HEALTHIER TOGETHER PLAN TABLE OF CONTENTS

Transcription

1 Healthier Together Plan January 1, 2016

2 HEALTHIER TOGETHER PLAN TABLE OF CONTENTS Healthier Together Plan Highlights... 1 Introduction... 2 Who Is Eligible?... 2 How Do I Enroll?... 2 How Does Plan Coverage Work?... 3 Can I use the Plan to Save Money on Premiums under the Medtronic Medical Plan?... 3 Who Pays For My Coverage?... 3 How Will My Part-Time Status Affect My Eligibility?... 4 What Happens If I Become Disabled?... 4 What If I Want To Cancel My Healthier Together Coverage?... 4 What Happens If I Die, Can My Dependents Continue Healthier Together Coverage?... 4 When Does My Healthier Together Coverage End?... 4 How Do I Make a Claim?... 4 What If a Claim of Mine is Denied?... 5 Statute of Limitations/Lawsuits... 5 Cobra Notice... 5 Administrative Information... 8 Your ERISA Rights... 9 Uses And Disclosures Of Your Protected Health Information... 9 Assistance With Your Questions Termination Of The Plan Interpretation Of The Plan The following information pertains to your coverage under the Medtronic Healthier Together Plan, effective as of January 1, This document serves as the Summary Plan Description for the Healthier Together component of the Medtronic Group Insurance Plan. i

3 HEALTHIER TOGETHER PLAN HIGHLIGHTS Who is eligible for the Healthier Together Plan? In general, you are eligible for wellness coverage under the Healthier Together Plan if you are currently employed by Medtronic, Inc. and regularly scheduled to work at least 20 hours per week. The Plan allows you to earn Recognize! points by participating in various wellness activities. Your covered spouse or grandfathered domestic partner is also eligible to participate in wellness activities and can help you earn additional Recognize! points for your account. Your dependents, other than your spouse or grandfathered domestic partner, are not eligible for the Healthier Together Plan. Your domestic partner is a grandfathered domestic partner if you and your partner submitted an affidavit that was approved before December 31, How do I begin participating in the Healthier Together Plan? You begin participating in the Healthier Together Plan once you begin participating in any component of the Plan. For the Wellness Screening, you become a participant when you register for the screening. When your spouse or grandfathered domestic partner registers they also are electing to participate in the Plan. How are Healthier Together Plan benefits funded? Medtronic pays the entire cost of the Plan. If you terminate employment, you will be required to contribute to the cost of continuing coverage under the Healthier Together Plan if you elect to continue coverage through COBRA. What if I do not want to participate in the Healthier Together Plan? If you do not want to participate in the Healthier Together Plan, you do not have to sign up. If I participate in the Healthier Together Plan, can I save money on my premium for the Medtronic Medical Plan? Yes. If you are covered by the Medtronic Medical Plan, you will save on your premium for 2017 if you participate in the Healthier Together Plan and earn at least 25 points during If your spouse or grandfathered domestic partner is also covered by the Medtronic Medical Plan, then you and your spouse or grandfathered domestic partner must each earn at least 25 points during If you and (if applicable) your spouse or grandfathered domestic partner do not each earn at least 25 points during 2016, your 2017 premium for the Medtronic Medical Plan will include a $50 per month surcharge. What happens if I die, can my eligible spouse or grandfathered domestic partner continue participating in the Healthier Together Plan? Yes, your eligible spouse or grandfathered domestic partner can continue his or her available Healthier Together coverage through continuation coverage. 1

4 INTRODUCTION The company provides wellness coverage under the Healthier Together Plan (hereinafter referred to as the Plan ) to assist you in evaluating and taking steps to improve your current health and wellness. The Plan is an important part of your overall wellness program. If you meet the eligibility criteria described below, Medtronic will pay for your coverage under the Plan. This summary provides general information about the Plan, such as who is eligible and how to enroll. Specific information about the wellness benefits, including the Recognize! points you and, if applicable, your spouse or grandfathered domestic partner can help you earn for various wellness activities is available at medtronic.healthiertogether.com. Information about other Medtronic plans is available through mymedtronic Benefits, Policies & Services or by contacting AskHR at WHO IS ELIGIBLE? You are eligible to participate in the Plan if you are a citizen or resident of the United States, employed by Medtronic, Inc. or a participating affiliate (hereinafter referred to as Medtronic ) and classified by Medtronic as a regular employee of Medtronic scheduled to work at least 20 hours per week. Employees covered under a collective bargaining agreement are eligible for coverage under the Plan only if coverage specifically is required pursuant to the terms of the applicable collective bargaining agreement. Plan benefits for employees eligible to participate in the Plan due to the terms of a collective bargaining agreement are governed by the terms of that agreement and, in the event of any conflict between the terms of this summary and the terms of the applicable collective bargaining agreement, the terms of the applicable collective bargaining agreement will govern. Individuals employed in Puerto Rico or who Medtronic designates as temporary employees (including employees on a temporary agency payroll), leased employees, casual workers, interns, contract workers, independent contractors or similar classifications performing services for Medtronic, are not considered regular employees whether or not they are paid W-2 wages by Medtronic. If you are eligible for the Plan, your spouse or grandfathered domestic partner may also be eligible to participate in wellness activities and help you earn additional Recognize! points for your account. Your dependents, other than your spouse or grandfathered domestic partner, are not eligible for the Healthier Together Plan. Your domestic partner is a grandfathered domestic partner if you and your partner submitted an affidavit that was approved before December 31, If you have questions regarding whether an individual qualifies as an eligible spouse or grandfathered domestic partner, contact AskHR. When do I become eligible? If you are not covered by a collective bargaining agreement, you become eligible on the date you first satisfy the Plan s eligibility requirements (for example, on your date of hire). If you are covered by a collective bargaining agreement, you become eligible on the 61st day after you first satisfy the Plan s eligibility requirements (for example, on the 61st day after your date of hire). Qualified Medical Child Support Orders (QMCSO) In certain circumstances a court may order that you use your Medtronic medical coverage to cover a child s medical expenses by filing a QMCSO with the company. Because children are not eligible for Plan coverage, a QMCSO will not cause them to be able to participate in the Plan. For more information, contact AskHR. HOW DO I ENROLL? Enrollment varies for each component of the Plan. To enroll in the Wellness Screening component you and, if applicable, your spouse or grandfathered domestic partner can sign up for and attend one of the various Wellness Screening sessions offered by Medtronic. To enroll for other components of the Plan and earn Recognize! points you and, if applicable, your spouse or grandfathered domestic partner must register on the Healthier Together website at medtronic.healthiertogether.com. Note that if you and your spouse or grandfathered domestic partner are both covered by the Medtronic Medical Plan, then you and your covered spouse or grandfathered domestic partner can save money on your 2017 premium by each earning 25 points during If you and your covered spouse or grandfathered domestic partner do not earn at least 25 points during 2016, your 2017 premium will include an additional 2

5 $50 per month surcharge. See the section of this SPD entitled Can I use the Plan to Save Money on Premiums under the Medtronic Medical Plan? If you have a condition that impacts your ability to complete the 25 point requirement, please contact the Manager of Health and Wellness at Medtronic at for further assistance. HOW DOES PLAN COVERAGE WORK? The Plan provides you with up to 50 Recognize! points each year if you participate in various wellness activities. You can earn an additional 25 Recognize! points if your spouse or grandfathered domestic partner participates in these wellness activities. If you choose to participate in the Plan, you will need to register on the Healthier Together website at medtronichealthiertogether.com. The website provides a complete list of the available wellness activities and the number of Recognize! points you can earn by participating in these activities. Your spouse or grandfathered domestic partner can also register and help you earn additional Recognize! points. The Plan includes a wide range of wellness activities for example: You can receive a flu vaccination (onsite or offsite) and receive 5 Recognize! points. You can complete a wellness screening (onsite or offsite) and receive 10 Recognize! points. The wellness screening includes a blood draw that is analyzed for various health risks and a personalized results booklet. You can achieve biometric test goals and receive up to 10 Recognize! points You can participate in a weight management, stress management or smoking cessation program and receive 10 Recognize! points. You can participate in global wellness challenges and receive 15 Recognize! points When you participate in any of the Plan s wellness activities, you earn Recognize! points. You can earn up to 50 Recognize! points each year for activities you complete in the Healthy Incentives Program. Your spouse or grandfathered domestic partner can also participate in various wellness activities and help you earn up to 25 additional Recognize! points each year. Points are credited to your Recognize! account on a weekly basis. Recognize! awards are a taxable event for employees. As of the date of this summary, Medtronic provides an additional tax assistance payment on the same paycheck when the points are taxed to help cover all or a significant portion of the tax obligation. Specific information about the Plan s wellness activities can be found on the Healthier Together website. If you have additional questions, please contact AskHR at CAN I USE THE PLAN TO SAVE MONEY ON PREMIUMS UNDER THE MEDTRONIC MEDICAL PLAN? Yes. If you earn at least 25 points under the Healthier Together Plan during 2016, you will pay lower 2017 premiums under the Medtronic Medical Plan. If your spouse or grandfathered domestic partner is also covered by the Medtronic Medical Plan, then you must each earn at least 25 points under this Plan during 2016 to pay lower 2017 premiums under the Medtronic Medical Plan. To receive the discounted 2017 premiums, you and (if applicable) your spouse or grandfathered domestic partner must complete the point requirements by December 23, If you and (if applicable) your spouse or grandfathered domestic partner do not each earn at least 25 points during 2016, you will pay an extra $50 per month surcharge for your coverage under the Medtronic Medical Plan. Because the company payroll cycle runs every two weeks, this means you will need to pay an additional pre-tax deduction of $23.07 on each paycheck during Medtronic will communicate any changes to the applicable surcharge and pre-tax deduction amounts before the beginning of each Plan Year. You can go to the Healthier Together website to confirm that you or (if applicable) you and your spouse or grandfathered domestic partner have completed the point requirements. WHO PAYS FOR MY COVERAGE? Medtronic covers the entire cost of the Plan for active employees and their eligible spouse or documented domestic partner. 3

6 HOW WILL MY PART-TIME STATUS AFFECT MY ELIGIBILITY? The Healthier Together Plan coverage generally is available for part-time employees scheduled to work 20 hours or more per week. For complete eligibility requirements, please refer to the Who is Eligible? section of this SPD. WHAT HAPPENS IF I BECOME DISABLED? If you are disabled and are receiving benefits under Salary Continuation or from the Medtronic Long Term Disability Plan as of July 31, 2014, you and your eligible spouse or grandfathered domestic partner will continue coverage as long as you are receiving benefits. If you become disabled on or after August 1, 2014, and thereafter transition to receiving benefits from the Medtronic Long Term Disability Plan, you and your eligible spouse or grandfathered domestic partner will continue coverage for 24 months from the date your Long Term Disability. This coverage will run concurrent to COBRA. You may also be eligible to extend coverage under COBRA for an additional 5 months by paying 150% of the total premium (for a total of up to 29 months of coverage). You will need to provide your Social Security disability determination information to AskHR. WHAT IF I WANT TO CANCEL MY HEALTHIER TOGETHER COVERAGE? If you no longer want to participate in the Healthier Together Plan, you should stop attending on site wellness screenings and onsite flu vaccinations, stop using the website and no longer complete the requirements. WHAT HAPPENS IF I DIE, CAN MY DEPENDENTS CONTINUE HEALTHIER TOGETHER COVERAGE? If you are eligible for Plan coverage when you die, your eligible spouse or documented domestic partner may elect to continue Plan coverage by electing and paying for continuation coverage through the Consolidated Omnibus Budget Reconciliation Act ( COBRA ). COBRA is a federal law requiring companies to offer continuation of health care benefits for a period of time if coverage is lost due to a qualifying event. For information about continuation of coverage under COBRA, please refer to the COBRA Notice section. WHEN DOES MY HEALTHIER TOGETHER COVERAGE END? Your coverage under the Plan will end on the date any of the following events occurs: Your employment terminates, You are laid off or take an approved leave of absence, other than a leave under the Family and Medical Leave Act, You are no longer an eligible employee as described in this summary, The date on which your Family and Medical Leave Act ends if you do not return to work, or Your spouse or grandfathered domestic partner s coverage will end when any of the following events occurs: Your coverage stops, or Your spouse or grandfathered domestic partner is no longer eligible. If your coverage ends, you and your spouse or grandfathered domestic partner may be able to continue Plan coverage for a period of time under COBRA, as described in the COBRA Notice Section. HOW DO I MAKE A CLAIM? You may make a claim for benefits under this Plan, by communicating your request in writing to the Claims Administrator. You will be notified if a written application is required or if additional information is needed to complete the processing of your claim for benefits. The following procedure will apply to claims for benefits. If your claim is denied in whole or in part, the Claims Administrator will provide you written notice within 30 days, unless there are special circumstances. In some instances, more than 30 days may be required to make a decision. In this case, the Claims Administrator must notify you that more time (up to 15 additional days) is needed and explain the reasons. The Claims Administrator s notice that a claim is denied will explain the reasons for the denial and make reference to the specific Plan provisions on which the decision is based. If the Claims Administrator requires additional information in 4

7 order to process your claim, a description of this information will be furnished in conjunction with an explanation of why it is necessary. You or your dependents must file a claim for benefits under this Plan within 12 months after you knew or should have known of the principal facts on which the claim is based. That time limit also applies to claims other than claims for benefits (e.g., a claim that you are eligible for coverage or a claim to enforce your rights under ERISA). Anyone claiming a benefit or right by or through you or your dependents will be treated as knowing everything that you or your dependents know for purposes of determining the time limit to bring a claim. If you or your dependents do not bring a claim within the Plan s required time period, you and your dependents will lose the right to bring that claim. You and your dependents will have failed to exhaust the Plan s internal administrative appeal process which is a prerequisite to bringing a suit under ERISA. WHAT IF A CLAIM OF MINE IS DENIED? If you disagree with a notice of denial of benefits, you have the right to file a written petition for review with the Claims Administrator within 180 days of receiving the notice. You or your representative must state the specific reasons for appealing the claim. Pertinent documents and records may be reviewed by you or your representative to help you in stating your claim. Within 60 days after receiving your petition for review, the Claims Administrator will notify you in writing of the final decision and the reasons for reaching this decision. If the initial denial of your claim is affirmed on review, you will be furnished with a written notice of adverse benefit determination on review setting forth: the specific reason(s) for the adverse decision on review; the specific Plan provisions on which the decision is based; a statement of your right to review (on request and at no charge) relevant documents and other information; if the decision was based on an internal rule, guideline, protocol or other similar criterion, a description of the specific rule, guideline, protocol or other similar criterion or a statement that such a rule, guideline, protocol or similar criterion was relied on and that a copy of it will be provided to you free of charge upon request; and a statement of your right to bring suit under 502(a) of ERISA. If you do not appeal within the Plan s required time period, you will lose the right to appeal and you will have failed to exhaust the Plan s internal administrative appeal process which is generally a prerequisite to bringing a lawsuit under ERISA. STATUTE OF LIMITATIONS/LAWSUITS No claimant may begin any legal action to recover Plan benefits or to enforce or clarify rights under the Plan, under ERISA or under any other provision of law, whether or not statutory, until the claims procedures described in this summary have been exhausted in their entirety. Legal action must be commenced in the proper forum before the earlier of 30 months after the claimant knew or reasonably should have known of the principal facts on which the claim is based, or 12 months after the claimant exhausts the claims procedure under the Plan. Knowledge of all facts that you or your dependents knew or reasonably should have known will be imputed to every claimant who is or claims to be entitled to benefits or rights by reference to you or your dependents for the purpose of applying the time periods. In any legal action brought relating to the Plan all explicit and implicit determinations by the claims administrator, Medtronic and any other fiduciary (including determinations as to whether the claim, or a request for a review of a denied claim, was timely filed) will be given the maximum deference permitted by law. Any review of a final decision or action of the persons reviewing a claim will be based only on the evidence presented to or considered by those persons at the time they made the decision that is the subject of review. COBRA NOTICE A federal law, known as COBRA (the Consolidated Omnibus Budget Reconciliation Act), requires the Plan to offer covered employees and their covered dependents the opportunity to elect a temporary extension of health coverage (called continuation coverage ) in certain instances where coverage under the Plan would otherwise end. You do not have to show that you are insurable to qualify for 5

8 continuation coverage. However, you may be required to pay the full premium plus a 2% administrative fee for your continuation coverage. Please contact AskHR for additional information. This notice generally describes your rights under COBRA and is intended to inform you (the employee) and your eligible dependent, in a summary fashion, of your rights and obligations under this law. Both you and your spouse should take the time to read this notice carefully. The Plan offers no greater COBRA rights than what the COBRA statute requires, and this Notice should be construed accordingly. Any oral representations made to you regarding your COBRA rights under the Plan, if inconsistent with the Plan documents, or with federal law, are without force or effect. Qualified Beneficiaries, Qualifying Events and Maximum Coverage Periods If you are covered by the Plan, you may have the right to elect continuation coverage for up to 18 months after your coverage would normally end due to a reduction in your hours of employment (including layoff) or the termination of your employment (for reasons other than gross misconduct). If you are a covered spouse of an employee covered by the Plan, you may have the right to elect continuation coverage under the Plan for up to 18 months after your coverage normally would end if you lose coverage as a result of a reduction in your spouse s hours of employment (including layoff) or the termination of your spouse s employment (for reasons other than gross misconduct). You may have the right to elect continuation coverage for up to a total of 36 months from the date your coverage normally would end if you lose coverage for any of the following reasons: 1) The death of your spouse. 2) Divorce or legal separation from your spouse. 3) Your spouse becomes entitled to Medicare benefits. While Medicare coverage is a specific COBRA qualifying event, this Plan does not terminate coverage for individuals when they become entitled to Medicare, so this event is not a qualifying event for purposes of this Plan. Continuation coverage similar to COBRA continuation coverage for a covered spouse is available for grandfathered domestic partners. For more information regarding continuation coverage for grandfathered domestic partners please contact AskHR. Normally, if you are a dependent child of an employee covered by the Plan, you might have the right to continue your coverage under the Plan, however, the Plan does not cover children, so there are no continuation rights for children under this Plan. In addition, as a covered employee of Medtronic or the covered spouse or surviving spouse of a covered employee of Medtronic, you have the right to elect continuation coverage if you lose coverage due to a bankruptcy under Title 11 of the United States Code with respect to Medtronic. In that case, the maximum continuation coverage period for a covered employee or surviving spouse will end on the date of his or her death, and the maximum continuation coverage period for the spouse of the covered employee will end 36 months after the covered employee s death. Your Notice Obligations Under the law, the employee or spouse has the responsibility to inform the Plan of a divorce or legal separation. This notification must be in writing postmarked within 60 days of the later of (a) the qualifying event, or (b) the date the qualifying beneficiary would lose coverage on account of the qualifying event. Notification must be made in writing and sent to AskHR, 15 Hampshire Street, Mansfield, MA If you are the spouse or former spouse of an employee covered by the Plan, you should provide this notice even if you are not currently covered under the Plan if you believe your coverage may have been dropped in anticipation of a divorce or legal separation, as you may have the right to elect continuation coverage for the period after the divorce or legal separation. If you or your spouse fails to provide this notice to the Plan within the 60- day period, your spouse who loses coverage will forfeit the right to elect continuation coverage. If you have already elected to continue your Plan coverage through COBRA, and you have a subsequent qualifying event, then your notification must be made in writing, postmarked within the 60- day period noted above and sent to WageWorks, COBRA Department, P.O. Box 14055, Lexington, KY

9 Election Procedures When the Plan is timely notified of a divorce or legal separation that has caused a loss of coverage, or upon Medicare entitlement, or death of the employee, affected spouse will be notified of the right to continue their Plan coverage. Your spouse then will then have 60 days from the date the Plan provides you or your spouse with notice of the right to elect continuation coverage (or, if later, the date your coverage would otherwise end if no continuation was elected) to elect to continue your coverage. You (the employee) and/or your spouse may elect continuation coverage even if you are covered under another employer-sponsored group health plan or Medicare. If you do not elect to continue coverage within the 60-day election period, you will lose your right to elect continuation coverage and your coverage under the Plan will end. If you waive continuation coverage during the 60-day election period, you may revoke your waiver in writing at any time before the end of the 60-day election period. If you revoke your waiver, however, you will not receive retroactive coverage, i.e., coverage from the date of your loss of coverage until the day your waiver is revoked. Each qualifying individual has an independent right to elect continuation coverage. Thus, an employee or covered spouse may make a binding election to receive continuation coverage for any other qualifying family member. Type of Coverage If you elect to continue your coverage under COBRA, the Plan is required to give you coverage which, as of the time coverage is being provided, is identical to the coverage provided under the Plan to similarly situated employees or eligible spouses, although it may be modified if coverage changes for active employees or eligible spouses. You also will be given the same rights as active employees to change your coverage for reasons permitted under the Plan. Premiums for Continuation Coverage Under the law, you may be required to pay the full premium for continuation of your coverage under the Plan, as applicable, plus a 2% administrative fee. The first premium payment must be made within 45 days of the date you elect continuation coverage and must be retroactive to the date coverage was lost. Claims incurred during the period covered by the initial payment will not be paid until the payment is received. All other premiums are due on the first day of the month for which the premium is paid, subject to a 30-day grace period. If premium payments are not postmarked within the required time, continuation coverage will be cancelled retroactively to the last day of the month for which premiums were paid on time. Once coverage is terminated, there is no reinstatement. Termination of Continuation Coverage Before the End of the Maximum Coverage Period Your continuation coverage may automatically terminate (before the end of the maximum coverage period) when any one of the following events occurs: Medtronic ceases to provide group health coverage to any of its employees or retirees. After electing continuation coverage, you become covered under another group health plan (as an employee or otherwise) AND: (1) you are not subject to any preexisting condition limitation or exclusion under that plan; OR (2) you have satisfied any such preexisting condition limitation or exclusion; OR (3) any such preexisting condition limitation or exclusion does not apply to you because of your creditable coverage under the Medtronic Healthier Together Plan and/or any other plans. The premium for your continuation coverage is not paid on time. COBRA continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant who is not receiving continuation coverage (such as fraud). Special Rule for Certain Disabilities If the qualifying event is a reduction in hours or termination of employment and a qualified beneficiary in connection with the event is determined by the Social Security Administration to have been disabled at any time during the first 60 days of continuation coverage, all qualified beneficiaries who are receiving continuation coverage under the Plan due to the event may extend their continuation coverage for up to 29 months. The Social Security Administration must formally determine under Title II or Title XVI of the Social Security Act that the disability exists and when it began. Persons continuing coverage under this special rule generally will be required to pay up to 150% of the cost of this coverage for the 19th through 29th month. 7

10 For the 29-month continuation period to apply, notice of the disability determination must be provided to the Plan in writing within 60 days of the date the determination is issued and before the end of the initial 18-month continuation period. Notice of any determination by the Social Security Administration that you or a covered dependent is no longer disabled must be provided to the Plan within 30 days of the date the determination is issued. Both of these notices must be sent to WageWorks, COBRA Department, P.O. Box 14055, Lexington, KY If notice of a Social Security disability determination is provided on a timely basis, the maximum coverage period for all qualifying family members will end as of the first day of the month that begins more than 30 days after the date of the determination or, if later, the date the maximum coverage period would otherwise end without regard to the special rule for disabilities. Oral notices will not be accepted. Special Rules for Multiple Qualifying Events If a spouse is receiving continuation coverage under the Plan due to a reduction in hours or termination of employment and a second qualifying event (other than a Title 11 proceeding) occurs within the 18- month or 29-month maximum coverage period that gives rise to a 36-month maximum coverage period for a spouse (for example, the employee dies or becomes divorced), the maximum continuation coverage period under the Plan for the spouse or dependent child becomes 36 months from the date coverage would otherwise be lost due to the reduction in hours or termination of employment. Change of Address or Status If you or your spouse have changed addresses, have a change in your marital status, or if a you or your spouse is determined to be disabled or no longer disabled, you must promptly notify AskHR. Once you are continuing your coverage through COBRA, you must notify WageWorks, COBRA Department, P.O. Box 14055, Lexington, KY and the Human Resource Operations Center of any address changes. Failure to timely provide this notice could adversely affect your ability to exercise your COBRA rights. For More Information If you have any questions about this notice or the provisions of this law, please contact the Human Resource Operations Center. ADMINISTRATIVE INFORMATION Official Plan Name Medtronic Healthier Together Plan, also commonly referred to in this summary as the Plan. Plan Type The Plan is a self-funded group health plan. Plan Number The Plan is a component plan of the Medtronic Group Insurance Plan which is plan number 540. Plan Sponsor and Plan Administrator Medtronic, Inc 710 Medtronic Parkway, LC 245 Minneapolis, Minnesota Phone: (763) Plan s Sponsor s Employer Identification Number Plan Year The Plan operates on a calendar year basis, beginning on January 1 and ends on December 31. Plan Funding The Plan is a self-funded wellness plan and the money to pay for the Plan comes from Medtronic. Agent for Service of Legal Process Vice President, Chief Litigation Counsel Medtronic 710 Medtronic Parkway Minneapolis, Minnesota Phone: (763) Legal process may also be served on the Plan Sponsor and Plan Administrator at the address above. Claims Administrator Medtronic Attn: Sr. Benefits Director, Americas 710 Medtronic Parkway, LC 245 Minneapolis, Minnesota Phone: (763) For Appealing a Claim Contact the Claims Administrator in writing at the address above. 8

11 YOUR ERISA RIGHTS As a participant in the Plan, 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: Receive Information About Your Plan and Benefits Examine, without charge, at the Plan Administrator s office and at other specified locations such as work sites, all documents governing the Plan, including insurance contracts, collective bargaining agreements and a copy of the latest 5500 annual report filed by the Plan with the US. 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 operation of the Plans, including insurance contracts and collective bargaining agreements, and copies of the latest 5500 annual report and updated summary annual descriptions. The administrator may make a reasonable charge for the copies. Receive a summary of the Plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. 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 plans. 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 discriminate against you in any way to prevent you from obtaining a pension or welfare benefit or exercising your rights under ERISA. Enforce Your Rights 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 provided you have exhausted the administrative procedures under the Plan. If it should happen that Plan fiduciaries misuse the Plan s money, or if you re discriminated against for asserting your ERISA rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. If you file suit against the Plan, the court will decide who should pay court costs and legal fees. If you re 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. You may have additional rights under ERISA. However, applicable law and the Plan s provisions require you to pursue all claim and appeal rights on a timely basis before seeking other legal recourse regarding claims for benefits., USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION Protected Health Information (PHI) is individually identifiable information created or received by a health care provider or a health care plan. This information is related to your past, present, or future health or the payment for such health care. PHI includes demographic information that either identifies you or provides a reasonable basis to believe that it could be used to identify you. If your claim for a 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 9

12 Restrictions on the Use and Disclosure of Protected Health Information Your employer may not use or disclose PHI for employment-related actions or decisions. Your employer may only use or further disclose PHI as permitted or required by law and will report any use or disclosure of PHI that is inconsistent with the allowed uses and disclosures. Separation Between the Employer and the Plan The employees, classes of employee or other workforce members below will have access to PHI only to perform the plan administration functions that the employer provides for the Plan. The following may be given access to PHI: Sr. Benefits Director, Americas Others as Job Duties May Require (Please see Privacy Notice for details) This list includes every employee or class of employees or other workforce members under the control of the employee who may receive PHI relating to the ordinary course of business. The employees, classes of employees or other workforce members identified above will be subject to disciplinary action and sanctions for any use of disclosure of PHI that is in violation of these provisions. The employer will promptly report such instances to the Plan and will cooperate to correct the problem. The employer will impose appropriate disciplinary actions on each employee or workforce member and will reduce any harmful effects of the violation. If you want more information about the Plan s privacy practices, have questions or concerns, or believe that the Plan may have violated your privacy rights, please contact the Plan Administrator using the Administrative Information provided above. You may also submit a written complaint to the U.S. Department of Health and Human Services. The Plan will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request or you can log on to or call (866) ASSISTANCE WITH YOUR QUESTIONS If you have any questions about the 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), US. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, US. Department of Labor, 200 Constitution Avenue NW, Washington, D.C You may also obtain certain publications about your rights and responsibilities under ERISA by calling the Employee Benefits Security Administration Brochure Request Line (also called Publications Hotline ) at , logging on to the Internet at or contacting the EBSA field office nearest you. TERMINATION OF THE PLAN Medtronic reserves the right to amend or terminate the Plan at any time. If the Plan is terminated, Participants will receive no further benefits under the Plan. INTERPRETATION OF THE PLAN The Plan Administrator has full and complete discretion to interpret and administer the Plan, and has delegated this authority to the Senior Vice President, Chief Human Resources Officer, the Vice President of Global Rewards and the Senior Benefits Director (hereinafter the Authorized Individuals). Pursuant to this delegation, the Authorized Individuals have full and complete discretion to interpret and administer the Plan including, without limitation, discretionary authority to interpret the Plan, make rules, determine eligibility for benefits, determine coverage and benefit amounts, resolve all claims and disputes regarding the Plan and further delegate any or all of such discretionary authority as they deem appropriate. The decisions of the Authorized Individuals are final and binding on all persons and can be overturned on review only if they are arbitrary, capricious or otherwise constitute an abuse of discretion. The Plan supports your right to protect the privacy of your medical information. The Plan will not retaliate in any way if you choose to file a complaint with the Plan or with the U.S. Department of Health and Human Services. 10