BENEFIT GUIDE 2018-2019 - Home

BENEFIT GUIDE 2018-2019 - Home
BENEFIT GUIDE 2018-2019 - Home
                                                                                                     ABOUT YOUR BENEFITS

   WELCOME                                                                                            New Hire Steps to Enroll
                                                                                                      Employee Eligibility
                                                                                                      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
                                                                                                     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.
BENEFIT GUIDE 2018-2019 - Home
                                      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

                                                                                                               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

                           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.
                                                                                                             their benefits ) to review their options                           • THE HDHP                          of your Benefit
                                                                                                                                        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!
                                                                                                               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

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.

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                                             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                                     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.
                                                                                          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
BENEFIT GUIDE 2018-2019 - Home

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!
BENEFIT GUIDE 2018-2019 - Home
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
BENEFIT GUIDE 2018-2019 - Home

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!
BENEFIT GUIDE 2018-2019 - Home
 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
BENEFIT GUIDE 2018-2019 - Home

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

6      Forever 21 – Your Style, Your Benefits!
BENEFIT GUIDE 2018-2019 - Home

Managing Your Health Online is easy on                  Manage Your Health Online
It's easy to take charge of your health care through!   From your computer, go to 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                                        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
 • Free online seminars                                           Wellness Tools
 • Strategies to simplify your life                               Members can get Wellness Coaching by phone at
 • and much more...                                      or take online healthy lifestyle
Simply go to                      programs at at no additional
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 
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
 • Find network doctors, clinic or hospital
 • Find pharmacies and fill prescriptions

                                                                                                  2018-2019 Benefit Guide     7
BENEFIT GUIDE 2018-2019 - Home

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
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.

    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

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.

 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) 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!
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.

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.

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

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

 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:
                                                                               •   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
                                                                                 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

 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
     •   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
     • Coverage available for the              Plan Features Include:
       employee, spouse and child(ren)                                                                         • $12,500, $15,000, $20,000 or
                                                • Waiver of premium                               Children
     • Hospital care – admission,                                                                 15 days to
                                                • Accelerated death benefit                                    • Coverage is contingent on medical
       confinement to a hospital, critical                                                        24 years
       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
                                                  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 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.
     • Child care, elder care, attorney and financial planner

14      Forever 21 – Your Style, Your Benefits!

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
          Customized maternity education

                                                            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:

                                                            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

                                                               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
                                                               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
 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 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!
                                      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

        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
ts.           Call 1-844-800-0820 or                                              • You areGet help understanding
                                                                                            considering    visiting a hospital
                                                    consultation with                        your condition and
                    go to                                                    emergency room for a non-emergency
                                                      board-certified                     deciding which treatment
                                                                                    health condition
 mmonly Register
                  UHC       through a virtual visitdoctor
                                                                                            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!
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

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.

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

Choose from a diversified menu of investments.

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

Access your plan information online at any time
by visiting

    To Enroll or Register Your Account            HR Benefits Department            For Financial Questions
          Fidelity Investments           The Pasadena Group at Morgan Stanley
   or                          or 844-435-5621   or
             800-835-5097                                                                 855-211-1223
         800-587-5282 (Spanish)
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