Usfts SPD

2011 Benets Summary
for U.S. Salaried and Full-Time Hourly Associates
Whats inside
1 13 29 35 44 135 151 165 174 186 197 210 217 226 235 243 251 286 297 304 305 306 314 334 341 345 349 351 Life Events Eligibility and Enrollment Benefits for Same-sex Domestic Partners Medical Coverage During Your First 90 Days U.S. Medical (except California and Hawaii) California Medical Hawaii Medical The Critical Illness Protection Plan Dental Vision Spending Accounts Health Savings Account Life Insurance Disability for Full-Time Hourly Associates Disability for Salaried Associates Accidental Death & Dismemberment FutureBuilder Employee Stock Purchase Plan Work/Life Benefits Time-Off Benefits Leaves of Absence COBRA Coverage Claims and Appeals Plan Administration Medicare Part D HIPAA Notice Benefits Contact List Payroll Deductions for 2011
IMPORTANT NOTICE
This 2011 Benefits Summary contains an important notice about your prescription drug coverage and Medicare. You will find this notice in the Medicare Part D chapter in the back of this book.
No habla o lee ingls?

Por favor llame al Benefits Choice Center (Centro de Opcin de Beneficios) al 1-800-555-4954 y diga Estados Unidos para hablar con un representante en espaol.
The Company benefit plans also provide benefits to the following groups of associates of Home Depot U.S.A., Inc. and its affiliates in the U.S., who receive different versions of the Benefits Summary: part-time hourly associates and certain associates of THD AtHome Services who are paid 100% by commission. The Company benefit plans also provide benefits to full-time hourly, part-time hourly and salaried associates in the Companys affiliates in Guam, Puerto Rico and St. Thomas, who receive different versions of the 2011 Benefits Summary.
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Life Events
U.S. Salaried & Full-Time Hourly Associates
Chapter Contents
2 2 3 3 4 4 5 Life Events Same-sex Domestic Partner Life Events Marriage Divorce/Legal Separation/Annulment Judgement, Order or Decree, including a Qualified Medical Child Support Order (QMCSO) Birth Adoption, Placement or Termination of Adoption 5 6 6 Death of Loss of Coverage Due to Moving Gain or Loss of Other Coverage
10 Change of Employment Status 11 Military Leave 12 Leaves of Absence
Life Events
Get the Most Value from Your Plan
What do you need?
Notify the Benefits Choice Center within 30 days of your qualified status change Make allowed changes in your benefits after qualified status change
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Find it here...
Call the Benefits Choice Center at 1-800-555-4954 and speak with a representative Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954
Life Events
When your life changes, chances are your benefits will need to change too. As you learn more about when you are able to change your benefit elections during the year, youll find out that marriage, divorce, birth or adoption, or your spouses employment change are events that may allow you to make certain changes in your benefits. Youll also find out that you have 30 days from the date of the event to contact the Benefits Choice Center or to visit Your Benefits ResourcesTM and make your changes. Although, due to IRS regulations, you are generally not permitted to make election changes during the year for benefits paid through a cafeteria plan on a pre-tax basis, the IRS does allow election changes to be made during the year on account of and consistent with certain life events (also referred to in this book as qualified status changes). This section outlines the life events which may permit you to make election changes to the benefits provided to you by the Company. Use the charts to help guide you through the benefit coverages you may need to change following a particular life event. Absent a qualified status change or rolling 12-month election for life and disability, no mid-year election changes can be made.
Remember that all election changes made as a result of a life event must be made within 30 days after the date of the event unless noted otherwise. If you experience a qualified status change, your requested change in benefits must be consistent with, and correspond to, the qualified status change. For example, if you are divorced and had been covered under your spouses medical plan, it would be consistent to elect coverage under the Companys Medical Plan. However, if you did not lose coverage as a result of the divorce, it would not be consistent for you to elect medical coverage. If you experience a qualified status change during the grace period under the healthcare spending account, changes are only allowed for your election in the current year and not in the year to which the grace period applies. For purposes of this Life Events chapter, your spouse means your spouse as defined in the Eligibility and Enrollment chapter, and references to your child or children only include your own children, and do not include the child(ren) of your same-sex domestic partner. In addition, references to your dependents do not include your same-sex domestic partner or his or her child(ren)
regardless of whether they are considered your dependents under other chapters in this summary. Note: the Plan Administrator may also permit any other changes provided for under the Plan document or IRS regulations in addition to those listed in these charts.
Same-sex Domestic Partner Life Events

For information on making coverage changes for your same-sex domestic partner or children of your partner, see the Benefits for Same-sex Domestic Partners chapter. For information on life insurance and/or AD&D coverage for your opposite-sex partner see the Life Insurance and AD&D chapters.
To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954
Life Events
You can change your benefits as follows:
If you have the following change in status Marriage3 You wish to add self, spouse and/or children Documentation verifying the dependency or status change. Date of marriage Can add coverage for self, spouse and/or children and change medical option (e.g., from HMO to PPO) Can drop coverage for self and/or children, if covered under spouses employers plan You will be asked to provide the Benefits Choice Center with You must notify the Benefits Choice Center within 30 days after Medical, Dental, Vision, Critical Illness Protection & Health Savings Account4,6
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Health Care Spending Account
Dependent Day Care Spending Account
Voluntary Term Life, Dependent Term Life, AD&D Insurance, Legal Services Plan1,2,5
Disability2
Can start or increase contributions
Can add or increase coverage for self, spouse and/or children Can drop or decrease coverage for self, spouse and/or children
Not applicable
You wish to drop coverage
Documentation verifying the dependency or status change.
Date of marriage or date new coverage gained, whichever is later
Can stop or decrease contributions, if covered under new spouses health plan
Can stop or decrease contributions if new spouse is not employed or makes a dependent care election under his or her plan
Divorce/Legal Separation/Annulment You wish to drop your dependents coverage under the plan You must drop coverage for spouse and any stepchildren who cease to be your dependents You wish to add self and/or your eligible children under the plan3 Documentation verifying the dependency or status change. Documentation verifying the dependency or status change. Date of decree Can drop coverage for children with proof of coverage under other parents plan Can start, stop, increase or decrease contributions Can start, stop, increase or decrease contributions Can add, increase, drop or decrease coverage for self and/or children Not applicable
Can add or change coverage option for self and/or children if you or at least one child has lost coverage under spouses plan
Can start or increase contributions where coverage is lost under spouses health plan
Can add or increase coverage for self and/or children
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 4 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 5 Changes to the Legal Services Plan can only be made during Annual Enrollment. 6 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
If you have the following change in status You will be asked to provide the Benefits Choice Center with You must notify the Benefits Choice Center within 30 days after Medical, Dental, Vision, Critical Illness Protection & Health Savings Account6,8
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Disability2
Judgement, Order or Decree, including a Qualified Medical Child Support Order (QMCSO)5 Requires coverage for your child under this plan Approved court order, judgement or decree requiring coverage Issuance of a court order Coverage will start as soon as order is approved Coverage is automatically added for child(ren) and self, if not enrolled, as specified by the judgement order or decree Medical Plan option may change to provide required coverage Requires coverage of your child under spouses plan Birth3 You wish to add self, spouse and/ or new child4 Documentation verifying the dependency or status change. Documentation verifying the dependency or status change. Date of birth Can add coverage for new child, self, other children and spouse and/or change coverage option (e.g., from HMO to PPO) Can drop coverage for self, spouse and/or other dependents if you gain coverage under spouses plan following birth Can start or increase contributions Can start or increase contributions Can add or increase coverage for self, spouse and/or children No change permitted Not applicable Approved order requiring coverage Date other employer plan accepts the order Drop coverage for child(ren) covered by the order Can increase or start contributions No change permitted No change permitted Not applicable
You wish to drop coverage for self, spouse, or other children and cover under spouses plan
Can stop or decrease contributions
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If you are already covered under a self-insured medical plan with associate + family or associate + child(ren), and you add your newborn or newly adopted child (or child placed for adoption) within the first 12 months of birth, adoption or placement for adoption, coverage will be effective from date of the qualifying event. If you are already covered under a self-insured medical plan with associate only or associate and spouse and add your newborn or newly adopted child after 60 days but within six months of the birth or adoption, coverage will be effective the date the Benefits Choice Center receives your request. For other allowable changes after 30 days, please see the Newborn and Adopted Children section in the Enrollment and Eligibility chapter. 4 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 A QMCSO may require coverage for your child, but not your spouse or former spouse. 6 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 7 Changes to the Legal Services Plan can only be made during Annual Enrollment. 8 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
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Disability2
Adoption, Placement or Termination of Adoption3 You wish to add self, spouse and/or new child4 You wish to drop coverage and cover child under spouses plan You wish to drop coverage due to termination of adoption proceedings Death of Your dependent covered under Home Depot plan Your spouse, and you and/or your child(ren) lose coverage under your spouses plan Documentation verifying the dependency or status change. Date of death Must drop coverage for dependent who died Can decrease or stop contributions Can decrease or stop contributions Drop coverage for deceased dependent; can drop or decrease your coverage Can add or increase coverage for self and children Not applicable Documentation verifying the dependency or status change. Date of adoption or placement Can add self, spouse and child(ren) and change coverage option (e.g., HMO to PPO) Can drop coverage for self, spouse and/or dependents if become covered under spouses plan Must drop coverage for child who ceases to be an eligible dependent Can start or increase contributions Can stop or decrease contributions if termination number of dependents Can start or increase contributions Can stop or decrease contributions if termination decreases the number of dependents Can add or increase coverage for self, spouse and/or child No change permitted Not applicable
Drop affected child only
Date coverage ends with other employer
Can add coverage for self and/or children or change coverage option if you or any child lost coverage under spouses plan4
1 Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If you are already covered under a self-insured medical plan with associate + family or associate + child(ren), and you add your newborn or newly adopted child (or child placed for adoption) within the first 12 months of birth, adoption or placement for adoption, coverage will be effective from date of the qualifying event. If you are already covered under a self-insured medical plan with associate only or associate and spouse and add your newborn or newly adopted child after 60 days but within six months of the birth or adoption, coverage will be effective the date the Benefits Choice Center receives your request. For other allowable changes after 30 days, please see the Newborn and Adopted Children section in the Enrollment and Eligibility chapter. 4 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 6 Changes to the Legal Services Plan can only be made during Annual Enrollment. 7 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
If you have the following change in status You will be asked to provide the Benefits Choice Center with You must notify the Benefits Choice Center within 30 days after3 Medical, Dental, Vision, Critical Illness Protection & Health Savings Account5,7
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Disability2
Loss of Coverage Due to Moving You have a work site transfer or ZIP Code change resulting in a change to your plan eligibility You have a work site transfer or ZIP Code change resulting in no change to your plan eligibility Address must be updated in payroll system Your move to a new ZIP code Can change plan option (i.e., HMO to PPO) No change permitted Can increase, start, decrease or stop contributions No change permitted You are automatically enrolled in coverage when first eligible. See the Disability chapter for more information on coverage once enrolled No change permitted
Address must be updated in payroll system
Your move to a new ZIP code
No change permitted
No change permitted
Can increase, start, decrease or stop contributions
No change permitted
Gain or Loss of Other Coverage3 Gain of coverage due to spouses employers period of coverage differing from Home Depots period of coverage8 Loss of coverage due to spouses employers period of coverage differing from Home Depots period of coverage Gain coverage due to change in spouses or dependents employment8
1 2 3 4
Effective date of coverage gained
Can drop or decrease coverage for self, spouse and/or children if become covered under spouses plan Can add or increase coverage for self, spouse and/or children if covered under the spouses plan4 Can drop or decrease coverage for self, spouse and/or children if covered under newly available plan
No change permitted
Can drop or decrease coverage for self, spouse and/or children
Not applicable
Documentation verifying the dependency or status change. Documentation verifying the dependency or status change.
Effective date of coverage lost
Can add or increase coverage for self, spouse and/or children Can drop or decrease coverage for self, spouse and/or children
Date coverage begins with other employer
No change permitted
An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. Must be actively at work for coverage to take effect. You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage. If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 6 Changes to the Legal Services Plan can only be made during Annual Enrollment. 7 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center. 8 Once the spouse gains coverage and is therefore no longer eligible, he/she must be removed from coverage under the Home Depot plan.
Life Events
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Disability2
Gain or Loss of Other Coverage3 (continued) Loss of coverage due to childs loss of eligibility under the Home Depot plans You, your child or dependent lose coverage under another health plan because it no longer offers benefits to similarly situated individuals Loss of coverage due to you, your spouses or your dependents loss of eligibility under another health plan5 Loss of coverage due to action of other employer by termination of all plans of the same type or by ceasing all employer contributions to coverage that is not COBRA coverage
1 2 3 4
Effective date of coverage lost
You must drop coverage for dependent child
No change permitted
Can drop or decrease coverage for self, spouse and/or children Not applicable
Not applicable
Can add coverage and/or change coverage for you, your spouse or your children4
Date coverage ends
Can add or increase coverage for self, spouse and/or children or change coverage option if you add affected dependent4 Can add or increase coverage for self, spouse and/or children or change coverage option if covered under spouse's plan4
Can increase or start contributions
No change permitted
Not applicable
Not applicable
Date other coverage involuntarily ends
No change permitted
Not applicable
An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. Must be actively at work for coverage to take effect. You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage. If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 Loss of eligibility does not include loss of coverage due to failure to pay premiums on a timely basis or termination for cause (such as making fraudulent claims). 6 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 7 Changes to the Legal Services Plan can only be made during Annual Enrollment. 8 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
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Disability2
Gain or Loss of Other Coverage3 (continued) Loss of coverage due to the exhaustion of COBRA coverage6 Documentation verifying the dependency or status change. Date COBRA coverage ends with other employer Can add or increase coverage for self, spouse and/or children or change coverage option if covered under spouses plan4 If option is eliminated, can add coverage for self, spouse, and/or children If option is added, can drop coverage for self, spouse and/or children if covered under new option4 You, your spouse or your dependent lose coverage under Medicare or Medicaid, and you wish to add coverage You or your spouse gain coverage by Medicare or Medicaid, and you wish to drop coverage
1 2 3 4
No change permitted
No change permitted
Not applicable
Spouses employer eliminates or adds a benefit option (e.g., HMO, PPO, POS or Indemnity)
Effective date of change
No change permitted
Date when coverage ends
Can add or increase coverage for self, spouse and/or children who lost coverage under Medicare or Medicaid (medical only)4 Can drop or decrease coverage for self, spouse and/or children covered by Medicare or Medicaid (medical only)
Not applicable
Date when Medicare or Medicaid coverage begins
Can decrease or stop contributions
An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. Must be actively at work for coverage to take effect. You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage. If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 Changes to the Legal Services Plan can only be made during Annual Enrollment. 6 Exhaustion of COBRA means that an individual's COBRA continuation coverage ceases for any reason other than either failure of the individual to pay premiums on a timely basis, or for cause (such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan) 7 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 8 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
You will be asked to provide the Benefits Choice Center with You must notify the Benefits Choice Center within 30 days after Medical, Dental, Vision, Critical Illness Protection & Health Savings Account6,7
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If you have the following change in status
Disability 2
Gain or Loss of Other Coverage3 (continued) Gain eligibility under Medicaid or CHIP Documentation verifying the dependency or status change. You must notify the BCC within 60 days after the date you become eligible for Medicaid or CHIP You must notify the BCC within 60 days after the date when Medicaid or CHIP coverage ends Can drop or decrease coverage for self, spouse and/or children covered by Medicaid or CHIP (medical only) Can add or increase coverage for self, spouse and/or children who lost coverage under Medicaid or CHIP (medical only)4 Can decrease or stop contributions No change permitted Not applicable Not applicable
Lose coverage under Medicaid or CHIP
Can increase or stop contributions
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage. 4 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 5 Changes to the Legal Services Plan can only be made during Annual Enrollment. 6 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 7 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Life Events
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Disability2
Change of Employment Status Salaried to Full-Time Hourly Full-Time Hourly to Salaried Part-Time Hourly to Full-Time Hourly Date of employment status change or eligibility date Can add coverage for self, spouse, and/or children3 Can start contributions Can start contributions No change allowed No change allowed No change allowed No change allowed Can add, increase, decrease or drop coverage for self You are automatically enrolled in coverage when first eligible See the appropriate Disability chapter for more information on coverage changes once enrolled
Can add, increase, decrease or drop coverage for self, spouse and/or children
Full-Time Hourly to Part-Time Hourly
Coverage, except Dental, Vision and Critical Illness Protection, cancelled for self, spouse and/or children. See the Part-time Benefits Summary
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 4 Changes to the Legal Services Plan can only be made during Annual Enrollment. 5 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 6 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
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Life Events
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If you have the following change in status Military Leave Leaving for and returning from a military leave of absence within the same calendar year
Disability2
Date leave begins or date leave ends
Coverage before leave will automatically be reinstated. OR can add, change or stop coverage for you, your spouse or your children3
Coverage before leave will automatically be reinstated OR can add, increase or stop contributions
Coverage before leave will automatically be reinstated OR can add, increase or stop contributions
Coverage before leave will automatically be reinstated except coverage requiring evidence of insurability OR can add, increase or stop coverage for self, spouse and/or children Can add, increase or stop coverage for self, spouse and/or children
Not applicable
Leaving for and returning from a military leave of absence in a subsequent year
Can add, change or stop coverage for you, your spouse or your children3
Can add, increase or stop contributions
Can add, increase or stop contributions
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If you enroll in medical coverage, you can elect the Health Assessment & Hidden Health Risk Screening Credit. To receive this credit, you as the associate must complete the health assessment and participate in the hidden health risk screening. You also can elect the tobacco-free credit if you meet the Companys tobacco-free requirements. If you enroll your spouse or domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your spouse meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your spouse (your spouse only completes the health assessment to receive this credit spouses do not participate in the screening). 4 Changes to the Legal Services Plan can only be made during Annual Enrollment. 5 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 6 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
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Life Events
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If you have the following change in status Leaves of Absence Going on a leave of absence
Disability2
Date leave begins
Can drop coverage for you, your spouse or children Coverage before leave will automatically be reinstated
Can stop contributions or continue under COBRA3
Contributions stop3
Can drop coverage for you, your spouse or children
Coverage ends4
Returning from a leave of absence within the same calendar year
Date leave ends
Payroll deductions will automatically be reinstated at the same annual goal amountthis means your contribution level will be higher to reach your annual goal amount before the end of the calendar year OR You can decrease your goal amount so that payroll deductions remain at the same contribution level as before your leave by calling the Benefits Choice Center within 30 days of return from leave If you return from leave in a subsequent year: For the health care account: the coverage you enrolled in during Annual Enrollment will start. If you were on COBRA, you can enroll in the health care account within 30 days of your return from leave For the dependent care account: you can enroll within 30 days of your return from leave. You will need to adjust your contribution amount depending on the number of pay periods remaining in the calendar year
Coverage before leave will automatically be reinstated
Returning from a leave of absence the following calendar year (or any subsequent year, up to five years, for military leave)
Date leave ends
Coverage you are enrolled in when you return from leave will continue after you return from leave. If you dont have coverage(s) when you return from leave, you can enroll within 30 days of the date you return from leave
Coverage before leave will automatically be reinstated. If you want to add/stop or increase/decrease coverage, see the applicable chapter for requirements (Life Insurance chapter, AD&D chapter or the Full-time Hourly Disability or Salaried Disability chapter). For information on the Legal Services Plan or other Voluntary Benefits, call the Benefits Choice Center
1 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your spouse. See the Life Insurance chapter for more information. 2 Must be actively at work for coverage to take effect. 3 If your contributions stopped during your leave, you cannot submit expenses you have during the leave even if you elect to increase your biweekly contributions to make up contributions missed during your leave. 4 Disability benefits will continue if your disability began before the start of your leave. 5 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 6 Changes to the Legal Services Plan can only be made during Annual Enrollment. 7 You can start, stop, increase or decrease your HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
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Eligibility & Enrollment

Chapter Contents
14 Full-Time Hourly Associate Eligibility 14 Salaried Associate Eligibility 14 Temporary Associates, Leased Employees and Independent Contractors 15 When Coverage Begins 15 Dependent Eligibility: Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans 17 Dependent Eligibility: Voluntary Dependent Term Life Insurance (Spouse and Child) and Family AD&D Plans 19 Enrolling for Coverage 19 22 22 23 24 24 24 24 Enrolling as a New Associate Annual Enrollment Healthy Living Credits Qualified Change in Status/Life Events Declining Coverage Full-Time Hourly Associates:Opting Out of Automatic Enrollment Cost for Coverage About Before-Tax Contributions 25 When Your Coverage Ends 25 Continuing Coverage 25 Employment Status Changes 25 25 26 Full-Time Hourly Associates Full-Time Hourly Associates Salaried Associates 25 If Youre Rehired
26 Service Requirements For MetLife Group Benefits If You Are Rehired 26 Medicaid and the Childrens Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families

What do you need?
Get the Annual Enrollment Guide and the New Associate Guide Enroll for benefits Change your benefit elections if you have a qualified status change
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Find it here...
www.livetheorangelife.com Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954.
Full-Time Hourly Associate Eligibility

As a full-time hourly associate, you are eligible to participate in the Companys health and welfare benefit Plans, as described in this book if you are classified by the Company as full-time hourly and have completed your waiting period. The Company also offers Group Benefits which include the MetLaw Legal Services Plan, Auto and Home Insurance and Veterinary Pet Insurance. For more information on these plans, call the Benefits Choice Center and say Additional Programs at the main menu. Your coverage begins on the first day after you complete your waiting period, as follows:
When Coverage Begins on the 91st day on the 29th day
Salaried Associate Eligibility

If you are classified by the Company as a salaried associate, you are eligible to participate immediately in the Companys health and welfare benefit plans, as described in this book. The company also offers Group Benefits which include the MetLaw Legal Services Plan, Auto and Home Insurance and Veterinary Pet Insurance. For more information on these plans, call the Benefits Choice Center and say Additional Programs at the main menu. Your coverage in most Plans begins on your date of hire. When you enroll during Annual Enrollment, your coverage begins January 1. See When Coverage Begins in this chapter for more information on when coverage begins. Medical coverage for salaried associates begins on your date of hire if you enroll during your initial eligibility period. However, if you enroll in one of the Home Depot medical plans, you will have different coverage from the plan you enrolled in during your first 90 days of employment. See the For New Salaried Associates: Medical Coverage During Your First 90 Days of Employment chapter for more information. This does not apply to associates in Hawaii or associates who enroll in the Kaiser Permanente Georgia or Northwest HMO.
Temporary Associates, Leased Employees and Independent Contractors

If you are on the Companys payroll system as a temporary associate, you are not eligible to participate in health and welfare benefits or other benefit programs except for the FutureBuilder 401(k) Plan. See the eligibility rules for additional information. Leased employees and independent contractors are also ineligible for these benefits.1 If you are working for the Company as a temporary associate and are added to the Companys payroll system as a full-time hourly associate, your length of employment for eligibility for health and welfare benefits will include your time as a temporary associate. If you are converted from a temporary associate to a full-time hourly associate, you will become eligible for health and welfare benefits as of the later of your 91st day (29th day in Hawaii) of employment or the date you are converted to full-time status. If you are working for the Company as a leased employee or independent contractor and are added to the Companys payroll system, your length of employment for eligibility for health and welfare benefits will not include your time as a leased employee or independent contractor.
Where You Work U.S., except Hawaii Hawaii
Your Waiting Period 90 days 28 days
When you enroll during Annual Enrollment, your coverage begins on January 1. See When Coverage Begins in this chapter for more information on when coverage begins.
1 If you are later determined to be an employee of the Company for any reason and become eligible for benefits, you may participate in benefits only from date of determination, even if the determination becomes effective on an earlier date.
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When Coverage Begins
Coverage may be postponed for all Plans, except Medical and Critical Illness Protection coverage, as follows: You are not actively working on the day your coverage begins. Coverage for you and your eligible family members will be delayed until you return to work and complete your waiting period. Your dependent is confined at home, in a hospital or elsewhere for medical reasons. Coverage for that individual will be delayed until his or her attending doctor provides a final medical release. (Final medical release refers to a statement from the attending physician that treatment for the condition has been completed and that the patient may return to normal activities.) If you are not working due to a work-related injury, coverage for you and your family will not be delayed. Coverage will start the day after you complete your waiting period.
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employers plan unless he/she: works for a company with 100 or fewer employees, works part-time, works for The Home Depot or is self-employed. You and your spouse or same-sex domestic partner will be required to sign an affidavit confirming they meet these requirements. Common-law spouses are not eligible. Your domestic partner, if you do not have a legal spouse. Your domestic partner must meet all of the following requirements: Is an adult who is of the same-sex as you; Is at least age 18 or older; Has not registered as a member of another domestic partnership within the past six months; Is not in the relationship solely for the purpose of obtaining the benefits of coverage; Is in an exclusive, mutually committed relationship with you and intends to continue the relationship indefinitely; Has lived with you for at least six consecutive months and intends to do so indefinitely; Is not related to you in a manner that would bar a legal marriage in the state in which you live; Is not married or in a civil union or similarly recognized relationship with anyone but you; and Shares with you the responsibility for common welfare and basic financial obligations on a continuing basis. In California: To cover your same-sex domestic partner, the six-month requirements do not apply to medical coverage under the Health Net options. You may cover your opposite-sex domestic part15
ner when one or both persons are over age 62, are residents of California, and also meet the eligibility criteria for Medicare benefits. In Washington: State-registered domestic partners are treated the same as married spouses. This applies to medical coverage under the Kaiser PermanenteNorthwest HMO only. In Georgia and Maryland: You may cover your opposite-sex domestic partner in medical coverage under the Kaiser PermanenteGeorgia HMO and Kaiser PermanenteMid-Atlantic HMO only. The same-sex domestic partner requirements outlined in this chapter apply to opposite-sex domestic partners. In Ohio: To cover your same-sex domestic partner, he or she cannot be registered as a member of another domestic partnership within the past twelve months. This applies to medical coverage under the Kaiser PermanenteOhio HMO only.
Eligibility: Dependent Children

Eligible dependent children may be covered under the Company Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans through the last day of the calendar year in which the child turns 26. Eligible dependent children include the following: Your natural and adopted children, and children placed with you for adoption; Children for whom you are appointed legal guardian; Stepchildren; and Your eligible domestic partners dependents may be covered under the same plans that you enroll in, provided: they do not have health coverage available through a natural parents benefit program;
Dependent Eligibility: Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans
The following dependents can participate in the Company Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans as described in this document: Your legal spouse, unless you are legally separated. Your legal spouse is a person of the opposite sex to whom you are married under state law. Your legal spouse or domestic partner is not eligible to be covered under a Home Depot medical plan if he/she is eligible for coverage under his/her

they are in the legal custody or guardianship of you or your same-sex domestic partner; you or your same-sex domestic partner claims them on your federal income tax return; and that enrollment in your current medical plan is permitted for the same-sex domestic partner. Your domestic partner has to meet the eligibility requirements for your domestic partners dependents to be eligible; however, you do not have to cover your domestic partner in order to cover his or her eligible dependent children. If you have legally adopted your domestic partners children, then the children qualify as eligible dependents without regard to your domestic partners eligibility. Ohio residents: If you (the associate) are a resident of Ohio and enrolled in the Kaiser Permanente-Ohio HMO, your eligible child(ren) can be covered until the childs 28th birthday. Call the Benefits Choice Center at 1-800-555-4954 for more information. Dependent grandchildren are not eligible unless the associate is enrolled in a fully insured HMO that is filed in a state that requires coverage for dependent grandchildren. The HMO that is required to cover dependent grandchildren is: Kaiser PermanenteNorthwest: Kaiser PermanenteNorthwest covers dependents of dependents (grandchildren) as long as the parent of the grandchild is your dependent and the grandchild has been covered since birth by any health plan. Children for whom you are required to provide coverage under a Qualified Medical Child Support Order (QMCSO), but only for coverage under the group health plans as required under the order.
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Eligibility: Disabled Dependent Children

A dependent is considered to be disabled if that child is incapable of self-support because of mental retardation or physical disability and such disability existed prior to the last day of the calendar year in which the child turns 26. You may continue to cover a dependent child who is eligible for coverage as defined in Dependent Eligibility: Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans and is incapable of self-support because of mental or physical disability on the last day of the calendar year in which the child turns 26 as long as the child was covered under the Plan before that date. You can continue coverage for your disabled child as long as the mental or physical disability continues. To continue coverage, you must contact the Benefits Choice Center within 30 days after coverage would otherwise end. Documentation will be required. If you first become eligible for the benefit plans after the last day of the calendar year in which your disabled child turns 26, you can cover that child if: your child meets the definition of a disabled child below; and you enroll yourself and that child within your initial eligibility period. The Companys Medical, Vision and Dental Plans reserve the right to have your child examined by a physician of their choice to determine the existence of your childs disability.
Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the Company plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. You may also enroll in the plan if you lose Medicaid or CHIP coverage or become eligible to participate in a Medicaid or CHIP premium assistance program. You must request special enrollment in the Company plan within 60 days from the date of loss of coverage or the date of eligibility.
Newborn and Adopted Children

If you are not covered under a Company Medical Plan option, to enroll a newborn or newly adopted child (or child placed for adoption) for coverage, you must call the Benefits Choice Center or access the Your Benefits Resources web site and enroll them no later than 30 days after the childs birth, date of adoption or placement for adoption. However, if you are already covered under the Companys self-insured Medical Plan, and you add your newborn, or newly adopted child (or child placed for adoption) within 60 days, coverage is effective from the date of the qualifying event. If you are already covered under the Companys selfinsured Medical Plan either as Associate Only or Associate + Spouse, and you add your new child after 60 days but within six months of the childs
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birth, adoption or placement for adoption, coverage is effective the date the Benefits Choice Center receives your request. If you are already covered under the self-insured Medical Plans with Associate + Family or Associate + Child(ren), and you add your newborn or newly adopted child (or child placed for adoption) within the first 12 months after birth, adoption or placed for adoption, coverage will be effective from date of the birth, adoption or placement for adoption. If you wish to change your coverage option due to the birth of a child, you must call the Benefits Choice Center or go to the Your Benefits Resources web site to add the child within 30 days if you are not covered under the Medical or Dental Plan or within 60 days if you are covered.
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your opposite-sex domestic partner, except where participation is specifically provided for in this Benefits Summary (e.g., medical coverage in California under certain circumstances, legal services, voluntary dependent life and voluntary AD&D). your domestic partner and his or her children if the domestic partner does not or ceases to satisfy the requirements as outlined in Dependent Eligibility: Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans any family member, including yourself, while on active duty in any military service for any country (subject to military leave and continuation of benefits coverage requirements under federal law) children as of the last day of the calendar year in which they turn 26, unless they meet the requirements for disabled children (see Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans Eligibility: Disabled Dependent Children) or they have fully insured coverage and the states insurance laws require that coverage is extended past age 26. foster children, except under the Critical Illness Protection Plan. A foster child can be covered under the Critical Illness Protection Plan if the child is placed with you or your domestic partner by an authorized placement agency or by judgement, decree or other order of any court of competent jurisdiction
Dependent Eligibility: Voluntary Dependent Term Life Insurance (Spouse and Child) and Family AD&D Plans
The following dependents can participate in the Companys Voluntary Dependent Term Life Insurance and Family AD&D Plans (except Basic Life Insurance for dependents1) as described in the Life Insurance and AD&D chapters: Your legal spouse, unless you are legally separated. Your legal spouse is a person to whom you are married under state law. Your same- or opposite-sex domestic partner and his or her eligible dependents, if you do not have a legal spouse, must meet all of the following requirements: Has an exclusive mutual commitment to you to share responsibility for each other's welfare and financial obligations which has existed for at least six months prior to his or her enrollment in life insurance and/or AD&D coverage(s) and which is expected to last indefinitely; Has shared the same residence with you for at least six months prior to his or her enrollment in life insurance and/or AD&D coverage(s); Is 18 years of age or older; Is not married; and Is not related to you by blood in a manner that would bar marriage in the state in which you reside (does not apply to Maine residents)
Eligibility: Family Members Who Cant Participate

The following family members cannot participate in the Companys benefit Plans as described in this book: your spouse, if you are legally separated your spouse or domestic partner, if he or she is eligible for coverage under his/her employers plan unless he/she: works for a company with 100 or fewer employees, works part-time, works for The Home Depot or is self-employed. your ex-husband or ex-wife, if divorced from you your common-law spouse and his or her children
1 The dependent eligibility rules for Basic Life Insurance are stated in Dependent Eligibility: Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans
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Under Age 19 Unmarried Dependent Children
The following dependents are eligible to participate: A child who is legally adopted or placed with you for adoption; A child, stepchild or child of your same- or opposite-sex domestic partner who lives in your home and is dependent on you for more than onehalf of his or her support, as defined by the Internal Revenue Code of the United States, and has been reported as a dependent on your most recent Federal income tax return; and A child for whom benefits must be provided by court order, that the Company has been notified of (as set forth in a divorce decree).
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If your dependent meets the five-month requirement for full-time student status, you must drop that dependent before the end of the year if he or she ceases to be dependent on you for financial support.
have a newborn or newly adopted child, you must call the Benefits Choice Center or access Your Benefits Resources to enroll your new child. For information on enrolling a newborn or newly adopted child more than 30 days after the childs birth date of adoption or placement with you for adoption, see Enrolling or Making Changes After Initial Enrollment later in this chapter.
Disabled Dependent Children

If your dependent child (as defined in Under Age 19 Unmarried Dependent Children) is covered under the Voluntary Dependent Term Life Insurance and/or Family Voluntary AD&D Plan on the day before he or she reaches age 19 (or, if later, when first eligible), he or she will continue to be an eligible dependent after reaching age 19 as long as the child remains unable to work in self-sustaining employment because of a physical handicap or developmental disability and: The child is and remains chiefly dependent on you for support; The child is and remains a dependent as defined in Under Age 19 Unmarried Dependent Children except for the age limit; You make any payment for the coverage as required by the Company.
Family Members Who Cant Participate

The following family members cannot participate in the Voluntary Dependent Term Life and Family Voluntary AD&D Plans as described in this book: your spouse, if you are legally separated your ex-husband or ex-wife, if divorced from you your same- or opposite-sex domestic partner and his or her children if the same- or opposite- sex domestic partner does not or ceases to satisfy the requirements as outlined in Dependent Eligibility: Voluntary Dependent Term Life Insurance (Spouse and Child) and Family AD&D Plans in this chapter. children over age 19, unless they are full-time students or they meet the requirements for disabled children foster children children for whom the associate is only a legal guardian except eligible stepchildren and eligible children of your same-sex domestic partner stillborn or unborn children children over age 26, even if a full-time student, unless they are disabled
Over Age 19 Unmarried Dependent Children Who Are Full-Time Students

This includes the following: Unmarried dependent children up to age 26 if the child is a full-time student at a high school or an accredited college, university or approved vocational trade school and primarily dependent on the associate for support. A dependent is determined to be a full-time student if he or she meets the institutions definition of a full-time student for at least five months during the school year. Schools may include any accredited institution that is eligible for federal grants or student loans, including two- and four-year programs. The dependent does not have to be continuously enrolled as a full-time student to be eligible. Coverage for full-time students will end at the end of the year the dependent child reaches age 26.

To enroll a newborn or newly adopted child (or child placed with you for adoption) in Voluntary Dependent Term Life coverage for children, you must call the Benefits Choice Center or access the Your Benefits Resources web site and enroll them no later than 30 days after the child's birth, date of adoption or placement with you for adoption. Even if you have children enrolled in Voluntary Dependent Term Life Insurance coverage for children when you
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your spouse (or same- or opposite-sex domestic partner) age 70 or over (for Family Voluntary AD&D only)
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Enrolling for Coverage

Enrolling as a New Associate
You will receive benefits enrollment information after you join the Company. You must access the Your Benefits Resources web site or call the Benefits Choice Center to enroll: Full-time hourly associates: within 90 days of your date of hire Salaried associates: within 30 days of your date of hire For Hawaii associates: Hawaii full-time hourly associates: within 28 days of your date of hire Hawaii salaried associates: within 30 days of your date of hire If the enrollment information was mailed to the address on the Company records, no exception will be made. You are responsible for updating your postal address in the Company records. Please call the Human Resources Service Center at 1-866-698-4347 to update your information. Paper enrollments will not be accepted. If you do not enroll when you are first eligible as a new hire, you will not be able to enroll in Medical, Prescription Drug, Dental Vision,or Critical Illness Protection benefits or the Spending Accounts until the next Annual Enrollment unless you have a qualified status change during the year. You may enroll in Voluntary Term Life (subject to an approved Evidence of Insurability form),
Voluntary Dependent Term Life for your spouse (an approved Evidence of Insurability form may be required), Voluntary Dependent Term Life for your child, Voluntary AD&D or Short- and Long-Term Disability (subject to an approved Evidence of Insurability form) once during any rolling 12-month period. Note: The Company Full-time Hourly and Salaried Long-term Disability Plans have pre-existing condition limitations. Enrolling or Making Changes After Initial Enrollment By enrolling or making changes to your benefits (including such actions as, but not limited to, adding a dependent), you are responsible for providing truthful and accurate information. Providing false information may result in exclusion from (i.e., loss of eligibility for) all Company-sponsored welfare benefit plans and/or disciplinary action as outlined in the Companys code of conduct. As part of an ongoing dependent verification process, you will be asked to provide documentation verifying the eligibility of your dependents. If you request to add one or more dependent(s) to medical coverage who were not previously certified as eligible, you will receive a Dependent Certification Notice in the mail or you can print it directly from the Your Benefits Resources web site. You must provide the required documentation within 45 days of enrolling or coverage for your non-certified dependent(s) will be terminated. If you decline coverage for yourself and/or your eligible dependents during your initial eligibility period, or if you do not enroll for coverage when you or your eligible dependents are first eligible, you can enroll during the next Annual Enrollment or if you have a
qualified status change; subject to certain restrictions. For more information, see the Life Events chapter. Federal law requires the Company to limit the times that you can change your benefit elections for the Medical, Dental and Vision Plans and Spending Accounts to: once a year during Annual Enrollment; and when you experience a qualified change in status. The Company limits the number of times you can change your elections for the Critical Illness Protection Plan as follows: once a year during Annual Enrollment; and when you experience a qualified change in status. However, you can drop Critical Illness Protection Plan coverage for yourself or your dependents at any time by calling the Benefits Choice Center. Any change made during a subsequent Annual Enrollment period for Medical, Prescription Drug, Dental, Vision, Critical Illness Protection, MetLaw Legal Plans and/or Spending Account coverage will start on January 1 of the new Plan year. For more information on qualified status changes, see the Life Events chapter. For information on making coverage changes for your domestic partner or children of your partner, see the Benefits for Same-sex Domestic Partners chapter. You may change your benefit elections for Voluntary Term Life Insurance, Voluntary Dependent Term Life Insurance and Voluntary AD&D Insurance: (Continued on page 22.)
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Enrolling in Benefits as a New Associate
Plan Medical and Prescription Drug Is Enrollment Necessary?
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U.S.: Yes. (except Hawaii) Hawaii: No. Associates, but not their dependents, are enrolled automatically in the HMSA PPO Medical Plan. If you do not want coverage, you must complete an HC-5 form within 30 days of your date of hire. You must enroll your dependents if you want them to have coverage. Yes. Yes. Yes. No. Automatic with Medical enrollment. Not available otherwise. This is a Company-paid benefit. No. Automatic when you enroll dependents in Medical. Not available otherwise. This is a Company-paid benefit. No. Enrollment is automatic for newly eligible associates during their initial eligibility period. If you do not want disability insurance, you must opt out during your enrollment period. If you opt out of STD/LTD coverage, you must complete and submit an Evidence of Insurability form, which must be approved by Liberty Mutual, to later enroll for coverage. No. Enrollment is automatic. You will automatically be defaulted into the Tax Plan Cost option. This means that the Company-paid LTD premium will be charged to you as income and you will pay income taxes on the premium. However, any LTD benefit you receive, if approved, will be tax-free income to you. If you want to receive LTD under the Tax on Benefit option, you can choose this option during your enrollment session. Yes. You must complete and submit an Evidence of Insurability form for all coverage more than three times your pay (or over $500,000 for salaried associates only), which must be approved by Minnesota Life. Yes. You must complete and submit an Evidence of Insurability form for all coverage over $20,000, which must be approved by Minnesota Life. Yes. No. Coverage is automatic. This is a Company-paid benefit. Yes. Yes. Yes. Yes. Yes. Yes.
Dental Vision Critical Illness Protection Plan Basic Term Life Insurance Basic Dependent Term Life Insurance Full-time Hourly Associate Disability Insurance: Short-term Disability (except associates in California, New Jersey, Rhode Island and Hawaii*) Long-term Disability (all associates) Salaried Associate Disability Insurance (Short-term and Long-term)
Voluntary Term Life Insurance Voluntary Dependent Term Life Insurance for Spouse/Domestic Partner Voluntary Dependent Term Life Insurance for Children Basic Accidental Death & Dismemberment (AD&D) Insurance Voluntary AD&D Insurance Spending Accounts (health care and dependent day care) Health Savings Account (for High Deductible Health Plan participants only) Legal Services Plan FutureBuilder Employee Stock Purchase Plan
*State disability plans automatically cover associates working in California, Hawaii, New Jersey and Rhode Island.
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If you and your spouse or same-sex domestic partner both work for the Company, you have enrollment options that include the following:
If You and Your Spouse or Same-sex Domestic Partner Both Work for the Company
Plan Medical See the Medical/
Prescription Drug
Choice Each of you can enroll in associate-only coverage
Considerations With this choice, both you and your spouse are automatically covered for the Company-paid Basic Term Life Insurance. See the Life Insurance chapter for more information. Your spouse or same-sex domestic partner will be covered by Basic Dependent Term Life Insurance. See the Life Insurance chapter for more information. With this choice: Your spouse and children are covered as dependents. Your spouse must be enrolled in the same Medical Plan Option, such as the $550 Deductible PPO, that you elect. Your spouse and each child are covered by Basic Dependent Term Life Insurance for $2,000. See the Life Insurance chapter for more information. The dependents you cover under Medical also will be covered under the prescription drug plan. If you enroll in a PPO medical option, you will make a separate prescription drug election. If you enroll in an HMO or the HDHP for Medical coverage, you do not choose a separate prescription drug planprescription drug benefits are included in the HMOs and the HDHP.
chapter for more information
One of you can enroll in associate + spouse (or same-sex domestic partner) coverage One of you can enroll in associate + family (children and spouse or same-sex domestic partner) coverage
Prescription Drugs See the Medical/ Prescription Drug chapter for more information Dental, Vision and Critical Illness Protection Plan See the Dental, Vision and Critical Illness Protection Plan chapters for more information
See next column
Each of you can enroll in associate-only coverage One of you can enroll in associate + spouse (or same-sex domestic partner) coverage With this choice: Your spouse is covered as a dependent. Your spouse must be enrolled in the same Dental, Vision and/or Critical Illness Protection Plan option that you elect. With this choice: Your spouse and children are covered as dependents. Your spouse must be enrolled in the same Dental, Vision and/or Critical Illness Protection Plan option that you elect.
One of you can enroll in associate + family (children and spouse or same-sex domestic partner) coverage
Voluntary Term Life See the Life Insurance chapter for more information
Each of you can enroll in Voluntary Term Life Each of you can enroll each other in Voluntary Dependent Term Spouse Life Each of you can enroll your children in Voluntary Dependent Term Child Life You and your spouse or same- or opposite-sex domestic partner can be covered as a dependent spouse under each others plans. Both you and your spouse can cover your children under this plan.
Voluntary AD&D See the AD&D chapter for more information
Each of you can enroll in associate-only Voluntary AD&D Option Each of you can enroll in Voluntary Family AD&D Both you and your spouse or same- or opposite-sex domestic partner can cover each other and your children under this plan.
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once every rolling 12 months from the date of the election; and when you experience a qualified change in status. You will be required to provide an Evidence of Insurability form and be approved before coverage begins for some of these Plans. An Evidence of Insurability form is required if you didnt enroll when first eligible for Voluntary Term Life. An Evidence of Insurability form may be required for Voluntary Dependent Term Life Insurance for your spouse/domestic partner. For more information, see the Life Insurance and AD&D chapters.
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In years that the Company does not require you to actively enroll in Medical, Prescription Drug, Dental, Vision and Critical Illness Protection coverage during Annual Enrollment (including 2011) and you do not access the Your Benefits Resources web site or call the Benefits Choice Center to add, cancel or change your elections, you will be automatically assigned the same coverage if available in the new Plan year. If the same coverage is not available, you will be assigned to the coverage that is most similar to the coverage that is no longer available. Coverage elections made during Annual Enrollment will be effective January 1 of the following year and will continue until December 31 of that year, unless otherwise noted in your Annual Enrollment communications, subject to any evidence of insurability approval. Enrolling in Life and AD&D Insurance and Disability If you are enrolled in life, AD&D and/or disability insurance, you do not have to enroll in these plans during Annual Enrollmentyou will keep your coverage for the next calendar year unless you make a change.
Health Assessment & Hidden Health Risk Screening Credit Associates and spouses/domestic partners enrolled in a full-time Company medical plan are eligible to receive this credit. How to Get the Health Assessment & Hidden Health Risk Screening Credit for Yourself Youll receive this credit of $25 in each biweekly paycheck if you complete each of these steps: Elect the credit during your enrollment session; Complete the Simple Steps Health Assessment; and Participate in the hidden health risk screening. Once you elect your healthy living credits, complete your enrollment session and your enrollment has been confirmed, youll see a link to the Simple Steps Health Assessment on the Aetna web site. For complete information on how to access the Health Assessment, go to www.livetheorangelife.com, click Health Assessment and then click the Health Assessment User Guide. Note that the results of your Health Assessment are completely confidential! The Company will not have access to your results and your results will have no effect on your employment or your medical coverage. The hidden health risk screening will take place at work locations or you may also visit a Quest Diagnostics Patient Service Center that offers biometrics near you. The screening results you receive in the mail will give you your five key health risk numbersyour blood pressure, waist circumference, and your good cholesterol, blood sugar and triglyceride levels. Youll find out if you are at risk and, if so, steps you can take to reduce that risk.
Annual Enrollment
The Company usually holds annual benefits enrollment during the last quarter of each year. Annual Enrollment is the time when you make your benefit elections for the coming year. Enrolling in Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Coverage and the Spending Accounts There may be times when the Company requires you to actively enroll in the Medical, Prescription Drug, Dental, Vision and Critical Illness Protection Plans during Annual Enrollment by going to the Your Benefits Resources web site or calling the Benefits Choice Center. The spending accounts always require you to re-enroll each year during Annual Enrollment.
Healthy Living Credits

Each year during Annual Enrollment, regardless of whether the Company requires you to re-enroll or not, you must elect the healthy living credits that apply to you: Health Assessment & Hidden Health Risk Screening Credit Tobacco-Free Credit Associates who reside in Hawaii are not eligible for healthy living credits.
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Youll receive more information about the hidden health risk screening at your home address if you elect this credit. If you are hired mid-year, you may not need to participate in the screening until the next screening event. Additional details about the next Company screening event will be provided. Note: If you have a medical condition where it is medically inadvisable or unreasonably difficult for you to participate in the screening, there is a physician waiver process that can be completed that will allow you to continue receiving the credit. For more information, contact the Benefits Choice Center at 1-800-555-4954. How to Get the Health Assessment & Hidden Health Risk Screening Credit for Your Spouse/Domestic Partner Youll receive the Health Assessment & Hidden Health Risk Screening credit of $25 for your spouse in each biweekly paycheck if you are covering your spouse/domestic partner under a Company medical plan and: You elect the credit for your spouse/domestic partner during your enrollment session; and Your spouse completes the Simple Steps Health Assessment. Spouses/domestic partners do not need to participate in the hidden health risk screening to receive this credit. Tobacco-Free Credit If you enroll in a full-time Company medical plan, you are eligible to receive a $10 biweekly tobacco-free credit if you meet the following tobacco-free
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requirements: the participant has not smoked cigarettes, pipes or cigars or used smokeless tobacco products in the six months prior to the medical coverage effective date. Youll receive an additional $10 biweekly tobacco-free credit if your spouse/domestic partner is enrolled in a Company medical plan and also meets the tobacco-free requirements. During your enrollment session, you will indicate whether you qualify for this per-paycheck credit for yourself only, for yourself and your covered spouse/domestic partner or for your spouse/domestic partner only. Those who do not meet the tobacco-free requirements at the time of enrollment may qualify for the credit once they have been tobacco-free for six months. For example, if you quit on August 1, 2011, you may qualify for the credit on February 1, 2012. Once you reach six months of being tobacco-free in 2011, you can notify the Benefits Choice Center at 1-800-555-4954 to become eligible for the tobacco-free credit for the remainder of the year. If it is unreasonably difficult due to a medical condition or medically inadvisable for you to achieve the standards for the incentive under this program, you may qualify for the credit. Contact the Benefits Choice Center at 1-800555-4954 for more information. This exception requires a letter from your doctor.
However, you can drop Critical Illness Protection Plan coverage for yourself or your dependents at any time by calling the Benefits Choice Center. When Changes to Coverage Take Effect Generally, for your election to become effective, you must call the Benefits Choice Center, and speak to a representative within 30 days after the date the qualified change in status occurs. A 60-day election period applies to changes relating to Medicaid and CHIP coverage. For your election change to be effective, the Benefits Choice Center must determine that the requested enrollment change is consistent with the qualified change in status. If approved, all new coverages will be effective on the date of the change in status. For Life Insurance, your election change becomes effective when your Evidence of Insurability is approved, if applicable. If you experience a change in status due to marriage, divorce, birth, adoption, or placement for adoption, you may also access the Your Benefits Resources web site to make your election changes within 30 days after the date the event occurred. The Company may request that you provide required documentation of your qualifying change in status. Providing false information may result in exclusion from (i.e., loss of eligibility for) all Company-sponsored welfare benefit plans and/or disciplinary action as outlined in the Companys code of conduct.
Qualified Change in Status/Life Events

You cannot change or cancel your Medical, Dental, Vision, Spending Accounts, Life Insurance or AD&D elections mid-year except as shown in the Life Events chapter (or the Benefits for Same-sex Domestic Partners chapter).
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Declining Coverage
Participation in the Company benefit plans is voluntary. When you first become eligible for benefits, if you do not wish to enroll in coverage for yourself and/or your eligible family members (except STD and LTD and Hawaii medical Associate-Only category), you do not have to do anything.
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Disability for Full-Time Hourly Associates chapter for more information. Hawaii associates are automatically enrolled in the HMSA PPO Plan. Hawaii associates who do not want medical coverage must complete an HC-5 form and return the signed form to the Benefits Choice Center before your 28th day of employment or before the end of Annual Enrollment. This form verifies that you are exempt from enrolling in the Medical Plan. Associates who drop the coverage may re-enroll during Annual Enrollment or upon the occurrence of a qualified status change.
As a convenience to you, if you enroll in any of these Plans, your contributions will be deducted from your paycheck. If you are not on The Home Depot payroll system, your contributions will be deducted from your paycheck, except contributions for the following MetLife Group Benefits plans: MetLaw Legal Services Plan Auto and Home Insurance Veterinary Pet Insurance
Full-Time Hourly Associates: Opting Out of Automatic Enrollment

All newly eligible associates are automatically enrolled in the following Plans: U.S. Short-term Disability (STD), except in CA, HI, NJ and RIstate disability plans automatically cover associates working in these states Long-term Disability (LTD) Hawaii Medical (Associate-Only category) Long-term Disability (LTD) If you do not want the coverage, you must opt out by accessing the Your Benefits Resources web site or calling the Benefits Choice Center before your 91st day (29th day in Hawaii) of employment or before the end of Annual Enrollment. If you opt out of the plans, you may enroll in STD (Supplemental Short-term Disability in New York) and LTD during any rolling 12-month period, and approval of an Evidence of Insurability form is required. You also may elect these coverages when you experience a qualified status change or at annual enrollmentenrollment in these instances will count as once in a rolling 12-month period. See the
About Before-Tax Contributions Cost for Coverage

You are automatically covered and make no contributions for the cost of your Basic Term Life (if enrolled in the Medical Plan), Basic Dependent Term Life (if dependents are enrolled in a Medical Plan) and Basic Accidental Death and Dismemberment insurance. If you are a salaried associate, you are automatically covered and make no contributions to Short-term Disability and Long-term Disability. You must elect to pay income taxes on long-term disability benefits or on the cost of the long-term disability premium that the Company pays on your behalf. See Disability for Salaried Associates for more information. The other benefit Plans, including the Medical, Prescription Drug, Dental, Vision, Critical Illness Protection, Spending Accounts, Health Savings Account, Disability Insurance (for full-time hourly associates), Voluntary Term Life Insurance, Voluntary Dependent Term Life Insurance, Voluntary Accidental Death and Dismemberment Insurance and MetLaw Legal Services Plans, require contributions from you. 24 By enrolling in Medical, Prescription Drug, Vision and/or Dental Plans, you authorize the Company to reduce your gross pay with before-tax dollars for the required premiums. By enrolling in the Spending Accounts and/or Health Savings Account, you authorize the Company to reduce your gross pay with before-tax dollars for the amounts you elect. This means you will not pay Social Security taxes, federal income taxes and, in most cases, state income taxes on the money deducted from your paycheck for Medical, Prescription Drug, Vision, Dental, Spending Accounts and Health Savings Account. While you pay less in current taxes, the amount of your pay used to determine Social Security benefits at retirement may be reduced slightly. For more information about tax advantages of the Spending Accounts and Health Savings Accounts, see the Spending Accounts and Health Savings Account chapters in this book. If you have additional questions, please seek the advice of your tax or financial advisor.

When Your Coverage Ends
Medical, Prescription Drug, Vision, Dental, Critical Illness Protection, Spending Accounts, Disability, Basic Term Life, Voluntary Term Life, Basic Dependent Term Life, Voluntary Dependent Term Life, Basic AD&D, Voluntary AD&D Insurance and MetLaw Legal Services Plans will end as follows, unless otherwise required by law: on midnight on the last day in the pay period that your employment with the Company ends at midnight on the date you or any member of your family (dependents) no longer meet the eligibility requirements for participation in the Plans. if you are on a leave of absence. See the HR SOP applicable to you for information on when coverage ends for your specific type of leave. when you experience an employment status change (from full-time to part-time), your coverage ends at midnight on the date of the employment status change. when your payment grace period has expired after you stop making the required contributions for coverage. Your coverage in all Plans will be ended on your paid-through date. the date amendments to the Plans terminate certain benefits or terminate the Plans. if you are on a leave of absence, your eligibility to file a new disability claim ends on the day your leave begins. when you or any covered dependent has received the maximum basic benefit amount payable under the Critical Illness Protection Plan.
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Continuing Coverage
In some cases, you may continue Medical, Prescription Drug, Vision, Dental and Critical Illness Protection coverage as well as your Health Care Spending Account for you and your eligible family members after your coverage would typically end. See the COBRA Coverage chapter for more information. For information on continuing your Basic/Voluntary Term and AD&D Life Insurance, see the Life Insurance and AD&D chapters.
If your employment status changes to salaried, you are eligible for Salaried Health and Welfare plans on your employment status change date. If you are not enrolled in the Health and Welfare plans on your employment status change date, you must enroll within 30 days of your change date.
If Youre Rehired
Full-Time Hourly Associates
If you stop working for the Company and are rehired on a regular full-time basis, your enrollment in the Plans will be handled as follows: Within 30 days. If you were eligible before termination and are re-employed within 30 days and within the same calendar year, you are automatically reinstated in the same coverage. If you experienced a qualified status change, you must make changes to your benefits within 30 days of your rehire. If you were not eligible prior to termination and are re-employed within 30 days, you must complete the waiting period (U.S., except Hawaii90 days; Hawaii28 days) and enroll by your enrollment deadline. You will receive credit for previous employment. All coverages become effective on the first day after you complete the waiting period (U.S., except Hawaiion the 91st day; Hawaiion the 29th day), provided you enroll within 30 days of your rehire date. Between 31 days and six months. If you were eligible prior to termination and are rehired between 31 days and six months from your termination date, you are eligible immediately. You will receive an enrollment packet and you must reenroll within 30 days of your rehire date. You may choose different coverages.
Employment Status Changes

Full-Time Hourly Associates
If your employment status changes to part-time, your enrollment in the Health and Welfare plans will be handled as follows: If you have not completed the waiting period (U.S., except Hawaii90 days; Hawaii28 days), you must complete your waiting period and enroll within 30 days of your employment status change date. All coverages become effective on the first day after you complete your waiting period (U.S., except Hawaiion the 91st day; Hawaii on the 29th day). If you do not enroll within 30 days of your employment status change, you will have to wait until the next annual enrollment unless you experience a qualified status change. If you have completed the waiting period, you can continue the coverage you had before the employment status change under COBRA.
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If you were not eligible prior to termination, upon rehire you must complete the waiting period (U.S., except Hawaii90 days; Hawaii28 days). You will receive credit for previous employment. All coverages become effective on the first day after you complete the waiting period (U.S., except Hawaii on the 91st day; Hawaiion the 29th day), provided you enroll within 30 days of your rehire date. After six months. If you are rehired more than six months from the date of your termination, you will be considered a new hire for purposes of coverage under the benefit Plans and will have to complete the waiting period (U.S., except Hawaii90 days; Hawaii28 days) to be eligible for benefits. In all cases, if you enroll by your enrollment deadline, all coverages are effective on the date you become eligible. If you leave the Company due to a reduction in force and are rehired within 30 days of and in same calendar year, the coverage you had before your termination will be reinstated with no lapse. You must contact the Benefits Choice Center to have your coverage reinstated.
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After 30 days. If you are rehired after 30 days or within 30 days but in a different tax year from when you terminated, you will receive an enrollment kit and you must re-enroll to receive coverage. If you decline coverage or fail to enroll within the 30 day deadline, you may not enroll until the next Annual Enrollment, unless you have a qualified status change during the year. If you are rehired as a full-time hourly associate, the rules listed in If Youre RehiredFull-Time Hourly Associates apply.
If you transfer from Puerto Rico or St. Thomas to the United States, you will become eligible for U.S. benefits as of the later of your eligibility date or move date. If you are eligible for benefits and transfer from a salaried to an hourly status, the 90-day service requirement is waived (i.e., once eligible for benefits, eligibility is not taken away).
Service Requirements For MetLife Group Benefits If You Are Rehired

If you leave the Company and are later rehired, the following rules apply to service for your MetLife Group Benefits (MetLaw Legal Services Plan, Auto and Home Insurance and Veterinary Pet Insurance): For full-time hourly associates: If you are rehired six calendar months or less from termination, all previous service is counted toward benefit eligibility. If you are rehired more than six calendar months after termination, previous service is not counted toward benefit eligibility. For salaried associates: If you are rehired within 30 days, your coverage through the Company will continue through payroll deductions. If you pay your premiums through payroll deduction, you will continue to pay in this way.
Medicaid and the Childrens Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Salaried Associates
If you stop working for the Company, and you are rehired as a full-time salaried associate, your enrollment in the Plans will be handled as follows: Within 30 days and within the same calendar year. You are automatically reinstated in the same coverage unless a qualified status change occurred and you elect to change your coverage. If you have a status change, you may be able to add, drop, decrease or increase certain coverages. See the Life Events chapter for more information.
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Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employers health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employers plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
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If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of April 16, 2010. You should contact your State for further information on eligibility. To see if any more States have added a premium assistance program since April 16, 2010, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565
STATE ALABAMA: Medicaid ALASKA: Medicaid ARIZONA: CHIP ARKANSAS: CHIP CALIFORNIA: Medicaid COLORADO: Medicaid CHIP FLORIDA: Medicaid GEORGIA: Medicaid IDAHO: Medicaid CHIP INDIANA: Medicaid IOWA: Medicaid KANSAS: Medicaid KENTUCKY: Medicaid LOUISIANA: Medicaid MAINE: Medicaid MASSACHUSETTS: Medicaid and CHIP MINNESOTA: Medicaid MISSOURI: Medicaid MONTANA: Medicaid NEBRASKA: Medicaid
WEBSITE www.medicaid.alabama.gov health.hss.state.ak.us/dpa/programs/medicaid/ www.azahcccs.gov/applicants/default.aspx www.arkidsfirst.com/ www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx www.colorado.gov/ www.CHPplus.org www.fdhc.state.fl.us/Medicaid/index.shtml dch.georgia.gov/ Click on Programs, then Medicaid www.accesstohealthinsurance.idaho.gov www.medicaid.idaho.gov www.in.gov/fssa/2408.htm www.dhs.state.ia.us/hipp/ www.khpa.ks.gov chfs.ky.gov/dms/default.htm www.dhh.louisiana.gov/offices/?ID=92 www.maine.gov/dhhs/oms/ www.mass.gov/MassHealth www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance www.dss.mo.gov/mhd/index.htm medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml www.dhhs.ne.gov/med/medindex.htm
PHONE 1-800-362-1504 (Outside of Anchorage):1-888-318-8890 (Anchorage):1-907-269-6529 1-877-764-5437 1-888-474-8275 1-866-298-8443 1-800-866-3513 1-303-866-3243 1-866-762-2237 1-800-869-1150 1-208-334-5747 1-800-926-2588 1-877-438-4479 1-888-346-9562 1-800-766-9012 1-800-635-2570 1-888-342-6207 1-800-321-5557 1-800-462-1120 1-800-657-3739 1-573-751-6944 1-800-694-3084 1-877-255-3092
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STATE NEVADA: Medicaid CHIP NEW HAMPSHIRE: Medicaid NEW JERSEY: Medicaid CHIP NEW MEXICO; Medicaid and CHIP NEW YORK: Medicaid NORTH CAROLINA: Medicaid NORTH DAKOTA: Medicaid OKLAHOMA: Medicaid OREGON: Medicaid CHIP PENNSYLVANIA: Medicaid RHODE ISLAND: Medicaid SOUTH CAROLINA: Medicaid TEXAS: Medicaid UTAH: Medicaid VERMONT: Medicaid VIRGINIA: Medicaid CHIP WASHINGTON: Medicaid WEST VIRGINIA: Medicaid WISCONSIN: Medicaid WYOMING: Medicaid WEBSITE dwss.nv.gov/ www.nevadacheckup.nv.org/
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PHONE 1-800-992-0900 1-877-543-7669 1-800-852-3345 x5254 1-800-356-1561 1-800-701-0710 1-888-997-2583 1-800-541-2831 1-919-855-4100 1-800-755-2604 1-888-365-3742 1-800-359-9517 1-800-359-9517 1-800-644-7730 1-401-462-5300 1-888-549-0820 1-800-440-0493 1-866-435-7414 1-800-250-8427 1-800-432-5924 1-866-873-2647 1-877-543-7669 1-304-342-1604 1-800-362-3002 1-307-777-7531
www.dhhs.state.nh.us/DHHS/MEDICAIDPROGRAM/default.htm www.state.nj.us/humanservices/dmahs/clients/medicaid/ www.njfamilycare.org/index.html www.hsd.state.nm.us/mad/index.html Click on Insure New Mexico for CHIP www.nyhealth.gov/health_care/medicaid/ www.nc.gov www.nd.gov/dhs/services/medicalserv/medicaid/ www.insureoklahoma.org www.oregon.gov/DHS/healthplan/index.shtml www.oregon.gov/DHS/healthplan/app_benefits/ohp4u.shtml www.dpw.state.pa.us/partnersproviders/medicalassistance/ doingbusiness/003670053.htm www.dhs.ri.gov www.scdhhs.gov www.gethipptexas.com health.utah.gov/medicaid/ ovha.vermont.gov/ www.dmas.virginia.gov/rcp-HIPP.htm www.famis.org/ hrsa.dshs.wa.gov/premiumpymt/Apply.shtm www.wvrecovery.com/hipp.htm dhs.wisconsin.gov/medicaid/publications/p-10095.htm www.health.wyo.gov/healthcarefin/index.html
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Benefits for Same-Sex Domestic Partners

Chapter Contents
30 Domestic Partner Eligibility 30 Certifying Your Relationship 30 Enrolling Your Partner and/or Your Partners Children 31 Benefits Available to Same-sex Domestic Partners 31 Medical, Critical Illness Protection, Dental and Vision Benefits 31 31 Life and AD&D Insurance Benefits MetLaw Legal Services
31 Tax Considerations 32 33 Determining Your Premiums and Calculating Your Taxable Income Making Coverage Changes

What do you need?
Certify your same-sex domestic partner relationship Add your same-sex domestic partner as a dependent and enroll him or her in benefits
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Find it here...
Go to Your Benefits Resources at http://resources.hewitt.com/homedepot or call the Benefits Choice Center at 1-800-555-4954. Go to Your Benefits Resources at http://resources.hewitt.com/homedepot or call the Benefits Choice Center at 1-800-555-4954.
Domestic Partner Eligibility

Domestic partner eligibility for the benefit plans is described in Dependent Eligibility: Medical, Dental, Vision and Critical Illness Protection Plans and Dependent Eligibility: Voluntary Dependent Term Life Insurance (Spouse and Child) and Family AD&D Plans in the Eligibility and Enrollment chapter.
Enrolling Your Partner and/or Your Partners Children

You may enroll your same-sex domestic partner and/or your partners eligible dependents in the Companys Medical, Dental, Vision, Critical Illness Protection Plan and your same- or opposite-sex domestic partner and/or your partners eligible dependents in the Companys Life and AD&D Plans. After you have reviewed this chapter along with other applicable benefit chapters in this Benefits Summary and made the choices that are right for you and your family, add your same-sex (or opposite-sex for Life and AD&D) domestic partner as a dependent and enroll him or her in benefits by accessing the Your Benefits Resources web site or calling the Benefits Choice Center. To add your partner as a dependent, you will need to answer a series of questions to certify your same-sex domestic partners eligibility. Then you can make benefits elections for your partner and/or your partners eligible dependents.
Certifying Your Relationship

Before you can enroll your partner and/or your partners eligible dependents in benefits, you must certify that your relationship qualifies for same-sex domestic partner benefit coverage. To certify your same-sex domestic partners eligibility, youll need to answer a series of questions. To certify your relationship, go to Your Benefits Resources or contact the Benefits Choice Center. Certification is also required before enrolling opposite-sex domestic partners and/or their eligible dependents in the Voluntary Dependent Term Life Insurance (spouse and child) and Family AD&D Plans.
You may enroll your partner in benefits when you first become eligible, when you first experience a life event described in Making Coverage Changes, or within 30 days of meeting both of the following eligibility requirements: you and your partner reach age 18 and you complete the sixth consecutive month of living together (this six-month requirement does not apply for Health Net). You may also enroll your eligible partner and/or your partners eligible dependent during annual benefits enrollment. Important! If enrolling in or making changes to your benefits (including such actions, but not limited to, adding eligible dependents or verifying a childs fulltime student status), you are responsible for providing truthful and accurate information. Providing false information may result in exclusion from (i.e., loss of eligibility for) all Company-sponsored welfare benefit plans and/or disciplinary action as outlined in the Companys code of conduct.
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Benefits Available to Same-sex Domestic Partners
Medical, Critical Illness Protection, Dental and Vision Benefits
You can enroll your same-sex domestic partner and his or her eligible dependents as eligible dependents under your Medical, Critical Illness Protection, Dental or Vision plans.
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Your same-sex domestic partner and/or his or her eligible dependents will be automatically enrolled in Basic Dependent Term Life Insurance if you elect medical coverage for him or her. For your life insurance or accidental death & dismemberment coverage, you can name your same- or opposite-sex domestic partner as your beneficiary.
Tax Considerations
If you enroll your same-sex domestic partner and his or her children in coverage, you will pay the same premium as associates who enroll their spouse and/or eligible dependent children in the medical, dental and vision plans. However, the portion of the premium that you and the Company pay to cover your same-sex domestic partner and/or his or her eligible dependent children will be reported as taxable income on your paycheck. You may also be subject to income tax on the value of Basic Dependent Term Life Insurance provided by the Company. This is because the Internal Revenue Code may not recognize domestic partners as qualifying for tax-free benefits. The portion of the premium that you and the Company pay for your coverage will not be taxable. In California, if you have registered your partner with the states Domestic Partner registry, you may be exempt from state income tax on this amount. Contact your tax advisor.
Life and AD&D Insurance Benefits

You can enroll your same- or opposite-sex domestic partner and his or her eligible dependents as eligible dependents under the Voluntary Dependent Term Life Insurance (spouse and child) and Family AD&D Plans. You can enroll, cancel or change your coverage once during a rolling 12-month period, or when you have a status change.
MetLaw Legal Services

If you enroll in the MetLaw Legal Services Plan, coverage under this Plan is also available to your same-sex domestic partner.
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Determining Your Premiums and Calculating Your Taxable Income
The premiums that you pay for medical, dental or vision coverage are the same as those published for covering a spouse and/or child(ren). To determine your taxable income, you must determine the portion of the premium that applies to your same-sex domestic partners coverage. Call the Benefits Choice Center at 1-800-555-4954 to obtain the total premiums for your specific plans.
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How Taxable Income for SSDP Coverage is Calculated

Coverage Premium Calculation You + Spouse Associate + Spouse total premium minus Associate-only premium You + Child(ren) You + Family Associate + Child(ren) total premium minus Associate-only premium Associate + Family total premium minus Associate-only premium
2011 Total Premiums

2011 Biweekly1 Total Premium2 (associate premium + Company subsidy) Coverage Associate Associate + Spouse $750 Deductible Plan Only $199.66 $399.31
Associate + Child(ren) $359.39 Associate + Family $579.00
1 Weekly payroll deductions for premiums will be half of this amount. 2 This amount does not include prescription drug coverage premiums.
Taxable Income Calculation Examples

Coverage Scenario Associate + Spouse coverage in the $750 Deductible plan (associate is covering his or her SSDP) Associate + Child(ren) coverage in the $750 Deductible plan (associate is covering his or her SSDPs children) Associate + Family coverage in the $750 Deductible plan (associate is covering his or her SSDP and the SSDPs children) Associate + Child(ren) coverage in the $750 Deductible plan (associate is covering one of his or her own children and his or her SSDPs children) Associate + Family coverage in the $750 Deductible plan (associate is covering the associates children and his or her SSDP) Medical Taxable Income Calculation $399.31 - $199.66 = $199.65 of taxable income biweekly
$359.39 - $199.66 = $159.73 of taxable income biweekly
No additional taxation
Because of certain rules under the Internal Revenue Code, you cannot make before-tax contributions or receive tax-free employer contributions for your SSDP or your SSDPs dependents health coverage. Accordingly, the company must report these amounts to the IRS as taxable income.
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Making Coverage Changes
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You may access the Your Benefits Resources web site or call the Benefits Choice Center to change coverage for your same-sex domestic partner (SSDP) or opposite-sex domestic partner (OSDP) for Life and AD&D coverage and/or your partners dependent children, only during annual enrollment or when one of the following occurs:
Plan coverage changes

Change Type Associate & SSDP meeting the following 2 requirements: Reaching age 18 Reaching the 6th consecutive month of living together 4 SSDPs dependent meeting dependent eligibility requirements Ceasing to satisfy the SSDP requirements Ending dependent eligibility of SSDPs dependent Death of SSDP (dependents of SSDP will not be able to continue coverage) Death of covered dependent of SSDP Birth (of associates child) Birth (of SSDPs child) Adoption/Legal guardianship (associate adopting) Adoption/Legal guardianship (SSDP adopting) Notification Rules Within 30 days of meeting both requirements (from 18th birthday or end of 6th month of residing together) Full-time & Salaried Medical/Dental/Vision/ Critical Illness Protection3 Can add SSDP and/or eligible dependents of SSDP to the associates current coverage1 Full-Time & Salaried Voluntary Term Life, Dependent Term Life5, and AD&D Insurance Can add or increase coverage for self, SSDP or OSDP and/or eligible dependents of SSDP or OSDP2
Within 30 days of meeting the dependent eligibility requirements Within 30 days of ceasing to satisfy the SSDP requirements Within 30 days of ceasing to be an eligible dependent of SSDP As soon as possible following death
Can add newly qualified dependent(s) of SSDP to the associates current coverage Drop SSDP and any covered dependents of SSDP (no changes allowed for the associates coverage) Drop dependent(s) of SSDP (no changes allowed for the associates coverage) Drop deceased SSDP & any covered dependents of the SSDP Drop deceased dependent(s) of SSDP Since this is the associates child, the rules in the Life Events chapter would be followed Can add new eligible dependent(s) of SSDP to the associates current coverage Since this is the associates child, the rules in the Life Events chapter would be followed Can add newly adopted eligible dependent(s) of SSDP to the associates current coverage
Can add or increase coverage for self and/or eligible dependents of SSDP or OSDP2 Drop SSDP or OSDP and dependents of SSDP or OSDP Drop dependents of SSDP or OSDP Drop deceased SSDP or OSDP and/or dependent(s) of SSDP or OSDP Drop deceased dependent(s) of SSDP or OSDP See the Life Events chapter Can add or increase coverage for self and/or new eligible dependent(s) of SSDP or OSDP2 See the Life Events chapter Can add or increase coverage for self and/or new eligible dependent(s) of SSDP or OSDP2
As soon as possible following death See the Life Events chapter Within 30 days of birth See the Life Events chapter Within 30 days of adoption
1 If you enroll your domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your domestic partner meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your domestic partner (your domestic partner only completes the health assessment to receive this credit domestic partners do not participate in the screening). 2 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your domestic partner. See the Life Insurance chapter for more information. 3 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 4 This six-month requirement does not apply for Health Net. 5 Must be actively at work for coverage to take effect.
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Plan coverage changes
Change Type QMCSO on Child of SSDP Gain of coverage due to SSDPs annual enrollment differing from Home Depots Loss of coverage due to SSDPs annual enrollment differing from Home Depots Notification Rules See the Plan Administration chapter N/A
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Full-time & Salaried Medical/Dental/Vision/ Critical Illness Protection1 Can add child as required by valid QMCSO No changes allowed, will have to wait until annual enrollment No changes allowed, will have to wait until annual enrollment No changes allowed, will have to wait until annual enrollment Can add SSDP and/or eligible dependents of SSDP (if each had been covered under the SSDPs plan) to the associates current coverage2 Can add SSDP and/or eligible dependents of SSDP (if each had been covered under the SSDPs plan) to the associates current coverage2
Full-Time & Salaried Voluntary Term Life, Dependent Term Life5, and AD&D Insurance N/A No changes allowed4
N/A
Can add or increase coverage for self, SSDP or OSDP and/or eligible dependents of SSDP or OSDP3 No changes allowed4
Gain of coverage due to N/A SSDPs or eligible dependent of SSDPs change in employment Loss of coverage due to Within 30 days of loss of coverage SSDPs or eligible dependent of SSDPs change in employment Loss of coverage due to action of SSDPs employer by termination of all plans of the same type or by ceasing all employer contributions Loss of coverage due to an expiration of SSDPs COBRA coverage SSDPs employer eliminates benefit option (i.e. HMO, PPO, POS...) SSDPs employer adds a benefit option (i.e. HMO, PPO, POS...) You or your SSDP loses coverage under Medicare or Medicaid and you wish to add coverage You or your SSDP gains coverage under Medicare of Medicaid and you wish to add coverage Within 30 days of loss of coverage
Can add or increase coverage for self, SSDP or OSDP and/or eligible dependents of SSDP or OSDP3 Can add or increase coverage for self, SSDP or OSDP and/or eligible dependents of SSDP or OSDP3
Within 30 days of loss of coverage
Can add SSDP and/or eligible dependents of SSDP (if each had been covered under the SSDPs plan) to the associates current coverage2 No changes allowed, will have to wait until annual enrollment No changes allowed, will have to wait until annual enrollment No changes allowed, will have to wait until annual enrollment
No changes allowed4
N/A
No changes allowed4
N/A
No changes allowed4
N/A
No changes allowed4
N/A
No changes allowed, will have to wait until annual enrollment
No changes allowed4
1 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents. 2 If you enroll your domestic partner in Home Depot medical coverage, you also can elect the tobacco-free credit (if your domestic partner meets the Companys tobacco-free requirements) and the Health Assessment & Hidden Health Risk Screening Credit for your domestic partner (your domestic partner only completes the health assessment to receive this credit domestic partners do not participate in the screening). 3 An Evidence of Insurability form may be required for adding or increasing voluntary term life and voluntary dependent term life coverage for you or your domestic partner. See the Life Insurance chapter for more information. 4 You will have to wait until the next enrollment opportunity based on your rolling 12-month election, see the Eligibility and Enrollment chapter for more information. 5 Must be actively at work for coverage to take effect.
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For New Salaried Associates: Medical Coverage During Your First 90 Days
Chapter Contents
36 38 38 38
Medical Coverage During Your First 90 Days If You Are Enrolled in an Aetna Medical Plan If You Are Enrolled in the High Deductible Health Plan If You Are Enrolled in an Anthem Blue Cross Blue Shield (BCBS) Medical Plan If You Are Enrolled in a Kaiser Permanente Colorado, Mid-Atlantic or Ohio HMO If You Are Enrolled in an Out-of-Area Medical Plan Additional State-Mandated Eligibility Rules During Your First 90 Days
41 42 42 42 42
Eligibility Rules During Your First 90 Days If You Are a California Associates If You Are Enrolled in a Health Net HMO If You Are Enrolled in a California Kaiser Permanente HMO Availability of Health Net Salud y Mas Option During Your First 90 Days Grandfathered Plans
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39 39
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Medical Coverage During Your First 90 Days

What do you need?
Answers to questions about your 90-day coverage To have any part or all of the deductible and out-of-pocket maximum that you satisfy under the 90-day medical plan carried over into the plan that you enrolled in To have any out-of-pocket maximum you have satisfied in the 90-day prescription drug plan carried over into your prescription drug plan as of your 91st day
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Find it here...
Call the Benefits Choice Center at 1-800-555-4954 Contact your medical plan administrator as of your 91st day. For phone numbers, see Contact Your Medical Plan in the Medical chapter For Kaiser, call 1-847-698-4340 For Anthem BCBS, call 1-877-434-2734 Contact your prescription drug plan administrator as of your 91st day: For Aetna and Anthem BCBS members: Caremark at 1-866-490-3376

As a salaried associate, under any plan you choose, your medical and prescription drug coverage begins on your date of hire if you enroll by your enrollment deadline. However, during your first 90 days of employment, you will have different coverage from the medical and prescription drug plan you enrolled in. This different coverage during your first 90 days does not apply to: Associates who enroll in the Kaiser Permanente HMO-Georgia or the Kaiser Permanente HMONorthwest; or Associates in Hawaii. Here is some general information about your coverage during your first 90 days: The coverage category you select when you enroll (associate only, associate + spouse or same-sex domestic partner, associate + children or associate + family) will automatically apply for your first 90 days and after. Healthy living credits will automatically be applied to your medical payroll deduction during your first 90
days. Your payroll deductions will change to reflect the plan you enrolled in on your 91st day. For healthy living credits to continue on your 91st day you must take action to receive the credits. See the Eligibility and Enrollment chapter for information on healthy living credits. Youll receive an ID card from your 90-day medical provider for your 90-day medical and prescription drug coverage. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical and prescription drug expenses during your first 90 days. You can carry over any part or all of the deductible and out-of-pocket maximum that you satisfy under the 90-day plan into the medical and prescription drug plan that you enrolled in. Your coverage during your first 90 days depends on the medical plan you enrolled in during your enrollment sessionmedical plans through Aetna, Anthem Blue Cross Blue Shield, Kaiser Permanente or Health Net. To find out your coverage during your first 90 days, see the Your Medical and Prescription Drug Coverage During Your First 90 Days chart or the For California Associates: Your Medical and Prescription Drug Coverage During Your First
90 Days chart at the end of this chapter. Youll find important information about your coverage during your first 90 days and the steps you need to take to transition from your 90-day coverage to the coverage in which you enrolled in the section that applies to your particular medical plan: If You Are Enrolled in an Aetna PPO Plan If You Are Enrolled in the High Deductible Health Plan If You are Enrolled in an Anthem Blue Cross Blue Shield Medical Plan If You Are Enrolled in the Kaiser Permanente Colorado, Mid-Atlantic or Ohio HMO If You Are Enrolled in an Out-of-Area Plan If You Are a California Associate If You Are Enrolled in a California Kaiser Permanente HMO If You Are Enrolled in a Health Net HMO For special eligibility rules that may apply to you during your first 90 days, see Additional State-Mandated Eligibility Rules During Your First 90 Days and Eligibility Rules During Your First 90 Days later in this chapter.
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Your Medical and Prescription Drug Coverage During Your First 90 Days (except CA)
For your first 90 days of coverage You enrolled in: Aetna $550 Deductible Aetna $750 Deductible Aetna $1,000 Deductible High Deductible Health Plan BCBS $550 Deductible BCBS $750 Deductible BCBS $1,000 Deductible BCBS $550 Out-of-Area Plan BCBS $750 Out-of-Area Plan BCBS $1,000 Out-of-Area Plan Colorado Kaiser Permanente HMO Basic and Standard Mid-Atlantic Kaiser Permanente HMO Basic and Standard Ohio Kaiser Permanente HMO Basic and Standard Your medical coverage is: Aetna $550 Deductible/ Open Choice PPO network Aetna $750 Deductible/ Open Choice PPO network Aetna $1,000 Deductible/ Open Choice PPO network Aetna $1,000 Deductible/ Out-of-Area Aetna $550 Out-of-Area Aetna $750 Out-of-Area Aetna $1,000 Out-of-Area Aetna $550 Out-of-Area Aetna $750 Out-of-Area Aetna $1,000 Out-of-Area Aetna $550 Out-of-Area Aetna $550 Out-of-Area Aetna $550 Out-of-Area Your prescription drug coverage is through: Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna Aetna On your 91st day of coverage Your medical coverage will be: Aetna $550 Deductible/ Choice POS II network Aetna $750 Deductible/ Choice POS II network Aetna $1,000 Deductible/ Choice POS II network High Deductible Health Plan/ Aetna Choice POS II network BCBS $550 Deductible/ BlueCard PPO network BCBS $750 Deductible/ BlueCard PPO network BCBS $1,000 Deductible/ BlueCard PPO network $550 Out-of-Areaadministered by BCBS $750 Out-of-Areaadministered by BCBS $1,000 Out-of-Areaadministered by BCBS Kaiser Permanente Kaiser Permanente Kaiser Permanente Your prescription drug coverage will be with: Caremark Caremark Caremark Caremark Caremark Caremark Caremark Caremark Caremark Caremark Kaiser Permanente Kaiser Permanente Kaiser Permanente
Different coverage during your first 90 days does not apply to associates who enroll in the Kaiser Permanente HMO-Georgia or the Kaiser Permanente HMO-Northwest.
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If You Are Enrolled in an Aetna Medical Plan

During your first 90 days of coverage, you will use the Aetna Open Choice PPO network. This network is very similar to Aetnas Choice POS II network, which will be your network on your 91st day. To find a network provider, go to www.livetheorangelife.com, click Find a Provider/Transition of Care, click Aetna, click DocFind and then click Salaried First 90 Days. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Aetna 90-day medical plan automatically will be carried over into the Aetna plan that you enrolled in. During your first 90 days of coverage, your prescription drug coverage will be through Aetna. For information about your prescription drug coverage, see the Aetna Prescription Drug Coverage During Your First 90 Days chart. Any part of the out-of-pocket maximum that you satisfy under the Aetna prescription drug coverage will automatically be carried over to the Caremark prescription drug plan you elected.
Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Aetna 90-day medical plan automatically will be carried over into the High Deductible Health Plan that you enrolled in. During your first 90 days of coverage, your prescription drug coverage will be through Aetna. For information about your prescription drug coverage, see the Aetna Prescription Drug Coverage During Your First 90 Days chart. Any part of the out-of-pocket maximum that you satisfy under the Aetna prescription drug coverage will automatically be carried over to your HDHP deductible and out-of-pocket maximum
On your 91st day, your BCBS medical coverage will begin and you will have to use a BlueCard PPO network provider to take advantage of in-network benefits. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Aetna 90-day medical plan will be carried over into the BCBS plan that you enrolled in if you call BCBS and provide EOBs documenting your expenses during your first 90 days. During your first 90 days of coverage, your prescription drug coverage will be through Aetna. For information about your prescription drug coverage, see the Aetna Prescription Drug Coverage During Your First 90 Days chart. Be sure to keep all of your EOBs documenting any of your prescription drug expenses during your first 90 days. On your 91st day, the Caremark prescription drug coverage you enrolled in will begin. Call Caremark to have any out-of-pocket maximum you have satisfied in the 90-day prescription drug plan carried over into your Caremark prescription drug plan.
If You Are Enrolled in an Anthem Blue Cross Blue Shield (BCBS) Medical Plan
During your first 90 days of coverage, you will have medical coverage through an Aetna outof-area plansee the Your Medical and Prescription Drug Coverage During Your First 90 Days chart for the plan that applies to you. You can see any doctor; however, consider using a doctor who participates in the BlueCard PPO network, which will be the network youll use as of your 91st day. To find a network provider, go to www.livetheorangelife.com, click Find a Provider/ Transition of Care, then click Anthem Blue Cross Blue Shield. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical expenses during your first 90 days.
If You Are Enrolled in the High Deductible Health Plan

During your first 90 days of coverage, you will have coverage under the Aetna $1,000 Deductible Out-of-Area (OOA) plan.
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If You Are Enrolled in a Kaiser Permanente Colorado, Mid-Atlantic or Ohio HMO

If you are enrolled in a Kaiser Permanente Colorado, Mid-Atlantic or Ohio HMO: During your first 90 days of coverage, you will have medical coverage through the Aetna $550 out-of-area plan. During your first 90 days under this plan, you can see any doctor. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical expenses during your first 90 days. On your 91st day, your Kaiser Permanente HMO coverage will begin and you will have to use Kaiser Permanente HMO providers or no benefits will be paid. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Aetna 90-day medical plan will be carried over into the Kaiser Permanente HMO that you enrolled in if you call Kaiser Permanente and provide EOBs documenting your expenses during your first 90 days. During your first 90 days of coverage, your prescription drug coverage will be through Aetna. For information about your prescription drug coverage, see the Aetna Prescription Drug Coverage During Your First 90 Days chart. Be sure to keep all of your EOBs documenting any of your prescription drug expenses during your first 90 days. On your 91st day, your prescription drug coverage through Kaiser Permanente will begin. Call Kaiser Permanente to have any out-of-pocket maximum you have satisfied in the 90-day prescription drug plan carried over into your Kaiser Permanente plan.
If You Are Enrolled in an Out-of-Area Medical Plan

If you are enrolled in an out-of-area medical plan: During your first 90 days of coverage, you will have medical coverage through an out-of-area plan administered by Aetnasee the Your Medical and Prescription Drug Coverage During Your First 90 Days chart for the plan that applies to you. You can see any doctor; however, consider using a doctor who participates in the BlueCard PPO network; the administrator for your OOA medical plan as of your 91st day is AnthemBCBS. Even if you are in an out-of-area option, you can still save money by taking advantage of the network discounts if you choose to go to a BlueCard PPO network provider. To find a network provider, go to www.livetheorangelife.com, click Find a Provider/Transition of Care, then click Anthem Blue Cross Blue Shield. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical expenses during your first 90 days. On your 91st day, your BCBS medical coverage will begin. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Aetna 90-day medical plan will be carried over into the BCBS plan that you enrolled in if you call BCBS and provide EOBs documenting your expenses during your first 90 days. During your first 90 days of coverage, your prescription drug coverage will be through Aetna. For information about your prescription drug coverage, see the Aetna Prescription Drug Coverage During Your First 90 Days chart. Be sure to keep
all of your EOBs documenting any of your prescription drug expenses during your first 90 days. On your 91st day, the Caremark prescription drug coverage you enrolled in will begin. Call Caremark to have any out-of-pocket maximum you have satisfied in the 90-day prescription drug plan carried over into your Caremark prescription drug plan.
Additional State-Mandated Eligibility Rules During Your First 90 Days

If you are a resident of Kansas, Louisiana, Ohio, Texas or Washington, additional state-mandated eligibility rules apply to you during your first 90 days as shown in the chart later in this chapter. Keep in mind that the Home Depot eligibility requirements described in the Eligibility and Enrollment chapter apply as of your 91st day. In other words, if you enroll a dependent based only on the state-mandated rule and he or she does not meet the Home Depot eligibility requirements, he or she will not be eligible for coverage as of your 91st day. Any dependent who is enrolled in medical coverage based solely on a statemandated eligibility rule and loses eligibility on your 91st day of employment is eligible for coverage under COBRA and will receive information about COBRA coverage in the mail. Questions? Call the Benefits Choice Center at 1-800-555-4954.
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Aetna Prescription Drug Coverage During Your First 90 Days*

Coverage1 Deductible (individual/family) Out-of-Pocket Maximum (individual/family) Mandatory Generic if you receive a brand drug when a generic equivalent is available Retail Generic Preferred Brand Non-Preferred Brand Mail Order Generic Preferred Brand Non-Preferred Brand You pay 20% You pay 25% You pay 45% You pay 20% You pay 25% You pay 45% None $750/$1,500 The generic coinsurance plus the difference in the cost of the brand and the generic drug
* Oral contraceptives purchased in a 30-day supply can be obtained through a retail pharmacy during your first 90 days; beginning on your 91st day, oral contraceptives are available only through the mail-service program or if you receive a 90-day supply at a CVS pharmacy.
1
You must use pharmacies that participate in the Aetna network; there is no coverage for prescriptions received from an out-of-network pharmacy.
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Eligibility Rules During Your First 90 Days

If you are enrolled in a medical plan that requires 90-day coverage, the eligibility rules are the same as those described in the Eligibility and Enrollment chapter except for the following: You can enroll your spouse if you are legally separated. Keep in mind that on your 91st day, your spouse is not eligible for coverage if you are legally separated. The rules for dependent children during your first 90 days are: Natural and adopted children and children placed with you for adoption; Stepchildren and children for whom you have custody or are a legal guardian; and Children of your same-sex domestic partner.
Keep in mind that additional eligibility requirements for dependent children apply on your 91st day. See the Eligibility and Enrollment chapter for information. In addition to the same-sex domestic partner requirements in the Eligibility and Enrollment chapter, the following requirements apply during your first 90 days: Your same-sex domestic partner must be of the age of consent in your state of residence (keep in mind that you cannot cover a same-sex domestic partner under the age of 18 as of your 91st day) You may be asked to demonstrate your samesex domestic partners interdependence with you by submitting proof of at least three of the following:
Common ownership of real property (joint deed or mortgage agreement) or a common leasehold interest in property; Common ownership of a motor vehicle; Drivers license listing a common address; Proof of joint bank accounts or credit accounts; Proof of designation as the primary beneficiary for life insurance or retirement benefits, or primary beneficiary designation under your will; or Assignment of a durable property power of attorney or health care power of attorney. If you cover a dependent who meets the 90-day eligibility requirements but does not meet the eligibility requirements as of the 91st day you must call the Benefits Choice Center to remove that dependent from your coverage as of the 91st day.
State-Mandated Eligibility Rules During Your First 90 Days

State Kansas Mandates Mandates coverage for the delivery expenses incurred by the birth mother, upon the request of the adopting parent who is the insured. The birth mother will be considered a dependent of the adopting parent and will be subject to the same deductible, coinsurance and limitations or exclusions of coverage applicable to dependents. No other benefits will be payable for the expenses incurred after the birth mother is discharged from the facility where the child is born. Grandchildren who are legal wards No student status or financial dependency required Coverage for an unmarried child until the childs 28th birthday. Mandates coverage for grandchildren if the insured claims the child as a dependent for tax purposes. However, this requirement can only be applied to the grandchilds initial application. Mandates coverage for state registered domestic partners
Louisiana Ohio Texas Washington
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If You Are a California Associate

For California Associates: Your Medical and Prescription Drug Coverage During Your First 90 Days
For your first 90 days of coverage You enrolled in: Health Net HMOBasic and Standard Kaiser Permanente HMO Basic and Standard $450 Health Net Out-of-Area Plan $1,200 Health Net Out-of-Area Plan Your medical coverage is: $450 Health Net Out-of-Area Plan $450 Health Net Out-of-Area Plan $450 Health Net Out-of-Area Plan $1,200 Health Net Out-of-Area Plan Your prescription drug coverage is through: Health Net Health Net Health Net Health Net On your 91st day of coverage Your medical coverage will be: Health Net Kaiser Permanente $450 Health Net Out-of-Area Plan $1,200 Health Net Out-of-Area Plan Your prescription drug coverage will be with: Health Net Kaiser Permanente Health Net Health Net
If You Are Enrolled in a Health Net HMO

During your first 90 days of coverage, you will have medical coverage through the Health Net $450 Out-of-Area (OOA) plan. You can see any doctor; however, consider using a doctor who participates in the Health Net Elect Open Access (EOA) network, which will be the network youll use as of your 91st day. To find a network provider, go to www.livetheorangelife.com, click Find a Provider, then click Health Net. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical expenses during your first 90 days. On your 91st day, your Health Net HMO coverage will begin and you will have to use a Health Net EOA network provider or no benefits will be paid. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Health Net $450 OOA medical plan automatically will be carried over into the out-of-pocket maximum of the Health Net HMO that you enrolled in.
If You Are Enrolled in a California Kaiser Permanente HMO

During your first 90 days of coverage, you will have medical coverage through the Health Net $450 Out-of-Area (OOA) plan. During your first 90 days under this plan, you can see any doctor. Be sure to keep all of your explanation of benefit statements (EOBs) documenting any of your medical expenses during your first 90 days. On your 91st day, your Kaiser Permanente HMO coverage will begin and you will have to use Kaiser Permanente HMO providers or no benefits will be paid. Any part or all of the deductible and out-of-pocket maximum that you satisfy under the Health Net $450 OOA medical plan will be carried over into the out-of-pocket maximum of the Kaiser Permanente HMO that you enrolled in if you call Kaiser Permanente and provide EOBs documenting your expenses during your first 90 days.
Availability of Health Net Salud y Mas Option During Your First 90 Days
The Health Net Salud y Mas option is available (1) at annual enrollment and (2) in conjunction with a qualified life event after you have completed 90 days of service.
Grandfathered Plans
The Home Depot Medical and Dental Plan believes the following plans - Aetna 90-day, Aetna/SRC parttime plans, Kaiser HMO Georgia Basic, Kaiser HMO Georgia Standard, Kaiser HMO Northwest Basic, Kaiser HMO Northwest Standard, Health Net OOA $450, and Health Net OOA $1,200 - are grandfathered health plans under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.
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Being a grandfathered health plan means that your plan or policy may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the Benefits Choice Center. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-4443272 or www.dol.gov/ebsa/healthreform. This web site has a table summarizing which protections do and do not apply to grandfathered health plans.
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U.S. Medical
(Except California and Hawaii)
Chapter Contents
45 45 47 48 49 52 64 69 72 82
Contacting your Medical Plan Types of Medical Plans (PPO, HMO, OOA) PPO and OOA Plans How the PPO and OOA Plans Work Using the PPO Network Benefit Coverage Charts for PPO and OOA Plans Medical Programs: Aetna Medical Programs: Anthem Blue Cross Blue Shield Whats Covered by the PPO and OOA Plans What the PPO and OOA Plans Do Not Cover
85 91 91 93 93
Prescription Drug Plan for PPO and OOA Plans High Deductible Health Plan (HDHP) How the HDHP works HDHP Prescription Drug Coverage Whats Covered by the HDHP
103 What the HDHP Does Not Cover 106 Benefit Coverage Chart for the HDHP 110 HMO Plans 127 General Information for all Medical Plans
U.S. Medical (except California and Hawaii)
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The information below is provided so that you can get in touch easily with your Medical Plan. You may also contact the Benefits Choice Center at 1-800-555-4954.
Contacting Your Medical Plan

Medical Plan Provider PPO Plans Aetna Anthem Blue Cross Blue Shield High Deductible Health Plan Aetna HMO Plans Kaiser Permanente Out-of-Area Plans Anthem Blue Cross Blue Shield 1-877-434-2734 www.livetheorangelife.com 1-855-9KAISER (1-855-952-4737) http://my.kp.org/homedepot 1-800-695-9744 www.livetheorangelife.com 1-800-695-9744 1-877-434-2734 www.livetheorangelife.com www.livetheorangelife.com Toll-Free Number Internet Address
For Information on the California and Hawaii medical plans, see the California Medical chapter and the Hawaii Medical chapter.
The Medical Plans

The Company offers you a choice of Medical Plans designed to help you and your family maintain good health and also to offer protection from the financial burden of a serious illness or injury. All Plans offer access to a selection of doctors, specialists, hospitals and other health care providers. All Plans pay benefits only for covered
services that are considered by the claims administrator to be medically necessary or as indicated within the Plans guidelines for care. Some of the coverage options are grandfathered plans under the new Health Care Reform laws. Please read more about this in Grandfathered Plans later in this chapter.
New Salaried Associates: Please review the For New Salaried Associates: Medical Coverage During Your First 90 Days chapter for important information regarding medical and prescription drug coverage during your first 90 days of employment.
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Types of Plans Available
Type of Plan PPO plans: $550 Deductible $750 Deductible $1,000 Deductible Administered by: Network: Depending on where you live: Aetna OR Anthem-Blue Cross Blue Shield Aetna members: Aetna Choice POS II network Anthem-Blue Cross Blue Shield members: BlueCard PPO network Aetna Choice POS II network
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How the Plans Are Different There are three main differences in the plans: how much you pay for the coverage through payroll deductions how much you pay out-of-pocket for deductibles, copayments or coinsurance whether or not you can go to out-of-network providers and receive benefits
Healthy Living Credits

If you enroll in a Home Depot medical plan, you may be eligible to receive healthy living credits in each biweekly paycheck. If you enroll your spouse/domestic partner in a Home Depot medical plan, you may be eligible to receive additional healthy living credits in each biweekly paycheck. See the chart below for an overview of the credits. More information on these credits can be found in the Eligibility and Enrollment chapter and on www.livetheorangelife.com.
Credit Tobacco-free Credit Biweekly Amount Associate: $10 Spouse: $10 Who is Eligible? Associate and spouse/ domestic partner who have been tobaccofree for 6 months or more (or have never used tobacco) and are covered under a Company medical plan Associate and spouse/ domestic partner who enroll in a Company medical plan and complete the health assessment AND the associate participates in the Hidden Health Risk Screening
High Deductible Health Plan (HDHP) with Health Savings Account (HSA) HMO plans (availability depends on where you live) Out-of-area (OOA) plans
Aetna
Coverage Categories
You may select one of four coverage categories for the Medical Plans: associate only associate + spouse (or same-sex domestic partner) associate + child(ren) associate + family (children and spouse or same-sex domestic partner)
Health Assessment & Hidden Health Risk Screening Credit Associate: $25 Spouse: $25
Depending on where you live: Kaiser Permanente
Kaiser Permanente local network
Anthem-Blue Cross BlueCard PPO Blue Shield network*
* You can use any doctor; however, consider using a doctor who participates in the BlueCard PPO network to save money by taking advantage of the network discounts.
Youll see the plans available to you on the Your Benefits Resources web site when you enroll.
ID Cards
Once you become covered under a Home Depot Medical Plan, you will receive an identification (ID) card(s). Keep your ID card with you at all times, and show it at your doctors office each time you receive medical treatment. It will help your doctor verify your benefits. If you are in a PPO, the HDHP or an OOA medical plan, youll receive a separate ID card from Caremark. Please note that the possession of an ID card does not entitle you to benefits. Your enrollment in a medical plan must be effective when medical services are received for you to be entitled to benefits.
Comparison of the Medical Plans

Because the Company understands that each associates situation is unique, a variety of Medical Plans are available. Associates who select a PPO or Out-of-Area medical option also select a separate prescription drug plan that best suits their familys needs. Associates who select an HMO or the HDHP do not choose a separate prescription drug plan---prescription drugs are included in the HMOs and the HDHP.
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Get the Most Value from Your PPO or OOA Plan
What do you need?
PPO plans Find an in-network provider (doctor, hospital) Precertify planned hospital stays, inpatient surgery and other services that require precertification Register in a maternity care program Contact your disease management program Contact the Healthy Body Healthy Weight Program Find out more about bariatric surgery requirements Prescription Drug Coverage for PPO Plans
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Find it here...
Aetna Anthem Blue Cross Blue Shield Go to www.livetheorangelife.com and click on Find a Provider > Medical, and then choose the health plan that you are enrolled in 1-800-223-6857 1-877-434-2734
For more information in this chapter, find it here

Aetna Finding In-Network Providers Aetna: Precertification Program Aetna: Maternity Care Programs Aetna: Disease Management Program Bariatric Surgery Enrolling in the Prescription Drug Plan Anthem-BCBS: Precertification Program Anthem-BCBS: Future Moms Anthem-BCBS: Disease Management Anthem Blue Cross Blue Shield
Information about the Hidden Health Risk Screenings Hidden Health Risk Information Line: 1-877-870-5063 Beginning Right: 1-800Future Moms: CRADLE-1 (1-800-272-3531) 1-800-828-5891 Aetna Health Connections: 1-800-695-9744 1-800-695-9744 Active Disease Management: 1-877-904-8702 1-877-434-2734
Aetna and Anthem BCBS: 1-800-606-1031 CVS Caremark: Call 1-866-490-3376 (866-490-DEPO) or go to www.caremark.com
PPO and OOA Plans

The Company offers three PPO options. Your benefits depend on whether you use your Plans in-network providers or you use out-of-network providers. Using in-network providers lowers the cost of health care services for you and for the Company. $550 Deductible Plan. You pay more in payroll deductions so that you can have lower deductibles and out-of-pocket maximums. $750 Deductible Plan. The $750 Deductible option has a lower payroll deduction than the $550 Deductible with a higher deductible and out-of-pocket maximum. $1,000 Deductible Plan. Offers the lowest payroll deduction among the PPO Plans. Your out-of-pocket maximum, deductible, coinsurance for out-of-network care and copayments are higher
than with other choices, but you still have comprehensive coverage. For more information, see How the PPO and OOA Plans Work. Covered services, limitations and exclusions for the PPO Plans are listed in Whats Covered by the PPO and OOA Plans and What the PPO and OOA Do Not Cover.
a provider in the BlueCard PPO network, you will be able to pay your copay and the provider will submit the claim for you. If you receive services from a provider that is not in the network, you will need to pay out of your pocket at the time of service and submit a claim for reimbursement. For more information on finding BlueCard PPO providers, see Finding In-Network Providers earlier in this chapter. For more information on how the OOA Plans work, see How the PPO and OOA Plans Work in this chapter. If you live in California, see the California Medical chapter. Covered services, limitations and exclusions for the Out-of-Area Plans are listed in the Whats Covered by the PPO and OOA Plans and What the PPO and OOA Plans Do Not Cover sections.
Out-of-Area Plans
If your ZIP code is outside the standard network areas, you may choose the $550, $750 or $1,000 Out-of-Area Plan. You may go to any doctor and receive the same benefits as you would in-network for the PPO $550, $750 or $1,000 Plans. The Out-of-Area Plan is administered by AnthemBlue Cross Blue Shield. If you receive services from
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How the PPO and OOA Plans Work
Annual Deductible
For most medical services, the PPO and OOA Plans begin to pay in-network benefits and out-of-network benefits only after you and your family pay an initial amount of covered medical expenses. This is called your annual deductible. Keep in mind, there is a separate deductible for the Prescription Drug Plan noted later in this chapter. The annual deductibles by Plan are:
Out-ofNetwork Individual/ Family $1,100/$3,300 $1,500/$4,500 $2,000/$6,000 n/a n/a n/a
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claims incurred at out-of-network providers count only toward the out-of-network deductible. If you have more than three covered family members (including yourself), once the total amount applied toward your family deductible reaches the maximum amount, no other family member has to pay toward the deductible for the remainder of that Plan year. No individual family member, however, can be credited with more than the amount of the individual deductible toward the annual family deductible. For example, if you are enrolled in the $550 Plan, use only in-network providers and have four members in your family with each member incurring covered medical expenses of $450 toward his or her individual deductible within the same year of coverage, your family deductible has been met for in-network coverage when the fourth family member reaches $300 in medical expenses ($450 x 3 + $300 = $1,650).
Out-of-Pocket Maximums
After your annual deductible is satisfied, the Plan pays a portion of your eligible costs. The amount depends on the type of Plan you choose and whether you use in-network or out-of-network providers. The annual deductible and the portion you pay for covered expenses are your out-of-pocket expenses. However, the Plan limits the amount you have to pay out of your own pocket for in-network and out-of-network services.
Out-ofPocket Maximums* $550 Deductible $750 Deductible $1,000 Deductible $550 Out-ofArea Plan $750 Out-ofArea Plan $1,000 Outof-Area Plan In-Network Individual/ Family $3,000/$6,000 $4,000/$8,000 $5,000/$10,000 $3,000/$6,000 $4,000/$8,000 $5,000/$10,000 Out-of-Network Individual/ Family $6,000/$12,000 $8,000/$16,000 $10,000/$20,000 n/a n/a n/a
In-Network Individual/ Family $550 Deductible $750 Deductible $1,000 Deductible $550 Outof-Area Plan $750 Outof-Area Plan $1,000 Outof-Area Plan $550/$1,650 $750/$2,250 $1,000/$3,000 $550/$1,650 $750/$2,250 $1,000/$3,000
Hospital Copay
Depending on the Medical Plan you select, you or a covered family member may be required to pay a hospital admission copay in addition to your annual deductible.
Per Admission Copay $550 Deductible $750 Deductible $1,000 Deductible Out-ofNetwork $600 $600 $600
*Includes annual deductible.
If you have three or fewer family members (including yourself) covered by the Medical Plan, you and each of your family members must satisfy the individual deductible. This means that you pay for your covered expenses up to the deductible before the Plan begins paying benefits for that individual (except for services for which the deductible doesnt apply). Medical services received at in-network providers count only toward the in-network deductible. Medical
In-Network $150 $200 $250
Out-of-pocket expenses for in-network and outof-network services are not combined when determining if deductibles or maximums have been met. If you and your covered family members use innetwork and out-of-network providers during the same plan year, out-of-pocket expenses will accumulate separately toward the deductibles and out-of-pocket amounts.
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The Plan pays 100% of most covered in-network and out-of-network medical expenses incurred during the remainder of the calendar year when: you or a covered family member has reached the individual out-of-pocket expense limit; or your familys out-of-pocket expenses total the family limit. Your annual deductible counts toward your out-ofpocket maximum. Please keep in mind there is a separate out-of-pocket maximum for the Prescription Drug Plan. The Plan does not count the following expenses toward your annual out-of-pocket maximum: copayments for in-network office visits penalties imposed by the Plan for out-of-network services when you or a covered family member fails to use the precertification program as required (see Aetna Precertification Program or AnthemBlue Cross Blue Shield Precertification Program in this chapter for information) any expenses not covered by the Plan the hospital per admission copay cost for mail service prescription drugs and the pharmacy management program. See Prescription Drugs later in this chapter for more information. amounts over the reasonable and customary charge for the services received. Does not apply to Out-of-Area Plans. When using an in-network provider for services, copayments (such as the copayment for in-network office visits) are not applied toward the annual
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deductible or the out-of-pocket maximum. Also, when you or your covered family members meet the out-of-pocket maximum, only those services with an annual deductible and coinsurance will be paid at 100% for the rest of that year. Your options annual deductible applies toward your annual out-of-pocket maximum. You will always pay the copayments for in-network services, as well as any other expenses not covered by the Plan. For the Out-of-Area plans, out-of-pocket maximums are combined for in-network and out-of-network services. Lifetime Maximum The Plan provides medical benefits (in-network and out-of-network services combined) with an unlimited lifetime maximum for you and each covered family member. The Plan has other limitations on specific types of services as listed in the PPO Plans Summary of Benefits charts. Office Visit Copayments The amount of your office visit copayment (and how much you pay through payroll deductions for office visit coverage) depends on which medical option you select and whether you visit a PCP or a specialist. Primary Care Physician (PCP) This is the network provider who: Is selected from the list of primary care physicians in your networks directory; supervises, coordinates and provides initial care and basic medical services as a general or family care practitioner, or in some cases, as an internist or a pediatrician; initiates referrals for specialist care and maintains continuity of patient care. However, referrals are not required in the PPO and OOA plans. Specialist A physician who practices in any generally accepted medical or surgical sub-specialty. 49
Office Visit Options $550 Deductible $750 Deductible $1,000 Deductible
PCP Office Visits $25 copayment $30 copayment $30 copayment
Specialist Office Visits $35 copayment $45 copayment $45 copayment
Aexcel Specialist Office Visits (applies to Aetna members only) $25 copayment $30 copayment $30 copayment
For more information on Aexcel, see Aetna Programs: Finding an Aexcel Specialist in this chapter.
Using PPO In-Network Providers

Using In-Network Providers
It pays to use providers that participate in the network applicable to your medical plan administrator: For Aetna members: the Aetna Choice POS II network For Anthem-Blue Cross Blue Shield members: the BlueCard PPO network When you use in-network providers (doctors, specialists, hospitals and other health care providers who participate in the network), the Medical Plan begins to work for you immediately. Heres how: Doctor office visitsYou pay a copayment (the amount depends on which medical option you choose) with no deductible for most charges related to the treatment of covered illnesses and injuries. Emergency room careAlways try to locate an in-network provider when you require emergency room care away from home. However, in a life-

threatening emergency if you receive emergency room services from an out-of-network provider, your emergency room services will be covered at the in-network level. Hospitals and other servicesFor most other covered medical services (such as inpatient and outpatient surgeries, home health care, inpatient mental health and substance abuse treatment, alternative treatment centers, etc.), you pay a portion of pre-negotiated charges after you meet the Plans individual annual deductible. You also are required to pay a hospital copay if admitted for an inpatient hospital stay. For deductibles related to the Plans, see Annual Deductible and Hospital Copay in How the PPO and OOA Plans Work. Fees for servicesIn general, the pre-negotiated fees charged by in-network providers are lower than those you might otherwise pay out-of-network providers for the same service. Medical claim formsYou do not file medical claim forms when you receive in-network services. Your doctor will file claims for you and will receive payment from your plan directly for the covered services. Refer to the PPO Plans Summary of Benefits charts for a detailed list of benefits. By using network providers, you get the best value from the Plan because you receive the greatest level of coverage. The same doctors, hospitals and other health care providers may not be included in the provider network from year to year. In addition, before you schedule an appointment, you should always confirm the doctors, hospitals or other health care providers participation in the network by contacting your claims administrator.
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Finding In-Network Providers To find a network provider, go to www.livetheorangelife.com, click Find a Provider and click Find Provider Directory. A listing of providers is available to you upon request. Once you have identified a doctor, call the doctors office to verify that new patients are being accepted. When you make an appointment, make sure to give the doctors office your medical ID card.
If your out-of-network provider charges more than the Aetna recognized charge (for physician services) you will be responsible for paying your share of the recognized charges plus 100% of any charges over the recognized charge. Charges that you pay in excess of the recognized charge do not count toward your deductible or your out-of-pocket maximum.
Using Out-of-Network Providers (Excluding Dialysis)

When you use out-of-network providers (doctors, specialists, hospitals and other health care providers not participating in the network), you pay a portion of most covered services after you meet your plans individual annual deductible. Refer to the PPO Plans Summary of Benefits for a detailed list of out-of-network benefits.
Non-Participating Physician Services for Anthem BCBS Members

Since out-of-network providers can charge any amount for their services, the Plan will pay benefits only on charges considered reasonable and customary (R&C). R&C is the amount charged by the majority of doctors for the same medical services and procedures within the same geographical area. This amount is determined by insurance companies and is used as the maximum allowable amount for calculating the benefit they will pay for medical services. Generally, claims for a particular procedure are eligible for full benefits; however, some medical claims submitted to the plan will be above the R&C level. If your out-of-network doctor charges more than the R&C level, you will be responsible for paying your share of the covered charges plus 100% of any charges over the R&C level. Fees charged by participating providers are pre-negotiated and do not exceed R&C levels. R&C levels do not apply to the Out-of-Area plans.
Non-Participating Physician Services for Aetna Members

Out-of-network providers can charge any amount for their services. The Plan will pay benefits on physician services only if the charges are less than or equal to the Aetna recognized charge. The recognized charge for a service or supply is the lowest of: The provider's usual charge for furnishing it; or The charge Aetna determines to be appropriate based on factors such as the cost of providing the same or a similar service or supply and the manner in which charges for the service or supply are made, billed or coded.
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Hospital Services
Out-of-network hospitals can charge any amount for their services. The Plan will pay benefits on hospital services only if the charges are considered reasonable and customary (R&C). R&C is the amount charged by the majority of hospitals for the same medical services and procedures within the same geographical area. This amount is determined by insurance companies and is used as the maximum allowable amount for calculating the benefit they will pay for medical services. If your out-of-network provider charges more than the R&C level (for hospital services), you will be responsible for paying your share of the covered charges plus 100% of any charges over R&C level. Charges that you pay in excess of R&C level do not count toward your deductible or your out-of-pocket maximum. Recognized charges and R&C levels do not apply to the following: Out-of-Area plans Care members receive because of circumstances outside of their control such as: Emergency care at out-of-network facilities services from out-of-network doctors (radiologists, anesthesiologists, pathologists) at in-network facilities To receive out-of-network benefits, you must submit a claim form along with original itemized bills for services covered under your Plan.
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Using Out-of-Network Providers for Dialysis

Out-of-network coverage for dialysis services performed at an outpatient dialysis treatment center (including all pharmacy, Epoetin (EPO), injectable drugs, biologics, laboratory, diagnostic testing and supplies) will be as follows: $550 & $750 Deductible Options: You pay 40% after deductible, subject to a $650 maximum per visit. Charges that you pay above the $650 per-visit maximum do not apply to the annual out-of-pocket maximum and would be your responsibility. $1,000 Deductible Option: You pay 50% after deductible, subject to a $650 maximum per visit. Charges that you pay above the $650 per-visit maximum do not apply to the annual out-of-pocket maximum and would be your responsibility.
How to Receive Out-of-Network Benefits

To receive out-of-network benefits, you must submit a claim form along with original itemized bills for services covered under your Plan. Refer to Filing Claims Under the Medical Plans in the Claims and Appeals chapter for more information on filing out-of-network claims. When you use out-of-network providers, the Plan begins to pay benefits after you and/or your family meets the Plans annual deductible (see Annual Deductible for more information). After the annual deductible is met, the Plan pays a percentage of most covered medical expenses incurred during the same year by you and your covered family members. Expenses that you pay in excess of the reasonable and customary level do not count toward your deductible or your out-ofpocket maximum. You will be responsible for paying the difference between what the Plan pays and what your doctor charges. This includes any amounts over the reasonable and customary level.
If You Are in an Aetna Plan

If you decide to utilize an Aetna network dialysis treatment center, you may be eligible for transition of care coverage. For additional information, please call Aetna member services at 1-800-695-9744.
If You Are in an Anthem BCBS Plan

If you decide to utilize a BlueCard PPO network dialysis treatment center, you may be eligible for transition of care coverage. For additional information, please call Anthem BCBS member services at 1-877-434-2734.
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$550 Deductible Option
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In-Network (You Pay) Medical Lifetime Maximum DeductiblePer calendar year Family Deductible Limitonce met, all family members will be considered as having met their deductible for the remainder of that calendar year. Coinsurance Out-of-Pocket MaximumIdentifies the maximum amount of out-of-pocket expenses that a member will have to pay in a calendar year for most services. Once the limit is met, most expenses will be paid at 100% for the remainder of that calendar year. Family Out-of-Pocket MaximumSpecifies the amount which a family must meet before all family members receive reimbursement at 100%. Primary Care Physician's Office VisitApplies to internist, general physician, family practitioner or pediatrician. Specialist Office Visit Aexcel1 Specialist Office VisitSee Finding an Aexcel1 Specialist Office Visit to Non-Aexcel1 Specialist When An Aexcel1 Specialist is Available Walk-in Clinic Preventive Care
2
Out-of-Network (You Pay) Unlimited $1,100 $3,300 40% $6,000 includes deductible
Unlimited $550 $1,650 20% $3,000 includes deductible
$6,000 includes deductible $25 PCP copay $35 Specialist copay $25 Specialist copay $50 Specialist copay $15 copay
$12,000 includes deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible
Well Child CareIncludes routine immunizations, travel immunizations & flu shots. Age/frequency guidelines suggest 7 exams in 1st 12 months of life, 3 visits in second 12 months of life; 3 visits in 3rd 12 months of life; 1 exam per calendar year thereafter to age 18 Adult Routine Physical Exam1 exam per calendar year Adult and Child Routine Immunizations, Travel Immunizations and Flu Shots Routine GYN1 routine GYN exam per calendar year with 1 pap smear & related lab fees Routine Mammogramage/frequency guidelines suggest baseline at age 35, 1 every 2 calendar years after age 35 and 1 every calendar year after age 403 Routine Prostate Specific Antigen (PSA) Test and Digital Rectal Exams (DRE)age/frequency guidelines suggest 1 routine DRE and PSA per calendar year for males age 40 and over Colorectal Cancer ScreeningsAge/frequency guidelines suggest all members age 50+: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), Double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years).3 Routine Eye Exam
100% Covered, no copay, no deductible
40%, no deductible
100% Covered, no copay, no deductible 100% Covered, no copay, no deductible 100% Covered, no copay, no deductible 100% Covered, no copay, no deductible 100% Covered, no copay, no deductible 100% Covered, no copay, no deductible
40%, no deductible 40%, no deductible 40%, no deductible 40%, no deductible 40%, no deductible 40%, no deductible
Not Covered; discounts available
1 Aexcel network not applicable for BCBS members; 2 For all coverage options, services are covered as recommended by the United States Preventive Services Task Force (USPSTF). Immunizations will be covered as recommended by the Centers for Disease Control (CDC). For the list of the recommended preventive services, please visit USPSTF website, www.healthcare.gov/center/regulations/prevention/recommendations.html. 3 Under certain circumstances, age/frequency limits may vary based on risk factors.
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In-Network (You Pay) Hospital Care Inpatient Copay/DeductiblePer admission Inpatient Hospital CoinsuranceIncludes inpatient surgery expenses, room & board & misc fees, physician expenses, routine nursery care, prescription drugs and all other inpatient care. Outpatient Hospital ExpensesHospitals and other facilities (i.e., ambulatory surgery center, hospital outpatient dept.). Includes short-term rehabilitation in a hospital outpatient setting. Other Physician Services AcupunctureCovered in lieu of anesthesia only Allergy Testing & TreatmentOffice Visit Allergy Testing & Treatmentperformed in an independent lab Allergy InjectionsNot given by the physician, or not in conjunction with an office visit Maternity /ObstetricsDelivery charges are covered under the Hospital benefit, subject to the per confinement copay, if any. Second Surgical Opinion Outpatient SurgerySurgeon's charges performed in an office setting. Outpatient SurgerySurgeon's charges performed in other settings (outpatient department of hospital or ambulatory surgery center) Diagnostic Procedures Diagnostic LabPerformed in a doctors office as part of physician office visit and billed by a physician, covered same as physician office visit cost sharing Diagnostic Labperformed in an independent lab Diagnostic Labperformed in an outpatient hospital Diagnostic X-rayPerformed as part of physician office visit and billed by physician, covered same as physician office visit cost sharing Diagnostic X-rayPerformed in a free-standing facility or outpatient hospital Complex imaging servicesPerformed as part of physician office visit and billed by physician, covered same as physician office visit cost sharing Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanfree-standing facility Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanoutpatient hospital Covered at applicable PCP or Specialist office visit cost sharing 100% Covered, no copay, no deductible 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible 20%, no deductible 20% after deductible $150 copay 20% after deductible 20% after deductible
Out-of-Network (You Pay)
$600 copay 40% after deductible 40% after deductible
40% after deductible
Covered at applicable PCP or Specialist Office Visit cost sharing 100% covered, no copay, no deductible 100% Covered, no copay, no deductible OB Visits - Specialist office visit copay applies to 1st prenatal visit only. 40% after deductible 40% after deductible 40% after deductible
Covered at applicable PCP or Specialist office visit cost sharing Covered at applicable PCP or Specialist office visit cost sharing 20% after deductible 40% after deductible
40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible 40% after deductible
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In-Network (You Pay) Emergency Medical Care Urgent Care Facility Emergency RoomAny copay applies only to E.R. Facility expenses. Related expensesradiology, pathology, anesthesia, surgeon, etc. covered at E.R. coinsurance, no copay. Non-Emergency Use of Emergency Room AmbulanceCovers medically necessary travel. Ground ambulance for member convenience or for non-clinical reasons is not covered. Family Planning Contraceptive Devices, Implants & InjectablesMedical plan covers associated office visit for injection of Depo-Provera and Lunell, Diaphragm fitting, and Cervical Cap, IUD & Norplant devices; see Pharmacy benefit for additional contraceptive coverages Voluntary Abortion Voluntary SterilizationCovers tubal ligation & vasectomy. Excludes reversals. InfertilityCovers diagnosis and treatment of underlying cause Advanced Reproductive Technology (ART) Other Services Routine Hearing Exam Routine Hearing Exams Frequency Limits Hearing Aids
1
Out-of-Network (You Pay) 40% after deductible
$35 UCF copay 20% and $150 copay if not admitted Not covered 20% after deductible
Member cost sharing based on type of service performed and place of service where rendered
Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Not Covered
100% Covered, no copay, no deductible 1 exam per calendar year 20% after deductible 20% after deductible and $150 admission copay 20% after deductible 20% after deductible 20% after deductible and $150 admission copay 20% after deductible 20% after deductible applies to physical, occupational and speech therapy 100% Covered after $35 specialist copay 20% after deductible; foot orthotics excluded
40%, no deductible
40% after deductible 40% after deductible and $600 admission copay 40% after deductible 40% after deductible 40% after deductible and $600 admission copay 40% after deductible 40% after deductible applies to physical, occupational and speech therapy 40% after deductible 40% after deductible; foot orthotics excluded
Skilled Nursing Facility90 days per calendar year Home Health Care150 visits per calendar year Private Duty Nursing70 8-hr shifts per calendar year Inpatient Hospice Care Outpatient Hospice Care Outpatient Short-Term RehabilitationPhysician's services and services of physical, speech or occupational therapists for diagnosis of developmental delays or for treatment of acute conditions if such services will result in significant improvement in member's condition Spinal DisordersSpinal Manipulations performed by an MD, DO, chiropractor or therapist, 25 visits per calendar year Durable Medical Equipment
1 Excluding hearing aid batteries and repairs.
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In-Network (You Pay) Other Servicescontinued Prosthetics Devicese.g., artificial limb; breast prosthesis Infusion Therapye.g., chemotherapy, hydration therapy, etc. performed in the home, office or outpatient facility. Mental Health Services Inpatient Mental Disorders Coinsurance Inpatient Copay/DeductibleApplies to inpatient Mental Health & Substance Abuse. Maximum Inpatient Days Per Year Outpatient Behavioral Health VisitApplies to outpatient therapy visits in an office or other outpatient setting Maximum Outpatient Visits Per Year Residential Treatment FacilitySubject to Inpatient Pre-certification requirements Intensive OutpatientTypically 3-5 hours/day, several days per week (subject to Inpatient Pre-cert requirements) Partial HospitalizationTypically 5-8 hours/day, several days per week (subject to Inpatient Pre-cert requirements). Alcohol and Drug Abuse Services Inpatient Rehabilitation & DetoxificationIn a hospital or treatment facility Maximum Inpatient Days Per Year Outpatient Chemical Dependency VisitApplies to outpatient visits in an office or other outpatient setting Maximum Outpatient Visits Per Year 20% after deductible and $150 admission copay No Limits $25 copay No Limits 20% 20% after deductible and $150 admission copay No Limits $25 copay No Limits 20% after deductible and $150 admission copay $25 copay $25 copay 20% after deductible
40% 40% after deductible and $600 admission copay
40% after deductible and $600 admission copay 40% after deductible 40% after deductible
40% after deductible and $600 admission copay
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In-Network (You Pay) Medical Lifetime Maximum DeductiblePer calendar year Family Deductible Limitonce met, all family members will be considered as having met their deductible for the remainder of that calendar year. Coinsurance Out-of-Pocket MaximumIdentifies the maximum amount of out-of-pocket expenses that a member will have to pay in a calendar year for most services. Once the limit is met, most expenses will be paid at 100% for the remainder of that calendar year. Family Out-of-Pocket MaximumSpecifies the amount which a family must meet before all family members receive reimbursement at 100%. Primary Care Physician's Office VisitApplies to internist, general physician, family practitioner or pediatrician. Specialist Office Visit Aexcel1 Specialist Office VisitSee Finding an Aexcel1 Specialist Office Visit to Non-Aexcel1 Specialist When An Aexcel1 Specialist is Available Walk-in Clinic Preventive Care
2
Unlimited $750 $2,250 20% $4,000 includes deductible
Well Child CareIncludes routine immunizations, travel immunizations & flu shots. Age/frequency guidelines suggest 7 exams in 1st 12 months of life, 3 visits in second 12 months of life; 3 visits in 3rd 12 months of life; 1 exam per calendar year thereafter to age 18 Adult Routine Physical Exam1 exam per calendar year Adult and Child Routine Immunizations, Travel Immunizations and Flu Shots Routine GYN1 routine GYN exam per calendar year with 1 pap smear & related lab fees Routine Mammogramage/frequency guidelines suggest baseline at age 35, 1 every 2 calendar years after age 35 and 1 every calendar year after age 403 Routine Prostate Specific Antigen (PSA) Test and Digital Rectal Exams (DRE)age/frequency guidelines suggest 1 routine DRE and PSA per calendar year for males age 40 and over Colorectal Cancer ScreeningsAge/frequency guidelines suggest all members age 50+: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), Double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years).3 Routine Eye Exam
40%, no deductible
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In-Network (You Pay) Hospital Care Inpatient Copay/DeductiblePer admission Inpatient Hospital CoinsuranceIncludes inpatient surgery expenses, room & board & misc fees, physician expenses, routine nursery care, prescription drugs and all other inpatient care. Outpatient Hospital ExpensesHospitals and other facilities (i.e., ambulatory surgery center, hospital outpatient dept.). Includes short-term rehabilitation in a hospital outpatient setting. Other Physician Services AcupunctureCovered in lieu of anesthesia only Allergy Testing & TreatmentOffice Visit Allergy Testing & Treatmentperformed in an independent lab Allergy InjectionsNot given by the physician, or not in conjunction with an office visit Maternity /ObstetricsDelivery charges are covered under the Hospital benefit, subject to the per confinement copay, if any. Second Surgical Opinion Outpatient SurgerySurgeon's charges performed in an office setting. Outpatient SurgerySurgeon's charges performed in other settings (outpatient department of hospital or ambulatory surgery center) Diagnostic Procedures Diagnostic LabPerformed in a doctors office as part of physician office visit and billed by a physician, covered same as physician office visit cost sharing Diagnostic Labperformed in an independent lab Diagnostic Labperformed in an outpatient hospital Diagnostic X-rayPerformed as part of physician office visit and billed by physician, covered same as physician office visit cost sharing Diagnostic X-rayPerformed in a free-standing facility or outpatient hospital Complex imaging servicesPerformed in a doctors office as part of physician office visit and billed by a physician, covered same as physician office visit cost sharing Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanfree-standing facility Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanoutpatient hospital Covered at applicable PCP or Specialist office visit cost sharing 100% Covered, no copay, no deductible 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible 20%, no deductible 20% after deductible $200 copay 20% after deductible 20% after deductible
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In-Network (You Pay) Emergency Medical Care Urgent Care Facility Emergency RoomAny copay applies only to E.R. Facility expenses. Related expensesradiology, pathology, anesthesia, surgeon, etc. covered at E.R. coinsurance, no copay. Non-Emergency Use of Emergency Room AmbulanceCovers medically necessary travel. Ground ambulance for member convenience or for non-clinical reasons is not covered. Family Planning Contraceptive Devices, Implants & InjectablesMedical plan covers associated office visit for injection of Depo-Provera and Lunell, Diaphragm fitting, and Cervical Cap, IUD & Norplant devices; see Pharmacy benefit for additional contraceptive coverages Voluntary Abortion Voluntary SterilizationCovers tubal ligation & vasectomy. Excludes reversals. InfertilityCovers diagnosis and treatment of underlying cause Advanced Reproductive Technology (ART) Other Services Routine Hearing Exam Routine Hearing Exams Frequency Limits Hearing Aid
1
Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Not Covered
100% Covered, no copay, no deductible 1 exam per calendar year 20% after deductible 20% after deductible and $200 admission copay 20% after deductible 20% after deductible 20% after deductible and $200 admission copay 20% after deductible 20% after deductible applies to physical, occupational and speech therapy 100% Covered after $45 specialist copay 20% after deductible; foot orthotics excluded
40%, no deductible
40% after deductible 40% after deductible and $600 admission copay 40% after deductible 40% after deductible 40% after deductible and $600 admission copay 40% after deductible 40% after deductible applies to physical, occupational and speech therapy 40% after deductible 40% after deductible; foot orthotics excluded
Skilled Nursing Facility90 days per calendar year Home Health Care150 visits per calendar year Private Duty Nursing70 8-hr shifts per calendar year Inpatient Hospice Care Outpatient Hospice Care Outpatient Short-Term RehabilitationPhysician's services and services of physical, speech or occupational therapists for diagnosis of developmental delays or for treatment of acute conditions if such services will result in significant improvement in member's condition Spinal DisordersSpinal Manipulations performed by an MD, DO, chiropractor or therapist, 25 visits per calendar year Durable Medical Equipment
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In-Network (You Pay) Other Servicescontinued Prosthetics Devicese.g., artificial limb; breast prosthesis Infusion Therapye.g., chemotherapy, hydration therapy, etc. performed in the home, office or outpatient facility. Mental Health Services Inpatient Mental Disorders Coinsurance Inpatient Copay/DeductibleApplies to inpatient Mental Health & Substance Abuse. Maximum Inpatient Days Per Year Outpatient Behavioral Health VisitApplies to outpatient therapy visits in an office or other outpatient setting Maximum Outpatient Visits Per Year Residential Treatment FacilitySubject to Inpatient Pre-certification requirements Intensive OutpatientTypically 3-5 hours/day, several days per week (subject to Inpatient Pre-cert requirements) Partial HospitalizationTypically 5-8 hours/day, several days per week (subject to Inpatient Pre-cert requirements). Alcohol and Drug Abuse Services Inpatient Rehabilitation & DetoxificationIn a hospital or treatment facility Maximum Inpatient Days Per Year Outpatient Chemical Dependency VisitApplies to outpatient visits in an office or other outpatient setting Maximum Outpatient Visits Per Year 20% after deductible and $200 admission copay No Limits $30 copay No Limits 20% 20% after deductible and $200 admission copay No Limits $30 copay No Limits 20% after deductible and $200 admission copay $30 copay $30 copay 20% after deductible
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$1,000 Deductible Option
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In-Network (You Pay) Medical Lifetime Maximum DeductiblePer calendar year Family Deductible Limitonce met, all family members will be considered as having met their deductible for the remainder of that calendar year. Coinsurance Out-of-Pocket MaximumIdentifies the maximum amount of out-of-pocket expenses that a member will have to pay in a calendar year for most services. Once the limit is met, most expenses will be paid at 100% for the remainder of that calendar year. Family Out-of-Pocket MaximumSpecifies the amount which a family must meet before all family members receive reimbursement at 100%. Primary Care Physician's Office VisitApplies to internist, general physician, family practitioner or pediatrician. Specialist Office Visit Aexcel Specialist Office VisitSee Finding an Aexcel Specialist
1 1
Unlimited $1,000 $3,000 20% $5,000 includes deductible
Office Visit to Non-Aexcel Specialist When An Aexcel Specialist is Available

1 1
Walk-in Clinic Preventive Care2 Well Child CareIncludes routine immunizations, travel immunizations & flu shots. Age/frequency guidelines suggest 7 exams in 1st 12 months of life, 3 visits in second 12 months of life; 3 visits in 3rd 12 months of life; 1 exam per calendar year thereafter to age 18 Adult Routine Physical Exam1 exam per calendar year Adult and Child Routine Immunizations, Travel Immunizations and Flu Shots Routine GYN1 routine GYN exam per calendar year with 1 pap smear & related lab fees Routine Mammogramage/frequency guidelines suggest baseline at age 35, 1 every 2 calendar years after age 35 and 1 every calendar year after age 403 Routine Prostate Specific Antigen (PSA) Test and Digital Rectal Exams (DRE)age/frequency guidelines suggest 1 routine DRE and PSA per calendar year for males age 40 and over Colorectal Cancer ScreeningsAge/frequency guidelines suggest all members age 50+: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), Double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years).3 Routine Eye Exam
50%, no deductible
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In-Network (You Pay) Hospital Care Inpatient Copay/DeductiblePer admission Inpatient Hospital CoinsuranceIncludes inpatient surgery expenses, room & board & misc fees, physician expenses, routine nursery care, prescription drugs and all other inpatient care. Outpatient Hospital ExpensesHospitals and other facilities (i.e., ambulatory surgery center, hospital outpatient dept.). Includes short-term rehabilitation in a hospital outpatient setting. Other Physician Services AcupunctureCovered in lieu of anesthesia only Allergy Testing & TreatmentOffice Visit Allergy Testing & Treatmentperformed in an independent lab Allergy InjectionsNot given by the physician, or not in conjunction with an office visit Maternity /ObstetricsDelivery charges are covered under the Hospital benefit, subject to the per confinement copay, if any. Second Surgical Opinion Outpatient SurgerySurgeon's charges performed in an office setting. Outpatient SurgerySurgeon's charges performed in other settings (outpatient department of hospital or ambulatory surgery center) Diagnostic Procedures Diagnostic LabPerformed in a doctors office as part of physician office visit and billed by a physician, covered same as physician office visit cost sharing Diagnostic Labperformed in an independent lab Diagnostic Labperformed in an outpatient hospital Diagnostic X-rayPerformed as part of physician office visit and billed by physician, covered same as physician office visit cost sharing Diagnostic X-rayPerformed in a free-standing facility or outpatient hospital Complex imaging servicesPerformed in a doctors office as part of physician office visit and billed by physician, covered same as physician office visit cost sharing Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanfree-standing facility Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scanoutpatient hospital Covered at applicable PCP or Specialist office visit cost sharing 100% Covered, no copay, no deductible 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible Covered at applicable PCP or Specialist office visit cost sharing 10%, no deductible 20%, no deductible 20% after deductible $250 copay 20% after deductible 20% after deductible
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In-Network (You Pay) Emergency Medical Care Urgent Care Facility Emergency RoomAny copay applies only to E.R. Facility expenses. Related expensesradiology, pathology, anesthesia, surgeon, etc. covered at E.R. coinsurance, no copay. Non-Emergency Use of Emergency Room AmbulanceCovers medically necessary travel. Ground ambulance for member convenience or for non-clinical reasons is not covered. Family Planning Contraceptive Devices, Implants & InjectablesMedical plan covers associated office visit for injection of Depo-Provera and Lunell, Diaphragm fitting, and Cervical Cap, IUD & Norplant devices; see Pharmacy benefit for additional contraceptive coverages Voluntary Abortion Voluntary SterilizationCovers tubal ligation & vasectomy. Excludes reversals. InfertilityCovers diagnosis and treatment of underlying cause Advanced Reproductive Technology (ART) Other Services Routine Hearing Exam Routine Hearing Exams Frequency Limits Hearing Aids1 Skilled Nursing Facility90 days per calendar year Home Health Care150 visits per calendar year Private Duty Nursing70 8-hr shifts per calendar year Inpatient Hospice Care Outpatient Hospice Care Outpatient Short-Term RehabilitationPhysician's services and services of physical, speech or occupational therapists for diagnosis of developmental delays or for treatment of acute conditions if such services will result in significant improvement in member's condition Spinal DisordersSpinal Manipulations performed by an MD, DO, chiropractor or therapist, 25 visits per calendar year Durable Medical Equipment Prosthetics Devicese.g., artificial limb; breast prosthesis Infusion Therapye.g., chemotherapy, hydration therapy, etc. performed in the home, office or outpatient facility.
Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Member cost sharing based on type of service performed and place of service where rendered Not Covered
100% Covered, no copay, no deductible 1 exam per calendar year 20% after deductible 20% after deductible and $250 admission copay 20% after deductible 20% after deductible 20% after deductible and $250 admission copay 20% after deductible 20% after deductible applies to physical, occupational and speech therapy 100% Covered after $45 specialist copay 20% after deductible; foot orthotics excluded 20% after deductible
50%, no deductible
50% after deductible 50% after deductible and $600 admission copay 50% after deductible 50% after deductible 50% after deductible and $600 admission copay 50% after deductible 50% after deductible applies to physical, occupational and speech therapy 50% after deductible 50% after deductible; foot orthotics excluded 50% after deductible
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In-Network (You Pay) Mental Health Services Inpatient Mental Disorders Coinsurance Inpatient Copay/DeductibleApplies to inpatient Mental Health & Substance Abuse. Maximum Inpatient Days Per Year Outpatient Behavioral Health VisitApplies to outpatient therapy visits in an office or other outpatient setting Maximum Outpatient Visits Per Year Residential Treatment FacilitySubject to Inpatient Pre-certification requirements Intensive OutpatientTypically 3-5 hours/day, several days per week (subject to Inpatient Pre-cert requirements) Partial HospitalizationTypically 5-8 hours/day, several days per week (subject to Inpatient Pre-cert requirements). Alcohol and Drug Abuse Services Inpatient Rehabilitation & DetoxificationIn a hospital or treatment facility Maximum Inpatient Days Per Year Outpatient Chemical Dependency VisitApplies to outpatient visits in an office or other outpatient setting Maximum Outpatient Visits Per Year 20% after deductible and $250 admission copay No Limits $30 copay No Limits 20% 20% after deductible and $250 admission copay No Limits $30 copay No Limits 20% after deductible and $250 admission copay $30 copay $30 copay
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Medical Plan Programs: Aetna Programs
In this section, youll find information on these Aetna programs: Precertification Program Finding an Aexcel Specialist in Aetnas Network Maternity Care Disease Management Case Management Informed Health Line Create Your Personal Health Record Aetna Discount Programs and Services
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Aetna Precertification Program

The Aetna Plan precertification program is designed to help ensure that the treatment or surgery recommended for you and your covered family members is the most appropriate. Specifically, the program: coordinates with your doctor to obtain information required for precertification may recommend that you or your family member get a second surgical opinion may recommend an alternative treatment, which may be considered more appropriate (the choice of which treatment to receive, however, is always yours) advises your doctor or hospital if the recommended treatment is a covered health service or has been otherwise approved (the choice of which treatment to receive, however, is always yours) monitors hospital stays until you or your covered family member is discharged Your Responsibilities If you are enrolled in an Aetna Choice POS II Plan, your in-network provider should precertify all in-network services that require precertification before treatment or surgery. However, you are responsible for calling Aetnas Member Services department to precertify any out-ofnetwork services listed in the When You Need Precertification and In an Emergency sections.
When You Need Precertification You or your provider should call Aetna to precertify medical treatment at least 14 days before any planned hospital admission or inpatient surgery. To receive full benefits under the Plan, you (or your provider) must precertify services and treatments. The list of services for which you must obtain precertification includes, but is not limited to, the following: Inpatient confinements surgical and non-surgical, excluding vaginal or Caesarian deliveries skilled nursing facility rehabilitation facility inpatient hospice (except Medicare) Observation stays greater than 23 hours Reconstructive procedures that may be considered cosmetic blepharaplasty/canthopexy/canthoplasty excision of excessive skin due to weight loss rhinoplasty/rhytidectomy gastroplasty/gastric bypass pectus excavatum repair breast reconstruction/breast enlargement breast reduction/mammoplasty surgical treatment of gynecomastia lipectomy or excess fat removal sclerotherapy or surgery for varicose veins Artificial intervertebral disc surgery Lumbar spinal fusion surgery
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Uvulopalatopharyngoplasty, including laser-assisted procedures Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular joint Dental implants and oral appliances Elective (non-emergent) transportation by ambulance or medical van, and all transfers via air ambulance Outpatient hospice care Stays in a Residential Treatment Facility Private duty nursing care The following conditionally eligible services (all services deemed never effective by Aetna are excluded from coverage) stereotactic radiosurgery somatosnesory evoked potential studies cognitive skills development hyperbaric oxygen therapy ostochondral allograft/knee cochlear device and/or implantation osseointegrated implant percutaneous implant of neuroelectrode array, epidural GI tract imaging through capsule endoscopy Botox injectionsbotulinum toxin type A Alpha 1-proteinase inhibitorhuman
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negative pressure wound therapy pump high-frequency chest wall oscillation generator system Medical injectables Synagis erythropoesis stimulating agents (ESA), such as darbepoetin alpha (Aranesp), and epotein alpha (Epogen and Procrit), and epoetin beta (Micera) intravenous immunoglobin (IVIG) growth hormone blood-clotting factors interferons, when used for hepatitis C: Pegasys, Peg Intron, Rebetron, Roferon A, Intron A, Infergen\ NOTE: Some medical injectibles will only be offered through the Prescription Drug Program. Please check with Caremark; pre-certification may be required. All home health care services, including home uterine monitoring Selected durable medical equipment electric or motorized wheelchairs and scooters clinitron and electric beds limb prosthetics customized braces In-network level of benefits for nonparticipating physicians and providers for non-emergent services only when there is an identified network deficiency
Special programs to precertify mental health or substance abuse services, see your Aetna ID card Beginning Right Maternity Program, including genetic testing, antenatal testing, perinatal consultations and counseling BRCA genetic testing pre-implantation genetic testing Transplant Services for all major organ transplant evaluations and transplants including, but not limited to, kidney, liver, heart, lung and pancreas, and bone marrow replacement or stem cell transfer after high-dose chemotherapy Outpatient imaging precertification for CTs, coronary computed tomographic angiography, MRI/MRA, nuclear cardiology, PET scans through MedSolutions. Providers can request precertifications from MedSolutions via phone, fax or email: Phone: 1-888-693-3211 Fax: 1-888-693-3210 web site: www.medsolutionsonline.com Bariatric surgery: see Bariatric Surgery later in this chapter Additional Precertification Information For inquiries regarding pre-certification please call 1-800-223-6857. Precertification approvals are valid for six months in all states.
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The Plan does not require precertification for lengths of stay 48 hours or less for normal childbirth nor for lengths of stay 96 hours or less for cesarean section deliveries. If the maternity stay exceeds these lengths of stay, however, precertification is required. In an Emergency In an emergency, you or your family must notify Aetna within 48 hours of any hospital admission. Precertification is not necessary in emergency situations if you are not admitted to the hospital. Penalty for Not Precertifying If you are using out-of-network providers and you do not call Aetna to precertify a required medical treatment, the Plan will reduce your benefits by $500 per occurrence. Penalty amounts do not count toward your out-of-pocket maximum or your deductible. Precertification for Skilled Facility and In-Patient Hospice Care If precertification has been requested and denied: no benefits will be paid for room and board benefits for all other skilled facility or hospice care facility expenses will be paid at the percentage specified under your medical plan option If precertification has not been requested and the confinement (or any day of such confinement) is necessary: no benefits will be paid for room and board benefits for all other skilled facility or hospice care facility expenses will be paid at the percentage specified under your medical plan option
* This credit is not available to associates in Hawaii.
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If precertification has not been requested and the confinement (or any day of such confinement) is not necessary: no benefits will be paid for room and board no benefits for will be paid for all other expenses Precertification for Home Health Care, Outpatient Hospice Care and Skilled Nursing Care If precertification for a service or supply has been requested and denied or if certification has not been requested and the service or supply is not necessary, no benefits will be paid for the denied or unnecessary service or supply. If certification has not been requested for a service or supply and the service or supply is necessary, benefits for the necessary service or supply will be paid as follows: expenses incurred for the service or supply, up to the excluded amount, will not be covered benefits for all other covered medical expenses incurred for the service or supply will be paid at percentage specified under your medical plan option Whether or not a day of confinement or a service or supply has been precertified, no benefit will be paid if the charges for such confinement or service or supply are excluded by any other terms of this Plan. To get precertification you must call the number shown on your ID card. Such certification must be obtained before an expense is incurred. If a person's physician believes that the person needs more days of confinement or services or supplies beyond those
which have been already certified you must call to certify more days of confinement or services or supplies. Prompt written notice will be provided to you of the days of confinement and services or supplies which have been certified. If services and supplies for hospice care have been certified and the person later requires confinement in a hospital for pain control or acute symptom management, any other precertification requirement in this Plan will be waived for confinement in a hospital. Precertification for Hospital and Treatment Facility Admissions for Alcoholism, Drug Abuse or Mental Disorders If, in connection with the treatment of alcoholism, drug abuse, or a mental disorder, a person incurs covered medical expenses while confined in a hospital or treatment facility; and it has not been precertified that such confinement (or any day of such confinement) is necessary; and the confinement has not been ordered and prescribed by the BHCC or an Aetna network provider upon referral by the BHCC
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Covered medical expenses incurred on any day not certified during the confinement will be paid only as follows: With respect to expenses for hospital and treatment facility board and room: If precertification has been requested and denied, or if precertification has not been requested and the confinement is not necessary, no benefits will be paid. If precertification has not been requested and the confinement is necessary, such expenses, up to the excluded amount, will not be covered medical expenses. With respect to all other hospital and treatment facility expenses: if certification has been requested and denied, or if precertification has not been requested and the confinement is necessary, such expenses, up to the excluded amount, will not be covered medical expenses. if precertification has not been requested and the confinement is not necessary, no benefits will be paid. Whether or not a day of confinement is certified, no benefits will be payable for covered medical expenses incurred on any day of confinement as a full-time inpatient if excluded by any other terms of this plan; except that, if certification has been given for any day of confinement, the exclusions of services and supplies because they are not necessary will not be applied to hospital and treatment facility board and room.
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To get the days certified, you must call the number shown on your ID card. Such certification must be obtained before confinement as a full-time inpatient, or in the case of an emergency admission, within 48 hours after the start of a confinement as a full-time inpatient or as soon as reasonably possible. If the person's physician believes that the person needs more days of confinement beyond those which have already been certified, additional days of confinement must be certified. This must be done no later than on the last day that has already been certified.
Aetna analyzes specialists performance using nationally recognized standards from many groups, including the American Heart Association, American College of Obstetricians and Gynecologists, Agency for Health Research and Quality, Society of Thoracic Surgeons, and Centers for Medicare & Medicaid Services. To find out more about Aexcel or to find an Aexcel-designated specialty, click Find a Provider and go to the DocFind online directory at www.livetheorangelife.com. When you see the blue star symbol and/or dates next to some names, this lets you know if those doctors are Aexcel-designated (and when their designation begins or ends). If you are not in an Aexcel plan and would like to learn more about opting into an Aexcel plan, call the Benefits Choice Center at 1-800-555-4954
Aetna: Finding an Aexcel Specialist in Aetnas Network

Depending on your location, you may have access to Aetnas Performance Network that provides Aexcel-designated doctors in 12 specialty areas. These Aexcel doctors are some of the best performers, in terms of clinical performance and efficiency, in their specialty areas. When you visit an Aexcel doctor, you can eliminate referrals and you also may lower your out-of-pocket costs.
The 12 medical specialties are: Cardiology Cardiothoracic Surgery Gastroenterology General Surgery Neurology Neurosurgery Obstetrics and Gynecology Orthopedics Otolaryngology/ENT Plastic Surgery Urology Vascular Surgery
Aetna: Maternity Care Programs

If you enroll in an Aetna Choice POS II or Aetna Out-ofArea option, you are eligible to participate in the Beginning RightSM Maternity Program. As soon as your doctor confirms your pregnancy, you should immediately call Aetna to register in the Beginning Right program. The program provides comprehensive educational materials about prenatal care, labor and delivery, and newborn care. And, if you have issues or risk factors that need special attention, the program nurses can give you personal case management to find ways to lower your risks.
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Pregnant mothers can join the Smoke-Free Moms-to-Beprogram to help to stop smoking during pregnancy. Stopping smoking can lower your babys risk for preterm delivery, low birth weight, sudden infant death syndrome (SIDS). If you enrolled in an Aetna Choice POS II option and are pregnant or thinking of becoming pregnant, call 1-800-695-9744. Go Online for even more health information on womens health: www.womenshealth.aetna.com. Youll find information on pregnancy and baby care, as well as: reproductive health menopause breast health heart health migraines depression
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offers you a high-quality suite of user-friendly, webbased tools and health information resources. For more information, go to www.livetheorangelife.com or call 1-800-695-9744.
member designee, develop a case management plan. The case managers plan may reflect short and longterm goals targeted to facilitate the achievement of individual members health goal.
Aetna: Case Management Program

We base our Aetna Health Connections case management program on the Case Management Society of Americas definition of case management. Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality health outcomes. Case managers review and coordinate services for members with multiple and complex needs with identified gaps in their care and for members who are at risk for high cost or high utilization. Case managers collaborate with the member, family, caregiver, member authorized representative, treating practitioner, health care provider community and our other programs to coordinate care, with a focus on member education and maximizing quality outcomes. Case managers provide the member with information about alternative coverage or continuing care opportunities, as appropriate, and inform the member of ways to obtain that coverage or care in the event the members benefits end and the member requires additional care. Alternative options for coverage or care may include local, state, or federally funded agencies or non-profit organizations. When in case management, case managers, in coordination with the attending physician, member or
Aetna: Informed Health Line

Aetna plan participants can use the Informed Health Line 24 hours a day, seven days a week to talk with a registered nurse about your health questions. The nurse counselors can help you better understand symptoms, discuss self-care options, and decide if you should see a doctor. They also can help you better understand a diagnosis and your treatment options. Call the Informed Health Line at 1-800-895-9744. Go Online for Even More Health Information Use the Healthwise Knowledgebase to find out more about a health condition or medications you take. Healthwise Knowledgebase is easy-to-use and has powerful search functions to help you find information about more than 3,400 topicshealth conditions, medical tests and procedures, medications and everyday health and wellness issues. Content is written and reviewed by an expert team of physicians, nurses, medical writers and researchers, and updated as new research is reported. Go to www.aetna.com and access the Aetna Navigator member web site to reach Healthwise Knowledgebase.
Aetna: Disease Management Program

Aetnas Health Connections Disease Management program provides support and resources on managing more than 30 chronic health conditions. Aetna Health Connections health support is provided by more than 2,000 clinical professionals, including doctors, nurses, pharmacists, social workers, wellness counselors, nutritionists, and weight loss therapists among others. They will work with you to coordinate your health care needs, help ensure that you understand your doctor's prescribed treatment plan in order to manage a chronic medical condition, and help you learn how to embrace a healthier lifestyle. Aetna Health Connections also
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Aetna: Create Your Personal Health Record
Aetnas Personal Health Record is a secure, online tool that lets you create, view, access, and manage your personal health information and share it with your doctors. By creating your Personal Health History, you can: Keep our health information in one place. Its always available for you to access in an emergency. Share your history with your doctor. You can print your detailed health summary and take it with you to give your doctors a more detailed view of your health. Maintain or even improve your health. Based on your health profile provided by insurance claims and information you enter yourself, the Personal Health Record generates personalized health-related alerts that can help you address your health needs in a timely manner. To access and create a Personal Health Record for yourself and/or covered family members, go to www.aetna.com and access the Aetna Navigator member web site.
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discounts on complementary health services and natural products. The Aetna Natural Products and ServicesSM program provides savings through American Specialty Health Networks, Inc. This includes massage therapy, acupuncture, chiropractic care, dietetic counseling, and natural products (such as over-thecounter vitamins, yoga equipment, aromatherapy, and nutritional and health supplements). discounts on hearing services and products. Aetna HearingSM provides discounts on hearing aids, hearing exams, and hearing aid services. Go to www.hearpo.com/aetna for more information. weight management program discounts. You and your eligible family members can save on weight loss programs and products from Jenny Craig. A 30-day membership is free, then you get 30% off an OnTrack 6-month (Gold) or 12month (Platinum) membership. Or you can get 15% off a Jenny Rewards 12-month membership. Get a personalized registration coupon through your Aetna member web site. other savings programs! Aetna offers other savings programs such as discounts on Sonicare toothbrushes, discounts on Zagat.com subscriptions, discounts on eDiets memberships, and more. Go to www.livetheorangelife.com to find out about other healthy savings programs.
Medical Plan Programs: Anthem Blue Cross Blue Shield Programs

In this section, youll find information on these programs: Precertification Program Maternity Care Disease Management Case Management Discount Programs and Services
Anthem BCBS: Precertification Program

The precertification program is designed to help ensure that the treatment or surgery recommended for you and your covered family members is the most appropriate. Specifically, the program: Coordinates with your doctor to obtain information required for precertification May recommend that you or your family member get a second surgical opinion May recommend an alternative treatment, which may be considered more appropriate (the choice of which treatment to receive, however, is always yours) Advises your doctor or hospital if the recommended treatment is a covered health service or has been otherwise approved (the choice of which treatment to receive, however, is always yours) Monitors hospital stays until you or your covered family member is discharged
Aetna: Discount Programs and Services

If you enroll in one of the Aetna medical options, you may have access to these discount programs and services at no extra cost: preferred rates for fitness club memberships in the GlobalFit network (with over 2,000 locations). Go to www.globalfit/fitness for a list of participating clubs. Then enroll online or call 1-800-298-7800.
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If you are enrolled in an Anthem BCBS Plan, your innetwork provider will typically precertify all in-network services that require precertification before treatment or surgery. However, you are responsible for ensuring that the necessary precertification requirements have been met prior to treatment or surgery. You are also responsible for calling Anthem BCBS Member Services department to precertify any outof-network services listed in this section. You or your provider should call Anthem-Blue Cross Blue Shield to precertify medical treatment at least 14 days before any planned hospital admission or inpatient surgery. To receive full benefits under the Plan, you (or your provider) must precertify services and treatments. The list of services for which you must obtain precertification includes, but is not limited to, the following: Inpatient Admission: Elective admissions Emergency admissions (Claims Administrator requires Plan notification no later than two business days after admission) Newborn stays beyond mother Inpatient skilled nursing facility (SNF) Long term acute care facility (LTAC) Rehabilitation facility admissions OB related admissions (complications, excludes childbirth) Bariatric surgery: See Bariatric Surgery under Whats Covered by the PPO and OOA Plans or Whats Covered Under the HDHP
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Outpatient Services: Outpatient imaging services: All CT/CTA scans MRI/MRA/MRS PET Scans Nuclear Cardiology Echocardiograms Lumbar spinal surgeries (fusion only) UPPP surgery (uvulopalatopharyngoplasty, uvulopharyngoplasty) Plastic/reconstructive surgeries including but not limited to: Blepharoplasty Rhinoplasty Panniculectomy, Diatasis Recti Repair Insertion/Injection of Prosthetic Material Collagen Implants Chin Implant, Mentoplasty, Osteoplasty Mandible DME/Prosthetics: recommendation is to verify benefits for all DME, and medical necessity on the list below Wheelchairs; deluxe, motorized or powered, and accessories Hospital beds, rocking beds and air beds Prosthetics: electronic or externally powered and select other prosthetics Custom made and /or custom fitted prefabricated orthotics and braces Private duty nurse services in the home setting
Bariatric surgery: See Bariatric Surgery under Whats Covered by the PPO and OOA Plans or Whats Covered Under the HDHP Human Organ and Bone Marrow/Stem Cell Transplants: Inpatient admissions for ALL solid organ and bone marrow/stem cells (Including kidney only transplants) All outpatient services for the following: Stem Cell/Bone Marrow transplant (with or without myeloablative therapy) Donor Leukocyte Infusion Mental Health/Substance Abuse (MHSA): Acute inpatient admissions Electric convulsive therapy (ECT) Intensive outpatient therapy (IOW) Partial hospitalization (PHP) Residential care Penalty for Not Precertifying If you do not obtain the required precertification, a $500 penalty will apply and the Plan may not pay for all services rendered. Precertification does not guarantee coverage for or payment of the service or procedure reviewed. For benefits to be paid, on the date you receive service: You must be eligible for benefits; The service or surgery must be a covered benefit under Your Plan and medically necessary; The service cannot be subject to an exclusion under Your Plan
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You must not have exceeded any applicable visit limits under Your Plan.
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Active Health Disease Management Provided to Anthem BCBS Members

ActiveHealth Disease Management is a comprehensive disease management solution that provides ongoing support to members with complex and chronic conditions encourages positive behavior change and enables smarter, more informed clinical decisions. The program is accredited by NCQA and currently covers 35 adult and six pediatric conditions. CareEngine reviews members health profiles and identifies those who can derive the most benefit from the program, based on their profile. Each participant is paired with a primary nurse who performs a health assessment and then prepares a personalized action plan that addresses the members identified health conditions as well as any clinical alerts identified by the CareEngine. Information obtained from the member during the assessment is fed back into the CareEngine and is integrated with other data streams that may lead to the generation of additional clinical alerts. Disease Management interactively involves the physician and the member in the care process by providing the physician with clinical information to help support the best medical care, and educating, empowering and motivating members to understand their conditions and take action to improve their health.
Anthem BCBS: Future Moms

Future Moms is a program designed to help you have a safe delivery and a healthy child. As soon as you know youre expecting, just pick up the phone and call one of Anthems experienced, registered nurses. Theyll send everything you need to participate right to your home, including: A toll-free number you can call for answers to your questions about important topics such as pregnancy, labor, nursing and postpartum depression. The line is staffed by registered nurses 24 hours a day, seven days a week. A helpful prenatal care book Your Pregnancy Week by Week. Educational materials to help you handle any unexpected events. Screening by a registered nurse to see if you might be at risk for depression or premature delivery. Useful tools to help you, your doctor and your Future Moms nurse keep track of your pregnancy and spot possible risks. Free phone consultations with a dietitian, pharmacist, exercise physiologist or licensed behavioral health clinician, if needed To learn more, log in to anthem.com.
Case managers review and coordinate services for members with multiple and complex needs with identified gaps in their care and for members who are at risk for high cost or high utilization. Case managers collaborate with the member, family, caregiver, member authorized representative, treating practitioner, health care provider community and our other programs to coordinate care, with a focus on member education and maximizing quality outcomes. Case managers provide the member with information about alternative coverage or continuing care opportunities, as appropriate, and inform the member of ways to obtain that coverage or care in the event the members benefits end and the member requires additional care. Alternative options for coverage or care may include local, state, or federally funded agencies or non-profit organizations. When in case management, case managers, in coordination with the attending physician, member or member designee, develop a case management plan. The case managers plan may reflect short and long-term goals targeted to facilitate the achievement of individual members health goal.
Discount Programs SpecialOffers@Anthem

With SpecialOffers@Anthem, you can access discounts on products and services that help promote better health and well-being. Log in to www.anthem.com.
Anthem BCBS: Case Management

Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality health outcomes.
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Whats Covered by the PPO and OOA Plans
The PPO and OOA Plans cover most medical bills for illness or injury, as long as the treatment, service or supply is considered medically necessary or is a covered service. The Plan considers a service or supply medically necessary if it is a generally accepted health care practice and is required to treat the condition of the patient, as determined by the claims administrator. The fact that a doctor or other provider of medical services prescribes, recommends or approves a treatment, service or supply does not automatically make it a covered expense under the Medical Plan. The Well-Care benefits cover in- and out-of-network preventive prostate cancer screenings, mammograms, Pap smears, colorectal screenings, in-network well-child care services and some additional in-network welladult care services. For percentages of coinsurance and deductible amounts for the PPO and OOA Plans, see the PPO and OOA Plans Summary of Benefits charts.
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treatment facility: room and board, up to the private room limit; other necessary services and supplies Outpatient Treatment Expenses incurred for the effective treatment of alcoholism or drug abuse while the person is not confined as a full-time inpatient in a hospital or treatment facility will be considered covered medical expenses. Charges incurred for the treatment of alcoholism or drug abuse on an inpatient or an outpatient basis are covered medical expenses to the same extent as charges incurred for the treatment of any other disease.
Meet the following Obesity Guidelines:* BMI of equal to or greater than 40, irrespective of co-morbidities as defined by National Institute of Health (NIH), or BMI of equal to or greater than 35, with at least one significant co-morbid condition as defined by National Institute of Health (NIH). AND Complete a 3-month physician supervised weight loss program that includes nutritionist/ dietician involvement or complete a three-month multidisciplinary surgical prepatory regimen in accordance with your plan administrators bariatric medical policy; AND Complete a pre-surgery psychological evaluation; AND Have the surgery performed at a facility that has been designated a Bariatric Surgery Institute of Quality as defined by Aetna or Anthem BCBS AND Seek prior approval before obtaining any Bariatric Services through pre-certification/prior notification to activate bariatric surgery benefit. If you live more than 100 miles from a designated Institute of Quality, you may be eligible for Travel and Lodging reimbursement of up to $50 per night per person (up to $100 total). There is a $10,000 Travel & Lodging maximum per procedure. All Travel and Lodging reimbursement must be pre-approved. Exclusions Related to Bariatric Surgery Cosmetic Surgery to correct such skin conditions as excess skin after successful weight loss, unless medically necessary
Bariatric Surgery
Coverage for bariatric surgery requires you to satisfy the following eligibility criteria in order to seek approval for the bariatric surgery benefit. For Aetna members considering bariatric surgery, call 1-800-695-9744 For Anthem BCBS members considering bariatric surgery, call 1-877-434-2734 You will be assigned a case manager that can help you review the eligibility requirements, precertify, find a designated Institute of Quality (IOQ) or get other information regarding your bariatric surgery benefit. You must meet these initial eligibility requirements. Other rules may apply:
Alcoholism or Drug Abuse

Certain expenses for the treatment are covered medical expenses. Inpatient Treatment If a person is a full-time inpatient either in a hospital or in a treatment facility, then coverage is as shown below: hospital: treatment of medical complications of alcoholism or drug abuse, such as cirrhosis of the liver, delirium tremens, or hepatitis; and effective treatment of alcoholism or drug abuse
* Obesity Guidelines are based on National Institute of Health (NIH) guidelines. Eligibility design will be updated automatically for BMI as NIH guidelines are updated.
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Breast Reduction and Abdominoplasty, unless medically necessary Revisions, unless medically necessary Any member under the age of 18 drug addiction chronic brain syndrome alcoholism senility mental retardation any other mental disorder
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a tubal ligation for voluntary sterilization voluntary abortions Charges for the reversal of a sterilization procedure are not covered.
Skilled Nursing Facility

The Plan covers charges made by a skilled nursing facility for the following services and supplies, provided that they are furnished to a covered person while he or she is confined while convalescing from a disease or injury: room and board, including charges for services, such as general nursing care, made in connection with room occupancy. Not included is any charge for daily room and board in a private room that exceeds the semi-private room limit use of special treatment rooms x-ray and lab work physical, occupational or speech therapy oxygen and other gas therapy other medical services usually given by a skilled facility. This does not include private or special nursing, or physician's services medical supplies Benefits will be paid for no longer than 90 days during any one calendar year. Skilled Nursing Facility Limitations Benefits will not be provided when a member reaches the maximum level of recovery possible and no longer requires other than routine care. Charges for these skilled facility expenses are not covered:
Home Health Care

Home health care provides a program for the members care and treatment in the home. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the members attending physician. Home health care expenses are covered if: the charge is made by a home health care agency; and the care is given under a home health care plan; and the care is given to a person in his or her home. Home health care expenses are charges for: part-time or intermittent care by an R.N. or by an L.P.N. if an R.N. is not available part-time or intermittent home health aide services for patient care and in direct support of care by an R.N. or an L.P.N. Part-time or intermittent medical social services by a social worker when provided in conjunction with, and in direct support of care by an R.N. or an L.P.N. Medical supplies, prescription drugs and lab services by or for a home health care agency to the extent they would have been covered under this plan if you had continued your hospital stay
Emergency Room
It is important that all visits to a hospital emergency room occur in the context of a true emergency, such as a life-threatening illness or injury. These include severe breathing problems, major burns, head injuries, acute heart attack symptoms, uncontrollable bleeding, unconsciousness or other extreme circumstances. emergency care. Covered medical expense for charges made by the hospital will be covered if treatment is received in the emergency room of a hospital while a person is not a full-time inpatient. You must verify the treatment is a true emergency. non-emergency care. No benefits are payable if treatment is received in the emergency room of a hospital while a person is not a full-time inpatient and the treatment is not for emergency care.
Family Planning
The charges made by a physician or hospital services even though they are not incurred in connection with the diagnosis or treatment of a disease or injury, are covered medical expenses. Benefits will be payable for: a vasectomy for voluntary sterilization
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physical, occupational, and speech therapy. Note: Covered services available under Home Health Care do NOT reduce outpatient benefits available under the Physical Therapy section shown in this Plan. the following expenses to the extent they would have been covered under this Plan if the person had been confined in a hospital or skilled facility: medical supplies; drugs and medicines prescribed by a physician; oxygen and its administration; and lab services provided by or for a home health care agency The plan covers up to 150 visits in a calendar year. Each visit by a nurse or therapist is considered one visit. Each visit of up to four hours by a home health aide is considered one visit. Any service not specifically outlined above is not covered under Home Health Care benefits.
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Outpatient Care: services and supplies furnished to a person while not confined as a full-time patient. Hospice Outpatient Care Charges made by a hospice care agency for: part-time or intermittent nursing care by an R.N. or L.P.N. for up to eight hours in any one day medical social services under the direction of a physician, including: assessment of the person's social, emotional, and medical needs, and home and family situation; identification of the community resources that are available to the person; and assisting the person to obtain those resources as needed. psychological and dietary counseling consultation or case management services by a physician physical and occupational therapy
physical and occupational therapy part-time or intermittent home health aide services (mainly for caring for the person) for up to eight hours in any one day medical supplies drugs and medicines prescribed by a physician psychological and dietary counseling Not included are charges for: funeral arrangements pastoral counseling financial or legal counseling, including estate planning and the drafting of a will homemaker or caretaker services that are not solely related to care of the person, including sitter or companion services for either the person who is ill or other members of the family, transportation, housecleaning, and maintenance of the house respite care furnished during a period of time when the person's family or usual caretaker cannot, or will not, attend to the person's needs
Hospice Care
This is care given to a terminally ill person by or under arrangements with a hospice care program. Hospice Facility Expenses Charges made by a hospice facility, hospital or skilled facility for: Inpatient Care: room and board and other services and supplies furnished to a person while a fulltime inpatient for pain control and other acute and chronic symptom management. Charges that exceed the semi-private room limit for daily room and board are not covered.
part-time or intermittent home health aide services (mainly for caring for the person) for up to eight hours in any one day medical supplies drugs and medicines prescribed by a physician The plan covers outpatient care charges made by these providers, as long as the provider is not an employee of a hospice care agency and the hospice care agency is responsible for the care of the person: physician for consultant or case management services physical or occupational therapist home health care agency for:
Hospitals
Inpatient Hospital Expenses Charges made by a hospital for semi-private room and board and other hospital services and supplies while a covered person is confined as a full-time inpatient. Semi-private room limit is determined based on the room and board charge that an institution applies to the most beds in its semi-private rooms with 2 or more beds. If there are no such rooms, the rate is based on the rate most commonly charged by similar institutions in the same geographic area.
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For In-Network Care If a private room is used, the daily board and room charge will be covered if your network provider requests a private room and Aetna or Anthem BCBS approves this request. If these procedures are not followed, any part of the daily board and room charge that is more than the semi-private room limit is not covered. For Out-of-Network Care You are responsible for any charge for daily room and board in a private room that exceeds the Plans semi-private room limit. Outpatient Hospital Expenses Charges made by a hospital for hospital services and supplies that are provided to a covered person who is not a full-time inpatient. Mental Disorders Charges incurred for the treatment of a mental disorder on an inpatient or an outpatient basis are covered medical expenses to the same extent as charges incurred for the treatment of any other disease.
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length of stay not in excess of 48 hours (or 96 hours). In-network maternity benefits include the following: Initial visit to confirm pregnancycovered at 100% after specialist copayment Medically necessary ultrasounds, sonograms and other diagnostic testscovered at the applicable cost sharing based on the place in which the service was rendered. Global delivery feeincludes subsequent prenatal visits, routine urinalysis, delivery and postnatal visitscovered at coinsurance after deductible. Hospital copay applies.
subject to the same annual deductible, coinsurance and/or copayment provisions otherwise applicable.
Surgery
pre-admission tests performed in the hospital or other location, such as a laboratory or doctors office surgeons fees related to a surgical procedure covered by the Plan assistant surgeons fees during a covered surgical procedure, if it is determined that the condition of the patient and the type of surgery performed requires the use of a second doctor doctors fees for administering anesthesia during a covered surgical procedure. To qualify for benefits, the anesthesia must be administered by a doctor other than the surgeon or the assistant surgeon, except if the attending doctor is performing outpatient oral surgery
Mastectomies
Federal law requires group health plans offering mastectomy coverage also to cover reconstructive surgery and prostheses following mastectomies. Therefore, if you or a covered family member receives benefits for a medically necessary mastectomy and elect breast reconstruction after the mastectomy, coverage will also be provided for the following: all stages of reconstruction of the breast on which the mastectomy has been performed surgery and reconstruction of the other breast to produce a symmetrical appearance breast prosthesis (artificial replacements) treatment of physical complications with respect to all stages of a mastectomy, including lymphedemas (swelling associated with the removal of the lymph nodes) This coverage will be provided in consultation with the attending physician and the patient, and it will be
Transplant Services
Covered expenses include charges incurred during a transplant occurrence. The following will be considered to be one transplant occurrence once it has been determined that you or one of your dependents may require an organ transplant. Organ means solid organ; stem cell; bone marrow; and tissue. For example: Heart Lung Heart/ Lung Simultaneous Pancreas Kidney (SPK) Pancreas Kidney Liver
Maternity Benefits
As required by federal law, maternity benefits are not restricted for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mothers or newborns attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, the Plan does not require that a provider obtain authorization from or notify the plan for prescribing the
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Intestine Bone Marrow/Stem Cell Multiple organs replaced during one transplant surgery Tandem transplants (Stem Cell) Sequential transplants Re-transplant of same organ type within 180 days of the first transplant Any other single organ transplant, unless otherwise excluded under the plan. The following will be considered to be more than one Transplant Occurrence: Autologous blood/bone marrow transplant followed by allogenic blood/bone marrow transplant (when not part of a tandem transplant) Allogenic blood/bone marrow transplant followed by an autologous blood/bone marrow transplant (when not part of a tandem transplant) Re-transplant after 180 days of the first transplant Pancreas transplant following a kidney transplant A transplant necessitated by an additional organ failure during the original transplant surgery/process More than one transplant when not performed as part of a planned tandem or sequential transplant, (e.g., a liver transplant with subsequent heart transplant). Benefits will be paid: At 100% after the deductible for a treatment received at a facility designated by the plan as
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an Institute of Excellence (IOE) for the type of transplant being performed. Each IOE facility has been selected to perform only certain types of transplants. At 80% after the deductible and after the inpatient per-confinement copay for treatment received at a participating facility but a Non-IOE transplant facility. As out-of-network for services and supplies obtained from a facility that is not a network participating facility The plan covers: Charges made by a physician or transplant team. Charges made by a hospital, outpatient facility or physician for the medical and surgical expenses of a live donor, but only to the extent not covered by another plan or program. Related supplies and services provided by the IOE facility during the transplant process. These services and supplies may include: physical, speech and occupational therapy; bio-medicals and immunosuppressants; home health care expenses and home infusion services. Charges for activating the donor search process with national registries. Compatibility testing of prospective organ donors who are immediate family members. For the purpose of this coverage, an immediate family member is defined as a first-degree biological relative. These are your biological parents, siblings or children. Inpatient and outpatient expenses directly related to a transplant. Covered transplant expenses are typically incurred 76
during the four phases of transplant care described below. Expenses incurred for one transplant during these four phases of care will be considered one transplant occurrence. A transplant occurrence is considered to begin at the point of evaluation for a transplant and end either 180 days from the date of the transplant; or upon the date you are discharged from the hospital or outpatient facility for the admission or visit(s) related to the transplant, whichever is later. The four phases of one transplant occurrence and a summary of covered transplant expenses during each phase are: 1. Pre-transplant evaluation/screening: Includes all transplant-related professional and technical components required for assessment, evaluation and acceptance into a transplant facilitys transplant program; 2. Pre-transplant/candidacy screening: Includes HLA typing/compatibility testing of prospective organ donors who are immediate family members; 3. Transplant event: Includes inpatient and outpatient services for all covered transplant-related health services and supplies provided to you and a donor during the one or more surgical procedures or medical therapies for a transplant; prescription drugs provided during your inpatient stay or outpatient visit(s), including bio-medical and immunosuppressant drugs; physical, speech or occupational therapy provided during your inpatient stay or outpatient visit(s); cadaveric and live donor organ procurement; and 4. Follow-up care: Includes all covered transplant expenses; home health care services; home infu-

sion services; and transplant-related outpatient services rendered within 180 days from the date of the transplant event. If you are a participant in the IOE program, the program will coordinate all solid organ and bone marrow transplants and other specialized care you need. Any covered expenses you incur from an IOE facility will be considered network care expenses. Important Reminders To ensure coverage, all transplant procedures need to be precertified by your medical plan administration. Refer to the Aetna or Anthem BCBS precertification section of this chapter. Limitations Unless specified above, not covered under this benefit are charges incurred for: Outpatient drugs including bio-medicals and immunosuppressants not expressly related to an outpatient transplant occurrence; Services that are covered under any other part of this plan; Services and supplies furnished to a donor when the recipient is not covered under this plan; Harvesting or storage of organs, without the expectation of immediate transplantation for an existing illness; Harvesting and/or storage of bone marrow, tissue or stem cells, without the expectation of transplantation within 12 months for an existing illness;
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Cornea (Corneal Graft with Amniotic Membrane) or Cartilage (autologous chondrocyte or autologous osteochondral mosaicplasty) transplants, unless otherwise authorized by Aetna or Anthem BCBS. If a person is a transplant patient, this Plan will pay a benefit for travel expenses and lodging expenses but only to the extent described below and only if charges incurred for the transplant procedures and treatment types are covered medical expenses. Any charges made by the transplant facility for services and supplies that are: furnished in connection with any of the procedures or treatment listed below; and are included under this Plan as covered medical expenses will be considered to be expenses incurred for in-network care and paid at 100%. Transplant Procedure and Treatment Types Transplant Travel Expenses These are expenses incurred by a transplant patient and approved in advance by Aetna or Anthem BCBS for transportation between his or her home and the transplant facility to receive services in connection with any listed procedure or treatment. Also included are expenses incurred by a companion, and approved in advance by your medical plan administrator, for transportation when traveling with a transplant patient between the transplant patient's home and the IOE facility to receive such services.
IOE Lodging Expenses These are expenses incurred by an transplant patient, and approved in advance for lodging away from home: while traveling between his or her home and the facility to receive services in connection with any listed procedure or treatment; or to receive outpatient services from the facility in connection with any listed procedure or treatment. The maximum benefit payable for these expenses is $50 per night. Also included are expenses incurred by a companion, and approved in advance by your medical plan administrator, for lodging away from home: while traveling with an IOE patient between the transplant patient's home and the facility to receive services in connection with any listed procedure or treatment; or when the companion's presence is required to enable a transplant patient to receive such services on an inpatient or outpatient basis. The maximum benefit payable for these expenses is $50 per night.
Oral Surgery
Expenses for the treatment of the mouth, jaws, and teeth are covered medical expenses, but only those for: teeth, mouth, jaws, jaw joints; or supporting tissues (this includes bones, muscles, and nerves).
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For these expenses, "physician" includes a dentist. The Plan covers surgery needed to: treat a fracture, dislocation, or wound cut out: the roots of a tooth without removing the entire tooth cysts, tumors, or other diseased tissues cut into gums and tissues of the mouth when not done in connection with the removal, replacement or repair of teeth alter the jaw, jaw joints, or bite relationships by a cutting procedure when appliance therapy alone cannot result in functional improvement non-surgical treatment of infections or diseases, excluding those of or related to the teeth Dental insurance will serve as primary payor for the following services. If the member does not have dental insurance or it does not cover these services, the Plan will cover the following surgery needed to cut out: Teeth partly or completely impacted in the bone of the jaw Teeth that will not erupt through the gum Other teeth that cannot be removed without cutting into the bone Dental work, surgery and orthodontic treatment needed to remove, repair, replace, restore or reposition:
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natural teeth damaged, lost, or removed; or other body tissues of the mouth fractured or cut out due to injury. Any such teeth must have been: free from decay; or in good repair; and firmly attached to the jaw bone at the time of the injury The treatment must be done in the calendar year of the accident or the next one. If crowns (caps), dentures (false teeth), bridgework or in-mouth appliances are installed due to such injury, covered medical expenses include only charges for: the first denture or fixed bridgework to replace lost teeth; the first crown needed to repair each damaged tooth; and an in-mouth appliance used in the first course of orthodontic treatment after the injury. Except as provided for injury, not included are charges: for in-mouth appliances, crowns, bridgework, dentures, tooth restorations, or any related fitting or adjustment services; whether or not the purpose of such services or supplies is to relieve pain
for root canal therapy for routine tooth removal (not needing cutting of bone) The plan covers oral surgery and related dental services to correct a gross anatomical defect present at birth that results in significant functional impairment of a body part, if the services or supplies will improve function. The plan covers fluoride treatment, removal of teeth and hyperbaric oxygen therapy in connection with covered radiation therapy. Not included are charges: to remove, repair, replace, restore or reposition teeth lost or damaged in the course of biting or chewing to repair, replace, or restore fillings, crowns, dentures or bridgework for non-surgical periodontal treatment for dental cleaning, in-mouth scaling, planing or scraping for myofunctional therapy; this is muscle training therapy or training to correct or control harmful habits
Routine Cancer Screenings

For information, see the Summary of Benefits chart in this chapter.
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Routine Physical Exams
Charges made by your primary care physician or a network provider for a routine physical exam given to you, your spouse/same sex partner, or your dependent child may be covered medical expenses. If charges for a dependent childs routine physical exam are covered under any other benefit section, charges in connection with that physical exam are not considered covered medical expenses under this section. A routine physical exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified injury or disease. Included are immunizations for infectious disease, testing for tuberculosis, x-rays, lab, and other tests given in connection with the exam. For more information, see the Summary of Benefits chart in this chapter. These routine physical exam charges are not covered: services that are covered under any other group plan provided by the Company services for diagnosis or treatment of a suspected or identified injury or disease exams given while the person is confined in a hospital or other facility for medical care services that are not provided by a physician or under his/her direct supervision medicines, drugs, appliances, equipment, or supplies psychiatric, psychological, personality or emotional testing or exams exams in any way related to employment premarital exams vision or dental exams
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Short-Term Rehabilitation Expenses

Therapy Cognitive Therapy. Cognitive therapy is treatment to restore memory, perception, and normal thought processes following an injury to the brain. Coverage is limited to treatment to restore memory, perception and normal thought processes following an injury to the brain. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as multiple sclerosis, cerebral palsy, polio, spina bifida and amyotrophic lateral sclerosis (Lou Gehrigs disease). Covered therapy does not include therapy to develop cognitive skills that did not exist before the injury or therapy from which no further improvement can be expected. A licensed medical doctor or psychologist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Occupational Therapy. Occupational therapy is the therapeutic use of work and self-care activities to restore independent function and prevent disability. Coverage is limited to treatment to restore the loss of independent function and prevent disability of the therapeutic use of work and self-care activities caused by an injury or illness. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as
multiple sclerosis, cerebral palsy, polio, spina bifida and amyotrophic lateral sclerosis (Lou Gehrigs disease). Covered therapy does not include therapy for transportation activities or therapy from which no further improvement can be expected. A registered or licensed occupational therapist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Physical Therapy. Physical therapy is the use of physical means, such as massage, manipulation, heat, hydrotherapy, ultrasound or exercises to treat a disability of the body due to illness or injury. Coverage is limited to charges for manipulation, heat, hydrotherapy, ultrasound or exercises/interventions to treat a disability of the body due to illness or injury. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as multiple sclerosis or polio. Covered therapy does not include visual therapy or therapy from which no further improvement can be expected. A licensed medical physician, chiropractor or physical therapist, other than a person who is related to the patient by blood or marriage, must provide the physical therapy within the scope of his or her profession.
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Speech Therapy. Speech therapy is treatment to restore the skills necessary for intelligible speech. The loss of such skills must be due to illness or injury. Coverage is limited to charges necessary to restore an existing speech function (the ability to express thoughts, speak words and form sentences) that has been lost or impaired as a result of a disease or an injury. Significant functional improvement must be expected within a reasonable time frame. Significant improvement means the speech therapy is expected to restore the level of speech that the individual had obtained prior to the illness or injury. Covered therapy does not include therapy from which no further improvement can be expected. A registered or licensed speech therapist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Exception. Coverage for cognitive, physical, occupational and speech therapy will be available as stated above for situations where children have failed to acquire the necessary skills as a result of cerebral palsy, autism, Down syndrome or a severe neurological or genetic disorder. Therapy must be expected to result in significant improvement or be aimed at slowing or preventing further deterioration.
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All covered therapy must be diagnosed and prescribed by a licensed physician. Specific evaluation with standard test scores and measurable goals and objectives to determine progress and improved functional ability must be provided. Due to the review requirements of the Plan, authorization of benefits may be done on a retroactive basis. Therefore, it is possible that if services are rendered prior to approval, some or all of these services may not be covered. If approved, these services will be covered, based on the coinsurance level of the Plan you elected, after the appropriate individual annual deductible has been met. Some coverages may have limitations. The appropriate out-of-pocket maximum applies. The Plan does not provide coverage for sensory (auditory) integration therapy. This procedure has been proposed as a treatment approach to the management of children with various communication, behavioral, emotional and learning disorders. The effectiveness of this therapy is unproven. A meta-analysis of multiple research on sensory integration treatment was published in April 1999, which concluded that more recent studies do not show overall positive effects from sensory (auditory) integration therapy. In addition, the Plan does not cover charges for speech, cognitive, occupational and/or physical therapy services related to developmental delay for children or adults if therapy is not expected to result in significant improvement or be aimed at slowing or preventing further deterioration.
Other Medical Expenses

The Plan covers charges for: oxygen and/or rental of equipment required for its administration x-ray, radium, radioactive isotope therapy, outpatient radiation therapy, chemotherapy, dialysis and respiratory therapy blood (if not replaced), or other fluids actually injected into the circulatory system insulin syringes and test tapes if used by a provider during an office visit first pair of contact lenses or eyeglasses following cataract surgery anesthetics rental of durable medical and surgical equipment. In lieu of rental, the following may be covered: the initial purchase of such equipment if your medical plan administrator is shown that: long term care is planned, and that such equipment either cannot be rented or is likely to cost less to purchase than to rent repair of purchased equipment replacement of purchased equipment if Aetna or Anthem BCBS is shown that it is needed due to a change in the person's physical condition, or it is likely to cost less to purchase a replacement than to repair existing equipment or to rent similar equipment. Precertification is required for durable medical equipment.
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Artificial limbs and eyes. The plan does not cover charges for: eyeglasses vision aids communication aids orthopedic shoes, foot orthotics, or other devices to support the feet, unless necessary to prevent complications of diabetes or if the orthopedic shoe is an integral part of a leg brace and expense is included as part of the cost of the brace coverage for services related to the treatment of varicose veins if medically necessary. Precertification is required. Prescription drugsSee Prescription Drugs later in this chapter.
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Private duty services that are not covered include: nursing care that does not require the education, training and technical skills of a R.N. or L.P.N., such as transportation, meal preparation, charting of vital signs and companionship activities. private duty nursing care given while the person is an inpatient in a hospital or other health care facility. care provided to help a person in the activities of daily life, such as bathing, feeding, personal grooming, dressing, getting in and out of bed or a chair, or toileting. care provided solely for skilled observation except for no more than one four-hour period per day for a period of no more than ten consecutive days following the occurrence of: change in patient medication; need for treatment of an emergency condition by a physician, or the onset of symptoms indicating the likely need for such services; surgery; release from inpatient confinement; or any service provided solely to administer oral medicines, except where applicable law requires that such medicines be administered by a R.N. or L.P.N.
Experimental or Investigational Treatment

Covered expenses include charges made for experimental or investigational drugs, devices, treatments or procedures, provided all of the following conditions are met: You have been diagnosed with cancer or a condition likely to cause death within one year or less; Standard therapies have not been effective or are inappropriate; Your medical plan administrator determines, based on at least two documents of medical and scientific evidence, that you would likely benefit from the treatment; You are enrolled in a clinical trial that meets these criteria; The drug, device, treatment or procedure to be investigated has been granted investigational new drug (IND) or Group c/treatment IND status; The clinical trial has passed independent scientific scrutiny and has been approved by an Institutional Review Board that will oversee the investigation; The clinical trial is sponsored by the National Cancer Institute (NCI) or similar national organization (such as the Food & Drug Administration or the Department of Defense) and conforms to the NCI standards; The clinical trial is not a single institution or investigator study unless the clinical trial is performed at an NCI designated cancer center; and You are treated in accordance with protocol.
Private Duty Care

The charges made by a R.N. or L.P.N. or a nursing agency for "skilled nursing services" are included as covered medical expenses. No other charges made by a R.N. or L.P.N. or a nursing agency are covered. As used here, private duty care means services for: visiting nursing care by a R.N. or L.P.N. Visiting nursing care means a visit of not more than eight hours for the purpose of performing specific skilled nursing tasks. private duty nursing by a R. N. or L.P.N. if the person's condition requires skilled nursing care and visiting nursing care is not adequate.
Self-Injectible Drugs
Pharmacy and most injectible drugs are covered under the Caremark Prescription Drug Plan. Please contact Caremark at 1-866-490-3376.
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What the PPO and OOA Plans Do Not Cover
Coverage is not provided for: services and supplies not necessary for the diagnosis, care, or treatment of the disease or injury involved, as determined by your medical plan administrator. This applies even if they are prescribed, recommended, or approved by the person's attending physician or dentist. services not medically necessary for diagnosis or treatment of an illness or injury, unless specifically covered by the Plan all services or expenses incurred by you or your family before coverage started or after coverage has terminated under the plan unless the patient is enrolled in COBRA (see the COBRA Coverage chapter for more information) any services or supplies covered by a state workers compensation act or similar program or legislation wigs, unless medically necessary any services for which a charge would not have been made in the absence of coverage charges for services or supplies submitted more than 12 months from the date services were provided charges made by a non-participating physician for or in connection with surgery which exceed the following maximum when two or more surgical procedures are performed at one time. The maximum amount payable will be the amount otherwise payable for the most expensive procedure, and 50% of the amount otherwise payable for the secondary procedure and 25% of all other surgical procedures under the Aetna Medical Plan.
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Maximum amounts payable will follow the same reduction schedule but could differ by state under the Anthem BCBS medical plans. charges for the removal of organs or tissues to be donated to another, other than to a person covered by the Plan charges made by any covered provider who is a member of your or your dependents family care, treatment, services, or supplies that are not prescribed, recommended, or approved by the person's attending physician or dentist. services, treatment, education testing, or training related to learning disabilities or developmental delays if therapy is not expected to result in significant improvement or be aimed at slowing or preventing further deterioration. For more information, see the Therapy section. care furnished mainly to provide a surrounding free from exposure that can worsen the person's disease or injury treatment such as primal therapy, rolfing, psychodrama, megavitamin therapy, bioenergetic therapy, vision perception training, or carbon dioxide therapy treatment of covered health care providers who specialize in the mental health care field and who receive treatment as a part of their training in that field services of a resident physician or intern rendered in that capacity. charges that are made only because there is health coverage.
charges that a covered person is not legally obliged to pay. charges for custodial care, as determined by Aetna or Anthem BCBS charges, to the extent allowed by the law of the jurisdiction where the group contract is delivered, for services and supplies: furnished, paid for, or for which benefits are provided or required by reason of the past or present service of any person in the armed forces of a government furnished, paid for, or for which benefits are provided or required under any law of a government. This exclusion will not apply to "no fault" auto insurance if it is: required by law provided on other than a group basis
charges for eyeglasses, contacts, eye examinations, eye exercises, correction to vision (including but not limited to LASIK Radial Keratotomy) or fitting of glasses, unless specifically covered by the Plan. Any services or supplies related to education, training or retraining services or testing, including: special education, remedial education, job training and job hardening programs; therapy, drugs, implants, supplies, or counseling for sexual dysfunctions or inadequacies that do not have a physiological or organic basis sex change surgery or any treatment of gender identity disorders
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charges for services or treatment related to impotency and/or infertility, unless such services or treatment are to diagnose and/or treat a specific medical condition (other than previous voluntary sterilization) causing the impotency and/or infertility, and such charges are not directly related to giving birth and/or the birth process charges for in vitro fertilization and other artificial insemination routine physical exams, routine vision exams, routine dental exams, routine hearing exams, immunizations, or other preventive services and supplies, except to the extent coverage for such exams, immunizations, services, or supplies is specifically provided under the Plan marriage, family, child, career, social adjustment, pastoral or financial counseling. Aetna may consider these services for payment if there is no diagnosed behavioral health disorder. acupuncture therapy (except when acupuncture is performed by a physician as a form of anesthesia in connection with surgery that is covered under this Plan) plastic surgery, reconstructive surgery, cosmetic surgery, or other services and supplies which improve, alter, or enhance appearance, whether or not for psychological or emotional reasons, except to the extent needed to improve the function of a part of the body that is not a tooth or structure that supports the teeth and is malformed as a result of a severe birth defect (including harelip, webbed fingers or toes) as a direct result of disease or surgery performed to treat disease or injury or repair an injury that is:
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a result of a severe birth defect; including harelip, webbed fingers, or toes; or a direct result of disease or surgery performed to treat a disease or injury. Surgery must be performed in the calendar year of the accident which causes the injury; or in the next calendar year. charges that are not reasonable, as determined by Aetna or Anthem BCBS reversal of a sterilization procedure services or supplies furnished by a network provider in excess of the provider's negotiated charge for that service or supply. This exclusion will not apply to any service or supply for which a benefit is provided under Medicare before the benefits of the group contract are paid Any charges in excess of the benefit, dollar, day, visit or supply limits stated in this document. Any non-emergency charges incurred outside of the United States Charges submitted for services that are not rendered, or not rendered to a person not eligible for coverage under the plan. Charges submitted for services by an unlicensed hospital, physician or other provider or not within the scope of the providers license. Contraception, except as specifically described in the Whats Covered by the PPO and OOA Plans Section: over the counter contraceptive supplies including but not limited to condoms, contraceptive foams, jellies and ointments.
Costs for services resulting from the commission of, or attempt to commit a felony by the covered person. Dental Services except as covered as Oral Surgery under the plan. Orthodontic services or treatment (including appliances) related to temporomandibular joint (TMJ) syndrome unless all other nonsurgical options are deemed unsuccessful Disposable take-home supplies: Any outpatient disposable supply or device, including sheaths, bags, elastic garments, support hose, bandages, bedpans, syringes, blood or urine testing supplies, and other home test kits; and splints, neckbraces, compresses, and other devices not intended for reuse by another patient. Facility charges for care services or supplies provided in: rest homes; assisted living facilities; similar institutions serving as an individuals primary residence or providing primarily custodial or rest care; health resorts; spas, sanitariums; or infirmaries at schools, colleges, or camps charges for orthopedic shoes and other supportive appliances for the feet other than for expenses which are specified in the Whats Covered by the PPO and OOA Plans section Home and mobility: Any addition or alternation to a home, workplace or other environment, or vehicle and any related equipment or device, including:
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Bathroom equipment such as bathtub seats, benches, rails, and lifts; Purchase or rental of exercise equipment, air purifiers, central or unit air conditioners, water purifiers, waterbeds. and swimming pools; Exercise and training devices, whirlpools, portable whirlpool pumps, sauna baths, massage devices or over-bed tables; Equipment or supplies to aid sleeping or sitting, including electric beds, water beds, air beds, pillows, sheets, blankets, warming or cooling devices, elevating chairs, bed tables and reclining chairs; Equipment installed in your home, workplace or other environment, including stair-glides, elevators, wheelchair ramps, or equipment to alter air quality, humidity or temperature; Other additions or alternations to your home, workplace or other environment, including room additions, changes in cabinets, countertops, doorways, lighting, wiring, furniture, communication aids, wireless alert systems, or home monitoring; Services and supplies furnished mainly to provide a surrounding free from exposure that can worsen your illness or injury; Removal from your home, worksite or other environment of carpeting, hypo-allergenic pillows, mattresses, paint, mold, asbestos, fiberglass, dust, pet dander, pests or other potential sources of allergies or illness; and transportation devices, including stair-climbing wheelchairs, personal transporters, bicycles,
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automobiles, vans or trucks, or alternations to any vehicle or transportation device. Miscellaneous charges for services or supplies including: Annual or other charges to be in a physicians practice; Charges to have preferred access to a physicians services such as boutique or concierge physician practices; Cancelled or missed appointment charges or charges to complete claim forms; Personal comfort and convenience items: Any service or supply primarily for your convenience and personal comfort or that of a third party, including: Telephone, television, internet, barber or beauty service or other guest services; housekeeping, cooking, cleaning, shopping, monitoring, security or other home services; and travel, transportation, or living expenses, rest cures, recreational or diversional therapy. Services provided by a spouse, domestic partner, parent, child, step-child, brother, sister, in-law or any household member. Smoking: Any treatment, drug, service or supply to stop or reduce smoking or the use of other tobacco products or to treat or reduce nicotine addiction, dependence or cravings, including counseling, hypnosis and other therapies, medications, nicotine patches and gum. See Program Limitations in the Prescription Drug section for information on coverage for certain smoking cessation drugs if you are enrolled in the Quit for Life Tobacco Cessation Program.
Self-injectible drugs; coverage provided under the Caremark Prescription Drug Program unless prescribed while in the emergency room or inpatient during a hospital stay Treatment in wilderness programs or other similar programs Christian Science practitioners (Anthem BCBS only) Services provided in a halfway house (Anthem BCBS only) Services for hospital confinement primarily for diagnostic studies (Anthem BCBS only) Services for any form of telecommunication Services for weight reduction programs, services and supplies including, but not limited to, commercial weight loss programs Services that are defined by your plan administrator as Experimental or Investigational Services, unless they meet the conditions listed under Experimental and Investigational Services under Whats Covered by the Plans. Contact your plan administrator for more information regarding what is considered Experimental or Investigational. Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage. These excluded charges will not be used when determining benefits. The law of the jurisdiction where a person lives when a claim occurs may prohibit some benefits. If so, they will not be paid.
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Enrolling in the Prescription Drug Plan
By enrolling in the a PPO or Out-of-Area Medical Plan, you are agreeing to enroll and make the required contributions for a Prescription Drug Plan. You may not enroll in one plan without also enrolling in the other. If you elect a PPO or Out-of-Area Medical Plan and do not elect one of the prescription drug options during your enrollment period, you will be enrolled automatically in the $50 Deductible/Mail Copay Option. See the CVS Caremark Prescription Drug Coverage chart on the next page for more information. New Salaried Associates: Please review the For New Salaried Associates: Medical Coverage During Your First 90 Days chapter for important information regarding medical and prescription drug coverage during your first 90 days of employment.
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Using the Prescription Drug Plan

The Prescription Drug Plan is designed to encourage you to use generic drugs and preferred brand-name drugs. You may still obtain non-preferred brandname prescriptions, but you will pay a higher percentage of the cost. The definitions below explain the drug categories.
If a non-preferred brand does not have a preferred brand alternative, it will be covered at the preferred brand benefit level.
The Prescription Drug Options

You have three prescription drug options: Caremark $50 Deductible/Mail Copay$50 deductible for preferred and non-preferred brand drugs with a copay for mail order prescriptions; Caremark $50 Deductible/Coinsurance$50 deductible for preferred and non-preferred brand drugs with coinsurance for mail order prescriptions; or Caremark $100 Deductible/Coinsurance$100 deductible for preferred and non-preferred brand drugs with coinsurance for mail order prescriptions All of the options feature: No deductible for generic drugs. You wont have to meet your prescription drug plan deductible to begin receiving benefits for generic drugs. Over 60% of brand drugs have a generic equivalent approved by the FDA. No deductible and lower costs when you use the mail order service. Youll save time and money when you use the mail order service to purchase your maintenance drugs (up to a 90-day supply) and you pay no deductible on generic, preferred and non-preferred brand drugs you get through the mail. Maintenance drugs are drugs you take on an ongoing basis to treat chronic or long-term conditions, including, but not limited to, diabetes, heart disease, arthritis, high cholesterol, asthma, high blood pressure and allergies.
Generic
These are prescription drugs labeled by their basic chemical name. They have the same chemical composition, potency and form as brand-name equivalents, but are less expensive.
Brand Name
Preferred BrandThese are brand-name prescription drugs with no generic equivalent and are published on Caremarks Primary Preferred Drug list which is revised quarterly. Copies are available at www.caremark.com or by calling 1-866-490-3376. Non-Preferred BrandThese are brand-name prescription drugs with equally effective generic equivalents or preferred brand alternatives that do not appear on Caremarks Primary Prefered Drug List. If you or your doctor requests that a brand drug be dispensed when a generic equivalent is available, you will pay the generic copay or coinsurance (depending on your option) plus the difference between the discounted cost of the generic and the brand drug. This amount is not applied to your deductible or out-of-pocket maximum. If there is no generic drug for your prescription, you may choose the preferred or the non-preferred brand-name drug. However, you will pay more for the non-preferred brand.
Coverage Categories
When you select your prescription drug option, you will be assigned automatically to the same coverage category you elect for the Medical Plan: associate only associate + spouse (or same-sex domestic partner) associate + child(ren) associate + family (children and spouse or samesex domestic partner)
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CVS Caremark Prescription Drug Coverage

Caremark $50 Ded/Mail Copay
Deductible (individual/family) Out-of-Pocket Maximum (individual/family) Mandatory Generic if you receive a brand drug when a generic equivalent is available Generic (no deductible) Preferred Brand (deductible applies) Non-Preferred Brand (deductible applies) Generic Preferred Brand Non-Preferred Brand All Specialty Drugs $50/$150 $1,000/$2,000 The generic coinsurance or copay plus the difference in the cost of the brand and the generic drug You pay 20% You pay 25% You pay 45%
Caremark $50 Ded/Coinsurance Caremark $100 Ded/Coinsurance

$50/$150 $1,000/$2,000 The generic coinsurance plus the difference in the cost of the brand and the generic drug You pay 20% You pay 30% You pay 50% $100/$300 $1,750/$3,000 The generic coinsurance plus the difference in the cost of the brand and the generic drug You pay 20% You pay 35% You pay 55%
Retail (up to a 30-day supply)
Mail Order and CVS Retail (90-day supply with no deductible) $7 $50 $80 You pay $50 You pay 20% You pay 25% You pay 45% You pay $50 You pay 20% You pay 30% You pay 50% You pay $50
Specialty Drugs (30-day supply limit through CVS Caremark Specialty Pharmacy only)
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No deductible and lower cost when you get your maintenance drugs at a CVS pharmacy. You can purchase an 84-90 day supply of your maintenance drugs at a CVS pharmacy. When you get your maintenance drugs at a CVS pharmacy, there is no deductible for generic, preferred and non-preferred drugs, and you pay the mail order price. Maintenance drugs are drugs you take on an ongoing basis to treat chronic or long-term conditions, including, but not limited to, diabetes, heart disease, arthritis, high cholesterol, asthma, high blood pressure and allergies. Coverage for oral contraceptives. Oral contraceptives are only covered by the Mail Service prescription drug program or 84-90 day supplies at CVS pharmacies. You will not be reimbursed for the cost of a 30-day supply of oral contraceptives purchased from a retail pharmacy. Generics are preferred. All of the options also have an extra charge for brand drugs if a generic equivalent is available. If you or your doctor requests that a brand drug be dispensed when a generic equivalent is available, you will pay the deductible, if not already met, (for a retail prescription) plus the generic copay or coinsurance (depending on your option and mail or retail choice) plus the difference between the discounted cost of the generic and the brand drug. This amount is not applied to your deductible or out-of-pocket maximum.
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Here is an example of how this extra charge works for the $50 Deductible/Coinsurance option. This example assumes that the deductible has been met.
Coinsurance for Generic (20% of $5.33) $1.07
The chart below identifies some of the drugs that require prior authorization. Contact CVS Caremark at www.caremark.com or call 1-866-490-3376 (1-866-490-DEPO) for more information.
Cost of Brand Drug $42.02
Cost of Generic $5.33
Drugs that will Require Prior Authorization or are Subject to Quantity Limitations
Actiq Amerge Ana-Kit Anzemet Axert Botox Imitrex Kytril Maxalt Migranal Retin-A Relenza Stadol NS Tamiflu Toradol Zofran Zomig Specialty or Biotech Drugs
cost of brand - cost of generic + coinsurance for generic ($42.02 - $5.33 ) $36.69 + $1.07 = $37.76
Prior Authorization Drugs

If you or a covered family member is prescribed a drug that requires prior authorization from CVS Caremark, your physician or his or her representative should call CVS Caremark at 1-800-626-3046 or fax the request to 1-866-502-2296. If you call CVS Caremark to request prior authorization, you will be instructed to have your physician contact CVS Caremark to make the request. When CVS Caremark receives the call or fax from your physician, the request for prior authorization will be evaluated and the request will be approved or denied within 24 to 48 hours. If more information is needed, your doctor's office will be notified. If the prior authorization is approved, CVS Caremark will notify your physician. If prior authorization is denied, you and your physician will receive a letter which will include directions on how to appeal the denial. For more information, see the Claims and Appeals chapter.
Clinical Management Programs

Through a series of safety checks, Enhanced Retrospective Safety Review, Enhanced Safety and Monitoring Solution, and Drugs Savings Review help ensure that your prescription drug treatment is appropriate for your health situation. If these safety checks reveal a potential problem, a CVS Caremark pharmacy professional will directly contact your physician to review your treatment, and sometimes suggest a change to the current therapy. Under no circumstances will CVS Caremark change your medication without your doctors consent. If a suggested change is authorized, you will be notified via phone and/or letter which will contain the authorized change. Through the Enhanced Safety and Monitoring Solution, the program looks for overutilization or inappropriate usage of medication that has the potential to be addictive. Through this program the plan reserves the rights to take the following actions: limit your use of retail pharmacies or number of prescribers. Additionally, CVS Caremark may contact your prescribers.
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For medication to work properly, you must take it correctly. Thats why CVS Caremark also reviews medications that require you to take multiple doses (based on frequency per day or number of tablets/capsules per dose) and, if appropriate, suggests ways to make it easier for you to take your medication properly. For example, it may be possible to reduce the number of times you must take your medication each day without changing the total daily dosage. This not only helps you take your medication as instructed but also can reduce your out-of-pocket cost.
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Step Therapy
Some drugs require whats called step therapy. This means that a certain drug may not be covered unless youve first tried a generic drug in the same therapy class. Examples of medication classes for step therapy are those that treat conditions such as stomach ulcers, allergies, high blood pressure, cholesterol, migraine medications, osteoporosis, overactive bladder or insomnia/sleep problems. If you are on a drug requiring step therapy, you will receive a letter in the mail describing the requirements under the program. Note: additional medications requiring step therapy may be added and are subject to change.
How the Mail Service Program Works

The most cost-effective way to fill prescriptions for maintenance medications is through the Mail Service drug program, administered by CVS Caremark. When you and your covered family members enroll in any of the prescription drug options, you may participate in the Mail Service prescription drug program. You also have the option to pick up your 90-day mailorder prescription at a CVS Caremark retail location and still pay the mail service copays or coinsurance (depending on your option).
Specialty Pharmacy
The Home Depot Prescription Drug Plan through CVS Caremark includes a Specialty Pharmacy Program. This program offers you convenient access and delivery of your specialty medicine, along with personalized service and educational support for your specific therapy. You may be required to use CVS Caremarks Specialty Pharmacy when filling your specialty medicines. Examples of drugs that fall into this program include injectibles used to treat multiple sclerosis and rheumatoid arthritis, and growth hormone. Using CVS Caremark Specialty Pharmacy Services is easy and convenient. When you call CVS Caremark at 1-800-237-2767, a Specialty Pharmacy Specialist will promptly assist you with ongoing delivery needs, questions and support. In addition, a CVS Caremark pharmacist is available for emergency consultations from 6 am until 8 pm Central time, Monday through Friday. Keep in mind, prior authorization is required for specialty pharmacy drugs. This process may include trying an alternative product as your first line of therapy.
Advantages of the Mail Service Program

SavingsYou can get up to a 90-day supply of medication when you get a prescription filled through the CVS Caremark Mail Service Program. Ask your doctor to write a prescription for up to a 90-day supply plus refills, when clinically appropriate. ConvenienceYou can expect your medication to arrive 10 to 14 calendar days after CVS Caremark receives your prescription. Your package will include a new mail service order form and an invoice, if applicable. You also will receive the same type of information about your prescribed medication that you would receive from a retail pharmacy.
How the Retail Program Works

There are over 64,000 participating retail pharmacies in the national network. To locate a CVS Caremark participating retail pharmacy in your area, go to www.caremark.com and use the Find a Local Pharmacy search or call CVS Caremark Customer Care toll-free at 1-866-490-3376 (866-490-DEPO). After you meet the applicable annual deductible, you pay a percentage of the discounted price for preferred brand drugs, and a higher percentage of the discounted price for non-preferred brand drugs. Under each of the options, you only pay a deductible for brand name drugs at retail. There is no deductible for generic drugs.
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QualityCVS Caremark operates seven mail service pharmacies across the United States to provide quick service to plan participants wherever they live. To ensure your safety, CVS Caremarks mail service pharmacies are staffed by registered pharmacists. Just like your neighborhood pharmacist, CVS Caremarks pharmacists check each prescription to make sure it's filled correctly. In addition, your prescription history is reviewed to identify any possible problems with new medicines you may be prescribed.
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By PhoneCall CVS Caremark Customer Care toll-free at 1-866-490-3376 (866-490-DEPO) for fully automated refill service. Have your benefit ID number ready. By MailOnce you receive your medication, keep your refill labels to use on your next order form. Attach the refill label provided to the mail service order form and enclose payment with your order.
Any prescription drug more than one year old or not permitted by law in the state the medication is being dispensed. Vitamins, except single entity products for vitamins D, B, K, B12, folic acid and iron replacement. Medicines otherwise covered under the Medical Program. Medicines intended solely for cosmetic purposes, such as Rogaine /Minoxidil . Diet medications/Anti-obesity agents, such as Bontril. Self-care medicines and products (such as hand lotion). Any medicine that is not identified in the American Hospital Formulary Service Drug Medicines determined to be experimental or still under clinical investigation by health professionals. Over-the-counter medicines, even if the medicine also is available by prescription. Exceptions to this rule are prescriptions for aspirin for those over the age of 45, prescriptions for folic acid for women age 55 and under, and prescriptions for iron supplements for children 6-12 months of age. Nutritional and diet supplements (such as Multi Vitamins), including any supplements for newborn infants. Prescription devices such as elastic bandages and supports, GI-GU ostomy and irrigation supplies and needles/syringes other than insulin . However, respiratory prescription devices are covered, with the exception of Peak Flow Meters.
Program Limitations
Although most types of medicines are covered, there are some medicines, supplies and expenses that are not covered or have limited coverage. They include, but are not limited to: Smoking cessation medicines or aides (Prescription and OTC). These are covered upon enrollment in the Quit for Life program administered by Free and Clear. Cosmetic drugs Fluoride products (with exception of fluoride supplements for children 6 yrs of age and under) Fertility drugs, unless approved for non-fertility purposes Allergy serums Experimental drugs Certain over-the-counter (OTC) items; however certain OTC items may be covered to maintain compliance with the Patient Protection and Affordable Care Act. Immunization agents
Requesting a New Mail Service Prescription

To use the CVS Caremark Mail Service Program, ask your doctor to write a prescription for up to a 90day supply plus refills, when clinically appropriate. Then, complete a mail service order form and send it to CVS Caremark along with your original prescription and the appropriate payment to: CVS Caremark P.O. Box 659541 San Antonio, TX 78238
Requesting a Mail Service Prescription (Three Ways)

OnlineYou can order your mail service refills using www.caremark.com. Register online to receive refill reminders, informative newsletters and other email alerts. Have your benefit ID number handy to register. Members may choose to elect Auto Refill, which will allow CVS Caremark to automatically refill your prescription and send it to you before you run out of your current supply.
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Vaccines and toxoids are not covered under the Caremark Mail Service Program. Eligible vaccines and toxoids are covered when the prescriptions are filled at retail pharmacies. Any medicine provided while the person is an inpatient or outpatient in any healthcare facility. Any drug or medicine considered illegal under the Federal Food, Drug and Cosmetic Act, including, but not limited to, prescription drugs purchased in foreign countries for reimportation into the United States and prescription drugs purchased on the Internet from foreign countries. However, medicines purchased while on vacation in a foreign country due to a medical emergency may be covered. Call Caremark at 800-772-2301 if you have questions about coverage under these circumstances. Any supply with a National Drug Code (NDC) that is classified as a device, not a medicine. Any medicine determined not medically necessary. Emergency contraceptive kits. Alcohol wipes. Lancet devices. The expenses of administration or injection of any medicine. Any prescription, which exceeds the day supply limit per prescription or refill. Any refill of a medicine exceeding the number of refills specified by the provider.
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Any refill of a medicine more than one year after the latest prescription for the medicine or other than as permitted by the law of the jurisdiction in which the medicine is dispensed. Medicines that do not meet prior authorization requirements. Any medication that is illegally or unlawfully obtained Please Note: You may purchase some of these medications through CVS Caremark at a discount. For more information, go to www.caremark.com.
Filing Claims for Benefits

Prescription Drugs Purchased at Non-participating Pharmacies
When you use a participating pharmacy, you will not need to file a prescription drug claim. However, if you use a non-participating pharmacy or do not use your CVS Caremark ID card when filling your prescription(s), you must file a claim for benefits. Your claim must be filed within 365 days from the date you filled the prescription(s). Each claim should include the following information: associates name and Alternative ID number located on the ID card patients name pharmacys name, address and telephone number name of the prescribing doctor prescription number name of prescription drug date prescription was filled charge National Drug Control (NDC) number You can obtain prescription drug claim forms by either calling Caremark Customer Care at 1-866490-3376 or by logging on to www.caremark.com. Click on My Coverage, and then click on My Prescription Plan. From there, click on Print Forms, and then click on Prescription Drug Claim Form. Mail the completed claim form along with the prescription detail receipt(s) to the following address: CVS Caremark Attn: Claims Department P.O. Box 52196 Phoenix, AZ 85072-2196
Coverage at Non-Participating Pharmacies

Both brand-name (preferred and non-preferred) and generic prescriptions filled at non-participating pharmacies will be covered at 50% after meeting a $300 prescription drug deductible. There is a $3,000 individual annual out-of-pocket maximum. Disadvantages of using non-participating pharmacies are: Prescriptions are not discounted. You must pay in full for your prescriptions at the time of purchase. You have a higher annual deductible to satisfy and a higher out-of-pocket maximum. This deductible and out-of-pocket maximum are considered separate from your regular plan deductible and out-ofpocket maximum. You must file a CVS Caremark prescription drug claim form in order to be reimbursed.
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CVS Caremark Mail Service Program
When you use the CVS Caremark Mail Service Program, you do not have to file a claim. Simply mail your original prescription along with the mail service order form and your copayment or coinsurance (depending on your option) to CVS Caremark.
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The High Deductible Health Plan

The High Deductible Health Plan (HDHP) offers the lowest-cost coverage among the Company medical plans. However, you must meet the applicable deductible before benefits are payable for most covered servicesexcept preventive care and eligible preventive care prescription drugs, which are covered before the deductible is met. If you are enrolled in associate only coverage, you must meet the individual deductible of $2,000. If you have enrolled one or more dependents, you will need to meet the family deductible of $6,000. If you enroll in the HDHP, you have the option to open a health savings account (HSA). Through the HSA, you can pay for eligible out-of-pocket health care expenses with tax-free dollars and receive Home Depot matching contributions. In addition, your HSA earns interest and your balance rolls over from year to year. For more information about the HSA, see the Health Savings Account chapter. If you are a new salaried associate and enroll in the HDHP, you will have different medical coverage during your first 90 days of employment. Your HSA contributions will begin the first day of the first month beginning concurrent with or next following your 90th day of employment. See For New Salaried Associates: Medical Coverage During Your First 90 Days of Employment chapter for more information. The HDHP is administered by Aetna and uses the Aetna Choice POS II network of providers. The HDHP is not available in all areas-- youll see the plans available to you on the Your Benefits Resources web site when you enroll.
Its important to understand how the plan works and how its different from the PPO options as you consider whether this is a good option for you: You must meet the deductible ($2,000 individual/$6,000 family in-network) before benefits are payable for most covered services. This includes prescription drugs (except eligible preventive care drugs), office visits, diagnostic tests, outpatient surgery and hospital stays. There are no copays in the HDHP. In-network eligible preventive care services are free. Eligible preventive care services are 100% covered with no deductible when you use Aetna Choice POS II network providers. Eligible preventive care prescription drugs are covered before you meet the deductibleyou pay 20% of the cost of your eligible preventive care prescription drugs (in-network) with no deductible. Examples include specific drugs for coronary artery disease, diabetes, hypertension, respiratory disorders, and depression. For a complete list of eligible preventive care prescription drugs, go to www.caremark.com. Youll find information on HDHP benefits in the HDHP Summary of Benefits chart. For more information about the HDHP, see the following sections within this Medical chapter: Covered services, limitations and exclusions for the High Deductible Health Plan are listed in Whats Covered by the HDHP and What the HDHP Does Not Cover. Services and discounts available to HDHP participants through Aetna are explained in Aetna Programs. For information about filing claims, coordinating benefits with other plans, legal issues and more, see General Information.
CVS Caremark Extra Care Health Card

As a benefits-eligible Home Depot associate, you have access to CVS Caremarks Extra Care Health Card. This card gives you and your family a 20% discount on thousands of CVS/pharmacy brand health-related items valued at $1.00 or more*. Your card may be used at any CVS pharmacy location including online at www.cvs.com. Your savings will be indicated on your CVS store receipt labeled, HEALTH CARD DSC 20.0. For questions on ordering or re-ordering a card, contact Customer Care at 1-866-490-3376 (866490-DEPO). For questions related to balance transfers or additional details about the card and its benefits, please contact the Extra Care Health Card Team at 888-543-5938.
* Excludes prescriptions, alcohol, tobacco, lottery tickets, postage stamps, gift cards, money orders, prepaid cards, and photo finishing. Not valid on any items reimbursed on a governmental program. Excludes pharmacy items paid for in whole or part by state and/or federal health care programs and prescriptions purchased in NJ and NY. Also excludes controlled substances purchased in LA. Excludes Medicare recipients.
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How the Annual Deductible and Out-of-Pocket Maximum Works in the HDHP
For most medical services (except preventive care and eligible preventive care prescription drugs), the HDHP will begin to pay in-network and out-of-network benefits after you meet your annual deductible. Once you meet your out-of-pocket maximum, the HDHP pays 100% of most covered in-network and out-of-network medical expenses for the rest of the calendar year. The annual deductibles and out-ofpocket maximums for the HDHP are:
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If you are covering yourself only under the HDHP: You must meet the individual deductible of $2,000 for in-network services or $4,000 for out-of-network services before benefits begin, except for services that dont require the deductible. Eligible medical services received from both innetwork and out-of-network providers count toward the in-network deductible. Once you meet the in-network deductible, you will begin receiving benefits for in-network services. If you use out-of-network providers after meeting the in-network deductible, you will be required to meet the out-of-network deductible before receiving benefits for out-of-network services. For example, if you cover yourself only and receive $3,000 of covered services from an outof-network provider, you have satisfied the innetwork deductible and will begin receiving benefits for in-network services. However, you will not receive benefits for out-of-network services until you meet the full $4,000 out-of-network deductible. If you are covering one or more dependents under the HDHP: If you are covering more than yourself there is no individual deductible. Either you or a combination of you and your dependents expenses must meet the family deductible of $6,000 for innetwork services or $12,000 for out-of-network services before benefits begin, except for services that dont require the deductible. One family members expenses can satisfy the entire familys deductible.
For example, if you cover your spouse under the HDHP and your spouse receives $7,000 of in-network covered services, the family in-network deductible will be met. If your spouse receives $3,000 of in-network covered services, the in-network family deductible is not met. You or your spouse must incur an additional $3,000 of in-network covered services in order for the family deductible to be met. Eligible medical services received from both innetwork and out-of-network providers count toward the in-network deductible. Once you meet the in-network deductible, you will begin receiving benefits for in-network services. If you use out-of-network providers after meeting the in-network deductible, you will be required to meet the out-of-network deductible before receiving benefits for out-of-network services. For example, if you cover your spouse and children under the HDHP and your child receives $7,000 of covered services from an out-of-network provider, your family has satisfied the $6,000 in-network family deductible and will begin receiving benefits for in-network services. However, you will not receive benefits for out-ofnetwork services until you meet the full $12,000 out-of-network deductible. The Plan does not count the following expenses toward your annual out-of-pocket maximum: Penalties imposed by the Plan for out-of-network services when you or a covered family member fails to use the precertification program as required (see Aetna Programs: Precertification Program earlier in this chapter for information) Any expenses not covered by the Plan Amounts over the reasonable and customary level
High-Level Plan Design for HDHP

In-Network Deductible Out-of-Pocket Maximum Coinsurance Eligible Preventive Care Services Prescription Drugs1 Out-of-Network $2,0002/$6,0003 $4,000 2/$12,000 3 $5,0002/$10,0003 $10,000 2/$20,000 3 You pay 20% after deductible Covered at 100%no deductible You pay 50% after deductible You pay 50% no deductible
You pay 20% You pay 50% after deductible after deductible
Eligible Preventive You pay 20% You pay 50% Care Prescription no deductible no deductible Drugs1 Home Depot Matching Contribution to HSA
1 2 3
Up to $100 for associate-only coverage ($200 if covering dependents)
Non-preferred brand, you pay 40% For associate-only coverage For associates covering dependents
The annual deductible works differently in the HDHP than the PPO plans. Please note these rules for meeting the deductible under the HDHP:
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HDHP Prescription Drug Coverage
You must meet the deductible ($2,000 individual/$6,000 family in-network) before benefits are payable for prescription drugs, except eligible preventive care drugs. Eligible preventive care prescription drugs are covered before you meet the deductibleyou pay 20% of the cost of your eligible preventive care prescription drugs (in-network) with no deductible. Examples include specific drugs for coronary artery disease, diabetes, hypertension, respiratory disorders, and depression. For a complete list of eligible preventive care prescription drugs, go to www.caremark.com. The HDHP prescription drug coverage is administered by CVS Caremark. Once you have met your deductible, you pay 20% of the cost of generic and preferred brand-name drugs (eligible preventive care drugs do not require meeting the deductible) you receive at CVS Caremark network pharmacies. You may still obtain non-preferred brand name prescriptions, but you will pay a higher percentage (40%) of the cost. If you receive a prescription drug at a nonnetwork pharmacy, you pay 50% of the cost (after meeting your deductible, if applicable). Read about important provisions within your prescription drug coverage in the Prescription Drug section of this chapter, including: Prior Authorization Drugs Clinical Management Programs Using the Prescription Drug Plan How the Mail Service Program Works Program Limitations Coverage at Non-Participating Pharmacies Filing Claims for Benefits
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Whats Covered by the HDHP

The HDHP covers most medical bills for illness or injury, as long as the treatment, service or supply is considered medically necessary or is a covered service. The Plan considers a service or supply medically necessary if it is a generally accepted health care practice and is required to treat the condition of the patient, as determined by the claims administrator. The fact that a doctor or other provider of medical services prescribes, recommends or approves a treatment, service or supply does not automatically make it a covered expense under the Medical Plan. The Well-Care benefits cover in- and out-of-network preventive prostate cancer screenings, mammograms, Pap smears, colorectal screenings, in-network well-child care services and some additional in-network well-adult care services. For percentages of coinsurance and deductible amounts for the HDHP, see the HDHP Summary of Benefits charts.
Outpatient Treatment Expenses incurred for the effective treatment of alcoholism or drug abuse while the person is not confined as a full-time inpatient in a hospital or treatment facility will be considered covered medical expenses. Charges incurred for the treatment of alcoholism or drug abuse on an inpatient or an outpatient basis are covered medical expenses to the same extent as charges incurred for the treatment of any other disease.
Bariatric Surgery
Coverage for bariatric surgery requires you to satisfy the following eligibility criteria in order to seek approval for the bariatric surgery benefit. For Aetna members considering bariatric surgery, call 1-800-695-9744 You will be assigned a case manager that can help you review the eligibility requirements, precertify, find a designated Institute of Quality (IOQ) or get other information regarding your bariatric surgery benefit. You must meet these initial eligibility requirements. Other rules may apply: Meet the following Obesity Guidelines:* BMI of equal to or greater than 40, irrespective of co-morbidities as defined by National Institute of Health (NIH), or
Alcoholism or Drug Abuse

Certain expenses for the treatment are covered medical expenses. Inpatient Treatment If a person is a full-time inpatient either in a hospital or in a treatment facility, then coverage is as shown below: hospital: treatment of medical complications of alcoholism or drug abuse, such as cirrhosis of the liver, delirium tremens, or hepatitis; and effective treatment of alcoholism or drug abuse treatment facility: room and board, up to the private room limit; other necessary services and supplies
* Obesity Guidelines are based on National Institute of Health (NIH) guidelines. Eligibility design will be updated automatically for BMI as NIH guidelines are updated.
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BMI of equal to or greater than 35, with at least one significant co-morbid condition as defined by National Institute of Health (NIH). AND Complete a 3-month physician supervised weight loss program that includes nutritionist/ dietician involvement or complete a three-month multidisciplinary surgical prepatory regimen in accordance with your plan administrators bariatric medical policy; AND Complete a pre-surgery psychological evaluation; AND Have the surgery performed at a facility that has been designated a Bariatric Surgery Institute of Excellence as defined by Aetna AND Seek prior approval before obtaining any Bariatric Services through pre-certification/prior notification to activate bariatric surgery benefit. If you live more than 100 miles from a designated Institute of Quality, you may be eligible for Travel and Lodging reimbursement of up to $50 per night per person (up to $100 total). There is a $10,000 Travel & Lodging maximum per procedure. All Travel and Lodging reimbursement must be pre-approved. Exclusions Related to Bariatric Surgery Cosmetic Surgery to correct such skin conditions as excess skin after successful weight loss, unless medically necessary Breast Reduction and Abdominoplasty, unless medically necessary Revisions, unless medically necessary Any member under the age of 18
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Skilled Nursing Facility

The Plan covers charges made by a skilled nursing facility for the following services and supplies, provided that they are furnished to a covered person while he or she is confined while convalescing from a disease or injury: room and board, including charges for services, such as general nursing care, made in connection with room occupancy. Not included is any charge for daily room and board in a private room that exceeds the semi-private room limit use of special treatment rooms x-ray and lab work physical, occupational or speech therapy oxygen and other gas therapy other medical services usually given by a skilled facility. This does not include private or special nursing, or physician's services medical supplies Benefits will be paid for no longer than 90 days during any one calendar year. Skilled Nursing Facility Limitations Benefits will not be provided when a member reaches the maximum level of recovery possible and no longer requires other than routine care. Charges for these skilled facility expenses are not covered: drug addiction chronic brain syndrome alcoholism senility
mental retardation any other mental disorder
Emergency Room
It is important that all visits to a hospital emergency room occur in the context of a true emergency, such as a life-threatening illness or injury. These include severe breathing problems, major burns, head injuries, acute heart attack symptoms, uncontrollable bleeding, unconsciousness or other extreme circumstances. emergency care. Covered medical expense for charges made by the hospital will be covered if treatment is received in the emergency room of a hospital while a person is not a full-time inpatient. You must verify the treatment is a true emergency. non-emergency care. No benefits are payable if treatment is received in the emergency room of a hospital while a person is not a full-time inpatient and the treatment is not for emergency care.
Family Planning
The charges made by a physician or hospital services even though they are not incurred in connection with the diagnosis or treatment of a disease or injury, are covered medical expenses. Benefits will be payable for: a vasectomy for voluntary sterilization a tubal ligation for voluntary sterilization voluntary abortions Charges for the reversal of a sterilization procedure are not covered.
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Home Health Care
Home health care provides a program for the members care and treatment in the home. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the members attending physician. Home health care expenses are covered if: the charge is made by a home health care agency; and the care is given under a home health care plan; and the care is given to a person in his or her home. Home health care expenses are charges for: part-time or intermittent care by an R.N. or by an L.P.N. if an R.N. is not available part-time or intermittent home health aide services for patient care and in direct support of care by an R.N. or an L.P.N. Part-time or intermittent medical social services by a social worker when provided in conjunction with, and in direct support of care by an R.N. or an L.P.N. Medical supplies, prescription drugs and lab services by or for a home health care agency to the extent they would have been covered under this plan if you had continued your hospital stay physical, occupational, and speech therapy. Note: Covered services available under Home Health Care do NOT reduce outpatient benefits available under the Physical Therapy section shown in this Plan.
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the following expenses to the extent they would have been covered under this Plan if the person had been confined in a hospital or skilled facility: medical supplies; drugs and medicines prescribed by a physician; oxygen and its administration; and lab services provided by or for a home health care agency The plan covers up to 150 visits in a calendar year. Each visit by a nurse or therapist is considered one visit. Each visit of up to four hours by a home health aide is considered one visit. Any service not specifically outlined above is not covered under Home Health Care benefits.
Hospice Outpatient Care Charges made by a hospice care agency for: part-time or intermittent nursing care by an R.N. or L.P.N. for up to eight hours in any one day medical social services under the direction of a physician, including: assessment of the person's social, emotional, and medical needs, and home and family situation; identification of the community resources that are available to the person; and assisting the person to obtain those resources as needed. psychological and dietary counseling consultation or case management services by a physician physical and occupational therapy part-time or intermittent home health aide services (mainly for caring for the person) for up to eight hours in any one day medical supplies drugs and medicines prescribed by a physician The plan covers outpatient care charges made by these providers, as long as the provider is not an employee of a hospice care agency and the hospice care agency is responsible for the care of the person: physician for consultant or case management services physical or occupational therapist
Hospice Care
This is care given to a terminally ill person by or under arrangements with a hospice care program. Hospice Facility Expenses Charges made by a hospice facility, hospital or skilled facility for: Inpatient Care: room and board and other services and supplies furnished to a person while a fulltime inpatient for pain control and other acute and chronic symptom management. Charges that exceed the semi-private room limit for daily room and board are not covered. Outpatient Care: services and supplies furnished to a person while not confined as a full-time patient.
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home health care agency for: physical and occupational therapy part-time or intermittent home health aide services (mainly for caring for the person) for up to eight hours in any one day medical supplies drugs and medicines prescribed by a physician psychological and dietary counseling Not included are charges for: funeral arrangements pastoral counseling financial or legal counseling, including estate planning and the drafting of a will homemaker or caretaker services that are not solely related to care of the person, including sitter or companion services for either the person who is ill or other members of the family, transportation, housecleaning, and maintenance of the house respite care furnished during a period of time when the person's family or usual caretaker cannot, or will not, attend to the person's needs
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ly charged by similar institutions in the same geographic area. For In-Network Care If a private room is used, the daily board and room charge will be covered if your network provider requests a private room and Aetna approves this request. If these procedures are not followed, any part of the daily board and room charge that is more than the semi-private room limit is not covered. For Out-of-Network Care You are responsible for any charge for daily room and board in a private room that exceeds the Plans semi-private room limit. Outpatient Hospital Expenses Charges made by a hospital for hospital services and supplies that are provided to a covered person who is not a full-time inpatient. Mental Disorders Charges incurred for the treatment of a mental disorder on an inpatient or an outpatient basis are covered medical expenses to the same extent as charges incurred for the treatment of any other disease.
case, the Plan does not require that a provider obtain authorization from or notify the plan for prescribing the length of stay not in excess of 48 hours (or 96 hours). In-network maternity benefits include the following: Initial visit to confirm pregnancycovered at 100% after specialist copayment Medically necessary ultrasounds, sonograms and other diagnostic testscovered at the applicable cost sharing based on the place in which the service was rendered. Global delivery feeincludes subsequent prenatal visits, routine urinalysis, delivery and postnatal visitscovered at coinsurance after deductible. Hospital copay applies.
Mastectomies
Federal law requires group health plans offering mastectomy coverage also to cover reconstructive surgery and prostheses following mastectomies. Therefore, if you or a covered family member receives benefits for a medically necessary mastectomy and elect breast reconstruction after the mastectomy, coverage will also be provided for the following: all stages of reconstruction of the breast on which the mastectomy has been performed surgery and reconstruction of the other breast to produce a symmetrical appearance breast prosthesis (artificial replacements) treatment of physical complications with respect to all stages of a mastectomy, including lymphedemas (swelling associated with the removal of the lymph nodes)
Hospitals
Inpatient Hospital Expenses Charges made by a hospital for semi-private room and board and other hospital services and supplies while a covered person is confined as a full-time inpatient. Semi-private room limit is determined based on the room and board charge that an institution applies to the most beds in its semi-private rooms with 2 or more beds. If there are no such rooms, the rate is based on the rate most common-
Maternity Benefits
As required by federal law, maternity benefits are not restricted for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mothers or newborns attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any
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This coverage will be provided in consultation with the attending physician and the patient, and it will be subject to the same annual deductible, coinsurance and/or copayment provisions otherwise applicable. Kidney Liver Intestine Bone Marrow/Stem Cell
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Benefits will be paid: At 100% after the deductible for a treatment received at a facility designated by the plan as an Institute of Excellence (IOE) for the type of transplant being performed. Each IOE facility has been selected to perform only certain types of transplants. At 80% after the deductible and after the inpatient per-confinement copay for treatment received at a participating facility but a Non-IOE transplant facility. As out-of-network for services and supplies obtained from a facility that is not a network participating facility The plan covers: Charges made by a physician or transplant team. Charges made by a hospital, outpatient facility or physician for the medical and surgical expenses of a live donor, but only to the extent not covered by another plan or program. Related supplies and services provided by the IOE facility during the transplant process. These services and supplies may include: physical, speech and occupational therapy; bio-medicals and immunosuppressants; home health care expenses and home infusion services. Charges for activating the donor search process with national registries. Compatibility testing of prospective organ donors who are immediate family members. For the purpose of this coverage, an immediate family member is defined as a first-degree biological relative. These are your biological parents, siblings or children.
Surgery
pre-admission tests performed in the hospital or other location, such as a laboratory or doctors office surgeons fees related to a surgical procedure covered by the Plan assistant surgeons fees during a covered surgical procedure, if it is determined that the condition of the patient and the type of surgery performed requires the use of a second doctor doctors fees for administering anesthesia during a covered surgical procedure. To qualify for benefits, the anesthesia must be administered by a doctor other than the surgeon or the assistant surgeon, except if the attending doctor is performing outpatient oral surgery
Multiple organs replaced during one transplant surgery Tandem transplants (Stem Cell) Sequential transplants Re-transplant of same organ type within 180 days of the first transplant Any other single organ transplant, unless otherwise excluded under the plan. The following will be considered to be more than one Transplant Occurrence: Autologous blood/bone marrow transplant followed by allogenic blood/bone marrow transplant (when not part of a tandem transplant) Allogenic blood/bone marrow transplant followed by an autologous blood/bone marrow transplant (when not part of a tandem transplant) Re-transplant after 180 days of the first transplant Pancreas transplant following a kidney transplant A transplant necessitated by an additional organ failure during the original transplant surgery/process More than one transplant when not performed as part of a planned tandem or sequential transplant, (e.g., a liver transplant with subsequent heart transplant).
Transplant Services
Covered expenses include charges incurred during a transplant occurrence. The following will be considered to be one transplant occurrence once it has been determined that you or one of your dependents may require an organ transplant. Organ means solid organ; stem cell; bone marrow; and tissue. For example: Heart Lung Heart/ Lung Simultaneous Pancreas Kidney (SPK) Pancreas
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Inpatient and outpatient expenses directly related to a transplant. Covered transplant expenses are typically incurred during the four phases of transplant care described below. Expenses incurred for one transplant during these four phases of care will be considered one transplant occurrence. A transplant occurrence is considered to begin at the point of evaluation for a transplant and end either 180 days from the date of the transplant; or upon the date you are discharged from the hospital or outpatient facility for the admission or visit(s) related to the transplant, whichever is later. The four phases of one transplant occurrence and a summary of covered transplant expenses during each phase are: 1. Pre-transplant evaluation/screening: Includes all transplant-related professional and technical components required for assessment, evaluation and acceptance into a transplant facilitys transplant program; 2. Pre-transplant/candidacy screening: Includes HLA typing/compatibility testing of prospective organ donors who are immediate family members; 3. Transplant event: Includes inpatient and outpatient services for all covered transplant-related health services and supplies provided to you and a donor during the one or more surgical procedures or medical therapies for a transplant; prescription drugs provided during your inpatient stay or outpatient visit(s), including bio-medical and immunosuppressant drugs; physical, speech or occupational therapy provided during your inpatient stay or outpatient visit(s); cadaveric and live donor organ procurement; and
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4. Follow-up care: Includes all covered transplant expenses; home health care services; home infusion services; and transplant-related outpatient services rendered within 180 days from the date of the transplant event. If you are a participant in the IOE program, the program will coordinate all solid organ and bone marrow transplants and other specialized care you need. Any covered expenses you incur from an IOE facility will be considered network care expenses. Important Reminders To ensure coverage, all transplant procedures need to be precertified by your medical plan administration. Refer to the Aetna precertification section of this chapter. Limitations Unless specified above, not covered under this benefit are charges incurred for: Outpatient drugs including bio-medicals and immunosuppressants not expressly related to an outpatient transplant occurrence; Services that are covered under any other part of this plan; Services and supplies furnished to a donor when the recipient is not covered under this plan; Harvesting or storage of organs, without the expectation of immediate transplantation for an existing illness; Harvesting and/or storage of bone marrow, tissue or stem cells, without the expectation of transplantation within 12 months for an existing illness; Cornea (Corneal Graft with Amniotic Membrane) 98
or Cartilage (autologous chondrocyte or autologous osteochondral mosaicplasty) transplants, unless otherwise authorized by Aetna. If a person is a transplant patient, this Plan will pay a benefit for travel expenses and lodging expenses but only to the extent described below and only if charges incurred for the transplant procedures and treatment types are covered medical expenses. Any charges made by the transplant facility for services and supplies that are: furnished in connection with any of the procedures or treatment listed below; and are included under this Plan as covered medical expenses will be considered to be expenses incurred for in-network care and paid at 100%. Transplant Procedure and Treatment Types Transplant Travel Expenses These are expenses incurred by a transplant patient and approved in advance by Aetna for transportation between his or her home and the transplant facility to receive services in connection with any listed procedure or treatment. Also included are expenses incurred by a companion, and approved in advance by your medical plan administrator, for transportation when traveling with a transplant patient between the transplant patient's home and the IOE facility to receive such services. IOE Lodging Expenses These are expenses incurred by an transplant patient, and approved in advance for lodging away from home:

while traveling between his or her home and the facility to receive services in connection with any listed procedure or treatment; or to receive outpatient services from the facility in connection with any listed procedure or treatment. The maximum benefit payable for these expenses is $50 per night. Also included are expenses incurred by a companion, and approved in advance by your medical plan administrator, for lodging away from home: while traveling with an IOE patient between the transplant patient's home and the facility to receive services in connection with any listed procedure or treatment; or when the companion's presence is required to enable a transplant patient to receive such services on an inpatient or outpatient basis. The maximum benefit payable for these expenses is $50 per night.
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the roots of a tooth without removing the entire tooth cysts, tumors, or other diseased tissues cut into gums and tissues of the mouth when not done in connection with the removal, replacement or repair of teeth alter the jaw, jaw joints, or bite relationships by a cutting procedure when appliance therapy alone cannot result in functional improvement non-surgical treatment of infections or diseases, excluding those of or related to the teeth Dental insurance will serve as primary payor for the following services. If the member does not have dental insurance or it does not cover these services, the Plan will cover the following surgery needed to cut out: Teeth partly or completely impacted in the bone of the jaw Teeth that will not erupt through the gum Other teeth that cannot be removed without cutting into the bone Dental work, surgery and orthodontic treatment needed to remove, repair, replace, restore or reposition: natural teeth damaged, lost, or removed; or other body tissues of the mouth fractured or cut out due to injury. Any such teeth must have been: free from decay; or in good repair; and
firmly attached to the jaw bone at the time of the injury The treatment must be done in the calendar year of the accident or the next one. If crowns (caps), dentures (false teeth), bridgework or in-mouth appliances are installed due to such injury, covered medical expenses include only charges for: the first denture or fixed bridgework to replace lost teeth; the first crown needed to repair each damaged tooth; and an in-mouth appliance used in the first course of orthodontic treatment after the injury. Except as provided for injury, not included are charges: for in-mouth appliances, crowns, bridgework, dentures, tooth restorations, or any related fitting or adjustment services; whether or not the purpose of such services or supplies is to relieve pain for root canal therapy for routine tooth removal (not needing cutting of bone) The plan covers oral surgery and related dental services to correct a gross anatomical defect present at birth that results in significant functional impairment of a body part, if the services or supplies will improve function. The plan covers fluoride treatment, removal of teeth and hyperbaric oxygen therapy in connection with covered radiation therapy.
Oral Surgery
Expenses for the treatment of the mouth, jaws, and teeth are covered medical expenses, but only those for: teeth, mouth, jaws, jaw joints; or supporting tissues (this includes bones, muscles, and nerves). For these expenses, "physician" includes a dentist. The Plan covers surgery needed to: treat a fracture, dislocation, or wound cut out:
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Not included are charges: to remove, repair, replace, restore or reposition teeth lost or damaged in the course of biting or chewing to repair, replace, or restore fillings, crowns, dentures or bridgework for non-surgical periodontal treatment for dental cleaning, in-mouth scaling, planing or scraping for myofunctional therapy; this is muscle training therapy or training to correct or control harmful habits
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services that are covered under any other group plan provided by the Company services for diagnosis or treatment of a suspected or identified injury or disease exams given while the person is confined in a hospital or other facility for medical care services that are not provided by a physician or under his/her direct supervision medicines, drugs, appliances, equipment, or supplies psychiatric, psychological, personality or emotional testing or exams exams in any way related to employment premarital exams vision or dental exams
which no further improvement can be expected. A licensed medical doctor or psychologist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Occupational Therapy. Occupational therapy is the therapeutic use of work and self-care activities to restore independent function and prevent disability. Coverage is limited to treatment to restore the loss of independent function and prevent disability of the therapeutic use of work and self-care activities caused by an injury or illness. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as multiple sclerosis, cerebral palsy, polio, spina bifida and amyotrophic lateral sclerosis (Lou Gehrigs disease). Covered therapy does not include therapy for transportation activities or therapy from which no further improvement can be expected. A registered or licensed occupational therapist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Physical Therapy. Physical therapy is the use of physical means, such as massage, manipulation, heat, hydrotherapy, ultrasound or exercises to treat a disability of the body due to illness or injury.
Routine Cancer Screenings

For information, see the HDHP Summary of Benefits chart in this chapter.
Routine Physical Exams

Charges made by your primary care physician or a network provider for a routine physical exam given to you, your spouse/same sex partner, or your dependent child may be covered medical expenses. If charges for a dependent childs routine physical exam are covered under any other benefit section, charges in connection with that physical exam are not considered covered medical expenses under this section. A routine physical exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified injury or disease. Included are immunizations for infectious disease, testing for tuberculosis, x-rays, lab, and other tests given in connection with the exam. For more information, see the HDHP Summary of Benefits chart in this chapter. These routine physical exam charges are not covered:
Short-Term Rehabilitation Expenses

Therapy Cognitive Therapy. Cognitive therapy is treatment to restore memory, perception, and normal thought processes following an injury to the brain. Coverage is limited to treatment to restore memory, perception and normal thought processes following an injury to the brain. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as multiple sclerosis, cerebral palsy, polio, spina bifida and amyotrophic lateral sclerosis (Lou Gehrigs disease). Covered therapy does not include therapy to develop cognitive skills that did not exist before the injury or therapy from
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Coverage is limited to charges for manipulation, heat, hydrotherapy, ultrasound or exercises/interventions to treat a disability of the body due to illness or injury. Therapy is expected to result in significant improvement in body function lost or impaired by disease (e.g., stroke) or accidental injury; or, its aimed at slowing or preventing further deterioration of body function impaired by a neurological disease such as multiple sclerosis or polio. Covered therapy does not include visual therapy or therapy from which no further improvement can be expected. A licensed medical physician, chiropractor or physical therapist, other than a person who is related to the patient by blood or marriage, must provide the physical therapy within the scope of his or her profession. Speech Therapy. Speech therapy is treatment to restore the skills necessary for intelligible speech. The loss of such skills must be due to illness or injury. Coverage is limited to charges necessary to restore an existing speech function (the ability to express thoughts, speak words and form sentences) that has been lost or impaired as a result of a disease or an injury. Significant functional improvement must be expected within a reasonable time frame. Significant improvement means the speech therapy is expected to restore the level of speech that the individual had obtained prior to the illness or injury. Covered therapy does not include therapy from which no further improvement can be expected. A registered or licensed speech therapist, other than a person who is related to the patient by blood or marriage, must provide therapy within the scope of his or her profession. Exception. Coverage for cognitive, physical, occupational and speech therapy will be available as stat-
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ed above for situations where children have failed to acquire the necessary skills as a result of cerebral palsy, autism, Down syndrome or a severe neurological or genetic disorder. Therapy must be expected to result in significant improvement or be aimed at slowing or preventing further deterioration. All covered therapy must be diagnosed and prescribed by a licensed physician. Specific evaluation with standard test scores and measurable goals and objectives to determine progress and improved functional ability must be provided. Due to the review requirements of the Plan, authorization of benefits may be done on a retroactive basis. Therefore, it is possible that if services are rendered prior to approval, some or all of these services may not be covered. If approved, these services will be covered, based on the coinsurance level of the Plan you elected, after the appropriate individual annual deductible has been met. Some coverages may have limitations. The appropriate out-of-pocket maximum applies. The Plan does not provide coverage for sensory (auditory) integration therapy. This procedure has been proposed as a treatment approach to the management of children with various communication, behavioral, emotional and learning disorders. The effectiveness of this therapy is unproven. A meta-analysis of multiple research on sensory integration treatment was published in April 1999, which concluded that more recent studies do not show overall positive effects from sensory (auditory) integration therapy. In addition, the Plan does not cover
charges for speech, cognitive, occupational and/or physical therapy services related to developmental delay for children or adults if therapy is not expected to result in significant improvement or be aimed at slowing or preventing further deterioration.
Other Medical Expenses

The Plan covers charges for: oxygen and/or rental of equipment required for its administration x-ray, radium, radioactive isotope therapy, outpatient radiation therapy, chemotherapy, dialysis and respiratory therapy blood (if not replaced), or other fluids actually injected into the circulatory system insulin syringes and test tapes if used by a provider during an office visit first pair of contact lenses or eyeglasses following cataract surgery anesthetics rental of durable medical and surgical equipment. In lieu of rental, the following may be covered: the initial purchase of such equipment if your medical plan administrator is shown that: long term care is planned, and that such equipment either cannot be rented or is likely to cost less to purchase than to rent repair of purchased equipment replacement of purchased equipment if Aetna is shown that it is needed due to a change in the person's physical condition, or it is likely to cost less to purchase a replacement than to repair existing equipment or to rent similar equipment.
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Precertification is required for durable medical equipment. Artificial limbs and eyes. The plan does not cover charges for: eyeglasses vision aids communication aids orthopedic shoes, foot orthotics, or other devices to support the feet, unless necessary to prevent complications of diabetes or if the orthopedic shoe is an integral part of a leg brace and expense is included as part of the cost of the brace coverage for services related to the treatment of varicose veins if medically necessary. Precertification is required. Prescription drugsSee HDHP Prescription Drug Coverage earlier in this chapter.
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Private duty services that are not covered include: nursing care that does not require the education, training and technical skills of a R.N. or L.P.N., such as transportation, meal preparation, charting of vital signs and companionship activities. private duty nursing care given while the person is an inpatient in a hospital or other health care facility. care provided to help a person in the activities of daily life, such as bathing, feeding, personal grooming, dressing, getting in and out of bed or a chair, or toileting. care provided solely for skilled observation except for no more than one four-hour period per day for a period of no more than ten consecutive days following the occurrence of: change in patient medication; need for treatment of an emergency condition by a physician, or the onset of symptoms indicating the likely need for such services; surgery; release from inpatient confinement; or any service provided solely to administer oral medicines, except where applicable law requires that such medicines be administered by a R.N. or L.P.N.
Experimental or Investigational Treatment

Covered expenses include charges made for experimental or investigational drugs, devices, treatments or procedures, provided all of the following conditions are met: You have been diagnosed with cancer or a condition likely to cause death within one year or less; Standard therapies have not been effective or are inappropriate; Your medical plan administrator determines, based on at least two documents of medical and scientific evidence, that you would likely benefit from the treatment; You are enrolled in a clinical trial that meets these criteria; The drug, device, treatment or procedure to be investigated has been granted investigational new drug (IND) or Group c/treatment IND status; The clinical trial has passed independent scientific scrutiny and has been approved by an Institutional Review Board that will oversee the investigation; The clinical trial is sponsored by the National Cancer Institute (NCI) or similar national organization (such as the Food & Drug Administration or the Department of Defense) and conforms to the NCI standards; The clinical trial is not a single institution or investigator study unless the clinical trial is performed at an NCI designated cancer center; and You are treated in accordance with protocol.
Private Duty Care

The charges made by a R.N. or L.P.N. or a nursing agency for "skilled nursing services" are included as covered medical expenses. No other charges made by a R.N. or L.P.N. or a nursing agency are covered. As used here, private duty care means services for: visiting nursing care by a R.N. or L.P.N. Visiting nursing care means a visit of not more than eight hours for the purpose of performing specific skilled nursing tasks. private duty nursing by a R. N. or L.P.N. if the person's condition requires skilled nursing care and visiting nursing care is not adequate.
Self-Injectible Drugs
Pharmacy and most injectible drugs are covered under the Caremark Prescription Drug Plan. Please contact Caremark at 1-866-490-3376.
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What the HDHP Does Not Cover
Coverage is not provided for: services and supplies not necessary for the diagnosis, care, or treatment of the disease or injury involved, as determined by your medical plan administrator. This applies even if they are prescribed, recommended, or approved by the person's attending physician or dentist. services not medically necessary for diagnosis or treatment of an illness or injury, unless specifically covered by the Plan all services or expenses incurred by you or your family before coverage started or after coverage has terminated under the plan unless the patient is enrolled in COBRA (see the COBRA Coverage chapter for more information) any services or supplies covered by a state workers compensation act or similar program or legislation wigs, unless medically necessary any services for which a charge would not have been made in the absence of coverage charges for services or supplies submitted more than 12 months from the date services were provided charges made by a non-participating physician for or in connection with surgery which exceed the following maximum when two or more surgical procedures are performed at one time. The maximum amount payable will be the amount otherwise payable for the most expensive procedure, and 50% of the amount otherwise payable for the secondary procedure and 25% of all other surgical procedures under the Aetna Medical Plan.
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charges for the removal of organs or tissues to be donated to another, other than to a person covered by the Plan charges made by any covered provider who is a member of your or your dependents family care, treatment, services, or supplies that are not prescribed, recommended, or approved by the person's attending physician or dentist. services, treatment, education testing, or training related to learning disabilities or developmental delays if therapy is not expected to result in significant improvement or be aimed at slowing or preventing further deterioration. For more information, see the Therapy section. care furnished mainly to provide a surrounding free from exposure that can worsen the person's disease or injury treatment such as primal therapy, rolfing, psychodrama, megavitamin therapy, bioenergetic therapy, vision perception training, or carbon dioxide therapy treatment of covered health care providers who specialize in the mental health care field and who receive treatment as a part of their training in that field services of a resident physician or intern rendered in that capacity. charges that are made only because there is health coverage. charges that a covered person is not legally obliged to pay. charges for custodial care, as determined by Aetna
charges, to the extent allowed by the law of the jurisdiction where the group contract is delivered, for services and supplies: furnished, paid for, or for which benefits are provided or required by reason of the past or present service of any person in the armed forces of a government furnished, paid for, or for which benefits are provided or required under any law of a government. This exclusion will not apply to "no fault" auto insurance if it is: required by law provided on other than a group basis
charges for eyeglasses, contacts, eye examinations, eye exercises, correction to vision (including but not limited to LASIK Radial Keratotomy) or fitting of glasses, unless specifically covered by the Plan. Any services or supplies related to education, training or retraining services or testing, including: special education, remedial education, job training and job hardening programs; therapy, drugs, implants, supplies, or counseling for sexual dysfunctions or inadequacies that do not have a physiological or organic basis sex change surgery or any treatment of gender identity disorders charges for services or treatment related to impotency and/or infertility, unless such services or treatment are to diagnose and/or treat a specific medical condition (other than previous voluntary sterilization) causing the impotency and/or infertility, and such charges are not directly related to giving birth and/or the birth process
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charges for in vitro fertilization and other artificial insemination routine physical exams, routine vision exams, routine dental exams, routine hearing exams, immunizations, or other preventive services and supplies, except to the extent coverage for such exams, immunizations, services, or supplies is specifically provided under the Plan marriage, family, child, career, social adjustment, pastoral, or financial counseling. Aetna may consider these services for payment if there is no diagnosed behavioral health disorder. acupuncture therapy (except when acupuncture is performed by a physician as a form of anesthesia in connection with surgery that is covered under this Plan) plastic surgery, reconstructive surgery, cosmetic surgery, or other services and supplies which improve, alter, or enhance appearance, whether or not for psychological or emotional reasons, except to the extent needed to improve the function of a part of the body that is not a tooth or structure that supports the teeth and is malformed as a result of a severe birth defect (including harelip, webbed fingers or toes) as a direct result of disease or surgery performed to treat disease or injury or repair an injury that is: a result of a severe birth defect; including harelip, webbed fingers, or toes; or a direct result of disease or surgery performed to treat a disease or injury. Surgery must be performed in the calendar year of the accident which causes the injury; or in the next calendar year.
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charges that are not reasonable, as determined by Aetna reversal of a sterilization procedure services or supplies furnished by a network provider in excess of the provider's negotiated charge for that service or supply. This exclusion will not apply to any service or supply for which a benefit is provided under Medicare before the benefits of the group contract are paid Any charges in excess of the benefit, dollar, day, visit or supply limits stated in this document. Any non-emergency charges incurred outside of the United States Charges submitted for services that are not rendered, or not rendered to a person not eligible for coverage under the plan. Charges submitted for services by an unlicensed hospital, physician or other provider or not within the scope of the providers license. Contraception, except as specifically described in the Whats Covered by the HDHP section: over the counter contraceptive supplies including but not limited to condoms, contraceptive foams, jellies and ointments. Costs for services resulting from the commission of, or attempt to commit a felony by the covered person. Dental Services except as covered as Oral Surgery under the plan. Orthodontic services or treatment (including appliances) related to temporomandibular joint (TMJ) syndrome unless all other nonsurgical options are deemed unsuccessful 104
Disposable take-home supplies: Any outpatient disposable supply or device, including sheaths, bags, elastic garments, support hose, bandages, bedpans, syringes, blood or urine testing supplies, and other home test kits; and splints, neckbraces, compresses, and other devices not intended for reuse by another patient. Facility charges for care services or supplies provided in: rest homes; assisted living facilities; similar institutions serving as an individuals primary residence or providing primarily custodial or rest care; health resorts; spas, sanitariums; or infirmaries at schools, colleges, or camps charges for orthopedic shoes and other supportive appliances for the feet other than for expenses which are specified in the Whats Covered by the HDHP section Home and mobility: Any addition or alternation to a home, workplace or other environment, or vehicle and any related equipment or device, including: Bathroom equipment such as bathtub seats, benches, rails, and lifts; Purchase or rental of exercise equipment, air purifiers, central or unit air conditioners, water purifiers, waterbeds. and swimming pools; Exercise and training devices, whirlpools, portable whirlpool pumps, sauna baths, massage devices or over-bed tables;

Equipment or supplies to aid sleeping or sitting, including electric beds, water beds, air beds, pillows, sheets, blankets, warming or cooling devices, elevating chairs, bed tables and reclining chairs; Equipment installed in your home, workplace or other environment, including stair-glides, elevators, wheelchair ramps, or equipment to alter air quality, humidity or temperature; Other additions or alternations to your home, workplace or other environment, including room additions, changes in cabinets, countertops, doorways, lighting, wiring, furniture, communication aids, wireless alert systems, or home monitoring; Services and supplies furnished mainly to provide a surrounding free from exposure that can worsen your illness or injury; Removal from your home, worksite or other environment of carpeting, hypo-allergenic pillows, mattresses, paint, mold, asbestos, fiberglass, dust, pet dander, pests or other potential sources of allergies or illness; and transportation devices, including stair-climbing wheelchairs, personal transporters, bicycles, automobiles, vans or trucks, or alternations to any vehicle or transportation device. Miscellaneous charges for services or supplies including: Annual or other charges to be in a physicians practice;
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Charges to have preferred access to a physicians services such as boutique or concierge physician practices; Cancelled or missed appointment charges or charges to complete claim forms; Personal comfort and convenience items: Any service or supply primarily for your convenience and personal comfort or that of a third party, including: Telephone, television, internet, barber or beauty service or other guest services; housekeeping, cooking, cleaning, shopping, monitoring, security or other home services; and travel, transportation, or living expenses, rest cures, recreational or diversional therapy. Services provided by a spouse, domestic partner, parent, child, step-child, brother, sister, in-law or any household member. Smoking: Any treatment, drug, service or supply to stop or reduce smoking or the use of other tobacco products or to treat or reduce nicotine addiction, dependence or cravings, including counseling, hypnosis and other therapies, medications, nicotine patches and gum. See Program Limitations in the Prescription Drug section for information on coverage for certain smoking cessation drugs if you are enrolled in the Quit for Life Tobacco Cessation Program. Self-injectible drugs; coverage provided under the Caremark Prescription Drug Program unless prescribed while in the emergency room or inpatient during a hospital stay
Treatment in wilderness programs or other similar programs Services for any form of telecommunication Services for weight reduction programs, services and supplies including, but not limited to, commercial weight loss programs Services that are defined by your plan administrator as Experimental or Investigational Services, unless they meet the conditions listed under Experimental and Investigational Services under Whats Covered by the HDHP. Contact your plan administrator for more information regarding what is considered Experimental or Investigational. Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage. These excluded charges will not be used when determining benefits. The law of the jurisdiction where a person lives when a claim occurs may prohibit some benefits. If so, they will not be paid.
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Aetna $2,000 High Deductible Health Plan (HDHP)
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In-Network (You Pay) Medical Lifetime Maximum Individual DeductiblePer calendar year; in- and out-of-network deductibles cross-apply. Family Deductible LimitIf you are covering more than just yourself, the family deductible must be satisfied before the plan begins paying benefits (except for services in which the deductible doesnt apply). The family deductible can be met by one family member or a combination of family members. Coinsurance Individual Out-of-Pocket MaximumIdentifies the maximum amount of out-of-pocket expenses that a member will have to pay in a calendar year for most services. Once the limit is met, most expenses will be paid at 100% for the remainder of that calendar year. In- and out-of-network deductibles cross-apply. Family Out-of-Pocket MaximumIf you are covering more than just yourself, the family out-of-pocket maximum must be satisfied before the plan begins paying benefits. The family out-of-pocket maximum can be met by one family member or a combination of family members. Primary Care Physician's Office VisitApplies to internist, general physician, family practitioner or pediatrician Specialist Office Visit Walk-In Clinic Preventive Care Well Child CareIncludes routine immunizations, travel immunizations & flu shots. Age/frequency guidelines suggest 7 exams in 1st 12 months of life, 3 visits in second 12 months of life; 3 visits in 3rd 12 months of life; 1 exam per calendar year thereafter to age 18 Adult Routine Physical Exam1 exam per calendar year Adult and Child Routine Immunizations, Travel Immunizations and Flu Shots Routine GYN1 routine GYN exam per calendar year with 1 pap smear & related lab fees Routine Mammogramage/frequency guidelines suggest baseline at age 35, 1 every 2 calendar years after age 35 and 1 every calendar year after age 40* Routine Prostate Specific Antigen (PSA) Test and Digital Rectal Exams (DRE) age/frequency guidelines suggest 1 routine DRE and PSA per calendar year for males age 40 and over Colorectal Cancer Screeningsage/frequency guide lines suggest all members age 50+: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), Double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years)*
* Under certain circumstances, age/frequency limits may vary based on risk factors.
Out-of-Network (You Pay) Unlimited $4,000 $12,000
Unlimited $2,000 $6,000
20% after deductible $5,000 includes deductible
50% after deductible $10,000 includes deductible
$10,000 includes deductible
$20,000 includes deductible
20% after deductible 20% after deductible 20% after deductible
100% Covered, no deductible
50%, no deductible
100% Covered, no deductible 100% Covered, no deductible 100% Covered, no deductible 100% Covered, no deductible 100% Covered, no deductible
50%, no deductible 50%, no deductible 50%, no deductible 50%, no deductible 50%, no deductible
50%, no deductible
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In-Network (You Pay) Preventive Carecontinued Colorectal Cancer Screeningsage/frequency guide lines suggest all members age 50+: Fecal occult blood test every year, Sigmoidoscopy (1 every 5 years), Double contrast barium enema (1 every 5 years), Colonoscopy (1 every 10 years)* Routine Eye Exam Routine Hearing Exam1 exam per calendar year Hearing Aids** Hospital Care Inpatient Hospital CoinsuranceIncludes inpatient surgery expenses, room & board & misc fees, physician expenses, routine nursery care, prescription drugs and all other inpatient care. Outpatient Hospital ExpensesHospitals and other facilities (i.e., ambulatory surgery center, hospital outpatient dept.). Includes short-term rehabilitation in a hospital outpatient setting. Other Physician Services AcupunctureCovered in lieu of anesthesia only Allergy Testing, Treatment, Injections Maternity / ObstetricsDelivery charges are covered under the Hospital benefit Second Surgical Opinion Outpatient Surgery Diagnostic Procedures Diagnostic Lab Diagnostic X-ray Complex imaging servicesMRA/MRS, MRI, CT Scan, PET scan Emergency Medical Care Urgent Care Facility Emergency Room E.R. Facility charges and related expenses (radiology, pathology, anesthesia, surgeon, etc.) Non-Emergency Use of Emergency Room AmbulanceCovers medically necessary travel. Ground ambulance for member convenience or for non-clinical reasons is not covered.
* Under certain circumstances, age/frequency limits may vary based on risk factors. ** Excludes hearing aid batteries and repairs.
50%, no deductible
Not Covered; discounts available 100% Covered, no deductible 20% after deductible 50%, no deductible 50% after deductible
20% after deductible 20% after deductible
20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible
50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible
20% after deductible 20% after deductible Not covered 20% after deductible
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In-Network (You Pay) Family Planning Contraceptive Devices, Implants & InjectablesMedical plan covers associated office visit for injection of Depo-Provera and Lunell, Diaphragm fitting, and Cervical Cap, IUD & Norplant devices; see Pharmacy benefit for additional contraceptive coverages Voluntary Abortion Voluntary SterilizationCovers tubal ligation & vasectomy. Excludes reversals. InfertilityCovers diagnosis and treatment of underlying conditions Advanced Reproductive Technology (ART) Other Services Skilled Nursing Facility90 days per calendar year Home Health Care150 visits per calendar year Private Duty Nursing70 8-hr shifts per calendar year Hospice Care Outpatient Short-Term RehabilitationPhysician's services and services of physical, speech or occupational therapists for diagnosis of developmental delays or for treatment of acute conditions if such services will result in significant improvement in member's condition. Spinal DisordersSpinal Manipulations performed by an MD, DO, chiropractor or therapist, 25 visits per calendar year Durable Medical Equipment Prosthetics Devicese.g., artificial limb; breast prosthesis Mental Therapye.g., chemotherapy, hydration therapy, etc. performed in the home, office or outpatient Infusion Health Services facility. Inpatient Mental Disorders CoinsuranceNo day limits Outpatient Behavioral Health VisitApplies to outpatient therapy visits in an office or other outpatient setting no visit limits Residential Treatment FacilitySubject to Inpatient Pre-certification requirements Intensive OutpatientTypically 3-5 hours/day, several days per week (subject to Inpatient Pre-cert requirements) Partial HospitalizationTypically 5-8 hours/day, several days per week (subject to Inpatient Pre-cert requirements). 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible applies to physical, occupational and speech therapy 20% after deductible 20% after deductible; foot orthotics excluded 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible
20% after deductible 20% after deductible 20% after deductible Not Covered
50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible applies to physical, occupational and speech therapy 50% after deductible 50% after deductible; foot orthotics excluded 50% after deductible 50% after deductible 50% after deductible 50% after deductible
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In-Network (You Pay) Alcohol and Drug Abuse Services Inpatient Rehabilitation & DetoxificationIn a hospital or treatment facilityno day limits Outpatient Chemical Dependency VisitApplies to outpatient visits in an office or other outpatient setting no visit limits Prescription Drugs All Prescription Drugs Except Eligible Preventive Care Prescription Drugs Eligible Preventive Care Prescription Drugs1
* Non-preferred brand, you pay 40% 1 A complete list of eligible preventive care prescription drugs is on www.caremark.com
20% after deductible* 20% no deductible*
50% after deductible 50% no deductible
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HMO Plans
HMO means Health Maintenance Organization. The Home Depot offers the following Kaiser Permanente HMOs: Kaiser Permanente Georgia Kaiser Permanente Northwest Kaiser Permanente Ohio Kaiser Permanente Colorado Kaiser Permanente Mid-Atlantic If you live within the service area of a Kaiser Permanente HMO offered by The Home Depot, you will see this option on the Your Benefits Resources web site when you enroll.If you are a new salaried associate and enroll in an HMO, you will have different medical coverage during your first 90 days of employment. See For New Salaried Associates: Medical Coverage During Your First 90 Days of Employment chapter for more information. This different coverage during your first 90 days does not apply to associates who enroll in Kaiser Permanente HMO-Georgia or Kaiser Permanente HMO-Northwest. Kaiser Permanente HMO members must receive care from a Kaiser Permanente network doctor or in a Kaiser Permanente medical office or no benefits will be paid. If you or your dependents seek care outside the HMO network, you will be responsible for the entire cost. Out-of-network care is not covered in the HMO. The only exception is for emergency care. If you are changing your coverage from any other medical insurance to Kaiser Permanente, you must
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see Kaiser Permanente providers in a Kaiser Permanente medical facility as of your coverage effective date for most ongoing care situations (for example, pregnancy). If you have any questions about the transition of care, visit Kaiser Permanente at http://my.kp.org/homedepot/ and look for Transition of Care within the In The Know section on the home page. If you live within the service area of a Kaiser Permanente HMO offered by the Company, you can find a Kaiser Permanente medical office near you by visiting http://my.kp.org/homedepot/. To find a Kaiser Permanente doctor, look up physicians profiles at www.kp.org/chooseyourdoctor. There, you can read each doctors personal statements and review their credentials to find the right doctor for you. Many Kaiser Permanente medical offices offer convenience with a wide range of services under one roof and extended hours: Exams, x-rays, lab and pharmacy services are available at many Kaiser Permanente medical offices. Medical offices are open after hours and on weekends. If you need coverage for dependents who may be out of the HMO service area (e.g., college students away from home or children for whom you are required to provide insurance through a court order), be sure to check with the HMO about coverage limitations. The charts later in this chapter provide some detail about HMOs you may be eligible for if you live in their service area. Complete HMO details regarding covered services, limitations and exclusionsas
well as information about filing and appealing claims for the HMOsare not described in detail in this Benefits Summary. Refer to Contacting Your Medical Plan for how to receive complete details on HMO coverage. The detailed information you receive should be considered part of this Benefits Summary.
HMO Standard and Basic Options

Each Kaiser Permanente HMO has a standard and basic option. The standard and basic options are different in the level of coverage they provide and in your share of the cost of the coverage. In most cases, if you choose the Standard Option HMO, your cost for coverage will be greater because you have higher benefits and lower out-of-pocket costs as shown in the following chart.
Standard Option Cost of HMO coverage Out-of-pocket maximum Office/prescription drug /visit copayments Higher Lower Basic Option Lower Higher
Lower
Higher
The provider network is the same for the standard and basic options. Refer to the HMO Summary of Benefits charts for details on how the standard and basic options in each region differ.
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HMO Benefits
The following benefits are available when you use HMO providers: Doctor office visits, well-child care and well-adult carePreventive care services are 100% covered. You may pay a copayment with no deductible for most charges related to the treatment of covered illnesses or injuries. Emergency careAlways try to locate an HMO provider when you require emergency care away from home. However, if an HMO provider is unavailable and you receive emergency services from a non-HMO hospital, your emergency services will be covered at the HMO in-network level for life-threatening situations only. Prescription drugsEach HMO offers its own prescription drug plan. You pay a fixed copayment for generic and brand-name prescription drugs. For details, please refer to the charts on the following pages and information provided to you by your specific HMO Plan. Hospitals and other servicesMedical services (such as inpatient and outpatient surgeries, home health care, inpatient mental health and substance abuse treatment, alternative treatment centers, etc.), are covered according to your HMOs benefits schedule.
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How the HMO Plans Work

Annual Deductible The HMOs available through the company require an annual deductible before benefits are paid for some services. The deductible varies according to the HMO. The services to which the deductible applies vary by plan. The exact amount is included in charts on the following pages and in the information provided by your HMO. Out-of-Pocket Maximums The out-of-pocket maximum limits the amount of money you have to pay before benefits are covered at 100%. This feature protects you from financial hardship in the case of a catastrophic illness. Outof-pocket maximums vary according to local HMOs. The exact amount is included in the charts on the following pages and in information provided by your HMO. You also may contact the HMOs Member Services department by calling the toll-free number listed on your ID card. For information on other provisions of your HMO Plan, see the information mailed to you by the HMO or call its Member Services department at the tollfree number listed on your ID card. Lifetime Maximum Benefits The HMO Plans provide benefits with an unlimited lifetime maximum for you and each covered family member.
E-Mail Your Doctor, Check Your Lab Results and More on www.kp.org
As a Kaiser Permanente member, you should sign up to the secure web sitewww.kp.orgwhere you can manage your care. You can make appointments at any time if you sign up for My Health Manager on www.kp.org. On My Health Manager, Kaiser Permanente members can: Make a doctors appointment E-mail doctors and specialists with routine health questions Order prescription refills, most of which can be mailed to you at no extra charge View certain lab results and your recent immunization history See details of past appointments and check future appointments All of this information is updated by Kaiser Permanentes electronic medical record system. Everyone you receive care from at Kaiser Permanente facilitiesyour personal physician, nurse, optometrist, pharmacist, surgeonis connected to one another through your electronic health record, and every Kaiser Permanente facility in your region is linked to your electronic health record.
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Kaiser Permanente HMOs
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Kaiser Permanente-GeorgiaStandard Option1 Background Information Self-Referral to OB-GYN Self-Referral to Specialist Default PCP Assigned if None Chosen? Calendar Year Deductible Annual Out-of-Pocket Maximum Coinsurance Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Preventive/Wellness Visit Well-Child Care Cancer Screenings; for screening mammography, cervical cancer screening, Fecal Occult Blood Test, and colorectal cancer screening (Flexible Sigmoidoscopy) Cardiovascular Screenings (Cholesterol as part of routine physical) PAP Test Mammogram Immunizations - Adult Immunizations - Child Allergy Tests and Treatments Well-Woman Physical Covered at 100% 100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100% $25 copay $35 copay Yes Yes Yes $250 Individual; $500 Family $1,000 Individual; $2,000 Family 90% covered after deductible Limit does not apply
Kaiser Permanente-GeorgiaBasic Option1
Yes Yes Yes $500 Individual; $1,000 Family $2,000 Individual; $4,000 Family 80% covered after deductible Limit does not apply
$25 copay $35 copay
Covered at 100% 100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100%
Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100% Injections covered at 100%; applicable doctor office visit copay will apply for tests and treatments Covered at 100%
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plan coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Contacting Your Medical Plan in this chapter. You may also call the Member Services number listed on your ID card.
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Kaiser Permanente-GeorgiaStandard Option1 Preventive Care - continued Routine PSA & Digital Rectal Exam Blood Pressure Stool Test Cholesterol Prostate Cancer Inpatient Care Hospital coinsurance or copay Outpatient Care Outpatient Surgery Chiropractic Services Lab Tests X-Rays Dx & therapeutic imaging outpatient not preventative, MRI, CT, PET Infertility Benefits In Vitro Fertilization Artificial Insemination Infertility Testing Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance 90% covered after deductible $100 copay waived if admitted Not covered Not covered Yes Not covered 90% covered after deductible $35 copay; limited to 30 visits per year 90% covered after deductible Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
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Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
80% covered after deductible
80% covered after deductible $35 copay; limited to 30 visits per year 100% covered; after applicable office visit copay; performed in office or free standing center; 80% covered; performed in outpatient hospital setting 100% covered; after applicable office visit copay; performed in office or free standing center; 80% covered; performed in outpatient hospital setting 100% covered; after applicable office visit copay; performed in office or free standing center; 80% covered; performed in outpatient hospital setting
100% covered; after applicable office visit copay; performed in office or free standing center; 90% covered; performed in outpatient hospital setting 100% covered; after applicable office visit copay; performed in office or free standing center; 90% covered; performed in outpatient hospital setting 100% covered; after applicable office visit copay; performed in office or free standing center; 90% covered; performed in outpatient hospital setting
Not covered Not covered Yes Not covered
80% covered after deductible $100 copay waived if admitted $45 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay; per trip
$45 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay; per trip
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Kaiser Permanente-GeorgiaStandard Option1 Prescription Drugs Retail: Generic Retail: Formulary Brand Retail: Non-Formulary Brand Mail Order: Generic Mail Order: Formulary Brand Mail Order: Non-Formulary Brand Mental Health Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Substance Abuse Services Rehab/Detox Outpatient Coverage Level/Visits Rehab/Detox Inpatient Coverage Level/Days $25 copay; unlimited visits 90% covered after deductible; unlimited days $25 copay; unlimited visits 90% covered after deductible; unlimited days
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$10 copay; 30-day supply; at Kaiser Permanente pharmacies; $16 copay at network pharmacies $30 copay; 30-day supply; at Kaiser Permanente pharmacies; $36 copay at network pharmacies Not covered $20 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
$15 copay; 30-day supply; at Kaiser Permanente pharmacies; $21 copay at network pharmacies $30 copay; 30-day supply; at Kaiser Permanente pharmacies; $36 copay at network pharmacies Not covered $30 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
$25 copay; unlimited visits 80% covered after deductible; unlimited days
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Kaiser Permanente-NorthwestStandard Option1 Background Information Self-Referral to OB-GYN Self-Referral to Specialist Default PCP Assigned if None Chosen? Calendar Year Deductible Annual Out-of-Pocket Maximum Coinsurance Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Preventive/Wellness Visit Well-Child Care Cancer Screenings; for screening mammography, cervical cancer screening, Fecal Occult Blood Test, and colorectal cancer screening (Flexible Sigmoidoscopy) Cardiovascular Screenings (Cholesterol as part of routine physical) PAP Test Mammogram Immunizations - Adult Immunizations - Child Allergy Tests and Treatments Well-Woman Physical Covered at 100% 100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100% $15 copay $25 copay Yes No Yes $250 Individual; $750 Family $1,500 Individual; $3,000 Family 90% covered after deductible Limit does not apply
Kaiser Permanente-NorthwestBasic Option1
Yes No Yes $500 Individual; $1,500 Family $2,500 Individual; $7,500 Family 80% covered after deductible Limit does not apply
$20 copay 80% covered after deductible
Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100% Injections $5; applicable doctor office visit copay will apply for tests and treatments Covered at 100%
Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100% Injections $5; applicable doctor office visit copay will apply for tests and treatments Covered at 100%
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Kaiser Permanente-NorthwestStandard Option1 Preventive Care - continued Routine PSA & Digital Rectal Exam Blood Pressure Stool Test Cholesterol Prostate Cancer Inpatient Care Hospital coinsurance or copay Outpatient Care Outpatient Surgery Chiropractic Services Lab Tests X-Rays Dx & therapeutic imaging outpatient not preventative, MRI, CT, PET Infertility Benefits In Vitro Fertilization Artificial Insemination Infertility Testing Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance 90% covered after deductible 90% covered after deductible Not covered 50% covered after deductible for diagnosis and treatment; donor services excluded Yes Not covered 90% covered after deductible $15 copay; limited to 30 visits per year 90% covered after deductible 90% covered after deductible 90% covered after deductible Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
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80% covered after deductible $20 copay; limited to 30 visits per year 80% covered after deductible 80% covered after deductible 100% covered; after applicable office visit copay; performed in office or free standing center; 80% covered; performed in outpatient hospital setting
100% covered; after applicable office visit copay; performed in office or free standing center; 90% covered; performed in outpatient hospital setting
Not covered 50% covered after deductible for diagnosis and treatment; donor services excluded Yes Not covered
80% covered after deductible 80% covered after deductible $20 copay; Plan or out-of-area non-Plan facility; emergency room coinsurance applies for treatment received at hospital emergency department 80% covered
$15 copay; Plan or out-of-area non-Plan facility; emergency room coinsurance applies for treatment received at hospital emergency department 90% covered
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Kaiser Permanente-NorthwestStandard Option1 Prescription Drugs Retail: Generic Retail: Formulary Brand Retail: Non-Formulary Brand Mail Order: Generic Mail Order: Formulary Brand Mail Order: Non-Formulary Brand Mental Health Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Substance Abuse Services Rehab/Detox OutpatientCoverage Level/Visits Rehab/Detox InpatientCoverage Level/Days DME Durable Medical Equipment 90% covered; Medicare criteria apply $15 copay; unlimited visits 90% covered after deductible; unlimited days $15 copay; unlimited visits 90% covered after deductible; unlimited days $15 copay; 30 day supply $30 copay; 30 day supply Not covered $30 copay; 90 day supply; maintenance formulary drugs only $60 copay; 90 day supply; maintenance formulary drugs only Not covered
$15 copay; 30 day supply $30 copay; 30 day supply Not covered $30 copay; 90 day supply; maintenance formulary drugs only $60 copay; 90 day supply; maintenance formulary drugs only Not covered
80% covered; Medicare criteria apply
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Kaiser Permanente-OhioStandard Option1 Background Information Self-Referral to OB-GYN Self-Referral to Specialist Default PCP Assigned if None Chosen? Calendar Year Deductible Annual Out-of-Pocket Maximum Coinsurance Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Preventive/Wellness Visit Well-Child Care Cancer Screenings; for screening mammography, cervical cancer screening, Fecal Occult Blood Test, and colorectal cancer screening (Flexible Sigmoidoscopy) Cardiovascular Screenings (Cholesterol as part of routine physical) PAP Test Mammogram Immunizations - Adult Immunizations - Child Allergy Tests and Treatments Well-Woman Physical Covered at 100% $25 copay $35 copay Yes No Yes $250 Individual; $500 Family $1,000 Individual; $2,000 Family 90% covered after deductible Limit does not apply
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Kaiser Permanente-OhioBasic Option1
$25 copay $35 copay
100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100%
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Kaiser Permanente-OhioStandard Option1 Preventive Care - continued Routine PSA & Digital Rectal Exam Blood Pressure Stool Test Cholesterol Prostate Cancer Inpatient Care Hospital coinsurance Outpatient Care Outpatient Surgery Chiropractic Services Lab Tests X-Rays Dx & therapeutic imaging outpatient not preventative, MRI, CT, PET Infertility Benefits In Vitro Fertilization Artificial Insemination Infertility Testing Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance 90% covered after deductible $100 copay; waived if admitted Not covered Yes Yes Yes 90% covered after deductible $20 copay; limited to 20 visits per year 90% covered after deductible is met 90% covered after deductible is met 90% covered after deductible Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
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80% covered after deductible $20 copay; limited to 20 visits per year 80% covered after deductible is met 80% covered after deductible is met 100% covered; after applicable office visit copay; performed in office or free standing center; 80% covered; performed in outpatient hospital setting
Not covered Yes Yes Yes
80% covered after deductible $100 copay; waived if admitted $45 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities 80% covered after deductible is met
$45 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities 90% covered after deductible is met
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Kaiser Permanente-OhioStandard Option1 Prescription Drugs Retail: Generic Retail: Formulary Brand Retail: Non-Formulary Brand Mail Order: Generic Mail Order: Formulary Brand Mail Order: Non-Formulary Brand Mental Health Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Substance Abuse Services Rehab Outpatient Coverage Level/Visits Rehab Inpatient Coverage Level/Days Detox Outpatient Coverage Level/Visits Detox Inpatient Coverage Level/Days DME Durable Medical Equipment 100% covered $25 copay; unlimited visits Not covered $25 copay; unlimited visits 90% covered after deducible is met $25 copay; unlimited visits 90% covered after deductible; unlimited days $10 copay; 31-day supply $30 copay; 31-day supply Not covered
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$15 copay; 31-day supply $30 copay; 31-day supply Not covered $30 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
$20 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
$25 copay; unlimited visits Not covered $25 copay; unlimited visits 80% covered after deducible is met
100% covered
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Kaiser Permanente-ColoradoStandard Option1 Background Information Self-Referral to OB-GYN Self-Referral to Specialist Default PCP Assigned if None Chosen? Calendar Year Deductible Annual Out-of-Pocket Maximum Coinsurance Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Preventive/Wellness Visit Well-Child Care Cancer Screenings; for screening mammography, cervical cancer screening, Fecal Occult Blood Test, and colorectal cancer screening (Flexible Sigmoidoscopy) Cardiovascular Screenings (Cholesterol as part of routine physical) PAP Test Mammogram Immunizations - Adult Immunizations - Child Allergy Tests and Treatments Well-Woman Physical Covered at 100% 100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100% $25 copay $35 copay Yes Yes Yes $250 Individual; $500 Family $1,000 Individual; $2,000 Family 90% covered after deductible Limit does not apply
Kaiser Permanente-ColoradoBasic Option1
Yes Yes Yes $500 Individual; $1,000 Family $2,000 Individual; $4,000 Family 80% covered after deductible Limit does not apply
$25 copay $35 copay
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Kaiser Permanente-ColoradoStandard Option1 Preventive Care - continued Routine PSA & Digital Rectal Exam Blood Pressure Stool Test Cholesterol Prostate Cancer Inpatient Care Hospital copay Outpatient Care Outpatient Surgery Chiropractic Services Lab Tests X-Rays Dx & therapeutic imaging outpatient not preventative, MRI, CT, PET Infertility Benefits In Vitro Fertilization Artificial Insemination Infertility Testing Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance 90% covered after deductible $100 copay; waived if admitted Not covered Yes Yes Not covered 90% covered after deductible $25 copay; limited to 20 visits per year 90% covered after deductible 90% covered after deductible 90% covered after deductible Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
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Not covered Yes Yes Not covered
80% covered after deductible $100 copay; waived if admitted $35 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay per trip
$35 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay per trip
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Kaiser Permanente-ColoradoStandard Option1 Prescription Drugs Retail: Generic Retail: Formulary Brand Retail: Non-Formulary Brand Mail Order: Generic Mail Order: Formulary Brand Mail Order: Non-Formulary Brand Mental Health Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Substance Abuse Services Rehab/Detox Outpatient Coverage Level/Visits Rehab/Detox Inpatient Coverage Level/Days DME Durable Medical Equipment 90% covered after deductible is met $25 copay; unlimited visits 90% covered after deductible; unlimited days $25 copay; unlimited visits 90% covered after deductible; unlimited days $10 copay; 30-day supply $30 copay; 30-day supply Not covered $20 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
80% covered after deductible is met
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Kaiser Permanente-Mid-AtlanticStandard Option1 Background Information Self-Referral to OB-GYN Self-Referral to Specialist Default PCP Assigned if None Chosen? Calendar Year Deductible Annual Out-of-Pocket Maximum Coinsurance Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Preventive/Wellness Visit Well-Child Care Cancer Screenings; for screening mammography, cervical cancer screening, Fecal Occult Blood Test, and colorectal cancer screening (Flexible Sigmoidoscopy) Cardiovascular Screenings (Cholesterol as part of routine physical) PAP Test Mammogram Immunizations - Adult Immunizations - Child Allergy Tests and Treatments Well-Woman Physical Covered at 100% 100% covered; for well child check ups to age 24 months; otherwise applicable office visit copay applies Covered at 100% $25 copay $35 copay Yes No Yes $250 Individual; $500 Family $1,000 Individual; $2,000 Family 90% covered after deductible Limit does not apply
Kaiser Permanente-Mid-AtlanticBasic Option1
$25 copay $35 copay
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Kaiser Permanente-Mid-AtlanticStandard Option1 Preventive Care - continued Routine PSA & Digital Rectal Exam Blood Pressure Stool Test Cholesterol Prostate Cancer Inpatient Care Hospital coinsurance Outpatient Care Outpatient Surgery Chiropractic Services Lab Tests X-Rays Dx & therapeutic imaging outpatient not preventative, MRI, CT, PET Infertility Benefits In Vitro Fertilization Artificial Insemination Infertility Testing Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance 90% covered after deductible $100 copay; waived if admitted $35 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay; per trip Not covered 50% covered Yes 50% covered 90% covered after deductible $35 copay; limited to 30 visits per year 90% covered after deductible 90% covered after deductible 100% covered; after applicable office visit copay; performed in office or free standing center; 90% covered; performed in outpatient hospital setting 90% covered after deductible Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
Not covered 50% covered Yes 50% covered
80% covered after deductible $100 copay; waived if admitted $35 copay; at designated Kaiser Permanente Medical Centers and after hours/urgent care facilities $100 copay; per trip
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Kaiser Permanente-Mid-AtlanticStandard Option1 Prescription Drugs Retail: Generic Retail: Formulary Brand Retail: Non-Formulary Brand Mail Order: Generic Mail Order: Formulary Brand Mail Order: Non-Formulary Brand Mental Health Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Substance Abuse Services Rehab/Detox Outpatient Coverage Level/Visits Rehab/Detox Inpatient Coverage Level/Days DME Durable Medical Equipment 50% covered $25 copay individual; $12 copay group (unlimited visits) 90% covered after deductible; unlimited days $25 copay individual; $12 copay group (unlimited visits) 90% covered after deductible; unlimited days $10 copay; 30-day supply $30 copay; 30-day supply Not covered $20 copay; 90-day supply; through Kaiser Permanente pharmacies $60 copay; 90-day supply; through Kaiser Permanente pharmacies Not covered
$25 copay individual; $12 copay group (unlimited visits) 80% covered after deductible; unlimited days
$25 copay individual; $12 copay group (unlimited visits) 80% covered after deductible; unlimited days
50% covered
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General Information About the Medical Plans
The following information in this section applies to the PPO and OOA medical plans and the HDHP: Claiming Benefits Under the Plans Filing Claims Under the Medical Plans Appealing a Claim Right to Recover Payment Subrogation and Reimbursement Refunds of Overpayments The following information in this section applies to ALL medical plansthe PPO, OOA, HDHP and HMOs: Coordinating with Other Plans Certificates of Health Plan Creditable Coverage If Youre Age 65 or Older Important Terms
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Being a grandfathered health plan means that your plan or policy may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the Benefits Choice Center. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-4443272 or www.dol.gov/ebsa/healthreform. This web site has a table summarizing which protections do and do not apply to grandfathered health plans.
Filing Claims Under the Medical Plans

If you receive covered health (medical) services from an in-network provider, you do not have to file a claim. In-network providers are responsible for filing claims for you. Your medical plan administrator pays innetwork providers directly for your covered health services. If an in-network provider bills you directly for any covered service, contact the claims administrator. However, you are responsible for meeting any annual deductible and for paying copayments to an in-network provider at the time of service, or when you receive a bill from the provider. If you receive covered health services from an out-ofnetwork provider, you are responsible for filing a claim. Where to Send Your Claims for Out-of-Network Services When you receive covered health services as a result of an emergency, or if you receive services from an out-of-network provider, you must submit the claim to your medical plan administrator. Timely Filing of a Claim You must submit a request for payment of benefits within one year after the date of service. If an out-of-network provider submits a claim on your behalf, you will be responsible for the timeliness of the claims submission. If you dont provide the claim information within one year after the date of service, benefits for that service will be denied or reduced, according to the claims administrators discretion. This time limit does not apply while you are legally incapacitated. If your claim relates to an inpatient stay, the date of service is the date your inpatient stay ends.
Grandfathered Plans
Information for PPO, OOA and HDHP Participants

Claiming Benefits Under the Plans
You or your beneficiary must file the appropriate forms to receive any benefits or to take any other action under the Plan. All forms required to take any action under the Plans are available from your medical plan administrator. Please refer to the descriptions of each benefit for additional information on claiming benefits. To be eligible for benefits, you must be covered under the Plan, properly submit a claim, and follow the Plans claims and appeals procedures. If a claim is denied initially, you must exhaust the appeals procedure before filing a suit.
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If you provide written authorization to allow direct payment to a provider, all or a portion of any eligible expenses due to a provider may be paid directly to the provider instead of being paid to the associate. Aetna will not reimburse third parties that have purchased or been assigned benefits by any health care provider. Information Required for Your Claim When you request payment of benefits, you do not have to use a claim form. However, you must provide all of the following information: associates name and address patients name, age and relationship to the associate contract number, which is on your ID card itemized bill from your provider that includes the following: patient diagnosis date(s) of service procedure code(s) and descriptions of service(s) rendered charge for each service rendered providers name, address and tax identification number Date the injury or sickness began, if applicable Statement indicating either that you are, or you are not, enrolled for coverage under any other group health insurance plan or program (if you are enrolled for other coverage, you must include the name of any other insurance company) Payment of Benefits
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Your medical plan administrator will make a benefit determination as described below. Benefits will be paid directly to you unless either of the following is true: The provider notifies your medical plan administrator that your signature is on file, assigning benefits directly to that provider, or You make a written request for the out-of-network provider to be paid directly at the time you submit your claim.
Appealing a Claim
Please refer to the Claims and Appeals chapter for more information on appealing a claim.
To this end, the Medical Plan assumes and shall be subrogated to all rights of recovery the covered person may have against the responsible third party, any liability or other insurance covering such third party and any person or entity who is or may be obligated to provide benefits or payments to a covered person, including benefits or payments for underinsured or uninsured motorist protection, no-fault or traditional auto insurance, medical payment coverage (auto, homeowners or otherwise), workers compensation coverage, other insurance carriers or third party administrators or any person or entity who is liable for payment to a covered person on any equitable or legal liability theory. These third parties and persons or entities are collectively referred to as third parties. The Medical Plan also shall have first right of reimbursement out of the proceeds of any settlement, judgment or other payment by any such third parties to or on behalf of a covered person in an amount equal to the benefits the Medical Plan paid. The Medical Plan also shall have first right of reimbursement out of the proceeds of any settlement, judgment or other payment by any such third parties to or on behalf of a covered person in an amount equal to the attorneys fees incurred by the Medical Plan in collecting from the covered person any funds held by the covered person that he or she recovered from any third party.
Right to Recover Payment

If your Medical Plan makes a payment by mistake, the plan has the right to recover the amount of overpayment from any person, insurance company or other organization to which the payment was made.
Subrogation and Reimbursement

If you or your covered family members (covered persons) are injured or become ill because of an act or omission of a third party, the Medical Plan is not obligated to pay any benefits relating to the injury or illness. However, the Medical Plan may advance payment of benefits relating to the injury or illness to the extent of the amounts receivable or received by the covered person from the third party, an insurer or any other person by way of settlement, judgment or other payment.
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The Medical Plan shall also have a lien against the proceeds of any recovery from any such third parties (whether by settlement, judgment or other payment) for that portion of the total recovery which is due the Medical Plan for benefits paid. The lien shall attach as soon as any person or entity agrees to pay any money to or on behalf of any covered person that could be subject to the Medical Plans right of recovery if and when received by the covered person. To aid the Medical Plan in the enforcement of its right of reimbursement and subrogation, the covered persons agree as follows: That a covered person will cooperate with the Plan in a timely manner in protecting its rights to subrogation, reimbursement and liens, including, but not limited to: providing any relevant information requested by the Medical Plan, signing and/or delivering such documents as the Medical Plan or its agents reasonably request to secure the subrogation and reimbursement claim and lien rights, responding to requests for information about any accident or injuries, appearing at depositions and in court, and obtaining the consent of the Medical Plan or its agents before releasing any third party from liability for payment of medical expenses.
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That failure to cooperate in this manner shall be deemed a breach of contract, and may result in the termination of health benefits and/or the institution of legal action against a covered person. A covered persons failure or refusal to sign any such document shall not impair or modify in any way the Medical Plans rights to subrogation, reimbursement and liens. That the Plan Administrator of the Medical Plan has the sole authority and discretion to resolve all disputes regarding the interpretation of the language stated herein. That covered persons must notify the Medical Plan Administrator within five business days of any proceeding relating to a claim against a third party and within two business days of any recovery or settlement. That no court costs or attorneys fees may be deducted from the Medical Plans recovery without the Medical Plans express written consent; any so-called Fund Doctrine or Common Fund Doctrine or Attorneys Fund Doctrine shall be inapplicable to the Medical Plan; and thus, shall not defeat this right; and the Medical Plan is not required to participate in or pay court costs or attorneys fees to the attorney hired by a covered person to pursue his or her damage/personal injury claim. Provided, however, that the Medical Plan Administrator may allow a proportional reduction for attorneys fees of the covered persons if their attorneys cooperate fully in enforcement of the Medical Plans rights.
That the Make Whole Doctrine is inapplicable and, regardless of whether a covered person has been fully compensated or made whole, the Medical Plan may collect from covered persons the proceeds of any full or partial recovery that a covered person or his or her legal representative obtain, whether in the form of a settlement (either before or after any determination of liability), judgment or other payment, irrespective of how such recovery is construed, designed or designated. The proceeds available for collection shall include, but not be limited to, any and all amounts earmarked as non-economic damage settlement or judgment. That benefits paid by the Medical Plan may also be considered to be benefits advanced. That covered persons agree that if they receive any payment from any third party as a result of an injury or illness, whether by settlement (either before or after any determination of liability) or judgment, the covered person will serve as a constructive trustee over the funds and failure to hold such funds in trust will be deemed as a breach of the covered persons duties hereunder. That covered persons or an authorized agent, such as the covered persons attorney, must hold any funds received from any third party that are due and owed to the Medical Plan, as stated herein, separately and alone, and failure to hold funds as such will be deemed as a breach of contract, and may result in the termination of health benefits or the institution of legal action against the covered person.
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That the Medical Plan shall be entitled to recover reasonable attorneys fees from covered persons incurred in collecting from the covered person any funds held by the covered person that he or she recovered from any third party. That the Medical Plan may set off from any future benefits otherwise allowed by the Medical Plan the value of benefits paid or advanced under this section to the extent not recovered by the Medical Plan. That covered persons will neither accept any settlement that does not fully compensate or reimburse the Medical Plan without the Medical Plans written approval, nor will the covered person do anything to prejudice the Medical Plans rights under this section. That covered persons will assign to the Medical Plan all rights of recovery against third parties, to the extent of the benefits the Medical Plan provided, plus reasonable costs of collection. That the Medical Plans right of reimbursement is first in priority, and must be paid regardless of whether the covered person is made whole and regardless of the designation of the recovery. That the Medical Plans rights will not be reduced due to the covered persons own negligence.
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That the Medical Plan may, at its option, take necessary and appropriate action to preserve its rights under these provisions, including filing suit in the covered persons name, which does not obligate the Medical Plan in any way to pay the covered person part of any recovery the Medical Plan might obtain for the amounts due the Medical Plan for benefits paid and attorneys fees incurred. The Medical Plan shall not be obligated in any way to pursue this right independently or on behalf of the covered person. That if the injury or condition giving rise to subrogation or reimbursement involves a minor child, this section applies to the parents or guardian of the minor child. That if the injury or condition giving rise to subrogation or reimbursement involves the wrongful death of a Medical Plan beneficiary, this section applies to the personal representative of the deceased Medical Plan beneficiary. If a covered person files a petition for bankruptcy after any injury or condition giving rise to subrogation or reimbursement, the covered person agrees that the Medical Plans right of subrogation, reimbursement, and lien existed in time prior to the creation of the bankruptcy estate. The Medical Plans right of subrogation and reimbursement will be based on the Medical Plans language in effect at the time of judgement, payment, or settlement.
Refund of Overpayments
If benefits are paid by the Plan for expenses incurred on account of a covered person, that covered person, or any other person or organization that was paid, must make a refund to the Plan if either of the following apply: All or some of the expenses did not legally have to be paid by the covered person. All or some of the payment made exceeded the benefits under the Plan. The refund equals the amount paid in excess of the amount that should have paid under the Plan. If the refund is due from another person or organization, the covered person agrees to help the Plan get the refund when requested. If the covered person, or any other person or organization that was paid, does not promptly refund the full amount, the amount of any future benefits that are payable under the Plan may be reduced. The reductions will equal the amount of the required refund. The Plan also retains all other rights in addition to the right to reduce future benefits that may be legally available.
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Information for PPO, OOA, HDHP and HMO Participants
Coordinating With Other Plans
If you or a covered family member is insured under another employers group health plan or any other form of insurance coverage like no-fault automobile insurance coverage, the Medical Plan will coordinate coverage with that other plan. The benefits payable under the Medical Plan, after reduction for benefits paid from all other primary plans, will not exceed the amount the Medical Plan would have paid if you had no other coverage. To determine which plan is primary (the primary plan pays benefits first), the following rules apply: the benefits under the Medical Plan are secondary to any coverage under no-fault or similar insurance a plan without a coordination provision is always the primary plan if all plans have a coordination provision, then the rules below apply: the plan covering the participant for whom the claim is made, other than as the dependent, pays first, and the other plan pays second the plan of the parent whose birthday (excluding the year of birth) occurs earlier in the calendar year is primary (for example, if the fathers birthday is June 1 and the mothers birthday is May 1, the mothers plan would be primary for covered dependent children) when birthdays of both parents are on the same day, the plan that has covered the dependent for the longer period of time will be primary
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when the parents of a covered dependent child are divorced or separated and the parent with custody has not remarried, that parents plan pays first for the child; the plan of the parent without custody pays second when the parent with custody of a covered dependent child has remarried, that parents plan pays first, the stepparents plan pays second and the plan of the parent without custody pays last when there is a court decree that would otherwise establish financial responsibility for the health care expenses of a covered dependent child, the plan covering the parent with financial responsibility is primary when none of the above establish an order of benefits determination, the plan that has covered the participant for the longest period of time will pay first If the Medical Plan is secondary, the Plan may pay benefits after the other plan has paidbut only if there are payable expenses that exceed the primary plans payment. Payment works as follows: The Medical Plan determines the amount it would have paid if it were the primary plan. If the amount actually paid by the primary plan is less than the amount that the Medical Plan would have paid as the primary plan, the Medical Plan will pay the difference between the amount it would have paid and the actual amount paid by the primary plan.
Certificates of Health Plan Creditable Coverage

After your coverage (or your dependents coverage) ends, a Certificate of Health Plan Creditable Coverage will be sent to your current address listed with the Plan Administrator. This certificate provides evidence of your health care coverage. You may need this certificate if you become covered by another group health plan or insurance policy with a pre-existing medical condition clause. A group health plan is required by law to reduce the duration of its pre-existing condition exclusion, day-for-day, by any period of prior coverageprovided you do not have a 63-day or longer break in health care coverage (not counting waiting periods for coverage). You and your dependents also have the right to request a Certificate of Health Plan Coverage at any time during the 24 months following loss of coverage. You may request this certification from the Benefits Choice Center at 1-800-555-4954.
If Youre Age 65 or Older

If you are an active associate age 65 or older (or an active associates spouse age 65 or older) who is eligible for Medicare, you may choose to end your coverage under the Company Medical Plan and elect Medicare coverage instead. Or, you may choose to continue coverage under this plan, which will be considered your primary plan and will pay benefits first. Medicare will be the primary payer to the full extent permitted by law, including for those individuals not in current employment, and as legally permitted for individuals with end-stage renal disease or who were totally disabled.
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If you are an active associate (or an active associates spouse) age 65 or older and have elected coverage under this plan, you should submit your claims to the Plan first. After the Company Plan pays, send a copy of the original bill along with a copy of the Companys Plans explanation of benefits to Medicare for reimbursement. Access to Medical Coverage After Retirement As an associate, you and your dependents may be eligible for medical coverage after you retire. To qualify for this benefit: you must be at least age 55 when you retire, you must have worked for the Company for a minimum of five years, you and your dependents must be covered under the Medical Plan at the time you retire, and you must continue medical coverage for you and your dependents under COBRA after your retirement, for the maximum period allowed. Prior to the end of your COBRA continuation period, you will receive information about converting medical coverage for you and your dependents to an individual policy issued by your Medical Plan. Pre-existing conditions will not apply and evidence of good health will not be required as long as you apply within the required time frame. Benefit levels and monthly premiums will be determined by your Medical Plan at the time of application. If you are age 65 or over at the time you retire, you are not eligible for a conversion policy.
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For information about additional medical and dental plan options for retirees who are under age 65 and retirees age 65 and older, read about the Retiree Health Access plans on www.livetheorangelife.com. For conversion information specific to the HMO Plans, you should contact your HMOs Member Services department. The number is located on your medical ID card. Under the Health Net plans, conversion is not limited by age, years of service, or COBRA enrollment. Contact the Member Services department for specific information. The number is located on your medical ID card. Home Depot does not provide these benefits; they are individual policies.
Doctor of Dental Surgery (D.D.S.) Doctor of Podiatry (D.P.M.) Doctor of Chiropractic (D.C.) Psychologist (Ph.D.) The definition does not include a resident physician, intern, person in training or those not licensed to practice medicine independently.
Explanation of Benefits (EOB)

An EOB is a statement sent to you by the claims administrator after you have filed a claim. It will include benefits paid on your claim by the Medical Plan and charges payable by you.
Important Terms
Custodial Care
An institution providing room and board and other institutional or nursing services provided for a person due to his or her age or mental or physical condition, mainly to aid the person in daily living. Or, medical services given merely as care to maintain the persons present state of health that cannot reasonably be expected to significantly improve a medical condition.
Extended Care Facility

An institution providing room, board and skilled nursing services for medical care. To be covered under the Medical Plan, the facility must: be a legally operated institution or part of such an institution and maintain a daily clinical record for each patient make available the services of a doctor at all times offer 24-hour nursing services under the supervision of a graduate registered nurse not be primarily a place for the aged or substance abusers; or a rest home, educational institution, custodial facility or similar institution
Doctor or Physician Providers

For purposes of the Medical Plan, doctor means a licensed, practicing doctor or dentist who is not related to the participants family by blood or by marriage. The definition includes the following: Doctor of Medicine (M.D.) Doctor of Osteopathy (D.O.)
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Home Health Care Agency
A public or private agency or organization or part of one that provides skilled nursing and other therapeutic services in the home. To be covered under the Medical Plan, a home health care agency must: be licensed as a home health care agency and maintain a daily clinical record for each patient be staffed by professionals, including at least one legally qualified doctor and one registered nurse provide full-time supervision of caregivers by a legally licensed doctor or by a registered nurse not be an agency used mainly for the care and treatment of mental health disorders or substance abuse
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provide on-premise facilities for diagnosis, therapy, and major surgery not be a health care facility that is primarily a nursing home, rest home, convalescent home or a residential treatment center for the treatment of substance abuse or mental health problems
nized by the relevant medical or dental community, or otherwise consistent with physician or dental specialty society recommendations and the views of physicians or dentists practicing in relevant clinical areas and any other relevant factors.
Mental Health Providers

The licensing of mental health care providers varies from state to state. To make sure that all mental health claims are processed consistently, our Medical Plan covers care from the following, as long as they are not related to the participants family by blood or by marriage: LMFTLicensed Marriage and Family Therapist LMHCLicensed Mental Health Counselor LPCLicensed Professional Counselor LCPCLicensed Clinical Professional Counselor LPCCLicensed Professional Clinical Counselor LMHPLicensed Mental Health Provider LPCMHLicensed Professional Counselor of Mental Health LCSWLicensed Clinical Social Worker CSWClinical Social Worker LFMCCLicensed Family Marriage Clinical Counselor PsychologistPh.D. If you have questions or need to locate a mental health care provider, call your Plans Member Services department.
Medically Necessary or Medical Necessity

Health care or dental services, and supplies or prescription drugs that a physician, other health care provider or dental provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that provision of the service, supply or prescription drug is: In accordance with generally accepted standards of medical or dental practice; Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury or disease; and Not primarily for the convenience of the patient, physician, other health care or dental provider; and Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease. For these purposes generally accepted standards of medical or dental practice means standards that are based on credible scientific evidence published in peer-reviewed literature generally recog-
Hospice Care
A coordinated plan of home and inpatient care that treats the terminally ill patient and family as a unit. Care is provided by a team made up of trained medical personnel and counselors. The team acts under an independent hospice administration and helps the family unit cope with physical, psychological, spiritual, social and economic stresses. The hospice must have obtained any required state or other governmental licenses and be approved by the claims administrator.
Hospital
A hospital must be legally operated and must: provide 24-hour room, board and nursing services for all patients and have a staff of one or more doctors available at all times
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Residential Treatment Center
Residential Treatment Center means an institution which (a) specializes in the treatment of psychological and social disturbances that are the result of mental health or substance abuse conditions; (b) provides a subacute, structured, psychotherapeutic treatment program, under the supervision of physicians; (c) provides 24-hour care, in which a person lives in an open setting; and (d) is licensed in accordance with the laws of the appropriate legally authorized agency as a Residential Treatment Center. A person is considered Confined in a Residential Treatment Center when she/he is a registered bed patient in a Residential Treatment Center upon the recommendation of a Physician.
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Coverage for Associates Working in a Foreign Country

The Medical Plan provides fully insured medical and dental coverage to you if you are an expatriate associate working on assignment in a foreign country and if you are enrolled in medical and dental coverage immediately before beginning your expatriate assignment. The Company provides this coverage at no charge to you. You will be covered under the expatriate medical and dental coverage while in your assigned country, but will use the standard Home Depot medical plan that you are enrolled in, if any, while you are in the United States. If your family remains in the U.S. while you are on assignment, they will be covered under the standard Home Depot medical or dental plan in which you have enrolled, if any.
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California Medical
Chapter Contents
136 California Medical Options 136 ID Cards 136 The Health Net Medical Plans 137 Precertification 137 Prescription Drugs for the Health Net Medical Plans 137 The Health Net Out-of-Area Plans (California) 143 Kaiser Permanente HMOs 143 The Benefits of Kaiser Permanente Membership 146 Health Net Salud HMO y ms California-Mexico Cross-Border Coverage 149 Health Net Salud HMO y ms Prescription Drug Coverage 150 Grandfathered Plans
California Medical
What do you need?
Find a Kaiser Permanente medical office and get information about your medical plan Find a Health Net network provider and get information about your medical plan Find Health Net Salud HMO y mas network providers and participating pharmacies in California Find SIMNSA network providers and participating pharmacies in Mexico
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Find it here...
Go to http://my.kp.org/homedepot or call 1-855-9KAISER (1-855-952-4737) Go to www.healthnet.com/homedepot or call 1-800-847-3991
Call (011-52-664) 683-29-02 or (011-52-664) 683-30-05
California Medical Options

As a California associate you have the following medical plan options: Health Net Basic HMO Health Net Standard HMO Kaiser Permanente Basic HMO Kaiser Permanente Standard HMO See Get the Most Value from Your Plan in this chapter to find out how to find a Kaiser Permanente medical facility or a Health Net network provider. If you live in Los Angeles, San Diego, Orange, Riverside or San Bernardino counties, you may be eligible to participate in the Salud HMO y ms Plan, described later on in this chapter. If you live outside an HMO network area, you will have two out-of-area (OOA) options: Health Net OOA $450 Health Net OOA $1,200
You will see the options available to you when you enroll on the Your Benefits Resources web site as a new hire, during Annual Enrollment, or if you move to a new location with a different plan. Medical coverage for salaried associates begins on your date of hire if you enroll during your initial eligibility period. However, if you enroll in one of the Home Depot medical plans, you may have different coverage from the plan you enrolled in during your first 90 days of employment. See For New Salaried Associates: Medical Coverage During Your First 90 Days of Employment chapter for more information.
If you are enrolled in a Home Depot Medical Plan in California, you and your spouse (if your spouse is also enrolled) may be eligible for the Health Assessment and Hidden Health Risk Screening Credit and/or the Tobacco-free Credit. See Healthy Living Credits in the Eligibility & Enrollment chapter for more information.
The Health Net Medical Plans

Health Net HMO members must use Health Net Elect Open Access (EOA) network providers. The EOA network contains HMO network providers and PPO network providers for certain services, providing you with access to more primary care physicians and the flexibility of self-referral access to certain specialists in Health Nets PPO network. So, you are able to choose between two tiers of benefitsHMO or PPO. Youll find a chart showing the services available in the Tier 2 PPO network later in this chapter.
ID Cards
Once you become covered under a Health Net or Kaiser Permanente medical plan, you will receive an identification (ID) card. Keep your ID card with you at all times, and show it at your doctors office each time you receive medical treatment or fill a prescription. It will help your doctor to verify your benefits. Please note that the possession of an ID card alone does not entitle you to benefits. You must be enrolled in a medical plan to receive benefits.
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To find a provider in the Health Net Basic and Standard options, visit www.healthnet.com/homedepot. Go to Provider Search and select the desired search method. Then select the "Elect, Elect Open Access & Select - POS" drop down option under plan name. The option defaults you to the "Tier 1" (HMO) network. If you would like to locate a "Tier 2" (PPO) network provider, you can select "Tier 2" from the "Narrow Your Results" section of the tool. You also can call Health Net's customer service line at 1-800-847-3991. The charts in this chapter provide information about services covered by the Health Net medical plans. For complete information on covered services, limitations, exclusions, and filing claims, see the Health Net Summary of Benefits booklet and the Evidence of Coverage booklet. These booklets are considered part of this Benefits Summary. Also, see Get the Most Value from Your Plan for Health Nets toll-free Member Services number and web site address.
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Precertification
For information about precertification requirements, you should refer to the Health Net Summary of Benefits or Evidence of Coverage booklet available online at www.healthnet.com/homedepot and will be mailed to you upon request. You also may call Health Net Member Services. The number is listed in Get the Most Value from Your Plan and is also printed on your ID card.
Mail Order Drug Program If your prescription is for a maintenance medication (a drug that you will be taking for an extended period), you have the option of filling it through the Prescription By Mail Drug Program. Through this program, you can receive up to a 90-day supply of maintenance medication for a lower cost. Mail order drug coverage is limited to participants residing or working in the U.S. For more information on the mail order drug program, go to www.healthnet.com or call the Customer Contact Center at 1-800-847-3991.
Prescription Drugs for the Health Net Medical Plans

Generic drugs will be dispensed when a generic equivalent is available. If you request a brand-name drug when a generic equivalent is available, you must pay the difference between the generic equivalent and the brand-name drug plus the Level 1 drug copayment.
The Health Net Out-of-Area Plans (California)

If your ZIP code is outside of the Health Net HMO network area, you may choose a $450 Out-of-Area Plan or a $1,200 Out-of-Area Plan. For covered services information, see Out-of-Area Plans Summary of Benefits section in this California Medical chapter.
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Health Net HMOs: California
Health NetStandard Background Information Self-Referral to OB-GYNOB-GYN must be part of the same participating physician group as your PCP or contracted PPO OB-Gyn 2 Self-Referral to Specialist in PPO Network for Select Office-Based Services Default PCP Assigned if None Chosen Calendar Year Deductible Annual Out-of-Pocket Maximum Lifetime Maximum Primary Care Routine Office Visit Specialty Care Preventive Care Annual Physical Exam Yes
1, 2
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Health NetBasic
1,2
Yes
Yes Yes $0/Individual; $0/Family $2,000/Individual; $4,000/Family Limit does not apply
Yes Yes $0/Individual; $0/Family $2,500/Individual; $7,500/Family Limit does not apply
$25 copay; $50 copay when using a PPO network provider $35 copay; $50 copay when using a PPO network provider
$25 copay; $50 copay when using a PPO network provider $35 copay; $50 copay when using a PPO network provider
100% covered; according to plans periodic exam schedule. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered
100% covered; according to plan's periodic health evaluation schedule. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered
Pediatric Exams Pap Smears (annually) Mammography Child Immunizations Inpatient Care Hospital Copay Outpatient Care Outpatient Surgery Chiropractic Services
3
$250 copay per year plus 10% coinsurance
$500 copay per year plus 20% coinsurance
90% covered; if performed in a PCP office: $25; specialist office: $35 $15 copay; limited to 30 visits per year
80% covered; if performed in a PCP office: $25; specialist office: $35 $15 copay; limited to 30 visits per year
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this chart and the information in your plans coverage booklets, the coverage booklets will govern. 2 Plan includes option to self-refer to PPO physicians statewide for exams consultations and some office based procedures. All other services including but not limited to maternity care, inpatient and outpatient hospital services and surgery, complex diagnostic procedures such as CT, MRI, MUGA, PET and SPECT are only covered when arranged through your PCP and provider group. 3 Must use American Specialty Health Plans of CA (ASH) network
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Health Net HMOs: California
Health NetStandard1,2 Infertility Benefits InfertilityDiagnosis and Treatment of Underlying Cause In Vitro Fertilization Artificial Insemination Fertility Drugs Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance Prescription Drugs
3,4
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Health NetBasic1,2 Member cost share based on location of service Not covered
Member cost share based on location of service Not covered
Hospital copay and coinsurance applies 90% covered $75 copay $100 copay
Hospital copay and coinsurance applies 80% covered $75 copay $100 copay
Retail: GenericOn Recommended Drug List Retail: Formulary BrandOn Recommended Drug List Retail: Non-Formulary Not On Recommended Drug List Mail Order: GenericOn Recommended Drug List Mail Order: Formulary Brand On Recommended Drug List Mail Order: Non-Formulary BrandNot On Recommended Drug List Mental Health Services 5 OutpatientCoverage Level/Visits InpatientCoverage Level/Visits Substance Abuse Services
5
$5 copay; up to a 30-day supply $30 copay; up to a 30-day supply $60 copay; up to a 30-day supply $10 copay; up to a 90-day supply $50 copay; up to a 90-day supply $90 copay; up to a 90-day supply
$5 copay; up to a 30-day supply $30 copay; up to a 30-day supply $60 copay; up to a 30-day supply $10 copay; up to a 90-day supply $50 copay; up to a 90-day supply $90 copay; up to a 90-day supply
$25 copay (unlimited visits); $50 when using PPO network provider $250 copay per year plus 10% coinsurance
Rehab/Detox OutpatientCoverage Level/Visits Rehab/Detox InpatientCoverage Level/Days
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this chart and the information in your plans coverage booklets, the coverage booklets will govern. 2 Plan includes option to self-refer to PPO physicians statewide for exams consultations and some office based procedures. All other services including but not limited to maternity care, inpatient and outpatient hospital services and surgery, complex diagnostic procedures such as CT, MRI, MUGA, PET and SPECT are only covered when arranged through your PCP and provider group. 3 Sexual dysfunction and appetite suppressant drugs are covered at 50%. 4 Must use participating pharmacies. 5 Provided through MHN Services
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Health Net Out of Area Plans: California
$450 Health Net Out-of-Area Plan Background Information Calendar Year Deductible Annual Out-of-Pocket Maximum Office Visits Primary Care Specialty Care Preventive Care2 Annual Well-Care Exam Well-Child Exams and Immunizations Pap Smears (annually) Mammography Prostate-Specific Antigen (PSA) Inpatient Care Hospital copay/Deductible Outpatient Care Outpatient Surgery Chiropractic Benefits Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Ambulance $300 then covered at 80% after annual deductible Covered at 80% after annual deductible $35 copay Covered at 80% after annual deductible Covered at 80% after annual deductible $35 copay; 25 visits per year $300 per admission; covered at 80% after annual deductible $25 copay $35 copay $450/Individual; $1,350/Family $2,500/Individual; $5,000/Family
1
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$1,200 Health Net Out-of-Area Plan
$1,200/Individual; $3,600/Family $4,000/Individual; $8,000/Family
$25 copay $35 copay
100% covered, according to the Plans periodic health evaluation schedule. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered 100% covered 100% covered
100% covered, according to the Plans periodic health evaluation schedule; deductible waived. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered 100% covered 100% covered
$300 per admission; covered at 80% after annual deductible
Covered at 80% after annual deductible $35 copay; 25 visits per year
$300 then covered at 80% after annual deductible Covered at 80% after annual deductible $35 copay Covered at 80% after annual deductible
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plans coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Get the Most Value from Your Plan. You may also call the Member Services number listed on your ID card. 2 The preventive services required by the Patient Protection and Affordable Care Act are covered at 100%.
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Health Net Out of Area Plans: California
$450 Health Net Out-of-Area Plan Background Information Infertility Benefits InfertilityDiagnosis and Treatment of Underlying Cause In Vitro Fertilization Artificial Insemination Fertility Drugs Mental Health/Substance Abuse Services OutpatientCoverage Level/Visits InpatientCoverage Level/Days Prescription Drugs2,3 Retail: Generic On Recommended Drug List Retail: Formulary Brand On Recommended Drug List Retail: Non-FormularyNot On Recommended Drug List Mail Order: Generic On Recommended Drug List Mail Order: Formulary Brand On Recommended Drug List Mail Order: Non-Formulary Brand Not On Recommended Drug List $5 copay per prescription; up to a 30-day supply $30 copay per prescription; up to a 30-day supply $60 copay per prescription; up to a 30-day supply $10 copay per prescription; up to a 90-day supply $50 copay per prescription; up to a 90-day supply $90 copay per prescription; up to a 90-day supply $25 copay (unlimited visits) Member cost share based on location of service Not covered
1
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$1,200 Health Net Out-of-Area Plan
$25 copay (unlimited visits) $300 per admission; Covered at 80% after annual deductible (unlimited days)
$300 per admission; Covered at 80% after annual deductible (unlimited days)
$5 copay per prescription; up to a 30-day supply $30 copay per prescription; up to a 30-day supply $60 copay per prescription; up to a 30-day supply $10 copay per prescription; up to a 90-day supply $50 copay per prescription; up to a 90-day supply $90 copay per prescription; up to a 90-day supply
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plans coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Get the Most Value from Your Plan. You may also call the Member Services number listed on your ID card. 2 Sexual dysfunction and appetite suppressant drugs are covered at 50%. 3 No coverage through non-participating pharmacies.
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Services Available in the Health Net Elect Open Access (EOA) Network: California
Tier 1 HMO Primary Care Physician (PCP) Office Visit Specialist Doctor Office Visit Preventive Care1 Annual Physical Exam Well Baby Care Well Woman Exam (Pap Smear) Immunizations Allergy Testing and Allergy Serum Allergy Injections Vision Exams (Diagnosis and treatment only) Hearing Exams (Diagnosis and treatment only) Inpatient and Outpatient Care Outpatient Surgery Basic80% Covered; $25 Copay if performed in PCP office; $35 Copay if performed in Specialists office Standard90% Covered; $25 Copay if performed in PCP office; $35 Copay if performed in Specialist office Basic$500 Copay; then 80% Covered Standard$250 Copay; then 90% Covered Basic80% Covered; Standard90% Covered $100 Copay $75 Copay $25 Copay Basic$500 Copay; then 80% Covered Standard$250 Copay; then 90% Covered $25 Copay Basic$500 Copay; then 80% Covered Standard$250 Copay; then 90% Covered $25 Copay 100% covered; (CT, MRI, PET, MUGA & SPECT: $50 copay) Not Covered 100% Covered 100% Covered 100% Covered 100% Covered $25 Copay $5 Copay $25 Copay 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered $50 Copay 100% Covered $50 Copay $50 Copay $25 Copay $35 Copay (requires a PCP referral; self-referral to OB-GYNs) Tier 2 PPO $50 Copay $50 Copay
Inpatient - Hospital Copay Emergency Care When Not Followed By Admission Ambulance Urgent Care Clinic Visit Mental Health Services Outpatient Coverage Inpatient Coverage Substance Abuse Services Outpatient Coverage Inpatient Coverage Other Services Physical, Speech, Occupational and Respiratory Therapies X-ray and Laboratory Services that do not require prior authorization Network
Not Covered
Not Covered Not Covered Not Covered $50 Copay Not Covered
$50 copay Not covered
$50 Copay (limited to 12 visits per year, all therapy types combined) 100% covered; (CT, MRI, PET, MUGA & SPECT is not covered)
Elect Open Access & Select - POS

1 The preventive services required by the Patient Protection and Affordable Care Act are covered at 100%.
Elect Open Access & Select - POS
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The following charts provide some detail about Kaiser Permanente Basic and Standard HMOs in California. The charts provide information about services covered by the Kaiser Permanente medical plans. For complete information on covered services, limitations, exclusions, and filing claims, see Kaiser Permanentes Summary of Benefits. This booklet is considered part of this Benefits Summary. Also, see Get the Most Value from Your Plan for Kaiser Permanentes toll-free Member Services number and web site address.
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Keep in mind that if you are changing your coverage from Health Net or any other medical insurance to Kaiser Permanente, you must see Kaiser Permanente providers in a Kaiser Permanente medical facility as of your coverage effective date for most ongoing care situations (for example, pregnancy). If you have any questions about the transition of care, visit Kaiser Permanente at http://my.kp.org/homedepot/ and look for Transition of Care within the In The Know section on the home page. Convenient Care and Extended Hours Many Kaiser Permanente medical offices offer convenience with a wide range of services under one roof and extended hours: Exams, x-rays, lab and pharmacy services are available at many Kaiser Permanente medical offices. Medical offices are open after hours and on weekends.
E-Mail Your Doctor, Check Your Lab Results and More on www.kp.org As a Kaiser Permanente member, you should sign up to the secure web sitewww.kp.orgwhere you can manage your care. You can make appointments at any time if you sign up for My Health Manager on www.kp.org. On My Health Manager, Kaiser Permanente members can: Make a doctors appointment E-mail doctors and specialists with routine health questions Order prescription refills, most of which can be mailed to you at no extra charge View certain lab results and your recent immunization history See details of past appointments and check future appointments All of this information is updated by Kaiser Permanentes electronic medical record system. Everyone you receive care from at Kaiser Permanente facilitiesyour personal physician, nurse, optometrist, pharmacist, surgeonis connected to one another through your electronic health record, and every Kaiser Permanente facility in your region is linked to your electronic health record.
The Benefits of Kaiser Permanente Membership

For complete information on Kaiser Permanente visit http://my.kp.org/homedepot. Kaiser Permanente members must receive care from a Kaiser Permanente network doctor or in a Kaiser Permanente medical office or no benefits will be paid. To find a Kaiser Permanente medical office near you, go to http://my.kp.org/homedepot. To find a Kaiser Permanente doctor, look up physicians profiles at www.kp.org/chooseyourdoctor. There, you can read each doctors personal statements and review their credentials to find the right doctor for you.
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Kaiser Permanente HMO: California
Kaiser PermanenteStandard1 (You Pay) Background Information Self-Referral to OB-GYNOB-GYN must be part of the same participating physician group as your PCP Self-Referral to Specialist Default PCP Assigned if None Chosen Calendar Year Deductible Annual Out-of-Pocket Maximum Lifetime Maximum Primary Care Routine Office Visit Specialty Care Annual Physical Exam $25 copay $35 copay Yes Yes Yes $0/Individual; $0/Family $2,500/Individual; $5,000/Family Limit does not apply
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Kaiser PermanenteBasic1 (You Pay)
Yes Yes Yes $0/Individual; $0/Family $2,500/Individual; $7,500/Family Limit does not apply
$25 copay $35 copay 100% covered; according to plan's periodic health evaluation schedule. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered
100% covered; according to plans periodic exam schedule. No coverage for third-party requests such as physicals for schools that are outside the periodic health evaluation schedule. 100% covered
Pediatric Exams Pap Smears (annually) Mammography Child Immunizations Inpatient Care Hospital Copay Outpatient Care Outpatient Surgery Chiropractic Services Infertility Benefits InfertilityDiagnosis and Treatment of Underlying Cause In Vitro Fertilization Artificial Insemination Fertility Drugs
$375 copay plus 10% coinsurance
$750 copay plus 20% coinsurance
$350 copay in a hospital or ambulatory surgery center. If performed in a PCP office: $25; Specialist office: $35 $15 copay; limited to 30 visits per year
$350 copay in a hospital or ambulatory surgery center. If performed in a PCP office: $25; specialist office: $35 $15 copay; limited to 30 visits per year
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this chart and the information in your plans coverage booklets, the coverage booklets will govern.
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Kaiser Permanente HMO: California
Kaiser PermanenteStandard1 (You Pay) Emergency Care When Followed by Admission When Not Followed by Admission Urgent Care Clinic Visit Ambulance Prescription Drugs2,3 Retail: GenericOn Recommended Drug List Retail: Formulary BrandOn Recommended Drug List Retail: Non-Formulary Not On Recommended Drug List (these drugs will only be covered if medically necessary) Mail Order: GenericOn Recommended Drug List Mail Order: Formulary Brand On Recommended Drug List Mail Order: Non-Formulary Brand Not On Recommended Drug List (these drugs will only be covered if medically necessary) Mental Health/Substance Abuse Services Mental IllnessOutpatient therapy Mental IllnessInpatient Care Chemical Dependency DetoxificationOutpatient Chemical Dependency DetoxificationInpatient Chemical Dependency RehabilitationInpatient Care $5 copay; up to a 30-day supply $30 copay; up to a 30-day supply $30 copay; 30-day supply $10 copay; up to a 90-day supply $50 copay; up to a 90-day supply $50 copay; up to a 90-day supply $375 copay plus 10% coinsurance $200 copay $25 copay at Kaiser Facilities 100% covered
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Kaiser PermanenteBasic1 (You Pay)
$750 copay plus 20% coinsurance $200 copay $25 copay at Kaiser Facilities 100% covered
$5 copay; up to a 30-day supply $30 copay; up to a 30-day supply $30 copay; 30-day supply $10 copay; up to a 90-day supply $50 copay; up to a 90-day supply $50 copay; up to a 90-day supply
$25 copay for individual; $12 for group (unlimited visits) $375 copay plus 10% coinsurance $25 copay for individual; $5 copay for group $375 copay plus 10% coinsurance $100 copay per admission (unlimited days)
$25 copay for individual; $12 for group (unlimited visits) $750 copay plus 20% coinsurance $25 copay for individual; $5 copay for group $750 copay plus 20% coinsurance $100 copay per admission (unlimited days)
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this chart and the information in your plans coverage booklets, the coverage booklets will govern. 2 Sexual dysfunction and appetite suppressant drugs are covered at 50%. 3 Must use participating pharmacies.
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Health Net Salud HMO y ms California-Mexico CrossBorder Coverage
The Salud HMO y ms Plan is available only if you reside in Los Angeles, San Diego, Orange, and parts of San Bernardino or Riverside counties. When you enroll, you can receive care through a select provider network in your local area Los Angeles, San Diego, Orange, San Bernardino or Riverside counties. You also have the flexibility to receive care in northern MexicoTijuana, Mexicali,
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Rosarito or Tecatefrom participating SIMNSA (Sistemas Mdicos Nacionales, S.A. de C.V.) providers, often at a reduced cost. Salud HMO y ms members in California have two options for medical care:
Your Health Care in California Visit your PCP (Primary Care Physician) or other providers if your PCP refers you. Your Health Care in Mexico Visit participating SIMNSA providers in Mexico without referrals and pay lower copays.
You can enroll your eligible dependents in Mexico who live within 50 miles of the California-Mexico border in Salud HMO y ms and receive benefits when they visit SIMNSA providers. When in California, your eligible dependents may visit California providers for emergency and urgent care only. The chart below provides basic information about the plan. For complete information on covered services, limitations, exclusions and filing claims, see the Salud HMO y ms Summary of Benefits and Evidence of Coverage booklet available at www.healthnet.com/homedepot.
Health Net Salud HMO y ms Network

SIMNSA Network (Mexico members)1 (You Pay) Background Information Lifetime Maximum (for each member) Annual Out-of-Pocket Maximum Primary Care Routine Physician Office Visit (within your medical group) Specialty Care Preventive Care Periodic Health Evaluations Vision and Hearing Examinations Immunizations for foreign travel/occupational purposes Immunizations except foreign travel/occupational purposes Dental Services (when medically necessary to properly monitor, control or treat a severe medical condition when excluded dental services are being performed)
1 Available to eligible dependents.
Health Net Salud Network (California members) (You Pay)
SIMNSA Network (Self-referral for California members) (You Pay)
N/A $1,500/for each member; $3,000/for two members; $4,500/for each family
$5 copay $5 copay
$15 copay $15 copay
$5 copay $5 copay
100% covered $5 copay 100% covered 100% covered 100% covered
100% covered $15 copay, vision 100% covered, hearing 20% 100% covered 100% covered
100% covered $5 copay 100% covered 100% covered 100% covered
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SIMNSA Network (Mexico members) (You Pay)

Hospital and Skilled Nursing Facility Services Unlimited days of hospital care with ancillary services in a private room in Mexico. In the US, unlimited days of hospital care in a semi-private room or ICU with ancillary services (excludes care for chemical dependency/mental disorders) Confinement for infertility services Confinement in a skilled nursing facility (limited to 100 days a calendar year) Maternity care. Includes routine nursery charges Outpatient services other than surgery Outpatient surgery at hospital or ambulatory surgical center Emergency and Urgent Care Use of emergency room (facility and professional services) Use of urgent care center (facility and professional services) Other Services Chiropractic Benefits N/A $10 copay; waived if admitted $10 copay 100% covered
$250 copay2
100% covered
50% 100% covered 100% covered 100% covered 100% covered
Not covered $250 copay2 $250 copay

2
50% 100% covered 100% covered 100% covered 100% covered
100% covered $250
$100 copay; waived if admitted $50 copay
$10 copay; waived if admitted $10 copay
$15 copay; 30-visit limit 4
N/A
Pregnancy Care Prenatal and postnatal office visit Normal delivery, Cesarean section. Includes newborn inpatient care provided by a member physician Family Planning (professional services only) Contraceptive devices Infertility services (including professional services, inpatient and outpatient care, treatment by injection and prescription drugs, if applicable) Care for Mental Disorders Outpatient mental visit for severe mental illness Inpatient care in a hospital or skilled nursing facility for severe mental illness Physician visit to hospital or skilled nursing facility for severe mental illness
1 2 3 4
$5 copay initial visit only 100% covered
$15 copay initial visit only $250 copay 2
$5 copay initial visit only 100% covered
100% covered 50%
100% covered Diagnosis covered; All other services not covered
100% covered 50%
$5 copay1 100% covered (unlimited days)1 100% covered1
$15 copay3 $250 copay2,3 100% covered3
Mental health and substance abuse services must be provided by a SIMNSA provider. Inpatient: A $250 copay is required for each inpatient hospital admission. After the copay is satisfied, the balance is payable at 100%. Administered by Managed Health Network (MHN). Authorizations provided by MHN. Contact MHN at 1-800-363-9371. Administered by American Specialty Health Plans of CA (ASH).
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SIMNSA Network (Mexico members) (You Pay)

Other Mental Illnesses (Non-severe mental illnesses) Outpatient mental visit for non-severe mental illness Inpatient care in a hospital or skilled nursing facility for non-severe mental illness Physician visit to hospital or skilled nursing facility for non-severe mental illness Chemical Dependency Rehabilitation Outpatient consultation (therapy, counseling or psychological testing) in an outpatient facility Detoxification (acute care for substance abuse) Inpatient rehabilitation for chemical dependency in a hospital or residential chemical dependency facility $5 copay1 100% covered1 100% covered (unlimited days)1 $5 copay1 100% covered; (unlimited days)1 100% covered1
$15 copay (unlimited visits) 2 $250 copay (unlimited days) 2, 3 100% covered
$15 copay (unlimited visits) 2 $250 copay (unlimited days) 2,3 $250 copay (unlimited days) 2,3
$5 copay1 100% covered1 100% covered (unlimited days)1
1 Mental health and substance abuse services must be provided by a SIMNSA provider. 2 Inpatient A $250 copay is required for each inpatient hospital copay. After copay is satisfied, the balance is payable at 100%. 3 Administered by Managed Health Network (MHN). Authorizations provided by MHN. Contact MHN at 1-800-363-9371.
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Health Net Salud HMO y ms Prescription Drug Coverage
The Salud HMO y ms covers prescription drugs when purchased in a SIMNSA or Health Net participating pharmacy: To find a Health Net participating pharmacy in California or to get a copy of the Health Net Recommended Drug List, go to www.healthnet.com or call the Health Net Customer Contact Center at 1-800-847-3991. To find a SIMNSA participating pharmacy in Mexico and for information on SIMNSAs Recommended Drug List, call SIMNSA at (011-52-664) 683-29-02 or (011-52-664) 683-30-05.
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For complete information on covered services, limitations and exclusions, see the Salud HMO y ms Summary of Benefits and Evidence of Coverage booklet available online at www.healthnet.com/homedepot.com. Generic drugs will be dispensed when a generic equivalent is available. If you request a brand-name drug when a generic equivalent is available, you must pay the difference between the generic equivalent and the brand-name drug plus the Level 1 drug copayment.
Mail Order Drug Program If your prescription is for a maintenance medication (a drug that you will be taking for an extended period), you have the option of filling it through the Prescription By Mail Drug Program. Through this program, you can receive up to a 90-day supply of maintenance medication for a lower cost. Mail order drug coverage is limited to participants residing or working in the U.S. For more information on the mail order drug program, go to www.healthnet.com or call the Customer Contact Center at 1-800-847-3991.
Health Net Salud HMO y ms Prescription Drug Coverage

SIMNSA Participating Pharmacy Outpatient Prescription Medication Drugs dispensed by SIMNSA Level I drugs listed on the Health Net Recommended Drug List (primarily generic) Level II drugs listed on the Health Net Recommended Drug List (primarily brand name) and diabetic supplies (including insulin) Level III (drugs not listed on the Health Net Recommended Drug List) Mail Order Level I drugs listed on the Health Net Recommended Drug List (primarily generic) Level II drugs listed on the Health Net Recommended Drug List (primarily brand name) and diabetic supplies (including insulin) Level III (drugs not listed on the Health Net Recommended Drug List) Not applicable Not applicable $10 copay; up to a 90 day supply $50 copay; up to a 90 day supply $5 copay Not applicable Not applicable Not applicable Not applicable $5 copay; up to a 30 day supply $30 copay; up to a 30 day supply $60 copay; up to a 30 day supply Health Net Participating Pharmacy
Not applicable
$90 copay; up to a 90 day supply
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Grandfathered Plans
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Being a grandfathered health plan means that your plan or policy may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the Benefits Choice Center. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This web site has a table summarizing which protections do and do not apply to grandfathered health plans.
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Hawaii Medical
Chapter Contents
152 Hawaii Medical Options 152 ID Cards 152 HMSAs Preferred Provider Plan (PPO) 152 Using PPO Providers 153 How to Receive PPO Benefits 153 Using Non-PPO Providers 153 How to Receive Non-PPO Benefits 153 Annual Deductible 154 Out-of-Pocket Maximums 154 Lifetime Maximum Benefits 154 HMSAs Health Plan Hawaii Plus (HMO) 154 Using HMO Providers 154 How to Receive HMO Benefits 154 Annual Deductible 154 Out-of-Pocket Maximums 155 Lifetime Maximum Benefits 155 Whats Covered Under the HMSA HMO and PPO 155 Maternity Benefits 155 Mastectomies 155 Chiropractic Benefits 155 Whats Not Covered Under the HMSA HMO and the PPO 159 HMSA Vision Care 159 HMSA Prescription Drug Benefits 159 159 160 160 Retail Prescription Drug Program Mail-Order Prescription Drug Program The Kaiser Permanente HMO Convenient Care and Extended Hours
160 E-Mail Your Doctor, Check Your Lab Results and More on www.kp.org 160 Advice Nurses 160 Referrals to Plan Providers 163 General Information About the Hawaii Medical Plans 163 Claiming Benefits Under the Group Health Plans 163 Filing Claims Under the Group Health Plan 164 Certificates of Health Plan Coverage 164 If Youre Age 65 or Older 164 Right to Recover Payment
Hawaii Medical
What do you need?
Find an HMSA provider or hospital Find a Kaiser Permanente medical office and get information about your medical plan
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Find it here...
Go to www.hmsa.com or call 1-808-948-6111 Go to http://my.kp.org/homedepot or call 1-855-9KAISER (1-855-952-4737)
Hawaii Medical Options

As a Hawaii associate, depending on where you live, you have the following medical options: HMSAPreferred Provider Plan (PPO) HMSAHealth Plan Hawaii Plus (HMO) Kaiser Permanente HMO HMSAs Preferred Provider Plan allows you the option of seeking medical care using both in-network and out-of-network doctors. HMSAs Health Plan Hawaii Plus allows you to seek medical care using only innetwork doctors, except in the case of an emergency. Kaiser Permanente members must receive care at a Kaiser Permanente medical facility. At most locations members can see their personal physician, receive x-ray, lab and pharmacy services all under one roof during extended office hours. There are also no claim forms required with Kaiser Permanente. See Get the Most Value from Your Plan in this chapter to find out how to find a Kaiser Permanente medical facility or an HMSA network provider.
This chapter, including the benefits charts, provides information about services covered by the HMSA and Kaiser Permanente Medical Plans. For complete information on covered services, limitations, exclusions, and filing claims, see HMSAs Guide to Benefits booklet or the Kaiser Permanentes Summary of Benefits. These booklets are considered part of this Benefits Summary. Also, see Get the Most Value from Your Plan for HMSAs and Kaiser Permanentes Member Services number and web site address.
HMSAs Preferred Provider Plan (PPO)

The Preferred Provider Plan lets you choose any doctor. Your benefits depend on whether you use your Plans Preferred Provider Organization (PPO) providers or non-PPO providers. Using PPO providers lowers the cost for health care services for you.
Using PPO Providers

When you use in-network providers (doctors, specialists, hospitals and other health care providers who participate in the network), the Medical Plan begins to work for you immediately. Heres how: Doctor office visitsYou pay a portion of the pre-negotiated charges with no deductible for most charges related to the treatment of covered illnesses, injuries and preventive services. Well-child careServices, including immunizations, for children through age five. Well-woman careIncludes routine annual Pap smears and routine mammograms Well-man careProstate cancer screening tests (PSAs) as directed by your PCP Well-adult careRoutine annual physical examinations
ID Cards
Once you become covered under an HMSA or Kaiser Permanente medical plan, you will receive an identification (ID) card. Keep your ID card with you at all times, and show it at your doctors office each time you receive medical treatment. It will help your doctor to verify your benefits. Please note that the possession of an ID card alone does not entitle you to benefits. Your enrollment in a medical plan must be effective when medical services are received to be entitled to benefits.
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Emergency careAlways try to locate an in-network provider when you require emergency care away from home. However, in a life-threatening emergency, if you receive emergency services from an out-of-network provider, your emergency services will be covered at the in-network level. However, you will be responsible for any charges above the eligible charge. See Using Non-network Providers later in this chapter for more information on eligible charges. Hospitals and other servicesFor most other covered major-medical services (such as inpatient and outpatient surgeries, home health care, inpatient mental health and substance abuse treatment, alternative treatment centers, etc.), you pay a portion of pre-negotiated charges. Fees for servicesIn general, the pre-negotiated fees charged by in-network providers are lower than those you might otherwise pay out-of-network providers for the same service. Medical claim formsYou do not file medical claim forms when you receive in-network services. Your doctor will file claims for you and will receive payment from your Plan directly. Refer to the Summary of Covered Services charts for a detailed list of PPO benefits.
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Once you have identified a doctor, call the doctors office to verify that new patients are being accepted. Let the doctor know that you are a member of the HMSA Preferred Provider Plan. When you call for an appointment, you should always confirm your doctors participation in the HMSA Preferred Provider Plan.
How to Receive Non-PPO Benefits

To receive non-PPO benefits, you must submit the original itemized bills for services covered under your Plan. When you use non-PPO providers, the Plan begins to pay benefits after you and/or your family pay an initial amount of covered expenses. This is called your annual deductible. After the annual deductible is met, the Plan pays 70% of most covered medical expenses incurred during the same year by you and your covered family members. Expenses that you pay in excess of EC do not count toward your deductible. Remember, you will be responsible for paying the difference between what the Plan pays and what your doctor charges. This includes any amounts over the EC.
Using Non-PPO Providers

When you use non-PPO providers (doctors, specialists, hospitals, and other health care providers not participating in the network), you pay 30% and the Plan pays 70% for most covered services, after you meet your Plans individual annual deductible. Refer to the Summary of Covered Services for a detailed list of non-PPO benefits. Since non-PPO providers can charge any amount for their services, the Plan will pay benefits only on charges considered an eligible charge (EC). EC is the lower of either the providers actual charge or the amount established as the maximum allowable fee. This amount is determined by HMSA and is used as the maximum allowable amount for calculating the benefit they will pay for medical services. If your non-PPO doctor charges more than the EC, you will be responsible for paying your share of the covered charges plus 100% of any charges over the EC. Always discuss fees with your non-PPO doctor in advance, and ask your doctor whether he or she will agree to waive charges over the EC.
Annual Deductible
The Plan begins to pay PPO and non-PPO benefits not eligible for a copayment only after you and your family pay an annual deductible, as follows:
PPO Individual Deductible Family Deductible $100 (only for major medical services) $300 (only for major medical services) Non-PPO $100
$300
How to Receive PPO Benefits

To receive PPO benefits, you must visit a PPO provider. For current information and to obtain a directory of providers and hospitals free of charge, call HMSA at 1-808-948-6111. You may also find this information on their web site at www.hmsa.com.
For additional information, refer to HMSAs Guide to Benefits.
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The Plan limits the amount you have to pay out of your own pocket for PPO and non-PPO services. Covered medical expenses for PPO and non-PPO services are limited to the following out-of-pocket annual maximums:
PPO Individual Maximum Family Maximum $2,500 $7,500 Non-PPO $2,500 $7,500
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Using HMO Providers

The following benefits are available when you use HMO providers: Doctors office visitsYou pay a copayment with no deductible for most charges related to the treatment of covered illnesses or injuries. Well-child careServices, including immunizations, for children through age five. Well-woman careIncludes routine annual Pap smears and routine mammograms Well-man careProstate cancer screening tests (PSAs) as directed by your PCP Well-adult careRoutine annual physical examinations Emergency careAlways try to locate an HMO provider when you require emergency care away from home. Depending upon where you receive emergency care will determine how the Plan pays. Hospitals and other servicesFor most other covered medical services (such as inpatient and outpatient surgeries, home health care, inpatient mental health and substance abuse treatment), refer to HMSAs Guide to Benefits. You do not file medical claim forms when you receive services. Your doctor will file claims for you and will receive payment from the Plan directly. Refer to the Summary of Covered Services for a detailed list of benefits.
How to Receive HMO Benefits

To receive benefits, you must select a Primary Care Physician (PCP) at the time of enrollment. If you do not, HMSA will select one for you. Once you have selected a PCP, call for an appointment before going to see your doctor. You must contact your physician for a referral before seeing another physician or obtaining services other than those provided by your PCP. If, for any reason, you would like to select a new PCP, call an HMSA Member Services representative to make the change. Additional reasons you may need to change your PCP: when you move when your PCP was originally chosen by HMSA Remember: If you visit another provider or receive special services without a referral from your PCP and approval from HMSA Health Plan Hawaii Plus, your claim for these services will be denied.
If your PPO doctor charges more than the eligible charge (EC), the amount over the eligible charge will not count toward your annual out-of-pocket maximum.
Lifetime Maximum Benefits

The Plan provides Medical Plan benefits with an unlimited lifetime maximum for you and each covered family member. The Plan has other limitations on specific types of services as described separately in HMSAs Guide to Benefits.
Annual Deductible
There is no annual deductible for the HMO Plan.
The Plan limits the amount you have to pay out of your own pocket. Covered medical expenses are limited to the following out-of-pocket annual maximums: Individual maximum: Family maximum: $2,500 $7,500
HMSAs Health Plan Hawaii Plus (HMO)

The HMSA Health Plan Hawaii Plus Plan offers quality medical coverage with lower out-of-pocket costs to you. When you choose this HMO Plan, you agree to use only your Plans HMO providers. Services provided by non-HMO providers are not covered except in an emergency.
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Lifetime Maximum Benefits
The Plan provides Medical Plan benefits with an unlimited lifetime maximum for you and each covered family member. The Plan has other limitations on specific types of services as described separately in HMSAs Guide to Benefits.
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Mastectomies
Federal law requires group health plans offering mastectomy coverage to also cover reconstructive surgery and prostheses following mastectomies. Therefore, if you or a covered family member receive benefits for a medically necessary mastectomy and elect breast reconstruction after the mastectomy, coverage will also be provided for: reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses (artificial replacements), and treatment of physical complications with respect to all stages of a mastectomy, including lymphedemas (swelling associated with the removal of the lymph nodes). This coverage will be provided in consultation with the attending physician and the patient, and it will be subject to the same annual deductible, co-insurance and/or copayment provisions otherwise applicable.
Chiropractic Benefits
Chiropractic benefits are administered by American Specialty Health Insurance (ASHI). The ASHI chiropractic benefits plan is a fully insured plan that is governed by the information provided directly to you by ASHI. If there are any discrepancies between the information in this book and the information provided by ASHI, the information provided by ASHI will govern. For detailed information about chiropractic benefits, contact ASHI directly. ASHI contact information can be found on the back of your ASHI ID card.
Whats Covered Under the HMSA HMO and PPO

Maternity Benefits
As required by federal law, maternity benefits are not restricted for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mothers or newborns attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, the Plan does not require that a provider obtain authorization from the Plan for prescribing the length of stay not in excess of 48 hours (or 96 hours).
Whats Not Covered Under the HMSA HMO and the PPO
Limitations and exclusions for the HMO and PPO Plans are not described in detail in this Benefits Summary. Please refer to HMSAs Guide to Benefits for detailed information. This Guide is considered part of this Benefits Summary.
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HMSA Summary of Covered Services
HMSAHealth Plan Hawaii Plus (HMO)1 Benefit Annual Deductible Individual Family Annual Out-of-Pocket Maximum Individual Family Lifetime Maximum Benefit All benefits Office Visits Office Visits Diagnostic Services X-rays and laboratory tests (connected with a same-day doctors office visit) X-rays covered at 90%; laboratory tests covered at 90% Not covered You pay $15 Not covered Unlimited Not covered $2,500 $7,500 Not covered None Not covered When You Use HMO Providers
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HMSAPreferred Provider Plan (PPO)1 When You Use PPO Providers When You Use Non-PPO Providers
When You Use Non-HMO Providers
$100 (for certain services) $300 (for certain services)
$100 $300
$2,5002 $7,5002
$2,5002 $7,5002
Unlimited
Unlimited
Covered at 90%
Covered at 70% of eligible charge after annual deductible
Covered at 80%
Well-Child Care Through Age 21 (including immunizations) Birth to 1 year (7 visits) Age 1 year (3 visits) Age 2 years (2 visits) Age 3 years through 21 years (1 visit per year) Preventive Visits Pap smears Preventive mammograms 1 baseline at ages 3539 1 every year after age 40 Prostate-Specific Antigen (PSA) test; 1 every year at or after age 50 90% Covered at 80% Covered at 100% Not covered Covered at 100% Covered at 70% of eligible charge after annual deductible Covered at 70% Covered at 100% Not covered Covered at 100% Covered at 70%, no deductible applies; Immunizations covered at 100%, no deductible applies
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plans coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Get the Most Value From Your Plan. You may also call the Member Services number listed on your ID card. 2 The deductible does not apply to the out-of-pocket maximum.
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HMSA Summary of Covered Servicescontinued
HMSAHealth Plan Hawaii Plus (HMO)1 Benefit Prescription DrugsDrug Plan 506/507 Annual deductible Individual Family Generic drugs (30-day supply) Single source generic drugs (30-day supply) Preferred brand drugs (30-day supply) Other brand-name drugs (30-day supply)
2
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When You Use HMO Providers
When You Use Non-HMO Providers
None $5 copay $10 copay $10 copay $10 member copayment plus $45 other brand-name drug cost share
None 80% of eligible charge after $5 copay 80% of eligible charge after $10 copay 80% of eligible charge after $10 copay 80% of remaining eligible charge after $10 member copayment plus $45 other brand-name drug cost share
None $5 copay $10 copay $10 copay $10 member copayment plus $45 other brand-name drug cost share
None 80% of eligible charge after $5 copay 80% of eligible charge after $10 copay 80% of eligible charge after $10 copay 80% of remaining eligible charge after $10 member copayment plus $45 other brand-name drug cost share
Mail-Order Prescription Drug Program (administered by Medco) (up to 90-day supply) Generic drugs (up to a 90-day supply) Preferred brand drugs (up to a 90-day supply) Non-formulary brand (up to a 90-day supply) Hospital Deductible per admission Room & board (semi-private) Doctors services Surgeons services Anesthesiologists services Diagnostic services (x-rays and laboratory tests) Newborn nursery charges/doctors visits Surgery None $75 copay per day Covered at 100% Covered at 100% for inpatient and $15 copay for outpatient Covered at 100% Covered at 100% for inpatient and covered at 90% of the eligible charge for outpatient Covered at 100% Covered at 100% Cutting covered at 90%; non-cutting covered at 80% Covered at 90% Covered at 90% for inpatient and 80% for outpatient Covered at 90% Covered at 90% for a cutting procedure and 80% for a non-cutting procedure Not covered None Covered at 90% None Covered at 70% of eligible charge after annual deductible Covered at 70% of eligible charge after annual deductible $10 copay $20 copay $20 member copay plus $135 cost share Not covered $10 copay $20 copay $20 member copay plus $135 cost share Not covered
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plans coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Get the Most Value From Your Plan. You may also call the Member Services number listed on your ID card. 2 Combined in- and out-of-network.
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HMSA Summary of Covered Servicescontinued
HMSAHealth Plan Hawaii Plus (HMO)1 Benefit Emergency Care Emergency room treatment Skilled Nursing Facility Home Health Care Hospice Care Durable Medical Equipment Ambulance If medically necessary, to the nearest emergency hospital Covered at 80% Covered at 80% $75 copay Covered at 100% semi-private room rate (up to 60 days per benefit period) Covered at 100% (up to 365 visits per illness or injury) Covered at 100% Covered at 50% for external devices; covered at 100% for internal devices Covered worldwide at $75 Not covered When You Use HMO Providers When You Use Non-HMO Providers
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Covered at 90% Covered at 90% (up to 120 days per calendar year) Covered at 100% (up to 150 visits per calendar year) Covered at 100% Covered at 80% of eligible charge after annual deductible
Covered at 90% of eligible charge Covered at 70% of eligible charge after annual deductible (up to 120 days per calendar year) Covered at 70% of eligible charge after annual deductible (up to 150 visits per calendar year) Not covered Covered at 70% of eligible charge after annual deductible
Covered at 80% after annual deductible
Mental Health & Substance Abuse Treatment Inpatient $75 copay per day (unlimited days) for hospital and facility; 100% covered for psychiatrist and psychologist services $15 copay (no visit limit) Not covered Covered at 90% (unlimited days) Covered at 70% of eligible charge after annual deductible (unlimited days) Covered at 70% of eligible charge after annual deductible (no visit limit)
Office visits
Covered at 90% (no visit limit)
1 This is a fully insured plan which is governed by the information provided directly to you by your health care plan insurer. If there are differences between the information in this book and the information in your plans coverage booklets, the coverage booklets will govern. For detailed information about any fully insured plan, contact the Plan Administrator directly. Plan phone numbers and web site addresses are listed in Get the Most Value From Your Plan. You may also call the Member Services number listed on your ID card.
Chiropractic Benefits
Administered by American Specialty Health Insurance (ASHI). For more information, call the number on the back of your ASHI ID card, which will be mailed to your home. Benefit Chiropractic benefit (per calendar year) In-Network You pay $20 copay per visit; 24 visit maximum Out-of-Network You pay 50% coinsurance up to $30 per visit, 12 visit maximum (combined with in-network)
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HMSA Vision Coverage
HMO Vision Services Eye Exam Single Lenses Multifocal Lenses Contact Lenses Contact Lens Fitting2 Frames $15 copay; limited to one exam per year $10 copay $10 copay $25 copay; $130 maximum Plan pays up to $45 $15 copay; must be from a designated category PPO
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PPO Non-Participating Up to $401 Up to $161 Up to $251 Up to $501 Up to $20 Up to $121
Participating 100% after $10 deductible 100% after $10 deductible 100% after $10 deductible Plan pays up to $130 after $25 annual deductible Plan pays up to $45 100% after $15 annual deductible3
1 Payment of entire claim is due at appointment and sent in for reimbursement. 2 Benefit is limited to one contact lens fitting per calendar year. 3 Frames must be chosen from a group selected by the provider. Other restrictions apply.
HMSA Vision Care

Show your HMSA Health Plan ID card to participating providers to obtain vision care services and receive discounts under the Plan. To find a vision center that participates in HMSA, Preferred Provider Plan, or Health Plan Hawaii Plus, call an HMSA Member Services representative at 1-808-948-6111.
Retail Prescription Drug Program

HMSA offers discounted prices when you fill your prescriptions at a participating pharmacy. To find a participating pharmacy in the HMSA network, call 1-808-948-6111.
Requesting a Mail-Order Prescription To use the mail-order prescription drug program, ask your doctor to prescribe ongoing medication for up to a 90-day supply, plus refills. Then, complete and mail a patient profile questionnaire along with your original prescription(s) and the appropriate payment to: HMSA Prescription Delivery Program Medco Health Solutions of Fort Worth P.O. Box 650322 Fort Worth, TX 75265-9946 Allow at least 14 days for delivery from the time you mail your prescription. The patient profile questionnaire is included in your HMSA Enrollment Kit; or you may obtain the questionnaire by calling or writing HMSA.
Mail-Order Prescription Drug Program

The most cost-effective way to fill prescriptions for maintenance medications is through mail order. When you and your covered family members enroll in the Medical Plan, you are automatically enrolled in the mail-order prescription drug program.
HMSA Prescription Drug Benefits

All HMSA Medical Plan participants can purchase their prescription drugs through HMSA (retail) and Medco (mail order). HMSA and Medco encourage use of generic drugs and preferred brand-name drugs. You may still obtain other brand-name prescriptions, but you will pay more. Refer to HMSAs Guide to Benefits for definitions and explanations of these drug categories.
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The Kaiser Permanente HMO
For complete information on Kaiser Permanente visit http://my.kp.org/homedepot. Kaiser Permanente members must receive care from a Kaiser Permanente network doctor or in a Kaiser Permanente medical office or no benefits will be paid. To find a Kaiser Permanente medical office near you, go to http://my.kp.org/homedepot. To find a Kaiser Permanente doctor, look up physicians profiles at http://my.kp.org/homedepot. There, you can read each doctors personal statements and review their credentials to find the right doctor for you. Keep in mind that if you are changing your coverage from Health Net or any other medical insurance to Kaiser Permanente, you must see Kaiser Permanente providers in a Kaiser Permanente medical facility as of your coverage effective date for most ongoing care situations (for example, pregnancy). If you have any questions about the transition of care, visit Kaiser Permanente at http://my.kp.org/homedepot and look for Transition of Care within the In The Know section on the home page.
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E-Mail Your Doctor, Check Your Lab Results and More on www.kp.org
As a Kaiser Permanente member, you should sign up to the secure web sitewww.kp.orgwhere you can manage your care. You can make appointments at any time if you sign up for My Health Manager on www.kp.org. On My Health Manager, Kaiser Permanente members can: Make a doctors appointment E-mail doctors and specialists with routine health questions Order prescription refills, most of which can be mailed to you at no extra charge View certain lab results and your recent immunization history See details of past appointments and check future appointments All of this information is updated by Kaiser Permanentes electronic medical record system. Everyone you receive care from at Kaiser Permanente facilitiesyour personal physician, nurse, optometrist, pharmacist, surgeonis connected to one another through your electronic health record, and every Kaiser Permanente facility in your region is linked to your electronic health record.
Advice Nurses
Kaiser Permanente has telephone advice nurses available to assist you. Advice nurses are registered nurses (RNs) specially trained to help assess medical symptoms and provide advice over the phone, when medically appropriate. They can often answer questions about a concern, tell you what to do if a Plan Medical Office is closed, or advise you about what to do next, including making a same-day Urgent Care appointment for you if it's medically appropriate. To reach an advice nurse, please call Member Services at 1-855-9KAISER (1-855-9524737).
Referrals to Plan Providers

A Plan Physician must refer you before you can receive care from specialists, such as specialists in surgery, orthopedics, cardiology, oncology, urology, and dermatology. However, you do not need a referral to receive care from any of the following: Your personal Plan Physician Generalists in internal medicine, pediatrics, and family practice Specialists in optometry, psychiatry, chemical dependency, and obstetrics/gynecology Complete detail regarding covered services, limitations and exclusions, as well as information about filing and appealing claims are not described in detail in this Benefits Summary. Please see the information mailed to your home by Kaiser Permanente or by calling 1-855-9KAISER (1-855-952-4737).
Convenient Care and Extended Hours

Many Kaiser Permanente medical offices offer convenience with a wide range of services under one roof and extended hours: Exams, x-rays, lab and pharmacy services are available at many Kaiser Permanente medical offices. Medical offices are open after hours and on weekends.
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Kaiser Permanente Summary of Covered Services
Benefit Annual Deductible Individual Family Annual Out-of-Pocket Maximum Individual Family Lifetime Maximum Benefit All benefits Office Visits Office Visits Diagnostic Services X-rays and laboratory tests (connected with a same-day doctors office visit) Well-Child Care Through Age 6 (including immunizations) Children through 12 months (6 visits) Children age 13 months through 24 months (2 visits) Children age 2 through 6 years (1 visit per year) Preventive Visits Pap smears Preventive mammograms 1 baseline at ages 3539 1 every year after age 40 Prostate-Specific Antigen (PSA) test; 1 every year at or after age 50 Prescription DrugsDrug Plan 357/358 Annual deductible Individual Family Generic drugs Preferred brand drugs Other brand-name drugs Generic drugs Preferred brand drugs Hospital Deductible per admission Room & board (semi-private) Doctors services U.S. Salaried & Full-Time Hourly Associates None None You pay $15 Unlimited $2,000 $6,000 None
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Kaiser Permanente HMO
Covered at 100%
Covered at 100%
Covered at 100%
$5 copay; 30-day supply $15 copay; 30-day supply Covered at preferred brand copay when medically necessary $10 copay; 90-day supply $30 copay; 90-day supply
Mail-Order Prescription Drug Program (administered by PrecisionRx) (up to 90-day supply)
Covered at 100%
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Kaiser Permanente Summary of Covered ServicesContinued
Benefit Hospital Surgeons services Anesthesiologists services Diagnostic services (x-rays and laboratory tests) Hospital Newborn nursery charges/doctors visits Surgery Emergency Care Emergency room treatment Skilled Nursing Facility Home Health Care Hospice Care Durable Medical Equipment Ambulance If medically necessary, to the nearest emergency hospital Mental Health & Substance Abuse Treatment Inpatient Office visits Chiropractic Benefits
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Kaiser Permanente HMO
Covered at 100%
Covered at 100%
$50 copay Covered at 100% (limited to 60 days per benefit period) Covered at 100% Covered at 100% Covered at 50%
Covered at 80%
Covered at 100% $15 copay
Administered by American Specialty Health Insurance (ASHI). For more information, call the number on the back of your ASHI ID card, which will be mailed to your home. Benefit Chiropractic benefit (per calendar year) In-Network You pay $15 copay per visit; 30 visit per year maximum
Kaiser Permanente Vision Coverage

Benefit Exam Prescription Glasses: lenses/frames/lens treatment; or Prescription Contact Lens and Contact Lens Exam at Kaiser Permanente In-Network $15 copay $150 allowance every year
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General Information About the Hawaii Medical Plans
Claiming Benefits Under the Group Health Plans
You or your beneficiary must file the appropriate forms to receive any benefits or to take any other action under the Plan. All forms required to take any action under the Plans are available from the claims administrator. Please refer to the descriptions of each benefit for additional information on claiming benefits. To be eligible for benefits, you must be covered under the Plan, properly submit a claim, and follow the Plan's claims and appeals procedures. If a claim is denied initially, you must exhaust the appeals procedure before filing a suit. Suits must be brought no later than one year following the date on which the appeals process under the Plan is exhausted. Where to Send Your Claims for Out-of-Network Services
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Information Required for Your Claim When you request payment of benefits, you do not have to use a claim form. However, you must provide all of the following information: associates name and address patients name, age and relationship to the associate contract number, which is on your ID card itemized bill from your provider that includes the following: patient diagnosis date(s) of service procedure code(s) and descriptions of service(s) rendered charge for each service rendered providers name, address and tax identification number date the injury or sickness began, if applicable statement indicating either that you are, or you are not, enrolled for coverage under any other group health insurance plan or program (if you are enrolled for other coverage, you must include the name of any other insurance company)
When you receive covered health services as a result of an emergency, or if you receive services from an out-of-network provider, you must submit the claim to your medical plan administrator. Timely Filing of a Claim You must submit a request for payment of benefits within one year after the date of service. If an out-of-network provider submits a claim on your behalf, you will be responsible for the timeliness of the providers claim submission. If you dont provide the claim information within one year after the date of service, benefits for that service will be denied or reduced, according to the claims administrators discretion. This time limit does not apply while you are legally incapacitated. If your claim relates to an inpatient stay, the date of service is the date your inpatient stay ends. If you provide written authorization to allow direct payment to a provider, all or a portion of any eligible expenses due to a provider may be paid directly to the provider instead of being paid to the associate. The group health Plan will not reimburse third parties that have purchased or been assigned benefits by any healthcare provider.
Filing Claims Under the Group Health Plan

If you receive covered health services from an in-network provider, you do not have to file a claim. In-network providers are responsible for filing claims for you. Your group health plan pays in-network providers directly for your covered health services. If an in-network provider bills you directly for any covered service, contact the claims administrator. However, you are responsible for meeting any annual deductible and for paying copayments to an in-network provider at the time of service, or when you receive a bill from the provider. If you receive covered health services from an out-of-network provider, you are responsible for timely filing of your claim.
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Payment of Benefits Your medical plan will make a benefit determination as described below. Benefits will be paid directly to you unless either of the following is true: The provider notifies your medical plan administrator that your signature is on file, assigning benefits directly to that provider, or You make a written request for the out-of-network provider to be paid directly at the time you submit your claim.
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If Youre Age 65 or Older

If you are an active associate age 65 or older (or an active associates spouse age 65 or older) who is eligible for Medicare, you may choose to end your coverage under the Company Medical Plan and elect Medicare coverage instead. Or, you may choose to continue coverage under this Plan, which will be considered your primary Plan and will pay benefits first. Medicare will be the primary payor to the full extent permitted by law, including for those individuals not in current employment, and as legally permitted for individuals with end-stage renal disease or who are totally disabled.
Certificates of Health Plan Coverage

After your coverage (or your dependents coverage) ends, a Certificate of Health Plan Coverage will be sent to the current address listed with the Plan Administrator. This certificate provides evidence of your health care coverage with the Company. You may need this certificate should you become covered by another group health plan or insurance policy with a pre-existing medical condition clause. A group health Plan is required by law to reduce the duration of its pre-existing condition exclusion, day-for-day, by any period of prior coverageprovided you do not have a 63-day or longer break in health care coverage (not counting waiting periods for coverage). You and your dependents also have the right to request a Certificate of Health Plan Coverage at any time during the 24 months following loss of coverage. You may request a copy from the Benefits Choice Center at 1-800-555-4954.

For detailed information on third-party liability rules, please refer to HMSAs Guide to Benefits or Kaiser Permanentes Summary of Benefits.
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The Critical Illness Protection Plan

Chapter Contents
166 The Critical Illness Protection Plan 166 Coverage Categories 166 When Benefits Are Paid 167 Wellness Benefit 167 Transportation Benefit 167 Lodging Benefit 167 Recurrence Benefit 169 Waiver of Premium Due to Disability
169 Critical Illnesses Covered Under the Plan 171 What the Plan Does Not Cover 172 Filing a Claim 172 Payment of Claims 172 Continuing Critical Illness Protection Plan Coverage When Coverage Ends 173 COBRA (Continuing Coverage After Termination)

What do you need?
Name a beneficiary Get a claim form Submit a claim, including a claim for wellness benefits Request portability coverage
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Find it here...
Go to www.allstateatwork.com/homedepot or Call Allstate Workplace Division at 1-866-828-8766
Fax your claim form and documentation to: 1-877-652-2979 Go to www.allstateatwork.com/homedepot or Call Allstate Workplace Division at 1-866-828-8766

The Critical Illness Protection Plan pays a lump-sum benefit for specific conditions, such as heart attack, stroke, cancer, transplant, Alzheimers disease and paralysis and benefits for eligible travel and lodging expenses. The plan also pays an annual benefit of $75 for wellness services per covered person. The Critical Illness Protection Plan is administered by Allstate Workplace Division. The lump-sum benefit paid for covered conditions is based on the benefit amount you choose when you enroll for this plan. Your Critical Illness Protection Plan basic benefit amount options are: $5,000 $10,000 $20,000 $30,000 Your cost for Critical Illness Protection Plan coverage is based on your basic benefit amount, the number of dependents you cover and your tobacco-user status. To view your rates, select the Critical Illness Protection Plan during your enrollment session and
enter your information (for example, tobacco-user status and number of dependents covered). Under the Critical Illness Protection Plan, benefits for covered conditions are paid at either 25% of your basic benefit amount or 100% of your basic benefit amount, depending on the condition. The Critical Illness Protection Plan Summary of Benefits chart shows the conditions payable at 100% and the conditions payable at 25%. You may discontinue your Critical Illness Protection Plan coverage at any time by calling the Benefits Choice Center.
When Benefits Are Paid

The Critical Illness Protection Plan will pay a benefit when a covered person is diagnosed with a critical illness if: The date of diagnosis is after the covered persons effective date of coverage; and The date of diagnosis for the critical illness is while the covered person is insured under the policy; and The critical illness is listed in the Critical Illness Protection Plan Summary of Benefits chart and matches the specific description in this chapter. A covered person can receive a benefit for each critical illness only once, unless the critical illness is named in the Recurrence Benefit section of this chapter. A covered person can receive benefits for different covered critical illnesses if the dates of diagnosis for each critical illness are separated by at least 90 days. The maximum basic benefit amount payable for all critical illnesses is the lesser of four times your basic benefit amount or $250,000 for each covered person. All benefits paid contribute toward the maximum basic benefit amount unless otherwise noted. Critical Illness Protection Plan coverage will end when you
Coverage Categories
You may select one of four coverage categories: Associate only Associate + spouse (or same-sex domestic partner) Associate + child(ren) Associate + family (children and spouse or samesex domestic partner)
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or any covered dependent has received the maximum basic benefit amount. Each critical illness must be diagnosed by a physician in the United States or its territories. Claims for benefits not satisfying all the criteria for diagnosis may be subject to review by an independent physician consultant. Emergency situations that occur while the covered person is outside the United States or its territories may be reviewed and considered for approval by a United States physician on foreign soil or when the covered person returns to the United States or its territories.
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The treatment facility must be more than 100 miles from the covered persons home. The plan does not pay for transportation for someone to accompany or visit the covered person receiving treatment, visits to a physicians office or clinic or for other services. If the treatment is for a covered child and common carrier travel is necessary, we will pay this benefit for up to two adults to accompany the child. Common carrier means the following: commercial airlines; passenger trains; inter-city bus lines; trolleys; or boats. It does not include taxis; intra-city bus lines; or private charter planes. The transportation benefit does not count toward the maximum basic benefit amount.
attack, stroke, coronary artery by-pass surgery, transplant, invasive cancer or carcinoma in situ, for which a benefit was previously paid if: The second date of diagnosis is more than 12 months after the first date of diagnosis for the critical illness; and The second date of diagnosis is while the covered person is covered under the plan; and For the cancer critical illness benefits, the covered person had no symptoms and did not receive any treatment during the 12 months after the prior occurrence. The benefit amount is equal to the benefit amount previously paid for that critical illness. A covered person can receive a recurrence benefit only once for each critical illness. For the purposes of the cancer critical illness benefits, treatment does not include maintenance drug therapy or routine follow-up office visits to verify if the cancer critical illness has returned. Maintenance drug therapy means ongoing hormonal therapy, immunotherapy or chemo-prevention therapy that may be given following the full remission of a cancer due to primary treatment. It is meant to decrease the risk of cancer recurrence rather than the palliation or suppression of a cancer that is still present. Symptoms mean the subjective evidence of disease or physical disturbance observed by a physician or other member of the medical profession, acting within the scope of their license.
Wellness Benefit
The plan pays $75 per calendar year per covered person for covered wellness services. Covered wellness services are listed in the Critical Illness Protection Plan Summary of Benefits chart in this chapter. Documentation must be provided for the service rendered. The wellness benefit does not count toward the maximum basic benefit amount.
Lodging Benefit
The plan pays $60 per day when a covered person receives treatment for a covered critical illness on an outpatient basis. The benefit is for lodging at a motel, hotel or other accommodations acceptable to the plan. This benefit is limited to 60 days per calendar year. This benefit is not payable for lodging occurring more than 24 hours prior to treatment or for lodging occurring more than 24 hours following treatment. Outpatient treatment must be received at a treatment facility more than 100 miles from the covered persons home. The lodging benefit does not count toward the maximum basic benefit amount.
Transportation Benefit
The plan pays the actual cost, up to $1,500 per calendar year, for round trip transportation coach fare on a common carrier; or a personal vehicle allowance of $0.50 per mile, up to $1,500 per calendar year, when travel is required by a covered person to receive treatment of a covered critical illness at a hospital (inpatient or outpatient), radiation therapy center, chemotherapy or oncology clinic or any other specialized free-standing treatment center. Mileage is measured from the covered persons home to the treatment facility as described above.
Recurrence Benefit
The plan will pay a recurrence benefit if a covered person is diagnosed for a second time with a heart 167
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Critical Illness Protection Plan Summary of Benefits

Plan pays 100% of benefit amount for: Heart attack Stroke Invasive cancer Heart transplant Lung transplant Liver transplant Pancreas transplant Kidney transplant Bone marrow transplant End stage renal failure Paralysis Complete blindness Complete loss of hearing Coma Benign brain tumor Alzheimers Disease Plan pays 25% of benefit amount for: Coronary artery bypass surgery Carcinoma in situ Amyotrophic lateral sclerosis (Lou Gherigs disease) Adrenal hypofunction (Addisons disease) Bone marrow donor Cerebral palsy Cystic fibrosis Hemophilia Huntingtons chorea Meningitis Multiple sclerosis Muscular dystrophy Myasthenia gravis Necrotizing fasciitis Osteomyelitis Scleroderma Sickle cell anemia Systemic lupus Tuberculosis Plan pays up to $75 per calendar year for each covered person for one of the following Pre Biopsy test for skin cancer Biopsy for skin cancer Oral cancer screening Blood test for triglycerides Bone marrow testing Colonoscopy Echocardiogram Electrocardiogram (EKG, including stress EKG) Flexible sigmoidoscopy Hemocult stool analysis Lipid panel (total cholesterol count) Mammography, including breast ultrasound Pap Smear, including ThinPrep Pap Test PSA (prostate specific antigenblood test for prostate cancer) Serum Protein Electrophoresis (test for myeloma) Stress test on bike or treadmill Annual physical examination (only for covered persons over 18 years of age) Immunizations
A covered person can receive benefits for each of the above critical illnesses if the dates of diagnosis for each critical illness are separated by at least 90 days.
Transportation Benefit Lodging Benefit
Actual cost, up to $1,500, for round trip coach fare on a common carrier; or $.50 per mile for personal vehicle travel, up to $1,500, to a facility if more than 100 miles from place of residence. $60 per day up to 60 days if facility is more than 100 miles from residence. Only applies to lodging occurring within 24 hours of, and including days of treatment. A benefit of 100% of the previously paid amount will be paid if a covered person is diagnosed for a second time with a heart attack, stroke, coronary artery bypass surgery, transplant, invasive cancer or carcinoma in situ. The second date of diagnosis must be more than 12 months after the first date of diagnosis for the critical illness, and for the cancer critical illness benefits, the covered person must have had no symptoms nor received any treatment during the 12 months after the prior occurrence.
Recurrence Benefit
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Waiver of Premium Due to Disability
Your premiums for this coverage will be waived if you: Become totally disabled due to a sickness or injury; and Remain disabled for at least 180 consecutive days. After the 180th day, your premiums will be waived until the earliest of: The date you are no longer totally disabled; or The date you reach age 65; or The date coverage ends. Disabled means you are under the continuous care of a physician and unable to perform all of the essential functions of your regular job or any gainful employment for which you are reasonably qualified based on your education, training or experience. Gainful employment means the performance of any occupation for wages, remuneration or profit, for which you are qualified by education, training or experience on a full-time or part-time basis. This benefit is payable only for the disability of the covered associate. It does not apply to covered dependents. Heart Attack
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Heart attack is the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis must be based on both: New electrocardiographic changes; and Elevation of cardiac enzymes or biochemical markers showing a pattern and to a level consistent with a diagnosis of heart attack. Heart attack does not include an established (old) myocardial infarction. The date of diagnosis for heart attack is the date of death (infarction) of a portion of the heart muscle. Stroke Stroke is the death of a portion of the brain producing neurological sequelae including infarction of brain tissue, hemorrhage and embolization from an extra-cranial source. There must be evidence of permanent neurological deficit. Stroke does not include: transient ischemic attacks (TIAs), head injury, chronic cerebrovascular insufficiency or reversible ischemic neurological deficits. The date of diagnosis for stroke is the date the stroke occurred based on documented neurological deficits and neuroimaging studies. Coronary Artery By-Pass Surgery Coronary artery by-pass surgery is the surgical operation to correct narrowing or blockage of one or more coronary arteries with by-pass grafts on the advice of a cardiologist registered in the United
States. Angiographic evidence to support the necessity for this surgery will be required. Coronary artery by-pass surgery does not include: abdominal aortic bypass; balloon angioplasty; laser embolectomy; atherectomy; stent placement; or other non-surgical procedures. The date of diagnosis for coronary artery by-pass surgery is the date the actual coronary artery by-pass surgery occurs. Transplant Transplant is the surgical transplantation of a heart, lung, liver, pancreas, kidney or bone marrow. The transplanted organ/tissue must come from a human donor. The date of diagnosis for transplant is the date the actual surgery occurs for the covered transplant. End Stage Renal Failure End stage renal failure is the irreversible failure of both kidneys to perform their essential functions, with the covered person undergoing peritoneal dialysis or hemodialysis. End stage renal failure does not include renal failure caused by a traumatic event, including surgical traumas. The date of diagnosis for end stage renal failure is the date renal dialysis first begins due to the irreversible failure of both kidneys to perform their essential functions.
Critical Illnesses Covered Under the Plan

The Critical Illness Protection Plan covers the specific conditions listed in The Critical Illness Protection Plan Summary of Benefits chart.
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Paralysis Paralysis is the total and permanent loss of voluntary movement or motor function of 2 or more limbs as the result of a sickness or injury. The date of diagnosis for paralysis is the date a physician establishes the diagnosis of paralysis based on clinical and/or laboratory findings as supported by medical records. Complete Blindness Complete blindness is a clinically proven irreversible reduction of sight in both eyes certified by an ophthalmologist with: Sight in the better eye reduced to a best corrected visual acuity of less than 6.60 (Metric Acuity) or 20/200 (snellen or E-chart Acuity); or Visual field restriction to 20 degrees or less in both eyes. The date of diagnosis for complete blindness is the date an ophthalmologist makes an accurate certification of complete blindness. Complete Loss of Hearing Complete loss of hearing is the total and irreversible loss of hearing in both ears. Complete loss of hearing does not include loss of hearing that can be corrected by the use of any hearing aid or device. The date of diagnosis for complete loss of hearing is the date the audiologist makes an accurate certification of total and permanent hearing loss. Coma
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Alzheimers Disease Alzheimers Disease is a progressive degenerative disease of the brain that is diagnosed by a psychiatrist or neurologist as Alzheimers Disease, which causes the covered person to be incapacitated. Incapacitated means that, due to Alzheimers Disease, the covered person: Exhibits the loss of intellectual capacity involving impairment of memory and judgment, which results in a significant reduction in mental and social functioning; and Requires substantial physical assistance from another adult to perform at least 3 of the activities of daily living, as defined below. As used in this benefit, the activities of daily living are: Bathing to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment. Dressing to put on and remove necessary clothing including braces, artificial limbs or other surgical appliances. Toileting to get on and off the toilet and maintain personal hygiene. Bladder and Bowel Continence to manage bowel and bladder function with or without protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained. Transferring to move in and out of a bed, chair or wheelchair, with or without the use of equipment.
Coma is a continuous profound state of unconsciousness lasting 14 or more consecutive days due to an underlying sickness or traumatic brain injury. It is associated with severe neurologic dysfunction and unresponsiveness of a prolonged nature requiring significant medical intervention and life support measures. Coma does not include a medically induced coma. The date of diagnosis for coma is the first day of the period for which a physician confirms a coma has lasted for 14 consecutive days. Benign Brain Tumor A benign brain tumor is a non-cancerous brain tumor: Confirmed by the examination of tissue (biopsy or surgical excision) or specific neuroradiological examination; and Resulting in persistent neurological deficits including but not limited to: loss of vision; loss of hearing; or balance disruption. Benign brain tumor does not include: Tumors of the skull; or Pituitary adenomas; or Germanomas. The date of diagnosis for a benign brain tumor is the date a physician determines a benign brain tumor is present based on examination of tissue (biopsy or surgical excision) or specific neuroradiological examination.
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Eating to consume food or drink that already has been prepared and made available, with or without the use of adaptive utensils. The date of diagnosis for Alzheimers Disease is the date a physician first diagnoses the covered person as incapacitated due to Alzheimers Disease. Cancer: Carcinoma In Situ A carcinoma in situ is a cancer where the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. Carcinoma in situ includes: Early prostate cancer diagnosed as stages A, I or II or equivalent staging; and Melanoma not invading the dermis. Carcinoma in situ does not include: Other skin malignancies; or Pre-malignant lesions (such as intraepithelial neoplasia); or Benign tumors or polyps. Cancer: Invasive Cancer Invasive cancer is a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Invasive cancer includes Leukemia and Lymphoma. Invasive cancer does not include: Carcinoma in situ; or Tumors in the presence of any human immunodeficiency virus; or Skin cancer other than invasive malignant
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melanoma in the dermis or deeper or skin malignancies that have become metastatic; or Early prostate (stages A, I or II) cancer. Cancer Diagnosis Requirements A cancer critical illness must be diagnosed in one of two ways: Pathological diagnosis means identification of cancer based on a microscopic study of fixed tissue or preparations from the hemic (blood) system. This type of diagnosis must be done by a certified pathologist whose diagnosis of malignancy is in keeping with the standards set by the American Board of Pathology. Clinical diagnosis means a clinical identification of cancer based on history, laboratory study and symptoms. The plan will pay benefits for a clinical diagnosis only if: A pathological diagnosis cannot be made because it is medically inappropriate or life-threatening; and There is medical evidence to support the diagnosis. The date of diagnosis for cancer critical illness is the day the tissue specimen, culture and/or titer(s) are taken on which the first diagnosis of cancer is based. The first diagnosis of cancer includes a diagnosis of a recurrence of a cancer that was previously diagnosed before the effective date of coverage if, after the previous diagnosis and before the date of diagnosis of the recurrence, the covered person is free of any symptoms and treatment of the cancer for the 12 consecutive months immediately
preceding the effective date of coverage or any 12 consecutive months thereafter. For purposes of this benefit, treatment does not include maintenance drug therapy or routine followup office visits to verify if the cancer critical illness has returned. Maintenance drug therapy means ongoing hormonal therapy, immunotherapy or chemo-prevention therapy that may be given following the full remission of a cancer due to primary treatment. It is meant to decrease the risk of cancer recurrence rather than the palliation or suppression of a cancer that is still present. For purposes of this benefit, symptoms means the subjective evidence of disease or physical disturbance observed by a physician or other member of the medical profession, acting within the scope of their license.
What the Plan Does Not Cover

The plan will not pay benefits for a critical illness that is, or is caused by, contributed to by or results from: War, declared or undeclared, participation in a riot, insurrection or rebellion. Intentionally self-inflicted injury or action. Illegal activities or participation in an illegal occupation. Substance abuse, to include abuse of alcohol, alcoholism, drug addiction or dependence upon any controlled substance.
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Filing a Claim
You can obtain a claim form by calling Allstate Workplace Division at 1-866-828-8766 or visiting Allstate Workplace Divisions web site at www.allstateatwork.com/homedepot to print the claim form. You must complete all applicable sections of the claim form and then give it to your attending physician. The physician will need to complete his or her section statement of the form. Once the form and supporting documentation is collected, all documents need to be mailed or faxed to Allstate Workplace Division. Mail to: Allstate Workplace Division P.O. Box 41189 Jacksonville, Florida 32203-1189 Electronic submission through: www.allstateatwork.com/homedepot. Fax to: 1-877-652-2979 Written proof of your claim must be furnished to Allstate Workplace Division within 90 days of each critical illness or payable loss. If it is not reasonably possible to provide written proof in the time required, Allstate Workplace Division will not reduce or deny any claim for this reason, as long as the proof is filed as soon as reasonably possible. In any event, the proof required must be given to Allstate Workplace Division no later than one year from the time specified unless you are legally incapacitated.
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Allstate Workplace Division has the right, at Allstate Workplace Divisions expense, to have you examined by a physician of Allstate Workplace Divisions choosing, as often as may be reasonably required while a claim is pending. Allstate Workplace Division may have an autopsy performed during the period of incontestability, where it is not forbidden by law. For information on appealing denied claims, see the Claims and Appeals chapter.
2. to the covered persons children including your domestic partners children, in equal shares, if living; otherwise 3. to the covered persons parents, in equal shares, if living; otherwise 4. to the covered persons siblings, in equal shares, if living; otherwise 5. to the covered persons estate. You may name a beneficiary by contacting Allstate Workplace Division at 1-866-828-8766 to request a beneficiary designation form or get the form online at www.allstateatwork.com/homedepot. Once you return the form to Allstate Workplace Division, your beneficiary designation will take effect on the date you signed it. Allstate Workplace Division has the right to recover any overpayments due to fraud or any error made in processing a claim. You must reimburse Allstate Workplace Division in full. Allstate Workplace Division will work with you to develop a reasonable method of repayment if you are financially unable to repay in a lump sum.
Payment of Claims
Allstate Workplace Division will send notice to you within 15 working days of receiving written proof of claim. If Allstate Workplace Division does not pay the loss within 15 working days upon receipt, this notice will state the reasons for failing to pay the claim, either in whole or in part. It will also provide an itemization of any documents or other information needed to process the claim. When all the requested information needed to process the claim has been received, Allstate Workplace Division will then have 15 working days to process and either pay the claim or deny it, in whole or in part, giving the reasons for denying such claim or any portion of it. Any amounts unpaid at your death may, at Allstate Workplace Divisions option, be paid to a person who is related to you and who survives you, in the following order: 1. to your spouse or domestic partner, if living; otherwise
Continuing Critical Illness Protection Plan Coverage When Coverage Ends

When your Critical Illness Protection Plan coverage through the Company ends, you may elect to continue your coverage through portability by sending Allstate Workplace Division a written request and payment of the first premiums for the portability coverage not later than 30 days after your coverage ends.
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No portability coverage will be provided if your Critical Illness Protection Plan coverage ends due to your failure to make required premium payments. The benefits, terms and conditions of the portability coverage will be the same as those provided under the plan when the insurance terminated except portability coverage will not have a waiver of premium provision. Portability coverage may include any eligible dependents covered under the plan. Portability coverage will be effective on the day after insurance under the policy terminates. For information about portability, call 1-866-828-8766.
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COBRA (Continuing Coverage After Termination)

You and your eligible dependents will be offered the opportunity to purchase a temporary extension of coverage under the Critical Illness Protection Plan at group rates in certain instances where coverage under the Critical Illness Protection Plan would otherwise end. This coverage is referred to in this Benefits Summary as COBRA coverage. For more information, see the COBRA Coverage chapter.
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Dental
Chapter Contents
175 175 175 176 177 Dental Plan Options Coverage Categories How the Dental Plan Options Work Maximum Benefits Special Rule for Orthodontia:Maximum Lifetime Orthodontia Benefit When Treatment Begins Applies Throughout Orthodontia Treatment Selecting a MetLife Dentist Scheduling Appointments with Your PDP Dentist Pretreatment Estimate of Benefits Pretreatment Estimate of Benefits Does Not Guarantee Payment The Alternate Benefit Provision Allows for Suitable Dental Treatment Filing Claims for Out-of-Network Services Limitations Changing Your Dental Plan 179 180 180 180 181 181 181 181 182 183 183 185 185 185 Whats Covered Under the Plan Benefits for In-Network Services Benefits for Out-of-Network Services Examples of How the Plan Pays Benefits Whats Covered Preventive and Diagnostic Basic Restorative Major Restorative Whats Not Covered Coordinating Benefits with Other Plans How Benefits Are Paid Through COB Right to Recover Payment Subrogation COBRA (Continuing Coverage After Termination)
177 177 177 177 177 178 178 178
Dental
What do you need?
Find a MetLife PDP dentist Get a claim form for out-of-network services Submit a claim form
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Find it here...
Go to www.metlife.com/dental and click Find a PDP dentist; Or call 1-800-638-9909 Go to www.metlife.com/dental to download a claim form; Or call 1-800-638-9909 Take a claim form with you to your dentist. Mail to: MetLife P.O. Box 981282 El Paso, TX 79998-1282 Go to www.resources.hewitt.com/homedepot, click the Health, Insurance tab, then Dental Or go to www.metlife.com/dental and set up a user ID and password.
Track your claims online and receive e-mail alerts when a claim has been processed Find out the approximate in-network (PDP) fees and out-of-network fees in your area for many dental services
Dental Plan Options

The Dental Plan offers you three dental options: MetLife $500 Maxcovers only preventive and basic restorative care MetLife $1,000 Maxhigh level of coverage including orthodontia MetLife $2,000 Maxhighest level of coverage including orthodontia
How the Dental Plan Options Work

All three dental options are MetLife Preferred Dentist Program (PDP) plans that let you use any dentist you want, but offer negotiated discounts when you go to a MetLife PDP network dentist. Your dental options provide you with comprehensive dental coverage for the majority of preventive, diagnostic and basic dental services, but vary in deductibles, maximum benefits, coinsurance and coverage of certain benefits. All of the dental options offer: Preventive dental care covered at 100%. Dental cleanings and checkups are covered at no cost if you use a dentist in the MetLife PDP (Preferred Dentist Program) networkyou dont have to meet the deductible for preventive care benefits to begin. All dental benefitsincluding preventive care benefitsare subject to the per-covered individual annual maximum benefit that applies to your dental option.
Lower costs when you go to MetLife PDP network dentist. You can use any dentist; however, you will pay less if you use a MetLife network dentist because PDP network negotiated fees typically range from 15% to 45% less than average fees for the same or similar services charged by dentists in your area. Access to large network of providers. To find a MetLife network dentist near you, go to www.metlife.com/dental. If your dentist is not part of the network, he or she can apply to become a MetLife PDP dentist by going to www.metdental.com, a web site for dentists only or calling 1-877-638-3379. Same coverage for non-network dentists. Youll have the same level of coveragethe same deductible, coinsurance and annual maximum for dental services regardless of whether you use a MetLife or non-network dentist. However, when you use a MetLife PDP network dentist, youll pay the negotiated fee, which is typically 15% to 45%
Coverage Categories
You may select one of four coverage categories for the dental plan options: associate only associate + spouse (or same-sex domestic partner) associate + child(ren) associate + family (children and spouse or same-sex domestic partner)
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lower than non-network dentists fees. For out-ofnetwork charges, you pay any amount above the reasonable and customary charge. MetLife discounts on cosmetic dentistry and other non-covered dental services. Youll receive the MetLife PDP dentist negotiated rate on cosmetic procedures and other services not covered by the dental options when you use a PDP dentist. You also will continue to receive the negotiated rate after you have reached your annual maximum benefit. The MetLife $500 Max option covers only preventive and basic restorative care and offers a lower payroll deduction. This plan is designed to encourage good dental health for associates and covered family members that may need only preventive and basic restorative dental services. This option has no coverage for major services or orthodontia. Preventive care and diagnostic services are covered at 100% when you use a MetLife network dentist or covered at 100% of the reasonable and customary charge for non-network dentists. See Whats Covered, Preventive and Diagnostic later in this chapter for a list of covered services. Basic restorative dental services are subject to the deductible and coinsurance. All dental benefits including preventive care benefitsare subject to the annual maximum benefit. This plan has an annual maximum benefit of $500 per covered individual.
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The MetLife $1,000 Max option covers preventive, basic restorative and major restorative care as well as orthodontia for covered dependent children under age 19 with a payroll deduction that is higher than the MetLife $500 Max option. Preventive care and diagnostic services are covered at 100% when you use a MetLife network dentist or covered at 100% of the reasonable and customary charge for non-network dentists. See Whats Covered, Preventive and Diagnostic later in this chapter for a list of covered services. Basic and major restorative dental services and orthodontia are subject to the deductible and coinsurance. All preventive/diagnostic and basic and major restorative dental benefits are subject to the annual maximum benefit. This plan has an annual maximum benefit of $1,000 per covered individual and a separate lifetime orthodontia maximum benefit of $750. The MetLife $2,000 Max option covers preventive, basic restorative and major restorative care as well as orthodontia for covered dependent children under age 19 and has the highest level of coverage with the highest payroll deduction. Preventive care and diagnostic services are covered at 100% when you use a MetLife network dentist or covered at 100% of the reasonable and customary charge for non-network dentists. See Whats Covered, Preventive and Diagnostic later in this chapter for a list of covered services. Basic and major restorative dental services and orthodontia are subject to the deductible and coinsurance. All preventive/ diagnostic and basic and major restorative dental benefits are subject to the annual maximum benefit. This plan has an annual maximum benefit of $2,000 per covered individual and a separate lifetime orthodontia maximum benefit of $1,500.
See Whats Covered for complete information on the services covered under the options.
Maximum Benefits
Each Dental Plan option pays a maximum annual benefit for you and each of your covered family members as follows: MetLife $500 Max$500 for each covered individual MetLife $1,000 Max$1,000 for each covered individual MetLife $2,000 Max$2,000 for each covered individual All preventive/diagnostic and basic and major restorative dental benefits are subject to the annual maximum benefit. Orthodontia has a separate lifetime maximum, as follows: MetLife $500 MaxNo orthodontia coverage MetLife $1,000 Max$750 lifetime maximum for each covered dependent child MetLife $2,000 Max$1,500 lifetime maximum for each covered dependent child The maximum is based on orthodontic services and procedures, whether in-network or out-of-network. Orthodontic services are available only for your child(ren) under age 19.
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Special Rule for Orthodontia: Maximum Lifetime Orthodontia Benefit When Treatment Begins Applies Throughout Orthodontia Treatment
The lifetime maximum orthodontia benefit that will apply is based on the option in which the covered dependent is enrolled when orthodontia services began. The maximum orthodontia benefit will not change throughout that dependents orthodontia treatment regardless of the option chosen in subsequent years. For example, if you are enrolled in the $500 Max option when orthodontia treatment begins, no orthodontia benefits are paid for any orthodontia treatment even if a benefit plan is chosen in subsequent years that covers orthodontia treatment. If you are enrolled in the $1,000 Max option when the orthodontia treatment begins, the $750 lifetime maximum benefit will apply throughout the orthodontia treatment regardless of whether you enroll in the $2,000 Max option or $500 Max option in subsequent years.
To get a list of participating PDP dentists: Go to www.metlife.com/dental, and click Find a PDP dentist; or Call 1-800-638-9909 to have a list faxed or mailed to you. If your current dentist does not participate in the PDP and youd like to encourage him or her to apply, tell your dentist to go to www.metdental.com, or call 1-877-638-3379 for an application. The web site and phone number are designed for use by dental professionals only.
Pretreatment Estimate of Benefits Does Not Guarantee Payment

The estimate of benefits payable may change based on the benefits, if any, for which a person qualifies at the time services are completed. You must provide proof on or after the date the dental service is received before the Dental Plan will pay benefits.
The Alternate Benefit Provision Allows for Suitable Dental Treatment

When more than one dental service could provide suitable treatment based on common dental standards, MetLife will determine the dental service on which benefits will be based and the expenses that will be considered as covered expenses. Benefits will be provided for treatment you receive in accordance with accepted dental standards for adequate and appropriate care. You and your dental provider are free to apply this benefit payment to the treatment of your choice; however, you are responsible for any expenses that exceed covered expenses. To avoid any surprises, use the Pretreatment Estimate of Benefits process so that you and your dentist know in advance what the Dental Plan will cover before any treatment begins.
Scheduling Appointments with Your PDP Dentist

To set up an appointment with your network dentist: Confirm with MetLife that the specific provider and location is participating Call the dental office you selected.
Pretreatment Estimate of Benefits

Whenever extensive dental work is proposed involving charges of $300 or more, your dentist can request a Pretreatment Estimate of Benefits from the Dental Plan. Your dentist should submit a detailed description of planned treatment and expected charges, including those for diagnostic x-rays, before dental work is started. If there is a major change in the treatment plan, a revised plan should be sent to your dental claims office. After reviewing the description of the planned treatment and expected charges, the Dental Plan will determine the services the plan may cover and advise your dentist.
Selecting a MetLife Dentist

A MetLife PDP dentist is a general dentist or specialist who has agreed to accept MetLifes negotiated fees as payment in full for services provided to plan participants. PDP fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services.
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Filing Claims for Out-of-Network Services

Your dentist may file your claims for you, which means you have little or no paperwork. Bring a claim form with you to your appointment. If you need a claim form, you can find one online at www.metlife.com/dental, or request one by calling 1-800-638-9909. You dont have to speak with a live representative to order a claim formthe MetLife automated voice response system is available 24 hours a day, 7 days a week. If your dentist does not file claim forms for you, you must complete a claim form and send it to: MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282 Be sure to fill out a separate form for each covered family member, even if more than one family member visited the same dentist on the same day. You can include more than one bill (with the same or different dates) on a single claim form if all expenses are for the same family member. If you or a covered family member are covered under another employers group health plan that is the primary payer of dental benefits, submit your claim to that plan first. After you receive payment, send a copy of the explanation of benefits along with copies of the itemized bills to MetLife for processing. See Coordinating Benefits with Other Plans in this chapter for more details on coordinating benefits with other plans.
Limitations
You should file all claims within 12 months of the date services are provided. The plan does not consider a claim form until the claims office receives all required information relating to the service or benefit provided. Claims filed more than 12 months following the date services were provided may not be eligible for benefits. If you have questions about any of the MetLife dental options, call MetLife at 1-800-638-9909 and follow instructions to speak to a representative.
Changing Your Dental Plan

You may change your dental option only during Annual Enrollment or when you have a qualified change in status. See the Life Events chapter for more information. For information on making coverage changes for your same-sex domestic partner, see the Benefits for Same-sex Domestic Partners chapter.
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Whats Covered Under the Plan
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The following charts summarize services and costs under the MetLife dental options. For more information, see Whats Covered and Whats Not Covered.
MetLife $500 Max Dental Services Annual Deductible (individual/family) Annual Maximum Benefit1 (per covered individual) Preventive and Diagnostic Care (deductible does not apply) Basic Restorative Care (fillings, root canals) Major Restorative Care (bridges, dentures, crowns) Orthodontia In-Network $25/$75 $500 Covered at 100% Out-of-Network $25/$75 $500 Covered at 100%2 MetLife $1,000 Max In-Network $50/$150 $1,000 Covered at 100% Out-of-Network $50/$150 $1,000 Covered at 100%2 MetLife $2,000 Max In-Network $50/$150 $2,000 Covered at 100% Out-of-Network $50/$150 $2,000 Covered at 100%2
You pay 30%
You pay 30%2
You pay 25%
You pay 25%2
You pay 20%
You pay 20%2
No coverage
No coverage
You pay 60%
You pay 60%2
You pay 50%
You pay 50%2
No coverage
No coverage
50% up to $750 lifetime maximum per covered dependent child
50%2 up to $750 lifetime maximum per covered dependent child
50% up to $1,500 lifetime maximum per covered dependent child
50%2 up to $1,500 lifetime maximum per covered dependent child
1 All preventive/diagnostic and basic and restorative dental benefits are subject to the annual maximum benefit. 2 Plan pays this percentage of the reasonable and customary (R&C) charge if you use a non-MetLife dentist.
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Benefits for In-Network Services

Payment for in-network services under each of the dental options is limited to the PDP negotiated charge. The PDP negotiated charge refers to the fees that participating PDP dentists have agreed to accept as payment in full, subject to any deductibles, copayments, coinsurance and benefit maximums. You are responsible for paying the deductible and any other charges that the Dental Plan does not cover.
Examples of How the Plan Pays Benefits

Here are some examples of how the MetLife dental options pay benefits when you go in-network or out-of-network. These examples assume that you have met your deductible. Example A: You are enrolled in MetLife $1,000 maximum plan and go to your dentist for a filling (a basic restorative service): the in-network PDP negotiated fee is $245 the out-of-network R&C cost is $400 the dentists usual fee is $475
In-Network When you receive care from a participating PDP dentist PDP fee $1,000 MetLife Max dental option pays: 75% x $245 PDP fee Your out-of-pocket cost $245.00 - $183.75 $61.25
Example B: You are enrolled in MetLife $2,000 maximum plan and go to your dentist for a crown (a major restorative service): the in-network PDP negotiated fee is $375 the out-of-network R&C cost is $500 the dentists usual fee is $600
In-Network When you receive care from a participating PDP dentist PDP fee $2,000 MetLife Max dental option pays: 50% x $375 PDP fee Your out-of-pocket cost $375.00 - $187.50 $187.50
Benefits for Out-of-Network Services

Payment of benefits for out-of-network services under each of the dental options is limited to the reasonable and customary (R&C) allowance. You are responsible for charges above R&C. The deductible, annual maximum and orthodontia lifetime maximum are combined for all in-network and out-of-network procedures and services. Certain limitations and exclusions apply to all three options. For further explanation of your dental coverage, call MetLife at 1-800-638-9909.
Out-of-Network When you receive care from a non-participating dentist Dentists usual fee $2,000 MetLife Max dental option pays: 50% x $500 R&C fee Your out-of-pocket cost $600.00 $250.00 $350.00
Out-of-Network When you receive care from a non-participating dentist Dentists usual fee $1,000 MetLife Max dental option pays: 75% x $400 R&C fee Your out-of-pocket cost $475.00 $300.00 $175.00
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Whats Covered
Here is a list of primary covered services and limitations under each of the dental options.
Basic Restorative
amalgam or resin fillings limited to once per 24month period on the same tooth and surface consultations, but not more than once in a 12-month period root canal treatment, but not more than once in any 24-month period for the same tooth periodontal scaling and root planing, but not more than once per quadrant in any 24-month period simple extractions periodontal maintenance where periodontal treatment (including scaling, root planing and periodontal surgery such as osseous surgery) has been performed. Periodontal maintenance is limited to four times in any year less the number of teeth cleanings received during the current calendar year gingivectomy, gingivoplasty and gingival curettage pulp capping (excluding final restoration) and therapeutic pulpotomy (excluding final restoration) pulp therapy and apexification/recalcification re-cementing of cast restorations or dentures simple repairs of cast restorations or denture occlusal adjustments, once per 12 months
Major Restorative
general anesthesia or intravenous sedation in connection with oral surgery, extractions or other covered services, when anesthesia is determined as necessary in accordance with generally accepted dental standards initial installation of full or partial dentures or implants once per 84 months: when needed to replace congenitally missing teeth; or when needed to replace natural teeth that are lost while you or a dependent is covered under the dental plan replacement of a non-serviceable denture if such denture was installed more than five years prior to replacement replacement of an immediate, temporary full denture with a permanent full denture if the immediate, temporary full denture cannot be made permanent and such replacement is done within 12 months of the installation of the immediate, temporary full denture relinings and rebasings of existing removable dentures: if at least six months have passed since the installation of the existing removable denture; and not more than once in any 36 month period adjustments of dentures, if at least six months have passed since the installation of the denture
Preventive and Diagnostic

oral exams twice per calendar year full mouth or panoramic x-rays once every 60 months cleaning of teeth (oral prophylaxis), twice per calendar year bitewing x-rays, one set in a calendar year for adults and children topical fluoride treatment for a child under age 19, twice per calendar year intraoral-periapical and extraoral x-rays pulp vitality and bacteriological studies for determination of bacteriologic agents diagnostic cast, twice per calendar year emergency palliative treatment to relieve tooth pain space maintainers for a covered child under age 14 once per location Sealants for a child under age 19, once per tooth every five years
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Initial installation of cast restorations but only when the tooth is fractured or has major decay that cannot be restored with regular filling Replacement of any cast restoration with the same or a different type of cast restoration but no more than one replacement for the same tooth within 84 consecutive months of a prior replacement prefabricated stainless steel crown or prefabricated resin crown, but no more than one replacement for the same tooth surface within 84 months crowns, inlays and gold fillings to restore teeth, but only when the tooth is fractured or has major decay that cannot be restored with regular fillings once per 84 months per tooth core buildup, but no more than once per tooth in a period of 84 months posts and cores, but no more than once per tooth in a period of 84 months labial veneers, but no more than once per tooth in a period of 84 months oral surgery except as mentioned elsewhere in this chapter periodontal surgery, including gingivectomy, gingivoplasty, gingival curettage and osseous surgery, but no more than one surgical procedure per quadrant in any 36-month period surgical extractions implants, but no more than once for the same tooth position in an 84-month period repair of implants, but not more than once in a 12-month period
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implant supported prosthetics, but no more than once for the same tooth position in an 84-month period Occlusal guard which typically treats the effects of bruxism or grinding of teeth and other occlusal factors
restorations or appliances used for the purpose of periodontal splinting counseling or instruction about oral hygiene, plaque control, nutrition and tobacco personal supplies or devices including, but not limited to: water piks, toothbrushes or dental floss initial installation of a denture or implant to replace one or more teeth which were missing before such person was insured for dental Insurance, except for congenitally missing teeth decoration or inscription of any tooth, device, appliance, crown or other dental work missed appointments services: covered under any workers' compensation or occupational disease law; covered under any employer liability law; for which the employer of the person receiving such services is not required to pay; or received at a facility maintained by the Company, labor union, mutual benefit association or VA hospital services covered under other coverage provided by the Company temporary or provisional restorations temporary or provisional appliances prescription drugs services for which the submitted documentation indicates a poor prognosis the following when charged by the dentist on a separate basis:
Whats Not Covered

The Dental Plan options will not reimburse you for expenses relating to the following: services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which are deemed experimental in nature services for which you would not be required to pay in the absence of dental coverage services or supplies received by you or your covered family member before the dental coverage starts for that person services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for: scaling and polishing of teeth; or fluoride treatments services which are primarily cosmetic, unless required for the treatment or correction of a congenital defect of a newborn child services or appliances which restore or alter occlusion or vertical dimension restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease
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claim form completion; infection control such as gloves, masks and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food caries susceptibility tests sedative fillings local chemotherapeutic agents modification of removable prosthodontic and other removable prosthetic services injections of therapeutic drugs application of desensitizing agents precision attachments associated with fixed and removable prostheses, except when the precision attachment is related to implant prosthetics adjustment of a denture made within six months after installation by the same dentist who installed it duplicate prosthetic devices or appliances replacement of a lost or stolen appliance, cast restoration or denture repair or replacement of an orthodontic device diagnosis and treatment of temporomandibular joint disorders intra- and extra-oral photographic images Fixed and removable appliances for correction of harmful habits
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Coordinating Benefits with Other Plans

If you or a covered family member is participating in this Dental Plan and is also covered under another employers group health plan, MetLife will coordinate coverage with that plan. Coordination of benefits (COB) is the process used to determine how claims for eligible Dental Plan expenses should be paid when you and a covered family member are covered under two or more dental plansfor example, if you and your spouse (or same sex domestic partner) both work and are covered by each others employerprovided dental plan. The term plan refers to: a group insurance plan an HMO a blanket plan uninsured arrangements of group or group type coverage a group practice plan a group service plan a group prepayment plan any other plan that covers people as a group motor vehicle No Fault coverage if the coverage is required by law any other coverage required or provided by any law or any governmental program, except Medicaid Each plan or part of a plan which has the right to coordinate benefits will be considered a separate plan.
Coordination of benefits applies only when the Dental Plan is the secondary plan. If the Dental Plan is the primary plan (for example, if the expense was incurred by you, as a Company associate), COB does not apply.
How Benefits Are Paid Through COB

When the Dental Plan is the secondary plan, the total amount payable under the Dental Plan, when added to the amount or value of the benefits or services provided by all other plans, will not exceed the amount or value of the allowable expense which is incurred. In no event will the amount the Dental Plan pays be more than Dental Plan would pay if there were no other plan. When the Home Depot dental plan is secondary, the Home Depot dental plan will pay whatever is lower: The Home Depot dental plans normal liability; or The part of the allowable expenses that were not paid by the primary plan (the remaining balance). If the reasonable and customary charge amount is different for the Home Depot dental plan and the other plan, the higher amount of reasonable and customary charge will be used as the COB allowable expense to calculate benefits.
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Which Plan is the Primary Plan When Coordination of Benefits Applies?

When you (the The Home Depot associate) are the patient When your spouse (or same sex partner) is the patient When your child is the patient The Home Depot Dental Plan is the primary plan. His or her plan is primary and the The Home Depot Dental Plan is secondary. The birthday rule is followed. This means that when both plans covering your child follow the birthday rule, the plan of the parent whose birthday occurs earlier in the year (regardless of the ages of the parents) is primary for the child. The birthday rule is an insurance industry standard. If one of the plans is issued out of the state whose laws govern this policy and determines the order of benefits based upon the gender of the parent, the plan with the gender rules shall determine the order of benefits. If you are legally separated or divorced (or were never married) benefits for a child will be determined in this order: If a court decree states that one parent is responsible for the childs healthcare expenses or health coverage and the plan for that parent has actual knowledge of the terms of the order, but only from the time of actual knowledge. The primary plan is determined in this order: The plan of the parent with custody of the child. The plan of the spouse of the parent with custody of the child. The plan of the parent not having custody of the child. The plan of the spouse of the parent not having custody of the child. If the above rules do not establish the order The plan covering the claimant for the longest period of time will be primary except: The plan covering the claimant as an active associate is primary over a plan covering the claimant as a laid-off or retired associate. If the other plan does not have this rule, it will not apply. The plan covering the claimant as an active participant is primary over a plan covering the claimant under a right of continuation provided by federal or state law. If the other plan does not have this rule, it will not apply.
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The allowable expense is any necessary, reasonable, and customary service or expense, including deductibles or coinsurance, covered in whole or in partby any one of the plans that cover the person for whom claim is made. When the benefits are in the form of services, the reasonable cash value of each service is the allowable expense and is a benefit paid. The reasonable cash value is an amount which a duly licensed provider of dental care services usually charges patients and which is within the range of fees usually charged for the same service by other dental care providers located within the immediate geographic area where the dental care service is rendered under similar or comparable circumstances. If you have any questions about the COB rules for the Dental Plan, call MetLife at 1-800-638-9909.
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Subrogation
There is no subrogation provision within this Plan. Subrogation is the right of the insurance company to recoup benefits paid to a participant through legal suit, if the action causing the disability and subsequent dental expenses was the fault of another individual.

Federal law requires that you and your eligible dependents be offered the opportunity to purchase a temporary extension of coverage under the Dental Plan at group rates in certain instances where coverage under the Dental Plan would otherwise end. This coverage is referred to as COBRA coverage. For more information, see the COBRA Coverage chapter.

If the Dental Plan makes a payment by mistake, the plan has the right to recover the amount of the overpayment from any person, insurance company or other organization to whom the payment was made.
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Vision
Chapter Contents
187 188 188 188 189 189 189 189 192 192 Vision Plan Options Coverage Categories Using EyeMed Select Network Providers Using Out-of-Network Providers Whats Covered Under the Vision Plan Eyeglasses Contact Lenses Additional Discounts on Eyeglasses and Contact Lenses Discounts on Laser Vision Correction Surgery Whats Not Covered 193 193 194 192 192 193 193 193 193 193 Coordination of Benefits Filing Claims Member Grievance Procedure Timely Filing Limitation Appealing a Denied or Reduced Claim Subrogation COBRA (Continuing Coverage After Termination) EyeMed Vision Discount Program Limitations and Exclusions for the EyeMed Vision Discount Program Vision Care Discount Program Through Aetna
Vision
What do you need?
Find an EyeMed Select network provider Get a claim form for an out-of-network provider Get a new EyeMed Select ID card Get information on eye health
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Find it here...
Go to www.eyemedvisioncare.com; or call EyeMeds Home Depot Member Services Department at 1-888-203-7447 from 7:30 a.m. to 11 p.m. Eastern time Monday through Saturday and 11 a.m. to 8 p.m. Eastern time on Sunday. Get an EyeMed Provider Nomination Form at www.livetheorangelife.com and give it to your provider OR Call EyeMeds Customer Care Center at 1-888-203-7447 to request that a form be sent to your vision care provider or give your vision care providers information to the Customer Care Representative during your call. Mail, fax or e-mail your claim form and itemized receipts to: EyeMed Vision Care, Attn: OON Claims, P.O. Box 8504, Mason, Ohio 45040-7111 oonclaims@eyemedvisioncare.com Fax: 1-866-293-7373 Go to www.EyeMedLasik.com; or call 1-877-552-7376 (1-877-5LASER6) Go to www.eyemedvisioncare.com; or call EyeMeds Home Depot Member Services Department at 1-888-203-7447 from 7:30 a.m. to 11 p.m. Eastern time Monday through Saturday and 11 a.m. to 8 p.m. Eastern time on Sunday. Call Aetna at 1-800-793-8616 from 8 a.m. to 11 p.m. Eastern time Monday through Saturday or 11 a.m. to 8 p.m. Eastern time on Sunday. For information on discounts on LASIK, call 1-800-422-6600
Nominate your vision care provider to the EyeMed vision network
File a claim for an out-of-network provider
Find out more about discounted laser vision correction surgery Get information on the EyeMed discount program (available to all Home Depot associates who are not enrolled in an EyeMed vision option) Get information on the Aetna Vision Discount program (only for those enrolled in Aetna Medical Plan)
Vision Plan Options

The EyeMed Vision Plan offers you two options: EyeMed Select $120 option; and EyeMed Select $150 option. Both options offer: No cost for eye exams. Eye exams are covered at no cost when you use EyeMed Select network providers. Annual eye exams are important to all ages, as an eye exam not only detects vision correction needs, but can reveal the signs of health conditions including diabetes and high blood pressure.
Pay less for eyeglasses and contact lenses when you use EyeMed Select network providers. Large network of retail and independent providers! The EyeMed Select network includes thousands of independent optometrists, ophthalmologists and opticians. Large network of leading optical retailers. Lenscrafters, Sears Optical, Target Optical, JC Penny Optical and most Pearle Vision locations are all EyeMed Select providers.
Discounts on laser vision correction. EyeMed offers vision plan participants a laser vision correction discount of 5% off any promotional price or 15% off the retail price for treatments performed through the U.S. Laser Network, owned and operated by LCA vision. Unlimited additional discounts on eyeglasses and contact lenses. Vision plan participants get a 40% discount off complete pairs of eyeglasses and a 15% discount off conventional contact lenses once your frame, lens and contact lens benefits have been used.
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Coverage Categories
For the Vision Plan, you may select one of four coverage categories: associate only associate + spouse (or same-sex domestic partner) associate + child(ren) associate + family (children and spouse or samesex domestic partner)
When you receive services at an EyeMed Select location, you wont have to file a claim form. You will have to pay the cost of any services or eyewear that exceeds your allowances and any applicable copayments (see The EyeMed Vision Plan Options chart later in this chapter). You will also owe state tax, if applicable, and the cost of non-covered expenses (see Whats Not Covered later in this chapter). Your EyeMed Select provider arranges eyewear fabrication and delivery.
Schedule an Appointment: Make an appointment with the out-of-network provider of your choice. Pay for all Services: Pay for all services at the point of care and ask the provider for an itemized receipt. Submit Out-of-Network Claim Form: Fill out and submit the out-of-network claim form with paid receipts to EyeMed for processing. Out-ofnetwork reimbursements are sent directly to you. Payment will include an Explanation of Benefits (EOB). See the Filing Claims section for more information on using out-of-network providers.
Using EyeMed Select Network Providers

To find an EyeMed Select network provider, go to www.eyemedvisioncare.com (be sure to look at Select network providers) or call EyeMeds Home Depot Member Services Department at 1-888-203-7447. Before you go to an EyeMed Select network provider, it is recommended that you call ahead for an appointment. When you arrive, show the receptionist or sales associate your EyeMed Select ID card. If you dont have your card, say that you are participating in the Home Depot vision care plan so your eligibility can be verified. You also can go to www.eyemedvisioncare.com to print an ID card or call EyeMeds Home Depot Member Services Department at 1-888-203-7447 to request a new ID card.
Using Out-of-Network Providers

If you visit an out-of-network provider, you are responsible for paying the provider in full at the time of service and then submitting the claim and receipts to EyeMed for reimbursement. You will be reimbursed for eligible services received from an out-ofnetwork provider as shown in The EyeMed Vision Plan Options chart later in this chapter. To receive care from an out-of-network provider: Request an Out-of-Network Claim Form: To ensure timely payment of your claim, get an out-of-network claim form at www.eyemedvisioncare.com before you see the provider. You can also call EyeMeds Home Depot Member Services Department at 1-888-203-7447 and the form will be mailed to you within 24 hours. Forms can also be emailed or faxed.
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Whats Covered Under the Vision Plan

Eyeglasses
The EyeMed Select $120 option provides benefits for frames once every 24 months and the EyeMed Select $150 option provides benefits for frames once every 12 months. If you use an EyeMed Select provider and choose a frame that exceeds your options allowance, you pay 80% of the balance over the allowance. Your provider will assist you in determining which frames are within your allowance and what the additional charges, if any, will be. If you use an out-of-network provider, you will be reimbursed up to the out-of-network frame allowance for your option. The lens benefit is available once every calendar year in both options. The options differ in the amount you pay for the lenses and lens options. Elective or medically necessary contact lenses may be provided instead of eyeglass lenses once every 12 months. You cannot receive benefits for contact lenses and eyeglasses in the same year. For information on frame and lens coverage, see The EyeMed Vision Plan Options chart later in this chapter.
Contact Lenses
The Vision Plan covers disposable, non-disposable or medically necessary contact lenses instead of eyeglass lenses. The contact lens fit and follow-up coverage depends on the type of contact lens you will be receiving: Standard Contact Lenses include spherical clear contact lenses in conventional wear and planned replacement (for example, disposable and frequent replacement). Premium Contact Lenses include all lens designs, materials and specialty fittings other than Standard Contact Lens (for example, toric and multifocal). Contact lenses are considered to be medically necessary if one of the following exists: To correct extreme vision problems (as determined by EyeMed) that cannot be corrected with spectacle lenses Certain conditions of keratoconus Certain conditions of anisometropia Certain conditions of high ametropia EyeMed recommends that your provider verify that contact lenses are medically necessary before submitting the claim. If proper verification is not obtained, you will receive the elective contact lens allowance. For information on contact lens fit and follow-up and contact lens coverage, see The EyeMed Vision Plan Options chart later in this chapter.
Additional Discounts on Eyeglasses and Contact Lenses

Once your frame, lens and contact lens benefits have been used for that calendar year, vision plan participants get a: 40% discount off complete pairs of eyeglasses 15% discount off conventional contact lenses 20% discount on items not covered by the plan. This cannot be combined with any other discounts or promotional offers and does not apply to EyeMed provider's professional services or contact lenses. These discounts are available through EyeMed Select providers only. After initial purchase, replacement contact lenses may be obtained by going to www.eyemedcontacts.com at substantial savings and mailed directly to the member. The contact lens benefit allowance is not applicable to this service. For more information on the additional discounts available to EyeMed members, call EyeMeds Home Depot Member Services Department at 1-888-203-7447.
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The EyeMed Select Vision Options
Item EyeMed Select $120 EyeMed Select Providers: You Pay
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EyeMed Select $150 Non-EyeMed Select Providers: Your Reimbursement After You Submit Claim Up to $40 EyeMed Select Providers: You Pay Non-EyeMed Select Providers: Your Reimbursement After You Submit Claim Up to $40
Exam (once every 12 months) Eyeglasses (frames and lenses) Frames
$0 copay
$0 copay
Plan pays first $120 then you pay 80% of balance over $120frame benefit available once every 24 months
Up to $45 available once every 24 months
Plan pays first $150 then you pay 80% of balance over $150frame benefit available once every 12 months
Up to $53available once every 12 months
Standard Plastic Lenses Single vision Bifocal Trifocal Lenticular Standard progressive (once every 12 months) Premium progressive (once every 12 months) Specialty Lens Options UV Coating Tint (Solid and Gradient) Standard Scratch-Resistance Standard Polycarbonate Standard Anti-Reflective Coating Photochromatic Transitions Edge Coating $0 $0 $0 $40 ($0 for dependents under age 19) $45 20% off 20% off 20% off Up to $11 Up to $11 Up to $11 Up to $28 N/A N/A N/A N/A $0 copay for all, covered in full Up to $11 Up to $11 Up to $11 Up to $28 Up to $32 Up to $53 Up to $53 Up to $11 To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954 $80 fixed pricing list $15 copay Up to $35 Up to $55 Up to $75 Up to $75 Up to $55 Up to $55 $0 copay Up to $35 Up to $55 Up to $75 Up to $75 Up to $84 Up to $140
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The EyeMed Select Vision Optionscontinued
Item EyeMed Select $120 EyeMed Select Providers
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EyeMed Select $150 Non-EyeMed Select Providers Reimbursement After You Submit Claim EyeMed Select Providers Non-EyeMed Select Providers Reimbursement After You Submit Claim
Contact Lens Fit and Follow-up (once comprehensive eye exam has been completed) Standard (examples include conventional, disposable, frequent replacement) Premium (examples include toric, multifocal) $0 fit and two follow-up visits Up to $40 $0 fit and two follow-up visits Up to $40
You get 10% off retail price, then you pay balance over the plans $40 allowance
Up to $40
You get 10% off retail price, then you pay balance over the plans $40 allowance
Up to $40
Contact Lenses (once every 12 months instead of eyeglasses) Conventional Plan pays first $120, then you pay 85% of balance over $120 Plan pays first $120, then you pay balance over $120 $0 copay Up to $96 Plan pays first $150, then you pay 85% of balance over $150 Plan pays first $150, then you pay balance over $150 $0 copay Up to $120
Disposable Medically Necessary
Up to $96 Up to $200
Up to $120 Up to $210
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Discounts on Laser Vision Correction Surgery

As a participant in an EyeMed vision option, you can save money on laser vision correction surgery. You will receive a 15% discount off regular pricing or a 5% discount off promotional pricing on LASIK, PRK and e-LASIK procedures through the US Laser Vision Network, which is owned and administered by LCA-Vision, the leading provider in the industry. For more information about this discount, visit www.EyeMedLasik.com or call 1-877-552-7376. This service is separate from your standard plan benefit. To access the laser vision discount: 1. Call the U.S. Laser Network at 1-877-552-7376 to find the laser correction provider most convenient for you. 2. Schedule a consultation with the provider. When making the appointment, tell the office that you are an EyeMed member. 3. During your consultation, you and your provider will determine whether or not you are a good candidate for the procedure. 4. If you choose to proceed with the treatment, call the U.S. Laser Network to request an authorization for your discount. A refundable deposit will also be requested at this time. The authorization will be sent to you and the laser provider. 5. Schedule your procedure. After your appointment be sure to follow all post-operative instructions carefully.
Whats Not Covered

Benefits are not provided for services or materials arising from: Orthoptic or vision training Subnormal vision aids and any associated supplemental testing Medical and/or surgical treatment of the eye, eyes or supporting structures Services provided as a result of any Worker's Compensation law Lost or broken materials Corrective eyewear required by an employer as a condition of employment and safety eyewear, unless specifically covered under plan Two pair of glasses in lieu of bifocals Aniseikonic lenses Certain frames where the manufacturer imposes a no-discount policy.
Filing Claims
When you receive services from an EyeMed Select provider, you will not have to file a claim form. If you visit an out-of-network provider, you are responsible for paying the provider in full at the time of service and then submitting the claim and receipts to EyeMed for reimbursement. Mail, fax or e-mail the completed form along with the itemized paid receipts for services and materials to: EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, Ohio 45040-7111 Fax: 1-866-293-7373 oonclaims@eyemedvisioncare.com If a claim for benefits is denied, EyeMed Vision Care will notify the member in writing of the specific reasons for the denial. The member may request a full review within 180 days of the date of a denial. The members written letter of appeal should include the following: The applicable claim number or a copy of the denial information or Explanation of Benefits, if applicable. The item of your vision coverage that the member feels was misinterpreted or inaccurately applied. Additional information from the members eye care provider that will assist in completing review of the members appeal, such as documents, records, questions or comments.
Coordination of Benefits
There is no coordination of benefits provision for the Vision Plan. If elected, benefits described in this Benefits Summary are provided regardless of whether or not you are covered by another plan, such as an HMO with a vision exam provision. In addition, you may also receive full discounts available through vision care discount programs offered through your Medical Plan.
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The appeal should be mailed to the following address: EyeMed Vision Care, L.L.C. Attn: Quality Assurance Dept. 4000 Luxottica Place Mason, Ohio 45040 Your appeal for benefits will be reviewed and you will be notified in writing of the decision, as well as the reasons for the decision, with reference to specific plan provisions.
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Timely Filing Limitation

For the Vision Plan, all claims must be received within 12 months of the date services are rendered. Claims filed after 12 months will not be considered for payment.
EyeMed Vision Discount Program

The EyeMed Vision Discount Program is available to all Home Depot associates who are not enrolled in an EyeMed vision option. For information on this program, see the EyeMed Vision Discount Program chart on the following page. Member will receive a 20% discount on those items purchased at participating Providers that are not specifically covered by this Discount design. The 20% discount may not be combined with any other discounts or promotional offers, and the discount does not apply to EyeMed Providers professional services, or contact lenses. Retail prices may vary by location. This Discount design is available through EyeMed Select providers only.
Appealing a Denied or Reduced Claim

If a claim for reimbursement or benefits is reduced or denied, in whole or in part, and you want the claim reconsidered, a written request for reconsideration must be submitted in accordance with the procedures set forth in the Claims and Appeals chapter.
Member Grievance Procedure

If you are dissatisfied with the services provided by an EyeMed Provider, you should either write to EyeMed at the address indicated above or call EyeMeds Home Depot Member Services Department at 1-888-203-7447. The EyeMed Vision Care Member Services representative will log the telephone call and attempt to reach a resolution to the issues you raised. If a resolution is not able to be reached during the telephone call, the concern will be addressed through the complaints and appeals process. The member will receive an acknowledgement letter from a Quality Assurance Specialist within three days that includes a resolution or a description of the appeal procedure and time line. If you are not satisfied with the resolution, the member may file a formal appeal as defined within EyeMed Vision Care's complaints and appeals process.
Subrogation
There is no subrogation provision within this Plan. Subrogation is the right of the insurance company to recoup benefits paid to a participant through legal suit, if the action causing the disability and subsequent medical expenses was the fault of another individual.
Limitations and Exclusions for the EyeMed Vision Discount Program

Discount is not provided for services or materials arising from: Orthoptic or vision training, subnormal vision aids, and associated supplemental testing Medical and/or surgical treatment of the eye, eyes, or supporting structures Corrective eyewear required by an employer as a condition of employment, and safety eyewear unless specifically covered under plan Services provided as a result of any Workers Compensation law Discount is not available on those frames where the manufacturer prohibits a discount

Federal law requires that you and your eligible dependents be offered the opportunity to purchase a temporary extension of coverage under the Vision Plan at group rates in certain instances where coverage under the Vision Plan would otherwise end. This coverage is referred to as COBRA. For more information, see the COBRA Coverage chapter.
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Vision Care Discount Program Through Aetna

In addition to the Vision Plan when you are enrolled under one of the Aetna medical plans, you are automatically entitled to participate in the Aetna Vision Discount program. Participating optical centers such as Sears, JCPenney, Pearle Vision stores and others, as well as selected doctors offices, provide discounts on products and services. To receive the vision care discounts, simply show your Aetna ID card to participating providers. You can find a vision center or doctors office that participates in the Aetna Vision Discount program by calling Aetna at 1-800-793-8616 from 8 a.m. to 11 p.m. Eastern time Monday through Saturday or 11 a.m. to 8 p.m. Eastern time on Sunday. The Aetna Vision Discount program offers discounts on LASIK. To find the closest surgeon for a LASIK procedure, call Aetna at 1-800-422-6600 from 8 a.m. to 9 p.m. Eastern time Monday through Friday or 9 a.m. to 6 p.m. Eastern time on Saturday. If you are found to be a candidate for LASIK surgery and wish to have the procedure performed, schedule a surgery date with the provider. Then call the LASIK number above with date of your surgery and pay a deposit not to exceed $100 per eye. At that time, you will receive an authorization number in order to receive the appropriate discount. In addition, your surgeon will receive written confirmation verifying your discount and the amount of your deposit. Your discount and deposit will be deducted from the surgeons fee at the time of treatment. For more information, see the Aetna Vision Discount Program chart later in this chapter.
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EyeMed Vision Discount Program

The EyeMed Vision Discount Program is available to all Home Depot associates who are not enrolled in an EyeMed vision option.
Vision Care Services Exam with Dilation as Necessary: Member Cost $5 off comprehensive exam $10 off contact lens exam
Complete Pair of Glasses Purchase*: frame, lenses and lens options must be purchased in the same transaction to receive full discount. Standard Plastic Lenses: Single Vision Bifocal Trifocal Standard Progressive Frames: Any frame available at provider location Lens Options: UV Coating Tint (Solid and Gradient) Standard Scratch-Resistance Standard Polycarbonate Standard Anti-Reflective Coating Other Add-Ons and Services Contact Lens Materials: (Discount applied to materials only) Disposable Conventional Laser Vision Correction**: Lasik or PRK Frequency: Examination Frame Lenses Contact Lenses $50 $70 $105 $135 40% off retail price
$15 $15 $15 $40 $45 20% discount
0% off retail price 15% off retail price 15% off retail price - or - 5% off promotional price Unlimited Unlimited Unlimited Unlimited
* Items purchased separately will be discounted 20% off the retail price. ** Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not always be available from a provider in your immediate location. For a location near you and the discount authorization, please call 1-877-5LASER6.
This is not Insurance
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Aetna Vision Discount Program1
Product or Service Eyeglass Frames (retail prices) Eyeglass Frames Lenses per Pair (uncoated plastic) Single vision Bifocal Trifocal Standard Progressive Lens Options per Pair (add to lens price above) Standard polycarbonate (includes UV and scratch-resistant coating) Scratch-resistant coating Ultraviolet (UV) coating Solid or gradient tint Glass Photochromic for glass Standard antireflective coating Eye Exams For eyeglasses For standard contact lensesfit and follow up For specialty contact lenses (i.e., Toric, Multifocal, Gas Permeable)fit and follow up Contact Lenses Contact Lenses Additional Vision-Related Items LASIK Procedure
1 Uses EyeMed Select Network.
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Reduced Fee/Member Cost
40% off retail price
$40 $60 $80 $120
$40 $15 $15 $15 20% discount 20% discount $45
$42 $82 ($40 plus $42 exam fee) $10 off standard fee (plus $42 exam fee)
15% discount on conventional lenses and 5% on disposable lenses
15% off the surgeon's standard fee (or 5% off promotional) through the U.S. Laser Network
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Spending Accounts
Chapter Contents
198 199 199 199 199 199 199 199 200 200 200 201 201 201 203 204 How the Spending Accounts Work The Health Savings Account and the Health Care Flexible Spending Account Health Care Spending Account Dependent Day Care Spending Account Manage Your Spending Account(s) Online Enrolling in Spending Accounts Eligible Dependents Health Care Spending Account Dependent Day Care Spending Account How Spending Accounts Can Help You Tax Advantages Built-in Budgeting Eligible Expenses for Spending Accounts Health Care Spending Account Dependent Day Care Spending Account How You Contribute to Your Spending Accounts 204 205 205 205 206 206 206 207 207 207 208 208 209 209 Payroll Deductions Changing Your Contribution Amount Increasing Your Contribution Amount Decreasing Your Contribution Amount Stopping Your Contributions If Your Employment Ends How the Health Care Account YSA Card Works When Your Card Can Be Suspended Validation of YSA Card Transactions Automatic Validation with Approved Merchants Supporting Documentation Filing for Reimbursement How Claims for Grace Period Expenses Are Reimbursed for 2010 Health Care Account Participants Limited Purpose Flexible Spending Account
Spending Accounts
What do you need?
Get detailed guidelines on eligible health care expenses (IRS publication 502) or eligible dependent day care expenses (IRS publication 503) Estimate your eligible expenses Manage your account online: Submit claims Review the status of your claim Find out if a claim needs your follow up Manage your account balance Get a complete list of select merchants for your health care account YSA card Where to fax or mail your itemized receipts Mail to: Your Spending Accounts P.O. Box 785040 Orlando, FL 32878-5040 Fax: 1-888-211-9900
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Find it here...
Go to www.irs.gov; or call 1-800-829-3676. Use the online spending account calculator on Your Benefits Resources at http://resources.hewitt.com/homedepot. Go to http://resources.hewitt.com/homedepot. or call the Benefits Choice Center at 1-800-555-4954
To receive your reimbursement by direct deposit
Go to the Your Benefits Resources web site and provide your bank account information.
How the Spending Accounts Work

The Company offers two Spending Accounts: one for health care and one for dependent day care. You may participate in one or both accounts, but you may not transfer money from one to the other. Heres a quick look at how the Company Spending Accounts work: You decide to participate when you first become eligible for benefits, at Annual Enrollment, or within 30 days of certain qualified status changes. See the Life Events chapter for more details. If you are hired or have a qualified status change on or after October 1, 2011, you can begin participating in the spending account; however, it's
important to note that the amount you elect to contribute to the spending account applies to the current plan year. Your deductions will likely be higher, since there are only a few pay periods remaining in the year. You put money into the account through regular payroll deductions. The account does not earn interest. You and your eligible dependents receive qualified services. Health care account participants: You will be issued a Your Spending Account (YSA) card which will have your annual election amount as an available balance. Before your first use, call the tollfree number on your card to activate it and sign the back of your card. Present the YSA card as
payment when you visit eligible providers and purchase eligible health care items or services. Using the YSA card for eligible health care expenses will save you from paying out of pocket. Choose the credit option if your transaction prompts you to choose between credit and debit. Provide your signature each time you use the YSA card. You may be required to submit additional documentation later. For more information about the YSA card, see How the Health Care Account YSA Card Works at the end of this chapter. Dependent day care account participants: you file for and then receive reimbursement for the qualified services from Your Spending Account.
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You can use the accounts to be reimbursed for: Dependent care services you received in 2011, for the dependent day care account. You have until April 30, 2012; to submit claims for qualified dependent care services received in 2011. You lose any money left in your account after April 30, 2012; and Health care services received through March 15, 2012, for the health care account. You have until April 30, 2012, to submit claims for qualified health care services received through March 15, 2012. You lose any money left in your account after April 30, 2012. If you participated in this account for 2010, see How Claims for Grace Period Expenses are Reimbursed for 2010 Health Care Account Participants in this chapter.
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This Spending Account is for qualified health care expenses for you and your eligible dependents not reimbursable by any other plan (such as a medical, dental or vision plan) covering you or your eligible dependents. You do not have to be enrolled in the Companys Medical Plan (or any other plan) to participate in the Health Care Spending Account. If youre enrolled in the Health Care Spending Account, you have the opportunity to pay for eligible health care expenses directly from your account with the YSA card. See How the Health Care Account YSA Card Works later in this chapter.
Learn why submitted claims may need your follow up and what to do about it. Manage your current account balance(s). Find information on other flexible spending account guidelines.
Enrolling in Spending Accounts

You can enroll in the account when you first become eligible for benefits, at Annual Enrollment, or when you have a qualified status change. For more information, see the Life Events chapter. To continue in the account each year, you must elect your annual contribution during Annual Enrollment for coverage to begin January 1 of the next year. If you fail to re-enroll during Annual Enrollment, you must wait for the next Annual Enrollment to participate in the accounts again, unless you experience certain qualified status changes.

This Spending Account is for qualified dependent care expenses for services that permit you and your spouse, if you are married, to work or look for work, or so your spouse can attend school full-time. If your spouse does not work, is not disabled, or is not a full-time student, you cannot use the Dependent Day Care Spending Account.
The Health Savings Account and the Health Care Flexible Spending Account
If you enroll in both a Health Savings Account and the Health Care Flexible Spending Account: Your health care spending account is limited and can only be used for eligible dental and vision expenses; it cannot be used for medical expenses. You will receive a PayFlex MasterCard to be used for both your limited health care spending account and your health savings account. For more information about the PayFlex MasterCard and the health savings account, see the Health Savings Account chapter.
Eligible Dependents
For the Health Spending Account, your dependent children (including your natural and adopted children, stepchildren and children for whom you are appointed legal guardian) are eligible through the last day of the calendar year in which the child turns 26. Please note that there is another age limit that applies to the Dependent Day Care Spending Account (see next page).
Manage Your Spending Account(s) Online

The Your Spending Account web site at Your Benefits Resources (http://resources.hewitt.com/ homedepot) is your best resource for current, personalized spending account information. When you visit the Your Benefits Resources web site, youll be able to: Submit and review the status of your claims. Access comprehensive listings of eligible expenses and merchants.
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Same-sex domestic partners and dependents of the domestic partner are not eligible unless the associate claims the persons as dependents on his or her federal income tax return. If you are divorced, your eligible dependents include your child or children for whom you and your exspouse provide more than half of the child's support and who is in the custody of one or both of you. A dependent who does not qualify as a child may be eligible as a qualifying relative if he or she receives more than half of his or her support from you and lives in the same principal place of abode with you as a member of your household.
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expenses, but you would use money remaining in your paycheck after federal taxes are withheld. Heres an example (based on 2011 tax tables):
With Account Pay Spending Account deposits Your taxable income Taxes You pay out-of-pocket Pay, minus taxes and out-of-pocket expenses Your tax savings $28,000 $1,500 $26,500 $6,532 $0 $19,968 $370 Without Account $28,000 $0 $28,000 $6,902 $1,500 $19,598 $0
Dependent Day Care Spending Account You may use the Dependent Day Care Spending Account to pay your childcare expenses on a before-tax basis, or you may pay those expenses with after-tax dollars and receive a tax credit on your income tax return. Which option will save you the most money will depend on a number of factors, including: Your total income (the tax credit goes down as your income goes up) Your number of dependents The amount of dependent care expenses you incur in a year In certain circumstances, you may be able to maximize your savings by using both the Dependent Day Care Spending Account and taking the tax credit. Because the tax laws that determine which option is best for you are very complicated, you may want to consult a tax advisor or review the appropriate IRS tax forms and guidance before making a decision. Other Tax Considerations Expenses reimbursed from your Spending Accounts cannot be claimed as deductions on your federal income tax return. You do not pay FICA tax on amounts you put into the Spending Accounts. This means that your Social Security benefits may be less than if you do not enroll in Spending Accounts. For most people, the difference is small.

To be an eligible dependent for the Dependent Day Care Spending Account, a child must be under age 13. Other dependents must be physically or mentally unable to care for themselves. Contact your tax advisor for advice regarding an individuals status as your dependent under the Internal Revenue Code. This example shows a typical tax savings. This example assumes a single filing status with zero exemptions, Medicare/Social Security tax of 5.65%, Federal tax rate of 15% and state tax of 4%. Actual savings differ for each associate depending on family income, the annual amount you choose for your Spending Account, and state and local tax rates. Please consult a tax professional for more details. Health Care Spending Account Most families can realize tax savings from the Health Care Spending Account. This is because only health care expenses exceeding 7.5% of your adjusted gross income can be deducted on your tax return. Using the previous example, only health care expenses exceeding $2,100 (7.5% of $28,000) would be deductible.
How Spending Accounts Can Help You

Tax Advantages
A Spending Account offers you a way to pay for qualified out-of-pocket expenses with money you set aside before taxes are taken out of your paycheck. This reduces your taxable income. Without a Spending Account, you would still pay for these
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Regarding the Tax-Savings Approaches Its important to note that any tax savings that may result from your participation in the Spending Accounts depend on your own personal situation and income level. Tax information included in this book is only general information. Because tax laws are complicated and subject to frequent change, you should talk with a qualified tax advisor if you have questions about whether to use the Spending Accounts or to take a tax deduction. By law, the Company cant offer you tax advice, or advise you on your Spending Account-related decisions. This law is designed to protect you by ensuring that you always get the most up-to-date advice, and that advice is only available from a qualified tax advisor.
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You also have to be careful not to put too much into your Spending Account. If you contribute more to the account than the cost of eligible services you receive, you lose the amount thats left over as of: December 31, 2011, for the Dependent Day Care Spending Account; and March 15, 2012, for the Health Care Spending Account. You must submit claims for reimbursement for both accounts by April 30, 2012.

Eligible expenses are those permitted by Section 213 and Section 125 of the Internal Revenue Code, and that are otherwise permissible under IRS regulations. Eligible expenses include, but are not limited to, the following: Acupuncture Ambulance service Braille books and magazines, limited to the difference between the cost of the Braille items and the cost for regular items Special car controls for people with disabilities Chiropractic, medical or podiatric expenses in excess of medical plan limits Cost for services by Christian Science practitioners Contact lenses and supplies such as saline and cleaning solutions Crutches Medical plan deductibles and coinsurance amounts Dental examinations, if not reimbursed under a dental plan Treatment for drug abuse or alcoholism, including meals and lodging if they are necessary for the treatment Prescription eyeglasses, including lenses, frames and exams Eye surgery
Eligible Expenses for Spending Accounts

The Internal Revenue Service (IRS) guidelines help determine which health care and dependent day care expenses may qualify for reimbursement under this plan. For detailed guidelines on eligible health care expenses see IRS publication 502. To order the publication, contact the Internal Revenue Service by phone at 1-800-829-3676 or via the Internet at www.irs.gov and request a copy of Publication 502, Medical and Dental Expenses. Keep in mind, however, that while the cost of longterm care insurance is listed as an eligible expense in IRS publication 502, it is not an eligible health care expense under the Health Care Spending Account. Insurance premiums for long-term care insurance are listed in Ineligible Health Care Expenses in this chapter.
Built-in Budgeting
With a Spending Account, you plan ahead and budget for qualified expenses. Careful planning is necessary to avoid cash-flow problems since you may have to pay for the expenses out-of-pocket and then file claims for reimbursement. See the Filing for Reimbursement section for more information.
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Purchase of a guide dog for a blind or deaf person Cost for keeping a mentally retarded person in a halfway house or special home (not the home of a relative), when recommended by a psychiatrist to help the person adjust from life in a psychiatric hospital to community living Hearing expenses, including examinations, hearing aids and batteries required to operate a hearing aid Hospitalization charges in excess of the reasonable and customary fees, including private room coverage Laboratory fees Costs for medical services provided by physicians, surgeons, specialists or other medical practitioners (as long as the service is not for cosmetic reasons) Medicine or other prescription drugs, including birth-control pills Expenses for medical care in a nursing home Nursing services when provided by a registered nurse or licensed practical nurse for medical care Services provided by an optometrist Orthodontia (braces) Orthopedic shoes, orthotics and braces Oxygen or oxygen equipment to relieve breathing problems caused by a medical condition Medically necessary psychiatrist and psychologist fees Smoking cessation programs
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Purchase or rental of special medical equipment such as wheelchairs, crutches and orthopedic shoes, if the primary purpose is medical care Tuition fees for a special school for a child who has severe learning disabilities caused by mental or physical impairments, including nervous system disorders, when recommended by a doctor. Tutoring fees for a teacher specially trained and qualified to work with children with severe learning disabilities are also eligible when recommended by a doctor. Medical expenses paid to a special school if the main reason for using the school is relieving the medical or physical disability Sterilization fees Surgery, including experimental procedures Special telephone for the deaf Audio-display television for the deaf Medical expenses for therapy received as medical treatment, such as speech, occupational, physical or cardiac therapy Vaccinations Weight-loss programs prescribed by a physician to treat an existing illness, such as heart disease or diabetes Health club dues, if accompanied by a doctors diagnosis such as obesity
Ineligible Health Care Expenses In general, health care expenses that do not qualify as medical deductions for federal income tax purposes are not eligible for reimbursement through a Health Care Spending Account. Examples of ineligible expenses include, but are not limited to, the following: Automobile insurance premiums, including any portion of the premium providing medical coverage for persons injured through an accident in or with the covered individuals vehicle Bottled water Insurance premiums for continued coverage through COBRA and for long-term care insurance (while the cost of long-term care insurance is listed as an eligible expense in IRS publication 502, it is not an eligible health care expense under the Health Care Spending Account) Cosmetics, such as toiletries and toothpaste Cosmetic surgery, except to correct congenital abnormality, bodily injury or disfiguring disease Any expense covered by a health plan Custodial care in an institution Dancing or swimming lessons, even when recommended by a qualified physician for health improvement Expenses that you filed on a federal tax return for a tax credit or for which a deduction is taken Funeral and burial expenses
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Expenditures for the general health of an individual, including expenses related to exercise, fitness, nutrition, recreation, vacation, or membership in a spa or health club Hair removal (electrolysis) Hair transplants Health club dues, YMCA dues, steam bath, etc., if not accompanied by a doctors diagnosis Household and domestic help, even if recommended by a qualified physician due to an individuals inability to perform physical housework Any expenses incurred in connection with an illegal operation or treatment Life insurance premiums or premiums for policies taken to provide repayment for loss of earnings or accidental loss of life, limb, sight, etc. Maternity clothes, diaper service, etc. Medical insurance premiums, including premiums for employer-provided medical and dental coverage and for contact lens insurance Over the counter drug expenses unless accompanied by a doctors prescription Charges by a nurse (RN or LPN) who cares for your normal, healthy newborn child Costs for sending a child with behavioral or disciplinary problems to a special school for benefits the child may receive from the course of study and disciplinary methods Transportation expenses to and from work, even if a physical condition requires a special means of transportation
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Vacation or travel, when taken for general health purposes, improvement of morale or to relieve physical or mental discomfort Vitamins, when taken for general health purposes Weight loss programs, unless prescribed by a doctor to treat an existing disease such as heart disease or diabetes Charges for medical care included in the tuition fee of a college or university
Amounts paid to a maid or cook if part of the services are provided to a person who qualifies for dependent care The full amount paid to a nursery school or pre-kindergarten, even when the school provides lunch and educational services Amounts paid to a relative who provides dependent care, provided the individual is not one of the following: Dependent for whom a personal exemption is allowed for federal income tax purposes Child or stepchild who is under the age of 19 at the end of the calendar year Amounts paid for services performed for the care of your dependent children under age 13 (whether the care is provided inside or outside your home) Amounts paid for services performed for the care of your spouse or dependent who is physically or mentally incapable of self-care (for example, an incapacitated parent) and for whom you can take a deduction on your federal tax return. If the care is provided outside your home, the spouse or dependent must spend at least eight hours each day in your home. Expenses for a summer day camp (does not qualify if the dependent stays overnight) Child care centers that care for six or more children and that meet the IRS definition of a qualified day care center Caregivers for a disabled spouse or dependent who lives with you

You must provide a completed statement from the care provider. The statement includes the care providers name, address, taxpayer identification number or Social Security number. The care providers statement must also include the amount of the expense you incurred. A care provider must be over 18 years of age and cannot be someone you claim as a dependent on your federal tax return. Services provided while you are on leave of absence, even if otherwise eligible, do not qualify for reimbursement from your Dependent Day Care Spending Account. Expenses that are eligible for reimbursement include, but are not limited to, the following: Expenses for an after-school program Amounts paid to a dependent care center, baby-sitter, nanny or nurse who cares for fewer than six individuals Expenses for a licensed day care center that cares for six or more unrelated individuals
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Ineligible Dependent Care Expenses Examples of ineligible expenses include, but are not limited to, the following: Services for children or stepchildren provided after the child reaches age 13 Services provided by your spouse, your child under age 19, or anyone else you claim as a dependent on your federal tax return Services provided for your child if you do not have legal custody of your child Services provided for children or other disabled relatives who do not live with you Overnight camp Amounts for kindergarten or above Services provided while you are on leave of absence, even if otherwise eligible, do not qualify for reimbursement from your Dependent Day Care Spending Account.
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How You Contribute to Your Spending Accounts

You decide the annual amount you want to contribute to one or both Spending Accounts. There are minimum and maximum amounts you can contribute for each Spending Account. Between the maximum and minimum, you can select any whole dollar amount.
Spending Account Type Health Care Dependent Day Care Minimum Annual Contribution $260 $260 Maximum Annual Contribution $5,000 $5,000
Payroll Deductions
You make contributions to a Spending Account through payroll deductions. The amount of your deduction is your annual contribution divided by the number of pay periods remaining in the year. There are usually 26 pay periods per year if you are paid biweekly; 52 pay periods if you are paid weekly. Example: If you elect $260 at Annual Enrollment for your Health Care Spending Account, your biweekly payroll deduction will be $10; if you elect $2,500, your biweekly payroll deduction will be $96.15. If you become eligible for the plan or experience a qualified status change after two pay periods have already passed and you elect $260, your biweekly payroll deduction will be $10.83; if you elect $2,500, your biweekly payroll deduction will be $104.17. If you increase your Spending Account election during the year because of a qualified status change, the amount of the increase will be spread over the remaining pay periods in the year. Example: If you elect $300 at Annual Enrollment for your Health Care Spending Account and then, because of a qualified status change, change your election to $600 halfway through the year (after you have paid $150 into the account), your biweekly payroll deduction for the second half of the year would be $34.62.
Limitations on Your Contributions If you and your spouse both participate in a Dependent Day Care Spending Account and you file a joint tax return, your contributions to the accounts cannot exceed a combined maximum of $5,000 per year. This limit applies whether you have one or more dependents receiving care. If you and your spouse file separate income tax returns, the most each of you may contribute is $2,500. The amount you can set aside in your Dependent Day Care Spending Account is further limited to your earned income or, if less, your spouses earned income. If your spouse is a full-time student or is disabled, the IRS treats your spouse as earning $250 monthly if you have one dependent or $500 monthly if you have two or more dependents.
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If you decrease your Spending Account election during the year because of a qualified status change, your remaining balance to be paid into the account will be divided over the remaining pay periods in the year. You cannot decrease your Spending Account election below the amount you have already paid into the account. Example: If you elect $600 at Annual Enrollment and then, because of a qualified status change, change your election to $300 halfway through the year (after paying in $300), you will not have any biweekly payroll deductions for the second half of the year. Please note that in this example you could decrease your election only to $300, because this is what you have already paid into the account. You may refer to your pay stub to see the amount you have paid into the account. The deduction is calculated before federal taxes and Social Security, and before most local and state taxes are withheld from your paycheck. The annual amount you elect will be deducted as long as you are actively employed. See the Stopping Your Contributions section for detailed information. Spending Accounts have a use it or lose it rule. You can use the accounts to be reimbursed for: Dependent care services you received in 2011, for the dependent day care account. You have until April 30, 2012, to submit claims for qualified dependent care services received in 2011. You lose any money left in your account after April 30, 2012; and
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Health care services received through March 15, 2012, for the health care account. You have until April 30, 2012, to submit claims for qualified health care services received through March 15, 2012. You lose any money left in your account after April 30, 2012. During a calendar year, you can increase, start, decrease or stop contributions to your Spending Accounts only when you experience certain qualified status changes. See Stopping Your Contributions in this chapter. For additional information, see the Life Events chapter.
If you want to increase your contributions to one or both Spending Accounts due to a qualified status change, contact the Benefits Choice Center at 1-800-555-4954 within 30 days of the qualifying event. The change you request will become effective as soon as administratively possible. Example: If you elect $300 at Annual Enrollment for your Health Care Spending Account, and then change your election to $600 effective on July 1, you can submit claims up to $300 for expenses you incurred between January 1 and December 31 (March 15 with the grace period), and $300 for expenses you incurred between July 1 and March 15 of the following year.
Changing Your Contribution Amount

The IRS determines when you can change the amount youre contributing to the Spending Accounts once you have started participation. You may increase, start, stop or decrease your contributions to the Spending Accounts only at Annual Enrollment or when you have certain qualified status changes. The rules vary according to the type of Spending Account. For a detailed listing of qualified status changes recognized by the plan and an explanation of how they may affect your Spending Accounts, see the Life Events chapter.
Decreasing Your Contribution Amount

If you decrease the amount of your spending account election due to a qualified status change, your new coverage amount is also effective on the date of your status change. Your new coverage amount must be equal to or more than the amount you have contributed through payroll deductions. If you want to decrease your contributions to one or both spending accounts due to a qualified status change, contact the Benefits Choice Center at 1-800-555-4954 within 30 days of the qualifying event. The change you request will become effective as soon as administratively possible.
Increasing Your Contribution Amount

If you increase the amount of your Spending Account election due to a qualified status change, your new coverage amount is effective on the date of the status change. This means that you can submit claims only for the additional amount of your election if they were incurred after the status change.
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Stopping Your Contributions

You may stop your contributions to the spending accounts only when you have certain qualified status changes. The rules vary according to the type of spending account. For a detailed listing of qualified status changes and an explanation of how they may affect your spending accounts, see the Life Events chapter. If you want to stop your contributions to one or both spending accounts due to a qualified status change, contact the Benefits Choice Center at 1-800-555-4954 within 30 days of the qualifying event. The change you request will become effective as soon as administratively possible.
If you dont continue making contributions through COBRA, you can submit claims until April 30 of the following year for eligible expenses you incurred up to midnight on the last day of the pay period in which your employment with the Company ends or you no longer meet the eligibility requirements for participation in the plan.
How the Health Care Account YSA Card Works

If youre enrolled in a Health Care Spending Account, you have the opportunity to pay for eligible health care expenses with the Your Spending Account MasterCard (YSA) card. The YSA card allows you to avoid paying for eligible health expenses out of pocket. When you use your YSA card, your eligible expenses are deducted automatically from your account. You can use your YSA card to pay for eligible health care expenses including prescriptions, medical copays and deductibles, dental work and vision care products. Its important to follow these YSA card guidelines to use your card as efficiently and conveniently as possible and to avoid having your card suspended:
Every item or service that you pay for using your YSA card must be an eligible health care expense. You can only use your YSA card to purchase eligible health care items or services dependent care expenses are not eligible for payment with your card. Always separate eligible health care items from ineligible items (e.g., magazines, cosmetics) before using your YSA card. Ineligible items must be purchased with another form of payment. Visit the Your Benefits Resources web site to review a complete list of eligible health care expenses. All YSA card transactions must be validated keep all of your itemized receipts. As part of the validation process, Your Spending Account will notify you by letter or by e-mail if itemized receipts are needed to validate your YSA card purchases. Although many transactions can be validated automatically, its important that you save all itemized receipts for your YSA card transactions in case supporting documentation is requested. If you do not provide the required documentation when requested, your YSA card transaction will be considered an overpayment and your YSA card may be suspended. Use select merchants and avoid sending in receipts! When you make eligible health care purchases using your YSA card with select merchants that can validate your expenses at the point of sale, the dollar amount will be deducted from your account automatically. No follow up needed! Select merchants include pharmacies, doctors and dental offices (including all MetLife PDP dentists), hospitals, clinics, vision centers and more. Visit the Your Benefits Resources web site for a listing of these select merchants.
If Your Employment Ends

If your employment with the Company ends: You cant contribute to the Dependent Day Care Spending Account. However, you can submit claims until April 30 of the following year for eligible expenses you incurred up to midnight on the last day of the pay period in which your employment with the Company ends or you no longer meet the eligibility requirements for participation in the plan. You can continue making contributions to your Health Care Spending Account through the end of the plan year in which you terminated by electing COBRA coverage. However, you will be making after-tax contributions, therefore no longer receiving the tax benefit of before-tax deductions that you had during your employment.
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Choose credit when you swipe your YSA card. The YSA card is a signature based debit card. This means youll be required to provide your signature, similar to when you use a credit card. If you choose the debit option, your transaction will not be processed. Use your YSA card to pay office visit, prescription drug and other plan copayments. Your YSA card will be programmed to recognize your plans copayment amounts (for example, a $25 copayment at a physicians office). No receipts will be required when you use your debit card to pay plan copayment amounts. Dont give the doctor your YSA card to pay the coinsurance amount at the time you receive service. You may use your YSA card to pay the coinsurance amount after the insurance has covered its portion and the provider has sent you a bill.
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Claim adjustments were made because of contribution amount changes, ineligible expenses, or improper processing of the claim. If Your Spending Account is unable to validate your YSA card transaction, youll receive a notice (via your profile preference e-mail or postal mail) requesting specific documentation. If you dont take action by the deadline or the expense is determined to be ineligible, your YSA card will be suspended from further use until the overpayment is repaid. If your YSA card is suspended, you wont be able to use the card, but you will be able to submit claims via the web site or through postal mail. Youll always have access to your account, regardless of the status of your YSA card. Once the overpayment is corrected, youll receive notification (via your profile preference e-mail or postal mail) that your YSA card was reinstated. Your Spending Account will allow you to resolve an overpayment on your account in one of the following ways: Resubmit your claim with additional information; Submit a new claim; or Repay your overpayment by mailing a check to Your Spending Account. The overpayment will remain active on the account until all amounts are recovered.
Validation of YSA Card Transactions

All YSA card transactions must be validated electronically at the point of sale or by submitting paper documentation afterward. This process involves requesting itemized receipts or other supporting documentation from you to verify that the card transaction is for an eligible health care expense. You should retain your itemized receipts for all transactions, as they may be required for validation purposes.
Automatic Validation with Approved Merchants

When you purchase eligible health care items by using your YSA card with approved merchants, your transaction can be validated automatically without having to provide an itemized receipt or supporting documentation. To be approved, a merchant must have an inventory information approval system (IIAS) installed. These IIAS-certified merchants have the ability to identify eligible items at the point of sale, which eliminates the need for additional documentation. They have programmed their systems to only allow eligible items and services to be processed on the YSA card. Any ineligible items must be paid for with another form of payment. For a complete listing of eligible expenses and approved merchants, visit the Your Benefits Resources web site. Please note that the listing is subject to change at anytime.
When Your Card Can Be Suspended

Each health care purchase made with your prepaid YSA card must be validated as an eligible health care expense. When an expense cant be validated by Your Spending Account, your account is placed in an overpayment status for which you are responsible. A YSA card overpayment commonly occurs when: You fail to respond to validation requests for YSA card transactions after the initial request was sent by Your Spending Account. Your YSA card transactions were authorized at the point of sale, and then later deemed ineligible after the validation process was completed.
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Your YSA card can also be used for other types of health care transactions without the need for submission of itemized receipts or further review. These transactions include recurring expenses, copayments, a specific merchant category code, and prescription purchases administered by CVS Caremark. Below is a brief explanation of each type of transaction. Recurring transactionsIf you purchase an eligible health care item or service using your YSA card, that same item or service will be validated automatically the next time you purchase it with your YSA card (at the same provider and for the same dollar amount). In addition, any recurring YSA card transactions will carry over to the new plan year for participants who reenroll in a flexible spending accountthis means youll be able to continue purchasing the same health care item or service (provided that the dollar amount does not change) without having to submit supporting documentation to Your Spending Account again the following plan year. CopaymentsYour YSA card will be programmed to recognize your plans copayment amounts without any additional validation being required (for example, a $25 copayment at a physicians office). Merchant categorySelect merchant categories have been identified because the majority of transactions are considered eligible health care expenses.
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Prescriptions through CVS CaremarkIf you have prescription drug coverage through CVS Caremark through the Company, your prescription purchases will typically be validated automatically simply present your YSA card at the time of purchase. Although your expense should be validated automatically, it is good practice to save your itemized receipts in case Your Spending Account requests proof of payment.
Filing for Reimbursement

You should always save your itemized receipts (listing the provider, date, amount, and item purchased) or any documentation that validates payment of eligible products or services. This also applies to expenses that you purchase with your YSA card. Saving receipts will help you keep track of your expensesplus, youll need to include these documents when you submit a claim for reimbursement to Your Spending Account. You have two options for submitting a claim: OnlineFor your convenience, you can submit a claim form online through the Your Benefits Resources web site. PaperIf you dont have Internet access, you can obtain a paper claim form by contacting the Benefits Choice Center at 1-800-555-4954. Whether you complete an online or paper claim form, youll need to send itemized receipts or other supporting documentation. If you dont fax or mail this supporting documentation with your completed claim form, your claim will be denied. Ensure your documentation is clear and legible. When faxing in your claim and itemized receipts, set your fax machine to a dark, high resolution setting and dont use highlighters. Use a stand alone fax machine. Faxes received from PC enabled fax machines may not transmit legibly. (You can test the clarity of your transmission by printing a fax confirmation page.)
Supporting Documentation
Manual claim submission and supporting documentation are sometimes required for the purchase of any prescription drug or health care service or item that isnt validated automatically. These types of purchases are conditionally reimbursed, pending validation of the expenses. The process for supporting documentation is outlined below: The merchant is reimbursed for the amount of the charge, and your available Health Care Spending Account balance is reduced. Youll be sent a letter or e-mail informing you that itemized receipts or other documentation are required to validate the YSA card transaction. If the documentation you provided is insufficient, youll be sent a letter or e-mail instructing you to provide more documentation. Expenses for which you dont provide adequate documentation are considered ineligible and treated as overpayments. Visit the Your Benefits Resources web site for the most current details on your account and a full listing of eligible health care expenses, approved merchants, and documentation requirements.
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Fax documentation to 1-888-211-9900. Mail paper claim forms and/or documentation to: Your Spending Account P.O. Box 785040 Orlando, FL 32878-5040 Receive reimbursement faster by enrolling in direct deposit. Your Spending Account can directly reimburse your bank account for validated claims. Visit the Your Benefits Resources web site and provide your bank account information so you can access your money quickly. If you dont enroll in direct deposit, youll receive reimbursement by check. You may submit claims for any amount. With the Health Care Spending Account, you have access to the total amount you elected for the calendar year as soon as eligible services are received. With the Dependent Day Care Spending Account, you can be reimbursed only up to the amount available in your account. Claims for expenses exceeding that amount will be reimbursed as additional funds accumulate in your account. You may submit claims at anytime during the calendar year and up until April 30 of the following year.
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How Claims for Grace Period Expenses Are Reimbursed for 2010 Health Care Account Participants
This is how claims for expenses you have incurred during the grace period (January 1, 2011 through March 15, 2012) are reimbursed: If you are participating in the health care spending account in 2010 and did not enroll in 2011, claims you file for expenses you have incurred during the grace period will be reimbursed through your 2010 account. If you are participating in the health care spending account in 2010 and enrolled in 2011, claims you file for expenses you incurred during the grace period can be reimbursed through your 2010 account if you have a remaining balance. If you do not have a remaining 2010 balance, claims you file for expenses you incurred during the grace period will be reimbursed through your 2011 account. If you are not participating in the health care spending account in 2010 and enrolled in 2011, claims you file for expenses you incurred during the grace period will be reimbursed through your 2011 account.
Limited Purpose Flexible Spending Account

For information on the Limited Purpose Flexible Spending Account, see If You Participate in the HSA and the Health Care Spending Account in the Health Savings Account chapter.
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Health Savings Account

Chapter Contents
211 211 212 212 212 212 212 212 213 213 213 213 213
Important Information on the HSA How the HSA Works HSA Eligibility Enrolling in the HSA When HSA Participation Begins If You Are on a Leave of Absence How the HSA Can Help You HSA Tax Advantages The HSA and the Medical Tax Deduction Regarding This Tax-Saving Approach If You Participate in the HSA and the Health Care Spending Account Using Your LPFSA Request for Documentation Letters
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Contributing Money to the HSA Payroll Deductions Transferring Funds from an IRA Contributing to an HSA in Certain Situations Your HSA Balance Changing Your HSA Contribution Amount When You Must Stop Contributions to Your HSA If You Take a Leave of Absence Qualified Medical Expenses Getting Reimbursed from Your HSA Filing Your Income Tax Return If You Die If You Leave the Company If You Are On COBRA

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Find it here...
Get detailed guidelines on qualified health care expenses according to Section 213(d) Go to www.irs.gov or call the IRS at 1-800-829-3676 Set up a Health Savings Account Stop, increase or decrease your HSA payroll deduction Call the Benefits Choice Center at 1-800-555-4954
HSA: Check your HSA balance Get reimbursement for medical expenses Transfer funds Track and analyze contribution limits Roll over funds from another HSA Change beneficiaries LPFSA: Check your LPFSA balance Enroll in direct deposit Request reimbursement See upcoming claim payments
Go to https://homedepot.healthhub.com or call PayFlex Customer Service at 1-800-506-9157, 8 a.m. 8 p.m. Monday through Friday and 10 a.m. 3 p.m. Saturday (Eastern time)
Go to https://homedepot.healthhub.com or call PayFlex Customer Service at 1-800-506-9157, 8 a.m. 8 p.m. Monday through Friday and 10 a.m. 3 p.m. Saturday (Eastern time)
Important Information on the HSA

This chapter discusses only some of the rules and limitations that apply to a Health Savings Accounts (HSA). It focuses only on Health Savings Accounts offered by the Company and addresses how the Company HSA works within the Companys overall benefits. It does not provide a comprehensive discussion of the legal requirements and tax consequences of contributing to an HSA; nor does it address provisions and rules that govern any HSA you might establish on your own. You should consult with your tax advisor before electing to contribute to an HSA, as the rules and regulations governing HSAs can be complex. It is your responsibility to know the rules governing HSAs, in particular those
around HSA eligibility, maximum contributions amounts and availability and taxation of HSA distributions. If you exceed the maximum contribution amount, the IRS imposes an excise tax on excess contributions.
Youll receive a matching contribution to your account from The Home Depot if you contribute to the HSA. For associate-only coverage, the matching contribution is up to $100 and if you are covering any dependents up to $200. The balance in your account earns interest tax free, and these earnings are distributed to you taxfree if you use them to pay for qualified health care expenses. You and any dependents can use the money in the account to pay for qualified health care expenses incurred after the HSA was established. If you use the money to pay for expenses that are not eligible, you will pay regular tax on the amount plus a 20% penalty tax.
How the HSA Works

Heres a quick look at how the Health Savings Account (HSA) works: You have the option to set up a Health Savings Account when you enroll in the High Deductible Health Plan and meet the other eligibility requirements as defined in the HSA Eligibility section. You put before-tax dollars into the HSA through regular payroll deductions.
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You access the money in your HSA using a PayFlex Carda MasterCardthat can be used anywhere MasterCard is accepted, such as your doctors office or pharmacy. If you do not use your PayFlex Card for your HSA purchases, you will need to request reimbursement online at https://homedepot.healthhub.com. Money left in your HSA at the end of the year stays in your HSA. Money can accumulate in your account and be used as a retirement income supplement. The money left in your account can be used to pay for medical expenses not covered by Medicare on a tax-free basis.
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For additional information, see Contributing to an HSA in Certain Situations.
How the HSA Can Help You

HSA Tax Advantages
The HSA allows you to pay for qualified medical expenses with money you put into the account before taxes are taken out of your paycheck before-tax dollars. This reduces your taxable income. Without an HSA, you would still pay for these expenses; however you would use money remaining in your paycheck after federal taxes are withheld after-tax dollars. The amount you will save using the account depends on your tax bracket. For example, if you are in the 15% tax bracket (in 2011, if your total taxable income is $17,001-$69,000 if you are married and filing jointly or $8,501-$34,500 if you are single), you save at least 20.65% when you use the account (15% federal tax plus 5.65% Social Security/Medicare tax). If you are in this tax bracket, your tax savings are shown in the chart below. If you are in a higher tax bracket, your tax savings could be higher. This example is based on filing a single return with zero exemptions. Actual savings differ for each associate depending on your income, the amount you put into your HSA and state and local taxes.
If You Contribute $400 $600 $1,000 $1,500 Your Tax Savings Could Be $83 $124 $207 $310
Enrolling in the HSA

You can establish an HSA at any time while you are enrolled in the High Deductible Health Plan and meet the other HSA eligibility requirements by calling the Benefits Choice Center. When you enroll in the HSA, you will need to activate your HSA. To activate your HSA, go to https://homedepot.healthhub.com. Once you complete the HSA enrollment process on https://homedepot.healthhub.com, your account can be activated and your PayFlex Card will be mailed to your home address.
HSA Eligibility
A Health Savings Account is available to you if you are: Enrolled in the High Deductible Health Plan, and Not covered under another health plan that is not a High Deductible Health Planthis includes your spouses medical plan and/or health care spending account and Medicare, but does not include specified disease coverage (such as the Critical Illness Protection Plan), dental, vision or long-term care coverage. Residents of California, Hawaii, Puerto Rico, Guam and the U.S. Virgin Islands are not eligible to participate in the Company-provided HSA. You may participate in the HSA provided by the Company or you may establish one on your own. The HSA rules discussed in the chapter may apply differently to you if you have a same-sex domestic partner and/or if you cover the child(ren) of your same-sex domestic partner. Please consult your tax advisor for more information.
When HSA Participation Begins

Participation in the HSA will begin on the first of the month following your coverage start date in the High Deductible Health Plan. If your HDHP coverage is effective on the first day of the month, your HSA coverage will start that day. If you are enrolled in the Health Care Spending Account during the year, you are not allowed to enroll in a HSA. If you are enrolled in the Health Care Spending Account at the time of annual enrollment, participation in the HSA will begin 04/01.
If You Are on a Leave of Absence

If you are on a leave of absence, you can contribute after-tax money to an HSA at any time while you are enrolled in the High Deductible Health Plan and meet the other HSA eligibility requirements. These contributions must be made directly by you to PayFlex using after-tax money.
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Because the amounts you put into the Health Savings Account are not included in your pay reported for Social Security and Medicare, your Social Security benefits may be less than if you do not enroll in the HSA. For most people, the difference is small.
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Spending Account. When you are enrolled in both the HSA and the Health Care Spending Account, your spending account is called a Limited Purpose Flexible Spending Account (LPFSA). Your ability to contribute to an HSA will be delayed if you enroll for the first time in the HSA during annual enrollment and contributed to the Heath Care Spending Account during the preceding year. Your contributions will be delayed until the end of the grace period for the Health Care Spending Account claims. (See the Spending Account chapter for more information on the grace period.)
The HSA and the Medical Tax Deduction

Expenses paid with funds from your HSA are not taken into account for determining the amount of income tax deduction allowed for medical expenses that exceed 7.5% of your adjusted gross income.
If you dont use your PayFlex Card for your LPFSA purchase, you will need to submit a claim for reimbursement online at https://homedepot.healthhub.com. You can choose to have your reimbursement deposited directly into your checking or savings account by enrolling in direct deposit online. To enroll in direct deposit, go to https://homedepot.healthhub.com, click Financial Center and then click Enroll in Direct Deposit.
Request for Documentation Letters

If you receive a Request for Documentation letter, this means that you are required to provide documentation to verify that you used your card to purchase an eligible item or service under your LPFSA, as regulated by the IRS. If you do not respond, the LPFSA balance on your card will be locked until you provide the requested documentation or payment. You have three ways to respond: Submit an itemized receipt or Explanation of Benefits (EOB) for the transaction(s) listed in the letter; Submit an itemized receipt or Explanation of Benefits (EOB) for another eligible item you purchased during the plan year; or Send a personal check or money order for the expense if you are unable to provide documentation. If you have any questions, call PayFlex Customer Service at 1-800-506-9157.
Regarding This Tax-Saving Approach

Its important to note that any tax savings that may result from your participation in the HSA depends on your own personal situation and income level. Tax information included in this book is only general information. Because tax laws are complicated and subject to frequent change, you should talk with a qualified tax advisor if you have questions. By law, the Company cant offer you tax advice or advise you on your HSA-related decisions. This law is designed to protect you by ensuring that you always get the most up-to-date advice, and that advice is only available from a qualified tax advisor.
Using Your LPFSA

As a LPSFA participant, you can use your PayFlex Card for your LPFSA eligible dental and vision purchases. Dental and vision expenses purchased with your PayFlex Card will be deducted from your LPFSA until there is no more money in your LPFSAat that point, all other qualified expenses will be deducted from your HSA balance. If you have not spent all the amounts in your Limited Flexible Spending Account by the end of the Plan Year, you may continue to incur claims for expenses during the "Grace Period." The "Grace Period" extends 2 1/2 months after the end of the Plan Year, during which time you can continue to incur claims and use up all amounts remaining in your Limited Flexible Spending Account. Any monies left at the end of the Plan Year and the Grace Period will be forfeited. For the Limited Flexible Spending Account, you must submit claims no later than the April 30th after the end of the Plan Year.
If You Participate in the HSA and the Health Care Spending Account
You can enroll in both the HSA and the Health Care Spending Account. However, if you enroll in both Plans, you may not be reimbursed for medical expenses from your Health Care Spending Accountyou can only be reimbursed for eligible dental and vision expenses from your Health Care
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Contributing Money to the HSA

You decide the amount you want to contribute to your HSA. You can contribute an amount up to the maximum HSA contribution amount based on the coverage category you choose. The total maximum contribution amount to the Company HSA is:
High Deductible Health Plan Coverage Category Associate Only Maximum Annual HSA Contribution Company Matching Contribution
It is your responsibility to make sure that you do not contribute more than the maximum amount allowed each year. If you exceed the maximum contribution amount, the IRS imposes a penalty on the excess contributions. In addition, you will be required to pay taxes on the interest earned on the excess contributions. However, under certain circumstances, you may be able to take a distribution of the excess contributions. For more information, contact PayFlex HSA Customer Service. It also is your responsibility to make sure that the distributions you receive from your HSA are for qualified medical expenses that meet the tax deductibility requirements. For more information on the tax requirements of your HSA, see Filing Your Income Tax Return.
You or your spouse enrolls in an HSA outside of the Companys HSA; or You have a domestic partner. As stated earlier in this chapter, you should contact your tax advisor about how the HSA works in your personal situation before opening an HSA.
Your HSA Balance

The balance in your HSA is deposited into an interest-bearing account. Your funds immediately begin earning interest, which is FDIC-insured. The HSA also gives you the ability to invest your deposits in mutual funds. A $1,000 minimum balance in the HSA must be maintained before any contributions can be made into the mutual funds that offer the following investment options: Money Market Sweepusing Schwab Money Market Mutual Funds. Access to 35 well-diversified mutual funds and four pre-planned portfolios actively managed by a professional money manager. Integration with access to Morningstar Research data and investment guidance. Unlimited trading and rebalancing at no additional cost. There is no minimum investment amount that is required per trade request. For detailed information on your investment options, visit https://homedepot.healthhub.com.
$3,050
$100
Associate + Spouse/ Domestic Partner Associate + Child(ren) Associate + Family
$6,150
$200
Transferring Funds from an IRA

You are allowed a one-time, tax-free trustee-to-trustee transfer of IRA funds into an HSA. Funds transferred from an IRA are subject to the maximum contribution limits and should be included in your total annual contribution. You must remain covered under a HDHP for 12 months after the transfer occurs. Otherwise, the funds transferred will be treated as taxable income and subject to a 20% excise tax.
If you enroll in an HSA any time between January 1 and December 1, you are allowed to make the full contribution regardless of the date you actually enroll in the HDHP. If you are age 55 or older, you can make additional catch-up contributions. The maximum amount of catch-up contributions that can be made in 2011 is $1,000.
Contributing to an HSA in Certain Situations

The rules governing HSAs can be complex, especially in the following situations: You or your spouse is enrolled in Medicare; Your spouse has medical coverage under the plan of another employer;
Payroll Deductions
You make contributions to your HSA through payroll deductions. You also may send checks directly to PayFlex. Any money you send directly to PayFlex will be after-tax dollars.
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Changing Your HSA Contribution Amount

You can start, stop, increase or decrease you HSA payroll deduction contribution at any time during the year by contacting the Benefits Choice Center.
Qualified Medical Expenses

Qualified expenses are those permitted by Section 213(d) of the Internal Revenue Code and that are otherwise permissible under IRS regulations. When you use the account to pay for qualified expenses, you pay with tax-free dollars. Qualified expenses include: Prescription drugs Doctors visits, lab, x-ray and other diagnostic and treatment services Routine health care (including prenatal care, smoking cessation, obesity weight-loss programs) Qualified long-term care services and qualified long-term care insurance COBRA premiums Health insurance for those on unemployment compensation Medicare Part A and B premiums, Medicare HMO or Medicare Advantage premiums (but not premiums for Medicare supplemental policies) You can use your HSA to pay for expenses incurred by yourself and any family members as long as the expenses were incurred after the HSA was established and are not covered by insurance or otherwise. If you use the account to pay for expenses that are not qualified, you will pay regular taxes on the amount of the unqualified expenses plus you will pay an additional 20% penalty tax unless the distribution is made after your death, disability or attaining age 65.
When You Must Stop Contributions to Your HSA

You are not eligible to continue contributing to your HSA through payroll deduction if you: Stop participating in the High Deductible Health Plan (for example if you move to an area where this Plan is not offered); Become covered under a health plan that does not qualify as a high-deductible plan (such as your spouses employers coverage); Become enrolled in Medicare (for example, if you become disabled); or Terminate employment or begin unpaid leave of absence with the Company.
It is your responsibility to make sure that the distributions you receive from your HSA are for qualified medical expenses to meet the tax-exemption requirements. For more information on the tax requirements of your HSA, see Filing Your Income Tax Return.
Getting Reimbursed from Your HSA

It is easy to access the money in your HSA. You dont have to complete a form, file for reimbursement and wait for a check. Instead, when you establish an HSA you will receive a MasterCard for your HSA that can be used anywhere MasterCard is accepted, such as your doctors office or pharmacy. If you do not use your PayFlex Card for your health care purchases, you can obtain reimbursement online provided the funds are available in your HSA. To be reimbursed, go to https://homedepot.healthhub.com, click on the Financial Center and select Health Savings Account. Then simply select Make a Withdrawal and complete all of the required fields. Your transaction will be submitted to the bank and can take anywhere from 24 to 48 hours, depending on your bank. You can be reimbursed for expenses up to the amount in your HSA. An HSA does not require thirdparty substantiation for transactions; however, you should save all of your medical expense receipts in the event of an IRS audit.
If You Take a Leave of Absence

If you go on unpaid leave, your payroll contributions in the HSA stop. You can, however, make direct payments to your account and use money already in your account to pay for eligible medical expenses.
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Filing Your Income Tax Return

Each January you will receive a 1099 Form for any distributions you receive from your HSA in the previous calendar year. You should save all of your medical expense receipts for income tax purposes. Be sure to consult your personal tax advisor for more information on this topic.
If You Leave the Company

If you leave the Company, you continue to have access to your HSA: If you get medical coverage under another qualified high deductible medical plan, you can continue to contribute to the PayFlex HSA on an aftertax basis or roll over the money in your PayFlex HSA into another HSA. If you become covered under a medical plan that is not a qualified high deductible medical plan, any money remaining in your HSA can still be used for qualified medical expenses.
If You Die
When you enroll in your HSA, you name a beneficiary for your HSA. If you die and: Your beneficiary is your spouse, your spouse is the new owner of the HSA. Your beneficiary is someone other than your spouse, the money in the HSA is taxable income to the beneficiaryunless the money is used for your (the deceased) medical expenses paid within one year of your death. For more information on how your account is distributed if you do not name a beneficiary or if your beneficiary cannot be located, call the PayFlex Customer Service Center at 1-800-506-9157.
If You Are On COBRA

While the High Deductible Health Plan is subject to COBRA coverage rules, the Health Savings Account is not. You can contribute after-tax money to your Health Savings Account while you have COBRA coverage under the High Deductible Health Plan.
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Life Insurance
Chapter Contents
218 218 218 218 219 219 219 219 219 220 221 221
Home Depot-Provided Basic Term Life Insurance Basic Term Life Insurance for Full-Time Hourly Associates Basic Term Life Insurance for Salaried Associates Basic Life Coverage for Your Family Basic Life Insurance Accelerated Death Benefit Voluntary Term Life Insurance When Voluntary Life Coverage Begins Voluntary Life Insurance Coverage for Salaried Associates Voluntary Life Insurance Coverage for Full-Time Hourly Associates Voluntary Dependent Life for Your Spouse or Domestic Partner Dependent Voluntary Life Insurance for Children Voluntary Dependent Life Benefits Payment
221 221 223 223 224 224 224 224 224 224 224
Voluntary Term and Voluntary Dependent Term Life Accelerated Death Benefit Continuing Basic/Voluntary Term Life Insurance When Coverage Ends Continuing Coverage through Portability Continuing Coverage by Converting to an Individual Policy Conversion for Your Dependents if You Die, Get Divorced or End a Domestic Partnership Benefit Reductions for You and Your Family Whats Not Covered Under the Life Insurance Plans Continued Insurance When You Are Totally Disabled Filing Claims for Benefits Appealing a Claim Designating a Beneficiary
Life Insurance
What do you need?
Enroll in coverage Change your coverage amounts Designate your beneficiaries Get additional information on continuing life insurance coverage after employment at the Company ends
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Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954. Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954. Go to Your Benefits Resources at http://resources.hewitt.com/homedepot. Call Minnesota Life at 1-866-293-6047.
Home Depot-Provided Basic Term Life Insurance

The Company provides, at no cost to you, the Basic Term Life Insurance Plan if you are enrolled in a Home Depot medical plan. If you become totally disabled while covered by Basic Term Life Insurance, a continued insurance benefit may be available (see Continued Insurance When You Are Totally Disabled later in this chapter).
Basic Term Life Insurance for Full-Time Hourly Associates

The Basic Term Life Insurance Plan covers you for $20,000 until age 70, provided you are enrolled in a Home Depot medical plan. After age 70, your Basic Term Life Insurance benefit will be reduced. See Benefit Reductions for You and Your Family later in this chapter for more information.
Basic Life Coverage for Your Family

The Company provides, at no cost to you, the Basic Dependent Term Life Insurance Plan for full-time hourly and salaried associates, which covers each member of your family (including your same-sex domestic partner) enrolled in a Home Depot medical plan with $2,000 of life insurance, payable only from a live birth. If both you and your spouse or same-sex domestic partner work for the Company, see If You and Your Spouse or Same-Sex Domestic Partner Both Work for the Company in the Eligibility and Enrollment chapter.
Basic Term Life Insurance for Salaried Associates

The Basic Term Life Insurance Plan covers you for $50,000 until age 70, provided you are enrolled in a Home Depot medical plan. After age 70, your Basic Term Life Insurance benefit will be reduced. See Benefit Reductions for You and Your Family later in this chapter for more information.
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Basic Life Insurance Accelerated Death Benefit

In the event your life expectancy is less than 365 days, as certified by your doctor and accepted by Minnesota Life, you may be eligible for an accelerated death benefit of up to 100% of your Basic Term Life Insurance amount to help with expenses incurred prior to death. If approved, the accelerated death benefit is paid to you in a lump sum. The plan will then reduce your Basic Term Life Insurance by the amount paid as an accelerated death benefit. If you recover after receiving an accelerated death benefit payment, the plan will not restore your life insurance amount to its original amount. Filing an Accelerated Death Benefit Claim To make a claim for an accelerated death benefit, you must complete a form available from the Benefits Choice Center and return the form with the following information to Minnesota Life: written medical diagnosis of your attending doctor and prognosis that your death is expected within 365 days due to injury or sickness; and your doctors reasons for the prognosis along with clinical, radiological, histological and laboratory evidence. Your doctor may not be yourself or a member of your family.
Minnesota Life reserves the right to make the final decision on payment of an accelerated death benefit. The accelerated death benefit is not available if benefits are assigned, or if there is an irrevocable beneficiary.
Voluntary Life Insurance Coverage for Salaried Associates

You can buy coverage equal to one to 10 times your annual base pay (rounded to the next higher multiple of $1,000, if not already a multiple of $1,000), up to a maximum of $1,000,000. Annual base pay includes your regular pay and any portion of regular pay that you defer. It does not include bonuses, premiums, incentive pay or other similar forms of Home Depot pay. For example, if your base pay is $38,000, you can buy: $38,000 (1x your annual base pay); $76,000 (2x your annual base pay); $114,000 (3x your annual base pay); continuing up to $380,000, which is 10 times your base pay. You may be required to provide an Evidence of Insurability form and be approved for coverage.
Voluntary Term Life Insurance

Depending on your familys financial situation, you may decide to purchase additional protection for yourself under the Voluntary Term Life Insurance Plan and/or for your eligible family members under the Voluntary Dependent Term Life Insurance Plan. You can purchase Voluntary Dependent Term Life Insurance even if you do not purchase Voluntary Term Life Insurance for yourself. In determining the amount of Voluntary Term Life Insurance to buy, keep in mind that Accidental Death and Dismemberment (AD&D) Insurance provides benefits only for deaths resulting from accidents, not deaths due to natural causes.
When Voluntary Life Coverage Begins

You must be actively at work for Voluntary Term Life and Dependent Term Life Insurance coverage to take effect. Actively at work means that you are performing all of the material duties of your job with the Company where these duties are normally carried out. If you were actively at work on your last scheduled working day, you will be deemed actively at work on a scheduled non-working day provided you are not disabled.
Voluntary Life Insurance Coverage for Full-Time Hourly Associates

You can buy coverage equal to one to 10 times your annual base pay (rounded to the next higher multiple of $1,000, if not already a multiple of $1,000), up to a maximum of $500,000. Annual base pay means your hourly base pay rate multiplied by 2,080 (40 hours per week times 52 weeks). Base pay does not include overtime, bonuses, premiums, incentive pay or other forms of Home Depot pay.
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For example, if your base pay is $16,650, you can buy: $17,000 (1x your annual base pay) $34,000 (2x your annual base pay) $51,000 (3x your annual base pay) continuing up to $170,000, which is 10 times your annual base pay. You may be required to provide an Evidence of Insurability form and be approved for coverage. Providing an Evidence of Insurability Form For Yourself If you are newly eligible for benefits and electing coverage during your initial enrollment period, you will need to provide an Evidence of Insurability (EOI) form if: You elect more than three times your pay; or You elect an amount over $500,000 (for salaried associates only). If you are increasing coverage outside of your initial enrollment, you will need to provide an Evidence of Insurability form if: You previously declined coverage, regardless of the level of coverage you select; You elect a coverage increase of more than one times pay; or You elect a coverage increase that would cause your coverage to go above $500,000 even if you elect one times pay and it causes your coverage to go above $500,000 (for salaried associates only).
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To approve your request for coverage, Minnesota Life may require a doctors statement and/or a physical exam. You are not eligible for the requested level of benefits until Minnesota Life has approved your Evidence of Insurability form. You must be actively at work for any life insurance coverage to become effective, including increases in coverage you may elect during any rolling 12-month period.
$250,000 maximum coverage amount. If your base pay is $22,650, you can buy: $23,000 (1x your annual base pay) $46,000 (2x your annual base pay) $69,000 (3x your annual base pay) continuing up to $230,000, which is 10 times your annual base pay. If You Enroll Your Domestic Partner For information on eligibility requirements for sameor opposite-sex domestic partners, see Dependent Eligibility in the Eligibility and Enrollment chapter. If you enroll your same- or opposite-sex domestic partner, you will be required to complete an Affidavit of Domestic Partnership attesting to your domestic partnership before you receive Voluntary Dependent Term Spouse Life Insurance coverage. See the Benefits for Same-sex Domestic Partners chapter for more information. Providing an Evidence of Insurability Form for Your Spouse or Domestic Partner If you choose to cover your spouse (or same- or opposite-sex domestic partner) for any amount above $20,000, you will need to complete an Evidence of Insurability form.
Voluntary Dependent Life for Your Spouse or Domestic Partner

You may purchase coverage for your spouse (or same- or opposite-sex domestic partner) equal to $20,000 or one to 10 times your annual base pay (rounded to the next higher multiple of $1,000, if not already a multiple of $1,000), up to a maximum of $250,000. The minimum amount of insurance you can purchase for your spouse (or same- or opposite-sex domestic partner) is $20,000. If you earn less than $20,000, you can choose the minimum coverage amount of $20,000. You may be required to provide an Evidence of Insurability form and be approved for coverage. For example, if your base pay is $38,000, you can buy: $38,000 (1x your annual base pay) $76,000 (2x your annual base pay) $114,000 (3x your annual base pay) $152,000 (4x your annual base pay) $190,000 (5x your annual base pay) $228,000 (6x your annual base pay) You could not purchase more than six times your annual base pay because that would exceed the
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To approve your request for coverage, Minnesota Life may require a doctors statement and/or a physical exam. You will be responsible for any related costs. Your spouses or same- or opposite-sex domestic partners coverage will not become effective until Minnesota Life has approved his or her Evidence of Insurability form.
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Dependent Voluntary Life Insurance for Children

You can choose from these coverage levels for each of your dependent children: $2,500, $5,000, $10,000, $15,000 or $25,000.
If approved, the accelerated death benefit is paid in a lump sum. The plan will then reduce the Voluntary Term Life Insurance amount by the amount paid as an accelerated death benefit. If you or your dependent recovers after receiving an accelerated death benefit payment, the plan will not restore the life insurance amount to its original amount. After a claim has been made for an accelerated death benefit, you will not be allowed to increase your Voluntary Term Life coverage. Filing an Accelerated Death Benefit Claim To make a claim for an accelerated death benefit, you must complete a form available from the Benefits Choice Center and you must return the form with the following information to Minnesota Life: written medical diagnosis of your attending doctor and prognosis that your death is expected within 365 days due to injury or sickness; and your doctors reasons for the prognosis along with clinical, radiological, histological and laboratory evidence. Your doctor may not be yourself or a member of your family. Minnesota Life reserves the right to make the final decision on payment of an accelerated death benefit. The accelerated death benefit is not available if benefits are assigned, or if there is an irrevocable beneficiary.
Continuing Basic/Voluntary Term Life Insurance When Coverage Ends

You may elect to continue through portability or conversion your Basic Term Life, Basic Dependent Life, Voluntary Term Life, and Voluntary Dependent Term Spouse Life and Voluntary Dependent Term Child Life Insurance and you may elect to continue through portability your Basic AD&D, Voluntary AD&D and Family Voluntary AD&D if you meet one of the following qualifications: your employment has ended due to voluntary termination of employment, leave, layoff, retirement or dismissal; or you cease to be in a class that is eligible for such insurancefor example, you have a change in employment status (e.g., full-time to part-time). If you would like to continue coverage through portability or conversion, call Minnesota Life at 1-866-293-6047 and the necessary forms will be mailed to you. You have the latter of 31 days from the date your coverage ends or 15 days from the date this notice was given, if notice is given more that 15 days from the date benefits were terminated. In no event will this period extend beyond 91 days from the date benefits were terminated. For information about the differences between portability and conversion, see the chart on the following page. To speak with a Minnesota Life representative who can answer questions about portability, call 1-866-293-6047. To be connected with a Minnesota Life representative who can answer questions about conversion, call 1-866-293-6047.
Voluntary Dependent Life Benefits Payment

In the event of the death of your dependent spouse or child, the death benefit will be paid to you if living, otherwise to your estate.
Voluntary Term and Voluntary Dependent Term Life Accelerated Death Benefit
In the event your or your dependents life expectancy is less than 365 days as certified by your doctor and accepted by Minnesota Life, you or your dependent may be eligible for an accelerated death benefit of up to 100% of you or your dependents Voluntary Term Life benefit amount to help with expenses incurred prior to death. You or your dependents must be covered under the Voluntary Term Life Insurance Plan.
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The Differences Between Portability and Conversion
Portability1: Continue Your Group Term Life with Minnesota Life Eligible coverage Basic Term Life and AD&D coverage, Voluntary Term Life and AD&D coverage and Dependent Term Life coverage can be ported. Dependent coverage can only be ported if associate coverage is ported. Group Term life, Accidental Death & Dismemberment (AD&D) Must be elected within 31 days of event below Coverage is lost due to: Termination of employment Other loss of eligibility Termination of group policy Nonpayment of premium All guaranteed issue Associate: age 79 Spouse: spouse's age 69 Child: qualifying age or associate's age 79 Associate: $10,000 Spouse/child: no minimum Previous Amount In Force, Not to exceed the maximum amount allowed under the Company-provided benefits. See the applicable maximums by plan within this chapter and the Accidental Death & Dismemberment chapter. No increases Decreases available Associate and spouse coverage reduces to 65% at age 70 and 50% at age 75 Associate: age 80 Spouse: spouses age 70 or associates age 80 Child: qualifying age limit or associates age 80 No change Layoff or leave Terminated disabled associates
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Conversion: Convert Your Group Term Life Insurance Benefits to an Individual Adjustable Life Basic, Voluntary and Dependent Term Life coverage can be converted. AD&D cannot be converted. Dependent coverage can be converted even if associate coverage is not converted. Individual life policy Must be elected within 31 days of event below Coverage is lost due to: Termination of employment Loss of eligibility Termination of group policy (after 5 years in the plan) Medical leave Layoff or leave Nonpayment of premium All guaranteed issue No maximum age
Type of insurance following election Eligibility timing Events allowing portability/conversion
Not allowed for Guaranteed issue Maximum age to elect
Minimum amount allowed Maximum amount allowed
No minimum Previous amount in force unless conversion is due to policy or class termination. If conversion is due to policy/class termination, maximum is the lesser of $10,000 or the existing coverage amount less the new coverage amount available under group replacement policy. Increases available (with Evidence of Insurability) Decreases available No age reductions No termination age
Increases/decreases available Age reductions Termination age
Effect of group contract termination on coverage already ported or converted Availability of conversion option 1 Subject to state availability.
No change
Available at any time after porting but not more than 31 days after ported coverage terminates
Not applicable
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Continuing Coverage through Portability

You may elect to continue life insurance coverage on you and your dependents lives for the same or a lower amount of insurance that you were receiving immediately before termination under the group term life plan subject to an overall minimum of $10,000 of your term life insurance. You must elect to continue your term life (Basic Life and/or Voluntary Term Life) in order to be able to continue the Dependent Life Insurance. Costs may differ from your current payroll deduction but are generally less expensive than an individual permanent life policy. Coverage may continue up to the lesser of age 80 for associates and up to age 70 for dependents.
Once Minnesota Life is notified that you are eligible for conversion, the necessary forms will be mailed to you. You have the latter of 31 days from the date your coverage ends or 15 days from the date this notice was given, if notice is given more that 15 days from the date benefits were terminated. In no event will this period extend beyond 91 days from the date benefits were terminated. If an individual policy is issued, the individual policy will be effective at the end of the 30-day period following the date your benefits end. Pay the required premium within 31 days following the date on which your insurance with the Company ended. Minnesota Life will base the premium for the individual policy on the covered persons age as of the policys effective date, the class of risk to which you belong and the type and amount of the policy. Limited conversion is available if, after you have been insured for at least five years, insurance is terminated because the policy is: Terminated; or Changed to reduce or terminate the insurance for that individual. You may convert up to the full amount of terminated insurance, but not more than the maximum. The maximum is the lesser of: $10,000; and The amount of life insurance which terminated minus any amount of group life insurance for which the insured becomes eligible under any
group policy issued or reinstated by us or any other carrier within 31 days of the date the insurance terminated under this policy. Neither the conversion right nor the limited conversion right is available if your coverage under this policy terminates due to failure to make, when due, required premium contributions. Under both the conversion right and the limited conversion right, you may convert your insurance to any type of individual policy of life insurance then customarily issued by Minnesota Life for purposes of conversion, except term insurance. The individual policy will not include any supplemental benefits, including, but not limited to, any disability benefits, accidental death and dismemberment benefits or accelerated benefits. If you do not receive written notice of your conversion right under this policy at least 15 days prior to the expiration date of the conversion period, you will have an additional period within which to exercise your conversion right, which shall not be longer than 91 days from the date your coverage ended. This additional period shall expire 15 days after you are given notice, but in no event will the additional period extend beyond 60 days after the expiration date of the period provided in the policy. If you die during the 31-day period allowed for conversion, Minnesota Life shall pay a death benefit even if an application for conversion has not been submitted. This benefit will be the amount you would have been eligible to convert. Nothing herein contained shall be construed to continue any insurance beyond the period provided in the policy.
Continuing Coverage by Converting to an Individual Policy

If you or your eligible family members lose coverage under the Term Life Insurance Plans, you may be eligible to obtain an individual life insurance policy customarily issued by Minnesota Life for conversions (not including Term Life Insurance.) See the chart The Differences Between Portability and Conversion on the previous page for more information. The amount of coverage will equal your coverage level under the Companys Basic Term Life, Basic Dependent Term Life, Voluntary Term Life and/or Voluntary Dependent Term Life Plans. To convert your life insurance to an individual policy, you must follow these steps:
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Conversion for Your Dependents if You Die, Get Divorced or End a Domestic Partnership
Your spouse or same- or opposite-sex domestic partner or children can convert for the same or a lower amount of insurance in the event of the associates death or a divorce or dissolution of domestic partnership.
Benefit Reductions for You and Your Family

The amount of your Basic Term Life Insurance and any Voluntary Term Life Insurance, as well as any Voluntary Dependent Term Life Insurance for you or your spouse/domestic partner will be reduced by: 35% on January 1 following your 70th birthday 50% on January 1 following your 75th birthday 70% on January 1 following your 80th birthday
If a suicide occurs within two years of the effective date of any coverage or within two years of the effective date of any increase in coverage, that coverage or increased amount of coverage will not be payable. Instead, Minnesota Life will pay the beneficiary any contributions paid for the increased coverage amount without interest. In addition, Minnesota Life will pay the beneficiary the amount of coverage in place the day before the effective date of an increase in coverage.
Appealing a Claim
If your claim is denied as described in the Claims and Appeals chapter of this book, you will receive a formal letter that states the reasons for the denial. You may appeal the denial by following the procedures in the Claims and Appeals chapter.
Designating a Beneficiary
You may designate the same beneficiary(ies) for all plans, or different beneficiaries for each plan. However, the associate is automatically the beneficiary of all dependent life insurance benefits. You can change your beneficiary(ies) at any time. You can designate or change beneficiaries on the Your Benefits Resources web site. You may want to change the designation of your beneficiary if you divorce, are legally separated from your spouse or end a relationship with your same- or opposite-sex domestic partner. To change your beneficiary designation go to the Your Benefits Resources web site. If there is no designated beneficiary at your death, any benefits for these plans will be paid in equal shares in the following manner: your spouse or your same- or opposite-sex domestic partner (as defined in the Eligibility & Enrollment chapter of this document); your surviving natural and adopted children your parents;
Continued Insurance When You Are Totally Disabled

Continued Insurance is a provision that keeps a death benefit in effect for a totally disabled associate until the earlier of benefit termination, employment termination, return from leave of absence or termination of your disability benefits provided that the appropriate premiums are paid throughout the period of total disability. At the time of benefit termination, the totally disabled associate may convert to an individual policy, or port if applicable.
Whats Not Covered Under the Life Insurance Plans

Death benefits are not paid under the Voluntary Term Life, and Voluntary Dependent Term Life Plans if you or your dependent commits suicide, while sane or insane, during the first two years of coverage under the Plan. This also applies to the living benefit. The living benefit never applies to sickness or injuries caused by attempted suicide and selfinflicted injury. The living benefit is not available if benefits are assigned or Minnesota Life has been notified that there is an irrevocable beneficiary.

The Benefits Choice Center must be notified if you or a family member dies while covered by the Basic Term Life and/or Voluntary Term Life Plans. Upon notification, the Benefits Choice Center will submit a claim to Minnesota Life who will provide the beneficiary with the appropriate claim forms. Your beneficiaries must complete and return the forms, along with other required information, to Minnesota Life for processing. Minnesota Life will pay interest from the date of death to the date of payment.
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your surviving brothers and/or sisters; or your estate. However, Minnesota Life instead can pay the benefit to your estate. Any such payment discharges all liability for the amount paid. In the event a beneficiary is not living on the date of your death, that beneficiarys portion of the benefit will be equally distributed to the remaining surviving beneficiaries. In the event of you and a beneficiarys simultaneous deaths, the benefit will be paid as if you survived your beneficiary. Benefits will not be paid to a beneficiary who has been convicted of murdering the covered person.
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Disability
U.S. Full-Time Hourly Associates
Chapter Contents
227 227 228 228 228 228 229 230 230 230
The Disability Plans Enrolling in the STD and LTD Plans Providing an Evidence of Insurability Form Paying for Your Coverage How the Short-term Disability Plan Works Qualifying for Benefits How the Plan Pays Benefits How the Long-term Disability Plan Works Exceptions Qualifying for Benefits
231 232 232 232 233 233 233 233 233 234
How the Plan Pays Benefits Limited Interruption of the Waiting Period Whats Not Covered Under the Disability Plans Benefit Reductions Termination of Benefits Filing Claims for Benefits When to Report Your Absence How Your Claims Are Handled Appealing a Claim Refund to Liberty for Overpayment of Benefits
Disability - Full-Time Hourly

What do you need?
File an STD claim
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Notify your District HR Manager or manager of your need to file a short-term disability claim or go to myApron.homedepot.com. Notify Liberty as soon as you know youll be unable to work for more than seven days by calling 1-888-404-5096, If you dont submit a claim within 15 days of the first day out of work, you may not be eligible for short-term disability benefits. Liberty Life Assurance Company of Boston (Liberty) will automatically transition your STD claim to LTD (if you are enrolled in LTD) approximately midway through the 90-day waiting period. You do not have to contact Liberty separately to initiate the LTD claim. Call Liberty at 1-888-404-5096. Send a fax to 1-866-578-7144; or mail to: Liberty Group Benefits Disability Claims Liberty Life Assurance Company of Boston P.O. Box 7211 London, KY 40742-7211
File an LTD claim
Check the status of an STD or LTD claim Provide information to Liberty
The Disability Plans

To help ensure your financial protection if you become disabled and are unable to work because of illness or injury, the Company offers you the Shortterm Disability (STD) Insurance Plan and the Longterm Disability (LTD) Insurance Plan. Generally, you have the choice to purchase: short-term and long-term disability insurance short-term disability insurance only (not available to associates working in California, Hawaii, New Jersey and Rhode Island) long-term disability only (for associates working in California, Hawaii, New Jersey and Rhode Island only)
State disability plans automatically cover associates working in California, Hawaii, New Jersey and Rhode Island. These associates are eligible to participate in the Long-term Disability Plan only. Associates working in New York are also covered under a state disability plan. However, since New Yorks state disability plan has limited benefits, the Company allows New York associates to participate in the Short-term Disability Plan. If you work in New York, you can begin receiving New York state disability plan benefits after completing four weeks of employment. These benefits are administered by Liberty. If you are eligible to participate in the Companys Shortterm Disability Plan, you must participate in that plan in order to participate in the Long-term Disability Plan. If you are not actively working on the day your coverage should begin, your coverage will be delayed until you return to work.
Enrolling in the STD and LTD Plans

You are automatically enrolled in both Disability Plans after completing your 90th day of service. Payroll deductions begin with your first paycheck after you complete your 90th day. If you do not want the coverage, you must opt out through the Your Benefits Resources web site or by calling the Benefits Choice Center. If you opt out of the Plans, you may enroll in STD and LTD during any rolling 12-month period, but an Evidence of Insurability form is required. Please read the Benefit Reductions section of this chapter carefully. Depending on your personal circumstances, the benefits you may receive from sources other than the STD or LTD Plans may significantly reduce any benefit that the Companys STD or LTD Plans might provide.
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Providing an Evidence of Insurability Form

You must submit an Evidence of Insurability form if you want to enroll in the Disability Plans and: You started work before January 1, 2001, and you did not enroll in disability coverage during your initial enrollment period. You were hired on or after January 1, 2001, and you opted out of automatic enrollment. The Evidence of Insurability form is mailed to your home following enrollment. To approve your request for coverage, Liberty, the Plans insurance company, may require a doctors statement and/or a physical exam. You will be responsible for any related costs. You do not have disability coverage until Liberty receives your completed form and approves your Evidence of Insurability form.
Base pay for hourly associates other than 100% commissioned associates means your regular hourly pay rate in effect as of the date of disability and does not include overtime, bonuses, premiums, incentive pay or any other form of pay from the Company. For 100% commissioned associates, base pay means your bonuses and commissions over the last 52 weeks, or your period of employment if shorter. These benefits are paid on a weekly basis, and you do not pay federal income taxes on the benefits received (unless you are working in New York, see the previous section for additional information).
5. an excused leave of absence (except medical leave for your own disabling condition and lay-off); and 6. an emergency leave of absence (except emergency medical leave for your own disabling condition). In addition, to qualify for short-term disability benefits, you must meet all of the following requirements: The disability period must be expected to last more than seven consecutive calendar days; You must be under the appropriate care and treatment of a qualified physician. This includes receiving treatment from a physician who is licensed and qualified in a discipline suitable to treat the disabling injury or illness. The treatment must: Be necessary to meet your basic health needs and is of demonstrable medical value; Be consistent in type, frequency, and duration of treatment with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies; Be consistent with the diagnosis of your conditions; and Have a purpose that is to maximize your medical improvement. You must not be able to perform the material and substantial duties of your own job; and Liberty must receive certification accompanied by appropriate medical documentation of a disability from your attending doctor before benefits are considered for payment. Liberty has the right to have you examined by a doctor of their choice when and as often as they reasonably choose, at Libertys expense.
Qualifying for Benefits

You must be actively at work on the day your coverage begins. "Actively at work" means the you must be actively at work for The Home Depot: 1. on a full-time and paid regular earnings; 2. for at least 30 hours per week; and either perform such work: a. at The Home Depot's usual place of business; or b. at a location to which The Home Depot business requires you to travel. You will be considered actively at work if you were actually at work on the day immediately preceding: 1. a weekend (except where one or both of these days are scheduled work days); 2. holidays (except when the holiday is a scheduled work day); 3. paid vacations; 4. any non-scheduled work day;
Paying for Your Coverage

Since you pay the premium for short-term and longterm disability coverage with after-tax dollars, you do not have to pay federal income taxes on the benefits you receive. If, however, you are working in the state of New York and receive benefits under the state disability plan, taxes will be deducted for the benefits you receive that are attributable to the portion of the state plan that is paid by the Company.
How the Short-term Disability Plan Works

After seven consecutive calendar days of an illness or injury during which you are unable to work, the Shortterm Disability Plan will pay 60% of base pay for an approved period of disability, not to exceed 25 weeks.
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6. vocational training; or
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How the Plan Pays Benefits

During the first seven consecutive calendar days that you are disabled, you may use any sick or vacation days you have available to receive pay for normally scheduled hours in accordance with Company policy. After the first seven consecutive calendar days, if approved, you will receive 60% of your base pay for the period of short-term disability, not to exceed 25 weeks. If you are receiving income from other sources (or in certain cases are eligible to receive income, such as Social Security benefits), however, your short-term disability weekly benefit will be reduced by the amount of your other income. See Benefit Reductions in this chapter for examples of other income. While an associate is receiving shortterm disability benefits, the premiums required for short-term and long-term disability (if elected) are deducted from the short-term disability benefit. Rehabilitation Program means a program that has been approved by Liberty for the purpose of helping you return to work. It may include but is not limited to, your participation in one or more of the following activities: 1. return to work on a modified basis with a goal of resuming employment for which you are reasonably qualified by training, education, experience and past earnings; 2. on-site modification/accommodation; 3. training to improve job seeking skills; 4. vocational assessment; 5. short-term skills enhancement;
7. restorative therapies, such as physical or occupational therapy and/or psychological or vocational counseling, to improve functional capacity to return to work. If you refuse to participate in a rehabilitation program recommended by Liberty your benefit will not be continued. If you refuse to accept a job with The Home Depot where workplace modifications or accommodations were made to allow you to perform your job, your benefit will not be continued. Recurring Disabilities If you have been receiving disability benefits and return to work for less than 14 calendar days, and then go out on disability again for the same or related cause, the disability, if approved, is considered to be recurring. In this case, the benefit continues through the balance of the 26-week period, from the original date of disability (the seven-calendar-day waiting period plus the approved period of disability of up to 25 weeks), and you do not have to complete another seven-calendar-day waiting period. If you have been receiving disability benefits and return to work for 14 calendar days or more, and then go out on disability again, regardless of the disability reason, a new 26-week period (the seven-calendar-day waiting period plus the approved period of disability up to 25 weeks) begins, if approved. You must satisfy the seven-calendar-day waiting period before the benefit payment would begin.
If you have been receiving disability benefits and return to work for at least one calendar day, and become disabled due to a different or unrelated cause, the disability is considered to be different. If approved, a new 26-week period (the sevencalendar-day waiting period plus the approved period of disability up to 25 weeks) begins. You must satisfy the seven-calendar-day waiting period before the benefit payment can begin. Partial Disability If you become partially disabled immediately following a period of disability in which you were fully disabled for at least the seven-calendar-day waiting period, the Short-term Disability Plan will continue to pay the weekly benefit for the remainder of the 25-week benefit payment period, provided you remain partially disabled and provide proof of disability when requested. The amount of the weekly benefit, when added to any compensation you may earn while partially disabled, cannot exceed 100% of your basic weekly earnings. Partial disability means that due to injury or sickness you: are under the appropriate care of a doctor; can perform at least one of the essential functions of your job or any other job on a part-time or full-time basis; and are earning at least 20% less per week than your base pay prior to the injury or sickness due to that injury or sickness.
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How the Long-term Disability Plan Works

After 26 consecutive weeks of illness or injury, if the disability qualifies as total disability, is expected to continue, and benefits are approved, the Long-term Disability Plan will pay 60% of basic monthly earnings (reduced by other income) for the remainder of the disability, up to the maximum benefit duration. For At Home Services 100% commissioned associates, basic monthly earnings means your bonuses and commissions over the past 52 weeks. For all other hourly associates, basic monthly earnings means your monthly rate of pay in effect as of the date of disability and does not include overtime, bonuses, premiums, incentive pay or any other form of pay from the Company. Long-term disability benefits are paid on a semi-monthly basis.
Age When Disability Begins Less than Age 60 Age 60 Age 61 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and over
Associates who become disabled before age 60 will receive benefits for as long as Liberty approves the disability, up to age 65. Associates who become disabled after age 60 will receive benefits for as long as Liberty approves the disability, up to the maximum benefit duration shown in the chart.
Physician which cannot be diagnosed using tests, procedures or clinical examinations typically accepted in the practice of medicine. Such symptoms may include, but are not limited to, dizziness, fatigue, headache, loss of energy, numbness, pain, ringing in the ear, and stiffness.
Exceptions
The maximum period of disability that the Plan will consider for disabilities due to mental illness, nonverifiable symptoms or nervous disorder; substance abuse, addiction or dependency will be 24 months from the date the disability starts. The 24-month maximum period of disability includes the six-month waiting period and 18 months of benefits. If you are confined to a hospital or institution at the end of this 24-month period, your benefits will be paid during this confinement. If you are not confined but fully participating in a treatment plan at the end of this 24-month period, your benefits will continue for up to 12 additional months. The 24-month maximum period of disability is a lifetime maximum. This means that you are limited to 24 months of benefits in total for the above mentioned disorders. Mental Illness means a psychiatric or psychological condition classified as such in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) regardless of the underlying cause of the Mental Illness. If the DSM is discontinued, Liberty will use the replacement chosen or published by the American Psychiatric Association. Substance Abuse means alcohol and/or drug abuse, addiction or dependency. Non-Verifiable Symptoms means your subjective complaints to a 230

To qualify for long-term disability benefits, your disabling illness or injury must not be the result of a pre-existing condition that causes disability in the first 12 months after your coverage starts. For purposes of this Plan, a pre-existing condition is any injury, illness, or other incapacitating condition for which you received medical care or took prescribed drugs during the 90 days immediately before the effective date of your long-term disability coverage. The Long-term Disability Plan will not pay benefits for any disability that begins in the first 12 months of coverage if it was caused by, was contributed to, or is a result of a pre-existing condition. Disability means that, due to an injury or sickness, you are unable to perform, with reasonable continuity, the material and substantial duties of any occupation. In addition, to qualify for long-term disability benefits: you must be unable to return to work after the initial 26-week period of disability; You must be under the appropriate care and treatment of a qualified doctor. This includes receiving treatment from a doctor whose medical training and clinical experience are suitable for treating your disability. The treatment must: Be necessary to meet your basic health needs and is of demonstrable medical value;
Benefit Duration to age 65 60 months 48 months 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months

Be consistent in type, frequency, and duration of treatment with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies; Be consistent with the diagnosis of your conditions; and Have a purpose that is to maximize your medical improvement. Liberty must consider that you are totally disabled; and Liberty must receive certification with accompanying medical documentation of a disability from your attending physician before benefits are considered for payment. Liberty has the right to have you examined by a physician of their choice when and as often as they reasonably choose, at Libertys expense.
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to receive income such as Social Security benefits), your long-term disability benefits will be reduced by the amount of your other income. See Benefit Reductions in this chapter for examples of other income. While an associate is disabled and receiving longterm disability benefits, the premiums required for long-term disability are waived. Partial Disability When Liberty receives proof that you are Partially Disabled and have experienced a loss of earnings due to injury or sickness and require the regular attendance of a physician, and are receiving appropriate treatment, you may be eligible to receive a monthly benefit, subject to any other provisions of this plan. How is your partial disability benefit calculated? For the first 18 months from your benefit begin date, your benefit will be an amount equal to 60% of your basic monthly earnings. The benefits will only be reduced if the monthly benefit payable plus any earnings exceed 100% of your basic monthly earnings. If the combined total is more, the monthly benefit will be reduced by the excess amount so that the monthly benefit plus your earnings do not exceed 100% of your basic monthly earnings. Thereafter, to figure your partial disability benefit, the formula (A divided by B) X C will be used. A = your basic monthly earnings minus your earnings received while you are partially disabled. This figure represents the amount of lost earnings.
B = your basic monthly earnings C = 60% of your basic monthly earnings plus your earnings received while you are partially disabled. On the first anniversary of benefit payments and each anniversary thereafter, for the purposes of calculating the benefit, the term "basic monthly earnings" is: 1. replaced by "Indexed Basic Monthly Earnings" and 2. increased annually by 7% or the current annual percentage increase in the Consumer Price Index, whichever is less. Partial disability means you, as a result of Injury or Sickness, are able to: 1. perform one or more, but not all, of the Material and Substantial Duties of any Occupation on an Active Employment or a part-time basis; or 2. perform all of the Material and Substantial Duties or Any Occupation on a part-time basis; and 3. earn between 20% and 80% of your Basic Monthly Earnings. In determining whether you are partially disabled, Liberty will not consider employment factors including, but not limited to, interpersonal conflict in the workplace, recession, job obsolescence, paycuts, job sharing and loss of professional or occupational license or certification. For purposes of determining partial disability, the injury must occur and partial disability must begin while you are insured for this coverage.

After 26 weeks of disability, if approved for long-term disability, you will receive 60% of your base pay for the remaining period of disability, up to the maximum benefit duration. The maximum monthly benefit is $5,000; the minimum monthly benefit is $50. If you are a 100% commissioned associate, your benefit is calculated based on your last 52 weeks of pretaxed earnings to include commission and bonus. The wages do not include renewal commissions, overtime pay or other compensation. Your benefit will not change throughout your disability period. However, if you are receiving income from other sources (or in certain cases eligible
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Limited Interruption of the Waiting Period

During the 180-day waiting period for long-term disability, limited interruption of the waiting period is allowed for up to 30 days. Any day of active work in this time will not count toward satisfying the waiting period. This limited interruption will not apply if, while you are actively at work, you become eligible for any group disability insurance. Recurrent Disability If, after a period of long-term disability during which you received benefits under this Plan, you resume your regular job on a full-time basis for less than six consecutive months, a disability which is related or due to the same cause or causes as the prior disability will be part of the same initial period of disability. If you resume work for more than six months, any recurrent disability will be treated as a new period of disability and a new elimination period must be completed. If you become eligible for coverage under any other group long-term disability policy, this recurrent disability provision will not apply. In that case, any recurrent disability will be treated as a new period of disability and a new elimination period must be completed. In the Event of Your Death If you are receiving long-term disability benefit payments at the time of your death, these payments will stop immediately. The Long-term Disability Plan does not provide survivor benefits.
Whats Not Covered Under the Disability Plans

The Short-term and Long-term Disability Plans do not cover a disability caused by or resulting from: 1. War, declared or undeclared, or any act of war; 2. intentionally self-inflicted injuries, while sane or insane; 3. active participation in a riot; 4. the committing of or attempting to commit a felony or misdemeanor; 5. cosmetic surgery unless such surgery is in connection with an injury or sickness sustained while the individual is a covered person; 6. a gender change, including but not limited to any operation, drug therapy or any other procedure related to a gender change.
disability or retirement benefits under the U.S. Social Security Act, the Railroad Retirement Act or any other governmental disability or retirement program. This reduction may apply even if you have not yet applied for benefits you are eligible to receive. any benefits to which your dependents are entitled because of your disability benefits to which you are entitled through no-fault insurance laws any disability benefits for which you are eligible under any other company group or individual insurance plan, or any government retirement system payments from any state STD program a prorated portion of any lump-sum payment you receive from a settlement, judgement award or compromise as compensation for lost income and any degree of impairment or loss of bodily function or capacity any income you earn from employment, including severance benefits If at any time Liberty determines that the total amount paid on a claim is more than the total amount due, including any overpayment resulting from retroactive benefits received from sources listed in Benefit Reductions, Liberty has the right to recover the excess amount from the person to whom such payment was made. Liberty may, at their option, recover the excess amount by reducing or offsetting against any future benefits payable.
Benefit Reductions
Your short-term and long-term disability benefits will be reduced to account for other income you receive while disabled. Other income includes benefits under the following: Workers compensation law, occupational disease laws, unemployment compensation laws or any similar state or federal law any compulsory disability benefits law or act any formal wage or salary payment plan of the Company or any formal or informal sick leave or wage continuation plan
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Estimating Social Security Benefits You are required to show proof that you applied for Social Security disability benefits. If you have not received approval or final denial of your claim from the Social Security Administration by the end of this 24 month period, Liberty reserves the right to begin reducing your Monthly Benefit by an estimate of Social Security benefits. Final denial of your claim means that you have received a "Notice of Denial of Benefits" from an Administrative Law Judge.
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as reasonably possible. If you fail to submit the claim timely, you may not be eligible for disability benefits. Once the claim is submitted, satisfactory proof of loss must be provided to Liberty within 90 days after completion of the waiting period. Failure to furnish such proof within such time shall not invalidate or reduce any claim if it was not reasonably possible to furnish such proof within such time. Such proof must be furnished as soon as reasonably possible, and in no event, except in the absence of legal capacity of the claimant, later than one year from the time proof is otherwise required. Proof of continued loss must be provided to Liberty within 30 days from the request for such proof. If you fail to provide satisfactory proof of loss, you may not be eligible or remain eligible for disability benefits. When you file a claim, by calling Liberty's claim intake office (1-888-404-5096), you should have the following information ready when you report your absence: Personal Information: Name, address, telephone number, e-mail address, date of birth and Social Security number Job Information: Store location, telephone number, occupation, work schedule and supervisors name/number Injury/Illness Information: How, when, and where the injury occurred, nature of the illness, and last day worked
Physician(s) Information: Name(s), address(es), telephone number(s), fax number(s) and e-mail address(es). Information is needed for each treating physician. Your Managers Information: Name, telephone number and e-mail address
When to Report Your Absence

If you are out of work for more than four days and expect your disability to last more than seven days, or if you know in advance that you will be out of work for more than seven days due to an injury, illness, or pregnancy (e.g., a scheduled surgery), call Liberty at 1-888-404-5096 immediately.
Termination of Benefits
Your long-term disability benefits will cease on the earliest to occur of the following: (1) you are no longer disabled; (2) you reach the end of the maximum benefit period; (3) you die; (4) you fail to provide proof of disability or proof that you are under appropriate care and treatment of a qualified doctor; (5) you refuse to cooperate with Liberty Mutual, including refusing an examination, evaluation or appropriate treatment; (6) you refuse to work where workplace modifications or accommodations were made; or (7) you are partially disabled and your earnings exceed 80% of your base pay.
How Your Claims Are Handled

A Liberty disability claims management unit will handle all STD and LTD claims for the Company associates. For important numbers and addresses see Get the Most Value From Your Plan earlier in this chapter.
Appealing a Claim
If your claim is denied as described in the Claims and Appeals chapter, you will receive a formal letter that states the reasons for the denial and outlines the process you must follow if you choose to appeal the denial. To appeal, you must request a review of the claim in writing to:

To file a short-term or long-term disability claim call Liberty at 1-888-404-5096, as soon as you know you will be unable to work more than seven consecutive days. Liberty will then forward any necessary forms to you and your doctor. You must submit a claim to Liberty within 30 days of the date of the loss on which the claim is based. If that is not possible, Liberty must be notified as soon
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Liberty Life Assurance Company of Boston Group Benefits Disability Claims Liberty Life Assurance Company of Boston P.O. Box 7211 London, KY 40742-7211
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Refund to Liberty for Overpayment of Benefits

If at any time Liberty determine that the total amount paid on a claim is more than the total amount due, including any overpayment resulting from retroactive awards received from sources listed in Benefit Reductions, Liberty has the right to recover the excess amount from the person to whom such payment was made. However, Liberty, at their option, may recover the excess amount by reducing or offsetting against any future benefits payable to such person.
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Disability
U.S. Salaried Associates
Chapter Contents
236 236 236 237 237 237 238
How the Short-term Disability Plan Works Enrollment/Qualified Status Changes Short-term Disability Related to Pregnancy and Childbirth How the Short-term Disability Plan Pays Benefits How the Long-term Disability Plan Works You Choose How Your LTD Benefit is Paid Detailed Example of How LTD Options Affect Your Paycheck and LTD Benefit
240 241 241 241 241 241 241 242 242 242
Rehabilitative Work Programs and Partial Disability Limited Interruption of the Waiting Period Recurrent Disability Termination of Benefits In the Event of Your Death Whats Not Covered Under the Long- and Short-Term Disability Plans Benefit Reductions Filing Claims for Benefits Additional Information for Filing Your Disability Claim Appealing a Claim
239 239 239 239
Duration of Long-term Disability Benefits Exceptions Qualifying for Benefits How the Plan Pays Benefits
Disability - Salaried
What do you need?
File an STD claim
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Find it here...
Notify your District HR Manager or manager of your need to file a short-term disability claim or go to myApron.homedepot.com. Notify Liberty as soon as you know youll be unable to work for more than seven days by calling 1-888-404-5096, If you dont submit a claim within 15 days of the first day out of work, you may not be eligible for short-term disability benefits. Liberty Life Assurance Company of Boston (Liberty) will automatically transition your STD claim to LTD approximately midway through the 26-week waiting period. You do not have to contact Liberty separately to initiate the LTD claim. Call Liberty at 1-888-404-5096. Send a fax to 1-866-578-7144; or mail to: Liberty Group Benefits Disability Claims Liberty Life Assurance Company of Boston P.O. Box 7211 London, KY 40742-7211
File an LTD claim Check the status of an STD or LTD claim Provide information to Liberty
The short-term disability portion of your disability benefits is not an ERISA (Employee Retirement Income Security Act of 1974) plan. ERISA rules and regulations, therefore, do not apply. Salaried short-term disability is provided under the terms of the Short-Term Disability for Salaried Associates SOP. This SPD includes a summary of those benefits, but the terms of the SOP shall govern if there is any conflict.
To request a leave of absence (LOA), store salaried associates should contact their District HR Manager. Non-store salaried associates should contact their Manager. He or she will provide you with the necessary information you will need to apply for this benefit. In addition, salaried associates must call Liberty Mutual at (888) 404-5096 to report a claim for shortterm disability.
Short-term Disability Related to Pregnancy and Childbirth

For Maternity Leave in connection with pregnancy and childbirth, you will receive full pay for the period you are physically unable to perform your job, as certified by the third-party administrator, based on medical information provided by your physician. This may be a combination of time before and after childbirth. Typically, the recovery period after childbirth is six weeks for a normal delivery and eight weeks for a cesarean section. You will receive pay for six weeks from the start of your Maternity Leave. If you are still physically unable to perform your job, the third-party administrator will certify the disability based on medical information provided by your physician. Upon receipt of this certification, your salary will be continued for the remaining period that you are physically unable to perform your job, up to a total maximum of 90 days. Once you are released from your physicians care, any available Maternity Leave to care for your child will be unpaid.
How the Short-term Disability Plan Works

The Home Depot provides you with short-term disability coverage for salaried associates who are unable to work due to personal illness or injury. If you are unable to perform the essential duties of your job or the duties of any suitable alternative position due to an illness or injury that is expected to last for a period of seven days or more, you will receive your regular bi-weekly pay for the period approved by the third-party administrator, up to a maximum of 90 days.
Enrollment/Qualified Status Changes

You are automatically enrolled in short-term disability and Long-term Disability. If you are not actively working on the day your coverage should begin, your coverage will be delayed until you return to work. These benefits are provided to you by the Company at no cost.
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How the Short-term Disability Plan Pays Benefits

You will receive your full pay for the period you are physically unable to work, not to exceed 90 days. If you are receiving income from other sources, such as Workers Compensation or a state-mandated short-term disability plan (California, New Jersey, Rhode Island, New York or Hawaii), your pay will be reduced by the amount of your other income. Salaried associates who work in California, New Jersey or Rhode Island must file a claim for shortterm disability benefits with their state disability office. Salaried associates who work in New York or Hawaii must file a claim for short-term disability benefits with Liberty Life Assurance Company of Boston (Liberty). See Benefit Reductions in this chapter for additional examples of other income. If you refuse to participate in a rehabilitation program recommended by Liberty and accommodated by The Home Depot, your benefit will not be continued. For more information on short-term disability benefits, see the Short-Term Disability for Salaried Associates SOP, available at myapron.homedepot.com (Click on My HR Pay & Benefits, scroll down to Benefits and Wellness and then Disability Management. In the search box enter LOA Short-Term Disability and select the Salaried HR SOP.) Or get a copy of the SOP by calling the Human Resources Service Center at 1-866-698-4347. The Short-Term Disability for Salaried Associates SOP is incorporated herein by reference.
How the Long-term Disability Plan Works

If the illness or injury for which you receive salary continuation qualifies as total disability, is expected to continue beyond 90 days, and if benefits are approved, the Longterm Disability Plan will pay the lesser of: 60% of base pay plus bonuses (which will be referred to as basic monthly earnings) for the remainder of the disability, to the maximum benefit duration; or If you receive income from certain other sources (other income), the Plan will instead pay 70% of base pay reduced by your other income for the remainder of the disability, up to the maximum benefit duration. Basic monthly earnings means your monthly rate of pay, including annual bonuses, in effect as of the date of disability, and does not include overtime, premiums, incentive pay or any other form of pay from the Company. These long-term disability benefits are paid on a monthly basis. The maximum monthly benefit is $25,000; the minimum benefit is $100. Your benefit will not change throughout your disability period.
You Choose How Your LTD Benefit is Paid

When you are hired and each year during your annual enrollment period, you can choose to receive any longterm disability benefits payable to you as a tax-free or taxable benefit: Tax Plan Cost Tax on Benefit Under the Tax Plan Cost option: The LTD premium paid for your coverage by The Home Depot will be charged to you as income and you will pay income taxes on the premium. Any LTD disability benefit you receive will be tax-free income to you. Under the Tax on Benefit option: The LTD premium paid for your coverage by The Home Depot will not be charged to you as income and you will not pay income taxes on the premium. Any LTD disability benefit you receive will be taxable income to you. If you dont make a choice during your annual enrollment session, youll be defaulted into the tax on plan option. You cannot change your choice until the next annual enrollment period.
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Here is an example of how the tax plan cost and the tax on benefit options affect the biweekly paycheck and the annual LTD benefit of an associate making $70,000 a year:
$70,000 a year salary Tax Plan Cost option Tax on Benefit option Net biweekly paycheck amount $1,699.84 Net Annual LTD benefit $42,000
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Tax Plan Cost

Paycheck Example: Earnings Regular Company Paid LTD Premium1 Taxes (on $2,707.95) $2,692.31 FICA Med (1.45%) $15.64 $39.27
Tax on Benefit
Paycheck Example: Earnings Regular $2,692.31 Taxes (on $2,692.31) FICA Med (1.45%) $39.04
FICA OASDI (6.2%) $167.89 Federal State $676.99 $108.32 $992.47 $1,699.84 GROSS PAY $2,692.31
FICA OASDI (6.2%) $166.92 Federal State Total Taxes NET PAY
2
$673.08 $107.69 $986.73 $1,705.58
$1,705.58
$26,607 GROSS PAY $2,707.95
Total Taxes NET PAY

2
As you can see, the tax plan cost option lowers your biweekly paycheck due to tax withholding on the company-paid premiumin this $70,000 salary example, it lowers each biweekly paycheck by $5.74 or $149.24 a yearbut provides a higher LTD benefit.
1 Taxable Income, not actual income 2 Net Pay reduced by $5.74 per paycheck or $149.24 annually
Impact on LTD Benefit (if approved for LTD) Impact on LTD Benefit (if approved for LTD) Annual LTD benefit (60% of annual base pay) Income Tax on Premium Paid by Company Annual LTD Benefit After Taxes $42,000 ($70,000 x 60%) $0 $42,000 Annual LTD before taxes (60% of annual base pay) Income tax on Benefit Received (assumes 25% federal, 4% state and 7.65% FICA=36.65%) Annual LTD Benefit After Taxes $42,000 ($70,000 x 60%) $15,393 ($42,000 x 36.65%) $26,607 ($42,000 - $15,393)
Detailed Example of How LTD Options Affect Your Paycheck and LTD Benefit
This example shows how each of the LTD options affects the paycheck and LTD benefit of an associate earning $70,000 a year.
Example Associate Profile Annual Base Pay Federal Income Tax Rate (based on single filing status) State Tax Rate FICA Total Tax Company Paid Biweekly LTD Premium for Annual Base Pay of $70,000 $70,000 25% 4% 7.65% 36.65% $15.64
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Duration of Long-term Disability Benefits

Associates who become disabled before age 60 receive benefits up to age 65. Associates who become disabled after age 60 will receive benefits for a limited period of time, as shown in the chart.
Age When Disability Begins Less than age 60 At age 60 but less than 61 At age 61 but less than 62 At age 62 but less than 63 At age 63 but less than 64 At age 64 but less than 65 At age 65 but less than age 75 At age 75 and older Benefit Duration To age 65 To age 65 48 months 42 months 36 months 30 months 24 months 12 months
Mental Illness means a psychiatric or psychological condition classified as such in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) regardless of the underlying cause of the Mental Illness. If the DSM is discontinued, Liberty will use the replacement chosen or published by the American Psychiatric Association. Substance Abuse means alcohol and/or drug abuse, addiction or dependency. Non-Verifiable Symptoms means your subjective complaints to a Physician which cannot be diagnosed using tests, procedures or clinical examinations typically accepted in the practice of medicine. Such symptoms may include, but are not limited to, dizziness, fatigue, headache, loss of energy, numbness, pain, ringing in the ear, and stiffness.
tion and after 24 months of benefit payments, you are unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation. For officers of The Home Depot, Disability means that, due to injury or sickness during the Elimination Period and until the officer reaches the end of the maximum LTD benefit period, the officer is unable to perform the Material and Substantial Duties of his or her own occupation. To qualify for long-term disability benefits: you must be unable to return to work after the initial 90-day period of disability you must continue to be under the appropriate care of a qualified doctor (qualified doctors include legally licensed physicians and practitioners who are not related to you and who are performing services within the scope of their licenses) Liberty must receive and approve certification with accompanying medical documentation of a disability from your attending doctor before benefits are considered for payment

To qualify for long-term disability benefits, your disabling illness or injury must not be the result of a pre-existing condition that causes disability in the first 12 months after your coverage starts. For purposes of this Plan, a pre-existing condition is any injury, illness or other incapacitating condition for which you were diagnosed or received medical care or took prescribed drugs during the 90 days immediately before the date your long-term disability coverage started. The Long-term Disability Plan will not pay benefits for any disability that begins in the first 12 months of coverage if it was caused by, contributed to, or is a result of a pre-existing condition. Disability means that, due to an injury or sickness during the 90 day waiting period and for the next 24 months of disability, you are unable to perform the Material and Substantial Duties of your own occupa-
Exceptions
The maximum period of disability that the Plan will consider for disabilities due to mental illness, nonverifiable symptoms or nervous disorders; substance abuse, addiction or dependency will be 24 months from the date the disability starts. The 24-month maximum period of disability includes the six-month waiting period and 18 months of benefits. The 24-month maximum period of disability is a lifetime maximum. This means that you are limited to 24 months of benefits in total for the above mentioned disorders.

After 90 days of salary continuation, if approved, you will receive the lesser of: 60% of base pay plus bonuses (known as basic monthly earnings) for the remainder of the disability, up to the maximum benefit duration, or
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If you receive income from certain other sources or, in certain cases, are eligible to receive income from other sources (other incomesee Benefit Reductions in this chapter for examples of other income), the Long-term Disability Plan will instead pay 70% of basic monthly earnings reduced by your other income for the remainder of the disability, up to the maximum benefit duration. If you are approved for a long-term disability benefit, this benefit may be paid to you from other income, the Long-term Disability Plan or a combination of both.
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If you refuse to participate in a rehabilitation program recommended by Liberty your benefit will not be continued. If you refuse to accept a job with The Home Depot where workplace modifications or accommodations were made to allow you to perform your job, your benefit will not be continued. When Liberty receives proof that you are Partially Disabled and have experienced a loss of earnings due to injury or sickness and require the regular attendance of a physician, and are receiving appropriate treatment, you may be eligible to receive a monthly benefit, subject to any other provisions of this plan. How is your partial Disability Benefit Calculated? For the first 24 months from your benefit begin date, your benefit will be an amount equal to 60% of your basic monthly earnings. The benefits will only be reduced if the monthly benefit payable plus any earnings exceed 100% of your basic monthly earnings. If the combined total is more, the monthly benefit will be reduced by the excess amount so that the monthly benefit plus your earnings do not exceed 100% of your basic monthly earnings. Thereafter, to figure your partial disability benefit, the formula (A divided by B) X C will be used. A = your basic monthly earnings minus your earnings received while you are partially disabled. This figure represents the amount of lost earnings. B = your basic monthly earnings C = 60% of your basic monthly earnings plus your earnings received while you are partially disabled.
On the first anniversary of benefit payments and each anniversary thereafter, for the purposes of calculating the benefit, the term "basic monthly earnings" is: 1. replaced by "Indexed Basic Monthly Earnings" and 2. increased annually by 7% or the current annual percentage increase in the Consumer Price Index, whichever is less. Partial Disability means you, as a result of Injury or Sickness, are able to: 1. perform one or more, but not all, of the Material and Substantial Duties of your Own Occupation or any Occupation on an Active Employment or a parttime basis; or 2. perform all of the Material and Substantial Duties of your Own Occupation or Any Occupation on a parttime basis; and 3. earn between 20% and 80% of your Basic Monthly Earnings. In determining whether you are partially disabled, Liberty will not consider employment factors including, but not limited to, interpersonal conflict in the workplace, recession, job obsolescence, paycuts, job sharing and loss of professional or occupational license or certification. For purposes of determining partial disability, the injury must occur and partial disability must begin while you are insured for this coverage.
Rehabilitative Work Programs and Partial Disability

Rehabilitation Program means a program that has been approved by Liberty for the purpose of helping you return to work. It may include but is not limited to, your participation in one or more of the following activities: 1. return to work on a modified basis with a goal of resuming employment for which you are reasonably qualified by training, education, experience and past earnings; 2. on-site modification/accommodation; 3. training to improve job seeking skills; 4. vocational assessment; 5. short-term skills enhancement; 6. vocational training; or 7. restorative therapies, such as physical or occupational therapy and/or psychological or vocational counseling, to improve functional capacity to return to work.
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Limited Interruption of the Waiting Period

During the 90-day waiting period for long-term disability, limited interruption of the waiting period is allowed for up to 90 days. Any day of active work in this time will not count toward satisfying the waiting period. This limited interruption will not apply if, while you are actively at work, you become eligible for any other group disability insurance.
appropriate treatment; (6) you refuse to work where workplace modifications or accommodations were made; or (7) you are partially disabled and your earnings exceed 80% of your basic monthly earnings.
Active Participation in a riot; The committing of or attempting to commit a felony or misdemeanor; Cosmetic surgery unless such surgery is in connection with an injury or sickness sustained while the individual is a covered person; or A gender change, including but not limited to any operation, drug therapy or any other procedure related to a gender change.
In the Event of Your Death

If you are receiving long-term disability benefit payments at the time of your death, the Long-term Disability Plan will pay your surviving spouse a onetime, lump-sum payment equal to three times your gross monthly benefit. If there is no surviving spouse, the benefit is divided equally among children under age 25. If there is no spouse and no children under the age of 25, the benefit will be payable to your estate.
Recurrent Disability
If after a period of long-term disability during which you received benefits under this Plan, you resume your regular job on a full-time basis for less than 12 consecutive months, any recurrent disability will be part of the same initial period of disability. If you resume work for more than 12 months, any recurrent disability will be treated as a new period of disability and a new 90-day waiting period must be completed. If you become eligible for coverage under any other group long-term disability policy, this recurrent disability provision will not apply. In that case, any recurrent disability will be treated as a new period of disability and a new 90-day waiting period must be completed.
Benefit Reductions
Your short-term disability and long-term disability benefits will be reduced to account for other income you receive while disabled. Other income includes benefits under the following: Workers Compensation law, occupational disease laws, unemployment compensation laws or any similar state or federal law any compulsory disability benefits law or act any formal wage or salary payment plan of the Company or any formal or informal sick leave or wage continuation plan disability or retirement benefits under the United States Social Security Act, the Railroad Retirement Act, or any similar plan or act. This reduction may apply even if you have not yet applied for benefits you are eligible to receive. any benefits to which your dependents are entitled because of your disability benefits to which you are entitled through no-fault insurance laws
Whats Not Covered Under the Long- and Short-Term Disability Plans
For information about whats not covered under the Short-term Disability Plan, see the Short-Term Disability for Salaried Associates SOP, available at myapron.homedepot.com (Click on My HR Pay & Benefits, scroll down to Benefits and Wellness and then Disability Management. In the search box enter LOA Short-Term Disability and select the Salaried HR SOP.) Or get a copy of the SOP by calling the Human Resources Service Center at 1-866-698-4347. The Short-Term Disability for Salaried Associates SOP is incorporated herein by reference. The Long-term Disability Plan does not cover a disability caused by or resulting from: War, declared or undeclared, or any act of war; Intentionally self-inflicted injuries, while sane or insane; 241
Termination of Benefits
Your long-term disability benefits will cease on the earliest to occur of the following: (1) you are no longer disabled; (2) you reach the end of the maximum benefit period; (3) you die; (4) you fail to provide proof of disability or proof that you are under appropriate care and treatment of a qualified doctor; (5) you refuse to cooperate with Liberty Mutual, including refusing an examination, evaluation or
any disability benefits for which you are eligible under any other group or individual insurance plan sponsored by any company or any government retirement system as a result of your job payments from any state STD program a prorated portion of any lump-sum payment you receive from a settlement, judgement, award or compromise as compensation for lost income and any degree of impairment or loss of bodily function or capacity any income you earn from employment, including severance benefits If at any time Liberty determines that the total amount paid on a claim is more than the total amount due, including any overpayment resulting from retroactive awards received from sources listed in Benefit Reductions, Liberty has the right to recover the excess amount from the person to whom such payment was made. Liberty may at their option, recover the excess amount by reducing or offsetting against any future benefits payable. You are required to show proof that you have applied for Social Security benefits. If you have not received approval or final denial of your claim from the Social Security Administration by the end of this 24-month period, we will begin reducing your Monthly Benefit by an estimate of Social Security benefits.
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To file a short-term disability or long-term disability claim: Notify your District Human Resources Manager or manager to apply for a medical leave of absence; and Contact Libertys Claim Intake Center at 1-888404-5096 to report your Short-term Disability and Long-term Disability claim; and Go to the Your Benefits Resources web site at http://resources.hewitt.com/homedepot If you do not submit a claim within 90 days of the end of the 90-day waiting period, you may not be eligible for long-term disability benefits.
Physician(s) information: Name(s), address(es), telephone number(s), fax number(s) and e-mail address(es). Information is needed for each treating physician District Human Resources Manager (DHRM) information: Name, telephone number and e-mail address
Appealing a Claim
If your claim is denied, you will receive a formal letter that states the reasons for the denial and outlines the process you must follow if you choose to appeal the denial. See the Claims and Appeals chapter of this book for more information.
Additional Information for Filing Your Disability Claim

You should have the following information ready when you report your disability: Personal information: Name, address, telephone number, e-mail address, date of birth and Social Security number Job information: Store location, telephone number, occupation, work schedule and supervisors name/number Injury/illness information: How, when and where the injury occurred, the nature of the illness and last day worked
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Accidental Death & Dismemberment

Chapter Contents
244 244 244 244 244 245 246 246 247
Basic AD&D Insurance Home Depot-Provided Basic AD&D Coverage for Full-Time Hourly Associates Home Depot-Provided Basic AD&D Coverage for Salaried Associates Voluntary AD&D Insurance Associate-Only Voluntary AD&D Option Family Voluntary AD&D Option AD&D Benefits Full Amount of Benefits Payable Continuing Basic/Voluntary AD&D When Coverage Ends
247 248 248 249 249 249 250 250 250
Continuing Coverage through Portability Whats Not Covered Under the Basic AD&D Plan Whats Not Covered Under the Voluntary AD&D Plan Filing Claims for Benefits Appealing a Claim Designating a Beneficiary Payment of Benefits Basic AD&D Voluntary AD&D

What do you need?
Enroll in coverage Designate your beneficiary Certify your domestic partner relationship Get a Domestic Partner Declaration Request a benefit be paid
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Find it here...
Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954. Go to Your Benefits Resources at http://resources.hewitt.com/homedepot Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954. Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice Center at 1-800-555-4954. Call the Benefits Choice Center at 1-800-555-4954 and speak with a Representative. You must provide written proof of any claim within 90 days after the date of loss.
Basic AD&D Insurance

Under the Basic AD&D Plan, you automatically receive coverage from the Company at no cost to you. You are not required to enroll in the Medical Plan to receive this benefit. This insurance covers death and injury caused solely by an accident.
Voluntary AD&D Insurance

You can purchase additional coverage through the Voluntary AD&D Insurance options. In deciding whether you need additional coverage, please keep in mind the following points: AD&D benefits are paid only when you are involved in an accident and within one year of the accident your injuries result in death or other losses as outlined in the AD&D Benefits chart. AD&D benefits are not paid for death as a result of natural causes. You must be actively at work for new Voluntary AD&D Insurance coverage to take effect. Actively at work means that you are performing all of the material duties of your job with the Company where these duties are normally carried out.
If you were actively at work on your last scheduled working day, you will be deemed actively at work: on a scheduled non-working day provided you are not disabled If you and your spouse, or same- or opposite-sex domestic partner, work for the Company, see If You and Your Spouse or Same-Sex Domestic Partner Both Work for the Company in the Eligibility and Enrollment chapter.
Home Depot-Provided Basic AD&D Coverage for Full-Time Hourly Associates

Under the Basic AD&D Plan, full-time hourly associates automatically receive coverage equal to $20,000 from the Company.
Associate-Only Voluntary AD&D Option

You can buy coverage equal to one to ten times your annual base pay (rounded to the next higher multiple of $1,000, if not already a multiple of $1,000), up to a maximum of $500,000. Annual base pay means: For full-time hourly associates: your hourly base pay rate multiplied by 2,080 (40 hours per week times 52 weeks).
Home Depot-Provided Basic AD&D Coverage for Salaried Associates

Under the Basic AD&D Plan, salaried associates automatically receive coverage equal to $100,000 from the Company and $250,000 for officers.
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For salaried associates: your regular pay and any portion of your regular pay that you defer. Annual base pay does not include overtime, bonuses, premiums, incentive pay or other forms of Company pay. For example, if your base pay is $16,650, you can buy: $17,000 (1x your annual base pay); $34,000 (2x your annual base pay); $51,000 (3x your annual base pay); continuing up to $170,000, which is ten times your annual base pay. When you are covered under the Associate-Only Voluntary AD&D Option, the Plan will pay an additional 10% of your benefit, up to a $10,000 maximum, if your death is the result of injuries from driving or riding in a private passenger car while wearing a properly fastened seat belt. Passenger car means any validly registered fourwheel private passenger car. It does not include: any commercially licensed car; or a private passenger car, which is being used for commercial purposes. Seat belt means any child restraint device that meets the definition of the state law in the jurisdiction of the state of residence of the individual; or any other restraint device which: meets published federal safety standards; has been installed by the car manufacturer; and has not been altered after such installation.
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The correct position of the seat belt must be certified by the investigating officer. A copy of the accident report must be submitted with the claim. Minnesota Life will not pay a seat belt benefit if the person driving was under the influence of alcohol or drugs. An amount equal to the full benefit amount is paid for a covered loss if you are unavoidably exposed to the elements as a result of a covered accident. If after one year your body has not been found after the transportation in which you were traveling either disappeared, made a forced landing, sank or was wrecked, it shall be presumed, subject to policy terms, that you died as a result of a covered accident. After four days of hospitalization for treatment of a covered accidental injury, you will receive a benefit while hospitalized of 1% of your selected benefit amount up to a maximum of $1,000 per month, for up to 12 months.
Spouses, or same- or opposite-sex domestic partner's, coverage equals 80% of your selected benefit amount, and each eligible dependent childs insurance equals 10% of your selected benefit amount. If your spouse or same- or opposite-sex domestic partner has a loss of life from a common accident, the spouse/domestic partner benefit will increase to 100% of associates amount of AD&D insurance. Additional 10% of your covered spouses, or sameor opposite-sex domestic partners, benefit, and your covered dependent childrens benefits, up to $10,000 maximum per person, if death is the result of injuries from driving or riding in a private passenger car while wearing a properly fastened seat belt. See Associate-Only Voluntary AD&D Option for more information. An amount equal to the full benefit amount is paid for loss of life of your covered spouse, or same- or opposite-sex domestic partner, and your covered dependent children if death results from unavoidable exposure to the elements and if, after one year, the covered persons body has not been found after the transportation in which the covered person was traveling either disappeared, made a forced landing, sank or was wrecked. If you die as a result of an accident while your spouse or same-or opposite-sex domestic partner is not employed, then if your spouse or same- or opposite-sex domestic partner enrolls in an accredited school for the purpose of training or refreshing skills needed for employment within one year of the accident, this option provides a benefit for costs incurred from enrolling for one year in such school (up to a maximum benefit of $5,000).
Family Voluntary AD&D Option

You can purchase Voluntary AD&D coverage for yourself, your spouse, or same- or opposite-sex domestic partner, and your dependent children (from live birth). Your spouse, or same- or opposite-sex domestic partner, is eligible for benefits up to his or her 70th birthday. See the Eligibility and Enrollment chapter for more information on dependent eligibility. With the Family Voluntary AD&D Option, you have the same coverage as you would with the AssociateOnly Option, and your covered spouse and covered dependent children have the following coverage:
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If you die as a result of an accident, this option provides for each dependent child an annual amount equal to 2% of your selected benefit amount, but not more than $6,000 per year, if such child, on the date of the accident, was: enrolled as a full-time student in a college, university or vocational school above the 12th-grade level; or at the 12th-grade level and subsequently enrolls as a full-time student in a college, university or vocational school within 365 days following the date of the accident. The education benefit for dependent children is payable for a maximum of four consecutive years as long as the dependent child remains a full-time student as described above. If there are no dependent children who qualify for the education benefit for dependent children on the date of your death, an additional benefit of $1,000 is paid to your beneficiary. After four days of hospitalization for treatment of a covered accidental injury, a benefit for your spouse, or same- or opposite-sex domestic partner, and your covered dependent children while hospitalized will be 1% of your selected benefit amount, up to a maximum of $1,000 per month, for up to 12 months.
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AD&D Benefits
If you are involved in an accident and your injuries result in death or loss of limb within one year of the date of the accident, the Plan will pay one of the following benefits:
% of Benefit Amount 100% 100% 100% 100% 75% 50% 50% 50% 25%
If your injuries result in a loss of a limb(s), you will receive the benefit payable under the Plan. If your injuries result in death, your designated beneficiary(ies) will receive the benefit payable under the plan. See Designating a Beneficiary in this chapter, for more information on beneficiaries.
Full Amount of Benefits Payable

For all covered losses caused by all injuries which you sustain in one accident, or a dependent sustains in one accident, not more than the full amount will be paid. Full amount means the amount of AD&D benefits: for which you are covered on the date of your accident; or that is in effect for that dependent on the date of that dependent's accident.
Type of Loss Loss of life Loss of two or more members1 Loss of speech and loss of hearing in both ears2 Quadriplegia3 Paraplegia3 Loss of one member1 Loss of speech or loss of hearing in both ears2 Hemiplegia3 Loss of thumb and index finger of same hand4
1 Member refers to hand, foot or eyesight. Loss of a hand means that all of the hand is cut off at or above the wrist. Loss of a foot means that all of the foot is cut off at or above the ankle. Loss of eyesight means that the eye is entirely blind and that no sight can be restored in that eye. 2 Loss of speech and hearing means the entire and irrecoverable loss which has lasted continuously for 12 consecutive months following the injury. 3 Quadriplegia means total paralysis of both upper and lower limbs. Paraplegia means total paralysis of both lower limbs. Hemiplegia means total paralysis of upper and lower limbs on one side of the body. Paralysis means loss of use, without severance, of a limb. Paralysis must be determined by competent medical authority to be permanent, complete and irreversible. 4 Loss of thumb and index finger means actual severance through or above the third joint from the tip of the index finger and the second joint from the tip of the thumb.
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Continuing Basic/Voluntary AD&D When Coverage Ends
You may elect to continue through portability your Basic AD&D, Voluntary AD&D, and Family Voluntary AD&D Dependent if you meet one of the following qualifications: your employment has ended due to voluntary termination of employment, leave, layoff, retirement or dismissal; or
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you cease to be in a class that is eligible for such insurancefor example, you have a change in employment status (e.g., full-time to part-time). If you would like to continue coverage through portability, call Minnesota Life at 1-866-293-6047 and the necessary forms will be mailed to you. You have the latter of 31 days from the date your coverage ends or 15 days from the date this notice was given, if notice is given more that 15 days from the date benefits were terminated. In no event will this period extend beyond 91 days from the date benefits were terminated.
Continuing Coverage through Portability

You may elect to continue AD&D coverage on you and your dependents lives for the same or a lower amount of insurance that you were receiving immediately before termination under the group term life plan subject to an overall minimum of $10,000 of your term life insurance. Costs may differ from your current payroll deduction but are generally less expensive than an individual permanent life policy. Coverage may continue up to the lesser of age 80 for associates and up to age 70 for dependents.
Portability: Continue Your Group Term Life, Including AD&D, with Minnesota Life
Eligible coverage Type of insurance following election Eligibility timing Events allowing portability/conversion Not allowed for Guaranteed issue Maximum age to elect Minimum amount allowed Maximum amount allowed Basic Term Life and AD&D coverage, Voluntary Term Life and AD&D coverage and Dependent Term Life coverage can be ported. Dependent coverage can only be ported if associate coverage is ported. Group Term life, Accidental Death & Dismemberment (AD&D) Must be elected within 31 days of event below Coverage is lost due to: Termination of employment Layoff or leave Other loss of eligibility Terminated disabled associates Termination of group policy Nonpayment of premium All guaranteed issue Associate: age 79; Spouse: spouse's age 69; Child: qualifying age or associate's age 79 Associate: $10,000; Spouse/child: no minimum Previous Amount In Force, Not to exceed the maximum amount allowed under the Company-provided benefits. See the applicable maximums by plan within this chapter and the Life Insurance chapter. No increases. Decreases available Associate coverage reduces to 65% at age 70 and 50% at age 75 Associate: age 80; Spouse: spouses age 70 or associates age 80; Child: qualifying age limit or associates age 80 No change Available at any time after porting but not more than 31 days after ported coverage terminates
Increases/decreases available Age reductions Termination age Effect of group contract termination on coverage already ported or converted Availability of conversion option 1 Subject to state availability. U.S. Salaried & Full-Time Hourly Associates
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Whats Not Covered Under the Basic AD&D Plan

The Basic AD&D Plan will not pay benefits for death or dismemberment that is caused directly or indirectly by, results from, or where there is a contribution from, any of the following: Self-inflicted injury or self destruction, whether sane or insane; Suicide or attempted suicide, whether sane or insane; The insureds participation in or attempt to commit a crime, assault, felony, or any illegal activity, regardless of any legal proceedings, or the absence of any legal proceedings, thereto; or Bodily or mental infirmity, illness or disease; The use of alcohol, drugs, medications, poisons, gases, fumes or other substances taken, absorbed, inhaled, ingested or injected, unless taken upon the advice of a licensed physician in the verifiable prescribed manner and dosage; Motor vehicle collision or accident where the insured is the operator of the motor vehicle and this insureds blood alcohol level meets or exceeds the level at which intoxication is defined in the state where the collision or accident occurred, regardless of any legal proceedings, or the absence of any legal proceedings, thereto; Infection, other than infection occurring simultaneously with, and as a direct result of, the accidental injury;
Physical or mental illness or diagnosis of or treatment for the illness; Travel in or descent from any aircraft, except as a fare-paying passenger on a regularly scheduled commercial flight on a licensed passenger aircraft carrier; War or any act of war, whether declared or undeclared; or Service in the military of any nations excluding the U.S. National Guard.
Bacterial infection, other than infection occurring simultaneously with, and as a result of, the accidental injury; Travel or flight in or on any vehicle used for aerial navigation including getting in, out, on, or off such vehicle, if the insured is: Riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or Acting as a pilot or a crew member of any aircraft, unless riding as a passenger; or Riding as a passenger in a non-chartered aircraft which is owned, leased, operated, or controlled by the eligible Associates employer; or A student taking a flying lesson, unless riding as a passenger; or Hang gliding; or Parachuting, except when the insured has to make a parachute jump for self-preservation; or War or any act of war, whether declared or undeclared; Riot or civil insurrection; or Service in the military of any nation excluding the U.S. National Guard.
Whats Not Covered Under the Voluntary AD&D Plan

The Voluntary AD&D Plan will not pay benefits for death or dismemberment that is caused directly or indirectly by, results from, or where there is a contribution from, any of the following: Suicide or attempted suicide, whether sane or insane; Intentionally self-inflicted injury or any attempt at self-inflicted injury, whether sane or insane; or The insureds participation in or attempt to commit a crime, assault or felony; Bodily or mental infirmity, illness or disease; Physical or mental illness or diagnosis of or treatment for the illness; Alcohol, drugs, poisons, gases or fumes, voluntarily taken, administered, absorbed, inhaled, ingested or injected;
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The Benefits Choice Center must be notified within 30 days after the date of loss if you or a family member covered by Basic AD&D and Voluntary AD&D Plans is injured or dies. Upon notification, a benefits representative in the Benefits Choice Center will provide the beneficiary with the appropriate claim forms. Your beneficiaries must complete and return the forms, along with other required information, to Minnesota Life for processing. When a claim is pending: If after reviewing all available medical information, Minnesota Life determines that an additional medical exam is necessary, Minnesota Life will specifically request one and that exam will be paid at Minnesota Lifes expense. Any other medical examination not specifically requested by Minnesota Life will not be paid by Minnesota Life. If an autopsy has not already been performed, and Minnesota Life determines one is necessary for claim determination purposes and not against the law, Minnesota Life will specifically request an autopsy be performed at Minnesota Lifes expense. The beneficiary is still required to submit the autopsy report of any non-Minnesota Life requested autopsy as necessary for a claim.
Proof of a claim for AD&D benefits must be provided to Minnesota Life no later than 90 days after the date of loss. Failure to provide such notice within 30 days and proof of loss within 90 days will not invalidate the claim if it is shown that notice and proof were given as soon as reasonably possible.
Designating a Beneficiary
You may designate the same beneficiary(ies) for all plans, or different beneficiaries for each Plan. However, the associate is automatically the beneficiary of all dependent AD&D insurance benefits. You can change your beneficiary(ies) at any time. You can designate or change beneficiaries, on the Your Benefits Resources web site. You may want to change the designation of your beneficiary from time to time. To change your beneficiary designation, you must go to the Your Benefits Resources web site at http://resources.hewitt.com/homedepot. If there is no designated beneficiary at your death, any benefits for these Plans will be paid in equal shares in the following manner: your spouse or same- or opposite-sex domestic partner (as defined in the Eligibility and Enrollment chapter of this document); your surviving natural and adopted children; your parents; your surviving brothers and/or sisters; or your estate. However, Minnesota Life instead can pay the benefit to your estate. Any such payment discharges all liability for the amount paid. Benefits will not be paid to a beneficiary who has been convicted of murdering the covered person.
Appealing a Claim
If your claim is denied as described in the Claims and Appeals chapter, you will receive a formal letter that states the reasons for the denial and outlines the process you must follow if you choose to appeal the denial. To appeal, you must request a review of the claim in writing to: Minnesota Life Group Division Claims P.O. Box 64114 St. Paul, MN 55164-0114
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Payment of Benefits
Basic AD&D
The AD&D benefits for a covered loss will be paid when Minnesota Life receives notice and satisfactory written proof of that loss: to your beneficiary for the loss of your life; and to you for any other covered loss sustained by you; and to you for the loss of life of a dependent, if you survive the dependent; if you do not survive, the benefits will be paid to your estate. to you for any other covered loss sustained by a dependent, if you survive that dependent; otherwise the benefits will be paid to your estate.
Voluntary AD&D
The Voluntary AD&D benefits for a covered loss will be paid when Minnesota Life receives notice and satisfactory proof of that loss. Any training benefit for a spouse, or same- or opposite-sex domestic partner, will be paid to your spouse and any education benefit for dependent children will be paid to each dependent child. All other Voluntary AD&D benefits will be paid: to your beneficiary for the loss of your life; and to you for any other covered loss sustained by you; and to you for the loss of life of a dependent, if you survive the dependent; if you do not survive, the benefits will be paid to your estate. to you for any other covered loss sustained by a dependent, if you survive that dependent; otherwise the benefits will be paid to your estate.
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FutureBuilder
Chapter Contents
252 What Is FutureBuilder? 252 Whos Eligible 253 How to Enroll 253 254 What Is Considered Eligible Compensation? Changing Your Contribution Rate and Investment Elections 260 What Is Vesting? 260 What Is a Break in Service? 261 Your Investment Options 262 BlackRock LifePath Portfolios 262 LifePath Retirement Portfolio
269 Large Cap Growth Fund 269 Mid Cap Value Fund 269 Mid Cap Growth Fund 270 International Fund 270 Small Cap Value Fund 271 Small Cap Growth Fund 271 Home Depot Stock Fund 272 Notice of Your Rights Concerning Employer Securities 272 Your Rights Concerning Home Depot Stock
275 276 277 278
Confirmation of Your Transaction Loans from Your Account Hardship Withdrawals In-Service Withdrawals
276 Accessing Your Plan Balance
263 LifePath 2015 Portfolio 263 LifePath 2020 Portfolio 263 LifePath 2025 Portfolio
278 Military Leave Distributions 278 Final Distributions of Your Account 280 Tax Considerations 281 How to Obtain Additional Information 281 Dividends 281 Forfeitures 281 When Benefits Are Not Paid 282 Right to Amend or Terminate the Plan 282 Implied Promises 282 Limiting Liability 282 Your Rights Under ERISA 285 Glossary of Investment Terms
254 Choosing a Beneficiary 254 Contributions to FutureBuilder 254 254 255 256 257 258 258 258 259 259 Your Contributions Before-tax Contributions Roth After-Tax 401(k) Contributions Catch-up Contributions If You Are Age 50 or Older How the Companys Matching Contribution Works Rollover Contributions If You Are on Military Leave Calculating the Company Match How Your Contributions are Invested Savings Limitations
264 LifePath 2030 Portfolio 264 LifePath 2035 Portfolio 265 LifePath 2040 Portfolio 265 LifePath 2045 Portfolio 266 LifePath 2050 Portfolio 266 FutureBuilder Core Funds 267 Stable Value Fund 267 Bond Fund 267 Balanced Fund 268 Large Cap Value Fund 268 Large Cap Index Fund
272 The Brokerage Window: Schwab PCRA 274 Different Investments Carry Different Risk and Return 274 Trading Restrictions 274 Notice of Importance of Diversification 275 Keeping Track of Your Account 275 FutureBuilder Statements
FutureBuilder
What do you need?
Begin building your future by enrolling Stay on top of your future by tracking your account performance Increase or decrease your contribution rate Apply for a loan Complete beneficiary election
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Find it here...
Go to http://resources.hewitt.com/homedepot or call the Benefits Choice Center at 1-800-555-4954
What Is FutureBuilder?
The sooner you begin contributing to FutureBuilder, the longer your money has to grow. Through the Plan, you can generally save anywhere from 1% to 50% of your pay, subject to certain limitations. For 2011, the IRS considers an associate who earned $110,000 in 2010 to be a highly compensated employee (HCE). HCEs can contribute between 1% and 8%. The Plans Administrative Committee may adjust the maximum contribution percentage from time to time. For example, the Administrative Committee increased the HCE contribution from 7% to 8% on September 1, 2009. This contribution limit will be referred to as the HCE limit subsequently in this chapter. For more information, go to the Your Benefits Resources web site or call the Benefits Choice Center.
As an incentive to save, the Company adds $1.50 to your account for every $1 you save on the first 1% of your pay, and 50 cents for every additional $1 you save from 2% to 5% of your pay. You must complete at least one year of service (at least 1,000 hours in a 12-month period), before your Company contributions begin. You can invest your account in the following three tiers to develop your investment portfolio: Tier One: BlackRock LifePath portfolios; Tier Two: FutureBuilders core funds; and Tier Three: The Schwab Personal Choice Retirement Account (PCRA), a self-directed brokerage window. You have direct access to your account information by accessing the Your Benefits Resources web site or by calling the Benefits Choice Center. Contact Schwab for information about your brokerage account.
If you leave the Company, youre entitled to the vested balance youve earned in FutureBuilder. You always have ownership of the money you put into FutureBuilder, including your before-tax, Roth after-tax 401(k) and rollover contributions.
Whos Eligible
Associates (other than those classified by the Company as temporary employees) are eligible to participate in the Plan after completing 90 days of service. If you are employed by the Company when 90 days have passed since you were first hired, you are eligible to make before-tax and/or Roth after-tax contributions, without regard to any intervening termination, leave of absence, reemployment, etc. Company matching contributions begin the first day of the calendar quarter beginning on or after the date you complete one year of service (at least 1,000 hours in a 12-month period), if you have enrolled.
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FutureBuilder
You are credited with hours of service for the calendar year in which you receive compensation for those hours. For example, you were not paid for some of the hours you worked in December 2010 until the January 2011 payroll. Because you were paid for those hours in January 2011, you will receive credit for those hours in 2011, even though you worked those hours in 2010. If you do not work at least 1,000 hours during your first 12 months of employment with the Company, your Company matching contributions will begin after completing 1,000 hours of service during any plan year (January 1December 31) that begins after you first become employed by the Company. Once eligible, you can begin participating at any time. If you dont enroll once you become eligible, you can enroll anytime thereafter. If you are classified by the Company as a temporary employee, you will be eligible to participate in the Plan on the first day of the calendar quarter beginning on or after the date you complete one year of service (at least 1,000 hours in a 12-month period).
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How to Enroll
You must enroll in FutureBuilder to start saving in the plan. On your hire date, you will receive an enrollment CD which contains FutureBuilder information. To enroll, you can: Access the Your Benefits Resources web site. Call the Benefits Choice Center, and speak to a representative. If you enroll by phone, a confirmation statement will be mailed to your home on the next business day. If you enroll through the web site, you should print a copy of your enrollment as your confirmation. When you enroll in FutureBuilder, you will need to choose: Your contribution rate. This is the percentage of pay that will be deducted from each of your paychecks. You can save anywhere from 1% to 50% of your pay, in whole percentages unless you are subject to the HCE limit. You also can choose to have your contribution percentage automatically increased through automatic escalation. If you choose automatic escalation, your FutureBuilder contribution percentage will automatically be increased by 1% each year up to a maximum target rate of 10% through the Quick Enrollment Process, or you can choose your own automatic contribution percentage increase and maximum target rate (up to 50%, unless you are an HCE). If you make your contribution rate escalation election by October 5th, your rate will be increased the following January 5th. You will receive a reminder
notification of your escalation election in December should you want to make changes prior to the escalation in January. Your investment elections. You must choose where you want contributions invested. See Your Investment Options. If you dont make an investment election, your contributions will be invested in the appropriate LifePath fund based on your age. Company match investment. The Plan allows you to choose where you want your matching contributions invested. If you don't make an investment election, your matching contributions will be invested using the same investment approach you have chosen for your own contributions.
What Is Considered Eligible Compensation?

For purposes of determining your contributions to the Plan, eligible compensation is defined as: Your Form W-2 wages; plus Any before-tax deferrals you make under a cafeteria plan and the 401(k) portion of the Plan; minus All reimbursements, expense allowances, fringe benefits, moving expenses, welfare benefits, and other similar amount; minus Wages paid before you become eligible for the Plan; minus Amounts paid as settlements and judgments; minus Amounts paid as in-kind awards or prizes and grossups on those amounts; minus Income attributable to stock options, restricted stock or other equity awards
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FutureBuilder
Please note that the IRS specifies a limit on the amount of annual compensation that may be taken into account when determining your payroll deductions to FutureBuilder. This dollar limit is an indexed amount and may change from time to time to reflect inflation. In 2011, the amount is $245,000.
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Choosing a Beneficiary
As a participant of FutureBuilder, you have the right to designate the beneficiary(ies) to receive your account balance in the event of your death. You can designate one or more individuals, a trust, or an estate as your beneficiary. You can designate your beneficiary(ies) by accessing the Your Benefits Resources web site. You should be sure that FutureBuilder has up-todate beneficiary designation information at all times. If you are married and designate anyone other than your spouse as beneficiary, a Beneficiary Designation Form will be sent to you. The designation will not be valid unless your spouse consents in writing on the Beneficiary Designation Form. Your spouses consent must be notarized. If you do not have a valid Beneficiary Designation on file when you die, or if your designated beneficiary does not survive you or cannot be located, your account will be paid to your surviving legal spouse, if any, or to your estate if you do not have a surviving legal spouse. No benefits are paid to any person responsible for a participants death.
Contributions to FutureBuilder
Your account is made up of your own before-tax contributions, Roth after-tax contributions, Company matching contributions, ESOP contributions previously made, and any rollover contributions you may make.
Changing Your Contribution Rate and Investment Elections

Once you have made your enrollment decisions, you can change your contribution rate or investment elections by using the Your Benefits Resources web site or calling the Benefits Choice Center. If you change your contribution rate before 1 a.m. (Eastern Time) on any Friday the week before your next payday, your change should be effective for your next paycheck. You will get a written confirmation in the mail if you make your changes over the phone. If you make your changes using the Your Benefits Resources web site, you should print a copy as your confirmation. A confirmation will always be mailed for investment election changes no matter how the election is made. If you are subject to the Companys Insider Trading Policy, any change in your investment elections, including investments within the brokerage window, or contribution rate must be made in compliance with the policy. Keep in mind that when you save through FutureBuilder, there is flexibility. In fact, you can stop contributing to the Plan by accessing the Your Benefits Resources web site or calling the Benefits Choice Center and changing your contribution rate to 0%. You can always resume contributions at any time.
Your Contributions
You can contribute from 1% to 50% of your pay in before-tax and/or Roth after-tax contributions to the Plan, in any whole percentage, unless you are subject to the HCE limit. Contributions are deducted automatically from your paycheck.
Before-tax Contributions
When you save with before-tax dollars, you save on your income taxes. Your contributions to the plan do not count as current income on your tax return, which means you do not pay current income taxes on what is set aside in the Plan. As a result, you defer paying federal and, in most cases, state and local income taxes on your FutureBuilder savings until you withdraw them or receive a distribution from the Plan.
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In the following example, if you save on a before-tax basis through FutureBuilder, you have an extra $375 in take-home earnings compared to savings on an after-tax basis. The example assumes you are single, that your eligible compensation is $25,000 and you contribute 10% of that amount to FutureBuilder as before-tax savings. The estimated federal taxes are based on the IRS 2010 tax table. In this example, the tax amount is $837.50 on the first $8,375 of taxable compensation, plus 15% of the amount over $8,375. Tax Credit for Before-Tax FutureBuilder Contributions
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Roth After-Tax 401(k) Contributions

Roth after tax 401(k) contributions are deducted from your net paycheck after Federal, state, and other employment taxes are withheld. Although contributions are subject to these taxes, they are not calculated based off of your net paycheck. Roth after-tax contributions are calculated based off of eligible compensation. The investment earnings on Roth contributions grow tax-free and remain tax-free even when you withdraw them during retirement, provided its a qualified withdrawal (generally, if youre age 59 or older and the withdrawal is made at least five years after making your first Roth contribution to FutureBuilder). Investment earnings on any other type of contribution to the FutureBuilder Plan (before-tax and Company matching contributions) are tax-deferred while in the Plan, but those earnings will be taxed when you make a withdrawal. Generally speaking, if you expect to be in a higher tax bracket in retirement than you are now (whether you expect higher taxable income or increased tax rates), Roth contributions might be a good choice. Roth contributions wont reduce your taxable income today, but after you retire and receive a qualified withdrawal, the Roth contributions, as well as earnings on those contributions, will be tax-free. If you expect to be in a lower tax bracket in retirement than you are now, before-tax contributions, in general, might be the better option. Consult your tax advisor.
You may be eligible to receive a federal tax credit equal to 10%, 20% or 50% of your annual FutureBuilder contribution, up to $1,000 if you file a: Single return and have annual income of $28,250 or less Joint return and have annual income of $56,500 or less Head-of-household return and have annual income of $42,375 or less
Tax Savings Comparison

Before-tax Savings Eligible Compensation Before-tax Contribution Taxable Compensation Estimated Federal Taxes Eligible Compensation after Taxes After-Tax Savings Remaining Take-Home Earnings $25,000 - $2,500 $22,500 - $2,956 $19,544 N/A $19,544 After-tax Savings $25,000 N/A $25,000 - $3,331 $21,669 - $2,500 $19,169
The percentage that applies is determined by your income level. Your spouse is able to do the same thing, so your family could receive a total tax credit of as much as $2,000. Heres an example of how it works. If you and your spouse had a combined income of $32,000, filed a joint tax return, and together contributed $4,000 ($2,000 each) to FutureBuilder, youd be eligible for a 50% tax credit. You would pay $2,000 ($4,000 x 50%) less in income taxes for the year. Certain conditions apply so check with your tax advisor for more information.
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Comparison of Traditional Before-tax 401(k) Contributions and Roth After-tax 401(k) Contributions
Traditional 401(k) Contributions
How are your contributions deducted from your pay? How do your contributions affect your current taxes?
Roth 401(k) Contributions
Contributions are deducted from before-tax pay Contributions are deducted from after-tax pay. They are subject to income tax withholding and are calculated based off of eligible compensation. Current taxable income is reduced so your current tax bill is lower Current taxable income is not reduced so there is no effect on your current tax bill Yes
Do contributions count toward the annu- Yes al contribution limit of $16,500? (See IRS Limits) Are contributions eligible for Company matching contributions? Are contributions available for loans and hardship withdrawals? When will you pay taxes on your contributions? Yes, up to FutureBuilder limits (up to 3.5% on your first 5% of pay) Yes
Yes, up to FutureBuilder limits (up to 3.5% on your first 5% of pay) Yes
Income taxes are paid on your contributions You have already paid taxes on your contributions, so no taxes are when you receive a distribution, unless your due if you receive a qualified distribution (Note: Does not apply to distribution is rolled over into an IRA or anoth- Company-matching contributions) er qualified employer-sponsored plan Income taxes are paid on investment earnings when you receive a distribution, unless your distribution is rolled over into an IRA or another qualified employer-sponsored plan No taxes are due on earnings from your Roth after-tax contributions if the withdrawal is a qualified distribution or if your distribution is rolled over into an IRA or another qualified employer-sponsored plan. Earnings on before-tax Company matching contributions will be taxed since those contributions have not yet been taxed. amount, such as $200, for your catch-up contribution election. That amount will be contributed out of each regular paycheck. Once you have made a catch-up contribution election, you won't have to elect a new catch-up contribution amount each year, unless you want to increase or decrease your contribution. Your catch-up election automatically will be carried over to the next year. Catch-up Contributions Limit For 2011, the catch-up contribution limit is $5,500. For example, you could elect to make catch-up contributions each pay period that would result in
When will you pay taxes on your investment earnings?
Catch-up Contributions If You Are Age 50 or Older

Catch-up contributions may allow associates who are age 50 or older to save even more in their FutureBuilder accounts than they normally could due to IRS or plan contribution limits. This can help you save even more as you approach retirement. Who Can Make Catch-up Contributions You are eligible to contribute catch-up contributions if you will be age 50 or over by the end of the current year. For example, you may start making catch-up contributions for 2011 even if you are not yet age 50 as long as you will turn age 50 by the end of 2011.
What is Considered Eligible Compensation In general, eligible compensation for catch-up contributions is the same as FutureBuilder eligible compensation. See What Is Considered Eligible Compensation earlier in this chapter. How to Elect Catch-up Contributions In order to make catch-up contributions, you have to be enrolled in FutureBuilder. You then can elect the amount you wish to contribute in catch-up contributions. You can choose to make catch-up contributions as before-tax and/or Roth after-tax contributions. Unlike your regular contribution elections that you make in percentages, you must elect a whole dollar 256
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an annual amount of $3,000 in before-tax contributions and $2,500 in Roth after-tax contributions. Its a good idea to annually review your contributions and make any changes that are appropriate. How Catch-up Contributions Are Made Like regular FutureBuilder contributions, you make catch-up contributions through convenient, automatic payroll deductions. Generally, catch-up contributions can only be made if you reach the IRS limit on contributions to FutureBuilder. For example, in 2011, the IRS contribution limit is $16,500. However if you qualify for catch-up contributions, you are allowed to contribute up to an additional $5,500, meaning that you could have contributed a total of $22,000 to your FutureBuilder account in 2011. In addition, if you are subject to the HCE limit and you contribute the maximum amount you are allowed under the HCE limit, you can make catch-up contributions (as long as you meet the catch-up contribution age restriction). For example, if in 2011, you contributed the HCE maximum and you qualified for catch-up contributions, you could have contributed up to an additional $5,500 to your FutureBuilder account in 2011.
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You also may contribute catch-up contributions if, as a result of the Plans non-discrimination testing, a portion of your regular contributions would be refunded to you. If you are eligible to receive a refund, the amount of the refund (or a portion of the amount) will be reclassified as a catch-up contribution if you meet the catch-up contribution age restriction. If your refund (or a portion of the amount) needs to be reclassified as a result of the testing, you do not need to elect the catch-up contribution. The catch-up contribution, in this case, will be made automatically. Catch-up Contributions and Company Match Catch-up contributions are not eligible to be matched, even if the catch-up contributions are reclassified as regular contributions. For more information on the Company match, see How the Companys Matching Contribution Works in this chapter.
if you save 5% to 50%, then the Company will contribute an amount equal to 3.5% of your pay. The Company match is determined and made on the same frequency as your regular, before-tax and/or Roth after-tax contributions, typically on a biweekly basis. Heres a snapshot of the boost you can get:
Your total FutureBuilder contributions equal this much of your pay 2.5% 4% 5.5% 7% 8.5% to 53.5%
If your contribution equals this much of your pay 1% 2% 3% 4% 5% to 50%

1
The Company match will equal this percentage of your pay1,2 1.5% 2% 2.5% 3% 3.5%
How the Companys Matching Contribution Works

For most associates, the Company will contribute $1.50 for every $1 you contribute on the first 1% of your pay, and 50 cents for each additional $1 you save from 2% to 5% of your pay. That means that
1 Youll receive a matching contribution on up to 5% of your pay, but generally you can save as much as 50% of your eligible pay. 2 The Company match on your contributions applies to your before-tax and Roth after-tax 401(k) contributions combined.
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This example shows how the Companys matching contribution is calculated for an associate with an annual eligible compensation of $20,000 who is contributing 7% of eligible compensation to FutureBuilder. This assumes that the associate begins making contributions on January 1 on a biweekly basis and continues making contributions to December 31 of the same year.
Rollover Contributions
If you are an active associate and eligible to participate in the Plan, on or after your eligibility date after completing 90 days of service, you may roll over any eligible distribution you receive from another eligible employer retirement plan sponsored by a previous employer or from an Individual Retirement Account (IRA). You may also roll over amounts distributed from a Section 403(b) or a Section 457 plan or amounts you contributed directly to an IRA. However, with the exception of Roth Rollovers, the Plan will not accept any amounts representing aftertax contributions you made to a prior employer's plan or an IRA. Only direct Roth rollovers will be accepted from qualified plans with Roth accounts. Indirect Roth rollovers and rollovers from Roth IRAs are not permitted. You may obtain more information about rollovers or request a rollover contribution form by accessing the Your Benefits Resources web site or calling the Benefits Choice Center and speaking to a representative.
Calculating the Company Match

Calculating the contributions for The first 1% of pay The next 4% of pay Next 2% of pay Total = 7% of Pay Associate Contribution $200 $20,000 x .01 = $200 $800 $20,000 x .04 = $800 $400 $20,000 x .02 = $400 Associate Contribution = $1,400 Company Match $300 $200 x 1.5 = $300 $400 $800 x .5 = $400 $0 Company Match = $700 Total Contribution $500 $200 + $300 = $500 $1,200 $800 + $400 = $1,200 $400 $400 + $0 = $400 Total Contributions = $2,100
The Company Match in Action Here is an example to show how matching contributions can add up at various contribution levels for an associate with an annual eligible compensation of $20,000, assuming you make contributions starting January 1 on a biweekly basis and continuing to December 31 of the same year.
Total Company Contribution Total Associate Contribution Total Contributions $1,700 $1,400 $1,100 $800 $500 $300 $200 1% $400 $400 2% $600 3% $500 $800 $600 $1,000 $1,200 $700 $1,900 $700
If You Are on Military Leave

$2,100 $700
$1,400
If you are on Military Leave and you are eligible to receive supplemental pay, your contributions to FutureBuilder will be made at the same percentage rate of participation you had elected before going on leave, unless you change the election, which can be done at any time. Corresponding Company matching contributions will continue to be deposited into your account.
4%
5%
6%
7%
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Upon re-employment after Military Leave, you may: Make up missed contributions that could have been made during the period of military service Receive Company matching contributions to the extent that you make up missed contributions that could have been made during the period of military service The period allowed for make-up contributions may be up to three times the length of military leave, but the make-up period may not exceed five years. The amount of your make-up contributions cannot exceed the amount that you would have been allowed to make had you remained continuously employed, reduced by the contributions you made from supplemental pay. How Your Company Matching Contributions Are Invested
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The Plan allows you to choose where you want your matching contributions invested. If you don't make an investment election, your matching contributions will be invested using the same investment approach you have chosen for your own contributions.
There is also a limit on the amount of your compensation used in determining your contributions to the Plan. The dollar limit on annual compensation is an indexed amount and may change from time to time. In 2011, this amount is $245,000. Your FutureBuilder contributions will be stopped once you have made contributions that reach the IRSdetermined annual contribution limit of $16,500 or the dollar limit on annual compensation of $245,000 or higher, whichever happens first. To ensure that contributions to the Plan are balanced between associates at lower and higher pay levels, the IRS rules could place further restrictions on the amount higher paid associates may contribute to the Plan. You will be notified if this applies to you. If youre affected by total annual contribution limits under federal law, the amounts you and the Company contribute on your behalf may be limited. Total annual contributions to certain benefit plans like FutureBuilder cannot exceed 100% of your compensation or $49,000 for 2011, whichever is less, under federal law. If youre affected by these limits, youll be notified.
Savings Limitations
Plan Limits For 2011, the IRS considers an associate who earned $110,000 or more in 2010 to be a highly compensated employee (HCE). HCEs contributions are subject to certain limitations. IRS Limits The IRS places the following restrictions on contributions to FutureBuilder: The combined amount of before-tax and Roth after-tax contributions you can make each calendar year is limited to a specific dollar amount. This amount, which the IRS adjusts to reflect inflation from time to time, in 2011 is $16,500, less any contributions you made to another eligible employer-sponsored retirement plan in the same year. If your combined contributions under FutureBuilder and another employer-sponsored plan exceed this limit for a given year, you must notify the Benefits Choice Center no later than March 1 of the next year in order to obtain a corrective distribution.
How Your Contributions are Invested

You decide how to invest the Companys and your contributions. If you change your mind, you can always access the Your Benefits Resources web site or call the Benefits Choice Center to change how your future contributions will be invested, how your current balance is invested, or both. The investment elections you choose for your own contributions will apply to both before-tax and Roth contributions. How Your Catch-up Contributions Are Invested Any catch-up contributions you make will be invested using the same investment approach that you have chosen for your own contributions. You can change how your contributions are invested at any time.
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What Is Vesting?
You earn ownership of Company matching contributions and the investment earnings on those amounts based on how long youve worked for the Company and its affiliates. This is called vesting. The vesting chart shows when you become vested for each type of contribution based on your years of service. For vesting purposes, a year of service is any calendar year in which you complete at least 1,000 hours of service. Keep in mind that all years of service from the date you start working at the Company are considered for vesting, even if you were not enrolled in FutureBuilder. You always have ownership of the money you put into FutureBuilder, including your before-tax, Roth after-tax, catch-up, and rollover contributions and all investment earnings on your contributions. This money is yours to take from the plan if you leave the Company and its affiliates. You should be aware, however, that if you take a distribution of the money from your account, you will have to pay taxes unless you roll over your distribution to an IRA or another employers plan. This will not apply to your Roth after-tax contributions and the earnings on your Roth after-tax contributionsthis money will not be taxed if you take a qualified distribution (generally, if youre age 59 or older and the withdrawal is made at least five years after making your first Roth contribution). However, you will pay taxes on any company matching contributions that apply to your Roth after-tax contributions. In addition, regardless of your service, you automatically become 100% vested in all Company contribuU.S. Salaried & Full-Time Hourly Associates
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FutureBuilder Vesting Schedule

Years of Service Less than 3 3 4 5 or more* Your Contributions and Earnings Always 100% Matching Contributions and Earnings 0% 100% ESOP Contributions and Earnings 0% 20% 40% 100%
* Effective January 1, 2010, associates with five years of employment will be vested in the Companys matching and ESOP contributions.
tions and earnings if, while you are employed by the Company and its affiliates: you reach five years of employment; you reach age 65; you become permanently and totally disabled; or you die.
If you return after a one-year break in service, but before a five-consecutive-year break in service: you will be eligible to rejoin the Plan immediately your FutureBuilder account will be reinstated and any amount forfeited from your account at termination will be restored, and once you have completed one year of service following your rehire date, all years of service accumulated prior to the break in service will be recognized for vesting purposes. If you return after more than a five-consecutive-year break in service: you will be eligible to rejoin the Plan immediately any amounts forfeited from your account at termination will not be restored, and all years of vesting service accumulated prior to the break in service will be recognized for vesting purposes once you have completed one year of service following your rehire date, if you were at least partially vested in your contributions or Company contributions.
What Is a Break in Service?

You will incur a break in service if you are not credited with at least one hour of service in the calendar year. If this happens for five consecutive calendar years, you will incur a five-consecutive-year break in service for vesting purposes. If you leave the Company and its affiliates after you become a participant in the Plan, but later return to work, the following break in service rules will apply: If you return before a one-year break in service: you will be eligible to rejoin the Plan immediately you will retain the years of service you had before your termination, and any amounts forfeited from your account at termination will be restored. 260
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Your Investment Options
FutureBuilder offers a wide variety of investment options allowing you to tailor a savings approach that suits your individual needs. The three-tiered investment structure contains LifePath Portfolios in Tier One, FutureBuilder core funds in Tier Two and a self-directed brokerage account in Tier Three. This investment structure allows you to: Choose a single LifePath fund; or Invest in FutureBuilder core funds only or the selfdirected brokerage account only; or Use a combination of FutureBuilder core funds and the self-directed brokerage account to develop your investment portfolio. The FutureBuilder Investment Committee continuously monitors the performance of each FutureBuilder core and LifePath fund to make sure the funds continue to be good investment options for associates, and may eliminate or add funds or change investment managers at any time. The following descriptions represent the FutureBuilder investment funds when this Benefits Summary was published but you should visit the 401(k) page on Your Benefits Resources web site for the most upto-date information on your investment fund options. Remember, you can transfer or change your investment elections at any time by accessing Your Benefits Resources web site at http://resources.hewitt.com/homedepot or by calling the Benefits Choice Center at 1-800-555-4954.
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Please remember, the Company and its affiliates make no guarantee of the performance of any of the investment options offered through FutureBuilder. Sometimes unfavorable market conditions can affect even the most conservative funds. None of the options are guaranteed not to lose money. No person with the Company or representing the Company is authorized to make any statement or give any assurance otherwise. For an explanation of many common investment terms, see the Glossary later in this chapter. Tier One: BlackRock LifePath PortfoliosIf you invest in a LifePath Portfolio, all you need to do is determine the target year when you want to start withdrawing your FutureBuilder savings. Based on the answer to that question, you can determine which LifePath Portfolio is the right starting point for you. Once you do that, you will not need to take any action to change LifePath Portfolios as you pass through the different stages of life, unless you choose to do so. Your portfolio is managed by a team of investment professionals and these professionals will change the portfolios asset mix for you over time. This option works well for individuals who do not have the time or interest needed to manage their own investments.
FUTUREBUILDER THREE-TIERED INVESTMENT STRUCTURE Very Knowledgeable Tier Three Brokerage Window General Level of Investment Knowledge
Tier Two
Core Funds
Tier One
LifePath Portfolios
Less Knowledgeable
Tier Two: Core FundsIn addition to the LifePath Portfolios, you can invest in any combination of FutureBuilder's core funds in 1% increments. Each of the core funds represents a different kind of investment (asset class) and has a different objective. Therefore, each offers a different level of risk and return potential. This option works well for individuals who prefer to construct their own portfolio, and are willing to commit more time to managing their own investments. This requires that you know your objectives, understand the risks involved in investing, periodically review your strategy and investments and make any adjustments needed to rebalance your account. If you choose this approach, you may want to take advantage of the FutureBuilder financial advisory service to help you make your decisions, or consult a professional financial advisor of your own.
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Tier Three: Self-Directed Brokerage Account Through the Schwab PCRA brokerage account, you can customize your portfolio even more than the Tier Two option by selecting from a wide variety of mutual funds and from most publicly traded stocks and bonds. This option works well for individuals who are experienced, knowledgeable investors, are willing to commit a significant amount of time managing their investments, and are comfortable paying applicable brokerage transaction fees that will be charged to their account.
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designed to reduce fluctuations in the value of your investment as the time that you will need your money approaches. One portfolioLifePath Retirementdoes not include a number because it is designed for people currently withdrawing their money or very close to retirement. The percentages of holdings for these funds are subject to change. Log on to Your Benefits Resources web site for the most current percentage information.
LifePath Retirement Portfolio

Official Fund Name: LifePath Index Retirement Portfolio
Investment Objective
The LifePath Retirement Portfolio is designed to provide a complete investment solution for investors who are retired or close to retirement by diversifying among many asset classes, with the largest percentages in U.S. fixed income and smaller holdings in U.S. equities. Although achieving reasonable levels of income generation is important for investors in retirement, it makes sense to have some of the portfolios assets in stocks, as most investors will still need some protection against inflation during their retirement years.
BlackRock LifePath Portfolios

The BlackRock LifePath portfolios are designed to be complete investment solutions for individual investors. You choose a LifePath portfolio based on the year you expect to need your moneygenerally, the year you plan to retire. The LifePath portfolios are diversified among many different asset classes (stocks, bonds and money market instruments) and adjusted over time to gradually become more conservative as your target retirement year approaches. You wont need to change LifePath portfolios as you become older (unless you choose to do so)the portfolios mix of investments will change for you over time. Each LifePath portfolio has a number in its name (such as 2020 in LifePath 2020) that represents the approximate year you plan to start withdrawing your money. As you get closer to this year, the investment mix is gradually shifted from a greater concentration of higher-risk investments (stock funds) to a greater concentration of lower-risk investments (bond funds and money market instruments). This shift is
Date of Birth* 1983 or greater Between 1978 & 1982 Between 1973 & 1977 Between 1968 & 1972 Between 1963 & 1967 Between 1958 & 1962 Between 1953 & 1957 Between 1948 & 1952 1947 or less
LifePath Portfolio Default LifePath 2050 LifePath 2045 LifePath 2040 LifePath 2035 LifePath 2030 LifePath 2025 LifePath 2020 LifePath 2015 LifePath Retirement
Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentage in U.S. fixed income (bonds) and U.S. equities (stocks). As of June 30, 2010, the percentage of holdings in these two asset classes was roughly 63.1% U.S. bonds and 25.2% U.S. stocks, with the balance of the portfolio in international stocks and real estate.
Risk and Return Characteristics

Conservative Aggressive
* Assumes retirement at age of 65.
Fees: See FutureBuilder Investment Expenses.
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LifePath 2015 Portfolio
Official Fund Name: BlackRock LifePath Index 2015 Portfolio
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of their investors as they age. The LifePath 2015 Portfolio has a moderately conservative asset mix as it has approximately 4 years to go before reaching its most conservative asset mix in 2015. Fees: See FutureBuilder Investment Expenses.

The LifePath 2015 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2013 and 2017. The portfolio is weighted toward an investment mix that has potentially less risk or volatility, while still holding some growth-oriented assets such as stocks to provide a limited amount of inflation protection

The LifePath 2020 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2018 and 2022. The portfolio is generally weighted toward investments with higher growth potential (such as stocks), while still using diversification to moderate the price fluctuations that these investments typically incur over the short to medium term.
All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2020 Portfolio has a moderately conservative asset mix as it has approximately 9 years to go before reaching its most conservative asset mix in 2020. Fees: See FutureBuilder Investment Expenses.
Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentage in U.S. fixed income (bonds) and U.S. equities (stocks). As of June 30, 2010, the percentage of holdings in these two asset classes was roughly 51.5% U.S. bonds and 31.9% U.S. stocks, with the balance of the portfolio in international stocks and real estate. These percentages are adjusted over time to gradually become more conservative as the portfolio gets closer to 2015. When it reaches its target year (2015), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.

The LifePath 2025 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2023 and 2027. The portfolio is generally weighted toward investments with higher growth potential (such as stocks), while still using diversification to moderate the price fluctuations that these investments typically incur over the short to medium term.
Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentage in U.S. fixed income (bonds) and U.S. equities (stocks). As of June 30, 2010, the percentage of holdings in these two asset classes was roughly 41.8% U.S. Bonds and 37.8% U.S. stocks, with the balance of the portfolio in international stocks and real estate. These percentages are adjusted over time to gradually become more conservative as the portfolio gets closer to 2020. When it reaches its target year (2020), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.

All LifePath Portfolios slowly reduce their risk and return over time to respond to the changing needs
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Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentages in U.S. fixed income (bonds), U.S. equities (stocks) and international equities. As of June 30, 2010, the percentage of holdings in these three asset classes was roughly 33.4% U.S. bonds, 42.9% U.S. stocks and 18.7% in international stocks, with the balance of the portfolio in real estate. These percentages are adjusted over time to gradually become more conservative as the portfolio gets closer to 2025. When it reaches its target year (2025), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.
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The LifePath 2030 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2028 and 2032. The portfolio is weighted toward investments with higher growth potential (such as stocks), while being less concerned with the inevitable price fluctuations that these investments typically incur over the short to medium term.
All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2030 has a balanced asset mix as it has approximately 19 years to go before reaching its most conservative asset mix in 2030. Fees: See FutureBuilder Investment Expenses.

Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentages in U.S. equities (stocks), U.S. Fixed Income (bonds) and international equities. As of June 30, 2010, the percentage of holdings in these three asset classes was roughly 47.3% U.S. stocks, 26% U.S. bonds and 20.5% in international equities with the balance of the portfolio in real estate. These percentages are adjusted over time to gradually become more conservative as the portfolio gets closer to 2030. When it reaches its target year (2030), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.

The LifePath 2035 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2033 and 2037. The portfolio is weighted toward investments with higher growth potential (such as stocks), while being less concerned with the inevitable price fluctuations that these investments typically incur over the short to medium term.
All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2025 Portfolio has a balanced asset mix as it has approximately 14 years to go before reaching its most conservative asset mix in 2025. Fees: See FutureBuilder Investment Expenses.
Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentages in U.S. equities (stocks) and international stocks. As of June 30, 2010, the percentage of holdings in these two asset classes was roughly 51.4% U.S. stocks and 22.4% international stocks, with the balance of the portfolio in U.S. bonds and real estate. These percentages
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are adjusted over time to gradually become more conservative as the portfolio gets closer to 2035. When it reaches its target year (2035), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.
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Asset Allocation
The portfolio is diversified among many asset classes, with the largest percentage in U.S. equities (stocks) and international stocks. As of June 30, 2010, the percentage of holdings in these two asset classes was roughly 55.2% U.S. stocks and 24.1% international stocks, with the balance of the portfolio in U.S. bonds and real estate. These percentages are adjusted over time to gradually become more conservative as the portfolio gets closer to 2040. When it reaches its target year (2040), it will be at its most conservative asset mix. At that time, the assets of this portfolio will be blended in the LifePath Retirement Portfolio. All investors in this portfolio will then own units in LifePath Retirement going forward.

The LifePath 2045 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2043 and 2047. The portfolio is heavily weighted toward investments with higher growth potential (such as stocks), while being less concerned with the inevitable price fluctuations that these investments typically incur over the short to medium term.

All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2035 portfolio has a moderately aggressive asset mix as it has approximately 24 years to go before reaching its most conservative asset mix in 2035. Fees: See FutureBuilder Investment Expenses.
Asset Allocation


The LifePath 2040 Portfolio is designed to be a complete investment solution for investors who expect to retire between 2038 and 2042. The portfolio is heavily weighted toward investments with higher growth potential (such as stocks), while being less concerned with the inevitable price fluctuations that these investments typically incur over the short to medium term.
All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2040 Portfolio has an aggressive asset mix as it has approximately 29 years to go before reaching its most conservative asset mix in 2040. Fees: See FutureBuilder Investment Expenses.
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The diagram below shows how the BlackRock LifePath portfolios compare to each other in terms of risk and return potential.
LifePath Retirement LifePath 2015 LifePath 2020 LifePath 2025 LifePath 2030 LifePath 2035 LifePath 2040 LifePath 2045 LifePath 2050
More Conservative Generally Lower Return Lower Risk Lower Volatility
More Aggressive Generally Higher Return Higher Risk Higher Volatility

Asset Allocation
FutureBuilder Core Funds

In addition to the LifePath Portfolios, you can invest in any combination of FutureBuilder's core funds in 1% increments. Each of the core funds represents a different kind of investment (asset class) and has a different objective. Higher risk investments may provide higher returns over the long term, but theres also a greater chance that you might lose a portion of your investment. On the other hand, if you put too much of your savings in safer investments, your return may be more stable but may not be great enough to meet your retirement income needs. Generally, the risk of any investment tends to decline the longer you hold it. Before choosing FutureBuilder funds, you need to decide how much risk youre willing to accept and the number of years you have to invest before youll need your money. The diagram below shows how the FutureBuilder core funds compare to each other in terms of risk and return potential.
All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2045 Portfolio has an aggressive asset mix as it has approximately 34 years to go before reaching its most conservative asset mix in 2045. Fees: See FutureBuilder Investment Expenses.

The LifePath 2050 Portfolio is designed to be a complete investment solution for investors who expect to retire after 2048. The portfolio is heavily weighted towards investments with higher growth potential (such as stocks), while being less concerned with the inevitable price fluctuations that these investments typically incur over the short to medium term.

All LifePath Portfolios slowly reduce their risk and return over time, to respond to the changing needs of their investors as they age. The LifePath 2050 Portfolio has an aggressive asset mix as it has approximately 39 years to go before reaching its most conservative asset mix in 2050.
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Stable Value Fund Bond Fund Balanced Fund Large Cap Value Fund Large Cap Index Fund Large Cap Growth Fund Mid Cap Value Fund Mid Cap Growth Fund International Fund Small Cap Value Fund Small Cap Growth Fund Home Depot Stock Fund
More Aggressive Higher Expected Return Higher Risk Higher Volatility More Conservative Lower Expected Return Lower Risk Lower Volatility
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Overall, this fund is the most conservative core fund offered through FutureBuilder. Due to its structure, the fund tends to earn interest with low price fluctuation. However, under certain conditions, the fund's return may lag behind alternatives like money market funds which tend to reflect rising interest rates more quickly.
This fund is expected to experience a low to moderate range of price fluctuations. It is intended for investors seeking moderate returns by investing in a diversified portfolio of high-quality fixed income securities. As with any security, an investment in bonds is subject to risk.
Comparison Index Performance Comparison Index Performance

Performance of the Stable Value Fund is compared to the CitiGroup 3 Month Treasury Bill Index, which has a similar risk profile. Fees: See FutureBuilder Investment Expenses. Performance of the Bond Fund is compared to the Barclays Capital US Aggregate Bond Index, which has a similar investment style. Fees: See FutureBuilder Investment Expenses.
Stable Value Fund

Official Fund Name: JPMorgan Stable Value Fund
The Stable Value Fund's objective is to preserve the value of money invested, perform better than the average money market fund, and earn consistent, reliable returns.
Bond Fund
Official Fund Name: BlackRock U.S. Debt Index Fund
Balanced Fund
Official Fund Name: BlackRock Balanced Fund
This fund seeks to match the performance of the Barclays Capital US Aggregate Bond Index by investing in a diversified sample of the bonds that make up the Barclays measure of the U.S. investment-grade bond market.
The BlackRock Balanced Fund seeks to achieve total return through capital appreciation and current income.
Asset Allocation
The fund invests in a high quality fixed income portfolio combined with investment contracts called benefit responsive wraps. The wrap contracts which are issued by insurance companies and banks provide preservation of participant balances, regardless of market conditions. The wraps also help to stabilize the returns of the fund, even when markets are volatile. The fixed income portfolio consists of investment grade fixed income securities, primarily U.S. Treasury, agency, corporate, mortgage-backed, asset-backed, and privately placed mortgage debt.
Asset Allocation
The fund invests approximately 60% of assets in the BlackRock Equity Index Fund (which invests in equity securitiesstocks) with the remainder of the fund in the BlackRock U.S. Debt Index Fund (which invests in fixed income securitiesbonds).
Asset Allocation
The fund is made up of bonds including U.S. Treasury and federal agency bonds, corporate bonds, residential and commercial mortgage-backed securities, and asset-backed securities.
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Asset Allocation
The companies invested in are typically larger, wellestablished organizations, though the fund also invests in mid-sized companies. Under normal circumstances, the Fund will invest at least 80% of fund assets in common stocks, including those of foreign issuers which are included in the S&P 500 Index. In addition, the fund may also invest up to 20% of its assets in securities of foreign issuers traded in the U.S. that are not included in the S&P 500 Index.
Large Cap Index Fund

Official Fund Name: BlackRock Equity Index Fund
This fund is expected to experience a moderate range of price fluctuations. However, the fund may experience larger or smaller price declines or price increases depending on different market conditions. The fund is more diversified than some of the other fund options since it is invested in two different asset classes. However, to further offset some of the funds risk, investors may wish to spread their savings among several funds that have different investment objectives and characteristics.
This fund seeks to provide growth and modest income on your savings by investing in each stock that makes up the S&P 500 Index.
Asset Allocation
The fund is made up of 500 stocks within major U.S. industries, such as manufacturing, finance, utilities and transportation.

Risk and Return Characteristics Comparison Index Performance

Performance of the Balanced Fund is compared to the 60% S&P 500 Index/40% Barclays Capital US Aggregate Bond Index, which have a similar investment styles. Fees: See FutureBuilder Investment Expenses. This fund is riskier than the Bond, Balanced and Stable Value Funds since it invests exclusively in stocks. While stocks can go up and down dramatically over short time periods, they have traditionally outperformed other types of investments over longer periods and have outpaced inflation as well. Given the short-term risks associated with equity investing, investors should consider this fund a long-term investment.
Large Cap Value Fund

Official Fund Name: Dodge & Cox Stock Fund
Comparison Index Performance

Performance of the Large Cap Value Fund is compared to the Russell 1000 Value Index, which has a similar investment style. Fees: See FutureBuilder Investment Expenses.
This fund is riskier than the Bond, Balanced and Stable Value Funds since it invests exclusively in stocks. While stocks can go up and down dramatically over short time periods, they have traditionally outperformed other types of investments over longer periods and have outpaced inflation as well. Given the shortterm risks associated with equity investing, investors should consider this fund a long-term investment.
The Large Cap Value Fund seeks to provide the opportunity for above-average, long-term growth of your savings by investing in common stocks of companies that the funds managers believe to be temporarily undervalued by the stock market but have favorable longterm growth prospects.

Performance of the Large Cap Index Fund is compared to the S&P 500 Index, which has a similar investment style. Fees: See FutureBuilder Investment Expenses.
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Large Cap Growth Fund
Official Fund Name: Rainier Large Cap Equity Fund1
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Performance of the Large Cap Growth Fund is compared to the total return of the Russell 1000 Growth Index. Fees: See FutureBuilder Investment Expenses.

The Fund seeks to maximize long-term capital appreciation. The Fund invests in a diversified portfolio of common stocks of U.S. companies. Rainier selects investments from companies of all sizes, while focusing on the mid- and large-capitalization segments of the domestic equity market. Highly speculative or illiquid stocks are not candidates for the Fund. To thoroughly diversify, the Fund consists of 75 to 150 different stocks, each making up a relatively small portion of the portfolio.
Mid Cap Value Fund

Official Fund Name: CRM Mid Cap Value Fund
This fund may be suitable for investors with a longterm investment time horizon and who are willing to accept a higher degree of risk for the opportunity of higher long-term potential returns.

Performance of the Mid Cap Value Fund is compared to the total return of the Russell Mid Cap Value Index. Fees: See FutureBuilder Investment Expenses.
The Fund seeks to achieve long-term capital appreciation within the mid cap value universe. The Fund is managed by a team of CRM investment professionals. The research team employs a bottom-up, fundamental research process to select stocks it believes are characterized by three attributes: change, neglect and relative valuation.
Asset Allocation
The team refers to its stock selection philosophy as Growth at a Reasonable Price (GARP). Stock selection focuses on companies that are likely to demonstrate superior earnings growth relative to their peers, and whose equities are selling at attractive relative valuations. The portfolio is diversified over a broad crosssection of economic sectors and industries.
Mid Cap Growth Fund

Official Fund Name: TimesSquare Mid Cap Growth Strategy Fund
Asset Allocation
The Fund invests in approximately 55-65 securities and is well diversified within market sectors. Under normal circumstances, the Fund invests at least 80% of its assets in a diversified portfolio of equity and equity related securities of U.S. companies with market capitalizations at the time of initial purchase similar to those in the Russell Midcap Value Index that are publicly traded on a U.S. securities market.
The Mid Cap Growth Fund seeks to provide capital appreciation by investing in the common and preferred stock of U.S. mid-capitalization companies. The portfolio management team uses a bottom-up, research-intensive approach to identify mid-capitalization growth stocks that it believes have the greatest potential to achieve significant price appreciation over a 12- to 18-month horizon.

This fund is riskier than the Bond, Balance and Stable Value Funds since it invests exclusively in stocks. While stocks can go up and down dramatically over short time periods, they have traditionally outperformed other types of investments over longer periods and have outpaced inflation as well. Given the shortterm risks associated with equity investing, investors should consider this fund a long-term investment.
1 Effective June 1, 2011, the Ranier Large Cap Equity Fund will convert from a trust portfolio mutual fund to an institutional separate account. For additional information, visit www.livetheorangelife.com and click on Financial Benefits (401(k) and more) and then Distributed Communications.
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Asset Allocation
The funds managers target U.S. firms that have exceptional management, distinct, sustainable competitive advantage, and strong, consistent growth. The fund may also invest up to 10% of its assets in foreign securities.
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Asset Allocation
Under normal circumstances, the Fund will invest at least 80% of its total assets in common stocks, preferred stocks, securities convertible into common stocks and securities that carry the right to buy common stocks of non-U.S. companies. The Fund also invests in American, European and Global Depository Receipts.

Performance of the International Fund is compared to the total return of the Morgan Stanley Capital International All Countries World Index ex. U.S. (MSCI ACWI ex. U.S.). Fees: See FutureBuilder Investment Expenses.

Small Cap Value Fund

Official Fund Name: Thompson, Siegel & Walmsley (TS&W) Small Cap Value

This fund may be suitable for investors with a longterm investment time horizon and who are willing to accept a higher degree of risk for the opportunity of higher long-term potential returns.
The Fund could under-perform other investments for any of the following reasons: the stock markets in the countries in which the Fund invests go down, markets continue to undervalue the stocks in the Funds portfolio, Dodge & Coxs opinion about the intrinsic worth of a company or security is incorrect. Since the Fund invests primarily in securities of foreign companies, there is a greater risk that the Funds share price will fluctuate more than if the Fund invested in U.S. issuers. The practice of short-term or excessive trading often referred to as market timing is prohibited by the Dodge & Cox International Stock Fund. Excessive trading by associates could interfere with the efficient management of the fund's portfolio, increase the fund's transaction costs, administrative costs and taxes, and/or impact the fund's performance. The Small Cap Value Fund seeks to provide investors with long-term capital growth primarily by investing in U.S. small capitalization companies. The long term investment objective is to consistently outperform the Russell 2000 Value Index over a complete market cycle. The portfolio will hold generally 85 names or less.

Performance of the Mid Cap Growth Fund is compared to the total return of the Russell Mid Cap Growth Index. Fees: See FutureBuilder Investment Expenses.
Asset Allocation
The fund will typically be fully invested in publicly traded U.S. firms and hold less than 5% cash. It will generally be well diversified among the nine Russell economic sectors, maintaining sector weights of +/10% of the Russell 2000 Value Index, with an emphasis on those it deems more favorable. Additionally, the fund will focus on small capitalization stocks, maintaining a weighted average market capitalization of +/-50% of the benchmark.
International Fund
Official Fund Name: Dodge & Cox International Stock Fund
The International Stock Fund seeks to provide longterm growth of principal and income by investing primarily in a diversified portfolio of equity securities issued by non-U.S. companies from at least three different foreign countries, including emerging markets. Securities for the fund are primarily those that have positive prospects for long-term growth in principal and income not reflected in the current price.
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Asset Allocation
The Funds investment team invests in common stock of small capitalization U.S. companies represented in the Russell 2000 Growth Index.
Home Depot Stock Fund

Official Fund Name: The Home Depot, Inc. Common Stock Fund
This fund poses a higher risk and is potentially subject to more variation in its returns than the prior funds listed, since it invests predominantly in smaller companies. Smaller companies are subject to higher risks because they often have more limited product lines, markets or financial resources. This fund is intended to offer the possibility of higher long-term returns through investing in small companies with the potential for significant long-term growth. Given the risks associated with equity investing, investors should consider this a long-term investment.
The objective of the Home Depot Stock Fund is to allow FutureBuilder participants to share in ownership of the Company.


This fund poses a higher risk and is potentially subject to more variation in its returns than the prior funds listed, since it invests predominantly in smaller companies. Smaller companies are subject to higher risks because they often have more limited product lines, markets or financial resources. This fund is intended to offer the possibility of higher long-term returns through investing in small companies with the potential for significant long-term growth. Given the risks associated with equity investing, investors should consider this a long-term investment.
Since it invests in only one stock, this fund is subject to greater risk than the other funds in the plan. Fees: See FutureBuilder Investment Expenses. About the Home Depot Stock Fund As of September 16, 2008, the Home Depot Stock Fund is no longer a future investment option through FutureBuilder. If you had an existing balance in the Home Depot Stock Fund as of that date, you can keep that balance in the fund; however, you can no longer contribute or transfer money into the fund after September 16, 2008.

Performance of the Small Cap Value Fund is compared to the total return of the Russell 2000 Value Index. Fees: See FutureBuilder Investment Expenses.

Performance of the Small Cap Growth Fund is compared to the total return of the Russell 2000 Growth Index. Fees: See FutureBuilder Investment Expenses.
Small Cap Growth Fund

Official Fund Name: Cadence Small Cap Growth Fund
The Small Cap Growth Fund seeks to provide longterm growth of capital by constructing an equity portfolio with small market capitalization designed to fluctuate with market trends and outperform the Russell 2000 Growth Index over a full market cycle, based on a disciplined growth philosophy and using bottom-up fundamental analysis.
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Notice of Your Rights Concerning Employer Securities
Your Rights Concerning Home Depot Stock
You can elect to move any portion of your account that is invested in company stock from that investment into any other investment alternatives under the Plan. This right extends to all your Home Depot stock under the Plan. If you have been notified that you are a designated associate, you can only change your investments in the Home Depot Stock Fund during designated window periods. You can contact the Benefits Choice Center for information about this right, including how to make an election. In deciding whether to exercise this right, you will want to give careful consideration to the following information that describes the importance of diversification. In deciding whether to exercise this right, you will want to give careful consideration to the benefits of a well-balanced and diversified investment portfolio. See Importance of Diversification.
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The Brokerage Window: Schwab PCRA

The Schwab PCRA (Personal Choice Retirement Account) is a brokerage account that gives you the freedom to invest your FutureBuilder account in a much wider range of investment choices. By expanding your choices beyond the LifePath portfolios and the core investment funds, you have the opportunity to custom-tailor your investment portfolio according to your needs and investment objectives. For example, through the brokerage window, you can invest in: A greatly expanded selection of no-load, no transaction-fee mutual funds from hundreds of leading fund companies to help you round out your portfolio. Stock listed on some of the major exchanges, including over-the-counter issues, so you can invest in companies you know and follow. Exchange-traded funds that help keep investment costs low. Individual bonds, CDs and other fixed income investments to help preserve capital or add stability to your portfolio. The Schwab PCRA account is subject to the requirements and limitations applicable to assets held in a qualified plan, like FutureBuilder. This is true regardless of anything to the contrary in documents provided to you by Schwab.
Once your Schwab account is established, you fund your PCRA by transferring money from your retirement plans other investments in a three-step process: Determine from which of your other investments you want to transfer money. Decide on the amount to transfer. Log onto the Your Benefits Resources web site (http://resources.hewitt.com/homedepot) and follow the steps to initiate a transfer. If you do not have internet access, you can also initiate a transfer by contacting the Benefits Choice Center. Money transferred from your retirement plans other fund choices into your PCRA will be automatically allocated to your Schwab sweep money market fund within two business days. Use these assets to purchase other investments in your PCRA. Due to the existing contractual agreement with JP Morgan, you will NOT be able to transfer money directly from the Stable Value Fund to the PCRA. You CAN transfer money out of the Stable Value Fund into any FutureBuilder fund EXCEPT the PCRA. You must wait for a period of 90 days before you can again transfer that money into the PCRA. You CAN move money directly into the PCRA from any fund EXCEPT the Stable Value Fund. For more information on the Schwab PCRA go to the Your Benefits Resources web site and click Schwab PCRA or call Schwab at 1-888-393-7272. You can also go to www.schwabpcra.com.
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FutureBuilder Investment Expenses*
LifePath Portfolios Stable Value Fund JPMorgan Stable Value Fund1 Bond Fund BlackRock Debt Index Fund Balanced Fund Large Cap Value Fund Dodge & Cox Stock Fund Large Cap Index Fund BlackRock Equity Index Fund Large Cap Growth Fund Rainier Large Cap Equity Fund
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Generic Fund Name
Mid Cap Value Fund CRM Mid Cap Value Fund
Mid Cap Growth Fund Times Square Mid Cap Strategy Fund
International Fund Dodge & Cox International Stock Fund
Small Cap Value Fund TS&W Domestic Small Cap Value2
Small Cap Growth Fund Cadence Small Cap Growth Fund
Home Depot Stock Fund Home Depot Stock Fund
Schwab PCRA Schwab Personal Choice Retirement Account
Official Fund Name Type of Fee
BlackRock LifePath Portfolios
BlackRock Balanced Fund
Investment Management Distribution, Service & Administration Fees Total Investmentrelated Fees8 Recordkeeping Add-on Fees9 Total Investment Expenses
0.150% 0.020%6 0.170% 0.340% 0.510%
0.150% 0.000% 0.150% 0.340% 0.490%
0.040% 0.020%6 0.060% 0.340% 0.400%
0.031%3 0.020%6 0.051% 0.340% 0.391%
0.420% 0.100%7 0.520% 0.240% 0.760%
0.025%4 0.020%6 0.045% 0.340% 0.385%
0.780%
0.690%
0.634%5 0.550% 0.000% 0.634% 0.340% 0.974% 0.100%7 0.650% 0.240% 0.890%
0.900%2 0.000% 0.900% 0.340% 1.240%
1.000%2 0.000% 1.000% 0.340% 1.340%
0.000% 0.000% 0.000% 0.340% 0.340%
Variable10
0.100%7 0.100%7 0.880% 0.240% 1.120% 0.790% 0.240% 1.030%
1 The investment management fee for the JPMorgan Stable Value Fund will be 0.13% from April 1, 2011 to March 31, 2012, after which it will revert back to 0.15%. 2 The TS&W Domestic Small Cap Value Fund and the Cadence Small Cap Growth Fund are offered through a separate account structure. The investment management fee will vary based upon total Home Depot assets invested in each of the funds. The reported fee represents an estimate based upon current participant assets invested in each Fund. The investment management fee schedule for the TS&W strategy is 0.90%. The investment management fee schedule for the Cadence strategy is 1.00% on the rst $100 million and 0.50% on the balance. 3 The BlackRock Balanced Fund is a 60% allocation to the BlackRock Equity Index Fund and a 40% allocation to the BlackRock U.S. Debt Index Fund. The reported fees represent a pro rata allocation of the investment management fees associated with each fund. 4 Effective October 9, 2007, the BlackRock Equity Index Fund changed from a tiered investment management fee schedule to a at annual investment management fee of 0.025%. 5 The TimesSquare Mid Cap Strategy Fund is offered through a separate account structure. The investment management fee will vary based upon total Home Depot assets invested in the fund. The reported fee represents an estimate based upon current participant assets invested in the Mid Cap Strategy Fund. The investment management fee schedule for the TimesSquare strategy is: 0.80% on the rst $50 million, 0.70% on the next $50 million and 0.60% on the balance. 6 Each BlackRock LifePath Portfolio, the BlackRock U.S. Debt Index Fund, the BlackRock Balanced Fund and the BlackRock Equity Index Fund is offered through a commingled investment fund structure. Commingled funds are charged for additional administrative fees incurred and include: fund accounting, auditing, tax reporting, operational reporting, proxy costs and litigation fees (if any). Actual administrative fees for each BlackRock fund will vary but have been capped at 0.02%. 7 Distribution and 12b-1 service fees are included in a mutual fund expense ratio and are used to cover distribution expenses. 12b-1 fees get their name from the SEC rule that authorizes their payment. Distribution fees include fees paid for marketing and selling fund shares, such as compensating brokers and others who sell fund shares, and pay for advertising, printing and mailing prospectuses to new investors, and the printing and mailing of sales literature. The SEC does not limit the size of 12b-1 fees that funds may pay. But under NASD rules, 12b-1 fees that are used to pay marketing and distribution expenses (as opposed to shareholder service expenses) cannot exceed 0.75% of a funds average net assets per year. 8 Total investment-related fees represent estimated investment management, distribution, 12b-1 service and administration fees as of March 1, 2011, and actual fees may vary. Mutual fund fees can change periodically; therefore, investors should consult the fund prospectus before investing. Additional fees may be incurred in the management of each portfolio, including trading and/or transaction fees. Trading/transaction fees will vary by fund based upon actual fund activity and are deducted from performance. 9 This fee is used to pay all external administrative expenses such as recordkeeping fees, consulting fees, legal fees, communication fees, trustee fees, and advice fees incurred by the plan on an annual basis. Prior to 2/1/2009, the company paid a portion of plan expenses. Effective March 1, 2011, the recordkeeping add-on fees were reduced from 0.38% to 0.34%. 10 Fees associated with the Schwab Personal Choice Retirement Account will vary based on the personal investment choices of each participant. Therefore, fee information must be obtained from Schwab.
* Additional fees which are intrinsic to the value of the assets, including stable value insurance wrapper costs, transaction and commission costs (including bid-ask spreads, market impact and opportunity costs), may apply. These fees will vary and are embedded in the earnings of the applicable fund.
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Different Investments Carry Different Risk and Return
Keep in mind that the different investment options offered carry different levels of risk. Higher risk investments may provide higher returns over the long term, but there's also a greater chance that you might lose a portion of your investment. On the other hand, if you put too much of your savings in safer investments, your return may be more stable but may not be great enough to meet your retirement income needs. By mixing high-risk and low-risk investments, you can achieve a balance that helps protect against an investment loss. Higher risk investments also tend to provide higher returns over the long term, while lower risk investments typically yield more stable, but lower returns. Generally, the risk of any investment tends to decline the longer you hold it. The ratio of high to low risk investments you choose should depend on how many years you have until retirement and your personal risk tolerance. The longer you have, the more aggressively you could invest because you have time to ride out the markets highs and lows. The closer you are to retirement age, the more conservatively you may want to invest because there is time to recover from market swings.
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Periodically, you should review your investment choices to ensure they are still in line with your savings goals. When necessary, reallocate your fund choices to meet your changing needs.
Notice of Importance of Diversification

To help achieve long-term retirement security, you should give careful consideration to the benefits of a well-balanced and diversified investment portfolio. Spreading your assets among different types of investments can help you achieve a favorable rate of return, while minimizing your overall risk of losing money. This is because market or other economic conditions that cause one category of assets, or one particular security, to perform very well often cause another asset category, or another particular security, to perform poorly. If you invest more than 20% of your retirement savings in any one company or industry, your savings may not be properly diversified. Although diversification is not a guarantee against loss, it is an effective strategy to help you manage investment risk. In deciding how to invest your retirement savings, you should take into account all of your assets, including any retirement savings outside of FutureBuilder. No single approach is right for everyone because, among other factors, individuals have different financial goals, different time horizons for meeting their goals, and different tolerances for risk. Therefore, you should carefully consider the rights described in this notice and how these rights affect the amount of money that you invest in Home Depot stock through FutureBuilder. It is also important to periodically review your investment portfolio, your investment objectives, and the investment options under FutureBuilder to help ensure that your retirement savings will meet your retirement goals. If you have questions about your rights described in this notice, including how to make this election, contact the Benefits Choice Center at 1-800-555-4954.
Trading Restrictions
Trading restrictions and/or fees may be placed on certain funds because of excessive and/or shortterm trading, which can negatively impact the funds performance. This means you may be required to wait a certain period of time before making reallocations or transfers. These time periods are known as purchase blocks. During a purchase block, youre still able to sell any amount you wish. Restrictions are not applicable to new contributions, loan payments, loans, withdrawals, distributions or rollovers. Currently, you are not able to transfer money directly from the Stable Value Fund to the Schwab PCRA. Money can be transferred out of the Stable Value Fund into any FutureBuilder fund except the Schwab PCRA, but you must wait for a period of 90 days before transferring those funds into the PCRA.
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Keeping Track of Your Account
You can track the progress of your account by reviewing your personal statement each quarter. Just access the Your Benefits Resources web site and print your online statement or call the Benefits Choice Center.
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Change your contribution rateadjust how much you are contributing into FutureBuilder; you can suspend contributing anytime by electing to contribute 0%. Change your future investment elections rearrange how your contributions will be invested as they are deducted from future paychecks. Transfer existing fund balancesmove around the money that is already in the Plan. Change your Company match investment electionchoose one or more of the Plan investment options. Obtain investment fund returnsobtain one-, three-, and five-year returns. Obtain a fund sheet or a fund prospectus that includes information about the fund, such as top portfolio holdings Access Morningstar fund information (online only) Obtain information on a funds investment expenses Request a loanfind out the amounts you have available for a loan and the rules regarding loans, model a loan, or request a loan. Request hardship withdrawal informationobtain the amounts you have available for a hardship withdrawal and the rules regarding hardship withdrawals. Request an age 59 in-service withdrawal obtain information regarding in-service withdrawals.
Request a final distributionobtain final distribution information. Request formsselect one or more administrative forms to be mailed to your home. A few select forms can be sent to your secured participant mailbox on the Your Benefits Resources web site if you prefer. Speak to a Benefits Choice representative whenever you need help working your way through the Your Benefits Resources web site, or need personal assistance. Representatives are available weekdays (excluding holidays) from 9 a.m. to 7 p.m. (Eastern Time).
FutureBuilder Statements
If you have an account balance in the Plan, you will receive a FutureBuilder account statement every quarter. This statement shows your Plan accounts activity for the quarter. It helps you keep track of the contributions to your account, investment results, fund transfers, and distributions. You can also find this information at any time on the Your Benefits Resources web site. You can also request a copy of the most recent quarterly statement by contacting the Benefits Choice Center.
Confirmation of Your Transaction

Each time you request a transaction through a Benefits Choice representative, a confirmation statement will be mailed to your home. Be sure to read each confirmation to make sure the transaction processed is what you intended. Confirmation statements for transactions made on the Your Benefits Resources web site will not always be mailed. It is a good idea to print your requests and confirmations for requests made on the web site. However, Confirmations of Investment Election Change will always be sent regardless of how the transaction was made. If you have any questions about a transaction you made, call the Benefits Choice Center.
Your Benefits Resources web site and the Benefits Choice Center
Your Benefits Resources web site and the Benefits Choice Center give you the ability to obtain information about your account, request forms, and make Plan transactions. You can access the Your Benefits Resources web site or call the Benefits Choice Center to do the following: Check your account balancesfind out your total account balance, balances by fund, and your current vested balances.
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Accessing Your Plan Balance
The goal of FutureBuilder is to help you save for the long term. However, there may be times during your working years when you will need to access the money in your Plan account. If you do, you may be able to take a loan, hardship or age 59 in-service withdrawal. Amount You Can Borrow
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Repayment of Your Loan Loan repayments will be made over the term of the loan (12 to 48 months) through automatic payroll deductions. As long as you still have four or more loan repayments left, you can request to pre-pay the outstanding balance of a loan without penalty. You will be limited to two early loan repayment requests over the life of your loan. You also have the option to make partial loan repayments on your loan (minimum amount of partial repayment is $500). The partial loan repayment will pay down principal owed on your loan (if you are behind on your loan, it will pay down past due principal and interest first). With the partial loan repayment process, you may be eligible to have your loan term or loan repayment amount decreased. All payments of principal and interest are invested according to your investment elections at the time of repayment. Defaulting on a Loan Your loan will be considered a distribution (withdrawal) from the plan and will be subject to applicable taxes and penalties if: your employment with the Company terminates for any reason and payment of the outstanding balance of your loan is not received within two months following the month of your termination; or you fail to pay the loan within its terms. If you have missed two consecutive scheduled repayments, your loan will be defaulted at the end of the quarter following the quarter in which the first scheduled repayment was missed unless the loan is paid off or completely caught up. You will receive notification if your loan is delinquent and subject to default and will have the opportunity to avoid default by sending in the past due repayments and making all future scheduled repayments.
Loans from Your Account

If you are an active associate, you may be able to borrow money from your Plan funds. The proceeds of a loan are not taxable. However, you repay the loan with after-tax dollars and interest. Also, as you repay the loan, both your principal and interest payments are credited back to your own account. You may only have one loan outstanding at any time. How to Apply for a Loan To apply for a loan from your FutureBuilder account, access the Your Benefits Resources web site or call the Benefits Choice Center to learn how much money you have available for a loan. You can also use the modeling option to determine the amount and repayment period that best fits your situation. Once youve decided the amount you wish to borrow, use the Your Benefits Resources web site or speak to a Benefits Choice representative to request the loan. Generally, you should receive your loan check approximately two to three weeks from the date of your request. If you authorize payment to be electronically transferred to a specified bank account, the proceeds will be deposited within three to five business days from the date your request is processed. You are responsible for ensuring the bank account number you provide is correct.
The amount you are permitted to borrow is determined, in part, by the vested value of your account. You must have a total vested balance of at least $2,100 in your rollover, before-tax, Roth after-tax and/or matching accounts to be eligible for the minimum loan amount. The minimum you can borrow is $1,000. The maximum is the lesser of: 50% of the value of your before-tax contributions, Roth after-tax contributions, vested Company match, and rollover contribution minus a $50 loan administrative fee; or $50,000 minus your highest outstanding loan balance in the preceding 12 months minus a $50 loan administrative fee. Interest Rate for Your Loan When you repay your Plan loan, you will also pay a fixed rate of interest. Both the interest and principal will go into your FutureBuilder account. Once the rate for your loan is determined, the rate is fixed for the term of the loan. Loans from your PCRA Account Loans may only be taken in an amount up to your balance in the core investment options and LifePath portfolios. If you wish to take a loan from your FutureBuilder account in an amount greater than that, you may need to transfer money from your PCRA account to the other investment options. Money cannot be taken directly from your PCRA account for loans. The amount available reflected on your statements and on the Your Benefits Resources web site excludes the balance in the PCRA when displaying the amount available for a loan.
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Loans While on Leave of Absence If you are on an approved leave of absence, your loan repayments will be suspended. The maximum period that payments will be suspended is 12 months, unless you are on Military Leave. When you return from leave, the interest that accrued while your payments were suspended will be added to your loan balance. Your payroll deductions and/or repayment period will be adjusted for the repayment of this additional amount. Loans While on Military Leave If you are on Military Leave: you will have your payments resumed and reamortized upon returning to active status; the loan period will be extended by the length of your leave period not to exceed five years; and the remaining balance will be reamortized to include interest accrued during the leave period. Interest will accrue at the rate applicable to your original loan agreement capped at 6% for the length of your military leave. The loan period will never extend beyond the IRS limit of five years. The time you are on Military Leave is not considered part of the loan period, and it does not count against the five-year limit (e.g., participants will pick up where they left off regardless of the length of military service with the exception that their repayments will be reamortized to include accrued interest).
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Hardship Withdrawals
To qualify for a hardship withdrawal, you must be actively employed, and you need to prove that you are experiencing a financial hardship and need a distribution from your Plan account for one of the following reasons: to pay for unreimbursed medical expenses that are incurred by you or your dependents; to purchase your principal residence (not including mortgage payments); to pay for tuition, books, room and board, and other education-related fees for the next 12 months for post-secondary education for yourself or your dependents; to cover the immediate need to prevent foreclosure or eviction from your principal residence; to pay funeral expenses for members of your immediate family; to pay federal income taxes (including penalties and interest) for the two most recently ended tax years; to pay for uninsured costs for repairs to your principal residence for damages caused by a natural disaster or accident; or to pay for legal fees and expenses incurred as a direct result of the adoption of a child. To qualify for a hardship withdrawal, you must provide documentation in support of your financial hardship, and you must have exhausted all other sources of funds to meet your needs.
If you qualify, you may receive up to 50% of the vested Company contributions, all of the rollover contributions, and all of the before-tax and Roth after-tax contributions from your Plan funds, excluding earnings. In any event, the amount of your distribution may not exceed: the actual amount of your expenses plus; an estimated amount to cover the federal income taxes you will have to pay on your distribution. The minimum hardship withdrawal allowed is $1,000 and you are limited to two hardship withdrawals every rolling 12 months. Generally, you should receive your check approximately two to three weeks from the date your request is approved and processed. If you authorize payment to be electronically transferred to a specified bank account, the proceeds will be deposited within three to five business days from the date your request is processed. You are responsible for ensuring the bank account number you provide is correct. Qualified non-elective contributions made to your FutureBuilder account are not available for hardship withdrawals.
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Hardship Withdrawals from your PCRA Account Withdrawals may only be taken from your account assets invested in the core investment options and LifePath portfolios. If you wish to take a hardship withdrawal from your FutureBuilder account, you may need to transfer money from your PCRA account to the other investment options if the amount youre requesting exceeds your balance in the core funds and the LifePath portfolios. You can't take a hardship withdrawal directly from the PCRA. The amount available reflected on your statements and on the Your Benefits Resources web site excludes the balance in the PCRA when displaying the amount available for a withdrawal. Tax Considerations On any hardship withdrawal, 10% will automatically be withheld. You may waive this 10% withholding, if you choose. However, it is important to note that the taxes you may owe on the distribution could be higher than what is automatically withheld, depending on your tax bracket. Consult a tax advisor for more information on your personal situation.
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You may request up to two withdrawals during a rolling 12-month period in the form of cash, or a combination of cash and shares of Home Depot stock (if you already own them). If you call prior to 4 p.m. (Eastern Time) or market close if earlier, on any business day, your request will be processed that day. Generally, you should receive your check approximately two to three weeks from the date your request is processed. If you authorize payment to be electronically transferred to a specified bank account, the proceeds will be deposited within three to five business days from the date your request is processed. You are responsible for ensuring the bank account number you provide is correct. In-Service Withdrawals from your PCRA Account Withdrawals may only be taken from the account assets invested in core investment options and LifePath portfolios. If you wish to take an in-service withdrawal from your FutureBuilder account, you may need to transfer money from your PCRA account to the other investment options if the amount youre requesting exceeds your balance in the core funds and the LifePath portfolios. You can't take an in-service withdrawal directly from the PCRA. The amount available reflected on your statements and on the Your Benefits Resources web site excludes the balance in the PCRA when displaying the amount available for a withdrawal.
Military Leave Distributions

If you are on active duty in the uniformed services for more than 30 days, you will be treated as separated from service for purposes of being able to receive a distribution of your contributions and associated earnings. If you elect such a distribution, you will be restricted from making up contributions to the plan for a period of six months from the date of the distribution.
Final Distributions of Your Account

You may receive a final distribution of the vested portion of your FutureBuilder account in a lump-sum payment when you: terminate employment with the Company for any reason; or become totally and permanently disabled. Your beneficiary may receive a final distribution of the vested portion of your FutureBuilder account in the event of your death. You or your beneficiary may request payment in one of the following forms: 100% cash; or cash and if you already own Home Depot stock through FutureBuilder, shares of The Home Depot, Inc. common stock which you can receive as an in-kind transfer or as a stock certificate.
In-Service Withdrawals
Once you reach age 59, if you are actively employed, you may request a withdrawal of the vested portion of your FutureBuilder account. For Roth after-tax contributions, you will not pay taxes on your Roth after-tax contributions earnings if your distribution is qualified. A distribution of your Roth after-tax contributions and their earnings is qualified if you are age 59 or older and the withdrawal is made at least five years after making your first Roth contribution to the plan.
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You may request payment to be paid as a: rollover to an IRA or another eligible employer-sponsored retirement plan or to a 403(b) or 457 plan; or taxable distribution; or combination of both. Your beneficiary may request payment to be paid as a: rollover to an IRA or to another eligible employersponsored retirement plan or to a 403(b) or 457 plan (only if your beneficiary is your spouse); or taxable distribution to himself or herself; or combination of both. Your beneficiary may receive a final distribution of the vested portion of your FutureBuilder account in the event of your death. If you have funds in a PCRA account, you or your beneficiary may request payment of the assets in the PCRA account in one of the following forms: Cash; An in-kind rollover to an IRA; or A rollover in cash to an IRA or other eligible employer-sponsored retirement plan, a 403(b) plan or a 457 plan. Requesting a Final Distribution
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Deferring Your Final Distribution After you leave the Company, as long as your vested balance is greater than $1,000, you may elect to defer receiving the value of your FutureBuilder account. The latest you may defer taking payment is up to age 70. If you are still working at the Company or one of its affiliates when you reach age 70 , you will not be required to start taking payments until your separation from employment. For further information, call and speak to a Benefits Choice representative. If You Leave the Company Once you have left the Company and its affiliates, you may request to receive the vested balance of your FutureBuilder account. If you return to work for the Company before receiving a distribution, your balance will remain in your account. Please see What Is a Break in Service? for rules that apply if you leave the Company. If you do not request a distribution after leaving the Company and your vested account balance (including any rollover account) is or grows to greater than $1,000 before the end of the second full month following your separation from service, the funds will remain in your FutureBuilder account until the time you request a distribution. If your vested account balance is $1,000 or less, you cannot defer payment. Your balance will be distributed to you automatically at the end of the second full month after your separation from employment has been processed by the Human Resources Service Center. Or, you may call the Benefits Choice Center and speak to a representative to request a specific payout option to be made at least 30 days following your separation from service.
To request a final distribution, access the Your Benefits Resources web site or call the Benefits Choice Center. Provided that your separation from service has been processed by the Company, if you make a request prior to 30 days following the termination of your employment, your request will be processed as of the market close coinciding with or immediately following your termination date plus 30 days. Note that if the day of your distribution (your termination date plus 30 days) is not a business day, your distribution will be made on the first business day following. If you make a request prior to market close on or after 30 days following the termination of your employment, your request will be processed as of the date your request is made. Your balances remain active in the market through the market close date on the day your distribution processes. Once your request is processed, your stock certificate and/or check will be mailed to you, generally within two to three weeks. If you authorize payment in cash to be electronically transferred to a specified bank account, the proceeds will be deposited within three to five business days from the date your request is processed. You are responsible for ensuring the bank account number you provide is correct.
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If You Are Totally and Permanently Disabled You are considered totally and permanently disabled if you are wholly prevented from engaging in your regular duties for the Company or an affiliate by reason of a medically determinable physical or mental impairment that can be expected to result in death or to be of long-continued and indefinite duration as determined by the Administrative Committee or its designee. If you are actively employed and become disabled as determined by the Social Security Administration, you will be automatically considered to be disabled. If you are actively employed by the Company when you meet these qualifications, you will become 100% vested and may elect to receive the entire balance in your FutureBuilder account anytime thereafter. In the Event of Your Death If you die while you are employed by the Company or one of its affiliates, your FutureBuilder account will become 100% vested and will be paid to your designated beneficiary or in accordance with the Plans default rules if you havent designated a beneficiary. Federal law requires that the Plan pay benefits to your surviving spouse, unless you have received your spouses written, notarized consent allowing you to designate someone else.
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Tax Considerations
Your before-tax contributions, Company matching contributions, ESOP contributions and investment earnings (not including investment earnings on Roth aftertax contributions if your distribution is qualified) in your account are not taxable until you receive a distribution. At that point, special tax rules may apply. You should consult your tax advisor for specific help. Following is a description of some of the tax considerations. Your Roth after-tax contributions are not taxable and you will not pay taxes on your Roth after-tax contributions earnings if your distribution is qualified. A distribution of your Roth after-tax contributions and their earnings is qualified if you are age 59 or older and the withdrawal is made at least five years after making your first Roth contribution to the plan. The IRS stresses that 401(k) plans like FutureBuilder should be for retirement income. Under current tax law, if you terminate employment and receive a final distribution of your account before you reach age 55, or if you receive a hardship withdrawal or default on a loan before age 59, the IRS imposes a 10% penalty tax on your before-tax contributions, Company matching contributions, ESOP contributions and investment earnings (not including investment earnings on Roth aftertax contributions if your distribution is qualified) in addition to your regular income tax. This 10% additional tax does not apply if: your employment with the Company ends after you reach age 55; your account is paid after you reach age 59 or because of death or total permanent disability;
the money is paid out under a court-ordered qualified domestic relations order; you roll over the money into another eligible employer-sponsored retirement plan or IRA; or you use your distribution to pay unreimbursed deductible medical expenses. It is important to note that if you receive part of a lump-sum taxable distribution in Home Depot common stock, the original cost basis of the stock (i.e., the value when it was invested in stock in the plan) and any cash for a fractional share will be taxable income in the year the stock is received. When you later sell the stock, your tax liability will be based on any increase or decrease in the stocks value over the original cost basis of the stock distributed to you. In addition, current tax rules enable you to instruct the Company to make a direct rollover of all or part of your distribution (other than a hardship withdrawal) into an IRA or another eligible employer-sponsored retirement plan that accepts rollovers. If you elect a direct rollover of Home Depot stock, it is important that you first verify whether the receiving institution will accept the stock in kind. Unless you elect a direct rollover, the Trustee will automatically withhold 20% of the total cash amount you receive (not including Roth after-tax contributions and the investment earnings on the Roth contributions if the distribution is qualified) for federal income tax, as required by the IRS. The amount withheld goes directly to the IRS, and will be considered a credit when you file your income tax return. In some states, state tax withholding also is required. You can avoid this mandatory withholding by electing to have your eligible rollover distribution directly
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rolled over to an IRA or another eligible employers retirement plan. With a direct rollover, you instruct the Trustee to make the check and/or shares for your distribution payable to the plan or IRA that you intend to roll into. If you do not elect a direct rollover, the law requires the Trustee to withhold 20% of the taxable portion of your distribution. You can generally maintain the taxdeferred status of your distribution by rolling over all or a portion of the distribution into an IRA or eligible employer-sponsored retirement plan within 60 days after distribution, but you may still be taxed on the 20% withheld. You can roll over the total amount of your distribution if you replace the 20% with your own money, and then claim that amount as a credit on your annual tax return. If you deposit only a portion of the taxable distribution, you will owe current income tax on the remaining taxable distribution. The tax laws are complicated and subject to change, and the Company cannot provide individual tax advice. The Company suggests you seek advice from a qualified tax advisor or financial planner to be sure your personal circumstances are considered carefully if you make a withdrawal or when you receive a final distribution. Hardship withdrawals are not eligible to be rolled over into another plan or an IRA, and you may elect that income tax not be withheld from your hardship withdrawal.
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How to Obtain Additional Information

The information in this book summarizes only the federal (but not state and local) tax rules that might apply to your payment. The rules described here are complex and contain many conditions and exceptions that are not included in this information. Information on federal income tax consequences on FutureBuilder payments can be found in the FutureBuilder plan prospectus and Payments Rights Notice, available online or by calling the Benefits Choice Center. You may obtain more specific information on the tax treatment of payments from eligible employer-sponsored retirement plans in IRS Publication 575, Pension and Annuity Income, and IRS Publication 590, Individual Retirement Arrangements. These publications are available from your local IRS office, from the Internet on the IRS web site at www.irs.ustreas.gov/formspubs/index.html, or by calling 1-800-TAX-FORM (1-800-829-3676).
Forfeitures
Forfeitures are Company matching or ESOP contributions left in the plan by terminated associates who were not 100% vested. If you leave the Company before you are 100% vested, the amount forfeited will be used as a credit toward Company matching contributions for all active participants or to pay plan expenses.
When Benefits Are Not Paid

Its important that you understand the conditions under which benefits could be less than expected or not paid at all or limited, including: If, as the result of a divorce, youre responsible for child support, alimony, or marital property rights payments, all or a portion of your benefits could be assigned to meet these payments if a court issues a qualified domestic relations order (QDRO). If your account becomes subject to a QDRO, the expenses incurred by the plan in determining whether the QDRO meets applicable legal requirements may be charged against your account. You can obtain a free copy of the QDRO determination procedures by contacting the plan administrator. If the investment funds you choose experience losses, the value of your contributions can decrease. If the Plan does not pass required nondiscrimination tests, all or a portion of the contributions made on behalf of highly compensated employees may be reduced and refunded. Nondiscrimination tests are required by law to ensure a fair mix of contributions from employees at certain income levels. If youre affected by these limits, youll be notified.
Dividends
Dividends on the shares of Company stock paid to your Home Depot Stock Fund account will be used to acquire additional shares of Home Depot stock. On a quarterly basis you will be able to elect to have your dividends remain in the plan or paid to you. The dividend payments, if elected, will occur on an annual basis within 90 days of the end of the year. Dividend payout elections are only valid for the year in which they are made. You must make an active election each year to receive a cash payout. If you own Home Depot stock in your PCRA account, you will not have the option to have the dividend paid directly to you.
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Right to Amend or Terminate the Plan
The Company reserves the right to change, suspend, amend or terminate this Plan at any time, in whole or in part. Generally, account balances cannot be reduced except for investment losses, even by a Plan amendment. Termination of the Plan is unlikely, but if the Plan is terminated, your account automatically will become 100% vested. If any material changes are made to the Plan in the future, youll be notified.
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Limiting Liability
FutureBuilder is intended to meet the provisions of Section 404(c) under ERISA and Labor Reg. 2550.404c-1. This means that plan fiduciaries (those responsible for administering the plan) may be relieved of liability for losses resulting from a participants investment instructions. All questions or claims about eligibility and/or benefits under the FutureBuilder must be submitted within two years of the date payment is made or the date of the complaint.
Implied Promises
Nothing in this book says or implies that participation in this Plan is a guarantee of continued employment with the Company, nor is it a guarantee that contribution levels will remain unchanged in future years.
Your Rights Under ERISA

For information about your rights under the Employee Retirement Income Security Act (ERISA) and other important information, see the Plan Administration chapter.
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Request Contribution rate change Investment election change Fund transfer (fund transfers are limited to 1 per day) Hardship withdrawal request Deadline 1 a.m. (Eastern Time) on any Friday the week before your next payday 4 p.m. (Eastern Time) or market close on any business day 4 p.m. (Eastern Time) or market close on any business day Return your signed documentation to the Benefits Choice Center. When you call to request this transaction, the appropriate paperwork will be mailed to you. 4 p.m. (Eastern Time) or market close on any business day Effective Date
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Contributions at your newly elected rate begin with your next paycheck once you are eligible for the plan. All your future contributions after the day you call are invested according to your request. Your request will be processed as of the day you make the request at the closing prices on the day of your request. Transfers requested for the Schwab PCRA or through a financial advisory service will be processed as soon as administratively possible (within three to five business days of your request). Your request is processed based on the value of your account on the day your completed documentation is received and approved; generally, you will receive your check within two to three weeks after approval or within three to five business days if you authorize payment to be direct deposited into a specified bank account. If you request a final distribution prior to 30 days following the termination of your employment, your request is processed based on the value of your account as of market close coinciding with or immediately following your termination date plus 30 days. If you make a request prior to market close on or after 30 days following the termination of your employment, your request will be processed as of the date your request is made. Your balances remain active in the market through the market close date on the day of your distribution processes. Generally you will receive your check within two to three weeks or within three to five business days if you authorize payment to be direct deposited into a specified bank account. For more information, see Final Distributions of Your Account. If you request a final distribution prior to 30 days following the termination of your employment, your request is processed based on the value of your account as of market close coinciding with or immediately following your termination date plus 30 days. If you make a request prior to market close on or after 30 days following the termination of your employment, your request will be processed as of the date your request is made. Your balances remain active in the market through the market close date on the day of your distribution processes. Generally you will receive your check within two to three weeks or within three to five business days if you authorize payment to be direct deposited into a specified bank account. For more information, see Final Distributions of Your Account. Your request is processed as of the day you call, and the check should be received two to three weeks after your initial loan request is made or within three to five business days if you authorize payment to be direct deposited into a specified bank account. Your request will be processed as of the day you call at the closing prices on the day you call. You should receive your check within approximately two to three weeks from the date your request is processed or within three to five business days if you authorize payment to be direct deposited into a specified bank account.
Generally, your request is processed as of the day your completed documentation is received and approved.
Final distribution request (after your employment ends)
Force-Out (vested account balances equal to or less than $1,000)
4 p.m. (ET) or market close on last business day of second month following termination of your employment. If you do not request a final distribution by this deadline, your balance will be paid to you automatically as a taxable distribution. 4 p.m. (Eastern Time) or market close on any business day 4 p.m. (Eastern Time) or market close on any business day Return your signed documentation with rollover proceeds to the Benefits Choice Center. When you call or access the Your Benefits Resources web site to request this transaction, the appropriate paperwork will be mailed to you. 4 p.m. (Eastern Time) or market close on any business day
Loan
In-service withdrawal
Rollover contribution
Rollover distribution
If you request a rollover distribution to an IRA, another qualified plan, 403(b) plan, or 457 plan, following the termination of your employment, the timing of the distribution will mirror the final distribution effective date description noted above. In-kind rollovers of Home Depot stock from the Home Depot Stock Fund are available if the receiving institution accepts shares. If you have a Schwab PCRA fund balance, you may request a direct in-kind rollover to an IRA. For more information on the Schwab IRA Rollover, please contact Schwab.
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Request
Loan pre-payment, partial payoff or full payoff
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Deadline
Return your invoice with a money order for the loan payment amount to the Benefits Choice Center. When your employment ends or if you request an early payoff, the appropriate paperwork will be mailed to you. Contact the Benefits Choice Center at 1-800-555-4954 to request a review of your denied request. You must file a claim for benefits under FutureBuilder within two years of the date on which your benefits were paid or for all other claims not related to the payment of benefits, within two years from the date on which the action or omission complained of occurred.
Effective Date
Generally, your request is processed as of the day your payment is received.
Payment of a benefit or request for a transaction that has been denied Filing a formal claim for benefits and rights under the Plan.
Your request will be reviewed and you'll be informed when you'll receive a timely response.
You must appeal in writing to: Home Depot FutureBuilder Administrative Committee Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211
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Glossary of Investment Terms
Asset Allocationthe process of dividing investments among different kinds of assets, such as stocks, bonds, real estate and cash, to optimize the risk/reward trade off based on an individuals specific situation and goals. Asset Classa category of investments. Stable value investments, bonds and stocks are three asset classes. Balanced Funda fund that invests in both stocks and bonds in an attempt to achieve higher returns than all-bond funds, but with less risk than all-stock funds. Benchmarka standard against which an investment funds performance is measured. Bondessentially an IOU for a loan that you make to a corporation, bank or government. The bond issuer, or borrower, promises to pay you back the amount of the loan after a number of years. Collective/Commingled Fundscollective funds are pooled vehicles that commingle the assets of multiple individuals or organizations to cost effectively invest in a diversified portfolio. These funds are organized as group trusts and are exempt from registration requirements. Diversificationspreading your savings among more than one investment. It helps reduce market risk and protects against the volatility that can result from putting your money in just one investment. Dividenda payout to shareholders based on the companys earnings. The size and frequency of the dividend is determined by the board of directors.
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Growth Fundsfunds that invest in companies with strong earnings and growth prospects. The stocks of these companies usually have high price/earnings ratios. Index Fundsfunds that attempt to mirror the performance of a particular investment index, such as the S&P 500. They typically have lower fees than actively managed funds. International Fundsfunds that seek capital appreciation by investing primarily in common stocks of companies outside the United States. Currency fluctuations and political developments could add risk to the fund. Mutual Funda mutual fund is made up of investments selected by fund managers to match the stated objective of the fund. Mutual funds must be registered as investment companies under local securities laws. The mutual funds offered in FutureBuilder are the Dodge & Cox Stock Fund (ticker symbol DODGX), the Rainier Large Cap Equity Fund (RAIEX), the CRM Mid Cap Value Fund (CRIMX), and the Dodge & Cox International Stock Fund (DODFX). Although you can track these funds and their prices in a newspapers financial pages, keep in mind that the net asset values (NAVs) and share prices may differ from those listed in newspapers due to administrative fees. Price Earnings Ratioratio calculated by dividing the current price of a stock by the earnings per share. Prospectusa disclosure document required by the Securities and Exchange Commission for mutual funds and company stocks.
Rate of Returnthe amount your investment changes in value (gains or losses) over a period of time, expressed as a percentage of your initial investment. Riskthe chance that an investments value will go up or down over time, or that it wont stay ahead of inflation. Separate Accountlarge institutional investors are able to negotiate and establish an account directly with investment managers. Separate account structures allow plan sponsors to control investment guidelines and reduce total costs. The investment account is not registered with the Securities and Exchange Commission (SEC), and performance is not reported in a newspapers financial pages. The TimesSquare Mid Cap Growth, the TS&W Domestic Small Cap Value, and the Cadence Small Cap Growth strategies are all offered in a separate account structure. Stocksalso referred to as equities. Stocks represent ownership in an individual company. Investors typically buy and hold shares of a companys stock. Time Horizonthe number of years you have to invest your money before youll need to start withdrawing it. Value Fundsfunds that invest in under-priced companies that show signs of improvement. The stocks of these companies usually have low price/earnings ratios. Volatilitythe ups and downs of the value of an investment. Stock investments tend to have higher volatility than bond or stable value (income) investments.
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Employee Stock Purchase Plan

Chapter Contents
287 The Employee Stock Purchase Plan 287 288 288 288 288 288 289 289 289 289 290 290 Terms to Know: ESPP Administration Eligibility and Participation Enrolling in the Plan Automatic Rollover Discounted Stock Purchase Price Your Total Shares Calculating Your Payroll Deduction Limitations on Your Contributions Changing Your Payroll Deduction Termination of Employment Leave of Absence 287 How the ESPP Works 288 Participating in the Plan 290 290 290 291 291 291 291 291 292 292 292 292 292 293 Additional Special Circumstances Foreign Associates Your ESPP Account at Computershare Ownership of Shares Stockholder Privileges Cash Dividends & Reinvestment Account Statements Importance of Diversification Accessing Your Computershare Account Selling Your Shares Receiving Your Stock Sale Proceeds Certificate Withdrawals and Share Transfers Computershare Fees Computershare Contacts 293 293 293 293 294 294 294 294 294 294 295 295 295 296 Tax Benefits Tax Consequences Holding Period Dividends Reporting Capital Gains on the Sale of ESPP Shares Backup Withholding (W-9) Certification Available Shares Amendment and Termination Rights Not Transferable Restrictions on Resale of Common Stock Acquired under the Plan Applicable Laws Incorporation of Documents by Reference Available Information Company Financial Statements
290 Stock Ownership
294 ESPP Supplemental Information
292 Stock Transactions
289 ESPP Payroll Deductions
290 Special Circumstances
293 Taxes and the ESPP

What do you need?
Enroll in ESPP (Jan. 1 - June 16) (July 1 - Dec. 17) Change or stop your payroll deductions Sell your ESPP shares and receive proceeds Withdraw or transfer shares Purchase The Home Depot stock on the open market Get answers to your questions If a Plan has not ended If there is an error in the number of shares deposited to your Computershare account If you dont understand your payroll deduction or the amount isnt correct If you want to confirm that shares have been purchased for your account after a Plan has ended
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Find it here...
Log on to the Your Benefits Resources web site at http://resources.hewitt.com/homedepot. Log on to the Your Benefits Resources web site at http://resources.hewitt.com/homedepot. Call Computershare at 1-800-843-2150, or visit their web site at www-us.computershare.com/employee. See Stock Transactions for more information on selling shares and payment delivery options. Call Computershare at 1-800-843-2150, or visit their web site at www-us.computershare.com/employee to get the appropriate forms. Contact Computershare for more information. Call the Benefits Choice Center toll-free at 1-800-555-4954 and follow the voice prompts for the Employee Stock Purchase Plan.
Call MYTHDHR (1-866-698-4347); if you work for a subsidiary, call your payroll department Call Computershare at 1-800-843-2150 and speak with a representative, or go online at www-us.computershare.com
The Employee Stock Purchase Plan

At The Home Depot, were all working together to build success. Our Employee Stock Purchase Plan (ESPP) is designed to give you the opportunity to acquire ownership interest in The Home Depot, Inc. (the Company) by purchasing Company stock at a discount, and represents a key component of the total value you receive from the Company.
This Employee Stock Purchase Plan chapter constitutes a part of a prospectus covering securities that have been registered under the Securities Act of 1933. ESPP participants, as well as those associates who are considering enrolling in the ESPP, are encouraged to read this chapter and the documents incorporated by reference listed in Incorporation of Documents by Reference. The date of this prospectus is April, 2011.
How the ESPP Works

Your participation in the ESPP is voluntary, through convenient after-tax payroll deductions, in an amount that is comfortable for you. While there are no guarantees that the value of any stock will increase, investing can be an important part of your overall financial plan. Each calendar year, there are two opportunities to participate in The Home Depots ESPP. Each opportunity is called a Plan. Each Plan runs for six months: one plan begins January 1, and the next on July 1. A Plan in progress is referred to as a Current Plan, and the one to follow is referred to as the Next Plan.
Terms to Know:
Plan End Date (June 30 or Dec 31) Plan Pay Period End Date (June 16 or Dec 17)
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During an open enrollment period before a Plan begins, you decide how much money you wish to have deducted from each paycheck for that Plan. Your payroll deductions are a percentage (between 1%-20%) of your eligible earnings for each pay period. At the end of a Current Plan, the Company issues you as many shares (including fractional shares) of The Home Depot stock as can be purchased with the total of your payroll deductions (no interest or earnings accumulate on your contributions during the Plan). Shares are purchased for you after the Plan ends.
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To participate in a Plan, you must enroll during the open enrollment period for that Plan. The enrollment deadline for the January 1 Plan is December 17 and the enrollment deadline for the July 1 Plan is June 16. Limitation on Participation You are not eligible to participate in The Home Depot ESPP if you own, or if you hold, options to purchase 5% or more of the common stock of The Home Depot or a subsidiary, or if the purchase of ESPP shares would cause you to become a 5% shareholder.
To enroll using the automated phone system available through the Benefits Choice Center, call 1-800-555-4954 and select your language preference. At the main menu, say Employee Stock Purchase Plan and then follow the voice prompts to confirm your selection.
Automatic Rollover
The automatic rollover feature for the ESPP is available for the Current Plan. This means that the same percentage amount elected for the Current Plan will be deducted for the Next Plan, unless you elect to change your rate during the open enrollment period for the Next Plan. If you want to participate in the Next Plan and are not currently enrolled, you must take action to enroll online or through the automated phone system. See Eligibility and Participation, Enrolling in the Plan and Changing Your Payroll Deduction for more information.
ESPP Administration
The ESPP is administered by the Leadership Development and Compensation Committee of the Companys Board of Directors (the Committee). The Committee is vested with authority to set the number of shares to be included in any given Plan, to set the subscription (enrollment) and purchase periods, and to interpret and enforce the provisions of the ESPP.
Enrolling in the Plan

To participate in the ESPP, you must enroll during the open enrollment period using either the Your Benefits Resources web site, or by accessing the automated phone system available through The Home Depot Benefits Choice Center. To enroll, you need the same password you use for FutureBuilder (401k) and health benefits. It is important to note that this is not your Home Depot personal identification number (PIN), found on your paycheck. You also need your Social Security number. During the enrollment process, you will be asked for the percentage of your eligible earnings that you wish to have deducted each pay period (between 1% - 20%). To enroll online, log on to the Your Benefits Resources web site at http://resources.hewitt. com/homedepot and select the ESPP link under the Topics main menu. This link will direct you to the main ESPP page. Choose an option from the dropdown menu and follow the prompts to complete your transaction. You must confirm your selection before the transaction is complete. 288
Discounted Stock Purchase Price

The price of stock purchased through the ESPP is set with a 15% discount off the closing stock market price on the last day of the Plan. The Home Depot stock is traded on the New York Stock Exchange (NYSE).
Example: $35.00 - $5.25 $29.75 NYSE closing price ESPP discount (15% of $35) ESPP purchase price
Participating in the Plan

Eligibility and Participation
You are eligible to participate in the ESPP if you are employed by The Home Depot or a subsidiary company on the beginning day (Offering Date) of a Plan and have been added into all required administrative systems. To receive shares you purchased through payroll deductions, you must be an active associate on the last day of the Current Plan End Date (June 30 or Dec 31). See Special Circumstances for exceptions to this rule.

Your Total Shares
To determine the number of shares you will receive for a given Plan, divide the total amount deducted from your paycheck during the Plan by the stock purchase price. If your paycheck dollars are in a currency other than U.S. dollars, you must first convert the amount deducted using the conversion rate on the date the Plan ends.
Example: $1,500.00 $29.75 50.42 Total payroll deductions during Plan ESPP purchase price for Plan Shares purchased through Plan
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If your hours, pay rate or salary change during the Current Plan, your payroll deductions will be adjusted accordingly. In other words, the percentage rate of your payroll deduction will stay the same, unless you elect to change it as described in the next section. However, the dollar amount of your payroll deductions will change. What is Considered Eligible Pay? For purposes of determining your contributions to the ESPP, eligible pay is generally your taxable wages, plus your payroll deductions to the retirement plan and any before-tax payroll deductions for health and welfare benefit plans, minus reimbursements, expense allowances, fringe benefits, moving expenses, welfare benefits income attributable to Restricted Stock or other Equity Awards and other similar amounts.
rate, unless you elect to change your rate before the Pay Period End Date (June 16 or Dec. 17).
Changing Your Payroll Deduction

Anytime before the Pay Period End Date (June 16 or Dec 17), you may change your ESPP payroll deduction, according to the following rules: 1. Once the Current Plan has started, you cannot increase your payroll deduction percentage. 2. You may reduce your payroll deduction percentage only once during the Current Plan period. 3. You may stop your participation in the Current Plan at any time before the Pay Period End Date (June 16 or Dec. 17). If you choose to stop participating, future payroll deductions will be cancelled. You have two options if you stop participating in the Current Plan: Receive a refund by withdrawing the money that has already been deducted from your paycheck for that Plan. You will not receive any shares of stock at the end of the Plan. Since your ESPP payroll deductions are taken after taxes, no additional tax is withheld. You will receive a full refund for the amount that has been deducted from your pay for that Plan. Stop future deductions and leave the amount already withheld from your paycheck in that Plan. At the end of the Plan, The Home Depot will issue you as many shares of stock as the money deducted from your pay will allow. In other words, if you stop participating in one Plan before it ends, there is no automatic enrollment in the Next Plan. You may change your ESPP
If The Home Depot declares a stock split or has similar capital adjustments, the purchase price of the Current Plan and the number of shares your payroll deductions purchase will be adjusted accordingly.
Limitations on Your Contributions

Under the rules of the ESPP, there are limitations to your contributions, as follows: Your payroll deductions may not exceed the lesser of 20% of your eligible earnings (including bonuses), or $21,250. The maximum value of the stock you can purchase through the ESPP in a calendar year may not exceed $25,000, based on the closing stock price on the first day of a Plan. If you reach the maximum value of stock you can purchase in the current calendar year ($25,000), then you cannot participate in the ESPP for the remainder of the current year. However, you will automatically be enrolled in the Next Plan for the new calendar year at your Current Plan participation 289
ESPP Payroll Deductions

Calculating Your Payroll Deduction
Your ESPP payroll deductions are taken after taxes. The amount of your payroll deduction is a percentage of your eligible earnings for each pay period.
Example: $923 Eligibility earnings per pay period (Based on 26 pay periods per year; eligible annual pay of approximately $24,000, or about $12 per hour) ESPP elected participation rate Payroll deduction per pay period Pay periods during Plan (approximate) Total payroll deductions for Plan
x 5% $46.15 x 13 $599.95

payroll deduction by accessing the ESPP online or through the automated phone system. Prompts will lead you through each step to make your change. See Get The Most Value From Your Plan in the front of this section for more information. If you withdraw from the Current Plan, you must actively enroll in the Next Plan if you want to participate. After a Current Plan End Date (June 30 or Dec. 31), the total amount of your payroll deductions during the Current Plan will be used to purchase shares of stock. After a Pay Period End Date (June 16 or Dec. 17), you cannot receive a refund for your payroll deductions and will receive shares.
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Leave of Absence
If you are on Leave of Absence during the open enrollment period for the ESPP, you may enroll in the Next Plan while you are still on leave. Your contributions to the Plan start when your pay resumes after you return from leave. On the 91st day of a Leave of Absence, you lose your eligibility to participate in the Current Plan and your accumulated payroll deductions are automatically refunded to you approximately 2-3 paycycles later. If the Current Plan has not ended when you return to work, you cannot make up missed contributions. This loss of eligibility, which is determined by tax laws that govern the ESPP, applies unless your re-employment with the Company is guaranteed either by contract or by law (for example, under the provisions of FMLA or certain Military Leaves).
DeathYou die anytime while actively employed or you die while participating in a Current Plan under the retirement or disability provisions. If any of the special circumstances listed (retirement, death or disability) apply, and if you or the administrator of your estate do not make a timely election for a refund of your contributions, the monies in your account will be used to purchase stock at the end of the Current Plan.
Foreign Associates
The Committee may adopt rules or procedures to accommodate the requirements of local laws of foreign jurisdictions with respect to participants who are foreign nationals or who are deployed by the Company or any subsidiary outside the United States of America, as the Committee may consider necessary or appropriate to accommodate differences in local law, tax policy or custom.
Special Circumstances
Your participation in the ESPP and purchase of stock through a Current Plan will be affected by certain special circumstances including termination of employment, leave of absence, retirement, disability, and death.
Additional Special Circumstances

Retirement, disability, and death also affect participation in the ESPP. For the purposes of the ESPP, these circumstances are defined as follows: RetirementYou are terminating employment within three months before the end of a Current Plan End Date and satisfy the requirements of the Companys ESPP retirement provision (you are at least age 60 and have completed at least five years of continuous employment with the Company or one of its subsidiaries). DisabilityYou are terminating employment within three months of the end of a Current Plan and are eligible for permanent and total disability benefits under The Home Depot long term disability plan as defined in the Disability chapter.
Stock Ownership
Your ESPP Account at Computershare
Soon after a Plan ends, a personal account will be established with Computershare, The Home Depots ESPP service provider. The shares will be allocated into a book entry account established in your name. After your shares are allocated to your account, you will receive personal account information, including a PIN (personal identification number) from Computershare. For more information about your PIN, see Accessing Your Computershare Account.
Termination of Employment
If your employment termination date is on or before the last day of the Current Plan End Date (June 30 or Dec. 31), your rights to purchase shares under the ESPP will be cancelled. Your contributions to the Current Plan will be automatically refunded to you within 2-3 paycycles after your termination date.
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After your shares are deposited in your personal account, you will also receive an annual statement from Computershare. The statement will show 1) your total deduction amount, 2) the purchase price of the shares, and 3) the actual number of shares deposited into your account. Keep this statement for your tax records! Like any service provider, there are fees associated with doing transactions through Computershare. For more information, see Computershare Fees.
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Cash Dividends & Reinvestment

The Home Depot has, in the past, paid a cash dividend each quarter (the Company reserves the right to change its dividend policy in the future). If you have your stock certificates at home or in a safe deposit box, the dividend will be mailed to your home address. If your shares are being held at Computershare, any dividends will be automatically used to purchase additional shares of The Home Depot common stock. The shares purchased will be credited to your Computershare account.
Dividend Amount $0.01$100 $100.01$500 $500.01 + Fee 4% the greater of 2% or $4 1.5%
Account Statements
Computershare will mail you an annual statement, in January. This statement will include your current transaction or activity, your previous share balance, and your current share balance. It is very important that you keep these statements. You will need the information when you file your income tax return.
Importance of Diversification
A well-balanced and diversified investment portfolio is important to the long-term financial security of you and your beneficiaries. Broadly defined, diversification means having an investment portfolio mixed among different asset classes, such as stocks, bonds, and cash. The stock of a single company, such as The Home Depot, is subject to greater risk than diversified portfolios such as mutual fund investments. The value of an individual stock is subject to volatility and may decline over time. Most financial planners agree that having more than 20% of your total investment portfolio in any individual stock results in unnecessary risk-taking and wouldn't be considered adequate diversification. You may want to take this opportunity to evaluate your total investment portfolio allocations, including the stock you acquire under the ESPP, the investments in your FutureBuilder 401(k) account and any personal investments and savings you may have.
Ownership of Shares
You may not transfer ownership or pledge your right to receive shares through an ESPP Plan to anyone else. However, once the shares are purchased for you and are deposited in your Computershare account, you may generally sell or transfer the shares without any restriction. However, refer to Restrictions on Resale of Common Stock Acquired under the Plan for certain insider trading restrictions. In the case of your death, certain legal documents are required before the stock can be re-registered to anyone. Contact Computershare for more information. You may not designate a beneficiary for your ESPP account. For more information, see Special Circumstances.
If you do not wish to have your dividends reinvested, you must write Computershare and ask to be removed from the Dividend Reinvestment Plan. You must include your Social Security number or Global ID (Canada/Mexico), The Company Name Home Depot, and your current address so that Computershare can begin mailing your dividend checks. Computershare charges a commission for purchasing stock through their Dividend Reinvestment Plans. Refer to Computershare Fees for fees associated with transactions completed through Computershare. If you hold shares with any other brokerage account, any dividends on your shares will be credited to your account with this broker. Contact your broker for information about reinvesting these dividends.
Stockholder Privileges
Once you own at least one whole share of stock, you will receive notices of stockholder meetings, proxy statements, annual reports, and other literature sent to stockholders. As a stockholder, you will also benefit from any stock splits and cash dividends.
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Stock Transactions
Accessing Your Computershare Account
After you are allocated shares from a Plan, Computershare will send you a letter containing your five-digit PIN (personal identification number). You may change the PIN to another five-digit number at any time. The PIN you receive from Computershare will not be the same as the PIN on your paycheck. If you forget your PIN, you may contact Computershare by phone at 1-800-843-2150 to obtain a new one.
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Receiving Your Stock Sale Proceeds

Computershare offers you two options to receive payment for shares that you sell: 1. First-class mail on settlement day, which is the third business day after the sale of stock. This is the standard method for receiving payment. You pay only the regular transaction fee. See Computershare Fees for the current rate. 2. Wire transfer to bank account on settlement day. You must fax the following wire transfer information to Computershare: your name, address, Social Security number or Global ID Number, ABA/bank routing number, bank account number, corresponding bank information (if outside the U.S.), and day and evening telephone numbers. If you sell your stock and dont choose a delivery option, a check for your proceeds will be mailed to you (option 1).
shares to an investment account that you designate. If you request that a certificate be transferred to a minor (a person under 18 years of age), the certificate must be registered in the minors name and must include the name of an adult as custodian. If you request a certificate, it will arrive approximately three weeks after Computershare receives your request. If another person is taking ownership of the shares, the certificate will be mailed to that person, unless you request otherwise. There is a transaction fee for each certificate issued and for electronic share transfers. See Computershare Fees for more information.
Selling Your Shares

Once your shares have been deposited into your Computershare account, you may instruct Computershare to sell any or all of the shares in your account. Refer to Restrictions on Resale of Common Stock Acquired Under the Plan for certain insider trading restrictions. Computershare will accept orders to sell stock before the stock market opens (9:30 a.m. Eastern Time). Your stock will be sold at the opening price of the current day (not the closing price of the prior day, which is the price that Computershare quotes until the market opens). Computershare charges a commission for selling your stock. See Computershare Fees for more information.
Computershare Fees
The following fees are subject to change at any time without notice. To confirm the current fees, visit the Computershare web site at www-us.computershare.com Selling The Home Depot Stock $0.03 per share $25 minimum charge per transaction $5.35 confirmation charge per transaction SEC Section 31 fee Buying The Home Depot Stock To purchase stock through Computershare on the open market, you may join Depot Direct by accessing and completing an enrollment form online at http://www.comptershare.com/Investor.
Certificate Withdrawals and Share Transfers

Computershare cannot withdraw or transfer your shares until they have first been deposited to your account. You may obtain withdrawal/transfer forms by calling Computershare or through the web at www-us.computershare.com. After Computershare receives your shares from The Home Depot, you may have them withdrawn from your account and a certificate issued in your name or the name of someone you designate. Or, you may instruct Computershare to electronically transfer
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Payment of Proceeds by Wire Transfer Your proceeds can be wired directly to your checking account on the third business day following the sale of your stock, provided that Computershare has received your wiring instructions to your bank. Wire transfer fee ($15 U.S.). Your bank may also charge you a fee to receive the wire into your account. Certificate Issuance and Electronic Transfer Fees ($15 U.S.). The fee is waived for transfers to a Merrill Lynch account.
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Taxes and the ESPP

The information in this section provides only a brief explanation of some of the tax consequences associated with purchasing and selling shares of stock through the Employee Stock Purchase Plan. Be sure to consult your tax advisor for a full explanation.
Qualified Disposition If you sell your shares after the Holding Period expires, your shares are considered to be qualified. When you sell the qualified shares, the sale is considered a Qualified Disposition. If you sell your shares in a Qualified Disposition, you report on your tax return 15% of the stock closing price on the first day of the Plan (the discount amount) as ordinary compensation income (or, if less, the difference between fair market value of the ESPP shares on the date of the sale less the amount you paid for the shares). You report any remaining gain as long-term capital gains on your tax return. Long-term capital gains tax rates are generally (but not always) lower than your personal income tax rate. Consult your tax advisor for information on your personal situation. Disqualified Disposition If you sell before the end of the Holding Period, The Home Depot will report the difference between the stock closing price when the Plan ends less your purchase price for those shares as taxable wages on your Form W-2. You may have additional gain (for example, if the stock price has gone up since you purchased it). This gain is not included in your W-2 wages, but you must report the gain as a capital gain on your tax return. Consult your tax advisor for information on your personal situation.
Tax Benefits
When you purchase The Home Depot stock through the ESPP, you are not taxed on the 15% discount you receive off the market price. The difference is called the spread. You are taxed, however, when you sell your shares.
Computershare Contacts
You will need your Computershare account number and PIN to access your Computershare portfolio online or through the automated phone system. Phone Call 1-800-843-2150. Automated system available 24/7. Representatives available as follows: 8 a.m.7 p.m., Eastern Time 7 a.m.6 p.m., Central Time 6 a.m.5 p.m., Mountain Time 5 a.m.4 p.m., Pacific Time Mail Computershare Inc. Attn: ESPP/SOP 250 Royall Street Canton, MA 02021 Online www-us.computershare.com/employee
Tax Consequences
When you sell your ESPP shares, you are responsible for paying federal and any applicable state and local income taxes on your net gain from the sale of your shares. The purchase price, the date your shares are purchased, and the date you sell the shares all figure into the amount of tax you owe. If you sell shares, you will receive a transaction history and 1099-B form in January of the following year. Depending on the country where you live, you will be required to complete a W-9 (US) form or a W-8 (NonUS) BEN form.
Holding Period
Each Plan has a Holding Period. The Holding Period extends for two years after the first day of the Plan (the Offering Date).
Dividends
Any dividends you receive on your ESPP shares are taxable to you in the year during which they are paid.
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Reporting Capital Gains on the Sale of ESPP Shares
The gross proceeds on the sale of your shares are reported to you by Computershare on a Form 1099-B. When you complete your tax return, you should deduct the cost of your stock and any gain reported on your W-2 from the gross proceeds and calculate taxes on the new profit of your sale.
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ESPP Supplemental Information

Available Shares
A total of 11,246,203 shares are authorized under the ESPP as of April 2011 and are available for future issuance. The Authorized shares for issuance under the ESPP is subject to increase or decrease as the result of changes in The Home Depot stock such as stock splits, stock dividends, and similar events. Shares acquired under the ESPP are purchased from The Home Depot and may be newly issued shares, treasury shares, or shares that have been reacquired by The Home Depot.
Restrictions on Resale of Common Stock Acquired under the Plan

Federal law prohibits trading in securities on the basis of material non-public information and provides for substantial civil and criminal penalties for violations of these prohibitions. These prohibitions and penalties apply to the Company generally and to associates who participate in the ESPP. Moreover, the Companys Securities Laws Policy may impose additional limits on transactions in the Companys common stock. You should refer to Securities Laws Policy, which is available on the Companys intranet or in hard copy by request from the Companys Legal Department. The federal securities laws also limit the circumstances under which persons who are Affiliates can sell securities. Affiliates generally include the Companys executive officers, directors and stockholders who own more than 5% of the Companys common stock. You may contact the Companys Legal Department if you are uncertain as to whether or not the Company considers you to be an Affiliate. Non-Affiliate associates who purchase shares of common stock under the ESPP may generally resell the shares through a stockholder in the customary manner or to third persons without the use of a stockbroker. Associates who are Affiliates may resell their shares of common stock in accordance with the requirements of Rule 144 under the Securities Act. In addition, Affiliates and other associates who are Designated Associates under the Securities Laws Policy may only sell their shares of common stock during open window periods under the Policy. You should contact the Companys Legal Department if you are uncertain as to whether or not the Company considers you to be a Designated Associate.
Backup Withholding (W-9) Certification

The IRS requires Computershare to certify your name and Social Security number. The W-9 certifies, under penalty of perjury, that you gave Computershare your correct name and Social Security number and that you do not owe the IRS any taxes from prior years. If Computershare does not have your W-9 certification on file, they will withhold 30% from the proceeds when you sell your stock. They will also withhold 30% from the dividends paid by The Home Depot on your shares of stock. You may certify the required information electronically through Computershares automated phone system, online, or by submitting a completed W-9 form, which you may obtain by speaking with a Computershare representative. After you complete the form, you may fax or mail it to Computershare according to instructions provided by the representative. If Computershare is where you will hold your shares, you need to provide W-9 certification only once for your ESPP account. If Computershare receives your W-9 certification late, you must file for a refund on Form 1040 when you file your tax return with the IRS the following year.
Amendment and Termination

The Board of Directors may, at any time, amend the ESPP in any respect. The Home Depots stockholders must approve any amendment that would increase the number of shares that may be issued under the ESPP (other than an increase merely reflecting a change in The Home Depots capitalization) or a change in the designation of any corporations (other than a subsidiary of The Home Depot) whose employees may participate in the ESPP. The Plan and all rights of participants under the ESPP will terminate when all available shares have been purchased under the ESPP, or upon any earlier date determined by the Board of Directors. If necessary, the number of shares that may be purchased in a Plan will be prorated based on contributions.
Rights Not Transferable

The rights of ESPP participants may not be assigned or transferred and are not subject to lien.
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Certain officers are also subject to potential shortswing profit liability under Section 16(b) of the Exchange Act with respect to purchases and sales (or sales and purchases) of shares of the Companys common stock within a six-month period. For example, if an officer subject to Section 16 sells shares in the open market, he or she must ensure that at least six months passes before any direct or indirect purchases of Company securities, because the sales could be matched with the purchases, and the officer might be required to disgorge certain gains from the matched transactions. In addition, persons covered by Section 16 must report purchases and sales of ESPP shares within two business days after they occur. Directors and officers subject to Section 16 must pre-clear any transactions in the Companys securities with the Companys General Counsel.
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Incorporation of Documents by Reference

The following documents are incorporated by reference into this summary of the ESPP: 1. The Companys latest annual report on Form 10-K; 2. All other reports filed pursuant to Section 13(a) or 15(d) of the Exchange Act since the end of the Company fiscal year covered by the Companys latest annual report on Form 10-K (other than information deemed to be furnished and not filed under SEC rules); and 3. The description of the Common Stock contained in the Companys Report on Form 8-A filed with the Securities and Exchange Commission (the SEC) pursuant to the Exchange Act. All documents filed by the Company pursuant to Sections 13(a), 13(c), 14 and 15(d) of the Exchange Act (other than, in each case, documents or information deemed furnished and not filed under SEC rules) after the date of this summary and prior to the filing of a post-effective amendment which indicates that all securities offered hereby have been sold or which deregisters all securities then remaining unsold, will be deemed to be incorporated by reference in the summary and be a part hereof from the date of filing of such documents. The Company will provide without charge, upon written or oral request, the above documents which are incorporated by reference. Written or telephone requests should be directed to:
Investor Relations Department The Home Depot, Inc. 2455 Paces Ferry Road, N.W. Atlanta, Georgia 30339-4024
Available Information
The Company is subject to the information requirements of the Exchange Act and consequently files reports, proxy statements and other information with the SEC. Participants can inspect or copy reports, proxy statements and other such information filed by the Company at the public reference facility maintained by the SEC at: SEC 100 F Street, N.E. Washington, D.C. 20549 Copies of such materials (at prescribed rates) may be obtained from this facility. These materials are also available to the public from the SECs web site at www.sec.gov. The Companys common stock is listed on the NYSE, and certain of its reports, proxy statements and other information may be inspected at the offices of the NYSE: NYSE 20 Broad Street New York, New York 10005 The Company may provide additional updating information with respect to the common stock in the future to participants by means of appendices to this prospectus or delivery of other documents.
Applicable Laws
The ESPP is not subject to the requirements of the Employee Retirement Security Act of 1974 (ERISA) nor is it intended to be a qualified plan under Section 401(a) of the Internal Revenue Code of 1986.
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The Company has filed with the SEC a Registration Statement on Form S-8 (including all amendments thereto, the Registration Statement) with respect to the securities offered under the plans. This prospectus does not contain all of the information set forth in the Registration Statement and its exhibits and schedules. For further information about the Company and the securities offered through the plans, participants should consult the Registration Statement and its exhibits, which may be examined at the SECs public reference facility or through the SECs web site. Participants may obtain information about their ESPP account and shares by contacting: Stock Plan Administration Department The Home Depot, Inc. 2455 Paces Ferry Road Atlanta, Georgia 30339 1-800-654-0688, Ext. 13777 Participants receive reports showing the status of account annually. Participants should direct any questions regarding the Plan (other than requests for incorporated documents) to the Stock Plan Administration Department.
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Company Financial Statements

ESPP participants and associates eligible to participate in the ESPP may obtain a copy of the Companys latest Form 10-K in any of the following ways: a copy is posted on the Investors Relations portion of the Companys web site at http://ir.homedepot.com; request a copy from your Human Resource Manager; Write to request a copy from: The Home Depot, Inc. Investors Relations Department 2455 Paces Ferry Road, N.W. Atlanta, Georgia 30339-4024 call to request a copy from the Investors Relations Department at 1-770-433-8211 request a copy online through the Companys web site at http://ir.homedepot.com/comment.cfm a copy is posted on the Your Benefits Resources web site. See Enrolling in the Plan for details on accessing Your Benefits Resources web site.
Neither the Securities and Exchange Commission nor any state securities commission has approved or disapproved of the securities or passed upon the adequacy or accuracy of this prospectus. Any representation to the contrary is a criminal offense. The Company has not authorized anyone to give any information or make any representation about the Company or the ESPP that is different from, or in addition to, that contained in this prospectus, the related registration statement or in any of the materials incorporated by reference. Therefore, if given information of this type, you should not rely on it. If you are in a jurisdiction where offers to sell, or solicitations of offers to purchase, the securities offered by this document are unlawful, or if you are a person to whom it is unlawful to direct these types of activities, then the offer presented in this document does not extend to you. The information contained in this document speaks only as of the date of this document unless the information specifically indicates that another date applies. This is an unpublished work containing confidential and proprietary information of The Home Depot. 2006 Homer TLC, Inc. All rights reserved. The Home Depot stock is traded on the New York Stock Exchange (NYSE). Past performance does not guarantee future performance.
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Work/Life Benefits
Chapter Contents
298 Best Doctors 298 Back-Up Dependent Care Advantage Program 299 Building Better Health (BBH) 299 Quit for Life Program 299 Tuition Reimbursement Program 299 300 Benefits You Can Receive Eligibility
300 Matching Gift Program 300 Associate Referral Program Benefits 301 CARE/Solutions for Life 302 Health Advocate 302 Adoption Assistance 302 Application/Reimbursement
303 MetDESKPlanning for Special Needs Dependents
300 Team Depot
297
Work/Life Benefits
What do you need?
Find out more about Medical & Health Managements Building Better Health (BBH) wellness program at your store Enroll in Quit for Life Get a tuition reimbursement form and apply for reimbursement Receive tuition reimbursement Get more information about Adoption Assistance Participate in Team Depot community service projects Reach CARE/Solutions for Life Get help from Health Advocate MetDESK Planning for Special Needs Dependents
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Find it here...
Visit myApron, My HR, Pay and Benefits, Benefits and Wellness for more information and a listing of all the programs available through BBH. Call 1-866-784-8454 or visit www.quitnow.net/homedepot Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call 1-800-555-4954 Fax your completed form to the Benefits Choice Center at 1-847-883-8269 Call the Benefits Choice Center at 1-800-555-4954 Ask your supervisor or your sites Team Depot Captain and visit myApron>My Company tab>Community Involvement/Team Depot Call 1-800-553-3504 or go to www.caresolutionsforlife.com for educational information and referrals, available 24/7 Call 1-800-519-6689 Call 1-877-638-3375
Because the Company believes that our associates are our greatest resource, the Company offers many programs to enhance the quality of your life at work and at home. Your Work/Life Benefits include the following: Best Doctors
Each of these programs is delivered under a written document or SOP. In the event of a conflict between this chapter and the program document or SOP, the program document or SOP will govern.
One phone call to Best Doctors at 1-866-797-8021 gives Home Depot medical plan participants access to the expertise and experience of world-class physicians representing over 400 sub-specialties of medicine and surgery. Visit www.livetheorangelife.com and click on Health Plan Tools/Programs to learn more.
Best Doctors
If you are covered under a Home Depot medical plan, Best Doctors, can provide you with a confidential expert second opinion so you can be more confident youre getting the right diagnosis and the right treatment. When you or your family member is facing a health issue, its difficult to know exactly what to doespecially if you get conflicting advice from different specialists. You need the right answers to tough questions: Am I getting the right treatment? Is surgery really my best option? Is my doctor right?
Back-up Dependent Care Advantage Program Building Better Health Quit for Life Program Tuition Reimbursement Team Depot Matching Gift Program CARE/Solutions for Life Health Advocate Adoption Assistance MetDESKMetLifes Division of Estate Planning for Special Kids
Back-Up Dependent Care Advantage Program

The Home Depot has partnered with Bright Horizons to offer high-quality back-up dependent care when you need to be at work and your regular child or adult/elder care is unavailable, for example: Your regular caregiver or spouse is unavailable Your child's regular care center or school is closed Your loved one is mildly ill or recovering from surgery
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Associates who have been with the Company for at least one year will receive up to 10 days of care per year through a nationwide network of quality providers at deeply discounted rates for the following: Center-based child care In-home child care In-home mildly ill child care In-home adult/elder care Discounted rates are $25 per day for one child ($35 per day for more than one child) for center-based child care and $6 per hour for in-home child and/or adult/elder care (four hour minimum). You must register before using The Back-Up Care Advantage Program and reservations are required. It is hard to predict when your regular care will be unavailable, so plan ahead and register now. Requests for care can be placed from one month in advance up to the day that care is needed. You have two ways to register: Visit www.backup.brighthorizons.com (Username: homedepot; Password: homedepot) Call 877-5HDBUCA (877-543-2822) Learn more about this exciting benefit and Bright Horizons at www.livetheorangelife.com.
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Building Better Health (BBH)

BBH is The Home Depots health and wellness program available to all associates. BBH is one component of the Companys health management strategy aimed at improving our associates health and wellbeing. The goal of the BBH program is to educate and motivate our associates to take steps to maintain a healthy life. Wellness programs will focus on addressing leading modifiable health risk factors. Program focus areas include: Physical Activity/Fitness Nutrition/Weight Management Tobacco Cessation Preventive Health Screenings and Immunizations All associates are encouraged to eat well, exercise regularly, get routine health screenings and immunizations, be tobacco free and be an active participant in managing their health and taking advantage of the BBH program offerings available. See your store/locations Wellness Champion for more information..
if appropriateto prepare for your quit date. Along with five one-on-one sessions with your coach and unlimited phone support if needed, the program includes: Unlimited access to Web Coach, an online community offering e-learning tools, social support and information about quitting. Over-the-counter nicotine patches or gum provided for free if indicated by your Quit Coach (an eight week supply). Prescription drugs may also be covered by your medical plan. Talk to your Quit Coach for more information. Quit for Life is also available to your spouse if he or she is enrolled in a Home Depot medical plan. To enroll call Quit for Life at 1-866-quit-4-life (866784-8454).
Tuition Reimbursement Program

The Companys Tuition Reimbursement Program encourages and supports associates who enroll in college, university and technical school courses in order to obtain a degree or for professional development.
Quit for Life Program

The Home Depot offers associates who use any type of tobacco a program to help you stopthe Quit for Life Program. If youre ready to quit for life, your Quit Coach is ready to help. When you call the program, your highly trained Quit Coach will talk to you about your smoking history and daily smoking patterns. Your coach will use this information to develop a personalized planincluding medication,
Benefits You Can Receive

The Tuition Reimbursement Program reimburses eligible associates for 50% of the cost of tuition, books and class registration fees for approved courses in which the associate earns a grade of C or better or for pass/fail courses for which the associate earns a passing grade that is applied toward a degree.
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Reimbursements count toward the annual calendaryear maximum for the calendar year in which they are received. For example, if you complete a course in 2010 and you receive reimbursement for that 2011, the reimbursement counts toward your 2011 annual maximum. The Tuition Reimbursement Program reimburses eligible associates up to an annual calendar-year maximum of: For full-time hourly associates: $3,000 For salaried associates: $5,000
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Team Depot
Team Depot is our associate-led volunteer force that meets community needs through hands-on service. Every year through Team Depot, associates contribute countless hours to the communities in which they live and work, truly exemplifying our value of Giving Back. Every Home Depot retail store in the U.S., Canada and Mexico has a Team Depot captain and associate-volunteers. The Team Depot captain is an amazing leadership opportunity for our associates and allows them to plan and lead transformational community service projects.
You may also reach this web site through the Community Involvement section of MyApron and then by clicking Internal Partners to access Matching Gifts. 2. Register your gift by phoning the Matching Gift Center at 1-888-628-2442. With either method you will need your associate identification number, the recipient organizations name, amount, and date of your gift. By registering online, you will have the ability to print a confirmation of your gift registration. The Matching Gift Center cannot process incomplete gift registrations. If the match is approved, the gift will be made from the Foundation in the next scheduled distribution. To help with administrative costs, check disbursements are only made quarterly. Check the web site to track the status of your matched gift. If you need immediate assistance please contact customer service in the Matching Gift Center at 1-888-628-2442 or send an email to homedepot@matchgift.com. This program is available to U.S. and Canadian associates.
Eligibility
Eligibility for the Tuition Reimbursement Program begins on or after your anniversary date of employment. Part-time and temporary employees are not eligible for the Program. Salaried associates with more than 5% ownership as shareholders of the Home Depot are not eligible for this program. Highly compensated employees (HCE) may receive reimbursement for tuition under different rules with different tax consequences. If you are a highly compensated employee for 2011, please contact the Benefits Choice Center at 1-800-555-4954 for more information regarding tuition reimbursement. Courses must begin after the first anniversary date of employment and while the associate is an active employee. Eligibility ends if your employment terminates voluntarily or involuntarily before completion of courses unless its because of a reduction of force, your relocation at the Companys request or your death. For more information on the Tuition Reimbursement Program, please refer to the Tuition Reimbursement SOP located on myApron>HR SOPs.
Matching Gift Program

The Home Depot Foundation will match your gifts ranging from $25 to $1,000 per charitable organization each year on a dollar-for-dollar basis if you are a full-time or part-time associate.There is a $3,000 maximum per associate each calendar year. In order to be matched, the gift must have been given solely by the associate.The Foundation will not match pledges or monies raised by others. After sending your contribution to the organization, there are two easy ways for you to register your charitable gift and obtain a match for eligible organizations from The Home Depot Foundation: 1. Register your gift on the Matching Gift web site at www.givingprograms.com/homedepot, then: Click on the Programs tab at the top of the screen. Select Register, and then login.You will need to create a login and password to begin the gift registration process.
Associate Referral Program Benefits

The Home Depot Associate Referral Program has been enhanced to make home financing easier and less costly for Home Depot Associates. By using a company referred real estate agent and by financing your mortgage through Citimortgage or Wells Fargo Home Mortgage you will receive: Up to $400 reimbursement of pre-purchase home inspection fees.
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Waived lenders fees. Including - Appraisal, Credit Report, Tax Service, and Flood Certification. A value up to $600.00 Easy applications and quick approval decisions. Apply by phone, and in just minutes you can have a decision. Need moving services? We can refer you to a full service, professional van line. Call 800-654-0688, ext. 83211 (Kim Robinson kimberly_d_robinson@homedepot.com) or ext. 17920 (Cecelia Reese - cecelia_reese@homedepot.com) to be placed in our Home Purchase Program. To qualify for these benefits, the associate must be placed into the program prior to contacting a real estate agent.
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receive up to three face-to-face counseling sessions per concern with a local provider free of charge. CARE also may refer associates to community organizations for additional services. You are responsible for any fees these agencies may charge. CARE/Solutions for Life is a valuable resource when you have concerns related to any of the following: Confidential CounselingIndividual, relationship and family counseling, alcohol/drug assessment and referral. Associates, their immediate family members, and domestic partners are provided up to three face-to-face sessions, per issue every year at no cost. Alcohol/Depression ScreeningAutomated self-assessments help you evaluate potential symptoms for depression, alcohol/drug abuse and other concerns; available 24 hours a day, seven days a week. Access the screenings from the web. Look for the Access Concerns tab at www.CARESolutionsforLife.com. Prenatal CarePre-Natal Package includes tools designed to track babys development and document milestones after birth as well as two great gifts. Professionals can provide information about breastfeeding and other helpful tips. AdoptionInformation on adoption to help you understand the process; referrals to agencies and attorneys Child CareReferrals to child care including family-operated centers and in-home services and afterschool care centers. Parenting ResourcesResources and referrals to help you be the best parent you can be
Summer CareDetails on available day care, day camps and sleep-away camps to meet your childs needs School ProgramsInformation for students of all ages on tutoring, public and private schools, and schools for children with special needs Colleges and UniversitiesInformation on certificate and degree programs, grants, scholarships and financial aid Elder CareFree elder care kit package includes comprehensive guides to meet the needs of older adults as well as caregivers. Professionals offer resources and referrals for day care, retirement and nursing homes; information on dementia including Alzheimers disease Financial Counseling and Legal Services Associates who may benefit from financial or legal services can receive advice from a financial advisor or attorney. Financial counselors provide phone counseling to help with debt management, credit, and other money concerns. For legal services, the initial consultation is free, with attorneys providing additional ongoing services at a 25% discount off their usual fees. Convenience ServicesConvenience services help with a variety of concerns and save time because CARE does the research for you. Get information about entertainment, shopping, personal services, travel, recreation, household services, pet services and more. For Internet access log on to the www.CARESolutionsforLife.com web site and access educational information and referrals.
CARE/Solutions for Life

CARE/Solutions for Life is a free EAP (Employee Assistance Program) and Work/Life resource designed to help associates successfully manage challenges in your personal and work life. The program is available to all Company associates, spouses, household members and domestic partners, same or opposite sex. Experienced professionals are available 24 hours a day, seven days a week to provide assistance for a wide range of issues that may impact the quality of your life. CARE will listen to your concerns, answer questions and provide referrals to programs or agencies that offer the best assistance for your particular situation. Information you share with the EAP is confidential. (Exceptions to confidentiality are required by law when there is danger to the associate or another individual). Each year all associates may
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To speak with a CARE/Solutions for Life counselor anytime 24/7, call 1-800-553-3504. Asistencia telefnica y sitio web disponibles en espaol. Coverage under CARE extends automatically for 36 months under COBRA following any COBRA qualifying event at no cost to you or your eligible family members. See the COBRA chapter for more information about qualifying events and your notice obligations.
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Locating and researching current treatments for a medical condition Identifying best-in-class medical institutions for serious illnesses or injuries Complementing your basic health insurance coverage by helping your interactions with healthcare providers and claims administrators Helping you understand your benefit plan provisions and features Providing independent, confidential assistance and information. Health Advocate is not affiliated with any of the Plans claims administrators or any specific provider. You can call Health Advocate toll-free at 1-800-519-6689 Monday through Friday between 8:00 a.m. and 9:00 p.m. Eastern Time.
Application/Reimbursement
To obtain an Adoption Reimbursement form, access the Your Benefits Resources web site, call the automated phone system or speak to a Benefits Choice Center representative. Eligible expenses for reimbursement include: licensed adoption agency fees legal fees pregnancy expenses for the childs birth mother charges for temporary foster care before placement travel expenses to gain physical custody of the adopted child Return the completed Adoption Reimbursement Form with proof of eligible expenses, your store number and a copy of the Adoption Certificate or Decree to the Benefits Choice Center. If your application is approved, youll receive a Confirmation of Reimbursement in the mail at your home. If false or fraudulent information is given, the associate can be subject to termination. If your application is denied, youll receive a Reimbursement Denial Notice explaining the reason for the denial. For more information regarding Adoption Assistance, please call the Benefits Choice Center at 1-800-555-4954.
Health Advocate
The Company provides all associates with a free service, Health Advocate, to help you deal with benefit claims and billing issues, find an appropriate doctor, schedule specialized treatments as well as other types of assistance. Health Advocate will help you navigate the complexities of the healthcare system. When you call Health Advocate, youll speak with a Personal Health Advocate (PHA). Your PHA typically is a registered nurse who is supported by medical directors and claims and benefits specialists. He or she will work with you one-on-one to help find solutions to your healthcare or health insurance related issues. Whatever your healthcare need, your PHA will do the legwork and work with you through the entire process. Health Advocate covers your entire family you, your spouse, dependent children, your parents and your parents-in-law. Health Advocate can serve you by: Assisting with benefit claims and billing issues Helping you with eldercare issues
Adoption Assistance
The Company reimburses eligible adoption expenses up to a maximum of $3,000 for associates for each qualifying adoption. With our Family Leave of Absence policy, the adoptive parent may be eligible to take up to 24 weeks of unpaid leave. CARE/Solutions for Life provides adoption education and resources including referrals to family counselors. All associates with one year of continuous service are eligible for adoption assistance.
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MetDESKPlanning for Special Needs Dependents
MetDESK can assist you with the complicated process of planning for the future of your children or other dependents with special needs. Regardless of the age or disability of your dependent, trained representatives can help you navigate through financial and legal issues that are involved in providing not just lifetime care, but quality of life. MetDESK can help you with: protecting future government benefit eligibility for supplemental security income and Medicaid preparing a will assigning a guardian for your child planning for your dependent's financial security With MetDESK, you can take advantage of a comprehensive web site, as well as educational workshops and one-on-one counseling. MetDESK representatives can also steer you in the right direction for additional help that you may need. You do not need to enroll in this benefit. You may use MetDESK at any time, and it's available at no charge to all associates and their immediate family members and domestic partners. To learn more about MetDESK, call 1-877-638-3375 to speak with a MetDESK Customer Service Consultant.
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Time-Off Benefits
Chapter Contents
For information on time-off benefits see the following SOPs: Vacation SOP: Hourly Associates Vacation SOP: Salaried Associates Sick/Personal SOP: Hourly Associates Bereavement SOP: All Associates Jury Duty SOP: All Associates To find these SOPs, go to myapron.homedepot.com or call the HR Service Center at 1-866-698-4347.
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Leaves of Absence
Chapter Contents
For information on leaves of absence, see the following SOPs: Medical Leave of Absence SOP Military Leave of Absence SOP Leaves of Absence SOP (excluding Medical, Military and Involuntary)
To get a copy of these SOPs, call the HR Service Center at 1-866-698-4347.
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COBRA Coverage
Chapter Contents
307 COBRA Continuation Coverage 309 USERRA Continuation Coverage 309 Notifying the Company About a Qualifying COBRA Event 310 If You Are on a Leave of Absence 310 If a Disability Occurs 310 Paying for COBRA Coverage 311 Electing COBRA Coverage 311 When COBRA Coverage Starts 311 Status Changes and COBRA 311 311 New Spouse Newborn and Adopted Children
312 Individuals Eligible for the Federal Program Providing Trade Adjustment Assistance 313 When COBRA Coverage Ends 313 Certification of Creditable Coverage Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 313 Keep Your Plan Informed of Any Address Changes
COBRA Coverage
What do you need?
To begin coverage under COBRA for family members losing coverage due to the following qualifying events: divorce, legal separation or the end of a dependent childs eligibility To begin coverage under COBRA for loss of coverage due to any qualifying event other than the events listed above To extend COBRA coverage for participants who are disabled during the first 60 days of COBRA coverage To send any required documentation to the Benefits Choice Center
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Find it here...
Call the Benefits Choice Center at 1-800-555-4954 and speak with a Benefits Choice representative.
Call the Benefits Choice Center at 1-800-555-4954 after you receive your COBRA enrollment materials in the mail.
Call the Benefits Choice Center at 1-800-555-4954 and speak with a Benefits Choice representative. Mail to: The Home Depot Benefits Choice Center, P.O. Box 1493, 100 Half Day Road, Lincolnshire, IL 60069-1493.
COBRA Continuation Coverage

Associates and qualifying beneficiaries participating in the Company Medical, Vision and Dental Plans, CARE/Solutions for Life and the Health Care Spending Account have the right to choose continuation of coverage for certain qualifying events as provided under the Consolidated Omnibus Budget Reconciliation Act (COBRA) enacted under federal law on April 7, 1986 (Public Law 99-272, Title X). You may continue your critical illness protection plan coverage, whether or not it is subject to COBRA. Coverage will continue under the same terms that apply to medical coverage. COBRA requires that most employers sponsoring group health plans offer associates and qualifying beneficiaries the opportunity for a temporary extension of health coverage (called continuation of coverage) at group rates in certain instances (referred to as COBRA qualifying events) where coverage under the Plan would otherwise end. A qualified beneficiary is your
spouse or child covered under the Plan immediately before a qualifying event or a child born to or placed for adoption with an individual who has elected COBRA. A same-sex domestic partner cannot choose COBRA coverage on his or her own as a qualified dependent. However, an eligible same-sex domestic partner can be covered as a non-qualified beneficiary by a qualified beneficiary (for example, the associate covering the same-sex domestic partner as an eligible dependent). This means a same-sex domestic partner does not have independent COBRA rights and may only keep the same COBRA coverage as the covered associate. The continuation of coverage period allowed under COBRA begins: For termination of your employment, on the day following the last day of your final pay period; or At the end of the first 12 weeks of any medical or maternity leave under FMLA; or For all other qualifying events, from the date of the qualifying event. 307
The continued coverage under the Medical, Vision and Dental Plans, CARE/ Solutions for Life and Health Care Spending Account will be identical to those offered to similarly situated active associates, as required under COBRA. Continuation coverage is available for a maximum of the following periods: 18 months following a loss of coverage due to a termination of employment (other than for gross misconduct) or reduction in hours; 36 months following divorce or loss of dependent status; for Medicare, it is the later of 18 months from the date coverage is lost or 36 months from the date of the associates Medicare eligibility if Medicare entitlement occurred before the date of the COBRA qualifying event; 24 months for Military Leaves; and 29 months for a qualified disability (as long as the required notices and documents are provided within required timeframes). Coverage is continued for CARE/ Solutions for Life for 36 months without regard to the applicable COBRA qualifying event.
COBRA Coverage
COBRA Qualifying Events (which result in loss of coverage)
Qualifying Event Termination of your employment (except for gross misconduct) Change in your employment status (reduction in hours of employment) You or a family member covered under COBRA become permanently disabled within required timeframe (60 days of starting COBRA coverage) Your Personal Leave Military Leave Who Can Continue COBRA Coverage?1, 2 You and your covered eligible dependents You and your covered eligible dependents You and your covered eligible dependents You and your covered eligible dependents You and your covered eligible dependents4 Your covered eligible dependents Your covered spouse You and your covered eligible dependents Your child Your covered eligible dependents
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How Long Can COBRA Coverage Continue? 18 months from the last day of your final pay period 18 months from date of qualifying event 29 months from date of original qualifying event within required timeframe (60 days of starting COBRA coverage) 18 months from the 31st day after the date leave began 24 months from date of qualifying event4 (18 months under COBRA; six additional months under USERRA) 36 months from date of qualifying event 36 months from date of qualifying event 18 months from end of FMLA period
How Much Will COBRA Coverage Cost?2, 3 102% 102% 102% (first 18 months) 150% (last 11 months) 102% 0% Associates on Military Leave do not pay for COBRA coverage
Your death You divorce or become legally separated from your spouse Failure to return from FMLA leave
102% 102% 102% (active associate rates during the first nine months if on an approved leave of absence) 102% 102%
Your child is no longer eligible You enroll in Medicare then later experience termination of employment or reduction of benefits
36 months from date of qualifying event The later of: 36 months from the entitlement to Medicare, or 18 months from termination of employment or reduction in hours
1 Eligible dependents include your spouse or child(ren) already covered by the Plan on the day before the qualifying event. Eligible dependents also include a child born to or placed for adoption with you during a period of COBRA coverage. See Who Is Eligible in the Eligibility and Enrollment chapter. 2 For information on COBRA coverage for same-sex domestic partners and their child(ren), see COBRA Continuation Coverage in this chapter. 3 Your cost is based on the current total monthly premium times the percentage shown above. 4 If the associate on Military Leave drops coverage, his or her spouse and/or dependents can only continue COBRA for up to 18 months. Spouse and children can continue for 24 months only if the associate on Military Leave continues for 24 months. If Military Leave ends, associate and/or dependents can continue COBRA for up to 18 months only.
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COBRA Coverage
If a second qualifying event occurs during your initial 18 months of COBRA continuation coverage (such as a legal separation, divorce, etc.), the continuation of coverage period may be extended for the qualified dependent for up to 36 months from the date of the first qualifying event. The total period of continuation coverage, however, will never exceed 36 months from the date of the first qualifying event. In all cases, coverage for CARE/Solutions for Life is extended for 36 months. If you have fully insured coverage, state insurance laws may mandate continuation coverage that is longer or that otherwise differs from federal COBRA continuation coverage. State law in California allows 36 months of continuation coverage if you are enrolled in medical. Please refer to your Medical Plan coverage booklet or call your Medical Plan for more information. You do not have to show that you are insurable to choose continuation of coverage. However, continuation coverage is subject to your eligibility for coverage. The Plan administrator reserves the right to terminate your coverage retroactively if it is determined that you are ineligible. By electing COBRA coverage, you can also continue to contribute to your Health Care Spending Account through the end of the year in which the qualifying event occurs. You can file claims for qualified services you receive through the end of the Plan Year plus the applicable grace period while you are participating through COBRA.
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However, you cannot continue to contribute to your Dependent Day Care Spending Account while on COBRA. Associates on Military Leave are able to contribute to the Dependent Day Care Spending Account if their supplemental pay is sufficient to cover their elected contributions. See the Spending Accounts chapter in this book for more information.
Notifying the Company About a Qualifying COBRA Event

Under federal law, you and your eligible dependents are responsible for notifying the Benefits Choice Center (including providing all required documentation) of a divorce, legal separation or the end of a dependent childs eligibility under the Medical, Vision and Dental Plans and the Health Care Spending Account no later than 60 days after the event occurs. You start this notification process by calling the Benefits Choice Center at 1-800-555-4954 and asking to speak with a representative. The representative will ask you to mail any required documentation to the address of the Benefits Choice Center listed in the Get the Most Value From Your Plan chart at the start of this chapter. After you notify the Benefits Choice Center, the eligible dependents losing coverage will receive written notification advising them of their right to choose COBRA continuation coverage. If you or your eligible dependents do not notify the Benefits Choice Center on a timely basis, you and/or your eligible dependents will forfeit their rights to continue coverage under COBRA.
USERRA Continuation Coverage

Associates participating in the Company Medical, Vision and Dental Plans, CARE/Solutions for Life, and the Health Care Spending Account have the right to choose continuation coverage as provided under the Uniformed Services Employment and Reemployment Rights Act, as amended (USERRA) while on a military leave of absence. An election of COBRA coverage will be deemed to be an election of USERRA coverage and both coverages will run concurrently. The cost of USERRA coverage will be the same as the cost of COBRA coverage, and USERRA coverage continues for 24 months from the date your active coverage ends.
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COBRA Coverage
The Benefits Choice Center is responsible for notifying you and your covered eligible dependents of the right to choose COBRA continuation coverage for any qualifying event other than divorce, legal separation or the end of a dependent childs eligibility. Notification and billing will be handled by the Benefits Choice Center at 1-800-555-4954 or by mail at: Benefits Choice Center P.O. Box 0700 Carol Stream, IL 60132-0700
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The date the letter from Social Security was issued (the issue date of the Social Security Notice of Award Letter); or The start date of COBRA. If you do not provide timely notification of the Social Security determination of disability, no extension is available. The disabled participant must provide the required documentation of disability before the end of the 18-month COBRA coverage period. To submit the documentation establishing disability, mail or fax to: Benefits Choice Center P.O. Box 1493 Lincolnshire, IL 60069-1493 Fax: 1-847-883-8269 Coverage for the disabled participant and family members covered under the associate + spouse, associate + child(ren) or associate + family coverage categories may be extended up to a total of 29 months. It is also the disabled participants responsibility to notify the Benefits Choice Center within 30 days if a final determination has been made that the disabled person is no longer disabled. Disabled individuals and their covered family members will be required to pay 102% of the monthly premium for the initial 18 months of coverage. If coverage is extended to 29 months, the disabled qualified
beneficiary and his or her family members covered with the disabled qualified beneficiary under the associate + spouse, associate + child(ren) or associate + family coverage categories will pay 150% of the monthly premium after the first 18 months of COBRA coverage. Any qualified beneficiaries whose COBRA coverage was extended to 29 months but who are not covered with the disabled qualified beneficiary will pay 102% of the monthly premium for all 29 months.
Paying for COBRA Coverage

You are required to pay the premium that you were paying before the qualifying event plus the portion previously paid by the Company. An additional 2% will be added to your premium for administrative costs. If the premium rate changes for active associates, your monthly cost will also change. You will be responsible for premiums from the date COBRA coverage begins. Your initial premium is due within 45 days of the date you elect COBRA coverage. This initial premium may cover more than one month and there is no grace period after the 45 days. Subsequent premiums are due on the first day of each month. You will be given a 30-day grace period from the first of each month within which payment must be received. You may submit payment electronically or by U.S. postal mail. If you use U.S. postal mail, your payment is considered received on the postmark date on your payment. If you fail to pay your initial premium on time or fail to pay the subsequent premiums by the end of the grace period, you and your dependents coverage will be terminated and cannot be reinstated.
If You Are on a Leave of Absence

If you are on medical or family leave of absence, your COBRA coverage begins at the end of your FMLA leave. If payment is not received by the due date on the Billing Notice, coverage will be cancelled.
If a Disability Occurs
The 18 months of continuation coverage can be extended for an additional 11 months of coverage, to a maximum of 29 months, for all qualified beneficiaries, if the Social Security Administration determines that you or one of your covered dependents was disabled at any time prior to the qualifying event or within the first 60 days of COBRA continuation coverage. It is the disabled participants responsibility to inform the Benefits Choice Center with required documentation within 60 days of the later of:
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Electing COBRA Coverage
The Benefits Choice Center will send you and your covered dependents written notification of your right to choose COBRA continuation of coverage. This information will be provided in a personalized Enrollment Worksheet with instructions on how to enroll by calling the Benefits Choice Center. You and/or your covered dependents must enroll no later than 60 days after the date on the notification letter. Evidence of good health is not required to continue coverage under COBRA. If you do not enroll before your enrollment period expires, you and your eligible dependents will forfeit the right to extend coverage under COBRA. If it is determined that you are not eligible for COBRA coverage, youll receive a written explanation within 14 days. Continuation coverage is not available to non-resident aliens who do not receive any U.S. income or to relatives of non-resident aliens with no U.S. income. Coverage under CARESolutions for Life extends automatically for 36 months under COBRA following any COBRA qualifying event at no cost to you or your eligible dependents.
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When COBRA Coverage Starts

Provided you have complied with the requirements outlined above, COBRA continuation coverage starts: For termination of your employment, on the day following the last day of your final pay period; or At the end of the first 12 weeks of any medical or maternity leave under FMLA; or For all other qualifying events, from the date of the qualifying event.

To enroll a newborn or newly adopted child (or child placed for adoption) for coverage, you must call the Benefits Choice Center or access the Your Benefits Resources web site no later than 30 days after the childs birth, date of adoption or placement for adoption. However, if you are already covered under the Companys self-insured Medical Plan, and you add your newborn, or newly adopted child (or child placed for adoption) within 60 days, coverage is effective from the date of the qualifying event. If you are already covered under the Companys selfinsured Medical Plan either as Associate Only or Associate + Spouse, and you add your new child after 60 days but within six months of the childs birth, adoption or placement for adoption, coverage is effective the date the Benefits Choice Center receives your request. If you are already covered under the self-insured Medical Plans with Associate + Family or Associate + Child(ren), and you add your newborn or newly adopted child (or child placed for adoption) within the first 12 months after birth, adoption or placed for adoption, coverage will be effective from date of the birth, adoption or placement for adoption. If a second qualifying event occurs which would cause the child to lose coverage under the health plan (i.e., divorce, legal separation or death of the parent), the child, as a qualified beneficiary, will have COBRA rights to continue coverage. Your spouse added after your COBRA coverage starts, however, is a nonqualified beneficiary and will not have COBRA rights.
Status Changes and COBRA

If, during the 18 months (or 24 or 29 months, if applicable) of COBRA coverage or the 24 months of USERRA coverage, you experience a qualified status change, you may make any of the changes available to similarly situated active associates. See Life Events chapter for more information. You must notify the Benefits Choice Center no later than 30 days after the date of the change in status in most cases.
New Spouse
To enroll your new spouse for coverage, you must call the Benefits Choice Center or access the Your Benefits Resources web site no later than 30 days after the date you are married. Your new spouse will receive coverage, but only as a non-qualified beneficiary. This means he or she does not have independent COBRA rights and may only keep the same coverage as you.
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While covered under COBRA, you are also entitled to make other changes consistent with a qualified status change and to make changes during Annual Enrollment periods.
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If you receive an individual certification of eligibility for TAA benefits, you will be eligible for the following additional rights. First, the Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment assistance (TAA-eligible individuals). Under the new tax provisions, TAA-eligible individuals can (pursuant to IRS regulations) either take a tax credit or get advance payment of 80% (65% as of February 14, 2011) of premiums paid for qualified health insurance, including COBRA continuation coverage. If you would like additional information about these tax provisions, you need to call the Health Care Tax Credit Customer Contact Center toll-free at 1-866-628-4282 or refer to the information provided at www.doleta.gov. Second, TAA-eligible individuals who did not elect COBRA continuation coverage when they first became eligible for COBRA may have a second election period to elect COBRA coverage. This second election period is a 60-day period that begins on the first day of the month in which the individual becomes a TAA-eligible individual (as defined in the Internal Revenue Code), but only if such election is made not later than six months after the date of the TAA-related loss of coverage.
Individuals Eligible for the Federal Program Providing Trade Adjustment Assistance
The Trade Adjustment Assistance (TAA) program is a federal program established under the Trade Act of 1974 that provides aid to workers who lose their jobs or have a reduction in hours or wages due to increased imports from or a shift in production to certain foreign countries. In 2002, the TAA program was amended to add certain tax credits for health benefits and to provide individuals eligible for this program with a second opportunity to elect COBRA continuation coverage. Under the TAA program, either a group of employees, its union, or an authorized representative for the group must submit a petition for benefits to the U.S. Department of Labor. Petition forms can be obtained from your local State Employment Security Agency or from the U.S. Department of Labor, Division of Trade Adjustment Assistance. If the U.S. Department of Labor certifies your worker group, you must file an application for a determination of individual eligibility with your local office of the State Unemployment Insurance agency.
Coverage that is properly elected during this second election period will begin on the first date of this second election period and will not include any period prior to this second election period. In addition, to the extent the plan imposes any pre-existing condition exclusion, the period beginning on the date of the TAA-related loss of coverage and ending on the first day of the second election period described above is disregarded for purposes of determining if there has been a 63-day break in coverage for calculating creditable coverage that may offset the length of the preexisting condition exclusion. This Plan will provide a second COBRA election period to the extent required under the Trade Act of 2002 and any applicable future laws or regulations.
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COBRA Coverage
When COBRA Coverage Ends
Coverage under COBRA will end on the earliest of the following: a qualified beneficiary reaches the end of the 18-month, 29-month, or 36-month maximum coverage period, whichever is applicable a qualified beneficiary does not make required COBRA premium payments by the applicable due date a qualified beneficiary becomes covered under another employers group health plan after electing COBRA (other than the federal governments health plan while you are on a Military Leave). If the other group health plan contains any exclusion or limitation on a pre-existing condition that applies to you, you may continue COBRA coverage up to the date this exclusion ceases to apply a qualified beneficiary becomes entitled to Medicare after electing COBRA the Company terminates all group health coverage coverage is terminated for cause, such as fraudulent claim submission, on the same basis that coverage could terminate for similarly situated active employees when coverage ends for a qualified beneficiary, coverage also ends for non-qualified beneficiaries covered by the qualified beneficiary whose coverage has ended
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If your coverage ends before the scheduled coverage period (18, 29, or 36 months), you will receive a written notice indicating: the reason the coverage terminated early (such as a failure to pay premiums), the date of the termination, and any rights you and other qualified beneficiaries have under the plan and under law to elect other group or individual coverage
Keep Your Plan Informed of Any Address Changes

In order to protect your rights and those of your dependents, you should keep the Plan Administrator informed of any changes in your address or the addresses of your dependents. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Certification of Creditable Coverage Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
As required under HIPAA, when health coverage ends, a Certificate of Health Plan Creditable Coverage will be automatically sent to you. The Certificate of Health Plan Creditable Coverage will detail the total time you and your dependents were covered under the Company Medical Plan and the type of health plan you were covered under. Under HIPAA, the time covered under the Company Plan (including COBRA coverage) may be used to reduce a new employers pre-existing condition period, as long as there is no break in coverage of 63 days or more (or longer in some states). Because your Certificate of Health Plan Creditable Coverage can be important, particularly with regard to coverage for pre-existing conditions, you should make sure that your current address is on file by informing the Benefits Choice Center at 1-800-555-4954 when any changes occur.
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Claims & Appeals

Chapter Contents
Claiming Benefits Filing Claims for Benefits Filing Claims Under the Group Health Plans Filing Claims for Plans Other Than Group Health Plans 316 Timely Filing of an Out-of-Network Claim 316 Information Required for Your Claim 316 Payment of Health Plan Benefits 316 Appealing a Denied Claim Under Any Plan Other than Group Health or Disability Plan, Including FutureBuilder, Life and AD&D Insurance 317 Benefit Determination and Claims Appeals 317 Under the Fully-Insured Medical and Dental Plans 317 Under the Self-Insured Medical Plans 318 Aetna Choice POS II Medical Plans 318 Procedures Regarding Benefit Determinations 318 Filing an Appeal of an Adverse Benefit Determination 319 Exhaustion of Internal Appeals Process 319 Full and Fair Review of Claim Determinations and Appeals 315 315 315 316 319 Health Claims Voluntary Appeals 320 Referral to ERO 322 Anthem Blue Cross Blue Shield: Appeal Provisions 322 Notice of Adverse Benefit Determination 322 Appeals 323 How Your Appeal will be Decided 323 Notification of the Outcome of the Appeal 324 Appeal Denial 324 Second Level Appeals 324 External Review 324 Requirement to file an Appeal before filing a lawsuit 325 CVS Caremark Prescription Claim Appeals Process 325 Second Level Appeal Option 325 External Review Rights 325 Kaiser Permanente HMOs: Complaints, Grievances and Arbitration Process Overview 325 Introduction 326 Claims Inquiry Process 326 Grievance Process 327 Arbitration Process 328 Claims Involving the Critical Illness Protection Plan 328 Claim Review 328 Appeals Procedure 328 MetLife Dental Plans 328 Appealing the Initial Determination 329 EyeMed Vision Plans 329 Spending Accounts: Request for Level I Appeal 330 Appeal of Denied Level I Appeal 330 Defective Level II Appeals 331 PayFlex Claims Process - Limited Purpose Flexible Spending Account (LPFSA) 332 Claims Involving Disability Benefits and Disability Determinations 332 Employee Assistance Program: Claim Determinations 333 Adverse Determinations of a Claim for EAP Benefits 333 Appeals of Adverse Determinations of Claims for EAP Benefits 333 Appeal Decisions 333 Limitation of Actions
Claims & Appeals

What do you need?
Get answers to questions about claims and appeals of denied claims
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Find it here...
Contact the claims administrator for the applicable Plan. See the Plan Administrative Summary in the Plan Administration chapter for claim administrator phone numbers and addresses.
Claiming Benefits
You or your beneficiary must file the appropriate forms to receive any benefits or to take any other action under the Plan. All forms required to take any action under the plans are available from the claims administrator or plan administrator. Please refer to the appropriate section of each benefit for additional information on claiming benefits. To be eligible for benefits, you must be covered under the Plan, properly submit a claim, and follow the Plans claims and appeals procedures. If a claim is denied initially, you must exhaust the appeals procedure before filing a suit. The claim administrator making claim decisions (which for FutureBuilder is the Plan Administrator) has the right and discretionary authority to interpret the provisions of the Plan under which the claim is made and to make any and all determinations regarding final eligibility for benefits both legal and factual. Its decisions will be conclusive and binding.

For all group health benefits, questions about claims and appeals of denied claims should be directed to the claims administrator. For phone numbers and addresses, see the Plan Administration chapter. This applies to the following group health benefits: Fully-Insured Plans Health Net HMO, Out-of-Area and Salud y mas Kaiser Permanente HMOs: California, Colorado, Georgia, Hawaii, Mid-Atlantic, Northwest and Ohio HMSA Medical Plans Critical Illness Protection Plan (Allstate Workplace Division) MetLife Dental Plan EyeMed Vision Plan Self-Insured Plans PPO Medical Plans (Aetna and Anthem Blue Cross Blue Shield) High Deductible Health Plan (Aetna) Out-of-Area Plans (Anthem Blue Cross Blue Shield)
Filing Claims Under the Group Health Plans

If you receive covered health (medical, dental, prescription or vision) services from an in-network provider, you do not have to file a claim. In-network providers are responsible for filing claims for you. Your group health Plan pays in-network providers directly for your covered health services. If an innetwork provider bills you for any covered service, contact the claims administrator. However, you are responsible for meeting any annual deductible and for paying copayments and coinsurance to an innetwork provider at the time of service, or when you receive a bill from the provider. If you receive covered health services from an out-of-network provider, you are responsible for filing a claim. Where to Send Your Claims for Out-of-Network Services When you receive covered health services from an out-of-network provider, you must submit the claim to the appropriate claims administrator for your group health Plan. For addresses and phone numbers, see Medical and Dental Plan Administrators in the Plan Administration chapter.
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Claims & Appeals

Filing Claims for Plans Other Than Group Health Plans
For information on the process and requirements for filing a claim, see the FutureBuilder chapter for FutureBuilder claims, the Life Insurance chapter for life insurance claims, the AD&D chapter for AD&D claims and the Disability chapter for disability claims.
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itemized bill from your provider that includes the following: patient diagnosis date(s) of service procedure code(s) and descriptions of service(s) rendered charge for each service rendered
Appealing a Denied Claim Under Any Plan Other than Group Health or Disability Plan, Including FutureBuilder, Life and AD&D Insurance
If an application for benefits is denied in whole or in part, you or your representative will receive written or electronic notification from the claims administrator or Plan administrator, within 90 days after your claim is received (45 days for dismemberment and accelerated death benefit claims), or 180 days under special circumstances (105 days for dismemberment and accelerated death benefit claims) in which case you will be notified in writing before the end of the first 90-day period of the extension (45 days for dismemberment and accelerated death benefit claims), the reason why the extension is needed, and the date by which you can expect to receive a decision. The denial notice will include: the reasons for the denial with reference to the specific plan provisions on which the denial was based; a description of any additional information needed to perfect the claim; an explanation of why such information is necessary; a description of the Plans review procedures and applicable time limits; and a statement of the right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review. If your claim is denied and you would like your claim reconsidered, you or your representative must submit a written request for reconsideration of the claim to the claims administrator or Plan administrator, as applicable, within 60 days after receiving notice of the denial (180 days for dismemberment and accelerated death benefit
Timely Filing of an Out-of-Network Claim

You must submit a request for payment of benefits from the health Plans within one year after the date of service. If an out-of-network provider submits a claim on your behalf, you will be responsible for the timeliness of the providers submitting the claim. If you dont provide the claim information to the appropriate claims administrator within one year after the date of service, benefits for that service will be denied or reduced, according to the claims administrators discretion. This time limit does not apply while you are legally incapacitated. If your claim relates to an inpatient stay, the date of service is the date your inpatient stay ends.
providers name, address, and tax identification number date the injury or sickness began, if applicable statement indicating either that you are, or you are not, enrolled for coverage under any other group health insurance plan or program (if you are enrolled for other coverage, you must include the name of any other insurance company)
1 If your plan administrator is Anthem Blue Cross Blue Shield and if you have an out-of-network claim, you must use their claim form. Call member services at 1-877-434-2734 to obtain a form.
Payment of Health Plan Benefits

Aetna members: You may assign your benefits directly to your out-of-network provider through your providers office or by written authorization to Aetna. Assigning your benefits will allow Aetna to pay all or a portion of any eligible expenses due your provider directly to your provider instead of being paid to you. Anthem BCBS members: You may not assign your benefits directly to your out-of-network provider. All eligible expenses due to your provider will be paid to you and you must pay your out-of-network provider directly. The group health Plan will not reimburse third parties that have purchased or been assigned benefits by any health care provider. 316
Information Required for Your Claim

When you request payment of benefits from your health plan, you do not have to use a claim form1. However, you must provide all of the following information: associates name and address patients name, age, and relationship to the associate contract number, which is on your ID card (for the Vision Plan, use Home Depot in place of a contract number)
Claims & Appeals

claims). Any such request should be accompanied by documents, records, or other information in support of the appeal. You or your representative may have reasonable access to, and copies of, all documents, records, and other information relevant to the claim, free of charge. The review provided will take into account all comments, documents, records, and other information submitted by you, without regard to whether such information was submitted or considered in the initial claim determination. A failure to timely request a review of a denied claim will be treated as full and complete agreement with the denial. The claims administrator or Plan administrator will respond within 60 days of the appeal (45 days for dismemberment and accelerated death benefit claims), or 120 days under special circumstances (90 days for dismemberment and accelerated death benefit claims) in which case you will be notified in writing of the extension, of the reasons for the extension, and the date the review of the appeal is expected to conclude. In its response to the appeal, the claims administrator will explain, in writing: the reasons for the decision, again with reference to the specific plan provisions on which that decision is based; a statement that you are entitled to receive, upon request and free of charge, reasonable access to pertinent documents, records, and other information relevant to your claim for benefits; a description of the Plans voluntary appeal procedures (if any); and a statement of your right to bring an action under ERISA Section 502(a).
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The fiduciary making claim decisions has the right and discretionary authority to interpret the provisions of the Plan under which the claim is made and its decisions will be conclusive and binding. If the named fiduciary that decides claims is a committee or board of trustees that holds regularly scheduled meetings at least quarterly, the following applies. The named fiduciary will make a determination on claims no later than the date of the meeting of the committee or board of trustees that immediately follows the Plans receipt of a request for review, unless the request for review is filed within 30 days preceding the date of such meeting. In such case, a claim determination may be made by no later than the date of the second meeting following the Plans receipt of the request for review. If special circumstances require a further extension of time for processing, a determination must be made no later than the third meeting of the committee or board following the Plans receipt for review. If such an extension of time for review is required because of special circumstances, the Plan administrator must provide the claimant with written notice of the extension, describing the special circumstances and the date as of which determination of the claim will be made, prior to the commencement of the extension. The claimant must be notified of the results no later than five days after the claim has been evaluated.
Benefit Determination and Claims Appeals

Under the Fully-Insured Medical and Dental Plans
The fully-insured Plans listed in Filing Claims for Benefits earlier in this chapter automatically provide information to participants about the process for appealing denied claims. Such information is adopted by reference as part of the Claims and Appeals chapter. If you need more information about the process for appealing denied claims for benefits under a fully-insured Plan, you should contact the insurance Company directly. For phone numbers and addresses, see the Plan Administration chapter. Home Depot is not involved in the review of claims or appeals.
Under the Self-Insured Medical Plans

The self-insured medical plans are listed in Filing Claims for Benefits earlier in this chapter. The determination of benefits varies according to the type of service or benefits requested, and the type of health Plan. The following pages provide information that describes how the various self-insured Plans determine your benefits and how to appeal denied claims. You or an authorized representative may file claims and appeals. An authorized representative means a person you authorize, in writing and as required by the claims administrator, to act on your behalf. The Plan will also recognize a court order giving a person authority to submit claims on your behalf. In the case of a claim involving urgent care, a health care professional with knowledge of your condition may also act as your authorized representative. Reference to you in
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the sections explaining how to file claims and appeal denied claims are intended to include references to your authorized representative.
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Aetna Choice POS II Medical Plans

Procedures Regarding Benefit Determinations
Urgent Care Claims. An Urgent Care Claim is any claim for medical care or treatment for which the application of the time periods for making non-urgent care determinations could seriously jeopardize your life or health or your ability to regain maximum function, or, in the opinion of a physician with knowledge of your medical condition, would subject you to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim. If the Plan requires advance approval of a service, supply, or procedure before a benefit will be payable and if the Plan or your physician determines that such service, supply or procedure is for an urgent care claim, you will be notified of the decision not later than 24 hours after the claim is received. If there is not sufficient information to decide the claim, you will be notified of the information necessary to complete the claim as soon as possible, but not later than 24 hours after receipt of the claim. You will be given a reasonable additional amount of time, but not less than 48 hours, to provide the information, and you will be notified of the decision not later than 48 hours after the end of that additional time period (or after receipt of the information, if earlier).
Other Claims (pre-service and post-service). If the Plan requires you to obtain advance approval of a service, supply, or procedure before a benefit will be payable, a request for advance approval is considered a pre-service claim.You will be notified of the decision not later than 15 days after receipt of the pre-service claim. For post-service claims (claims for benefits that are filed after medical care has been received), you will be notified of the decision not later than 30 days after receipt of the claim. For either a pre-service or a post-service claim, these time periods may be extended up to an additional 15 days due to circumstances outside the plans control. In that case, you will be notified of the extension before the end of the initial 15- or 30day period. For example, they may be extended because you have not submitted sufficient information, in which case you will be notified of the specific information necessary and given an additional period of at least 45 days after receiving the notice to furnish that information.You will be notified of the Plans claim decision no later than 15 days after the end of that additional period (or after receipt of the information, if earlier). For pre-service claims which name a specific claimant, medical condition, and service or supply for which approval is requested, and which are submitted to a Plan representative responsible for handling benefit matters, but which otherwise fail to follow the Plans procedures for filing pre-service claims, you will be notified of the failure within five days (within 24 hours in the case of an urgent care 318
claim) and of the proper procedures to be followed. The notice may be oral unless you request written notification. Ongoing Course of Treatment. If you have received pre-authorization for an ongoing course of treatment, you will be notified in advance if the Plan intends to terminate or reduce benefits for the authorized course of treatment so that you will have an opportunity to appeal the decision before the termination or reduction takes effect. If the course of treatment involves urgent care, and you request an extension of the course of treatment at least 24 hours before its expiration, you will be notified of the decision within 24 hours after receipt of the request.
Filing an Appeal of an Adverse Benefit Determination

As an individual enrolled in the Plan, you have the right to file an appeal from an Adverse Benefit Determination relating to service(s) you have received or could have received from your health care provider under the Plan. An Adverse Benefit Determination is defined as a denial, reduction, termination of, or failure to, provide or make payment (in whole or in part) for a service, supply or benefit. Such Adverse Benefit Determination may be based on: Your eligibility for coverage, including a retrospective termination of coverage (whether or not there is an adverse effect on any particular benefit); Coverage determinations, including plan limitations or exclusions; The results of any Utilization Review activities;
Claims & Appeals

A decision that the service or supply is experimental or investigational; or A decision that the service or supply is not medically necessary. A Final Internal Adverse Benefit Determination is defined as an Adverse Benefit Determination that has been upheld by the appropriate named fiduciary (Aetna) at the completion of the internal appeals process, or an Adverse Benefit Determination for which the internal appeals process has been exhausted.
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or other information were submitted in connection with the initial claim. A copy of the specific rule, guideline or protocol relied upon in the Adverse Benefit Determination will be provided free of charge upon request by you or your Authorized Representative. You may also request that Aetna provide you, free of charge, copies of all documents, records and other information relevant to the claim. An Aetna representative may call you or your health care provider to obtain medical records and/or other pertinent information in order to respond to your appeal. Standard Appeals. With the exception of urgent care claims, you will have 180 days following receipt of an adverse benefit determination to appeal the decision to the Plan.You will be notified of the decision on appeal not later than 15 days (for pre-service claims) or 30 days (for post-service claims) after the appeal is received. If your claim involves urgent care, an expedited appeal may be initiated by a telephone call to Member Services. The Member Services telephone number is on your identification card.You may appeal urgent care claim denials either orally or in writing. All necessary information, including the appeal decision, will be communicated between you and the plan by telephone, facsimile, or other similar method.You will be notified of the decision not later than 36 hours after the appeal is received. Second Appeal. If you are dissatisfied with the appeal decision on a claim involving urgent care and want a reconsideration of the decision, you must file a second level appeal with the Plan. You will be notified of the decision not later than 36 hours after the appeal is received. 319
If you are dissatisfied with a pre-service or post-service appeal decision and want a reconsideration of the decision, you must file a second level appeal with the Plan within 180 days of receipt of the level one appeal decision. The Plan will notify you of the decision not later than 15 days (for preservice claims) or 30 days (for post-service claims) after the appeal is received. If you do not agree with the Final Internal Adverse Benefit Determination on review, you have the right to bring a civil action under Section 502(a) of ERISA, if applicable.
Exhaustion of Internal Appeals Process

You are required to complete all appeal processes of the Plan before being able to obtain External Review or bring an action in litigation.
Health Claims Voluntary Appeals

External Review External Review is a review of an Adverse Benefit Determination or a Final Internal Adverse Benefit Determination by an Independent Review Organization/External Review Organization (ERO) or by the State Insurance Commissioner, if applicable. A Final External Review Decision is a determination by an ERO at the conclusion of an External Review. You must complete all of the levels of standard appeal described above before you can request External Review, other than in a case of Deemed Exhaustion. Subject to verification procedures that the Plan may establish, your Authorized Representative may act on your behalf in filing and pursuing this voluntary appeal. You may file a voluntary appeal for External Review of any Adverse Benefit Determination or any Final Internal Adverse Benefit Determination that qualifies as set forth below.
Full and Fair Review of Claim Determinations and Appeals

You may file an appeal in writing to Aetna at the address provided in this booklet, or, if your appeal is of an urgent nature, you may call Aetnas Member Services Unit at the toll-free phone number on the back of your ID card (also listed at the end of this booklet). Your request should include the group name (that is, your employer), your name, member ID, or other identifying information shown on the front of the Explanation of Benefits form, and any other comments, documents, records and other information you would like to have considered, whether or not submitted in connection with the initial claim. You may submit written comments, documents, records and other information relating to your claim, whether or not the comments, documents, records
Claims & Appeals

The notice of Adverse Benefit Determination or Final Internal Adverse Benefit Determination that you receive from Aetna will describe the process to follow if you wish to pursue an External Review, and will include a copy of the Request for External Review Form. You must submit the Request for External Review Form to Aetna within 123 calendar days of the date you received the Adverse Benefit Determination or Final Internal Adverse Benefit Determination notice. If the last filing date would fall on a Saturday, Sunday or Federal holiday, the last filing date is extended to the next day that is not a Saturday, Sunday or Federal holiday. You also must include a copy of the notice and all other pertinent information that supports your request. If you file a voluntary appeal, any applicable statute of limitations will be tolled while the appeal is pending. The filing of a claim will have no effect on your rights to any other benefits under the Plan. However, the appeal is voluntary and you are not required to undertake it before pursuing legal action. If you choose not to file for voluntary review, the Plan will not assert that you have failed to exhaust your administrative remedies because of that choice. Request for External Review
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Preliminary Review Within 5 business days following the date of receipt of the request, Aetna must provide a preliminary review determining: you were covered under the Plan at the time the service was requested or provided, the determination does not relate to eligibility, you have exhausted the internal appeals process (unless Deemed Exhaustion applies), and you have provided all paperwork necessary to complete the External Review. Within one business day after completion of the preliminary review, Aetna must issue to you a notification in writing. If the request is complete but not eligible for External Review, such notification will include the reasons for its ineligibility and contact information for the Employee Benefits Security Administration (toll-free number 866-444-EBSA (3272)). If the request is not complete, such notification will describe the information or materials needed to make the request complete and Aetna must allow you to perfect the request for External Review within the 123 calendar days filing period or within the 48 hour period following the receipt of the notification, whichever is later.
The External Review process under this Plan gives you the opportunity to receive review of an Adverse Benefit Determination (including a Final Internal Adverse Benefit Determination) conducted pursuant to applicable law. Your request will be eligible for External Review if the following are satisfied: Aetna, or the Plan or its designee, does not strictly adhere to all claim determination and appeal requirements under federal law; or the standard levels of appeal have been exhausted; or the appeal relates to a rescission, defined as a cancellation or discontinuance of coverage which has retroactive effect. An Adverse Benefit Determination based upon your eligibility is not eligible for External Review. If upon the final standard level of appeal, the coverage denial is upheld and it is determined that you are eligible for External Review, you will be informed in writing of the steps necessary to request an External Review. An independent review organization refers the case for review by a neutral, independent clinical reviewer with appropriate expertise in the area in question. The decision of the independent external expert reviewer is binding on you, Aetna and the Plan unless otherwise allowed by law.
Referral to ERO
Aetna will assign an ERO accredited as required under federal law, to conduct the External Review. The assigned ERO will timely notify you in writing of the requests eligibility and acceptance for External Review, and will provide an opportunity for you to submit in writing within 10 business days following the date of receipt, additional information that the ERO must consider when conducting the External Review. Within one (1) business day after making the decision, the ERO must notify you, Aetna and the Plan.
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Claims & Appeals

The ERO will review all of the information and documents timely received. In reaching a decision, the assigned ERO will review the claim and not be bound by any decisions or conclusions reached during the Plans internal claims and appeals process. In addition to the documents and information provided, the assigned ERO, to the extent the information or documents are available and the ERO considers them appropriate, will consider the following in reaching a decision: (i) Your medical records; (ii) The attending health care professional's recommendation; (iii) Reports from appropriate health care professionals and other documents submitted by the Plan or issuer, you, or your treating provider; (iv) The terms of your Plan to ensure that the ERO's decision is not contrary to the terms of the Plan, unless the terms are inconsistent with applicable law; (v) Appropriate practice guidelines, which must include applicable evidence-based standards and may include any other practice guidelines developed by the Federal government, national or professional medical societies, boards, and associations; (vi) Any applicable clinical review criteria developed and used by Aetna, unless the criteria are inconsistent with the terms of the Plan or with applicable law; and
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(vii)The opinion of the ERO's clinical reviewer or reviewers after considering the information described in this notice to the extent the information or documents are available and the clinical reviewer or reviewers consider appropriate. The assigned ERO must provide written notice of the Final External Review Decision within 45 days after the ERO receives the request for the External Review. The ERO must deliver the notice of Final External Review Decision to you, Aetna and the Plan. After a Final External Review Decision, the ERO must maintain records of all claims and notices associated with the External Review process for six years. An ERO must make such records available for examination by the claimant, Plan, or State or Federal oversight agency upon request, except where such disclosure would violate State or Federal privacy laws. Upon receipt of a notice of a Final External Review Decision reversing the Adverse Benefit Determination or Final Internal Adverse Benefit Determination, the Plan immediately must provide coverage or payment (including immediately authorizing or immediately paying benefits) for the claim. Expedited External Review The Plan must allow you to request an expedited External Review at the time you receive: (a) An Adverse Benefit Determination if the Adverse Benefit Determination involves a medical condition for which the timeframe for completion of an expedited internal appeal would seriously jeopardize
(b) your life or health or would jeopardize your ability to regain maximum function and you have filed a request for an expedited internal appeal; or (c) A Final Internal Adverse Benefit Determination, if you have a medical condition where the timeframe for completion of a standard External Review would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function, or if the Final Internal Adverse Benefit Determination concerns an admission, availability of care, continued stay, or health care item or service for which you received emergency services, but have not been discharged from a facility. Immediately upon receipt of the request for expedited External Review, Aetna will determine whether the request meets the reviewability requirements set forth above for standard External Review. Aetna must immediately send you a notice of its eligibility determination. Referral of Expedited Review to ERO Upon a determination that a request is eligible for External Review following preliminary review, Aetna will assign an ERO. The ERO shall render a decision as expeditiously as your medical condition or circumstances require, but in no event more than 72 hours after the ERO receives the request for an expedited External Review. If the notice is not in writing, within 48 hours after the date of providing that notice, the assigned ERO must provide written confirmation of the decision to you, Aetna and the Plan.
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Anthem Blue Cross Blue Shield: Appeal Provisions
For purposes of these Appeal provisions, claim for benefits means a request for benefits under the plan. The term includes both pre-service and postservice claims. A pre-service claim is a claim for benefits under the plan for which you have not received the benefit or for which you may need to obtain approval in advance. A post-service claim is any other claim for benefits under the plan for which you have received the service. If your claim is denied or if your coverage is rescinded: you will be provided with a written notice of the denial or rescission; and you are entitled to a full and fair review of the denial or rescission. The procedure the Claims Administrator will follow will satisfy the requirements for a full and fair review under applicable federal regulations.
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a reference to the specific plan provision(s) on which the Claims Administrators determination is based; a description of any additional material or information needed to perfect your claim; an explanation of why the additional material or information is needed; a description of the plans review procedures and the time limits that apply to them, including a statement of your right to bring a civil action under ERISA if you appeal and the claim denial is upheld; information about any internal rule, guideline, protocol, or other similar criterion relied upon in making the claim determination and about your right to request a copy of it free of charge, along with a discussion of the claims denial decision; and information about the scientific or clinical judgment for any determination based on medical necessity or experimental treatment, or about your right to request this explanation free of charge, along with a discussion of the claims denial decision. the availability of, and contact information for, any applicable office of health insurance consumer assistance or ombudsman who may assist you For claims involving urgent/concurrent care: the Claims Administrators notice will also include a description of the applicable urgent/concurrent review process; and
the Claims Administrator may notify you or your authorized representative within 24 hours orally and then furnish a written notification.
Appeals
You have the right to appeal an adverse benefit determination (claim denial or rescission of coverage). You or your authorized representative must file your appeal within 180 calendar days after you are notified of the denial or rescission. You will have the opportunity to submit written comments, documents, records, and other information supporting your claim. The Claims Administrator's review of your claim will take into account all information you submit, regardless of whether it was submitted or considered in the initial benefit determination. The Claims Administrator shall offer two mandatory levels of appeal. The second level of appeal may be a panel review, independent review, or other process consistent with the entity reviewing the appeal. The time frame allowed for the Claims Administrator to complete its review is dependent upon the type of review involved (e.g. pre-service, concurrent, post-service, urgent, etc.).
Notice of Adverse Benefit Determination

If your claim is denied, the Claims Administrators notice of the adverse benefit determination (denial) will include: information sufficient to identify the claim involved the specific reason(s) for the denial;
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For pre-service claims involving urgent/concurrent care, you may obtain an expedited appeal. You or your authorized representative may request it orally or in writing. All necessary information, including the Claims Administrators decision, can be sent between the Claims Administrator and you by telephone, facsimile or other similar method. To file an appeal for a claim involving urgent/concurrent care, you or your authorized representative must contact the Claims Administrator at the number shown on your identification card and provide at least the following information: the identity of the claimant; the date(s) of the medical service; the specific medical condition or symptom; the providers name the service or supply for which approval of benefits was sought; and any reasons why the appeal should be processed on a more expedited basis. All other requests for appeals should be submitted in writing by the Member or the Members authorized representative, except where the acceptance of oral appeals is otherwise required by the nature of the appeal (e.g. urgent care). You or your authorized representative must submit a request for review to: Anthem Blue Cross and Blue Shield ATTN: Appeals P.O. Box 33200 Louisville, Kentucky 40232-3200
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Upon request, the Claims Administrator will provide, without charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim. Relevant means that the document, record, or other information: was relied on in making the benefit determination; or was submitted, considered, or produced in the course of making the benefit determination; or demonstrates compliance with processes and safeguards to ensure that claim determinations are made in accordance with the terms of the plan, applied consistently for similarly-situated claimants; or is a statement of the plans policy or guidance about the treatment or benefit relative to your diagnosis. The Claims Administrator will also provide you, free of charge, with any new or additional evidence considered, relied upon, or generated in connection with your claim. In addition, before you receive an adverse benefit determination on review based on a new or additional rationale, the Claims Administrator will provide you, free of charge, with the rationale.
The second-level review will be conducted by an appropriate reviewer who did not make the initial determination or the first-level appeal determination and who does not work for the person who made the initial determination or first-level appeal determination. If the denial was based in whole or in part on a medical judgment, including whether the treatment is experimental, investigational, or not medically necessary, the reviewer will consult with a health care professional who has the appropriate training and experience in the medical field involved in making the judgment. This health care professional will not be one who was consulted in making an earlier determination or who works for one who was consulted in making an earlier determination.
Notification of the Outcome of the Appeal

If you appeal a claim involving urgent/concurrent care, the Claims Administrator will notify you of the outcome of the appeal as soon as possible, but not later than 72 hours after receipt of your request for appeal. If you appeal any other pre-service claim, the Claims Administrator will notify you of the outcome of the appeal within 15 days after receipt of your request for appeal. If you appeal a post-service claim, the Claims Administrator will notify you of the outcome of the appeal within 30 days after receipt of your request for appeal.
How Your Appeal will be Decided

When the Claims Administrator considers your appeal, the Claims Administrator will not rely upon the initial benefit determination. The review will be conducted by an appropriate reviewer who did not make the initial determination and who does not work for the person who made the initial determination.
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Appeal Denial
If your appeal is denied, that denial will be considered an adverse benefit determination. The notification from the Claims Administrator will include all of the information set forth in the above section entitled Notice of Adverse Benefit Determination.
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Second Level Appeals

If you are dissatisfied with the Plan's first level appeal decision, a second level appeal may be available. If you would like to initiate a second level appeal, please write to the address listed in the Appeals section earlier in this chapter. Second level appeals must be submitted within 180 calendar days of the denial of the first level appeal. You are required to complete a second level appeal prior to submitting a request for an independent External Review.
For pre-service claims involving urgent/concurrent care, you may proceed with an Expedited External Review without filing an internal appeal or while simultaneously pursuing an expedited appeal through our internal appeal process. You or your authorized representative may request it orally or in writing. All necessary information, including the Claims Administrators decision, can be sent between the Claims Administrator and you by telephone, facsimile or other similar method. To proceed with an Expedited External Review, you or your authorized representative must contact the Claims Administrator at the number shown on your identification card and provide at least the following information: the identity of the claimant; The date (s) of the medical service; the specific medical condition or symptom; the providers name the service or supply for which approval of benefits was sought; and any reasons why the appeal should be processed on a more expedited basis. All other requests for External Review should be submitted in writing unless the Claims Administrator determines that it is not reasonable to require a written statement. Such requests should be submitted by you or your authorized representative to: Anthem Blue Cross and Blue Shield ATTN: Appeals P.O. Box 33200 Louisville, Kentucky 40232-3200
This is not an additional step that you must take in order to fulfill your appeal procedure obligations described above. Your decision to seek External Review will not affect your rights to any other benefits under this health care plan. There is no charge for you to initiate an independent External Review. Your External Review will be completed within 72 hours for urgent/concurrent reviews and within 45 calendar days for pre- and post-service reviews. The External Review decision is final and binding on all parties except for any relief available through applicable state laws or ERISA.
Requirement to file an Appeal before filing a lawsuit

No lawsuit or legal action of any kind related to a benefit decision may be filed by you in a court of law or in any other forum, unless it is commenced within one year of the Plan's final decision on the claim or other request for benefits. If the Plan decides an appeal is untimely, the Plan's latest decision on the merits of the underlying claim or benefit request is the final decision date. You must exhaust the Plan's internal Appeals Procedure but not including any voluntary level of appeal, before filing a lawsuit or taking other legal action of any kind against the Plan. If your health benefit plan is sponsored by your employer and subject to the Employee Retirement Income Security Act of 1974 (ERISA) and your appeal as described above results in an adverse benefit determination, you have a right to bring a civil action under Section 502(a) of ERISA.
External Review
If the outcome of the second level appeal is adverse to you, you may be eligible for an independent External Review pursuant to federal law. You must submit your request for External Review to the Claims Administrator within four (4) months of the notice of your final internal adverse determination. A request for a External Review must be in writing unless the Claims Administrator determines that it is not reasonable to require a written statement. You do not have to re-send the information that you submitted for internal appeal. However, you are encouraged to submit any additional information that you think is important for review.
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CVS Caremark Prescription Claim Appeals Process
When you would like a review of a drug coverage decision under The Home Depot prescription drug plan, you or your representative have the right to appeal the decision. An appeal may be filed within 180 days from the date of the claim. Appeals must be submitted in writing to CVS Caremark at the following address or fax number: CVS Caremark, Inc. Appeals Department, MC109 P.O. Box 52084 Phoenix, AZ 85072-2084 Fax Number: 1-866-689-3092 In your appeal, explain the reason for the appeal, the claim or drug being appealed, your CVS Caremark ID number, name, date of birth and any documentation that you feel is appropriate in support of your appeal (a copy of your benefits booklet, a doctor's letter, etc.). The appeal will be reviewed based on your prescription drug benefit design. If the appeal is due to a prior authorization denial, the prior authorization criteria will also be reviewed. Prior authorization denials are reviewed within 15 days. If your physician requests an urgent review of a prior authorization denial, it will be completed within 24 hours. Your physician may submit the request in writing to the address or fax number above or by calling 1-866-443-1183 (available only to physicians). All other appeals are reviewed within 30 days of CVS Caremark receiving complete information. For all appeals you will be notified of the determination in writing.
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Second Level Appeal Option

If your first level appeal is denied and you have an additional level of appeal (e.g., second-level appeal), the appeal contact information will also be provided in your written notification.
claim. If you or your physician believe your situation is urgent as defined by law, you or your physician may request an expedited appeal. Urgent requests must be clearly identified as urgent at submission. You or someone you name to act for you (your authorized representative) may file an appeal. You may name a relative, friend, advocate or anyone else as your appointed representative. You and that person may need to complete, sign and date a form showing that he/she is authorized under state law to represent you. By completing this form, you give that person legal permission to act as your appointed representative. You may supply any additional information when you submit your claim. You may also wish to present testimony on your behalf. If you request an external review, an independent organization will review our decision and provide you with a written determination. If this organization decides to overturn our decision, CVS Caremark will provide coverage or payment for your health care item or service.
External Review Rights

If your additional level of appeal (e.g., second level appeal) is also denied and you do not agree with the decision, you may have the right to request an external review of the decision as permitted under the Patient Protection and Affordable Care Act of 2010 or to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974 (ERISA). To request an external review of the denial of your claim, you must submit a request for external review within four (4) months after receiving your denial notice. The request should be sent to: CVS Caremark External Review Appeals Department MC109 P.O. Box 52084 Phoenix, AZ 85072-2084 For standard external review, a decision will be made within 45 days of receiving your request. However, if your situation meets the definition of urgent under the law, the external review of your claim will be conducted on an expedited basis. Generally, an urgent situation is defined by law as one in which your health may be in serious jeopardy or, in the opinion of your physician, you may experience pain that cannot be adequately controlled while you wait for a decision on the external review of your 325
Kaiser Permanente HMOs: Complaints, Grievances and Arbitration Process Overview

Introduction
A complaint is an expression of dissatisfaction with care, service, or benefits thats non-monetary in nature. A grievance is an expression of dissatisfaction for which the member seeks a referral, provision of services or supplies, or reimbursement for services or supplies or other financial resolution.
Claims & Appeals

To improve the quality of care and service we provide and increase member satisfaction, we encourage members to inform us when they have a complaint or grievance, and we work with them to address their issues as quickly and fairly as possible. Our members have the advantage of being able to meet directly with a Member Services representative at select Kaiser Permanente medical facilities to discuss a complaint or grievance in person. They can also file a complaint or grievance in writing via fax, mail, or e-mail on kp.org. Or they can call our Member Service Call Center and file over the phone. Several of the complaints we receive are addressed to the members satisfaction immediately or by the end of the next business day and members are notified of the resolution verbally. Any complaint or grievance that cannot be resolved by the end of the next business day is acknowledged by mail within five days. Representatives in the Member Services Departments at our medical facilities or case managers in the Member Case Resolution Center are responsible for investigating complaints or grievances that cannot be resolved by the end of the next business day. Representatives work with designated physician leaders and department managers to investigate the concerns reported in member complaints and to resolve them to the members satisfaction. A written notice of the resolution of the complaint is sent to the member within 30 days of receipt.
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Claims Inquiry Process

For California, Ohio, Northwest, Mid-Atlantic, and Georgia: Member inquiries about basic claims information can be conveniently made through Member Services, the single number they need for almost all their inquiries and services. Member Services representatives can tell a member if a claim has been paid or is on hold for any reason. More complex issues are sent via email to the Claims Administration Department. When the Member Services representative receives a response from the Claims Department, he or she calls the member with the updated information. California: (800) 464-4000 Ohio: (800) 686-7100 Georgia: (404) 261-2590, (888) 865-5813 Northwest: Portland metro area: (503) 813-2000, Toll-Free: (800) 813-2000 Mid-Atlantic: Washington, DC metro area: (301) 468-6000, Outside metro area: (800) 777-7902 Hawaii Only: Our Claims Administration Department can only take direct calls from members when they are making inquiries about emergency treatment from non Kaiser Permanente providers. They can be reached at (808) 243-6610, 8 a.m.4:30 p.m.,MondayFriday. Colorado Only: Members can make claims inquiries directly through our Claims Administration Department by calling (303) 338-3600, 9 a.m.4 p.m., MondayFriday.
Grievance Process
A grievance involves a dispute about coverage or medically necessary services. Similar to the complaint process, Case Managers in the Member Case Resolution Centers, investigate the issues and requests contained in member grievances. For issues involving medical care, physicians in a similar or same specialty participate in the investigation and review. After concluding the investigation, Case Managers prepare a case summary and forward the case to the appropriate reviewers for a decision. Only physicians can make a decision about medical necessity. If the grievance is denied, its automatically forwarded to the appeal process. Further investigation takes place with individuals not involved in the previous decision. The Case Manager prepares an updated case summary and forwards the case to the appropriate reviewers for a decision. As in the previous decision, only physicians can make a decision about medical necessity. Decisions are made based on a full investigation of the grievance, including the members perspective and other available information, such as medical records, medical necessity criteria, and the Evidence of Coverage. Written decisions about a grievance, including denials and approvals, are sent within 30 days of receiving the grievance. When a member or physician has requested an expedited review, well provide a written or oral response within 72 hours. If the members request is approved, the case manager will work with the members physician and medical center personnel to arrange for the member to receive the approved services.
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If the members request is denied, the letter will include the reasons for the denial and information about any additional options the member may have if they are dissatisfied with the decision. To maintain regulatory compliance and help ensure that member concerns are addressed quickly and fairly, we document written and verbal complaints and grievances in our complaints tracking system and track the complaint or grievance until its resolved and the case is closed. To monitor the effectiveness of our complaint resolution process and our quality and service performance, we generate a wide variety of reports daily, weekly, and monthly. These reports also help us develop best practices and quickly identify any negative trends so that corrective action can be implemented as needed. An ongoing, extensive, systematic quality review process helps to ensure high levels of performance, responsiveness, and regulatory compliance from intake through case closure. For specific information on filing a complaint or grievance and the options available to members, please refer to your group Evidence of Coverage.
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Arbitration Process
Arbitration is a widely used method of dispute resolution that is an alternative to traditional litigation; Kaiser Permanente's California Regions have used mandatory binding arbitration to resolve malpractice and other disputes for more than 25 years. Arbitration is used because it is a speedier and mutually more cost-effective and equitable form of dispute resolution than traditional courtroom litigation. In addition to Northern California and Southern California, the Hawaii and Colorado regions use arbitration. Kaiser Permanente uses binding arbitration to resolve disputes because it is mutually equitable and cost-effective for both sides. It also avoids the delays inherent to an overworked, backlogged court system. Arbitration is more private (regarding the discussion of medical records and other personal details) and less formal than traditional litigation. It is consequently more appropriate for the resolution of disputes with persons who, in many cases, continue to be Health Plan members. Members are notified about mandatory binding arbitration through Disclosure Forms and Evidences of Coverage, contracts, membership brochures and other publications, as well as by notification on Kaiser Permanente enrollment forms. Arbitration is used to resolve disputes (other than Small Claims Court cases or claims subject to a Medicare appeal procedure) such as those for premises or professional liability matters, including claims alleging medical malpractice. However, ERISA regulations prohibit mandatory arbitration of ERISA-regulated benefit claims.
Applicable to California only, the use of an Independent Administrator is to ensure impartial, independent administration of the arbitration process. The Independent Administrator is subject to scrutiny by the Arbitration Oversight Board and by regular audits and reports that are available to members and the public. Arbitrations are conducted according to the Rules of Procedure which were developed by the Independent Administrator in consultation with the Arbitration Oversight Board and Kaiser Permanente. For more information on the Office of the Independent Administrator, log on to: http://oia-kaiserarb.com/ The grievance process precedes the arbitration process and is used to resolve concerns or problems about coverage, services or benefits. A member who is dissatisfied with the decision reached in the grievance process can proceed to arbitration. Kaiser Permanente also supports and engages in early mediation in many cases.
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Claims Involving the Critical Illness Protection Plan
Claim Review
If a claim is denied, we will give written notice of: 1. the reason for denial; and 2. the policy provision that relates to the denial; and 3. your right to ask for a review of your claim; and 4. your right to submit any additional information that might allow us to change our decision. You may, upon written request, have any reports that are not confidential. We will make copies of those reports.
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MetLife Dental Plans

Appealing the Initial Determination
If MetLife denies your claim, you may take two appeals of the initial determination. Upon your written request, MetLife will provide you free of charge with copies of documents, records and other information relevant to your claim. You must submit your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLifes decision. Appeals must be in writing and must include at least the following information: Name of Employee Name of the Plan Reference to the initial decision Whether the appeal is the first or second appeal of the initial determination An explanation of why you are appealing the initial determination. As part of each appeal, you may submit any written comments, documents, records, or other information relating to your claim. After MetLife receives Your written request appealing the initial determination or determination on the first appeal, MetLife will conduct a full and fair review of your claim. Deference will not be given to initial denials, and MetLifes review will look at the claim anew. The review on appeal will take into account all comments, documents, records, and other information that you submit relating to your claim without regard to whether such information was submitted or considered in the initial determination. The person who will review your appeal will not be the same
person as the person who made the initial decision to deny your claim. In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny your claim. If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. This health care professional will not have consulted on the initial determination, and will not be a subordinate of any person who was consulted on the initial determination. MetLife will notify you in writing of its final decision within 30 days after MetLifes receipt of your written request for review, except that under special circumstances MetLife may have up to an additional 30 days to provide written notification of the final decision. If such an extension is required, MetLife will notify you prior to the expiration of the initial 30 day period, state the reason(s) why such an extension is needed, and state when it will make its determination. If MetLife denies the claim on appeal, MetLife will send you a final written decision that states the reason(s) why the claim you appealed is being denied and references any specific Plan provision(s) on which the denial is based. If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that you may request a copy free of charge. Upon written request, MetLife will provide you free of charge with copies of documents, records and other information relevant to your claim.
Appeals Procedure
No action at law or in equity shall be brought to recover under the policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of the policy. No action shall be brought after the expiration of 3 years after the time written proof of loss is required to be furnished.
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EyeMed Vision Plans
If a claim for benefits is denied, EyeMed Vision Care will notify the member in writing of the specific reasons for the denial. The member may request a full review by EyeMed Vision Care within 180 days of the date of a denial. The members written letter of appeal should include the following: The applicable claim number or a copy of the EyeMed Vision Care denial information or Explanation of Benefits, if applicable. The item of your vision coverage that the member feels was misinterpreted or inaccurately applied. Additional information from the members eye care provider that will assist EyeMed Vision Care in completing its review of the members appeal, such as documents, records, questions or comments. The appeal should be mailed to the following address: EyeMed Vision Care, L.L.C. Attn: Quality Assurance Dept. 4000 Luxottica Place Mason, Ohio 45040 EyeMed Vision Care will review your appeal for benefits and notify you in writing of its decision, as well as the reasons for the decision, with reference to specific plan provisions.
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Spending Accounts: Request for Level I Appeal

If any portion of your submitted claim isnt eligible for reimbursement, youll receive notification from Your Spending Account. If you believe that your claim (or a portion of it) was denied incorrectly, please call 1-800-555-4954 and speak to a representative. If the Benefits Choice Center determines that the claim (or a portion of it) was correctly denied, you may request a review of the denial at no cost by completing and submitting a Level I Appeal Initiation Form to Your Spending Account Benefit Determination Review Team. You may request the Level I Appeal Initiation Form from the Benefits Choice Center and it will be mailed to you as soon as possible. We must receive the Level I Appeal Initiation Form, along with any supporting comments, documents, and other information to be considered a valid Level I Appeal. Please mail your documentation, first-class postage paid, to: Your Spending Account Benefit Determination Review Team P.O. Box 1444 Lincolnshire, IL 60069-1444 When completing the Level I Appeal Initiation Form, please state the reason you believe the claim for benefits was improperly denied. You may submit any comments, questions, documents, or information that you deem appropriate. The Your Spending Account Benefit Determination Review Team will review your Level I Appeal and will consider the
applicable terms and provisions of the Plan and amendments to the Plan, information and evidence that is presented by you and any other information it deems relevant, within 30 days of receipt and provide you with a written explanation of the benefit determination. Defective Requests for Level 1 Appeal In the case of your failure to follow the Plans procedures for filing a valid Level I Appeal, you will be notified of the failure and the proper procedures to be followed in filing a Level I Appeal. This notice will be provided to you as soon as possible. Notice of Extension of Review Time The Benefit Determination Review Team may extend the period for making the benefit determination by 15 days if it determines that such an extension is necessary due to matters beyond its control. The Benefit Determination Review Team must notify you of the circumstances requiring the extension and the date by which it expects to render a decision before the end of the initial 30-day period. If an extension is necessary due to your failure to submit necessary information, the notice of extension will describe the required information. You will be given at least 45 days from receipt of the notice within which to provide the specified information, and the 30-day extension period in which the decision is required to be made will be suspended from the date on which the notification is sent to you until the earlier of (1) the date you respond to the request for additional information, or (2) the due date established by the Benefit Determination Review Team to provide the requested information.
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Manner and Content of Notification of Denied Level I Appeal You will be provided with written notice of any denial in accordance with applicable U.S. Department of Labor regulations. The notification will include: A.The specific reason or reasons for the denial; B.Reference to the specific provision(s) of the Plan on which the determination is based; C.A description of any additional material or information necessary for you to perfect the claim and an explanation of why such material or information is necessary; D.If an internal rule, guideline, protocol or other similar criterion was relied upon in making the denial, the notice will either (1) include the specific rule, guideline, protocol or other similar criterion of the Plan that was relied upon or (2) provide a statement that such rule, guideline, protocol or similar criterion was relied upon, and that a copy will be provided free of charge to you upon request; E.If the denial is based on a medical necessity or experimental treatment or similar exclusion or limit, the notice will provide either (1) an explanation of the scientific or clinical judgment relied upon for the determination, or (2) a statement that such explanation will be provided free of charge upon request; and F. A description of the Plans review procedures and the time limits applicable to such procedures, and if a claim involving urgent care, of the expedited review process.
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Appeal of Denied Level I Appeal

If any portion of your Level I Appeal is denied, and you believe that it was denied in error, you have the right to appeal that decision to the Your Spending Account Benefit Determination Review Team within 180 days of the date you received the denial notification. If you dont submit a Level II Appeal Initiation Form to the Your Spending Account Benefit Determination Review Team during this period, no further action will be taken and you will not be able to file a Level II Appeal for this claim at a later date. We must receive the Level II Appeal Initiation Form along with any supporting comments, documents, and other information to be considered a valid claim. Please mail your documentation, first-class postage paid, to: Your Spending AccountBenefit Determination Review Team P.O. Box 1444 Lincolnshire, IL 60069-1444 A Level II Appeal Initiation Form will be included with the Level I Appeal determination letter. If for some reason it is not, you may request that one be mailed to you by calling 1-800-555-4954 and speaking to a representative. When submitting your Level II Appeal Form, please state the reason you believe the claim for benefits was improperly denied. You may submit any comments, questions, documents, or information that you deem appropriate. The Your Spending Account Benefit Determination Review Team will review your Level II Appeal and will consider the applicable terms and provisions of the Plan and amendments
to the Plan, information and evidence that is presented by you and any other information it deems relevant, within 60 days of receipt and provide you with a written explanation of the benefit determination.
Defective Level II Appeals

In the case of your failure to follow the Plans procedures for filing a valid Level II Appeal, you will be notified of the failure and the proper procedures to be followed in filing a Level II Appeal. This notice will be provided to you as soon as possible. Your Level II Appeal will receive a full and fair review by someone other than the person who initially made the unfavorable benefit determination or his or her subordinate. You have the right to request copies of all documents, records, and other information used in evaluating your claim at no cost. If an internal rule, guideline, protocol, or another standard was relied on in making the unfavorable benefit determination, upon request, the Your Spending Account Benefit Determination Review Team will provide you with a copy free of charge. If the unfavorable benefit determination was made based on a lack of medical necessity, an experimental treatment, or another similar exclusion or limit, upon request, the Your Spending Account Benefit Determination Review Team will provide an explanation of the scientific or clinical judgment for the unfavorable benefit determination free of charge.
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If the Your Spending Account Benefit Determination Review Team denies your Level II Appeal and you arent satisfied with the decision, youll have rights under Section 502(a) of the Employment Retirement Income Security Act of 1974 (ERISA) to bring a civil action in federal court. Your state may have additional internal appeal and/or external review processes available to you to resolve disputes. Additionally, you and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor office.
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60 days after denial, you or your beneficiary may submit a written request for reconsideration of the denial to the Administrator. Any such request should be accompanied by documents or records in support of your appeal. You or your beneficiary may review pertinent documents and submit issues and comments in writing. The Administrator will review the claim and provide, within 60 days, a written response to the appeal. (This period may be extended an additional 60 days under certain circumstances.) In this response, the Administrator will explain the reason for the decision, with specific reference to the provisions of the Plan on which the decision is based. The Administrator has the exclusive right to interpret the appropriate plan provisions. Decisions of the Administrator are conclusive and binding. The Plan Administrator will provide written or electronic notification of any claim denial. The notice will state: (a) The specific reason or reasons for the denial; (b) Reference to the specific Plan provisions on which the denial was based; (c) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (d) A description of the Plan's review procedures and the time limits applicable to such procedures. This will include a statement of your right to bring
a civil action under section 502 of ERISA following a denial on review; (e) A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim; and (f) If the denial was based on an internal rule, guideline, protocol, or other similar criterion, the specific rule, guideline, protocol, or criterion will be provided free of charge. If this is not practical, a statement will be included that such a rule, guideline, protocol, or criterion was relied upon in making the denial and a copy will be provided free of charge to the claimant upon request. When you receive a denial, you will have 180 days following receipt of the notification in which to appeal the decision. You may submit written comments, documents, records, and other information relating to the claim. If you request, you will be provided, free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim. The period of time within which a denial on review is required to be made will begin at the time an appeal is filed in accordance with the procedures of the Plan. This timing is without regard to whether all the necessary information accompanies the filing.
PayFlex Claims Process Limited Purpose Flexible Spending Account (LPFSA)

For the Limited Flexible Spending Account you must submit claims no later than April 30 of the calendar year following the Plan Year. Any claims submitted after that time will not be considered. Claims that are insured will be handled in accordance with procedures contained in the insurance policies. All other general requests should be directed to the Administrator of our Plan. If a Limited Flexible Spending Account claim under the Plan is denied in whole or in part, you or your beneficiary will receive written notification. The notification will include the reasons for the denial, with reference to the specific provisions of the Plan on which the denial was based, a description of any additional information needed to process the claim and an explanation of the claims review procedure. Within
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A document, record, or other information shall be considered relevant to a claim if it: (a) was relied upon in making the claim determination; (b) was submitted, considered, or generated in the course of making the claim determination, without regard to whether it was relied upon in making the claim determination; (c) demonstrated compliance with the administrative processes and safeguards designed to ensure and to verify that claim determinations are made in accordance with Plan documents and Plan provisions have been applied consistently with respect to all claimants; or (d) constituted a statement of policy or guidance with respect to the Plan concerning the denied claim. The review will take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. The review will not afford deference to the initial denial and will be conducted by a fiduciary of the Plan who is neither the individual who made the adverse determination nor a subordinate of that individual. For information regarding fraudulent activity on your debit card, or any other dispute specific to the use of your debit card, please refer to the card holder agreement you received when the card was issued or call PayFlex at 1-866-828-8766.
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Claims Involving Disability Benefits and Disability Determinations

If Liberty denies your claim, you may appeal the decision. Upon your written request, Liberty will provide you free of charge with copies of documents, records and other information relevant to your claim. You must submit your appeal to your Liberty disability case manager within 180 days of receiving Libertys decision for the Full-Time Hourly ShortTerm Disability Plan and the Full-Time Hourly and Salaried Long-Term Disability Plans and within 30 days of receiving Libertys decision for the Salaried Short-Term Disability Plan. Submit your appeal to the following address: Group Benefits Disability Claims Liberty Life Assurance Company of Boston P.O. Box 7211 London, KY 40742-7211 Appeals must be in writing and should include the following information: 1. the reason why you feel your claim should not have been denied 2. any written comments, documents, records or other information relating to your claim that was not previously received and which you feel will support your claim
If Liberty Life does not receive your written request for review within 180 days of your receipt of the denial notice, the claim decision will be final, and no further review of your claim will be conducted. Under normal circumstances, you will be notified of the final decision within 45 days of the date that your request for appeal is received. If special circumstances cause a delay in our decision, you will be notified of the final decision no later than 90 days after your request for review is received.
Employee Assistance Program: Claim Determinations

ValueOptions will generally make a determination on your request for EAP services and inform you of its determination in your initial telephone call to request services. If ValueOptions cannot decide while on the initial call, ValueOptions will decide within five calendar days of your request for services or of notice to ValueOptions of a circumstance that affects the availability of further EAP services. ValueOptions will inform you by telephone of its determination within one business day after it decides. If ValueOptions determines that you need Urgent Care, ValueOptions will provide telephonic crisis counseling and make an appropriate referral through your benefit plan and/or emergency resources in the community. ValueOptions does not make Claim determinations relating to Urgent Care. Because ValueOptions pays all EAP providers directly, you should not make any payment to a provider for EAP services. In the event that you mistakenly pay a provider for EAP services, ValueOptions will make a determination on your
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request for reimbursement within 15 days after receipt of the Claim (if EAP services have not yet been received) or with 30 days after receipt of the Claim (if the EAP services have already been received).
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Adverse Determinations of a Claim for EAP Benefits

If a claim for EAP benefits is wholly or partially denied, ValueOptions will provide written notice of the denial to you or your Authorized Representative. This notice of the decision will: give the specific reason or reasons for the denial decision; identify Plan provisions on which the decision is based; describe any additional material or information necessary for an appeal review and an explanation of why it is necessary; explain the review procedure, including time limits for appealing the decision and to sue in federal court;
may submit written comments, documents, records and other information relating to your appeal, whether or not the comments, documents, records or information were submitted in connection with the initial claim for EAP benefits. On your request, ValueOptions will make relevant documents available to you. The review of the initial decision will consider all new information, whether or not it was presented or available for the initial decision. The person who conducts the appeal review will be different from the person(s) who originally denied your claim for EAP benefits and will not report directly to the original decision maker or prior reviewer. You or your Authorized Representative will be notified of the appeal decision within the following time frames: If the case involves an adverse determination on a request for EAP services or a pre-service adverse determination relating to reimbursement, within thirty days of ValueOptions receipt of the request for appeal; If the case involves a post-service adverse determination relating to reimbursement, within sixty days of ValueOptions receipt of the request for appeal.
Appeal Decisions
ValueOptions will give you or your Authorized Representative the decision on the appeal in writing. If the denial is upheld on appeal, the notice will include the following information: the specific reason or reasons for the denial decision; identification of Plan provisions on which the decision is based; notice of your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol or similar criterion relied on in making the decision; notice of your right to receive, free of charge, upon your request, reasonable access to, and copies of, all documents, records and other information relevant to the appeal; notice of your right to bring a civil lawsuit under ERISA 502(a). If you do not agree with the final decision of ValueOptions, you may bring a lawsuit in federal district court. You cannot bring legal action unless your Claim has been reviewed and denied by ValueOptions.
Appeals of Adverse Determinations of Claims for EAP Benefits

If you believe your claim for EAP benefits was denied in error, you may appeal the decision. Your appeal must be submitted in writing to ValueOptions within 180 days following your receipt of a denial notice. Your appeal should state the reasons why you feel your claim for EAP benefits is valid and include any additional documentation that you feel supports your claim for EAP benefits. You can also include any additional questions or comments. You
Limitation of Actions
No lawsuit with respect to any benefit payable or other matter arising out of or relating to any benefit plan may be brought before exhaustion of the appeal procedures set forth in this chapter. Any lawsuit must be filed no later than one year after the earlier of the date your claim arises or the date your claim is denied.
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Plan Administration
Chapter Contents
335 Benefit Plan Administration 335 335 336 336 336 336 336 337 337 Qualified Domestic Relations Order (QDRO) Under FutureBuilder Qualified Medical Child Support Order Provider Networks Plan Legal Matters Plan Year Plan and Employer Identification Numbers How the Plans Are Funded Amending or Terminating the Plans Authority and Control 337 Your Rights Under the Employee Retirement Income Security Act (ERISA) 337 337 338 338 338 Receive Information About Your Plan and Benefits Continue Group Health Plan Coverage Prudent Actions by Plan Fiduciaries Enforce Your Rights Assistance With Your Questions
338 Limitation of Actions 338 Plan Termination and Amendment
Plan Administration
What do you need?
Request a copy of the official plan documents for the Plans Receive a copy of the written procedures for determining whether a QMCSO is valid Find out who the claims administrator is for a specific Plan Get answers to questions about your rights under ERISA or help in obtaining documents
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Find it here...
Contact the Plan administrator at: Home Depot U.S.A., Inc., Benefits Department, Building C-18, 2455 Paces Ferry Road, Atlanta, GA 30339-4024 See the Plan Administration Summary at the end of this section for claim administrator phone numbers and addresses. The Plan Administrator and the Claims Administrator often are two different companies. Call the publications hotline of the Employee Benefits Security Administration (EBSA) at 1-866-444-3272; or go to www.dol.gov/ebsa; or Contact the nearest EBSA office.
Benefit Plan Administration

Many of the Company benefit plans operate under the guidelines of ERISA (Employee Retirement Income Security Act of 1974, as amended). The Company maintains these Plans for the exclusive benefit of its associates and, when applicable, associates legal spouses and eligible domestic partners and/or dependent children. ERISA requires that certain disclosures must be made to Plan participants. The following pages include this information as well as other important details about your benefits coverage.
Qualified Medical Child Support Order

The Plans provide coverage for your child pursuant to the terms of a Qualified Medical Child Support Order (QMCSO) even if you do not have legal custody of the child, the child is not dependent on you for support, and regardless of any enrollment season restrictions that might otherwise exist for dependent coverage. If the Plan receives a valid QMCSO and you do not enroll the dependent child, the custodial parent or state agency may enroll the affected child. Additionally, the Company will deduct from your pay any contributions required for such coverage unless payment is made by a state agency.
A QMCSO may be either a National Medical Child Support Notice issued by a state child support agency or an order or a judgment from a state court or administrative body directing the Company to cover a child under the Plan. Federal law provides that a QMCSO must meet certain form and content requirements in order to be valid. If you have any questions or you would like to receive a copy of the written procedure, free of charge, for determining whether a QMCSO is valid, please contact the Plan administrator.
Qualified Domestic Relations Order (QDRO) Under FutureBuilder

If you are a beneficiary/alternate payee under a QDRO, you are entitled to obtain from the Plan Administrator for FutureBuilder, without charge, a description of the Plans procedures governing QDRO determinations.
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Plan Administration
Provider Networks
Certain benefit options under the Medical, Vision and Dental Plans have provider networks which vary among the options. Benefits are generally greater when services are provided by a network provider. There is no guarantee that the same doctors, hospitals and other health care providers will be included in your Plans provider network from year to year. You should read your enrollment material very carefully to ensure that your network isnt changing in the next plan year. Before you call for an appointment each year, you should confirm the doctors, hospitals or other health care providers participation in your Plans network by contacting your claims administrator. Lists and/or directories of network providers are available, free of charge. Associates may also access up-to-date provider lists and directories through web sites of the individual plans, and through their toll-free Member Services numbers.
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Plan Year
The Plan Administrator maintains the Plans and all records on a fiscal-year basisFebruary 1 through January 31 of each year. For FutureBuilder, the Plan Administrator maintains the Plan and all records on a calendar year basis January 1 through December 31 of each year.
applicable or from the Companys general assets. The Spending Account contributions are not held in trust. The Company provides benefits for The Home Depot Basic Term Life, Basic Dependent Term Life, Basic AD&D, Voluntary Term Life, Voluntary Dependent Term Life and Voluntary AD&D through a group insurance policy underwritten by Minnesota Life. The Legal Services Plan (MetLaw) and Dental benefits are provided through a group insurance policy underwritten by Metropolitan Life Insurance Company. The Disability benefits are provided through a group insurance policy underwritten by Liberty Mutual. The Spending Account benefits are administered by Aon Hewitt. The Company provides benefits for the Medical Plans, including prescription benefits, a portion through self-funding, and a portion through contracts of insurance. Vision benefits under the Vision Plan are provided through a group insurance policy underwritten by Fidelity Security Life Insurance Company. Critical Illness Protection Plan benefits are provided through a group insurance policy underwritten by American Heritage Life Insurance Company. The Home Depot FutureBuilder is a tax-qualified defined contribution retirement Plan. Benefits under FutureBuilder are not insured under Title IV of ERISA because the Plan is not a defined benefit pension plan.
Plan and Employer Identification Numbers

The IRS has assigned the employer identification number 58-1853319 to the Plan Sponsor of all plans except FutureBuilder. For FutureBuilder, the IRS has assigned the employer identification number 95-3261426 to the Plan Sponsor. For Plan numbers, see Plan Administration Summary. Upon request, the plan administrator can provide you with a list of affiliated employers that have adopted the plans.
Plan Legal Matters

Service of process for all legal matters should be made on the Plan Sponsors registered agent for service of process, CT Corp., whose address is available from the Secretary of State in each jurisdiction in which the Plan is administered. Service may also be made upon the Plan Administrator or Trustee at: Home Depot U.S.A., Inc. Benefits Department BL C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 Service of process for insured benefit claims should be made on the insurance company or its agent for service of legal process.
How the Plans Are Funded

The Company and its associates make contributions to the Plans in amounts determined by the Company from time to time. The Companys contributions will be made to the appropriate Plans trust or insurance policy, where required, as specified by the Plans funding policy. An associates contributions will be made to the appropriate Plans trust or insurance policy, where required, as soon as administratively practical after such contributions have been received from the associate or withheld from the associates pay. Benefits are provided directly from the appropriate Plans trust or insurance policy, where required, as
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Plan Administration
Amending or Terminating the Plans
Although the Company established its benefit plans with the intention that they be maintained indefinitely, the Plans may be amended, terminated or discontinued at any time. In the event the plans are terminated, you and all other covered associates will be provided in a timely manner with written notice of such termination and your rights.
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Benefits under each Plan will be paid only if the Plan Administrator (or, for the fully insured benefits, the insurance carrier) decides in its discretion that the applicant is entitled to the benefits. The Plan administrator retains the full power and discretionary authority to interpret all other aspects of the Plan, and its decisions on those matters, including factual determinations, are final and binding.
operation of the Plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and an updated summary plan description. The administrator may make a reasonable charge for the copies. Receive a summary of the Plans annual financial report. The Plan administrator is required by law to furnish each participant with a copy of this summary annual report.
Authority and Control

The Plan Administrator (or, for the fully insured benefits, the insurance carrier) has the full power and authority in its absolute discretion to determine all questions of eligibility for and entitlement to benefits, whether legal or factual, and to interpret and construe the terms of the plans. Benefits under each plan will be paid only if the Plan Administrator (or, for the fully insured benefits, the insurance carrier) decides in its discretion that the applicant is entitled to them. The claims administrator or insurer has the full power and authority in its absolute discretion to determine whether a claim is payable under the Plan and to interpret and construe the terms of the Plan and make factual determinations with respect to claims and appeals for benefits and is a named fiduciary for such purposes.
Your Rights Under the Employee Retirement Income Security Act (ERISA)
As a participant in the Medical and Dental Plans, the Vision Plan, the Welfare Benefits Plans and the portion of the Cafeteria Benefit Plan providing the Health Care Spending Account, and FutureBuilder, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to the following.
Continue Group Health Plan Coverage

You may continue certain coverage options for yourself, spouse or dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights. See the COBRA Coverage chapter for more information. You should be provided a certificate of creditable coverage, free of charge, from your group health plan when you lose coverage under the Plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.
Receive Information About Your Plan and Benefits

Examine, without charge, at the Plan administrators office and at other specified locations, such as work sites, all documents governing the Plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan administrator, copies of documents governing the
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Plan Administration
Prudent Actions by Plan Fiduciaries
In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called fiduciaries of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a pension or welfare benefit or exercising your rights under ERISA.
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In addition, if you disagree with the Plans decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court. If it should happen that Plan fiduciaries misuse the Plans money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees; for example, if it finds your claim is frivolous.
Limitation of Actions
No lawsuit with respect to any benefit payable or other matter arising out of or relating to any benefit plan may be brought before exhaustion of the appeal procedures set forth in the Claims and Appeals chapter. Any lawsuit must be filed no later than one year after the earlier of the date your claim arises or the date your claim is denied.
Plan Termination and Amendment

The Plan Sponsor expects and intends to continue the Plans but reserves its right to amend or terminate the Plans, in whole or in part, without notice. The Plan Sponsor may also increase or decrease its contributions or the participants contributions to the Plans. If the Plans are terminated while you are employed by the Company, you will not have any further rights other than the payment of benefits for covered losses or expenses incurred before the Plans are terminated. The amount and form of any final benefit you or your beneficiary receives will depend on any contract provisions affecting the Plans and the Plan Sponsors decisions. If there are any Plan assets remaining in trust following termination, the use of such Plan assets shall be governed by the terms of the applicable trust.
Enforce Your Rights

If your claim for a pension or a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court.
Assistance With Your Questions

If you have any questions about your plan, you should contact the Plan administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan administrator, you should contact the nearest office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by: calling the publications hotline of the Employee Benefits Security Administration at 1-866-444-3272; logging on to the Internet at www.dol.gov/ebsa; or contacting the EBSA field office nearest you.
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Plan Administration
Plan Administration Summary
Plan Name Plan Type Home Depot Medical and Dental Plan A welfare plan for reimbursement of non-occupational medical care claims (a portion through selffunding and a portion through contracts of insurance), prescription drugs and dental care claims (a portion through self-funding and a portion through contracts of insurance) and employee assistance benefits 501 Home Depot U.S.A., Inc. Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211 Not applicable Home Depot Vision Plan A welfare plan for reimbursement of vision care claims through a contract of insurance Home Depot Welfare Benefits Plan
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Home Depot Cafeteria Benefit Plan A benefit plan allowing associate contributions for medical, dental and vision coverage to be made on a pre-tax basis and providing health care and dependent day care spending accounts.
The Home Depot FutureBuilder A qualified defined contribution retirement plan, with associate and company contributions
A welfare plan for payment of accidental death and dismemberment, life, disability, critical illness, tuition reimbursement and pre-paid legal benefits through contracts of insurance
Plan Number Plan Sponsor
511 Home Depot U.S.A., Inc. Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211 Not applicable
001 The Home Depot, Inc. Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211 The Northern Trust Co. 50 S. LaSalle St. Chicago, IL 60675 The Home Depot FutureBuilder Administrative Committee Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211 The recordkeeper is: Aon Hewitt 3350 Riverwood Pkwy Atlanta, GA 30339-3370 1-770-956-7777
Plan Trustee
Plan Administrator*
The Administrative Committee Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211
The Administrative Committee Benefits Department, Building C-18 2455 Paces Ferry Road Atlanta, GA 30339-4024 1-770-433-8211 EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, Ohio 45040-7111 Fax: 1-866-293-7373
Claims Administrator, Insurer or Recordkeeper
See list on following page for Medical and Dental Plan claims administrators
For Disability: Liberty Group Benefits for Disability Claims Life Insurance Company of Boston P.O. Box 7211 London, KY 40742-7211 1-888-404-5096 For Life Insurance: Minnesota Life 400 Robert St. N. St. Paul, MN 55101-2098 1-866-293-6047
For MetLaw: Hyatt Legal Services (pre-paid legal) 1111 Superior Ave. Cleveland, OH 44114 1-800-423-0300 For Critical Illness Protection: Allstate Workplace Division 1776 American Heritage Life Drive Jacksonville, FL 32224-6687 1-866-828-8766
Aon Hewitt 3350 Riverwood Pkwy Atlanta, GA 30339-3370 1-770-956-7777 For Spending Accounts: Aon Hewitt P.O. Box 785040 Orlando, FL 32878-5040 1-800-555-4954 For Limited Flexible Spending Account: PayFlex Systems USA, Inc. P.O. Box 3039 Omaha, NE 6810 1-800-506-9157
The insurer and claims administrator is the Named Fiduciary for decisions on claims and appeals for all Plans other than FutureBuilder.
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Plan Administration
Medical, Dental and Vision Claim Administrators
Medical Plans Health Net HMO, OOA PPO and Salud HMO y Mas P.O. Box 14702 Lexington, KY 40512 1-800-847-3991 Kaiser CaliforniaHMO (Northern California) Attn: California Claims Administration Department P.O. Box 12923 Oakland, CA 94604-2923 1-800-390-3510 Kaiser CaliforniaHMO (Southern California) Claims Administration Department P.O. Box 7004 Downey, CA 90242-7004 1-800-390-3510
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KaiserHMO Northwest 500 NE Multnomah Street Suite 100 Portland, OR 97232-2099 1-800-813-2000
KaiserHMO Georgia P.O. Box 190849 Claims Administration Atlanta, GA 31119 404-261-2825
Kaiser HMOHawaii Kaiser Foundation Health Plan, Inc. Attn: Claims Administration 80 Mahalani St. Wailuku, HI 96793 243-6610 (Oahu) 1-877-875-3805 (Neighbor Islands)
Medical Plans AetnaPOS PO Box 981106 El Paso, TX 79998-1106 1-800-695-9744 www.aetnanavigator.com Blue Cross Blue Shield PO Box 37010 Louisville, KY 40233-7010 1-877-434-2734 Kaiser Permanente Colorado - Claims Southern Colorado Service Area PO Box 372910 Denver, CO 80237-6910 1-888-681-7878 Kaiser Permanente Colorado Claims Denver/Boulder/ Longmont Service Area P.O. Box 373150 Denver, CO 80237 1-888-681-7878 Kaiser Permanente Mid-Atlantic - Claims PO Box 6233 Rockville, MD 20849 301-468-6000 (Metro area) 1-800-777-7902 (Outside metro area) Kaiser Permanente Ohio Claims PO Box 5316 Cleveland, OH 44101-9774 1-800-686-7100
Prescription Drug CVS Caremark Attn: Claims Department P.O. Box 52196 Phoenix, AZ 85072-2196 CARE/Solutions for Life CARE/Solutions for Life Latham Claims Department EAP P.O. Box 1290 Latham, NY 12110 1-800-553-3504 Dental Plan MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282 1-800-638-9909 www.metlife.com/dental Vision Plan EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, Ohio 45040-7111 Fax: 1-866-293-7373 oonclaims@eyemedvisioncare.com Health Savings Account PayFlex Systems USA, Inc. P.O. Box 3039 Omaha, NE 6810 1-800-506-9157 U.S. Salaried & Full-Time Hourly Associates
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Medicare Part D
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MEDICARE PART D
Important Notice from The Home Depot About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with The Home Depot and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Home Depot has determined that the prescription drug coverages offered by Home Depot that are listed in the Creditable Coverage column of the table below are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay. Home Depot has determined that the prescription drug coverages offered by Home Depot that are listed in the Non-Creditable column of the table below are, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription coverage drug pays. This is important because most likely you will get more help with your drug costs if you join a Medicare drug plan than if you only have coverage from Home Depot. Read this notice carefullyit explains the options you have under Medicare prescription drug coverage, and can help you decide whether or not you want to enroll. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st. This may mean that you may have to wait to join a Medicare drug plan and that you may pay a higher premium (a penalty) if you join later. You may pay that higher premium as long as you have Medicare prescription drug coverage. However, if you have creditable prescription drug coverage through no fault of your own, you will be eligible for a sixty (60) day Special Enrollment Period because you lost creditable coverage to join a Part D plan. In addition, if you lose or decide to leave Home Depot coverage, you will be eligible to join a Part D plan at that time using an Employer Group Special Enrollment Period. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. If you decide to join a Medicare drug plan, your Home Depot coverage will not be affected.
Creditable Coverage Notice

If you elected prescription drug coverage that is listed as Creditable Coverage in the following table, please read this notice carefullyit may contain important information about your eligibility for Medicare prescription drug benefits. Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium if you later decide to enroll in Medicare coverage.
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Medicare Part D
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Your Prescription Drug Coverage: Creditable or Non-Creditable

Plan PPO and Out-of-Area Options Caremark $50 Deductible/Mail Copy Option Caremark $50 Deductible/Coinsurance Option Caremark $100 Deductible/Coinsurance Option California Medical Options Health Net HMOBasic and Standard (California) Kaiser Permanente Basic and Standard HMO Health Net Out-of-Area Plans Salud HMO y mas Hawaii Medical Options HMSA Preferred Provider Plan (Hawaii) HMSA Health Plan Hawaii Plus (Hawaii) Kaiser Permanente HMO HMOs Kaiser HMO Colorado Basic Kaiser HMO Colorado Standard Kaiser HMO Georgia Basic Kaiser HMO Georgia Standard Kaiser HMO Mid-Atl Basic Kaiser HMO Mid-Atl Standard Kaiser HMO Northwest Basic Kaiser HMO Northwest Standard Kaiser HMO Ohio Basic Kaiser HMO Ohio Standard Creditable Non-Creditable
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Medicare Part D
Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan. You should also know that if you drop or lose your coverage with Home Depot and dont enroll in Medicare prescription drug coverage within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to enroll in Medicare prescription drug coverage later. If you go 63 continuous days or longer without prescription drug coverage that's at least as good as Medicare's prescription drug coverage, your monthly premium will go up at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than the base beneficiary premium. You'll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll. For more information about this notice or your current prescription drug coverage Contact the Benefits Choice Center for further information at 1-800-555-4954. NOTE: Youll get this notice each year. You will also receive this notice at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a copy.
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For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is available in the Medicare & You handbook. Youll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. You can also get more information about Medicare prescription drug plans from these places: Visit www.medicare.gov for personalized help Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) Call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048 For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the plans approved by Medicare which offer prescription drug coverage after you first become eligible, you may need to give a copy of this notice when you join to show that you are not required to pay a higher premium amount. You may request another copy of this notice by going to Your Benefits Resources at http://resources.hewitt.com/homedepot. Date: November 1, 2005 The Home Depot Vice PresidentBenefits 2455 Paces Ferry Road, NW Atlanta, GA 30339-4024 1-770-433-8211 (Benefits Department)
Non-Creditable Coverage Notice

If you elected prescription drug coverage that is listed as Non-Creditable Coverage in the preceding table, please read this notice carefullyit may contain important information about your eligibility for Medicare prescription drug benefits.
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Medicare Part D
You might want to consider enrolling in Medicare prescription drug coverage. You can keep your coverage from Home Depot, regardless of whether it is as good as the Medicare drug plan. However, because the coverage you have with the Plans is, on average for all plan participants, NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay, you may pay a higher premium (a penalty) if you later decide to join in a Medicare prescription drug plan. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare and each year from November 15th through December 31st. This may mean that you may have to wait to join a Medicare drug plan and that you may pay a higher premium (a penalty) if you join later. You may pay that higher premium as long as you have Medicare prescription drug coverage. However, if you lose or decide to leave Home Depot coverage, you will be eligible to join a Part D plan at that time using a special enrollment period. You need to make a decision. When you make your decision, you should compare your current coverage, including which drugs are covered with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. If you decide to join a Medicare drug plan, your Home Depot coverage will not be affected. If you enroll in a Medicare drug plan and drop your Home Depot prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back.
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If you dont enroll in Medicare prescription drug coverage when you first become eligible for Medicare and change your mind later, you may pay more. If you enroll after you first become eligible for Medicare, your monthly premium for a Medicare prescription drug plan could be much higher than it would have been if you had enrolled when you first became eligible for Medicare. If you go 63 continuous days or longer without prescription drug coverage that is at least as good as Medicares prescription drug coverage, your premium will go up at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. You will have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. For example, if you go 19 months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium. In addition, you may have to wait until the following November to join. For more information about this notice or your current prescription drug coverage Contact the Benefits Choice Center for further information at 1-800-555-4954. NOTE: Youll get this notice each year. You may receive this notice at other times in the future, such before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Home Depot changes. You also may request a copy.
For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage will be available in the Medicare & You handbook from Medicare. You may also be contacted directly by Medicareapproved prescription drug plans. Youll get a copy of the handbook in the mail. You can also get more information about Medicare prescription drug plans from these places: Visit www.medicare.gov for personalized help Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) Call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048 For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). You may request another copy of this notice by going to Your Benefits Resources at http://resources.hewitt.com/homedepot. Date: November 1, 2005 The Home Depot Vice PresidentBenefits 2455 Paces Ferry Road, NW Atlanta, GA 30339-4024 1-770-433-8211 (Benefits Department)
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HIPAA Notice
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The Home Depot Health Benefits Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
En espaol: Este documento es una actualizacin del libro de Resumen de Beneficios que usted recibi anteriormente. Si usted tiene dificultad en entender cualquier parte de este documento, llame al 1-800-555-4954. Seleccione la opcin que le permita hablar en espaol; luego seleccione la opcin para asociados de Puerto Rico. Su llamada ser transferida a un representante que habla espaol. Los representantes estn disponibles de lunes a viernes, 8:00 A.M.5:00 P.M. (Hora Estndar del Atlntico). You and your eligible dependents receive group health benefits, that include medical, dental, prescription drug, vision and health care spending account benefits through group health plans (collectively, the Plan) offered by Home Depot U.S.A., Inc. and its participating subsidiaries (the Plan Sponsor). The Plan uses and discloses personally identifiable health information about you and other participants in the Plan (Participants). This personal information is referred to as protected health information (PHI). The Plan is required by law to protect the privacy of your PHI. As required by law, this provides you with notice of the Plans legal duties, its use and disclosure of PHI, your privacy rights, your right to file a complaint and whom to contact for additional information. It does not address medical information from your disability, workers compensation or life insurance programs, or any other health information not created or received by the Plan. These privacy practices may not be the same as those adopted by your health care providers or insurers. Please check with your providers or insurers if you would like to understand their privacy practices. For Health Care Operations. The Plan may use and disclose PHI as part of its general business operations as a group health plan. For example, the Plan may disclose PHI to assess the overall performance of the Plans, to audit claims processing and payment activities, for legal services, for premium rating and for medical reviews. The Plan will use and disclose your PHI for the management and administrative activities of the Plan.
Uses and Disclosures for Treatment, Payment and Health Care Operations
The Plan may use, disclose or share between the plans and benefits listed above your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining a specific written permission from you, known as an authorization. For Treatment. The Plan may use and disclose PHI as needed for the treatment of Participants. For example, PHI may be used and disclosed to coordinate and manage the activities of different health care providers who provide you with health care services covered under the Plan. For Payment. The Plan may use and disclose your PHI as part of activities related to the Plans payment for health care services. For example, the Plan may disclose your PHI to a doctor or hospital that calls to find out if you are eligible for coverage under the Plans. The Plan also will disclose your PHI to third parties, including third-party administrators and insurers hired by the Plan to make health benefit coverage determinations, to pay health care providers, to determine subrogation rights and coordinate benefits. 345
Other Uses and Disclosures For Which Authorization is Not Required

In addition, the Plan may use and disclose PHI without your written authorization: As Required by Law. The Plan may use or disclose PHI when required to do so by law.
HIPAA Notice
As Required for Judicial or Law Enforcement Purposes. The Plan may disclose PHI in a judicial or administrative proceeding and in response to a subpoena or other legal process (in certain circumstances), if the Plan is assured that the requesting party has made a good faith attempt to provide written notice of such disclosure to you. The Plan may also disclose your PHI for law enforcement purposes, such as reporting certain types of wounds, identifying or locating a suspect, fugitive, material witness or missing person. Except as otherwise required by law or in the case of an emergency, the Plan will disclose PHI about a Participant who may be a victim of a crime only if that individual agrees to the disclosure. For Public Health Activities and Public Health Risks. The Plan may disclose PHI to a public health authority in charge of collecting information, such as about births and deaths, injury, preventing and controlling disease, reports of child abuse or neglect, reactions to medications or product defects or problems or to notify a person who may be at risk for contracting or spreading a communicable disease. The Plan may disclose PHI about an individual whom the Plan reasonably believes to be a victim of abuse, neglect or domestic violence if required by law to report such information, if the victim agrees to such disclosure, or the Plan believes disclosure is necessary to prevent serious harm and the victim is unable to consent due to incapacity.
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For Health Oversight Activities. The Plan may disclose PHI to the government for oversight activities, such as audits, investigations, inspections, licensure or disciplinary actions, and other activities for monitoring the health care system, government programs, and compliance with civil rights laws. Coroners, Medical Examiners and Funeral Directors. The Plan may disclose PHI to coroners, medical examiners and funeral directors for the purpose of identifying a decedent, determining a cause of death or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law. Organ, Eye and Tissue Donation. The Plan may release PHI to organ procurement organizations to facilitate organ, eye and tissue donation and transplantation. Research. The Plan may use and disclose PHI for medical research purposes, subject to protections of your privacy. To Avoid a Serious Threat to Health or Safety. The Plan may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.
Specialized Government Functions. The Plan may use and disclose PHI of military personnel and veterans under certain circumstances. The Plan may also disclose PHI to authorized federal officials for intelligence, counterintelligence, other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations. Workers Compensation. The Plan may disclose PHI to comply with workers compensation or other similar laws that provide benefits for work-related injuries or illnesses. Health-related Benefits and Services. The Plan may use and disclose your PHI to inform you of treatment alternatives or other health-related benefits and services covered under the Plan or available to Participants; to inform you regarding the health care providers participating in the Plans networks; to inform you about replacement of or enhancement to the Plan; and to inform you of other similar matters that may be of interest to you, such as disease management programs. The Plan may use and disclose your PHI to encourage you to purchase or use a product or service through a face-to-face communication or by giving you a promotional gift of nominal value.
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HIPAA Notice
Disclosures to Plan Sponsor. The Plan may disclose your PHI to the Plan Sponsor and business associates, and may permit insurance companies that provide benefits under the Plan to disclose your PHI to the Plan Sponsor and business associates in accordance with its privacy policies. The Plan Sponsor has put protections in place to assure that the information will only be used for plan administration purposes and never for employment purposes. Disclosures to You or for HIPAA Compliance Investigations. The Plan may disclose your PHI to you or your authorized representative, and is required to do so in certain circumstances in connection with your rights of access to and an accounting of certain disclosures of your PHI. The Plan also must disclose your PHI to the Secretary of the United States Department of Health and Human Services (the Secretary") when requested by the Secretary to investigate Plans compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).
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Uses and Disclosures to Which You Have an Opportunity to Object

Unless you object, the Plan may disclose your PHI to a family member, other relative, friend or other person you identify as involved in your health care or payment for your health care. The Plan may also notify those people about your location or condition. In some circumstances, the Plan may make the disclosures identified in this paragraph without first giving you an opportunity to agree or object, such as in an emergency.
Regulatory Requirements
The Plan is required by law to maintain the privacy of your PHI, to provide individuals with notice of its legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice. The Plan reserves the right to change the terms of this Notice and its privacy policies, and to make the new terms applicable to all of the PHI it maintains. The Plan will revise this Notice and post a new Notice promptly after making an important change to its privacy policies. You have the following rights regarding your PHI: Restrictions. You may request that the Plan restrict the use and disclosure of your PHI. The Plan is not required to agree to any restrictions you request, but if the Plan does so it will be bound by the restrictions to which it agrees except in emergency situations. Confidential Communications. You have the right to request that communications of PHI to you from Plan be made by particular means or at particular locations. For instance, you might request that communications be made at your work address, or by email rather than regular mail. Your requests must be made in writing. The Plan will accommodate your reasonable requests.
Other Uses and Disclosures of PHI For Which Authorization is Required

Except as otherwise provided in this notice, all other types of uses and disclosures of your PHI will be made only with your written authorization, which you may revoke in writing at any time. Upon receipt of the written revocation of authorization, the Plan will stop using or disclosing your PHI, except to the extent necessary because the Plan has already taken action in reliance on the authorization.
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HIPAA Notice
Right to Inspect. Generally, you have the right to inspect and copy your PHI that the Plan maintains in a designated record set by making the request in writing. The Plan may deny your request to inspect and copy in certain circumstances. Within thirty (30) days of receiving your request (unless extended by an additional thirty (30) days), the Plan will inform you of the extent to which your request has or has not been granted. In some cases, the Plan may provide you a summary of the PHI you request if you agree in advance to such a summary and any associated fees. If you request copies of your PHI or agree to a summary of your PHI, the Plan may impose a reasonable fee to cover copying, postage and related costs. If the Plan denies access to your PHI, it will explain the basis for denial and whether or not you have an opportunity to have your request and the denial reviewed. Right to Amend. If you believe that your PHI maintained by the Plan contains an error or needs to be updated, you have the right to request that the Plan correct or supplement your PHI. Your request must explain why you are requesting an amendment to your PHI. Within 60 days of receiving your request (unless extended by an additional 30 days), Plan will inform you of the extent to which your request has or has not been granted. If your request is denied, the Plan will provide you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) if you do not file a statement of disagreement, submit a request that any future disclosures of the relevant PHI be made with a copy of your request and the Plans denial attached; and (iii) complain about the denial.
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Right to an Accounting. You generally have the right to request and receive a list of the disclosures of your PHI that the Plan has made at any time during the 6 years prior to the date of your request (but not before April 14, 2003). The list will not include disclosure for which you have provided a written authorization, and does not include certain uses and disclosures to which this Notice already applies, such as those: (i) for treatment, payment, and health care operations; (ii) made to you; (iii) to persons involved in your health care; (iv) for national security or intelligence purposes; or (v) to correctional institutions or law enforcement officials. Within 60 days of receiving your written request (unless extended by an additional 30 days), the Plan will either provide you with the accounting or notice of the denial of your request. The Plan will provide the list to you at no charge, but if you make more than one request in a year there may be a charge for each additional request. Right to Paper Copy. You have the right to receive a paper copy of this notice upon request, even if you have agreed to receive this notice electronically. If you believe your privacy rights with respect to your PHI have been violated, you may complain to the Plan by contacting the individual designated below and submitting a written complaint. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services. The Plan will in no manner penalize you or retaliate against you for filing a complaint regarding Plans privacy practices.
Contact Person
Complaints, submissions required to be in writing, inquiries and questions with respect to your privacy rights should be directed to: DirectorCorporate Compliance Privacy Officer The Home Depot 2455 Paces Ferry Road, NW, C-10 Atlanta, Georgia 30339-4024 For questions about the Notice of Privacy Practices or the Companys privacy rules, contact: Vice PresidentBenefits The Home Depot Benefits Department, C-18 2455 Paces Ferry Road, NW Atlanta, Georgia 30339-4024 Effective Date: April 14, 2003
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2011 Benefits Contact List

Phone Number General Assistance Benefits Choice Center: Benefits questions & enrollment HR Services:HR/Pay questions Aetna Choice POS II, HDHP, 24/7 Nurse Line Anthem Blue Cross Blue Shield CVS Caremark California Medical Plan Providers Health Net Kaiser Permanente Hawaii Medical Plan Providers HMSA Kaiser Permanente HMO 1-808-948-6111 1-800-847-3991 1-800-464-4000 1-800-555-4954
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Internet Address Your Benefits Resources http://resources.hewitt.com/homedepot
1-866-myTHDHR (1-866-698-4347) www.myTHDHR.com 1-800-695-9744 1-877-434-2734 1-866-490-3376 www.livetheorangelife.com www.livetheorangelife.com www.caremark.com www.healthnet.com/homedepot http://my.kp.org/homedepot www.hmsa.com
U.S. Full-Time Hourly/Salaried Medical and Prescription Drug Plan Providers
1-808-432-5955 Oahu; http://my.kp.org/homedepot 1-800-966-5955 Neighbor Islands
U.S. Full-Time Hourly/Salaried HMO Medical Plan Providers Kaiser PermanenteColorado Kaiser PermanenteGeorgia Kaiser PermanenteMid-Atlantic Kaiser PermanenteNorthwest Kaiser PermanenteOhio U.S. Full-Time Hourly/Salaried Health Savings Account PayFlex Aetna/SRC Critical Illness Protection Plan Provider Allstate Workplace Division 1-866-828-8766 www.allstateatwork.com/homedepot 1-800-506-9157 1-800-508-4015 https://homedepot.healthhub.com www.livetheorangelife.com U.S. Part-Time Medical and Hospital Indemnity Plan Provider 1-800-632-9700 1-888-865-5813 1-800-777-7902 1-800-813-2000 1-800-524-7377 http://my.kp.org/homedepot http://my.kp.org/homedepot http://my.kp.org/homedepot http://my.kp.org/homedepot http://my.kp.org/homedepot
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2011 Benefits Contact List (continued)

Phone Number Dental Care Plan Provider MetLife Vision Care Plan Provider EyeMed Vision Care Your Spending Accounts (YSA) Minnesota Life U.S. Full-Time Hourly/Salaried Disability Liberty Mutual U.S. Part-Time Hourly Life Insurance and Disability Aetna SRC To Learn About... Associate Discounts Best Doctors CARE/Solutions for Life CareerDepot ESPP (Employee Stock Purchase Plan) Foot Orthotics Discount Program Health Advocate The Home Depot Awareness Line: Report workplace concerns The Homer Fund (An independent public charity) Matching Gift (A program of The Home Depot Foundation) Merrill Lynch Quit for Life (Quit Tobacco Program) 1-800-843-2150 1-877-442-6437 1-800-519-6689 1-800-286-4909 1-770-433-8211 Ext. 12611 1-888-628-2442 1-800-843-2150 1-866-784-8454 1-866-904-0910 1-800-553-3504 1-800-508-4015 1-888-404-5096 1-888-203-7447 1-800-555-4954 1-888-254-1324 1-800-638-9909
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Internet Address www.metlife.com/dental or go to Your Benefits Resources for single sign-on www.eyemedvisioncare.com Your Benefits Resources http://resources.hewitt.com/homedepot Your Benefits Resources http://resources.hewitt.com/homedepot Your Benefits Resources http://resources.hewitt.com/homedepot Your Benefits Resources http://resources.hewitt.com/homedepot http://resources.hewitt.com/homedepot and select the Associate Discounts tab www.caresolutionsforlife.com https://careers.homedepot.com/cg www-us.computershare.com/employee; To enroll: http://resources.hewitt.com/homedepot http://hanger.com/patientcarecenters
U.S. Full-Time Hourly/Salaried Flexible Spending Accounts U.S. Full-Time Hourly/Salaried Life Insurance/Accidental Dismemberment
www.thdhomerfund.org www.givingprograms.com/homedepot www.bol.ml.com www.quitnow.net/homedepot
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Your Health Care Benet Biweekly Payroll Deductions for 2011
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Associate Associate Associate Associate Only + Spouse + Child(ren) + Family Non-CA Full-time Hourly and Salaried AssociatesMedical & Rx Coverage1 Medical PPO Plan Options $550 Deductible 2 $92.75 $241.00 $169.50 $280.00 $750 Deductible 2 $80.75 $217.00 $146.50 $246.50 $1,000 Deductible 2 $75.25 $205.50 $135.75 $230.75 Prescription Drug Options (if PPO is elected) Caremark $50 Deductible/Mail Copay $13.25 $27.00 $22.25 $41.75 Caremark $50 Deductible/Coinsurance $9.75 $19.75 $15.75 $31.25 Caremark $100 Deductible/Coinsurance $5.75 $12.25 $8.50 $19.50 Kaiser HMO Plan Options (GA, Northwest, CO, Mid-Atl, OH) Basic HMO $79.25 $215.25 $144.50 $245.25 Standard HMO $98.25 $252.50 $178.00 $299.50 High Deductible Health Plan (HDHP) Options + Health Savings Account (HSA) Aetna HDHP3 $74.25 $204.25 $132.00 $230.00 California Full-time Hourly and Salaried AssociatesMedical Coverage1 HMO Plan Options Health Net Basic HMO $88.00 $233.75 $164.75 $262.50 Kaiser Basic HMO $81.25 $212.75 $148.25 $237.75 Health Net Standard HMO $100.50 $260.00 $185.00 $302.50 Kaiser Standard HMO $92.25 $235.50 $165.75 $272.75 Health Net Salud HMO y ms $75.75 $201.25 $138.00 $221.00 Non-HI Full-time Hourly and Salaried AssociatesValuable Healthy Living Credits Tobacco-Free Credit +$10.00 +$20.00 +$10.00 +$20.00 Health Assessment & Hidden Health +$25.00 +$50.00 +$25.00 +$50.00 Risk Screening Credit 4 Non-HI Part-time Hourly AssociatesLimited Medical & Rx Coverage and Hospital Indemnity Plan Medical & Rx Options Aetna/SRC $10,000 Max $59.52 $118.98 $107.10 $190.38 Aetna/SRC $20,000 Max $82.80 $165.60 $149.04 $264.96 Hospital Indemnity Plan5 Coverage $6.90 $13.80 $11.28 $20.04
1 2 3 4
Associate Associate Associate Associate Only + Spouse + Child(ren) + Family Hawaii Full-time Hourly and Salaried Associates and DependentsMedical Coverage Medical Plan Options HMSA PPO $9.60 $174.00 $137.25 $220.75 HMSA HMO $9.60 $172.00 $135.75 $218.50 Kaiser HMO $9.60 $149.00 $117.50 $189.00 Hawaii Part-time Hourly AssociatesMedical Coverage Medical Plan Options for Associates Only HMSA PPO $4.80 n/a n/a n/a HMSA HMO $4.80 n/a n/a n/a Kaiser HMO $4.80 n/a n/a n/a Dependents of Part-time Hourly AssociatesLimited Medical & Rx Coverage and Hospital Indemnity Plan5 Medical Plan Options for Dependents of Part-time Hourly AssociatesLimited Medical & Rx Coverage Aetna/SRC $10,000 Max n/a $59.52 $59.52 $107.10 Aetna/SRC $20,000 Max n/a $82.80 $82.80 $149.04 Hospital Indemnity Plan5 Coverage n/a $6.90 $6.90 $11.28 All AssociatesDental & Vision Coverage Dental Options MetLife $500 Annual Maximum $5.52 $11.03 $11.16 $16.75 MetLife $1,000 Annual Maximum $11.50 $23.00 $23.28 $34.92 MetLife $2,000 Annual Maximum $14.26 $28.51 $28.86 $43.30 Vision Options EyeMed Select $120 $2.08 $3.64 $3.78 $6.32 EyeMed Select $150 $4.96 $8.87 $9.30 $14.59
Associates covering 3 or more children under the full-time hourly or salaried Home Depot medical plan will pay an additional $25 per biweekly pay period. A separate prescription drug election is required if you elect a PPO medical option. The Company will match an associates HSA contribution up to $100 for associate-only coverage (up to $200 if covering dependents). Associate must be covered under a full-time hourly or salaried Home Depot medical plan, complete the Health Assessment, and elect to complete the yearly Screening to receive the Health Assessment & Hidden Health Risk Screening Credit. A covered spouse or same-sex domestic partner will not be required to complete the screening but will be required to complete the Health Assessment to receive the credit. The Hospital Indemnity Plan is NOT a traditional medical plan but will provide some limited assistance with hospitalization costs.
For weekly rates, take the biweekly rates above, multiply by 26, then divide by 52. In some instances your paycheck may not be enough to cover the entire amount of your benefits premiums. In those cases, the amount of the premium above your paycheck is still owed and will be collected from your future paychecks.
For all other benefit premiums including the Critical Illness Protection Plan and Spending Account Information, ]log on to Your Benefits Resources at http://resources.hewitt.com/homedepot or call the Benefits Choice Center at 1-800-555-4954.
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Your Benets Resources Web site

Available 24 hours a day, 7 days a week, from any computer with Internet access Get information about your benefit plans and check your benefit coverage Change your coverage if you marry, divorce, have a baby or adopt a child Enroll in benefits during your eligibility period as a new associate or during Annual Enrollment Enroll in FutureBuilder and access your account
Creating your benets password

The first time you log on to the Your Benefits Resources Web site or call the Benefits Choice Center, youll create a password. Youll use this password each time you call or access the Web site. This is not the password or PIN printed on your paycheck.
What if you forget your password?

If you use the Your Benefits Resources Web site, you can enter a hint when creating the password to help you remember your password later. You can speak to a Benefits Choice Center representative and reset your password immediately by providing the identification information above. You can use the Your Benefits Resources Web site and the automated telephone system to request a new password. You will receive a temporary password in the mail within 710 days. Your password prevents unauthorized people from accessing or changing your benefits, including your FutureBuilder account contribution elections and investments. In order to ensure your privacy, be sure to keep your password in a safe place, and do not share your password with anyone.
Your password
Can contain numbers, letters or both Can be between 4 and 20 characters long Can be the same as your paycheck PIN When creating your password, you will be asked to provide the following identification information for security purposes: Social Security number, birth date, home ZIP code and date of hire.
Log onto Your Benefits Resources at www.livetheorangelife.com
The purpose of this book, called the Summary Plan Description (SPD), is to describe and explain benefit plans available to salaried and full-time hourly associates working in the United States of America. The SPD is intended only to help you understand the benefit plans available to you and can in no way modify the actual terms and provisions as specified in the legal documents that define the benefit plans. If there are differences between the information contained in the SPD and the provisions of the legal documents, the legal documents always govern. Legal documents include the Plan document, trust agreements, and insurance contracts.You may request a copy of these legal documents by writing to The Home Depot, Benefits Department C-18, 2455 Paces Ferry Road, Atlanta, GA 30339.
Benefits are provided to associates and their eligible dependents based on information the Company may request over the phone, in writing or online. The Company may ask you to provide original documentation for the purpose of verification before granting benefits. The Company may also ask you to sign a release authorizing the Company to solicit the required documentation and/or information from a designated third party. Providing false information may result in exclusion from (i.e., loss of eligibility for) all Company-sponsored welfare benefit plans and/or disciplinary action against you in accordance with the Companys Code of Conduct.
2011 Homer TLC, Inc. All rights reserved. Your Benefits Resources is a trademark of Hewitt Management Company LLC.
Confidential and Proprietary
This is an unpublished work containing confidential and proprietary information of The Home Depot. All rights reserved.
U.S. SALARIED & FULL-TIME HOURLY ASSOCIATES HD FTS 2011

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2011 Benets Summary

for U.S. Salaried and Full-Time Hourly Associates

No habla o lee ingls?

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

10 Change of Employment Status 11 Military Leave 12 Leaves of Absence

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Same-sex Domestic Partner Life Events

U.S. Salaried & Full-Time Hourly Associates

To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Health Care Spending Account

Dependent Day Care Spending Account

Can start or increase contributions

Can start or increase contributions

You wish to drop coverage

Documentation verifying the dependency or status change.

Date of marriage or date new coverage gained, whichever is later

Documentation verifying the dependency or status change.

Can add or increase coverage for self and/or children

U.S. Salaried & Full-Time Hourly Associates

To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Health Care Spending Account

Dependent Day Care Spending Account

Can stop or decrease contributions

U.S. Salaried & Full-Time Hourly Associates

To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Health Care Spending Account

Dependent Day Care Spending Account

Drop affected child only

Date coverage ends with other employer

U.S. Salaried & Full-Time Hourly Associates

To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Health Care Spending Account

Dependent Day Care Spending Account

Address must be updated in payroll system

Your move to a new ZIP code

Can increase, start, decrease or stop contributions

Documentation verifying the dependency or status change.

Effective date of coverage gained

Can stop or decrease contributions

Can drop or decrease coverage for self, spouse and/or children

Effective date of coverage lost

Can start or increase contributions

Date coverage begins with other employer

U.S. Salaried & Full-Time Hourly Associates

To enroll, go to www.livetheorangelife.com; for help, call 1-800-555-4954

MAIN MENU for BENEfITS SUMMARy

MAIN MENU for THIS CHApTER

Health Care Spending Account

Dependent Day Care Spending Account