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