Fit - ANNUAL ENROLLMENT GUIDE
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ANNUAL ENROLL
ENROLLMENT NO AC TION =
GUIDE NO COVERAGE
FOR YOUR 2015 BENEFITS
CHOOSE
THAT
THE PLANS
Fit
Core Package
ANN ANNUAL ENROLLMENT COMES ONCE A YEAR. UAL Make sure to take the time to review all your benefit options by reading this guide and using the tools and resources on PowerLine during enrollment. ENROLL If you want more detailed plan information the “Summary Plan Descriptions” are located in the Benefits Library on the PowerLine homepage. “Summary Plan Descriptions” explain MENT what the plan provides and how it operates. It’s important to choose the plans that fit!
WHAT’S INSIDE
ELIGIBILITY RULES ARE DIFFERENT 2
WHO YOU CAN COVER 3
HEALTH INSURANCE MARKETPLACE 4
YOUR DENTAL OPTIONS 5
VISION COVERAGE 7
ASSOCIATE-PAID TERM LIFE INSURANCE 8
AD&D COVERAGE 9
LEGAL SERVICES PLAN 9
ACCIDENT INSURANCE 9
CRITICAL ILLNESS INSURANCE 10
HOSPITILIZATION INSURANCE 10
ASSOCIATE DISCOUNT PROGRAM 11
BUSINESS TRAVEL ACCIDENT (BTA) 11
COMMUTER BENEFIT 11
1
THINGS YOU
NEED TO KNOW
ELIGIBILITY RULES YOU ARE ELIGIBLE FOR THE
CORE BENEFITS
ARE DIFFERENT CORE PACKAGE: Fewer than 1,560 hours*
Under the Affordable Care Act, also known as
annually
Health Care Reform, there are new rules for
determining who is eligible for medical benefits. Dental
As a result, eligibility for JCPenney medical Vision
benefits for non-exempt associates will be based
Associate Paid Life
on whether you are credited with 1,560 hours or
more during our new annual Look-Back Period. Spouse Life
For non-exempt associates, this means you
Child Life
average at least 30 hours each week.
AD&D
Under the new eligibility rules, you are eligible
Accident Insurance
for the Core package. Take a look at the chart
to see the benefits you are eligible for in 2015. Critical Illness
Be sure to watch the video at Hospitalization
www.JCPBenefits2015.com for an easy-to- Group Legal
understand overview of the new rules.
* 1,560 hours annually is the equivalent of 30 hours a week
during the Look-Back Period.
THE LOOK-BACK PERIOD HAS CHANGED
The annual Look-Back Period is the 52-week period preceding Annual Enrollment.
Hours are measured to determine eligibility for certain benefits. For 2015, this period
is from October 6, 2013 to October 4, 2014.
If you were not employed for the entire Look-Back period October 6, 2013 to
October 4, 2014, your hours will be evaluated after 11 months to see if you qualify for
Plus benefits or remain in the Core benefits package.
2
WHO YOU CAN COVER
You can cover eligible dependents under certain plans. Eligible dependents generally include your:
¡¡ Spouse or qualified domestic partner
¡¡ Children, stepchildren or children of a domestic partner who are under age 26
¡¡ Incapacitated children
COVERAGE EFFECTIVE DATES
The benefits that you elect during annual enrollment are effective for the full plan year — from
January 1 through December 31 of the upcoming year. Choose your benefit coverages carefully. As
a rule, once enrolled, you may not change, add or drop your benefit choices until the next annual
enrollment period, unless you experience a qualified status change.*
*Qualified status changes, which include events like marriage, divorce or birth of a child, are described more fully in your
Summary Plan Description.
NEW RESOURCE!
JCPenney is introducing a new service through PowerLine to help you resolve
billing and claims disputes, and to handle questions about how to use your benefits.
Beginning January 1, you can call a Benefits Advocate toll-free at 1-888-890-8900.
3
HEALTH INSURANCE MARKETPLACE
The Core Benefits Package does not include medical coverage. However, JCPenney does offer
tools and resources on PowerLine to assist you in finding medical coverage through state or federal
Marketplaces.
Marketplaces are designed to help you find medical coverage that meets your needs and fits your
budget. Also, you may be eligible for a tax credit that lowers your monthly premium. To get more
information, go to PowerLine and click on the Health Care Reform Marketplace link.
KEY DATES FOR THE HEALTH
INSURANCE MARKETPLACE:
¡¡ November 15, 2014 — Open Enrollment begins for 2015 coverage.
¡¡ December 15, 2014 — Deadline if you want new coverage to begin on January 1, 2015.
¡¡ February 15, 2015 — The last day you can apply for 2015 coverage before the end of
Open Enrollment.
4
YOUR DENTAL
OPTIONS
Remember to visit your dentist every
six months to make sure your gums and
teeth are healthy. Choose from up to three
options available through Aetna.
Dental Basic, Dental Plus or the DMO
(not available in all locations). The
Dental Basic option provides preventive
and basic services only. The Dental Plus
and DMO options also offer these services,
plus major care and orthodontia. The plans
differ in the amount of eligible expenses
they cover and how service is provided.
5
YOU HAVE THREE DENTAL OPTIONS TO CHOOSE FROM
PLAN FEATURE DENTAL BASIC DENTAL PLUS DMO*
Annual deductible
Individual You pay $50 You pay $50 You pay $0
Family You pay $150 You pay $150 You pay $0
Annual maximum $1,000 $2,000 No maximum
benefit
Preventive care JCPenney pays 100%** JCPenney pays 100%** JCPenney pays 100%.
(Oral exams, cleanings, (no deductible). (no deductible). You pay $0.
X-rays, etc.) You pay $0. You pay $0.
Basic care JCPenney pays 70%** JCPenney pays 80%** JCPenney pays 100%.
(Fillings, extractions, (no deductible). (no deductible). You pay $0.
sealants, etc.) You pay 30%. You pay 20%.
Major care Not covered. JCPenney pays 50%** JCPenney pays 50%.
(Bridgework, crowns, You pay 100%. (after deductible). You pay 50%.
inlays, etc.) You pay 50%.
Orthodontia Not covered. JCPenney pays 50%** The plan pays 50%
You pay 100%. (no deductible) up to (no deductible) for
$2.000 per person, per dependent children
lifetime. when treatment begins
You pay 50%. before age 19. Limited
to one complete
course of treatment per
lifetime.
You pay 50%.
* You must use an Aetna provider under the DMO.
** JCPenney will pay the reasonable and customary limits.
6
VISION COVERAGE
Healthy eyes and good eyesight play an important role in your everyday life, so take care of your eyes
and take advantage of JCPenney’s vision plan through EyeMed.
You and your family can get quality vision care and prescription eyewear through an extensive
network of 43,000 providers nationwide, including JCPenney Optical. This coverage can’t be used
in conjunction with your JCPenney Associate discount. You can still receive benefits if you go to a
provider outside the EyeMed Vision Care network, but your costs may be higher.
VISION BENEFITS
BENEFIT1 IN-NETWORK OUT-OF-NETWORK
Eye Exam (every 12 months) You pay $20 Plan will reimburse you up to $30
¡ ¡ Exam
¡ ¡ Refraction
¡ ¡ Prescription for eyeglasses
or contact lenses
Contact lenses2 You pay $0, up to a regular Plan will reimburse you,
(Benefit must be used in one value of $100 depending on type of lens
single visit per calendar year.) Conventional — $70
Disposable — $70
Medically necessary — $200
Frames You pay $0, up to $130 retail Plan will reimburse you up to $40
value;
20% off amount over $130
Eyeglass lenses3, 4 You pay $0 for standard Plan will reimburse
(Single vision, bifocal, plastic lenses regardless of you from $30 to $65, depending
trifocal, lenticular) size or power on type of lenses
1
Can’t be used in conjunction with other discounts, promotions or prior orders.
2
Benefits must be used in one single visit per 12 months based on date of service.
3
Allowable amount depends on type of lens (i.e., single, bifocal, trifocal, lenticular).
4
Additional lens coverage options are described more fully in your Summary Plan Description.
7OTHER
BENEFITS
JCPenney offers you access to term life insurance through MetLife. Term life insurance can help give
you peace of mind that your family is protected. You may purchase this coverage for yourself as well
as for your spouse/domestic partner and/or child(ren).
ASSOCIATE-PAID LIFE INSURANCE
ASSOCIATES SPOUSE/DOMESTIC PARTNER CHILD
Available options: Available options: Available options:
¡¡ May be ¡¡ May be purchased in increments ¡¡ $2,500 per child
purchased in of $5,000, up to a maximum of ¡¡ $5,000 per child
increments of $30,000
$10,000, up to ¡¡ $10,000 per child
¡¡ Your spouse/domestic partner
a maximum of coverage amount cannot be
$150,000 more than 50% of your
coverage amount
NOTE: Evidence of Good Health may be required.
8ACCIDENTAL DEATH AND DISMEMBERMENT
(AD&D) COVERAGE
The AD&D plan pays if you or a covered family member are in an accident and get hurt. The amount
of your benefit depends on your level of coverage and type of loss.
ACCIDENTAL DEATH AND DISMEMBERMENT
FOR YOUR SPOUSE/DOMESTIC
FOR YOURSELF FOR YOUR CHILD(REN)
PARTNER
¡¡ May be ¡ ¡ Same as your AD&D coverage ¡¡ $5,000 per child/covered loss
purchased in amount, up to a maximum of
increments of $30,000
$10,000, up to
a maximum of
$150,000
LEGAL SERVICES PLAN
The Hyatt Group Legal Plan provides a wide range of legal advice and fully covered legal services for
you and your eligible dependents. The plan can help protect you financially if you need covered legal
services, and you can choose from a network of more than 12,000 plan attorneys. Some examples of
services covered under the plan include:
¡¡ Preparation of wills and codicils ¡ ¡ Sale, purchase, or refinancing of a second
¡¡ Personal bankruptcy or vacation home
¡¡ Consumer protection ¡ ¡ Civil litigation defense
¡¡ Estate planning ¡ ¡ Home equity loans
¡¡ Sale, purchase or refinancing of your ¡ ¡ Identity theft defense
primary residence
For more information, go to PowerLine or visit Hyatt Group Legal Plans at info.legalplans.com
and enter the access code GETLAW.
ACCIDENT INSURANCE
Accident Insurance, administered by Aflac, provides benefits directly to you when you get hurt
and require medical services as a result of a covered off-the-job accident. The plan pays benefits
regardless of other insurance you may have. Accident Insurance helps you pay deductibles, copays
and coinsurance. You may take this coverage with you if you leave JCPenney in certain circumstances.
Work-related accidents or sicknesses are not covered under this plan. The amount of the benefit is
determined by the type of injury.
9CRITICAL ILLNESS INSURANCE
Critical Illness Insurance, provided by Aflac, pays each covered person upon the initial diagnosis of a
covered critical illness. You can choose $5,000, $10,000, $20,000, $30,000, $40,000 or $50,000 in
coverage. Benefits are paid for the illnesses based on occurrence. This plan is portable, which means
you can take it with you if you leave JCPenney, with certain stipulations.
HOSPITALIZATION INSURANCE
This is not a comprehensive major medical plan, nor is it intended to replace a major medical plan.
The plan is intended to provide you and your covered dependents with benefits to help you pay for
expenses you incur when admitted to a hospital for an overnight stay. This plan pays $500 daily for
hospital confinements with a 10-day annual maximum benefit.
BENEFITS HELP IS AT HAND
JCPenney is introducing a new service through PowerLine to help you resolve billing
and claims disputes, and to handle questions about how to use your benefits. For
example, an Advocate can assist you with billing or claims issues regarding Dental
coverage or answer questions on your Vision Coverage. Beginning January 1, you can
call a Benefits Advocate toll-free at 1-888-890-8900.
10Don’t forget about these other benefits available to you!
ASSOCIATE DISCOUNT PROGRAM
A great thing about working at JCPenney is Associates, and eligible dependents, receive a 25%
discount on all merchandise and a 20% discount on all services. Exclusions include: Gift Cards,
Shipping and Handling, Optometrist exams and Sephora products purchased through jcp.com.
BUSINESS TRAVEL ACCIDENT (BTA)
Provided by the Company at no cost to you — protects you if you are injured while traveling on
Company business.
COMMUTER BENEFIT
JCPenney offers a Commuter Benefit to make riding the train, bus, ferry or van pool to work more
affordable. The cost of your commuting options is deducted from your paycheck each month pre-tax,
so you see savings in the form of reduced tax withholdings.
Go to PowerLine via the Kiosk
or call 1-888-890-8900
REMEMBER
Monday–Friday, No Action =
No Coverage
8 a.m.–8 p.m. Central time
PowerLine Specialists and web chat available
This enrollment guide provides general information about the benefit plans and programs available to JCPenney
Associates. For full details, exclusions and disclosures, please consult the specific plan document, insurance policies,
certificate and/or outlines of coverage. In the event of any conflict between this enrollment guide and any Summary
Plan Description, the Summary Plan Description will prevail. Further, this enrollment guide is not intended as a
contract of employment or a guarantee of current or future benefits or employment. JCPenney reserves the right to
amend or terminate any plans. Detailed plan information is provided in your Summary Plan Descriptions (SPDs). To
view detailed plan information, log on to PowerLine. From the homepage, go to the “Plan Information” box and click
the Benefits Library link. This will take you to the Your Benefits Options and Summary Plan Descriptions page.
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