BENEFIT GUIDE 2018-2019 - Home
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WHAT’S INSIDE ABOUT YOUR BENEFITS WELCOME New Hire Steps to Enroll Employee Eligibility 1 2 Dependent Eligibility 3 Dear fellow employees: HEALTH BENEFITS Thank you for being a part of the Medical Overview 4 Comparing Medical Plans 5 Forever 21 family and for contributing Health Savings Account 6 to our success. Additional Health Plan Resources 7 Your health and well-being is very Dental Benefits 8 Vision Benefits 9 important to us and, as such, we Maternity Support 15 are committed to providing a Tobacco Cessation 16 comprehensive benefits program that Kaiser – Talk to a Doctor by Phone 17 will help you and your family members UHC – Virtual Visits 18 live a happy and healthy lifestyle. FINANCIAL PROTECTION BENEFITS We are pleased to present the 2018- Flexible Spending Accounts 10 2019 Forever 21 Benefits Guide to help Commuter Parking and Transit 11 you navigate your options for the year Critical Illness Insurance 12 and select the best plan for you and Hospital Confinement Indemnity 12 your family members. Individual Short Term Disability 12 Accident Insurance 13 Please review this Benefits Guide Voluntary Life Insurance 13 carefully and save this as a reference Commuter Parking & Transit 16 throughout the year. Should you require further assistance, do not OTHER BENEFITS & PERKS hesitate to contact the Human Employee Assistance Program 14 Resources Benefits Department at Travel Assistance 14 844-435-5621. 401(k) Retirement Savings 19 Discounts for F21 Employees 20 Sincerely, BENEFIT RESOURCES Alex Ok, President Legal Notices 21 Benefit Contacts 29 General Disclaimer: The material provided in this guide is for general information purposes only. The details of the plans and policies are contained in the official plan and policy documents including some insurance contracts. The plan (and underlying coverage of benefits) can be amended at any time for any reason without prior notice, at Forever 21’s sole and absolute discretion. In the event of any conflict between this guide and the plan document, the actual plan document will govern.
STEPS TO ENROLL FOR NEWLY ELIGIBLE EMPLOYEES TO 2018 OPEN ENROLLMENT If you are enrolling during the Open Enrollment Please read follow the enrollm ent the enclos steps on the online. OPEN ENROLLMENT: ed Benefi t Guide and back of this the impor tant flyer to compl highlig ete your 2018-2 hts below, then 019 benefi ts period, please disregard this page and refer to ACTION IS REQUIRE D AUGUST 6–17 IMPORTANT HIGHLIG Do I Need to Enroll? HTS FOR 2018-20 • NEW HDHP+H 19 YES, all eligible introducing SA MEDICA a new UnitedHe L PLAN! We are on to SmartBe employees are required option that althcare medical n is paired with (where available or speak with a Benefit to either log Learn more a on pages 4-6 Health Savings Account. plan Counselor their benefits ) to review their options • THE HDHP of your Benefit Guide. enrollment for the 2018-20 and confirm IS GOING enrolled in AWAY. If you 19 plan year. the are during Open HDHP and do not take currently Work at the Distributi enrolled in Enrollment, action you will automati your cover letter for how to enroll. on Center? Benefit the coverage) for new HDHP+HSA plan cally be on-site to answer Counselors will the new plan (employee-only your questions and help you enroll. be • CHANG year. Benefit Counse ES TO lors will be California pleaseTHE KAISER PLANS. Distribution available at the Kaiser plans: be aware there are If you live in Center August the two changes limited so see 6-10. Appoint (was $30) and the urgent to your manage ments are care copay the is sign up for an available r as soon as possible to $200 (was $150). emergency room copaynow $50 Benefit Counse time. If you is now lor, you do enroll • NEW ADOPTI not need to through a We know familyON ASSISTANCE PROGRA enroll online. comes first. assistance Our new adoption M! program SPECIAL INSTRUC make the process is designed to help TIONS FOR EMPLOY reimbursement more manageable employees HIRED ON OR AFTER EES expenses that of reasonable and necessar by providing AUGUST JULY 2 adopting an you incur in the process y eligible child. of All benefits Benefit Guide See page 10 legally eligible employ for details. of your or after July ees hired on • OUR WELLNE 2, 2018 are of our current SS MISSION CONTIN participate not require UES. in Open Enrollm d to hunt for a new Rally partners hip, Forever In place be provided ent and will align with and health and wellness program 21 is on the with enrollm culture. We integrate more fully with that will before their ent instruct are committ enrollment ions are effective ed to providing our employee period. in our employe improving health and options that es meaningful redemptions and their families. All to must be made Rally gift 30, 2018 or are forfeited prior to Septembcard by the participa er nt. We understand the important role that our benefit programs play in the lives of our employees and Your Benefit Counselor will take your elections and answer any questions you may have their families. That’s why we’re committed to about your benefit choices. Shortly after your offering excellent benefits that not only protect enrollment, you will receive instructions on how your physical and financial health but provide to obtain your confirmation statement detailing peace of mind when it comes to protecting your your elections, any covered dependents, and paycheck deduction amounts. lifestyle and planning for the future. FOLLOW THESE EASY STEPS TO ENROLL IN YOUR NEW BENEFITS PROGRAM: Step 1 Review this Benefit Guide. Need more information? Enrolling is easy! Please note that your benefits Additional benefits information is available at are effective the 1st of the month following two www.myf21benefits.com months of continuous employment. You must take action to enroll or waive your benefits Step 2 WITHIN 45 DAYS OF YOUR HIRE DATE. If you Prepare for your enrollment. Discuss the benefit plan options do not enroll in a timely manner, you must wait with your family and gather your dependent and/or beneficiary for the next annual enrollment period and may be information, such as Social Security numbers, birth dates, etc. subject to insurance company approval for some plans. Do not wait! Step 3 Schedule your appointment online or through the Employee Benefit Resource Center. It’s quick and easy. Visit http://f21.myenrollmentinfo.com WANT MORE INFO? If you DO NOT have access to the Internet or find For detailed information about the there are no appointments available online, you can benefit plans available to you, log on to call 855.289.1799, Monday through Friday, to schedule an appointment. www.smartben.com User ID = f21 + your employee ID number ONCE YOU ENROLL, ALL BENEFIT ELECTIONS ARE Password = IN EFFECT THROUGH THE REMAINDER OF THE PLAN Your birthdate MMDDYYYY YEAR ENDING ON SEPTEMBER 30, 2019 2018-2019 Benefit Guide 1
EMPLOYEE ELIGIBILITY AND ENROLLMENT Employees are eligible for benefits as follows: BENEFIT TYPE WHO’S ELIGIBLE WAITING PERIOD Medical, Dental, Vision, Flexible Spending Accounts, Buy-up Term Life, Short Term Disability, Whole Life Insurance, Critical Full-time and Part-time Variable employees 1st of the month following two months of service Illness Insurance, Accident Insurance, Hospital Confinement Indemnity Insurance, EAP, Travel Assistance Full-time, Part-time Variable and San Fransisco First of the month Commuter Parking and Transit Flexible Spending Account Part-time employees following eligibility Full-time and Must be at least 21 years old with 1 year of service 401(k) Plan Part-time employees and 1,000 hours worked Employer Paid Benefits (Base Plan Term Life Insurance, Short Corporate/Remote Corporate Full-time Employees First of the month following two months of service and Long Term Disability) Paid Time Off (PTO) Full-time employees Varies Paid Holidays: Memorial Day, Independence Day, Labor Day, Corporate and Distribution Center Full-time Upon hire date Thanksgiving Day, Christmas Day, New Year’s Day employees; and Retail Managers job class 50-0 Corporate and Distribution Center Full-time Paid Bereavement Leave Upon hire date employees; and Retail Managers job class 50-0 Employed for 12 months UNPAID Family and Medical Leave (FMLA) All employees (with at least 1,250 hours worked) UNPAID Pregnancy Leave (State Specific Laws Apply) All employees Varies 10% Employee Discount, Cell Phone Discount through AT&T and Verizon, Working Advantage and Dell Product Discounts, All employees Upon hire date 24-Hour Fitness, Pet Insurance Jury Duty Varies Where mandated by law This is a high level overview. Please check your employee handbook for further information. Benefits may vary by state and mandated laws. 2 Forever 21 – Your Style, Your Benefits!
DEPENDENT ELIGIBILITY QUALIFIED LIFE EVENTS (QLE) SPOUSAL SURCHARGE You can only make changes to your benefits during the Employees are subject to a surcharge when covering plan year if you have a qualified life event. You can process a spouse under their Forever 21 health plan that has these events in SmartBen within 30 days of the event. the option to elect health care coverage through their Qualified life event examples include: employer. The additional cost is $70 dollars per pay period if the below situation applies to you. You will be subject to a surcharge if: • Your spouse is working at an employer who offers group health insurance, but has declined that Marriage coverage and wants to remain on the Forever 21 health plan. • Your spouse is eligible and/or enrolled in Medicare, still actively working at their own employer that offers You and/or your Birth or Adoption group health insurance and covered under your dependents become of a Child Forever 21 health plan. covered by another group health plan • Your spouse is offered coverage for any time period throughout the year with their employer, and you choose to continue their coverage under the Forever 21 health plan. You will NOT be subject to a surcharge if: • You and your spouse are BOTH employed at Forever End of COBRA Court order requiring Continuation Coverage you to add coverage for 21 and are covered under the company’s health plan. through another employer a dependent child • Your spouse is eligible and/or enrolled in Medicare, and is covered under your Forever 21 health plan. • Your spouse is a retiree from another employer, is not actively working and is covered under your Forever 21 health plan. If you or your dependent has a qualifying event due to one of these work or family status changes and you are • Your spouse is self-employed, regardless of whether not currently enrolled, you may be eligible to enroll with or not they offer insurance to their employees and is the dependent. Any premium change will be made in the covered under your Forever 21 health plan. month the change occurred. • Your spouse is a part-time employee, doesn’t have You must notify Human Resources and provide proper access to health coverage and is covered under your documentation within 30 days of the QLE in order to Forever 21 health plan. obtain coverage. Otherwise, changes cannot be made • Your spouse has insurance available through their own until the next Open Enrollment. employer, the employer does not make contributions toward the cost of the health insurance and is covered Qualifying Dependents under your Forever 21 health plan. We pro-actively audit eligible dependents. It’s important for you to review members on your plan to make sure SMOKER/TOBACCO SURCHARGE they’re qualifying dependents. Smokers and all types of tobacco users, including pipes, As a reminder only the following dependents are eligible e-cigarettes, cigars, cigarettes and chewing tobacco are to be on your plan: subject to a $20 per pay period surcharge. Please contact • Legal spouse or domestic partner HR Benefits for solutions to help you quit using tobacco. • Your child(ren) or the child(ren) of your legal spouse, until age 26. 2018-2019 Benefit Guide 3
MEDICAL PLAN OVERVIEW Forever 21 offers a variety of medical plans to choose the plan that best meets your needs. MEDICAL PLAN OPTIONS MEDICAL PLAN HIGHLIGHTS (ALL STATES) • Kaiser Permanente HMO – California Only UHC HSA and PPO Plans • UHC Choice EPO – California Only • All of the plans cover in network preventive care at 100%. • UHC Choice Plus HSA – All States • All of the plans provide coverage for both in-network • UHC Choice Plus PPO Low – All States and out-of-network service providers, but you can • UHC Choice Plus PPO High – All States save money and spend less out of your own pocket by using in-network providers. About the Plans • You can review the differences between the All of our plans provide coverage for medical care and HDHP+HSA and PPO plans on page 5. prescription drugs. The company pays a portion of the plan’s premium for you and your enrolled dependents. NEW! UHC HDHP+HSA PLAN Please review the details on page 5 to compare the plans that are available to you. There is one HDHP with HSA plan available through UHC. • You pay for expenses out of pocket until your annual MEDICAL PLAN HIGHLIGHTS (CALIFORNIA ONLY) deductible is met. Kaiser Permanente HMO • Once your deductible is met, you and the plan share expenses until you reach your out-of-pocket limit. • There is no deductible for the HMO plan. • Compatible with a Health Savings Account (HSA) that • You are required to use doctors and facilities that are lets you save money for current and future health care in the Kaiser Permanente HMO network. If you go expenses (the funds never expire). See page 6 for outside of the network, benefits will not be covered more information. (except in certain emergency situations). • Preventive care services are covered at 100% when HOW PAYING FOR NETWORK CARE WORKS WITH AN HSA performed by a Kaiser Permanente network provider. STEP 1: STEP 2: STEP 3: UHC EPO DEDUCTIBLE COINSURANCE OUT-OF-POCKET MAX • Under the UHC EPO plan, you must first meet a You pay for After you reach When you reach deductible before the insurance will start covering all services, the deductible, the plan's out-of- health care expenses, with the exclusion of copays. including your you share the pocket max, you • You are required to use doctors and facilities that prescriptions, costs with the are done paying. are in the UHC EPO network. If you go outside of the until you meet plan. The plan pays your deductible. network, benefits will not be covered (except in certain You can use your 100% of eligible emergency situations). You can use your HSA to help pay expenses for HSA to help cover your share. the rest of the • Preventive care services are covered at 100% when your expenses. coverage year. performed by a UHC network provider. UHC PPO PLANS There are two PPO plan options to choose from: PPO Low and PPO High. • You will have set copays for doctor visits and prescription drug expenses in-network and coinsurance for all other health care expenses. • You must first meet a deductible before the insurance will start covering health care expenses, with the exclusion of copays. 4 Forever 21 – Your Style, Your Benefits!
MEDICAL PLAN COMPARISONS KAISER PERMANENTE HMO / UHC EPO (AVAILABLE IN CALIFORNIA ONLY) Premium Contributions (per paycheck) Kaiser Permanente HMO Plan UnitedHealthcare Choice EPO Plan Employee Only $42.54 $49.53 Employee + Spouse* $84.08 $97.83 Employee + Child(ren) $79.46 $93.85 Employee + Family $125.62 $144.70 Benefits and Covered Services In Network Only In Network Only Annual Deductible None $500 individual / $1,000 family Coinsurance (plan / member) 100% / 0% 90% / 10% Maximum Out of Pocket $1,500 individual / $3,000 family $2,000 individual / $4,000 family Lifetime Maximum Benefit None None Physician Office Visit $30 copay per visit $30 copay per visit Specialist Office Visit $50 copay per visit $50 copay per visit Urgent Care $30 copay per visit $30 copay per visit Inpatient Hospital $500 copay per admission You pay 10% after deductible plus $500 copay per admission Emergency Room $200 copay per visit You pay 10% after $200 copay per visit Prescription Drug Benefits Kaiser Permanente HMO Plan UnitedHealthcare Choice EPO Plan Generic $15 copay, up to 30-day supply $15 copay Brand Name $35 copay, up to 30-day supply $35 copay Non Preferred Brand $35 copay, up to 30-day supply** $50 copay Specialty You pay 20% coinsurance, up to $100 max. You pay 20% up to $100 copay * Forever 21 supports domestic partner coverage in all states. Domestic partnership is processed on a post-tax basis. Imputed income will apply. See page 3 for spousal surcharge information. **Medications in this category require the provider to submit an exception request for it to be covered. UHC MEDICAL OPTIONS (AVAILABLE IN ALL STATES) Premium Contributions (per paycheck) NEW! UHC HDHP+HSA Plan UHC Choice Plus PPO Low UHC Choice Plus PPO High Employee Only $31.35 $43.35 $66.00 Employee + Spouse* $61.77 $85.50 $130.69 Employee + Child(ren) $58.73 $82.03 $125.36 Employee + Family $91.00 $126.40 $193.47 Benefits and Covered Services In Network Out of Network In Network Out of Network In Network Out of Network $2,000 individual $4,000 individual $1,000 individual $2,000 individual $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 Coinsurance (plan / member) 70% / 30% 50% / 50% 70% / 30% 50% / 50% 80% / 20% 60% / 40% $5,000 individual $8,000 individual $4,000 individual $8,000 individual $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 $14,300 family $24,000 family $12,000 family $24,000 family Lifetime Maximum Benefit Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited $25/$50 copay per You pay 50% $25/$50 copay $20/$40 copay Physician/Specialist Office Visit You pay 50% You pay 40% visit after deductible after deductible per visit per visit $150 copay per visit You pay 50% $20 copay per Urgent Care $25 copay per visit You pay 50% You pay 40% after deductible after deductible visit You pay 30% after You pay 30% after You pay 50% Inpatient Hospital $250 copay per You pay 50% You pay 20% You pay 40% deductible after deductible day, up to 3 days Emergency Room $250 copay per visit after deductible You pay 30% after $100 copay per visit You pay 20% Prescription Drug Benefits NEW! UHC HDHP+HSA Plan UHC Choice Plus PPO Low UHC Choice Plus PPO High Generic $15 copay after deductible $15 copay $10 copay Brand Name $35 copay after deductible $35 copay $35 copay Non-Preferred Brand $60 copay after deductible $60 copay $60 copay After your deductible is met, you pay Specialty You pay 30% up to a $150 copay You pay 30% up to a $150 copay 30% up to a $150 copay * Forever 21 supports domestic partner coverage in all states. Domestic partnership is processed on a post-tax basis. Imputed income will apply. See page 3 for spousal surcharge information. As a reminder, copays do not count toward your deductible but do count toward your out-of-pocket maximum. 2018-2019 Benefit Guide 5
HEALTH SAVINGS ACCOUNT (HSA) What are the benefits of a health savings account (HSA)? A HSA LETS YOU SAVE MONEY (TAX-FREE!) You are eligible to open an HSA if you are covered by FOR HEALTH CARE EXPENSES. SPEND an HSA qualifying high deductible health plan (HDHP). NOW OR SAVE FOR LATER... YOU DECIDE. HSAs are tax advantaged accounts that help people save and pay for qualified medical expenses. Benefits include: How much can I contribute to an HSA? • Contributions are pre-tax or tax deductible. The IRS sets annual contribution limits each year. • Earnings are income tax-free. • Individual coverage: $3,450 • You can make tax-free withdrawals for qualified • Family coverage: $6,900 medical expenses. Keep in mind that any contributions made to your HSA • You can carry over unused funds from year to year. by family members or others count toward this limit. • The HSA is yours to keep even if you change jobs, If you are 55 or older, you can contribute an additional change health plans or retire. $1,000 each year. Note: The primary account holder must be 55 or older (even if the spouse is of that age). Note: Contributions are tax deductible on your federal tax return. Some states do not recognize What can I use my HSA for? HSA contributions as a deduction, and some states You can use the funds in your HSA to pay for qualified tax interest earned on your HSA. Your own HSA medical, dental, vision and prescription drug expenses, contributions are either tax deductible or pre-tax (if including over-the-counter drugs that have been made by payroll deduction). See IRS Publication 969, prescribed by a doctor, as defined in IRS Publication or consult a qualified tax advisor to see how your state 502. Once you are 65, you can withdraw funds for any treats HSA contributions. reason without paying a penalty, but they will be subject You are NOT eligible to open an HSA if: to ordinary income tax. If you are under age 65 and use your HSA funds for nonqualified expenses, you will need • You are enrolled in a Health Care Flexible Spending to pay taxes on the money you withdraw, as well as an Account (FSA) with an outstanding balance (Limited additional 20 percent penalty. Purpose FSA is permissable). • You are currently enrolled in Medicare, TRICARE, or What happens to my remaining account balance at the TRICARE for Life. end of the year? • You are claimed as a dependent on another Any remaining balance automatically rolls over each year. individual’s tax return. • You have received Veteran's Administration benefits Can I use my HSA to pay for qualified medical expenses within the past three months, except for preventive for a spouse or tax dependent? care. (If you are a veteran with a disability rating from Yes, even if your spouse or tax dependent is covered the VA, this exclusion does not apply.) under another health plan. How can I use my HSA to pay for medical services? What happens to my HSA if I no longer am covered by a You can use your Optum Bank® Health Savings Account qualifying high deductible plan (HDHP)? Debit Mastercard®; use online bill pay; or pay out-of- pocket and then distribute funds from your HSA to While you can no longer contribute to your HSA, you can reimburse yourself. still use the remaining funds to pay or be reimbursed for future qualified medical expenses. Can I reimburse myself with HSA funds for qualified medical expenses incurred prior to my enrollment in an HSA? No, qualified medical expenses may be reimbursed only if the expenses are incurred after the date your HSA was established. 6 Forever 21 – Your Style, Your Benefits!
ADDITIONAL HEALTH PLAN RESOURCES FOR UNITEDHEALTHCARE (UHC) MEMBERS FOR KAISER MEMBERS (CALIFORNIA ONLY) Managing Your Health Online is easy on myuhc.com Manage Your Health Online It's easy to take charge of your health care through myuhc.com! From your computer, go to www.kp.org/registernow and • Review claim information follow the sign-on instructions. • Find a physician or facility • Once you are registered, download the Kaiser Permanente app to your smart device – use your • View your benefits www.kp.org User ID and Password to activate the app. • Update or manage your account information • View most lab results and refill most prescriptions • Find health information • Email your doctor’s office with questions • Print temporary ID cards and more • Schedule and cancel routine appointments Health and Wellness Resources • Print vaccination records UHC offers a wide variety of health and wellness resources • Use tools to manage your coverage and costs such as: • Manage a family member’s health care • Health family education at every stage of your life Heart Care • Fitness education Kaiser Permanente’s high quality cardiac care has reduced • Nutrition education serious heart attacks among members by 62%. Learn • Healthy weight management more at www.kp.org/healthylifestyles. • Free online seminars Wellness Tools • Strategies to simplify your life Members can get Wellness Coaching by phone at • and much more... www.kp.org/wellnesscoach or take online healthy lifestyle Simply go to www.uhc.com/health-and-wellness programs at www.kp.org/healthylifestyles at no additional cost. Discount Programs Prevention UnitedHealthcare’s discount program helps you and your Kaiser Permanente leads the way with cancer preventive family save typically 10 to 25 percent on many health and screenings. Learn more about the screenings offered at wellness purchases not included in your standard health www.kp.org/prevention. benefit plan. Use the plan for: • Weight management from Jenny Craig®, Kaiser Mobile App Nutrisystem® and other popular programs • Schedule, cancel, view routine appointments • Nutrition counseling • Refill most prescriptions • Fitness clubs including Anytime Fitness®, Bally Total • Email your doctor's office FitnessSM, Curves®, Gold’s Gym®, Jazzercise®, MyGym® and Snap Fitness™ • See most lab test results • Fitness equipment and apparel • Natural products and foods • Stress reduction and relaxation UHC Mobile App • Digital health plan ID cards • Contact a registered nurse 24/7 about medical questions • Find network doctors, clinic or hospital • Find pharmacies and fill prescriptions 2018-2019 Benefit Guide 7
DENTAL COVERAGE Forever 21’s Freedom of Choice dental coverage includes a choice of two dental options, DMO and PPO, that cover preventive and YOU HAVE THE FREEDOM TO 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 change. If you wish to change plans, you’ll need to log on to SmartBen and make your change through a “Life Event”. Changes made prior to the 15th of the CHECK OUT THE MOBILE APP! month will be effective the first of the following month. 1. Download the Aetna AETNA DMO AETNA PPO mobile app to your The Aetna DMO plan provides The Aetna PPO plan provides the smartphone. coverage inside of the Aetna DMO freedom to visit any licensed dentist 2. Use the app to find a network. If you use a dentist outside without a referral. If you pick a dentist provider, view claims, of the network, benefits will not be from Aetna’s PPO network of over see your ID card, and covered. Under the DMO, you choose 130,000 providers, your benefit a primary care dentist from Aetna’s dollars will go farther when you use contact Aetna customer network of over 10,000 providers. network dentists. service. Your primary care dentist will help you Like the DMO plan, most preventive manage your care. care services are covered at no *DMO is not offered in the following states: AL, cost. The difference is that you will AK, AR, LA, ME, MS, ND, NH, PR, SC need to meet the PPO plan’s annual deductible before non-preventive services are covered, and there is a limit to how much the plan will pay for services each year. AETNA DENTAL® FREEDOM OF CHOICE (CHOOSE BETWEEN TWO PLAN OPTIONS MONTHLY) Premium Contributions (per paycheck) Aetna DMO Aetna PPO Employee Only $6.15 $6.15 Employee + 1 Dependent* $11.06 $11.06 Employee + 2 or More Dependents* $18.40 $18.40 Benefits and Covered Services In Network Only In Network Out of Network Calendar Year Deductible None $50 individual / $150 family $100 individual / $300 family Calendar Year Benefit Maximum None $1,500 per person $1,500 per person The most the plan will pay Preventive and Diagnostic Serivces Covered 100% with $10 copay for exam Covered 100%, no deductible You pay 50%, no deductible Exams, cleanings, x-rays, sealants Basic Services Covered 100% You pay 30% after deductible You pay 50% after deductible Fillings, simple tooth extractions, root canals, gum treatment, oral surgery Major Services You pay 40% You pay 50% after deductible You pay 50% after deductible Crowns, inlays, onlays, cast restorations, bridges, dentures, implants Orthodontia for Adults and Children Covered 100% after $2,400 copay You pay 50%, no deductible You pay 50%, no deductible Orthodontia Lifetime Benefit Maximum 24 months $1,500 per person $1,500 per person *Forever 21 supports domestic partner coverage in all states. Domestic partnership is processed on a post-tax basis. Imputed income will apply. 8 Forever 21 – Your Style, Your Benefits! 8
VISION COVERAGE You have the flexibility to choose between the VSP Core and the VSP Premium plans. Please review the side-by-side comparison below to determine which option is right for you. Vision is a separate option from the medical plan, so you can get just the coverage you need! Whether or not you enroll in a medical plan with Forever 21, you now have the flexibility to choose between the VSP Core and the VSP Premium plans. Please review the side-by-side comparison below to determine which option is right for you. VSP VISION PLAN OPTIONS Premium Contributions Core Coverage Premium Coverage (per paycheck) Employee Only $0.23 $1.98 Employee + Spouse* $0.35 $3.96 Employee + Child(ren) $0.35 $4.25 Employee + Family* $0.46 $6.78 Covered Services Description Copay Description Copay Well Vision Exam • Once every plan • Once every plan $10 $10 year year Prescription Glasses $25 $25 Frames • $130 allowance • $175 allowance for a wide for a wide selection of selection of Included in $25 Included in $25 frames frames prescription prescription • $70 allowance at • $95 allowance at glasses copay glasses copay Costco Costco • Once every two • Once every plan plan years year Lenses Included in $25 Included in $25 • Once every two • Once every plan prescription prescription plan years year glasses copay glasses copay Contact Lenses (instead • $130 allowance • $175 allowance of glasses) for contacts and for contacts and contact lens contact lens exam (fitting and $0 exam (fitting and $0 evaluation) evaluation) • Once every two • Once every plan plan years year *Forever 21 supports domestic partner coverage in all states. Domestic partnership is processed on a post-tax basis. Imputed income will apply. Plan year begins October 1. DID YOU KNOW? The vision plan is "paperless" and does not use ID cards. When you visit an eye care professional, you can contact VSP to verify your coverage using your social security number. 2018-2019 Benefit Guide 9
FLEXIBLE SPENDING ACCOUNTS (FSAs) Flexible Spending Accounts (FSAs) enable you to set aside money on a pre-tax basis to pay for certain eligible out-of-pocket expenses. There are four types of accounts: the Healthcare FSA, the Limited Purpose Health FSA (for those who enroll in the HSA medical plan), the Dependent Care FSA, and the Adoption Assitance FSA. PLEASE NOTE: Our Flexible Spending Accounts will have a short plan year from January 1, 2019 to September 30, 2019. Be sure to only elect the amount you anticipate to use during those nine months. As of October 1, 2019 the FSAs will share the same plan year as our other benefits. NEW! ADOPTION ASSISTANCE FSA HEALTHCARE FSA The Adoption Assistance FSA lets you reimburse yourself The Healthcare FSA allows you to set aside pre-tax dollars for the reasonable and necessary expenses that you to pay for eligible health-related expenses that may not be incur in the process of legally adopting an eligible child, covered by insurance. including adoption fees, court costs, attorney fees and Use your Healthcare FSA to cover expenses such as: related travel costs. • Deductibles, copayments and coinsurance Expenses incurred in carrying out a surrogate parenting arrangement or the adoption of a step-child are not eligible. • Prescription drugs copayments • Eye examinations, glasses, contacts, LASIK Who Is an Eligible Child? • Hearing examinations An “eligible child” is a child who has not yet reached age • Transportation to and from medical provider 18 or is physically or mentally incapable of caring for him or • Orthodontic expenses herself. Also, the child must be younger than you and must be unmarried. • Smoking cessation programs ROLLOVER FEATURE: You may rollover up to $500 for How Much Can I Set Aside? your Healthcare FSA to the following calendar year. The maximum amount of reimbursement that you may receive in connection with the adoption of any one child NEW! LIMITED PURPOSE HEALTH FSA is $13,810 (this will be adjusted for inflation in years after The Limited Purpose Health FSA is similar to the 2018). This is a total rather than an annual amount, even if Healthcare FSA but is specifically designed for those the expenses occur over a period of years. who enroll in the HSA medical plan. Because you cannot You can enroll in the adoption assistance account at any time during the have two tax-advantage health spending accounts at the year once an adoption is formally approved to proceed. You must use the same time, the LPHFSA can only be used to pay for dental, account balance within the plan year elected, and funds must be used for vision, and preventive expenses not covered by your expenses that were incurred during that plan year. medical plan. ROLLOVER FEATURE: You may rollover up to $500 for DEPENDENT CARE FSA your Limited Purpose FSA to the following calendar year. The Dependent Care FSA allows you to pay for dependent daycare while you are at work or school. If you have NEW! HEALTH SAVINGS ACCOUNT dependent children under the age of 13 or dependents If you enroll in the UnitedHealthcare HSA plan, you are of any age who are unable to care for themselves, you can eligible to enroll in a Health Savings Account (HSA) to help enroll in this plan and choose the amount you want to put pay for current and future medical expenses. aside for daycare. Some examples of eligible Dependent Care Expenses include: What is a Health Savings Account (HSA)? • Day care facility fees (excluding transportation, An HSA is a tax-exempt account where contributions earn lunches and educational services) interest to pay for medical expenses even after retirement. • Before-school and after-school care, day camp Funds in this account can be contributed by anyone and contributions are tax deductible. Funds roll over from year • In-home babysitting fees (income must be claimed by to year, and you withdraw your money tax-free at any time your care provider) to pay for eligible medical expenses as determined by • Nursery school and preschool (preschool expenses the IRS. HSA account holders can keep the account if they are eligible if the amount you pay for schooling cannot change employers. Read more about the Health Savings be separated from the cost of care). Account on page 6. 10 Forever 21 – Your Style, Your Benefits!
COMMUTER PARKING AND TRANSIT Forever 21 offers parking and transit flexible spending accounts (FSAs) that allow you to use tax-free dollars to pay for your commute to and from work. You can change the amount you set aside into your parking and/or transit account each month. PAYING FOR COVERED EXPENSES Use Your P&A Benefits Card If you enroll in the parking and/or transit plan, you will receive a debit card that can be used to pay for your parking and/or transportation expenses to and from work. Employees who enroll in both the health care FSA and parking and/or transit FSA will receive one debit card for all accounts. No Out-of-Pocket Claim Submissions Allowed P&A does not allow reimbursement of out-of-pocket 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. CONTRIBUTION AMOUNTS There are limits to how much you can set aside into your parking and/or transit account. Below are the IRS pre-set maximum pre-tax contributions for 2019. • PARKING: $260 per month • TRANSIT: $260 per month MAKING CHANGES Your commuting expenses may change over time; the parking and transit plans are designed to be flexible and allow you to change your election amount each month. When Changes are Effective Please note that any change you make will become effective with the first pay period beginning on or after the following month. For example, if you are going on a vacation and will not be commuting to work, you can change your election amount for that month in SmartBen through a life event. 2018-2019 Benefit Guide 11
VOYA VOLUNTARY BENEFITS SHORT TERM DISABILITY INSURANCE CRITICAL ILLNESS INSURANCE A short-term, non-occupational injury or illness can prevent If serious illness strikes, the last thing you need to worry you from working for a period of time. Should this happen, about is how to pay the bills: medical copayments and the Short Term Disability plan will replace a portion of deductibles, car payments, rent or mortgage, and your lost income. The amount of coverage available varies utilities. With Compass Critical Illness Insurance, if you based on your location. Some states provide a state are diagnosed with a covered illness, you receive a lump disability benefit. This voluntary benefit is available to sum cash benefit – even if you receive benefits from other retail and distribution center employees only. insurance. Use the cash benefit however it is needed – whether for treatments not covered by insurance or a Benefit Amount: dream vacation to celebrate your recovery – you decide. • Employees residing in CA, HI, NJ, NY, RI – 70% of your Employees must have access to comprehensive medical weekly earnings, to a maximum of $1,250 per week coverage with Forever 21 or another source in order to (benefit amount is offset by the state disability benefit) enroll in this plan. • All other employees – 60% of your weekly earnings, to Coverage Options: a maximum of $1,250 per week Employee must be covered to elect spouse or child Benefits become payable after the 7th day of injury coverage, no minimum benefit or illness and will pay for up to 12 weeks. If you waive • Employee: $5,000 - $30,000, in increments of $5,000 coverage during your initial enrollment, Evidence of Insurability (EOI) may be required to enroll at a • Spouse: $5,000 - $15,000, in increments of $5,000 future time. • Child: $1,000, $2,500, $5,000 or $10,000 Examples of Covered Illnesses Include: HOSPITAL CONFINEMENT INDEMNITY INSURANCE • Heart attack The Compass Hospital Confinement Indemnity insurance pays daily and initial confinement benefits if you have a • Stroke covered stay in a hospital, critical care unit or rehabilitation • End stage renal (kidney) failure facility. The benefit amount is determined based on the • Coronary artery bypass type of facility and the number of days you stay. Employees • Coma must have access to comprehensive medical coverage with Forever 21 or another source in order to enroll in this plan. • Major organ failure • Permanent paralysis Plan Features: • Cancer, carcinoma in situ, skin cancer HOSPITAL CONFINEMENT INDEMNITY • Also includes deafness, blindness, benign brain tumor Coverage is available for the employee, and occupational HIV Who is eligible? spouse, and children Plan Features Include: Initial confinement benefit $1,000 • $75 wellness benefit when a covered person has a Daily hospital confinement $100 per day, up to 30 days health screening test Critical care unit benefit $200 per day, up to 15 days • $200 mammogram benefit (age limit restrictions apply) Rehabilitation facility $50 per day, up to 30 days • Restoration of benefits* – pays an additional benefit if benefit a covered person experiences a second covered illness for a different condition (must occur after a defined IMPORTANT: Check with you your period of consecutive months) • Recurrence benefit* – receive a benefit for the same Benefits Enrollment Counselor critical illness or condition a second time (must occur regarding pre-existing conditions. after a defined period of consecutive months) *Restoration and recurrence do not apply to cancer. 12 Forever 21 – Your Style, Your Benefits! 12
VOYA VOLUNTARY BENEFITS ACCIDENT INSURANCE TERM LIFE INSURANCE WHOLE LIFE INSURANCE The Compass Accident Insurance Group term life insurance is available Premier Whole Life insurance policies plan pays you a direct benefit for to you, your spouse and your can provide protection for both specific injuries and events resulting dependent children. Rates are based working years and post-retirement, from a covered on or off the job on age and salary. while building cash value. Your accident. The plan also includes a monthly premiums are based on your hospital confinement benefit for Coverage Options: age at time of enrollment and will not illness. The amount paid depends on Employee must be covered to elect increase as you get older. the type of injury and care received. spouse or child coverage. You can use your payment to help Coverage Options: pay for unexpected expenses, such TERM LIFE Employee does not need to be as deductibles and copays, home • 1x, 2x, or 3x annual salary, to a covered to elect spouse or child health care costs, lost time from maximum of $500,000; guarantee coverage work, everyday expenses, utilities, Employee issue $200,000 and groceries. Employees must have • Benefits reduce to 65% at age 70 and to 50% at age 75 WHOLE LIFE access to comprehensive medical • Non-tobacco user: $5,000 - $500,000 coverage with Forever 21 or another • $10,000, $25,000, $50,000 or • Tobacco user: $5,000 - $250,000 $100,000, not to exceed 100% of • $1,000 increments source in order to enroll in this plan. the employee amount; guarantee Spouse • Ages 15-65 coverage is guaranteed issue $50,000 Examples of Covered Injuries Include: • Benefits reduce to 65% at age 70 Employee up to $20 per week, not to exceed $75,000 • Broken bones and to 50% at age 75 • Ages 66-70 coverage is contingent • Joint dislocations / torn ligaments • Live birth to 6 months - $1,000 on medical questions for $25,000 of Child • 6 months to age 26 - $5,000 or guarantee issue • Ruptured discs $10,000 • Non-tobacco user: $5,000 - $500,000 • Burns • Tobacco user: $5,000 - $250,000 *If you waive coverage during your • $1,000 increments • Concussions initial enrollment, Evidence of • Ages 15-65 coverage is contingent on • Eye injuries Insurability (EOI) may be required to Spouse medical questions for the greater of enroll at a future time. $5 per week or $5,000 Plan Features Include: • Ages 66-77 requires medical questions • Coverage available for the Plan Features Include: employee, spouse and child(ren) • $12,500, $15,000, $20,000 or • Waiver of premium Children $25,000 • Hospital care – admission, 15 days to • Accelerated death benefit • Coverage is contingent on medical confinement to a hospital, critical 24 years questions care unit or rehabilitation facility, • Accidental death & surgery dismemberment benefit *If you waive coverage during your • Follow up care – medical initial enrollment, Evidence of • Employee Assistance Program Insurability (EOI) may be required to equipment, physical therapy, (EAP) enroll at a future time. prosthetic devices • Travel Assistance • Emergency care – ground/ air ambulance, emergency • Funeral planning and concierge Plan Features Include: room treatment, initial doctor services • Waiver of premium treatment, follow-up • Long term care benefit doctor treatment • Accidental death benefit • Accelerated death benefit Voya Financial voluntary plan provisions and availability may vary by state; some exclusions and limitations may apply. 13 2018-2019 Benefit Guide 13
NEED TO ADD ADOPTION ADDITIONAL BENEFITS ASSISTANCE SOMEWHERE Employee Assistance Program Travel Assistance Through Voya, you have access to ComPsych When traveling more than 100 miles from home, Voya GuidanceResources®, which provides support, Travel Assistance offers enhanced security for your resources and information for personal and work-life leisure and business trips. You and your dependents issues. This plan includes three telephone counseling can take advantage of four types of services: pre-trip sessions per issue. information, emergency personal services, medical This no-cost counseling service helps you address assistance services and emergency transportation personal issues you or your family members may face, services. up to 3 sessions per incident, per year. Guidance Pre-Trip Information – These valuable services Consultants, highly trained master’s and doctoral help you start your trip the right way. This coverage level clinicians, are available anytime to listen to your can provide you with important, up-to-date travel concerns and quickly refer you to telephone counseling information, including immunization, visa and passport and other resources for: requirements, foreign exchange rates and travel/ • Stress, anxiety and depression tourist advisories, temperature and weather conditions, cultural information, and embassy/consular referral. • Relationship/marital conflicts Emergency Personal Services – In the event of an • Problems with children unexpected situation of a non-medical nature, this • Job pressures coverage offers access to several valuable services, • Grief and loss including urgent message relay, interpretation/ translation services, emergency travel arrangements, • Substance Abuse recovery of lost or stolen luggage or personal • Call 877.533.2363 anytime for confidential possessions, legal assistance and/or bail bond. assistance. Medical Assistance Services – Get medical referrals for GuidanceResources Online is your one stop for expert local physicians and dentists, medical case monitoring, information of the issues that matter most to you… prescription assistance and eyeglass replacement, relationships, work, school, children, wellness, legal, arrangement and payment of emergency medical financial, free time and more. services (up to $10,000 with a written guarantee of reimbursement from the eligible member). Go to www.guidanceresources.com and enter the Forever 21 Web ID: MY5848i to find knowledge at Emergency Transportation Services – Should you your fingertips: need medical care or assistance while traveling, this plan can help. • Timely articles, Help Sheets, tutorials, streaming videos and self-assessments Contact Voya Travel Assistance 24 hours a day, 365 days a year for any of the services outlined above. Call toll free at 800.859.2821 or • “Ask the Expert” personal responses to your Worldwide, Collect at 202.296.8355. questions • Child care, elder care, attorney and financial planner searches 14 Forever 21 – Your Style, Your Benefits!
MATERNITY SUPPORT PROGRAMS FOR UHC MEMBERS FOR KAISER MEMBERS (CALIFORNIA ONLY) Get personalized support before, during and Kaiser Permanente provides proud parents with everything they need, from ultrasounds to classes after your pregnancy! to delivery nurses, they are available to help families Earn Rewards for a Healthy Pregnancy by enrolling experience a lifetime of good health. within your first trimester of pregnancy. To get started, • Prenatal programs – pregnancy, childbirth, contact UHC at 877-201-5328 (available Monday-Friday breastfeeding and baby care from 8 a.m. to 8 p.m. CST.) • Manage your pregnancy online – make appointments, email your doctor, get test results and more. Access to a dedicated nurse for any questions you have • Mom-to-be tools – Pregnancy week by week, new baby checklist, what to bring to the hospital, Healthy Support for your special health care Beginnings newsletters needs Learn more about Kaiser's prenatal commitment at kp.org/pregnancy. Customized maternity education material CHECK OUT OVIA'S FERTILITY AND PREGNANCY APPS REMEMBER TO ENROLL YOUR Manage your parenthood journey with Ovia Health! Ovia BABY FOR BENEFITS COVERAGE offers three apps to guide you on your journey: WITHIN 30 DAYS OF BIRTH. As a Forever 21 employee, you also have access to a variety of helpful support tools from Ovia, including: • Health assessment • Personal health coach • Comprehensive health tracking • Health & medical programs • Fertility chart • Anonymous community • Cycle trends • Fertility forecast How to sign up: 1. Download the app(s) on your mobile device 2. Select “Health” to take the Ovia Health Assessment 3. Select “Update my healthcare information” 4. Under “Employer,” enter and select your employer 5. Enter additional information: first name, last name, date of birth, zip code 6. Accept the terms and conditions and select “Save” 2018-2019 Benefit Guide 15
MAKE HEALTHY HAPPEN TIPS FOR SAVING MONEY ON HEALTH CARE IMAGINE TACKLING STRESS Commit to healthy living: Eat well, exercise and steer clear of unhealthy habits such as smoking and excessive WITHOUT A CIGARETTE. alcohol consumption. Use a Primary Care Provider (PCP): Patients with a PCP have better management of chronic diseases, lower WE CAN HELP overall health care costs and a higher level of satisfaction MAKE IT A REALITY. with their care. UHC Network: When looking for any type of health myquitforlife.com/forever21 care provider, select a UHC provider; your out-of-pocket costs will be lower. To find a provider, visit www.myuhc. 866.744.8454 com. Kaiser Network: When looking for any type of health QUIT FOR LIFE PROGRAM care provider, select a Kaiser provider; your out-of- pocket costs will be lower. To find a provider, visit Quitting is about more than just not smoking. Quit For www.kp.org. Life program in association with the American Cancer Society, is tailored to your individual smoking habits and Get preventive screenings: Annual well-visits with your needs. PCP give an opportunity to work on health goals and • When you call or enroll online, a Quit Coach staff provide necessary medical advice and identify health member will work with you to help you accomplish concerns before they become major issues. your goal. Consult with your doctor: Always ask your doctor about • You may even qualify for free nicotine replacement lower cost alternatives for recommended care, services therapy, such as the patch or gum. and prescriptions. • Register through the American Cancer Society at Avoid the emergency room for non-emergencies: If quitnow.net or call 866.QUIT-4-LIFE (744-8454) to get you need to see a doctor after hours for a relatively minor started. issue, such as a sprained ankle or a cold, use an urgent care facility or a CVS MinuteClinic instead of the ER. ELIGIBILITY Use generic medications: Generic medications The program is available to employees and spouses cost significantly less than brand; ask your doctor or (including domestic partners) enrolled in a Forever 21 pharmacist to prescribe generics whenever possible. medical plan. Enrollment is free and confidential! Use a Flexible Spending Account or Health Savings Account: These accounts save you money because deductions are made before state, federal and Social Security taxes are withheld from your paycheck. 16 Forever 21 – Your Style, Your Benefits!
WHERE TO GO FOR CARE KNOW BEFORE YOU GO! It’s important to know where to go when you need care. Sometimes it’s clear where to go when you need care, such as when you’re suddenly having severe chest pain or you’ve broken your leg. At other times, it’s not so clear. It’s good to learn about your choices. Knowing where to go can make a big difference in cost and wait time. How to choose between... URGENT CARE EMERGENCY ROOM PRIMARY CARE Visit an Urgent Care Center for Visit the Emergency Room for true Visit your Primary Care Physician non-life-threatening conditions emergencies such as: for timely treatment and care: that are time-sensitive, such as: • Chest pain • Full range of preventive • Allergic reactions • Stroke care services for adults and • Bone X-rays, sprains, or strains children • Seizures • Cold and flu • Fever, colds, flu and other • Head or neck injuries common illnesses • Minor injuries / pain • Sudden or severe pain • Referrals to a specialist • Rashes, cuts, or scrapes • Heart attack symptoms • Ongoing medical conditions • Eye swelling or irritation • Severe vomiting, diarrhea or non-urgent medical • Sore / strep throat • Fainting, dizziness, weakness concerns • Bronchitis / allergies • Uncontrolled bleeding • Migraines / headaches • Problems breathing • Cuts that need stitches • Sudden or unexplained loss of • Nausea, vomiting, or diarrhea consciousness • Tetanus shots or flu vaccines 2018-2019 Benefit Guide 17
TELEMEDICINE / VIRTUAL VISITS DID YOU KNOW YOU CAN GET CARE FROM A DOCTOR— WHEREVER YOU ARE? When you have a minor health condition that doesn’t require an in-person medical exam, you may be able to address it with a doctor by phone or video chat.** You’ll get great care, and you’ll save time! Get help with things like:* • Allergies • Colds and coughs • Some follow-up visits • Upper respiratory infections • Fever ual Visits • Pink eye • Migraine/headache • Rash • Sore throat *Telephone or video appointments are not appropriate for emergency s to care online. conditions, such as severe shortness of breath, severe abdominal pain, severe bleeding, or urgent conditions— like sprains, falls, or . Any time. cuts needing stitches. **Subject to copays and deductibles. See your Summary Plan Description for details. If you reasonably believe you have an emergency medical condition, call 911 or go to the nearest emergency department. An emergency medical condition is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health. well, or your child is sick, the last thing you want to do is leave to sit in a waiting room. Now, you don’t have to. Use virtual visits when: see and talk to a doctor from your mobile device or computer • Your doctor is not available ent. Most visits CONNECT take about 10-15 minutes and doctors INTERACT can write • You becomeDIAGNOSE ill while traveling eded, that you can pickMEMBERS: KAISER up at your local pharmacy. And, it’s part Real-time ts. Call 1-844-800-0820 or • You areGet help understanding considering visiting a hospital consultation with your condition and go to kp.org emergency room for a non-emergency board-certified deciding which treatment health condition mmonly Register treated UHC through a virtual visitdoctor MEMBERS: at myuhc.com options might be best e and treat a wide range of non-emergency medical : Not good for: • Anything requiring an exam or test • Diarrhea • Rash on • Complex or chronic conditions • Fever • Sinus problems • Injuries requiring bandaging or • Migraine/headaches • Sore throat sprains/ broken bones • Pink eye • Stomach ache l visits 18 Forever 21 – Your Style, Your Benefits!
SAVE FOR RETIREMENT THROUGH OUR 401(K) PLAN The Forever 21, Inc. 401(k) Plan is through Fidelity Investments. You may access your account or enroll electronically and start saving toward your retirement at www.401k.com. ELIGIBILITY Qualified full-time employees of Forever 21 are eligible to enroll on the first of the month after 1 year of service. Part- time employees are eligible to enroll after 1 year of service and 1,000 hours worked. All employees are required to be at least 21 years old. COMPETITIVE MATCH The Company provides an advantageous SafeHarbor Matching Contribution, which is 100% of the first 3% you contribute and 50% of the next 2% you contribute. The match is immediately vested, meaning the Company’s contributions belong to you as soon as the match is provided. EXPANDED INVESTMENT OPTIONS Choose from a diversified menu of investments. WORLD CLASS CUSTOMER SERVICE An experienced Fidelity Investments representative is ready to help you with the enrollment process or to gain online access. In addition, the financial advisors at the Pasadena Group at Morgan Stanley can help assist with any investment or financially related questions. Please see contact information below. NETBENEFITS – ONLINE FIDELITY ACCOUNT Access your plan information online at any time by visiting www.401k.com. To Enroll or Register Your Account HR Benefits Department For Financial Questions Fidelity Investments HR.email@example.com The Pasadena Group at Morgan Stanley www.40lk.com or or 844-435-5621 firstname.lastname@example.org or 800-835-5097 855-211-1223 800-587-5282 (Spanish) 19
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