Walgreen Health and Welfare Plan

1 SUMMARY plan DESCRIPTION for the Walgreen Health and Welfare plan Effective January 1, 2021 TABLE OF CONTENTS -i- Introduction .. 1 IMPORTANT 3 About This Document .. 4 Whom to .. 5 Eligibility .. 10 You Are Eligible .. 10 Additional Medical plan Eligibility Requirements for Hourly Team Members Subject to Employer Mandate .. 11 Eligible Dependents .. 13 Domestic Partner .. 14 Imputed income .. 15 When Your Spouse or Other Eligible Dependents Are Also Team Members .. 15 Enrollment .. 17 As a New Team Member .. 17 If You Leave the Company and Are Rehired .. 17 Your Dependents.

2 17 Social security Numbers Generally Required for Enrollment .. 18 Open Enrollment .. 18 If You Do Not Enroll .. 19 Declining Enrollment and Special Enrollment Period Rules .. 19 Enrollment Under a Qualified Medical Child Support Order ( QMCSO ) .. 19 Paying for Coverage .. 21 Your Contribution .. 21 Medical Premium Surcharge for Tobacco Users .. 21 Paying for Coverage Active Team Members .. 22 When Coverage Begins .. 23 New Team Members .. 23 Current Team Members .. 23 Changing Your Coverage .. 24 During the 24 Qualified Change in Status .. 24 TABLE OF CONTENTS (continued) -ii- Special Enrollment Rights.

3 24 Other Changes in Circumstance .. 25 Special Enrollments in a Qualified Health plan .. 25 Reduction in Hours of Service .. 26 How to Make Changes During the Year .. 26 Your Medical Coverage .. 31 What Medical Options Will Be Available? .. 31 Care Coordination .. 32 Surgical Centers of Excellence .. 33 Overview of Medical plan Options and Networks .. 33 Primary Care Provider (PCP) Requirements .. 34 EPO Network Common Features Applicable to Most Options .. 35 United Healthcare (UHC) Nexus Medical plan Network .. 35 United Healthcare (UHC) Navigate Medical plan Network .. 36 United Healthcare (UHC) Choice Medical plan Network.

4 36 United Healthcare (UHC) Core Medical plan Network .. 36 Blue Cross Blue Shield of Illinois (BCBSIL) Networks .. 36 POS Network Option Options Through Kaiser Permanente .. 36 HMO Network Option Only Applicable in Certain States .. 37 Emergency Room Coverage .. 38 Health Reimbursement Arrangement (HRA) .. 38 Health Savings Account (HSA) Plans .. 38 Enrollment in Medicare .. 39 How Health Savings Account Plans Work .. 39 Coordination with Healthcare FSA .. 39 Limited Purpose FSA .. 39 Tax Information .. 40 Highly Compensated Individuals .. 40 Medical Coverage in Hawaii .. 40 Medical Coverage in Puerto Rico.

5 41 TABLE OF CONTENTS (continued) -iii- Medical Coverage in US Virgin Islands .. 41 Rescission of Coverage .. 41 Continuation of Coverage Through COBRA .. 41 Your Prescription Drug Coverage .. 41 Managing Your Health .. 42 Telehealth Services .. 42 Wellness Programs .. 44 365 Get Healthy Here & Life365 .. 44 $0 Copay Medication Program .. 44 Tobacco-Free 45 Healthy Living Centers .. 46 Special Disease Management/Prevention Programs .. 47 Coordination with Medicare .. 47 The Aon Active Health Exchange .. 48 Your Dental Coverage .. 49 What Dental Options Will Be Available?

6 49 Overview of Options .. 49 Basic PPO Options Bronze Option .. 50 Basic Buy-Up PPO Options Silver Option .. 50 Enhanced PPO Options Gold Option .. 50 Dental Health Maintenance Organizations ( DHMOs ) Platinum Option .. 50 Continuation of Coverage Through COBRA .. 50 Your Vision 51 What Vision Options Will Be Available? .. 51 Overview of Options .. 51 Discount plan with Eye Exam Option Bronze plan Option .. 52 PPO plan Options Silver and Gold Options .. 52 Continuation of Coverage Through COBRA .. 52 Health Coverage for Team Members Temporarily Working Outside the United States.

7 53 TABLE OF CONTENTS (continued) -iv- Your Flexible Spending Accounts ( FSAs ).. 54 Electing How Much to Contribute .. 54 Annual Limitation on Use of FSAs .. 54 How the Healthcare FSA Works .. 55 Eligible Healthcare FSA or Limited Purpose FSA Dependents .. 56 Coordination with the Health Reimbursement Arrangement ( HRA ) account .. 56 How the Healthcare FSA, Limited Purpose FSA, and HSA Work in Tandem .. 57 Qualified Change in Status .. 58 Eligible Healthcare FSA Expenses .. 58 Ineligible FSA Expenses .. 59 Eligible and Ineligible HSA Expenses .. 60 Payment of Eligible Healthcare FSA Expenses (including Limited Purpose FSA).

8 60 Limited Purpose Flexible Spending Account .. 60 Using Your Spending Account ( YSA ) Card .. 61 Continuation of Healthcare FSA and Limited Purpose FSA Coverage through COBRA .. 64 How the Dependent Care FSA Works .. 64 Eligible Dependent Care FSA Dependents .. 64 Qualified Change in Status .. 65 Eligible Dependent Care FSA 65 Ineligible Dependent Care Expenses .. 66 Payment of Eligible Dependent Care Expenses .. 67 Dependent Care FSA Annual Statement of benefits .. 68 Dependent Care Tax Credit .. 68 Filing an FSA Claim .. 68 Submitting a Claim via the benefits Support Center.

9 68 Submitting a Claim Using the Reimburse Me Mobile App .. 69 Nondiscrimination 70 Forfeitures .. 70 Termination of Participation .. 70 TABLE OF CONTENTS (continued) -v- The Transportation Benefit plan .. 71 Eligibility .. 71 Eligibility Exception .. 71 How to Enroll .. 71 Eligible Expenses .. 72 Transit Pass Expenses .. 72 Parking Expenses .. 72 How the plan Works .. 72 Determine Your Expenses .. 73 Enroll in the plan .. 73 Receive Before-Tax Payroll Deductions .. 73 Pay Your Transit Expenses .. 73 Receive Pass or Reimbursement .. 74 How the plan Can Save You Money.

10 74 Transit Payment .. 75 Parking Payment .. 75 Filing a Claim .. 75 Maximum Qualified Benefit Allowed .. 76 Overestimated Expenses .. 76 Underestimated Expenses .. 76 employee Assistance Program .. 77 Eligibility .. 77 Loss of Eligibility .. 78 benefits .. 78 Session Maximums .. 79 79 Coordination with the Medical plan .. 79 When benefits End .. 79 When Coverage Ends .. 80 When Health Coverage Ends .. 81 TABLE OF CONTENTS (continued) -vi- Retiree Health plan Coverage .. 82 Continuation of Coverage Through COBRA .. 83 Coordination of benefits .. 84 Retiree Health plan Coverage.