BENEFIT GUIDE 2017-2018 - Home

 
BENEFIT GUIDE 2017-2018 - Home
2017-2018
BENEFIT GUIDE
       2017-2018 Open Enrollment Guide   1
BENEFIT GUIDE 2017-2018 - Home
ENROLL ONLINE WITH                       Scan this code with
                                                                WELCOME TO YOUR BENEFITS
SMARTBEN
                                          your smart phone
                                           or tablet to go to                                                                                                                         WHAT TO EXPECT FOR THIS PLAN YEAR
JULY 10 - 28
                                                  SmartBen!     OPEN ENROLLMENT!
                                                                OPEN ENROLLMENT: JULY 10 - 28, 2017                                                       HIGHLIGHTS                                                                   SPOUSAL SURCHARGE
                                                                Do I Need to Enroll?                                                                      Kaiser Medical Plan Changes                                                  Employees are subject to a surcharge when covering
                                                                                                                                                                                                                                       a spouse or registered same-sex domestic partner
                                                                Your benefits will rollover to the new plan year, with the                                 Plan Feature                  Last Year                  This Year          under their Forever 21 health plan who has the option to
                                                                exception of the Flexible Spending Account (FSA). For those                                Office visit                  $25 copay                 $30 copay           elect health care coverage through their employer. The
                                                                who participate in the Health and Dependent Care FSA’s,                                                                                                                additional cost is $70 dollars per pay period if the below
                                                                                                                                                           Outpatient hospital          $150 copay                $250 copay
                                                                you will have to make a new election amount for 2018. Those                                                                                                            situation applies to you.
                                                                                                                                                           Urgent care                   $25 copay                 $30 copay
    Step 1                                                      who participate in the commuter parking and transit may
                                                                make changes monthly as always.                                                            Emergency Room               $100 copay                $150 copay           You will be subject to a surcharge if:
    Visit https://enroll.smartben.com from your                                                                                                            Ambulance                     $50 copay                $150 copay
                                                                If you would like to make changes or enroll in benefits, you                                                                                                            • Your spouse or registered same-sex domestic partner
    computer or smart device’s web browser and                  can do so by visiting https://enroll.smartben.com from July                                Non-Preferred Brand Rx   Retail: $30, Mail: $60    Retail: $35, Mail: $70      is working at an employer who offers group health
    enter your username and password:                           10 through July 28, 2017. Use the instructions to the left to                              Specialty Medications         $30 copay           You pay 20%, max. $100       insurance, but has declined that coverage and wants
    •   Username: Enter “F21” plus your                         log on and complete your enrollment before the deadline.                                                                                                                  to remain on the Forever 21 health plan.
        employee ID number. For example, for                    Additionally, if you need technical assistance, more
                                                                                                                                                          Medical Plan Premiums                                                         • Your spouse or registered same-sex domestic partner
        an employee ID 54321 you would enter                    information about the new voluntary benefit plans or would                                Kaiser and UHC plan premiums will increase by $1.00 per                         is eligible and/or enrolled in Medicare, still actively
        F2154321.                                               like to enroll in the Voya Financial Whole Life Insurance plan,                           pay period (see page 4 for updated rates).                                      working at their own employer that offers group health
                                                                please contact the Benefits Enrollment Support Center                                                                                                                     insurance and covered under your Forever 21 health
    •   Password: Enter your date of birth as                   during the Open Enrollment period at (855) 210-1940. In                                   Dental                                                                          plan.
        MMDDYYYY (no dashes or slashes). If your                order to avoid potential wait times to speak with a benefit                               Aetna DMO
                                                                                                                                                                                                                                        • Your spouse or registered same-sex domestic partner
        birthday was May 9, 1989, you would enter               counselor, make an appointment online in advance by                                        • Exam copay increasing from $5 to $10                                         is offered coverage for any time period throughout the
        05091989. (You will be prompted to change               visiting http://forever21.myannualenrollment.com.                                                                                                                         year with their employer, and you choose to continue
                                                                                                                                                           • Orthodontia copay increasing from $2,300 to $2,400
        your password at this time.)                                                                                                                                                                                                      their coverage under the Forever 21 health plan.
                                                                All changes made during Open Enrollment                                                   Vision
    Step 2                                                      are effective as of October 1, 2017.                                                      There are no changes to the vision plan offered through VSP.                 You will NOT be subject to a surcharge if:
    From the home page, click the “Begin                                                                                                                                                                                                • You and your spouse or registered same-sex domestic
    Enrollment” icon and then the “Annual                                                                                                                 Smoker/Tobacco Surcharge                                                        partner are BOTH employed at Forever 21 and are
                                                                Important Notes About Enrollment
    Enrollment” button.                                                                                                                                   Smokers and all types of tobacco users, including pipes,                        covered under the company’s health plan.
                                                                Employees Hired On/After August 2                                                         e-cigarettes, cigars, cigarettes and chewing tobacco are                      • Your spouse or registered same-sex domestic partner
    Step 3                                                      All benefits eligible employees hired on or after August 2,                               subject to a $20 per pay period surcharge. Please contact                       is eligible and/or enrolled in Medicare, and is covered
                                                                2017, are not required to participate in Open Enrollment and                              HR Benefits for solutions to help you quit using tobacco.                       under your Forever 21 health plan.
    Click on each benefit to enroll or make                     will be provided with enrollment instructions before their
    changes to a selection.                                     enrollment period.                                                                        Voluntary Benefits                                                            • Your spouse or registered same-sex domestic partner
                                                                                                                                                          If you wish to enroll in a voluntary plan for the first time                    is a retiree from another employer, is not actively
    Step 4                                                                                                                                                during Open Enrollment, some plans may require EOI                              working and is covered under your Forever 21 health
    Once your elections are complete, each                                                                                                                (Evidence of Insurability). Learn more on page 9.                               plan.
    benefit will have a green light next to it. To                                                                                                                                                                                      • Your spouse or registered same-sex domestic partner
                                                                                                                                                          DEPENDENT AUDIT
                                                                CONTENTS
    proceed to the next step, click the button                                                                                                                                                                                            is self-employed, regardless of whether or not they
    labeled ”Elect & Continue.”                                                                                                                                                                                                           offer insurance to their employees and is covered
                                                                                                                                                          A dependent audit will be conducted at the end of 2017.
                                                                                                                                                                                                                                          under your Forever 21 health plan.
                                                                What To Expect For This Year ..............................................2              It’s important for you to review members on your plan to
    Step 5                                                      Medical Plan Overview..........................................................3          make sure they’re qualifying dependents.                                      • Your spouse or registered same-sex domestic partner
    Be sure to review everything for accuracy. Click                                                                                                                                                                                      is a part-time employee, doesn’t have access to health
                                                                Medical Plan Comparisons...................................................4              As a reminder only the following dependents are eligible
                                                                                                                                                                                                                                          coverage and is covered under your Forever 21 health
    “Continue” when prompted. You will then                     Virtual and Telephonic Medical Care...................................5                   to be on your plan:
                                                                                                                                                                                                                                          plan.
    need to enter your initials to agree to your                Dental Coverage...................................................................7        • Legal spouse
    enrollment selections.                                                                                                                                                                                                              • Your spouse or registered same-sex domestic partner
                                                                Vision Coverage ....................................................................8      • Same-sex registered domestic partner                                         has insurance available through their own employer,
                                                                Voya Voluntary Benefits.........................................................9
    Step 6                                                      Flexible Spending Accounts ..............................................11
                                                                                                                                                           • Your child (ren), the child (ren) of your legal spouse or                    the employer does not make contributions toward the
                                                                                                                                                             registered same-sex domestic partner, until age 26.                          cost of the health insurance and is covered under your
    Success! You have enrolled. Print your                      EAP and Travel Assistance..................................................12                                                                                             Forever 21 health plan.
    confirmation statement for your records.                                                                                                              Take the opportunity during Open Enrollment to remove
                                                                Legal Notices.......................................................................13    non-qualifying dependents from your plans to remain
                                                                Contacts.......................................................................... Back   in compliance. Remember, you are responsible for all
                                                                                                                                                          medical claim cost for ineligible dependents.
1       Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                                 2017-2018 Open Enrollment Guide     2
BENEFIT GUIDE 2017-2018 - Home
MEDICAL PLAN OVERVIEW                                                                                                 MEDICAL PLAN COMPARISONS

Forever 21 offers five comprehensive medical plans through Kaiser Permanente and                                                                          KAISER PERMANENTE HMO / UHC EPO (AVAILABLE IN CALIFORNIA ONLY)
UnitedHealthcare (UHC).                                                                                                   Premium Contributions (per paycheck)                       Kaiser Permanente HMO Plan                                    UnitedHealthcare Choice EPO Plan
                                                                                                                          Employee Only                                                            $42.54                                                        $49.53
                                                                                                                          Employee + Spouse*                                                       $84.08                                                        $97.83
MEDICAL PLAN OPTIONS                                       MEDICAL PLAN HIGHLIGHTS                                        Employee + Child(ren)                                                    $79.46                                                        $93.85
    •   Kaiser Permanente HMO – California Only                                                                           Employee + Family                                                       $125.62                                                        $144.70
                                                           Kaiser Permanente HMO (California Only)                        Benefits and Covered Services                                       In Network Only                                                In Network Only
    •   UHC Choice EPO – California Only
                                                            • There is no deductible for the HMO plan.                    Annual Deductible                                                         None                                              $500 individual / $1,000 family
    •   UHC Choice Plus PPO HDHP – All States
                                                            • You are required to use doctors and facilities that are     Coinsurance (plan / member)                                            100% / 0%                                                     90% / 10%
    •   UHC Choice Plus PPO Low – All States                                                                              Maximum Out of Pocket                                      $1,500 individual / $3,000 family                               $2,000 individual / $4,000 family
                                                              in the Kaiser Permanente HMO network. If you go
    •   UHC Choice Plus PPO High – All States                 outside of the network, benefits will not be covered        Lifetime Maximum Benefit                                                  None                                                          None
                                                              (except in certain emergency situations).                   Physician Office Visit                                             $30 copay per visit                                          $30 copay per visit
About the Plans                                                                                                           Urgent Care                                                        $30 copay per visit                                          $30 copay per visit
                                                            • Preventive care services are covered at 100% when
All of our plans provide coverage for medical care and                                                                    Inpatient Hospital                                              $500 copay per admission                    You pay 10% after deductible plus $500 copay per admission
                                                              performed by a Kaiser Permanente network provider.
prescription drugs. The company pays a portion of the                                                                     Emergency Room                                                    $150 copay per visit                                You pay 10% after $200 copay per visit
plan’s premium for you and your enrolled dependents.       UHC EPO (California Only)                                      Prescription Drug Benefits                                    Kaiser Permanente HMO Plan                                  UnitedHealthcare Choice EPO Plan
Please review the details on page 4 to compare the plans                                                                  Generic                                                     $15 copay, up to 30-day supply                                           $15 copay
                                                            • Under the UHC EPO plan, you must first meet a
that are available to you.                                                                                                Brand Name                                                  $35 copay, up to 30-day supply                                           $35 copay
                                                              deductible before the insurance will start covering
                                                                                                                          Non Preferred Brand                                        $35 copay, up to 30-day supply**                                          $50 copay
                                                              health care expenses, with the exclusion of copays.
                                                                                                                          Specialty                                             You pay 20% coinsurance, up to $100 max.                              You pay 20% up to $100 copay
                                                            • You are required to use doctors and facilities that        *Forever 21 supports registered same-sex domestic partner coverage in all states. Please contact the HR Benefits Department at (213) 741-8897 or
                                                              are in the UHC EPO network. If you go outside of the       HR.benefits@forever21.com for more information. Domestic partnership is processed on a post-tax basis. Imputed income will apply. See page 2 for
                                                              network, benefits will not be covered (except in certain   spousal surcharge information.
                                                              emergency situations).                                     ** Medications in this category require the provider to submit an exception request for it to be covered.
                                                            • Preventive care services are covered at 100% when                                                           UHC PPO OPTIONS (AVAILABLE IN ALL STATES)
                                                              performed by a UHC network provider.                        Premium Contributions (per paycheck)          UHC Choice Plus PPO HDHP                      UHC Choice Plus PPO Low                    UHC Choice Plus PPO High
                                                                                                                          Employee Only                                             $31.35                                         $43.35                                    $66.00
                                                           UHC Choice Plus PPO Plans (All States)                         Employee + Spouse*                                        $61.77                                         $85.50                                    $130.69
                                                           There are three PPO plan options to choose from:               Employee + Child(ren)                                     $58.73                                         $82.03                                    $125.36
                                                                                                                          Employee + Family                                         $91.00                                        $126.40                                    $193.47
                                                           PPO HDHP, PPO Low and PPO High.
                                                                                                                          Benefits and Covered Services                In Network            Out of Network          In Network         Out of Network         In Network          Out of Network
                                                            • All the PPO plans cover in network preventive care at                                                                                              $2,000 individual     $4,000 individual    $1,000 individual      $2,000 individual
                                                              100%.                                                                                                 $3,000 individual       $6,000 individual
                                                                                                                          Annual Deductible                                                                      $4,000 2 persons      $8,000 2 persons     $2,000 2 persons       $4,000 2 persons
                                                                                                                                                                     $6,000 family           $12,000 family
                                                                                                                                                                                                                   $6,000 family        $12,000 family        $3,000 family          $6,000 family
                                                            • You will have set copays for doctor visits and
                                                                                                                          Coinsurance (plan / member)                  70% / 30%               50% / 50%            70% / 30%             50% / 50%            80% / 20%              60% / 40%
                                                              prescription drug expenses in-network and
                                                                                                                                                                                                                 $5,000 individual     $8,000 individual    $4,000 individual      $8,000 individual
                                                              coinsurance for all other health care expenses.                                                       $6,000 individual      $12,000 individual
                                                                                                                          Maximum Out of Pocket                                                                 $10,000 2 persons     $16,000 2 persons     $8,000 2 persons      $16,000 2 persons
                                                                                                                                                                     $12,000 family         $24,000 family
                                                            • You must first meet a deductible before the insurance                                                                                               $15,000 family        $24,000 family       $12,000 family         $24,000 family
                                                              will start covering health care expenses, with the          Lifetime Maximum Benefit                      Unlimited              Unlimited             Unlimited             Unlimited            Unlimited              Unlimited
                                                              exclusion of copays.                                                                                                                                                                           $20 copay per
                                                                                                                          Physician Office Visit                    $25 copay per visit       You pay 50%       $25 copay per visit         You pay 50%                             You pay 40%
                                                                                                                                                                                                                                                                  visit
                                                            • The PPO Plans provide coverage for both in-network                                                                                                                                             $20 copay per
                                                              and out-of-network service providers, but you can           Urgent Care                              $125 copay per visit       You pay 50%       $25 copay per visit         You pay 50%                             You pay 40%
                                                                                                                                                                                                                                                                  visit
                                                              save money and spend less out of your own pocket by                                                                                               You pay 30% after
                                                              using in-network providers.                                 Inpatient Hospital                          You pay 30%             You pay 50%         $250 copay per      You pay 50%             You pay 20%           You pay 40%
                                                                                                                                                                                                                 day, up to 3 days
                                                            • You can review the differences between the three PPO
                                                                                                                          Emergency Room                                     $250 copay per visit               You pay 30% after $100 copay per visit                     You pay 20%
                                                              plans on page 4.
                                                                                                                          Prescription Drug Benefits                    UHC Choice Plus PPO HDHP                      UHC Choice Plus PPO Low                    UHC Choice Plus PPO High
                                                                                                                          Generic                                                $15 copay                                   $15 copay                                   $10 copay
                                                                                                                          Brand Name                                             $35 copay                                   $35 copay                                   $35 copay
                                                                                                                          Non-Preferred Brand                                    $60 copay                                   $60 copay                                   $60 copay
                                                                                                                          Specialty                                    You pay 30% up to a $150 copay              You pay 30% up to a $150 copay              You pay 30% up to a $150 copay
                                                                                                                         *Forever 21 supports registered same-sex domestic partner coverage in all states. Please contact the HR Benefits Department at (213) 741-8897 or
                                                                                                                         HR.benefits@forever21.com for more information. Domestic partnership is processed on a post-tax basis. Imputed income will apply. See page 2 for
                                                                                                                         spousal surcharge information.
3       Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                   2017-2018 Open Enrollment Guide                      4
BENEFIT GUIDE 2017-2018 - Home
UHC VIRTUAL VISITS                                                                                                                                 KAISER TELEPHONE APPOINTMENTS

                                                                                                                                                                                              NOW, YOU CAN GET CARE FROM A DOCTOR—                                          CALL FOR CARE AT A LOCATION NEAR YOU
                                                                                                                                                                                              WHEREVER YOU ARE                                                              Baldwin Park, Downey, and       Panorama City Medical
                                                                                                                                                                                                                                                                                                            Center
                                                                                                                                                                                              Do you have a minor health condition? If it doesn’t require                   South Bay
                                                                                                                                                                                              an in-person medical exam, you may be able to address it                                                      Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                                                                                              with a doctor by phone.                                                       Baldwin Park Medical            1-888-778-5000
                                                                                                                                                                                                                                                                            Center
                                                                                                                                                                                              You’ll get great care, and you’ll save time.                                                                  Woodland Hills Medical
                                                                                                                                                                                                                                                                            Mon–Fri, 7 a.m. to 7 p.m.       Center
                                                                                                                                                                                              Some examples of conditions:*

    Virtual Visits
                                                                                                                                                                                                                                                                            1-800-780-1277
                                                                                                                                                                                                                                                                                                            Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                                                                                               • Allergies                                                                  Downey Medical Center           1-888-515-3500
                                                                                                                                                                                               • Colds and coughs                                                           Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                                                                                                                                                                            Sat–Sun, 7 a.m. to 1 p.m.       Los Angeles
                                                                                                                                                                                               • Some follow-up visits                                                      1-800-823-4040
    Get access to care online.                                                                                                                                                                 • Upper respiratory infections                                               South Bay Medical
                                                                                                                                                                                                                                                                                                            Los Angeles Medical
                                                                                                                                                                                                                                                                                                            Center
    Any where. Any time.                                                                                                                                                                      When you call us, we will:                                                    Center                          Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                                                                                                                                                                            7 days, 24 hours                1-800-954-8000
                                                                                                                                                                                               • Make sure you’re 18 and over
                                                                                                                                                                                                                                                                            1-800-780-1230                  West Los Angeles
                                                                                                                                                                                               • Confirm you’ve had at least 1 face-to-face visit with us
                                                                                                                                                                                                                                                                                                            Medical Center
    When you don’t feel well, or your child is sick, the last thing you want to do is leave                                                                                                    • Schedule a 1-hour window for the doctor to call you                        Inland Empire and               Mon–Fri, 7 a.m. to 7 p.m.
    the comfort of home to sit in a waiting room. Now, you don’t have to.                                                       Use virtual visits when:                                       *Telephone appointments are not appropriate for emergency                    Coachella Valley                1-800-954-8000
    A virtual visit lets you see and talk to a doctor from your mobile device or computer                                       • Your doctor is not available                                conditions, such as severe shortness of breath, severe abdominal pain,
                                                                                                                                                                                                                                                                            Fontana Medical Center
    without an appointment. Most visits take about 10-15 minutes and doctors can write                                                                                                        severe bleeding, or urgent conditions— like sprains, falls, or cuts needing
                                                                                                                                                                                                                                                                            Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                                                                                                                                                                                                            Orange County
                                                                                                                                • You become ill while traveling                              stitches.
    a prescription*, if needed, that you can pick up at your local pharmacy. And, it’s part                                                                                                                                                                                 Sat, 7 a.m. to 3:30 p.m         Orange County–Anaheim
    of your health benefits.                                                                                                    • You are considering visiting a hospital                     If you reasonably believe you have an emergency medical condition, call                                       Medical Center
                                                                                                                                                                                                                                                                            1-888-750-0036
                                                                                                                                  emergency room for a non-emergency                          911 or go to the nearest emergency department. An emergency medical
                                                                                                                                  health condition                                            condition is a medical or psychiatric condition that requires immediate       Moreno Valley Medical           Mon–Fri, 7 a.m. to 7 p.m.
    Conditions commonly treated through a virtual visit                                                                                                                                       medical attention to prevent serious jeopardy to your health. For the         Center                          1-888-988-2800
    Doctors can diagnose and treat a wide range of non-emergency medical                                                                                                                      complete definition of an emergency medical condition, please refer to
    conditions, including:                                                                                                      Not good for:                                                 your Evidence of Coverage.                                                    Mon–Fri, 7 a.m. to 7 p.m.       Orange County–Irvine
                                                                                                                                                                                                                                                                            Sat, 7 a.m. to 3 p.m.           Medical Center
                                                                                                                                • Anything requiring an exam or test
    • Bladder infection/                          • Diarrhea                                    • Rash                                                                                                                                                                      1-866-984-7483                  Mon–Fri, 7 a.m. to 7 p.m.
      Urinary tract infection                                                                                                   • Complex or chronic conditions
                                                  • Fever                                       • Sinus problems                                                                                                                                                            Ontario Medical Center          1-888-988-2800
    • Bronchitis                                                                                                                • Injuries requiring bandaging or                                                                                                           Mon–Fri, 7 a.m. to 7 p.m.
                                                  • Migraine/headaches                          • Sore throat
    • Cold/flu
                                                                                                                                  sprains/ broken bones                                                                                                                     Sat, 7 a.m. to 3:30 p.m.        San Diego
                                                  • Pink eye                                    • Stomach ache
                                                                                                                                                                                                                                                                            1-888-750-0036                  San Diego Medical
    Access virtual visits                                                                                                                                                                                                                                                                                   Center
                                                                                                                            * Prescription services may not be available in all states.                                                                                     Riverside Medical Center
                                                                                                                                                                                                                                                                            Mon–Fri, 7 a.m. to 7 p.m.       7 days a week, 7 a.m. to 7
    Log in to myuhc.com® and choose from provider sites where you can register for                                          Access to virtual visits and prescription services may not
                                                                                                                            be available in all states or for all groups. Go to myuhc.com
                                                                                                                                                                                                                                                                            Sat, 7 a.m. to 3:30 p.m.        p.m.
    a virtual visit. After registering and requesting a visit you will pay your portion of the                              for more information about availability of virtual visits and
                                                                                                                                                                                                                                                                                                            1-800-290-5000
    service costs according to your medical plan, and then you will enter a virtual waiting                                 prescription services. Always refer to your plan documents
                                                                                                                                                                                                                                                                            1-866-984-7483
                                                                                                                            for your specific coverage. Virtual visits are not an insurance
    room. During your visit you will be able to talk to a doctor about your health concerns,                                product, health care provider or a health plan. Virtual visits
    symptoms and treatment options.                                                                                         are an internet based service provided by contracted                                                                                            Kern County, Valleys,
                                                                                                                            UnitedHealthcare providers that allow members to select
                                                                                                                            and interact with independent physicians and other health                                                                                       Western Ventura
                                                                                                                            care providers. It is the member’s responsibility to select
                                                                                                                            health care professionals. Care decisions are between the                                                                                       Antelope Valley Service
                      To learn more, login to myuhc.com                                                                     consumer and physician. Virtual visits are not intended to
                                                                                                                                                                                                                                                                            Area
                                                                                                                            address emergency or life-threatening medical conditions
                                                                                                                            and should not be used in those circumstances. Services                                                                                         Mon–Fri, 7 a.m. to 7 p.m.
                                                                                                                            may not be available at all times or in all locations.
                                                                                                                            Members have cost share responsibility and all claims are                                                                                       1-877-554-4404
                                                                                                                            adjudicated according to the terms of the member’s benefit
    * Prescription services may not be available in all states.
    Access to virtual visits and prescription services may not be available in all states or for all groups. Go to myuhc.
                                                                                                                            plan. Payment for virtual visit services does not cover                                                                                         Kern County Service
                                                                                                                            pharmacy charges; members must pay for prescriptions (if
    com for more information about availability of virtual visits and prescription services. Always refer to your plan
    documents for your specific coverage. Virtual visits are not an insurance product, health care provider or a health     any) separately. Insurance coverage provided by or through                                                                                      Area Mon–Fri, 7 a.m. to 7
    plan. Virtual visits are an internet based service provided by contracted UnitedHealthcare providers that allow         UnitedHealthcare Insurance Company or its affiliates.                                                                                           p.m. 1-877-524-7373
    members to select and interact with independent physicians and other health care providers. It is the member’s          Administrative services provided by United HealthCare
    responsibility to select health care professionals. Care decisions are between the consumer and physician. Virtual      Services, Inc. or their affiliates.
    visits are not intended to address emergency or life-threatening medical conditions and should not be used in
5   thoseForever         21 Services
            circumstances.    – Yourmay  Style,
                                            not be Your
                                                   availableBenefits!
                                                             at all times or in all locations. Members have cost share                                                                                                                                                                              2017-2018 Open Enrollment Guide      6
    responsibility and all claims are adjudicated according to the terms of the member’s benefit plan. Payment for
BENEFIT GUIDE 2017-2018 - Home
DENTAL COVERAGE                                                                                                                                                             VISION COVERAGE

Forever 21’s Freedom of Choice dental coverage includes a choice                                                                                                                                  Forever 21’s vision benefits are administered through VSP. With two options to choose from,
of two dental options, DMO and PPO, that cover preventive and                                                                                   YOU HAVE THE FREEDOM TO                           you and your family can get quality care and materials at an affordable cost.
diagnostic, basic and major services, as well as orthodontia.
                                                                                                                                              SWITCH DENTAL PLANS MONTHLY
The chart below shows a side-by-side comparison of the two plan options. You
can begin by choosing one plan then switch to the other plan if your needs                                                                                                                        You have the flexibility to choose between the VSP Core and the VSP Premium plans. Please review the side-by-side
change. If you wish to change plans, you’ll need to call Aetna at (855) 850-9664                                                                                                                  comparison below to determine which option is right for you.
by the 15th of the month for the change to be effective the first of the following                                                                   CHECK OUT THE MOBILE APP!
month.                                                                                                                                                                                                                                          VSP VISION PLAN OPTIONS
                                                                                                                                                     1.     Go to https://www.aetna.
                                                                                                                                                            com/individuals-families/              Premium Contributions
                                                                                                                                                                                                                                               Core Coverage                                   Premium Coverage
AETNA DMO                                                                          AETNA PPO                                                                using-your-aetna-benefits/
                                                                                                                                                                                                   (per paycheck)
The Aetna DMO plan provides                                                        The Aetna PPO plan provides the                                          aetna-mobile.html or scane             Employee Only                                     $0.23                                              $1.98
coverage inside of the Aetna DMO                                                   freedom to visit any licensed dentist                                                                           Employee + Spouse*                                $0.35                                              $3.96
                                                                                                                                                            the code below.                        Employee + Child(ren)                             $0.35                                              $4.25
network. If you use a dentist outside                                              without a referral. If you pick a dentist
                                                                                                                                                                                                   Employee + Family                                 $0.46                                              $6.78
of the network, benefits will not be                                               from Aetna’s PPO network of over                                  2.     Download the Aetna mobile
covered. Under the DMO, you choose                                                 130,000 providers, your benefit                                          app to your smartphone.                Covered Services                   Description                  Copay                  Description                  Copay
a primary care dentist from Aetna’s                                                dollars will go farther when you use                              3.     Use the app to find a                  Well Vision Exam          • Focuses on your eyes and                          • Focuses on your eyes and
network of over 10,000 providers.                                                  network dentists.                                                                                                                           overall wellness                     $10            overall wellness                     $10
                                                                                                                                                            provider, view claims, see                                       • Every plan year**                                 • Every plan year**
Your primary care dentist will help you                                            Like the DMO plan, most preventive                                       your ID card, and contact
manage your care.                                                                                                                                                                                  Prescription Glasses                                             $25                                                 $25
                                                                                   care services are covered at no                                          Aetna customer service.
                                                                                   cost. The difference is that you will                                                                           Frames                    • $130 allowance for a wide                         • $175 allowance for a wide
*DMO is not offered in the following states/
                                                                                                                                                                                                                               selection of frames                                 selection of frames
territories: AL, AK, ME, MS, ND, NH, PR, SC,                                       need to meet the PPO plan’s annual                                                  Scan this code with your                              • $150 allowance for                                • $195 allowance for
SD, VT, WY, Virgin Islands, and Guam.                                              deductible before non-preventive                                                    smart phone or tablet to                                                                Included in $25                                     Included in $25
                                                                                                                                                                                                                               featured frame brands                               featured frame brands
                                                                                                                                                                             download the app                                                                    prescription                                        prescription
                                                                                   services are covered, and there is a                                                                                                      • $70 allowance at Costco                           • $95 allowance at Costco
                                                                                                                                                                                                                                                                glasses copay                                       glasses copay
                                                                                   limit to how much the plan will pay                                                                                                       • 20% off amount over your                          • 20% off amount over your
                                                                                   for services each year.                                                                                                                     allowance                                           allowance
                                                                                                                                                                                                                             • Every other plan year**                           • Every plan year**
                                                                                                                                                                                                   Lenses                    • Single vision, lined bifocal,                     • Single vision, lined bifocal,
                                                                                                                                                                                                                               and lined trifocal lenses       Included in $25     and lined trifocal lenses       Included in $25
                                                                                                                                                                                                                             • Polycarbonate lenses for          prescription    • Polycarbonate lenses for          prescription
                                                                                                                                                                                                                               dependent children               glasses copay      dependent children               glasses copay
                                      AETNA DENTAL® FREEDOM OF CHOICE (CHOOSE BETWEEN TWO PLAN OPTIONS MONTHLY)                                                                                                              • Every other plan year**                           • Every plan year**
    Premium Contributions (per paycheck)                                                         Aetna DMO                                                Aetna PPO                                Lens Enhancements         • Scratch-resistant coating             $0          • UV protection                         $0
                                                                                                                                                                                                                             • Standard progressive                  $0          • Scratch-resistant coating             $0
    Employee Only                                                                                   $6.15                                                   $6.15                                                               lenses                              $55          • Standard progressive                 $55
    Employee + 1 Dependent                                                                         $11.06                                                  $11.06                                                            • Premium progressive                                  lenses
    Employee + 2 or More Dependents                                                                $18.40                                                  $18.40                                                               lenses                            $95-105        • Premium progressive                $95-105
    Benefits and Covered Services                                                              In Network Only                      In Network                         Out of Network                                        • Custom progressive lenses                            lenses
                                                                                                                                                                                                                              (Plus, get an average of 20-       $150-$175       • Custom progressive                $150-$175
    Calendar Year Deductible                                                                        None                    $50 individual / $150 family        $100 individual / $300 family
                                                                                                                                                                                                                               25% off other lens options)                          lenses
    Calendar Year Benefit Maximum                                                                                                                                                                                                                                                 (Plus, get an average of 20-
                                                                                                    None                         $1,500 per person                    $1,500 per person
    The most the plan will pay                                                                                                                                                                                                                                                     25% off other lens options)
    Preventive and Diagnostic Serivces                                                                                                                                                             Contact Lenses (instead   • $130 allowance for                                • $175 allowance for
                                                                                     Covered 100% with $10 copay for exam         Covered 100%                   You pay 50%, no deductible
    Exams, cleanings, x-rays, sealants                                                                                                                                                             of glasses)                 contacts and contact                                contacts and contact
    Basic Services                                                                                                                                                                                                             lens exam (fitting and                              lens exam (fitting and
                                                                                                Covered 100%                You pay 30% after deductible        You pay 50% after deductible                                   evaluation)                           $0            evaluation)                           $0
    Fillings, simple tooth extractions, root canals, gum treatment, oral surgery
                                                                                                                                                                                                                             • 15% off contact lens exam                         • 15% off contact lens exam
    Major Services                                                                                                                                                                                                             (fitting and evaluation)                            (fitting and evaluation)
                                                                                                You pay 40%                 You pay 50% after deductible        You pay 50% after deductible
    Crowns, inlays, onlays, cast restorations, bridges, dentures, implants
                                                                                                                                                                                                                             • Every other plan year**                           • Every plan year**
    Orthodontia for Adults and Children                                                Covered 100% after $2,400 copay      You pay 50%, no deductible           You pay 50%, no deductible
                                                                                                                                                                                                  * Forever 21 supports registered same-sex domestic partner coverage in all states. Please contact the HR Benefits Department at (213) 741-8897 or
    Orthodontia Lifetime Benefit Maximum                                                          24 months                      $1,500 per person                    $1,500 per person
                                                                                                                                                                                                  HR.benefits@forever21.com for more information. Domestic partnership is processed on a post-tax basis. Imputed income will apply.
*Forever 21 supports registered same-sex domestic partner coverage in all states. Please contact the HR Benefits Department at (213) 741-8897 or
HR.benefits@forever21.com for more information. Domestic partnership is processed on a post-tax basis. Imputed income will apply.                                                                 ** Plan year begins October 1

7          Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                                                                                        2017-2018 Open Enrollment Guide   8
BENEFIT GUIDE 2017-2018 - Home
VOYA VOLUNTARY BENEFITS                                                                                                                 VOYA VOLUNTARY BENEFITS

SHORT TERM DISABILITY INSURANCE                                             CRITICAL ILLNESS INSURANCE                                              ACCIDENT INSURANCE                          TERM LIFE INSURANCE                               WHOLE LIFE INSURANCE
A short-term, non-occupational injury or illness can prevent                If serious illness strikes, the last thing you need to worry about is   The Compass Accident Insurance plan         Group term life insurance is available            Premier Whole Life insurance policies
you from working for a period of time. Should this happen,                  how to pay the bills: medical copayments and deductibles, car           pays you a direct benefit for specific      to you, your spouse and your                      can provide protection for both
the Short Term Disability plan will replace a portion of                    payments, rent or mortgage, and utilities. With Compass Critical        injuries and events resulting from a        dependent children. Rates are based               working years and post-retirement,
your lost income. The amount of coverage available varies                   Illness Insurance, if you are diagnosed with a covered illness, you     covered on or off the job accident. The     on age and salary.                                while building cash value. Your
based on your location. Some states provide a state                         receive a lump sum cash benefit – even if you receive benefits          plan also includes a hospital confinement                                                     monthly premiums are based on your
disability benefit. This voluntary benefit is available to                  from other insurance. Use the cash benefit however it is needed         benefit for illness. The amount paid        Coverage Options:                                 age at time of enrollment and will not
retail and distribution center employees only.                              – whether for treatments not covered by insurance or a dream            depends on the type of injury and care      Employee must be covered to elect                 increase as you get older.
                                                                            vacation to celebrate your recovery – you decide. Employees             received. You can use your payment to       spouse or child coverage. If you are
Benefit Amount:                                                             must have access to comprehensive medical coverage with                 help pay for unexpected expenses, such      enrolling for the first time or if                Coverage Options:
    • Employees residing in CA, HI, NJ, NY, RI – 70% of your                Forever 21 or another source in order to enroll in this plan.           as deductibles and copays, home health      you are increasing your coverage,                 Employee does not need to be
      weekly earnings, to a maximum of $1,250 per week                                                                                              care costs, lost time from work, everyday   you will be asked to complete an                  covered to elect spouse or child
      (benefit amount is offset by the state disability benefit)            Coverage Options:                                                       expenses, utilities, and groceries.         Evidence of Insurability (EOI) form.              coverage. If you are enrolling for the
                                                                            Employee must be covered to elect spouse or child                       Employees must have access to                                                                 first time or if you are increasing
    • All other employees – 60% of your weekly earnings, to
      a maximum of $1,250 per week
                                                                            coverage, no minimum benefit                                            comprehensive medical coverage with                         TERM LIFE                         your coverage, you will be asked to
                                                                                                                                                    Forever 21 or another source in order to                • You can increase by up to 1x your   complete an Evidence of Insurability
                                                                             • Employee: $5,000 - $30,000, in increments of $5,000
Benefits become payable after the 7th day of injury or                                                                                              enroll in this plan.                                      salary to a maximum of $500,000;    (EOI) form.
illness and will pay for up to 12 weeks.                                     • Spouse: $5,000 - $15,000, in increments of $5,000                                                                 Employee     guarantee issue $200,000
If you are enrolling for the first time or if you are                        • Child: $1,000, $2,500, $5,000 or $10,000                             Examples of Covered Injuries Include:                   • Benefits reduce to 65% at age 70                       WHOLE LIFE
                                                                                                                                                                                                              and to 50% at age 75
increasing your coverage, you will be asked to                                                                                                       •   Broken bones                                                                                           •
                                                                                                                                                                                                                                                              Non-tobacco user: $5,000 - $500,000
                                                                            Examples of Covered Illnesses Include:                                                                                          • $10,000, $25,000, $50,000 or                      •
                                                                                                                                                                                                                                                              Tobacco user: $5,000 - $250,000
complete an Evidence of Insurability (EOI) form.                                                                                                     •   Joint dislocations / torn ligaments                  $100,000, not to exceed 100% of
                                                                             •   Heart attack                                                                                                                                                                   •
                                                                                                                                                                                                                                                              $1,000 increments
                                                                                                                                                     •   Ruptured discs                                       the employee amount; guarantee                    •
                                                                                                                                                                                                                                                              Ages 15-65 coverage is guaranteed
                                                                                                                                                                                                 Spouse
HOSPITAL CONFINEMENT INDEMNITY INSURANCE                                     •   Stroke
                                                                                                                                                     •   Burns
                                                                                                                                                                                                              issue $50,000
                                                                                                                                                                                                            • Benefits reduce to 65% at age 70
                                                                                                                                                                                                                                                   Employee   up to $20 per week, not to exceed
The Compass Hospital Confinement Indemnity insurance                         •   End stage renal (kidney) failure                                                                                                                                             $100,000
                                                                                                                                                     •   Concussions                                          and to 50% at age 75                          • Ages 66-70 coverage is contingent
pays daily and initial confinement benefits if you have a                    •   Coronary artery bypass                                              •   Eye injuries                                                                                         on medical questions for $25,000 of
                                                                                                                                                                                                            • Live birth to 6 months - $1,000
covered stay in a hospital, critical care unit or rehabilitation             •   Coma                                                                                                            Child      • 6 months to age 26 - $5,000 or                  guarantee issue
facility. The benefit amount is determined based on the                      •   Major organ failure                                                Plan Features Include:                                    $10,000                                           • Non-tobacco user: $5,000 - $500,000
type of facility and the number of days you stay. Employees                                                                                                                                                                                                     • Tobacco user: $5,000 - $250,000
                                                                             •   Permanent paralysis                                                 • Coverage available for the
must have access to comprehensive medical coverage with
                                                                                                                                                       employee, spouse and child(ren)          Plan Features Include:                                          • $1,000 increments
Forever 21 or another source in order to enroll in this plan.                •   Cancer, carcinoma in situ, skin cancer                                                                                                                                         • Ages 15-65 coverage is contingent on
                                                                                                                                                                                                 • Waiver of premium                               Spouse
                                                                                                                                                     • Hospital care – admission,                                                                                 medical questions for the greater of
                                                                             •   Also includes deafness, blindness, benign brain tumor and
Plan Features:                                                                   occupational HIV
                                                                                                                                                       confinement to a hospital, critical       • Accelerated death benefit
                                                                                                                                                                                                                                                                  $5 per week or $5,000
                                                                                                                                                        care unit or rehabilitation facility,                                                                   • Ages 66-77 requires medical
                                                                                                                                                                                                 • Accidental death &                                             questions
                   HOSPITAL CONFINEMENT INDEMNITY                           Plan Features Include:                                                       surgery
                                                                                                                                                                                                   dismemberment benefit                                        • $12,500, $15,000, $20,000 or
                                  Coverage is available for the employee,    • $75 wellness benefit when a covered person has a                         • Follow up care – medical                                                                 Children
    Who is eligible?                                                                                                                                                                                                                                              $25,000
                                          spouse, and children                                                                                              equipment, physical therapy,         • Employee Assistance Program                     15 days to
                                                                                                                                                                                                                                                                • Coverage is contingent on medical
                                                                               health screening test                                                                                                                                               24 years
    Initial confinement benefit                   $1,000                                                                                                     prosthetic devices                    (EAP)                                                          questions
                                                                             • $200 mammogram benefit
    Daily hospital confinement         $100 per day, up to 30 days                                                                                        •         Emergency care –             • Travel Assistance
                                                                             • Restoration of benefits* – pays an additional
    Critical care unit benefit         $200 per day, up to 15 days
                                                                               benefit if a covered person experiences
                                                                                                                                                              ground/air ambulance,              • Funeral planning and concierge                 Plan Features Include:
                                                                                                                                                               emergency room                      services
    Rehabilitation facility
                                        $50 per day, up to 30 days             a second covered illness for a different                                                                                                                            • Waiver of premium
    benefit                                                                                                                                                       treatment, initial doctor
                                                                               condition (must occur after a defined                                                 treatment, follow-up                                                          • Long term care benefit
                                                                               period of consecutive months)                                                            doctor treatment                                                           • Accidental death benefit
                                                                             • Recurrence benefit* – receive a
                                                                               benefit for the same critical                                                                                                                                       • Accelerated death benefit
                                                                               illness or condition a second
                                                                               time (must occur after
                                                                               a defined period of                                                                                 Voya Financial voluntary plan provisions
                                                                               consecutive months)
                                                                                                                                                                                   and availability may vary by state; some
                                                                            *Restoration and recurrence do not apply
                                                                            to cancer.                                                                                             exclusions and limitations may apply.

9        Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                      2017-2018 Open Enrollment Guide                    10
BENEFIT GUIDE 2017-2018 - Home
FLEXIBLE SPENDING ACCOUNTS                                                                                                                          ADDITIONAL BENEFITS
                               COMMUTER PARKING, TRANSIT, DEPENDENT CARE, AND HEALTH CARE

 Forever 21 offers flexible spending accounts (FSAs) that allow you to use tax-free dollars to pay for qualifying expenses depending   EMPLOYEE ASSISTANCE PROGRAM                                             FOR UNITEDHEALTHCARE (UHC) MEMBERS
 on which account you choose.
                                                                                                                                       Through Voya, you have access to ComPsych                               Rally Wellness: Better Health Starts Online!
 COMMUTER PARKING & TRANSIT                                         DEPENDENT CARE AND HEALTH CARE FSAs                                GuidanceResources®, which provides support, resources
                                                                                                                                       and information for personal and work-life issues. This plan
                                                                    Forever 21 offers two additional types of flexible spending
 Paying for Covered Expenses: Use Your P&A Benefits Card            accounts (FSAs): the health care FSA and dependent care
                                                                                                                                       includes three telephone counseling sessions per issue.
                                                                                                                                       Employee Assistance Program (EAP) services are provided by
 If you enroll in the parking and/or transit plan, you will         FSA. These plans enable you to set aside money on a pre-tax        ComPsych® Corporation, Chicago, IL. For help, call (877) 533-2363.
 receive a debit card that can be used to pay for your              basis to pay for your out-of-pocket health and daycare costs.
 parking and/or transportation expenses to and from work.
 Employees who enroll in both the health care FSA and
                                                                    You must re-enroll annually in these plans in order to             TRAVEL ASSISTANCE
                                                                    participate for the next calendar year. The plans run on a
 parking and/or transit FSA will receive one debit card                                                                                When traveling more than 100 miles from home, Voya
                                                                    calendar-year basis (January 1-December 31). You may make
 for all accounts. If you are currently enrolled in the health                                                                         Travel Assistance offers enhanced security for your leisure
                                                                    your election for 2018 during Open Enrollment in July.
 care FSA and enroll in the parking and/or transit account,                                                                            and business trips. You and your dependents can take
 your election amount will be automatically added to your           If you are currently enrolled in one of the flexible spending      advantage of four types of services: pre-trip information,
 current debit card.                                                accounts, you can find detailed information on qualifying          emergency personal services, medical assistance services
                                                                    expenses at www.padmin.com.                                        and emergency transportation services.
 No Out-of-Pocket Claim Submissions Allowed                                                                                            Voya Travel Assistance services are provided by Europ Assistance USA,
 P&A does not allow reimbursement of out-of-pocket                                                                                     Bethesda, MD. For help, call (800) 859-2821.
 parking and/or transit expenses. You must pay with your
 P&A benefits card in order to use your parking and/or
 transit plan funds.                                                                                                                                                                                           The Rally Wellness portal and app are FREE for
 Contribution Amounts                                                                                                                                                                                          Forever 21 employees enrolled in UHC Visit myuhc.
                                                                                                                                                                                                               com or http://Forever21.werally.com to get started!
 There are limits to how much you can set aside into your
 parking and/or transit account. Below are the IRS pre-set                                                                                                                                                     Rally Mobile Registration Code: FORE01
 maximum pre-tax contribution for the year 2017.
                                                                                                                                                                                                               Tobacco Cessation Program
     • PARKING: $255 per month
                                                                                                                                                                                                               UnitedHealthcare’s tobacco cessation program is tailored
     • TRANSIT: $255 per month                                                                                                                                                                                 to your individual smoking habits and needs. You’ll set a
                                                                                                                                                                                                               “Quit Date” and begin a staged approach to stop smoking.
 Making Changes                                                                                                                                                                                                To access this program, log on to www.myuhc.com, click
 Your commuting expenses may change over time; the                                                                                                                                                             ‘Health&Wellness,’ then ‘Your Personal Health Center’ on
 parking and transit plans are designed to be flexible and                                                                                                                                                     the right side of the screen. Enrolling in a tobacco cessation
 allow you to change your election amount each month.                                                                                                                                                          program may qualify you for the non-tobacco user discount on
                                                                                                                                                                                                               the medical plan premium. Proof of enrollment/ or completion
 When Changes are Effective                                                                                                                                                                                    will be requested by HR Benefits.
 Please note that any change you make will become effective
 with the first pay period beginning on or after the following                                                                                                                                                 Baby on the way?
 month. For example, if you are going on a vacation and will                                                                                                                                                   If so, UnitedHealthcare has a program just for you. A healthy
 not be commuting to work, you can change your election                                                                                                                                                        pregnancy helps ensure a healthy mom and baby. The
 amount for that month in SmartBen through a life event.                                                                                                                                                       Maternity Support Program offers you and your dependents
                                                                                                                                                                                                               health and educational support from the time you consider
                                                                                                                                                                                                               starting or expanding your family, through the first few months
                                                                                                                                                                                                               of your new baby’s life. This free, confidential program is
                                                                                                                                                                                                               offered to you as part of your regular benefit package. To get
                                                                                                                                                                                                               the most from the program, it’s
                                                                                                                                                                                                               best to enroll during the first
                                                                                                                                                                                                               trimester of your pregnancy. To                 GIF T CARD
                                                                                                                                                                                                               enroll call 877-201-5328.

                                                                                                                                                                                                                                                                       $150

11     Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                          2017-2018 Open Enrollment Guide       12
BENEFIT GUIDE 2017-2018 - Home
LEGAL NOTICES                                                                                                                                            CAN I SAVE MONEY ON MY HEALTH INSURANCE                                      **Even if your employer intends your coverage to be affordable, you
                                                                                                                                                                                                                                      may still be eligible for a premium discount through the Marketplace.
                                                                                                                                                         PREMIUMS IN THE MARKETPLACE?
As part of Forever 21’s compliance obligations Forever 21 must              If you go 63 continuous days or longer without creditable prescription                                                                                    The Marketplace will use your household income, along with other
provide certain legal notices to its U.S. benefit eligible employees. The   drug coverage, your monthly premium may go up by at least 1% of              You may qualify to save money and lower your monthly premium, but            factors, to determine whether you may be eligible for a premium
required disclosure notices included within this packet are:                the Medicare base beneficiary premium per month for every month              only if your employer does not offer coverage, or offers coverage that       discount. If, for example, your wages vary from week to week (perhaps
                                                                            that you did not have that coverage. For example, if you go nineteen         doesn’t meet certain standards. The savings on your premium that             you are an hourly employee or you work on a commission basis), if you
•    Medicare Part D Notice                                                                                                                              you’re eligible for depends on your household income.
                                                                            months without creditable coverage, your premium may consistently                                                                                         are newly employed mid-year, or if you have other income losses, you
•    New Health Insurance Marketplace Coverage Options and Your
     Health Coverage
                                                                            be at least 19% higher than the Medicare base beneficiary premium.           DOES EMPLOYER HEALTH COVERAGE AFFECT                                         may still qualify for a premium discount.
                                                                            You may have to pay this higher premium (a penalty) as long as you           ELIGIBILITY FOR PREMIUM SAVINGS THROUGH THE                                  If you decide to shop for coverage in the Marketplace, HealthCare.gov
•    Continuation of Benefits under COBRA                                   have Medicare prescription drug coverage. In addition, you may have
                                                                                                                                                         MARKETPLACE?                                                                 will guide you through the process. Here’s the employer information
•    Notice of Privacy Practices                                            to wait until the following October to join.                                                                                                              you’ll enter when you visit HealthCare.gov to find out if you can get a
                                                                                                                                                         Yes. If you have an offer of health coverage from your employer that
•    HIPAA Special Enrollment Rights                                        For More Information About This Notice Or Your Current                                                                                                    tax credit to lower your monthly premiums.
                                                                                                                                                         meets certain standards, you will not be eligible for a tax credit through
•    Employer-Sponsored Wellness Programs                                   Prescription Drug Coverage…                                                  the Marketplace and may wish to enroll in your employer’s health plan.       CONTINUATION COVERAGE RIGHTS UNDER COBRA
•    Newborns and Mothers Health Protection Act                             Contact the person listed below for further information. NOTE: You’ll        However, you may be eligible for a tax credit that lowers your monthly
                                                                            get this notice each year. You will also get it before the next period you   premium, or a reduction in certain cost-sharing if your employer does        Introduction
•    Women’s Health and Cancer Rights Act (WHCRA)                           can join a Medicare drug plan, and if this coverage through Forever 21                                                                                    You’re getting this notice because you recently gained coverage under
                                                                                                                                                         not offer coverage to you at all or does not offer coverage that meets
                                                                            changes. You also may request a copy of this notice at any time.             certain standards. If the cost of a plan from your employer that would       a group health plan (the Plan). This notice has important information
IMPORTANT NOTICE FROM FOREVER 21 ABOUT YOUR                                                                                                                                                                                           about your right to COBRA continuation coverage, which is a
                                                                                                                                                         cover you (and not any other members of your family) is more than 9.5%
PRESCRIPTION DRUG COVERAGE AND MEDICARE                                     For More Information About Your Options Under                                                                                                             temporary extension of coverage under the Plan. This notice explains
                                                                                                                                                         of your household income for the year, or if the coverage your employer
Please read this notice carefully and keep it where you can find it. This   Medicare Prescription Drug Coverage…                                                                                                                      COBRA continuation coverage, when it may become available
                                                                                                                                                         provides does not meet the “minimum value” standard set by the
notice has information about your current prescription drug coverage        More detailed information about Medicare plans that offer prescription       Affordable Care Act, you may be eligible for a tax credit.                   to you and your family, and what you need to do to protect your
with Forever 21 and about your options under Medicare’s prescription        drug coverage is in the “Medicare & You” handbook. You’ll get a copy                                                                                      right to get it. When you become eligible for COBRA, you may also
drug coverage. This information can help you decide whether or not          of the handbook in the mail every year from Medicare. You may also be        NOTE: If you purchase a health plan through the Marketplace instead          become eligible for other coverage options that may cost less than
you want to join a Medicare drug plan. If you are considering joining,      contacted directly by Medicare drug plans.                                   of accepting health coverage offered by your employer, then you              COBRA continuation coverage.
you should compare your current coverage, including which drugs are                                                                                      may lose the employer contribution (if any) to the employer-offered
                                                                            For more information about Medicare prescription drug                                                                                                     The right to COBRA continuation coverage was created by a federal
covered at what cost, with the coverage and costs of the plans offering                                                                                  coverage. Also, this employer contribution -as well as your employee
                                                                            coverage:                                                                                                                                                 law, the Consolidated Omnibus Budget Reconciliation Act of 1985
Medicare prescription drug coverage in your area. Information about                                                                                      contribution to employer-offered coverage- is often excluded from
                                                                            •   Visit www.medicare.gov                                                                                                                                (COBRA). COBRA continuation coverage can become available to you
where you can get help to make decisions about your prescription drug                                                                                    income for Federal and State income tax purposes. Your payments for
                                                                                                                                                                                                                                      and other members of your family when group health coverage would
coverage is at the end of this notice.                                      •   Call your State Health Insurance Assistance Program (see the             coverage through the Marketplace are made on an after-tax basis.
                                                                                                                                                                                                                                      otherwise end. For more information about your rights and obligations
                                                                                inside back cover of your copy of the “Medicare & You” handbook          HOW CAN I GET MORE INFORMATION?                                              under the Plan and under federal law, you should review the Plan’s
There are two important things you need to know about your current
                                                                                for their telephone number) for personalized help                                                                                                     Summary Plan Description or contact the Plan Administrator.
coverage and Medicare’s prescription drug coverage:                                                                                                      For more information about your coverage offered by your employer,
                                                                            •   Call 1-800-MEDICARE (1-800-633-4227). TTY users should call              please check your summary plan description or contact:                       You may have other options available to you when you lose
1. Medicare prescription drug coverage became available in 2006
                                                                                1-877-486-2048.                                                                                                                                       group health coverage. For example, you may be eligible to buy
    to everyone with Medicare. You can get this coverage if you join                                                                                     Human Resources – 3880 N. Mission Road, Los Angeles, CA 90031
    a Medicare Prescription Drug Plan or join a Medicare Advantage          If you have limited income and resources, extra help paying for                                                                                           an individual plan through the Health Insurance Marketplace. By
                                                                            Medicare prescription drug coverage is available. For information            (213) 741-5100                                                               enrolling in coverage through the Marketplace, you may qualify for
    Plan (like an HMO or PPO) that offers prescription drug coverage.
    All Medicare drug plans provide at least a standard level of            about this extra help, visit Social Security on the web at www.              The Marketplace can help you evaluate your coverage options,                 lower costs on your monthly premiums and lower out-of-pocket costs.
    coverage set by Medicare. Some plans may also offer more                socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).     including your eligibility for coverage through the Marketplace and          Additionally, you may qualify for a 30-day special enrollment period for
    coverage for a higher monthly premium.                                                                                                               its cost. Please visit HealthCare.gov for more information, including        another group health plan for which you are eligible (such as a spouse’s
                                                                                                                                                         an online application for health insurance coverage and contact              plan), even if that plan generally doesn’t accept late enrollees.
2. Forever 21 has determined that the prescription drug coverage            Remember: Keep this Creditable Coverage notice. If you decide to             information for a Health Insurance Marketplace in your area.
    offered by Kaiser and UnitedHealthcare is, on average for all plan      join one of the Medicare drug plans, you may be required to provide                                                                                       What is COBRA continuation coverage?
    participants, expected to pay out as much as standard Medicare          a copy of this notice when you join to show whether or not you have          PART B: INFORMATION ABOUT HEALTH COVERAGE                                    COBRA continuation coverage is a continuation of Plan coverage
    prescription drug coverage pays and is therefore considered             maintained creditable coverage and, therefore, whether or not you are        OFFERED BY YOUR EMPLOYER                                                     when it would otherwise end because of a life event. This is also
    Creditable Coverage. Because your existing coverage is                  required to pay a higher premium (a penalty).                                                                                                             called a “qualifying event.” Specific qualifying events are listed later
                                                                                                                                                         This section contains information about any health coverage offered by
    Creditable Coverage, you can keep this coverage and not pay a                                                                                                                                                                     in this notice. After a qualifying event, COBRA continuation coverage
                                                                                                                                                         your employer. If you decide to complete an application for coverage
    higher premium (a penalty) if you later decide to join a Medicare                                                                                                                                                                 must be offered to each person who is a “qualified beneficiary.” You,
                                                                            Date:                           October, 2016                                in the Marketplace, you will be asked to provide this information. This
    drug plan.                                                                                                                                                                                                                        your spouse, and your dependent children could become qualified
                                                                                                                                                         information is numbered to correspond to the Marketplace application.
                                                                            Name of Entity/Sender:          Forever 21                                                                                                                beneficiaries if coverage under the Plan is lost because of the
When Can You Join A Medicare Drug Plan?
                                                                            Contact--Position/Office:       HR Benefits Department                                   3. Employer Name               4. Employer Identification        qualifying event. Under the Plan, qualified beneficiaries who elect
You can join a Medicare drug plan when you first become eligible for                                                                                                     Forever 21                 Number (EIN): 33-0994795
Medicare and each year from October 15th to December 7th.                   Address:                        3880 N. Mission Road                                                                                                      COBRA continuation coverage must pay for COBRA continuation
                                                                                                            Los Angeles, CA 90031                                 5,7-9. Employer Address
                                                                                                                                                                                                    6. Employer phone number
                                                                                                                                                                                                                                      coverage.
However, if you lose your current creditable prescription drug                                                                                                     3880 N. Mission Road,
coverage, through no fault of your own, you will also be eligible for a     Phone Number:                   213-741-5100                                           Los Angeles CA 90031
                                                                                                                                                                                                          (213) 741-5100              If you’re an employee, you’ll become a qualified beneficiary if you
two (2) month Special Enrollment Period (SEP) to join a Medicare drug                                                                                                                                                                 lose your coverage under the Plan because of the following qualifying
                                                                                                                                                           10. Who can we contact about employee
plan.                                                                       NEW HEALTH INSURANCE MARKETPLACE COVERAGE                                            health coverage at this job?
                                                                                                                                                                                                        12. Email address             events:
                                                                            OPTIONS AND YOUR HEALTH COVERAGE                                               Forever 21 Human Resource Department                                       •   Your hours of employment are reduced, or
What Happens To Your Current Coverage If You Decide
to Join A Medicare Drug Plan?                                                                                                                            As your employer, we offer a health plan to some employees. Eligible         •   Your employment ends for any reason other than your gross
                                                                            PART A: GENERAL INFORMATION                                                                                                                                   misconduct.
                                                                                                                                                         employees are regular, full-time employees, unless otherwise covered
If you decide to join a Medicare drug plan, your current Forever 21         When key parts of the health care law take effect in 2014, there will be     under a collective bargaining agreement. Variable hour employees             If you’re the spouse of an employee, you’ll become a qualified
coverage will not be affected. If you do decide to join a Medicare drug     a new way to buy health insurance: the Health Insurance Marketplace.         who meet the ACA requirements of 130 hours per month after an 11             beneficiary if you lose your coverage under the Plan because of the
plan and drop your current Forever 21 coverage, be aware that you and       To assist you as you evaluate options for you and your family, this notice   month measurement period following their date of hire are also eligible      following qualifying events:
your dependents will be able to get this coverage back.                     provides some basic information about the new Marketplace and                for coverage.
                                                                            employment­-based health coverage offered by your employer.                                                                                               •   Your spouse dies;
When Will You Pay A Higher Premium (Penalty) To Join A                                                                                                   With respect to dependents, we do offer coverage. Eligible
Medicare Drug Plan?                                                                                                                                                                                                                   •   Your spouse’s hours of employment are reduced;
                                                                            WHAT IS THE HEALTH INSURANCE MARKETPLACE?                                    dependents are Natural, step, adopted, and foster children as well as
You should also know that if you drop or lose your current coverage                                                                                      children that are under the legal guardianship and dependent upon            •   Your spouse’s employment ends for any reason other than his or
                                                                            The Marketplace is designed to help you find health insurance that
with Forever 21 and don’t join a Medicare drug plan within 63                                                                                            for support of our regular full-time employees. This coverage meets              her gross misconduct;
                                                                            meets your needs and fits your budget. The Marketplace offers “one-
continuous days after your current coverage ends, you may pay a             stop shopping” to find and compare private health insurance options.         the minimum value standard, and the cost of this coverage to you is          •   Your spouse becomes entitled to Medicare benefits (under Part A,
higher premium (a penalty) to join a Medicare drug plan later.              You may also be eligible for a new kind of tax credit that lowers your       intended to be affordable** based on employee wages.                             Part B, or both); or
                                                                            monthly premium right away. Open enrollment for health insurance                                                                                          •   You become divorced or legally separated from your spouse.
                                                                            coverage through the Marketplace begins in October 2013 for
                                                                            coverage starting as early as January 1, 2014.
13     Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                                    2017-2018 Open Enrollment Guide           14
BENEFIT GUIDE 2017-2018 - Home
LEGAL NOTICES                                                                                                                                           information of a person living or deceased (for a period of fifty years
                                                                                                                                                        after the death.)
                                                                                                                                                                                                                                        For purposes of this Notice, all actions of the Company and the Business
                                                                                                                                                                                                                                        Associates that are taken on behalf of the Plan are considered actions
Your dependent children will become qualified beneficiaries if they          COBRA continuation coverage if the employee or former employee             The Plan is required by law to provide notice to you of the Plan’s duties       of the Plan. For example, health information maintained in the files of
lose coverage under the Plan because of the following qualifying             dies; becomes entitled to Medicare benefits (under Part A, Part B,         and privacy practices with respect to your PHI, and is doing so through         the Claims Administrator is considered maintained by the Plan. So,
events:                                                                      or both); gets divorced or legally separated; or if the dependent          this Notice. This Notice describes the different ways in which the Plan         when this Notice refers to the Plan taking various actions with respect
•    The parent-employee dies;                                               child stops being eligible under the Plan as a dependent child. This       uses and discloses PHI. It is not feasible in this Notice to describe in        to health information, those actions may be taken by the Company or a
                                                                             extension is only available if the second qualifying event would have      detail all of the specific uses and disclosures the Plan may make of PHI,       Business Associate on behalf of the Plan.
•    The parent-employee’s hours of employment are reduced;                  caused the spouse or dependent child to lose coverage under the Plan       so this Notice describes all of the categories of uses and disclosures          HOW THE PLAN MAY USE OR DISCLOSE YOUR PHI
•    The parent-employee’s employment ends for any reason other              had the first qualifying event not occurred.                               of PHI that the Plan may make and, for most of those categories, gives
     than his or her gross misconduct;                                                                                                                                                                                                  The Plan may use and disclose your PHI for the following purposes
                                                                             ARE THERE OTHER COVERAGE OPTIONS BESIDES                                   examples of those uses and disclosures.
•    The parent-employee becomes entitled to Medicare benefits (Part                                                                                                                                                                    without obtaining your authorization. And, with only limited exceptions,
     A, Part B, or both);
                                                                             COBRA CONTINUATION COVERAGE?                                               The Plan is required to abide by the terms of this Notice until it is           we will send all mail to you, the employee. This includes mail relating
                                                                             Yes. Instead of enrolling in COBRA continuation coverage, there may        replaced. The Plan may change its privacy practices at any time and,            to your spouse and other family members who are covered under the
•    The parents become divorced or legally separated; or                                                                                               if any such change requires a change to the terms of this Notice, the           Plan. If a person covered under the Plan has requested Restrictions or
                                                                             be other coverage options for you and your family through the Health
The child stops being eligible for coverage under the Plan as a “dependent   Insurance Marketplace, Medicaid, or other group health plan coverage       Plan will revise and re-distribute this Notice according to the Plan’s          Confidential Communications, and if the Plan has agreed to the request,
child.”                                                                      options (such as a spouse’s plan) through what is called a “special        distribution process. Accordingly, the Plan can change the terms of             the Plan will send mail as provided by the request for Restrictions or
                                                                             enrollment period.” Some of these options may cost less than COBRA         this Notice at any time. The Plan has the right to make any such change         Confidential Communications.
                                                                             continuation coverage. You can learn more about many of these              effective for all of your PHI that the Plan creates, receives or maintains,
WHEN IS COBRA CONTINUATION COVERAGE                                                                                                                     even if the Plan received or created that PHI before the effective date of      Your Health Care Treatment: The Plan may disclose your PHI for
                                                                             options at www.healthcare.gov.                                                                                                                             treatment (as defined in applicable federal rules) activities of a health
AVAILABLE?                                                                                                                                              the change.
                                                                             IF YOU HAVE QUESTIONS                                                                                                                                      care provider.
The Plan will offer COBRA continuation coverage to qualified
beneficiaries only after the Plan Administrator has been notified that       Questions concerning your Plan or your COBRA continuation                  The Plan is distributing this Notice, and will distribute any revisions, only   Example: If your doctor requested information from the Plan about
a qualifying event has occurred. The employer must notify the Plan           coverage rights should be addressed to the contact or contacts             to participating employees and COBRA qualified beneficiaries, if any.           previous claims under the Plan to assist in treating you, the Plan could
Administrator of the following qualifying events:                            identified below. For more information about your rights under             If you have coverage under the Plan as a dependent of an employee,              disclose your PHI for that purpose.
•    The end of employment or reduction of hours of employment;              the Employee Retirement Income Security Act (ERISA), including             or COBRA qualified beneficiary, you can get a copy of the Notice by             Example: The Plan might disclose information about your prior
                                                                             COBRA, the Patient Protection and Affordable Care Act, and                 requesting it from the contact named at the end of this Notice.                 prescriptions to a pharmacist for the pharmacist’s reference in
•    Death of the employee; or
                                                                             other laws affecting group health plans, contact the nearest               Please note that this Notice applies only to your PHI that the Plan             determining whether a new prescription may be harmful to you.
•    The employee’s becoming entitled to Medicare benefits (under            Regional or District Office of the U.S. Department of Labor’s              maintains. It does not affect your doctor’s or other health care
     Part A, Part B, or both).                                                                                                                                                                                                          Making or Obtaining Payment for Health Care or
                                                                             Employee Benefits Security Administration (EBSA) in your area              provider’s privacy practices with respect to your PHI that they maintain.       Coverage: The Plan may use or disclose your PHI for payment
For all other qualifying events (divorce or legal separation of the          or visit www.dol.gov/ebsa. (Addresses and phone numbers of                                                                                                 (as defined in applicable federal rules) activities, including making
employee and spouse or a dependent child’s losing eligibility for                                                                                       RECEIPT OF YOUR PHI BY THE COMPANY AND
                                                                             Regional and District EBSA Offices are available through EBSA’s            BUSINESS ASSOCIATES                                                             payment to or collecting payment from third parties, such as health care
coverage as a dependent child), you must notify the Plan Administrator                                                                                                                                                                  providers and other health plans.
                                                                             website.) For more information about the Marketplace, visit
within 60 days after the qualifying event occurs. You must provide this                                                                                 The Plan may disclose your PHI to, and allow use and disclosure of your
notice to: Forever 21 Human Resources Department                             www.HealthCare.gov.                                                                                                                                        Example: The Plan will receive bills from physicians for medical care
                                                                                                                                                        PHI by, the Company and Business Associates without obtaining your
                                                                             KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES                                 authorization.                                                                  provided to you that will contain your PHI. The Plan will use this PHI, and
HOW IS COBRA CONTINUATION COVERAGE                                                                                                                                                                                                      create PHI about you, in the course of determining whether to pay, and
PROVIDED?                                                                    To protect your family’s rights, let the Plan Administrator know about     Plan Sponsor:                                                                   paying, benefits with respect to such a bill.
                                                                             any changes in the addresses of family members. You should also
Once the Plan Administrator receives notice that a qualifying event                                                                                     The Company is the Plan Sponsor and Plan Administrator. The Plan                Example: The Plan may consider and discuss your medical history
                                                                             keep a copy, for your records, of any notices you send to the Plan
has occurred, COBRA continuation coverage will be offered to each                                                                                       may disclose to the Company, in summary form, claims history and                with a health care provider to determine whether a particular treatment
                                                                             Administrator.
of the qualified beneficiaries. Each qualified beneficiary will have an                                                                                 other information so that the Company may solicit premium bids                  for which Plan benefits are or will be claimed is medically necessary as
independent right to elect COBRA continuation coverage. Covered              PLAN CONTACT INFORMATION                                                   for health benefits, or to modify, amend or terminate the Plan. This            defined in the Plan.
employees may elect COBRA continuation coverage on behalf of their           Forever 21 Human Resources Department                                      summary information omits your name and Social Security Number
                                                                                                                                                                                                                                        The Plan’s use or disclosure of your PHI for payment purposes may
spouses, and parents may elect COBRA continuation coverage on                                                                                           and certain other identifying information. The Plan may also disclose
                                                                             3880 N. Mission Road, Los Angeles, CA 90031                                                                                                                include uses and disclosures for the following purposes, among others.
behalf of their children.                                                                                                                               information about your participation and enrollment status in the Plan
                                                                             (213) 741-5100                                                             to the Company and receive similar information from the Company.                Obtaining payments required for coverage under the Plan
COBRA continuation coverage is a temporary continuation of coverage
                                                                             NOTICE OF PRIVACY PRACTICES                                                If the Company agrees in writing that it will protect the information           Determining or fulfilling its responsibility to provide coverage and/or
that generally lasts for 18 months due to employment termination
                                                                                                                                                        against inappropriate use or disclosure, the Plan also may disclose to          benefits under the Plan, including eligibility determinations and claims
or reduction of hours of work. Certain qualifying events, or a second        THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT                        the Company a limited data set that includes your PHI, but omits certain        adjudication
qualifying event during the initial period of coverage, may permit a         YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET                          direct identifiers, as described later in this Notice.                          •   Obtaining or providing reimbursement for the provision of
beneficiary to receive a maximum of 36 months of coverage. There             ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
are also ways in which this 18-month period of COBRA continuation                                                                                       The Plan may disclose your PHI to the Company for plan administration               health care (including coordination of benefits, subrogation, and
                                                                             The effective date of this Notice of Forever 21’s Health Information       functions performed by the Company on behalf of the Plan, if the                    determination of cost sharing amounts)
coverage can be extended:
                                                                             Privacy Practices (the “Notice”) is October 1, 2016.                       Company certifies to the Plan that it will protect your PHI against
DISABILITY EXTENSION OF 18-MONTH PERIOD OF                                                                                                                                                                                              •   Claims management, collection activities, obtaining payment
                                                                             Forever 21 Group Health Plan (the “Plan”) provides health benefits to      inappropriate use and disclosure.                                                   under a stop-loss insurance policy, and related health care data
COBRA CONTINUATION COVERAGE                                                  eligible employees of Forever 21 (the “Company”) and their eligible
                                                                                                                                                        Example: The Company reviews and decides appeals of claim denials                   processing
If you or anyone in your family covered under the Plan is determined         dependents as described in the summary plan description(s) for the
                                                                             Plan. The Plan creates, receives, uses, maintains and discloses health     under the Plan. The Claims Administrator provides PHI regarding an              •   Reviewing health care services to determine medical necessity,
by Social Security to be disabled and you notify the Plan Administrator
                                                                             information about participating employees and dependents in the            appealed claim to the Company for that review, and the Company uses                 coverage under the Plan, appropriateness of care, or justification of
in a timely fashion, you and your entire family may be entitled to get
                                                                             course of providing these health benefits.                                 PHI to make the decision on appeal.                                                 charges
up to an additional 11 months of COBRA continuation coverage, for
a maximum of 29 months. The disability would have to have started            For ease of reference, in the remainder of this Notice, the words “you,”   Business Associates: The Plan and the Company hire third parties,               •   Utilization review activities, including precertification and
at some time before the 60th day of COBRA continuation coverage              “your,” and “yours” refers to any individual with respect to whom          such as a third party administrator (the “Claims Administrator”), to                preauthorization of services, concurrent and retrospective review
and must last at least until the end of the 18-month period of COBRA         the Plan receives, creates or maintains Protected Health Information,      help the Plan provide health benefits. These third parties are known                of services
continuation coverage.                                                       including employees and COBRA qualified beneficiaries, if any, and         as the Plan’s “Business Associates.” The Plan may disclose your PHI to          The Plan also may disclose your PHI for purposes of assisting other
                                                                             their respective dependents.                                               Business Associates, like the Claims Administrator, who are hired by            health plans (including other health plans sponsored by the Company),
SECOND QUALIFYING EVENT EXTENSION OF                                                                                                                    the Plan or the Company to assist or carry out the terms of the Plan. In
                                                                             The Plan is required by law to take reasonable steps to protect your                                                                                       health care providers, and health care clearinghouses with their
18-MONTH PERIOD OF CONTINUATION COVERAGE                                                                                                                addition, these Business Associates may receive PHI from third parties          payment activities, including activities like those listed above with
                                                                             Protected Health Information from inappropriate use or disclosure.
If your family experiences another qualifying event during the 18                                                                                       or create PHI about you in the course of carrying out the terms of the          respect to the Plan.
months of COBRA continuation coverage, the spouse and dependent              Your “Protected Health Information” (PHI) is information about your        Plan. The Plan and the Company must require all Business Associates to
children in your family can get up to 18 additional months of COBRA          past, present, or future physical or mental health condition, the          agree in writing that they will protect your PHI against inappropriate use      Health Care Operations: The Plan may use and disclose your PHI
continuation coverage, for a maximum of 36 months, if the Plan is            provision of health care to you, or the past, present, or future payment   or disclosure, and will require their subcontractors and agents to do so,       for health care operations (as defined in applicable federal rules) which
properly notified about the second qualifying event. This extension          for health care provided to you, but only if the information identifies    too.                                                                            includes a variety of facilitating activities.
may be available to the spouse and any dependent children getting            you or there is a reasonable basis to believe that the information
                                                                             could be used to identify you. Protected health information includes
15     Forever 21 – Your Style, Your Benefits!                                                                                                                                                                                                                     2017-2018 Open Enrollment Guide            16
You can also read
NEXT SLIDES ... Cancel