agencies;

•	the removal of any criminal or civil judgements wrongly entered against you or a family member;

•	any challenge to the information in your or a family member' s consumer credit report; and

•	the reasonable fees incurred with prior notice to us by an identity fraud mitigation entity to:

•	provide services for the activities described above;

•	restore accounts or credit standing with financial institutions or similar credit grantors and credit agencies; and

•	monitor for up to one year the effectiveness of the fraud mitigation and to detect additional identity fraud activity after the first identify fraud occurrence.

•	you or a family member; or

•	a covered relative who witnessed the occurrence.

•	you;

•	from anywhere in the world except those places listed on the United States State Department Bureau of Consular Affairs Travel Warnings list at the time of the occurrence. The occurrence must include a demand for ransom payment which would be paid by you or a family member in exchange for the release of the kidnapped person(s).

•	a professional negotiator;

•	a professional security consultant;

•	professional security guard services;

•	a professional public relations consultant;

•	travel, meals, lodging and phone expenses incurred by you or a family member;

•	advertising, communications and recording equipment;

•	related medical, cosmetic, psychiatric and dental expenses incurred by a kidnapped person within 12 months from that person's release;

•	attorney’s fees;

•	a professional forensic analyst;

•	earnings lost by you or a family member, up to $25,000.

---

•	you or a family member;

•	a covered relative;

•	any guardian, or former guardian of you, a family member or covered relative;

•	any estranged spouse or domestic partner, or former spouse or domestic partner of you or a family member;

•	any person unrelated to you or a family member who lives with you or a family member or has ever lived with you or a family member for 6 or more months, other than a domestic employee, residential staff, or a person employed by you or a family member for farm work; or

•	a civil authority,

•	children, their children or other descendants of theirs;

•	parents, grandparents or other ancestors of theirs; or

•	siblings, their children or other descendants of theirs;

•	the reputational injury is reported to us as soon as reasonably possible but not later than 30 days after the personal injury

•	you obtain approval of the reputation management firm from us before incurring any fees or expenses, unless stated otherwise or an exclusion applies. There is no deductible for this coverage.

---

•	during any instruction, practice, preparation for, or participation in, any competitive, prearranged or organized racing,

•	on a racetrack, test track or other course of any kind.

•	required to provide; or

•	voluntarily provides

•	workers' compensation;

•	disability benefits;

•	unemployment compensation; or

•	other similar laws.

•	homeowner, condominium or cooperative association; or

•	not for profit corporation or organization for which he or she is not compensated; unless another exclusion applies.

---

•	is made a condition of employment of any residential staff;

•	is used as a basis for employment decisions;

•	interferes with performance of any residential staff's duties; or

•	creates an intimidating, hostile, or offensive working environment.

•	the actual or constructive termination of employment of any residential staff by you or a family member in violation of applicable employment law; or

•	breach of duty and care when you or a family member terminates an employment relationship with any residential staff.

•	employed by you or a family member, or through a firm under an agreement with you or a family member, to perform duties related only to a covered person's domestic, personal, or business pursuits covered under this part of your policy;

•	compensated for labor or services directed by you or a family member; and

•	employed regularly to work 15 or more hours per week.

•	employed by you or a family member, or through a firm under an agreement with you or a family member, to perform duties related only to a covered person's domestic, personal, or business pursuits covered under this part of your policy;

•	compensated for labor or services directed by you or a family member; and

•	employed to work 15 or more hours per week to substitute for any residential staff on leave or to meet seasonal or short- term workload demands for 30 consecutive days or longer during a 6 month period.

•	sexual molestation;

•	sexual misconduct or harassment; or

•	abuse.

---

•	not yield gross revenues in excess of $15,000 in any year;

•	have no employees subject to worker’s compensation or other similar disability laws;

•	conform to local, state, and federal laws.

•	not yield gross revenues in excess of $15,000, in any year, except for the business activity of managing one's own personal investments;

•	conform to local, state, and federal laws.

•	a residence of yours or a family member's that is occasionally rented and that is used exclusively as a residence; or

•	part of a residence of yours or a family member's by one or two roomers or boarders; or

•	part of a residence of yours or a family member' s as an office, school, studio, or private garage.

•	is incidental to your or a family member’s use of the premises as a residence;

•	does not involve employment of others for more than 1,500 hours of farm work during the policy period;

•	does not produce more than $25,000 in gross annual revenue from agricultural operations;

•	and with respect to the raising or care of animals:

•	does not produce more than $50,000 in gross annual revenues;

•	does not involve more than 25 sales transactions during the policy period;

•	does not involve the sale of more than 50 animals during the policy period.

•	you or a family member do not have any employees involved in your business or professional activities who are subject to workers' compensation or other similar disability laws; or, if you or a family member are a doctor or dentist, you do not have more than two employees subject to such laws;

•	you or a family member do not earn annual gross revenues in excess of $5,000, if you or a family member are a home day care provider.

---

•	extract pollutants from land or water;

•	test for, monitor, clean up, remove, contain, treat, detoxify or neutralize pollutants, or in any way respond to or assess the effects of pollutants.

---

---

•	are written specifically to cover excess over the amount of coverage that applies in this policy; and

•	schedule this policy as underlying insurance.

•	to physical exams by physicians we select, which we will pay for; and

•	medical reports; and

•	other pertinent records.

•	the Sponsoring Organization must notify us in advance of the requested cancellation date; and

•	the Sponsoring Organization must provide proof of notification to each member of the Defined Group covered under this policy.

---

---

---

---

•	Officer Transition Policy (Details process for officer leaving under the Officer Transition Policy)

•	Officer Leave of Absence (Details process for officer leaving under the Officer Leave of Absence Policy)

•	Officer Retirement (Details process for officer leaving under the Officer Retirement Policy)

•	Officer Termination (Details process for officer leaving under the Officer Termination Policy)

•	The reason(s) which led to the termination of the officer’s employment.

•	Whether responsibilities for existing or prospective client assignments were completed professionally and/or effectively transferred to another officer.

•	Whether appropriate follow-up action was taken by the officer to collect any outstanding client receivables.

•	Whether the former officer’s conduct prior to and following termination avoided disruption with respect to the firm’s relationships with its employees and its clients. If the former officer left to join a

---

•	Whether information confidential to the firm or any of its clients has been maintained as confidential by the former officer.

---

---

---

---

---

---

•	The firm will pay the reasonable annual dues and reasonable initiation fees for one country/special interest club. The Group Leader and the Chief Personnel Officer (CPO) will review club membership requests. Approval decisions will be based on the merits of each case.

•	The firm will pay the reasonable annual dues and the reasonable initiation fee for one luncheon/sport/health club. The initiation fee is limited to a maximum of $2,500. The Group Leader and the Chief Personnel Officer (CPO) will review club membership requests. Approval decisions will be based on the merits of each case.

---

•	Personal financial counseling

•	Personal tax preparation

•	Other tax or financial counseling

•	Estate planning services (i.e., preparation and updating of wills, trust agreements and other related documents)

•	Up to $10,000 in first-year service fees to establish a personal long-term financial strategy and estate plan. (Officers who elect to change financial counseling service firms will not be eligible for this additional reimbursement if it has been previously used.)

•	Up to $7,500 every three years to review and update the Officer’s estate plan

•	Up to $3,000 for fees associated with preparing estate plans and related documents following relocation of an Officer by the firm to a new tax jurisdiction (i.e., different state or country)

---

---

•	Maintain/improve their functional skills and/or develop increased knowledge of specific topics (e.g., industry trends)

•	Become familiar with new ideas from research and academia and participate in the exchange of professional views on these ideas

•	Learn from distinguished academics and leading business professionals

•	Address specific personal development needs in areas of importance to professional consultants

•	Tuition and/or fees

•	Travel

•	Living expenses

•	Study/course materials

•	Miscellaneous out-of-pocket costs

---

•	Form S-8 (No 333-205956) pertaining to the Second Amended and Restated Equity Incentive Plan of Booz Allen Hamilton Holding Corporation

•	Form S-8 (No 333-171288) pertaining to the Amended and Restated Equity Incentive Plan of Booz Allen Hamilton Holding Corporation, Booz Allen Hamilton Holding Corporation Officers’ Rollover Stock Plan, and Booz Allen Hamilton Holding Corporation Employee Stock Purchase Plan

•	Form S-3 (No 333-214855) pertaining to the registration of shares of Class A Common Stock of Booz Allen Hamilton Holding Corporation