Deere & Company Retiree Medical Credit Account

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1 Welcome Packet Instructions for using your Deere & Company Retiree Medical Credit Account Expenses Eligible for Reimbursement from your Retiree Medical Credit Account Instructions for Requesting Reimbursement Reimbursement Options Retiree Account Balance Information GDI Resources

2 Expenses Eligible for Reimbursement from Your Retiree Medical Credit Account The list below includes generally eligible IRS Code Section 213 expenses. Items marked with a * require a copy of a current prescription (written on a prescription pad). The prescription must be submitted each time a request for reimbursement is submitted for these items. Premiums: Medicare Supplement Plans Prescription Drug Plans Vision or Dental Plans Medicare Part B Long-term Care Insurance Post-tax contributions for other employers group health, dental and vision plans First aid Kit Gauze pads Guide dog or other animal used by a person with a physical disability Hearing aids/batteries Hemorrhoid medications * Herbs* Hospital fees Pain relief medications * Physical exams Physical therapy Prescription drugs Prosthetics Psychiatric care Psychoanalysis Psychological treatment Reading glasses Rubbing Alcohol * Qualified Medical Expenses: Acupuncture Alcoholism treatment program fees Allergy medicine * Ambulance service Antacids * Anti-Diarrhea medicine * Artificial limbs Bandages Braille books and magazines (above the cost of regular print) Car Modifications for equipment installed for the use of a person with a disability Chiropractic care Co-insurance charges Co-payments Cold medicine * Cold/Hot packs for injuries Contact lenses (including cleanser and saline solution) Cough drops* Crutches Deductible expenses Dental expenses (non-cosmetic services only) Dentures Diabetic supplies Dietary Supplements * Drug addiction treatment at a therapeutic center Eye drops * Eye exams Eyeglasses Immunizations Incontinence supplies Insulin Lasik Surgery Laboratory fees Laxatives * Massage therapy (only if prescribed by a physician for a specific diagnosis and provided by a licensed massage therapist) Medical services provided by physicians, surgeons, and specialists (non-cosmetic services only) Mileage related specifically to transportation to/from an eligible medical appointment Motion-sickness medications * Nasal Spray * Nicotine gum or patches * Ointments for muscle or joint pain or for first aid purposes * Optical care provided by Optometrists, Ophthalmologists or Opticians Organ transplants Orthodontics Orthotic inserts Osteopathic treatment Oxygen Sales tax payable for eligible services or items Sinus medicines * Smoking cessation programs Suppositories * Therapy (speech, physical, occupational) Thermometers Vaccines Vitamins * Wheelchair costs X-rays IRS REQUIREMENTS The IRS requires individuals to provide itemized receipts and a signed reimbursement form in order to receive reimbursement for eligible expenses from the plan. Automatic Premium Reimbursements: The IRS requirement for verification of premiums has been streamlined for your convenience. GDI and AFI Benefits have a partnership arrangement for those verifications to be sent from AFI Benefits directly to GDI eliminating your need to provide those verifications.

3 INSTRUCTIONS FOR REQUESTING REIMBURSEMENT You have the following two (2) options to request reimbursement from your Retiree Medical Credit Account. It is your responsibility to pay your insurance premiums, medical providers and pharmacies. You should retain copies of forms and accompanying documentation for your records. 1. AUTOMATIC PREMIUM REIMBURSEMENT* Automatic premium reimbursement allows you to have eligible insurance premiums purchased through AFI Benefits and Medicare Part B premiums reimbursed to you automatically; no further reimbursement forms are required for your premiums unless you cancel or change your insurance coverage. This form may also be completed electronically at *Note: The Automatic Premium Reimbursement option is only available for supplemental coverage purchased through AFI Benefits, or for Medicare Part B. Any other premium reimbursements must be submitted via the Manual Reimbursement option below. HOW TO ENROLL: You may enroll using the Automatic Premium Reimbursement Form (Form 1) at any time following your enrollment with AFI Benefits. WHEN TO EXPECT PAYMENT: Automatic premium reimbursements will occur no later than the 15th of each month. 2. MANUAL REIMBURSEMENT You may manually request reimbursement of eligible premium expenses not being paid through the Automatic Reimbursement option explained above and for other expenses listed on the Expenses Eligible for Reimbursement from Your Retiree Medical Credit Account list. This form may also be completed electronically at HOW TO REQUEST REIMBURSEMENT: To receive reimbursement for eligible medical and premium expenses using the Manual Reimbursement option, please submit a Manual Reimbursement Form (Form 2). Instructions are on the back of the form. WHEN TO EXPECT PAYMENT: GDI will process your manual reimbursement requests every Friday for requests received by noon (Eastern Time) on Wednesday of the same week. Requests received after noon (Eastern Time) on Wednesday will be processed the following week. Additional forms may be printed from or by calling the GDI Retiree Service Center at , Monday through Friday, 8 AM - 5 PM ET. You may also request forms by sending an to: retiree@gdynamic.com.

4 REIMBURSEMENT OPTIONS DIRECT DEPOSIT: GDI has the ability to deposit reimbursement payments directly to your bank account. If you would like to set up Direct Deposit, please complete the Authorization for Direct Deposit Form (Form 3) included in this Welcome Packet or enroll in this option on-line. PAPER CHECK: You will be reimbursed by paper check unless you enroll in the Direct Deposit option listed above. Retiree Account Balance Information To review your reimbursements and transactions, you may go online to Please refer to the Website Navigator for Retirees in this packet for instructions on how to access your account online. GDI will also issue a statement to you two times per year: June and October. You may also request your account balance by sending an to: retiree@gdynamic.com. If you do not have access to the internet or prefer to speak to someone in person, please call the GDI Retiree Service Center at , Monday through Friday, 8 AM - 5 PM ET. GDI RESOURCES TOLL FREE: FAX: POSTAL MAIL: WEB ACCESS: Retiree Service Center Monday through Friday, 8:00 AM - 5:00 PM Eastern Time You may leave a message during non-business hours. Calls will be returned the next business day (toll free) Faxes may be sent 24 hours a day, 7 days per week. retiree@gdynamic.com All s will be responded to within 2 business days. Attn: Retiree Benefits Group Dynamic, Inc. 411 US Route One, Falmouth, Maine To view your account: Select Click here to access your account Please refer to the Website Navigator for Retirees in this packet for instructions on how to access your account online.

5 Q Questions & A & Answers RETIREE MEDICAL CREDIT ACCOUNT BALANCE: How can I find out the balance in my RMC account? You may view your account online by logging into your account at If you do not have access to the Internet or prefer to speak to someone in person, please call the GDI Retiree Service Center at Additionally, GDI will mail an account statement to you in June and October of each year. REMAINING CREDITS: What happens to remaining Retiree Medical Credits in my account at the end of the year? If you have credits remaining at the end of the year, those credits will roll over to be used for future eligible health care premiums and expenses. REIMBURSEMENT REQUESTS: What is the timeframe for submitting reimbursement requests? The deadline for submitting reimbursement requests is December 31st of the next calendar year following the date of service. Example: For charges incurred 8/15/17, the deadline to submit for reimbursement is 12/31/18. RETIREE MEDICAL CREDIT ACCOUNT: What should I do if my RMC amount is incorrect? Please contact the GDI Retiree Service Center at GDI will work with John Deere to resolve any credit balance issues. RETIREE MEDICAL CREDIT ACCOUNT: How will I know how many credits I will receive in successive years? Like all health benefits, Retiree Medical Credits will be reviewed each year and are subject to change. You will be notified by John Deere once those amounts have been determined. LOST CHECK: What should I do if I lose my check? If you lose a reimbursement check, call the GDI Retiree Service Center immediately at Monday through Friday, 8 AM - 5 PM ET. If your call is during non-business hours, please leave a message and a representative will call you on the next business day. Note: GDI must wait 10 business days before replacing your lost check. To avoid lost or stolen checks, we recommend that you sign up for Direct Deposit to have your payments deposited directly into your bank account (see below). DIRECT DEPOSIT: How do I sign up for Direct Deposit? You can choose to have your reimbursements deposited directly into your bank account. Signing up for direct deposit on the Participant Portal is simple. See the Account Access section of the Website Navigator for Retirees in this packet for more information. If you do not have internet access, you can complete Form 3 - Authorization for Direct Deposit. MEDICAL EXPENSES: How do I submit a request for reimbursement? Complete a Manual Reimbursement Form (Form 2). Send your form and copies of itemized receipts to GDI by mail, fax or . You must send this form with your receipts each time you submit a request for reimbursement. You may include more than one expense with each request. MEDICAL EXPENSES: How do I inquire about reimbursement requests submitted? Log into your account at You can view your claim payments and account status online. If you do not have access to the internet or if you prefer to speak to someone in person, please call the GDI Retiree Service Center at Monday through Friday, 8 AM - 5 PM ET.

6 Q Questions & A & Answers MEDICAL EXPENSES: What medical expenses are eligible for reimbursement? Please refer to the enclosed Expenses Eligible for Reimbursement from your Retiree Medical Credit Account in this Welcome Packet. For additional copies, please visit or contact the GDI Retiree Service Center at Monday through Friday, 8 AM - 5 PM ET. INELIGIBLE MEDICAL EXPENSES: What if I inadvertently submit claims for reimbursement of expenses that are not considered eligible medical expenses? If GDI determines that an expense is not eligible for reimbursement, you will receive an notification or a letter in the mail notifying you that the claim was denied and what, if anything, you can provide to facilitate payment of the claim. CONTACT: For what type of issues do I contact the GDI Retiree Service Center? Please contact the Retiree Service Center with any questions, issues or information related to your Retiree Medical Credit Account; including payments, balances and claim information. PREMIUM REIMBURSEMENT: How do I submit a request for reimbursement of premiums? You may use one of the following options to submit a request: Automatic Premium Reimbursement: Complete the Automatic Premium Reimbursement Form (Form 1) and return it to GDI. This form will only need to be completed annually unless you make changes. This option currently can only be used for Medicare B premiums and insurance purchased through AFI Benefits. Manual Reimbursement: Complete the Insurance Premiums section of the Manual Reimbursement Form per the instructions on the back of the form (Form 2). Coverage under my spouse s plan: I am going to join my spouse on his/her group health plan. Can I be reimbursed for this coverage? Yes, provided that the coverage is not being paid for with pre-tax salary contributions. Complete the Insurance Premiums section of the Manual Reimbursement Form (Form 2). Please submit documentation that clearly indicates that the contribution was made on a post-tax basis. PREPAYMENT OF ANNUAL PREMIUM: If my insurance company allows prepayment for the full annual premium, can I submit that full year cost for reimbursement? Yes. To do so, you will need to complete and submit a Manual Reimbursement Form per the instructions on the back of the form (Form 2). MEDICARE PART D: What responsibilities do I have for my Medicare Part D prescription drug expenses? You must maintain records of all prescription drug expenses including prescriptions reimbursed from your Deere & Company Retiree Medical Credit Account. Information regarding Medicare Part D reporting requirements can be found at or from your Personal Benefits Specialist at AFI Benefits at CHANGES: If I change my address (or have other types of changes), do I need to notify John Deere, AFI Benefits and GDI? No. You only need to notify Deere Direct at who will update their records and transmit this information to AFI Benefits and GDI.