THE FOLLOWING LEGAL NOTICES ARE PROVIDED FOR ALL ASSOCIATES (INCLUDING PART-TIME ASSOCIATES), EXCEPT WHERE OTHERWISE INDICATED:

Transcription

1 Legal Notices THE FOLLOWING LEGAL NOTICES ARE PROVIDED FOR ALL ASSOCIATES (INCLUDING PART-TIME ASSOCIATES), ECEPT WHERE OTHERWISE INDICATED: GRANDFATHERED PLANS The Home Depot Medical and Dental Plan believes the following plans - Aetna 90-day, Aetna/SRC part-time plans, Kaiser HMO Georgia Basic, Kaiser HMO Georgia Standard, Kaiser HMO Northwest Basic, Kaiser HMO Northwest Standard, Health Net OOA $450, and HealthNet 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. 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 or This web site has a table summarizing which protections do and do not apply to grandfathered health plans. NEWBORNS AND MOTHERS HEALTH PROTECTION ACT NOTICE 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 mother s or newborn s 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 length of stay not in excess of 48 hours (or 96 hours). In-network maternity benefits include the following: Initial visit to confirm pregnancy covered at 100% after specialist copayment Medically necessary ultrasounds, sonograms and other diagnostic tests covered at the applicable cost sharing based on the place in which the service was rendered Global delivery fee includes subsequent prenatal visits, routine urinalysis, delivery and postnatal visits covered at after deductible Hospital copay applies WOMEN S HEALTH AND CANCER RIGHTS ACT NOTICE 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 subject to the same annual deductible, and/or copayment provisions otherwise applicable. NOTICE OF OPPORTUNITY TO ENROLL IN CONNECTION WITH ETENSION OF DEPENDENT COVERAGE TO AGE 26 Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in Home Depot health insurance coverage. Individuals may request enrollment for such children for 30 days from the date of notice. Enrollment will be effective January 1, For more information contact the Benefits Choice Center at

2 or MEDICAID AND THE CHILDREN S HEALTH INSURANCE PROGRAM () 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 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 and you live in a State listed below, you can contact your State Medicaid or office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or office or dial KIDS NOW or 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. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or, your employer s 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 employer s plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. 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, 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 U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services EBSA (3272) , Ext STATE WEBSITE PHONE ALABAMA: Medicaid ALASKA: Medicaid health.hss.state.ak.us/dpa/programs/medicaid/ (Outside of Anchorage): (Anchorage): ARIZONA: ARKANSAS: CALIFORNIA: Medicaid COLORADO: Medicaid FLORIDA: Medicaid GEORGIA: Medicaid dch.georgia.gov/ Click on Programs, then Medicaid IDAHO: Medicaid INDIANA: Medicaid IOWA: Medicaid KANSAS: Medicaid KENTUCKY: Medicaid chfs.ky.gov/dms/default.htm LOUISIANA: Medicaid MAINE: Medicaid MASSACHUSETTS: Medicaid and MINNESOTA: Medicaid Click on Health Care, then Medical Assistance MISSOURI: Medicaid MONTANA: Medicaid medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml NEBRASKA: Medicaid NEVADA: Medicaid dwss.nv.gov/ NEW HAMPSHIRE: Medicaid x5254 2

3 or STATE WEBSITE PHONE NEW JERSEY: Medicaid NEW MEICO; Medicaid and Click on Insure New Mexico for NEW YORK: Medicaid NORTH CAROLINA: Medicaid NORTH DAKOTA: Medicaid OKLAHOMA: Medicaid OREGON: Medicaid PENNSYLVANIA: Medicaid doingbusiness/ htm RHODE ISLAND: Medicaid SOUTH CAROLINA: Medicaid TEAS: Medicaid UTAH: Medicaid health.utah.gov/medicaid/ VERMONT: Medicaid ovha.vermont.gov/ VIRGINIA: Medicaid WASHINGTON: Medicaid hrsa.dshs.wa.gov/premiumpymt/apply.shtm WEST VIRGINIA: Medicaid WISCONSIN: Medicaid dhs.wisconsin.gov/medicaid/publications/p htm WYOMING: Medicaid MEDICARE PART D (FULL-TIME ASSOCIATES ONLY) 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 on page 4 of this SMM 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 on page 4 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 carefully it explains the options you have under Medicare prescription drug coverage, and can help you decide whether or not you want to enroll. Creditable Coverage Notice If you elected prescription drug coverage that is listed as Creditable Coverage in the following table, please read this notice carefully it 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. 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. 3

4 or 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. 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 don t 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. If you decide to join a Medicare drug plan, your Home Depot coverage will not be affected. PLAN CREDITABLE NON-CREDITABLE 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 HMO Basic and Standard (California) Kaiser Permanente Basic and Standard HMO 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 For more information about this notice or your current prescription drug coverage: Contact the Benefits Choice Center for further information at NOTE: You ll 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. 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. You ll 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 for personalized help Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) Call MEDICARE ( ); TTY users should call 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 or call them at (TTY ). 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 Date: November 1, The Home Depot; Vice President Benefits; 2455 Paces Ferry Road, NW; Atlanta, GA ; (Benefits Department)

5 2010 Benefits Summary Supplement: U.S. This booklet is a supplement to the 2010 Benefits Summary book for U.S. full-time hourly and salaried associates, and for U.S. part-time associates where specifically stated. It is also referred to as a summary of material modifications or SMM. This booklet includes revisions to sections of the Benefits Summary. The Benefits Summary remains in effect except as specifically changed in an SMM. The 2010 Benefits Summary includes complete descriptions of the benefits provisions, conditions and limitations. This supplement, and any other supplements, should be kept with and read with the 2010 Benefits Summary. In the event of a conflict between this SMM and the plan documents or policies, the plan documents or policies will govern. CHANGES TO THE ELIGIBILITY AND ENROLLMENT CHAPTER Under Dependent Eligibility: Medical, Dental and Vision Plans (Page 15), insert the following after the first bullet: Your legal spouse is not eligible for coverage under The Home Depot medical plan if he or she is self employed or works full-time for a company, other than The Home Depot, with more than 100 employees that offers medical coverage. If your spouse/domestic partner does not meet the new spouse eligibility rules above but coverage under a plan sponsored by your spouse/domestic partner s employer is not available effective January 1, 2011, contact the Benefits Choice Center. Documentation will be required. For ALL Associates (including part-time associates): Under When Your Coverage Ends : Replace the first, second and fourth bullets (fifth bullet instead of fourth for part-time associates) with the bullets below: On midnight on the day your employment with the Company ends. On midnight on the last day that you or any member of your family (dependents) no longer meet the eligibility requirements for participation in the Plans. When you experience an employment status change (for example, from full-time to part-time or part-time to full-time), your coverage ends at midnight on the day of the employment status change. CHANGES TO THE MEDICAL CHAPTER Under Injectable Drugs (page 74), replace the section with: Most self-injectable drugs will be covered under Caremark only and will not be covered under your medical plan. Please contact Caremark at Under CVS Caremark Prescription Drug Coverage (Page 93), replace the second row of this chart with the following from left to right: Out-of-Pocket Maximum (individual/family); $1,000/$2,000; $1,000/$2,000; $1,750/$3,000. Also, add an additional row to the chart as follows from left to right: Specialty Drugs (30-day supply through Mail Order only): You pay $50; You pay $50; You pay $50. Add to Step Therapy (page 95): If you take a sleep aid such as Edluar or Lunesta TM, you may need to try the preferred brand Ambien CR TM or the generic zaleplon (generic Edluar) or generic zolpidem (generic Lunesta). Also, if you take Arthrotec, Celebrex (excluding some strengths such as 400mg), or Flector, you may be required to try ibuprofen, indomethacin, meloxicam, or naproxen first. Please note these products are subject to change due to generics being made available. On pages 36 and 85, delete the UPMC HMO Western Pennsylvania information. Beginning January 1, 2011, the UPMC HMO Western Pennsylvania plan will no longer be offered. CHANGES TO THE CALIFORNIA MEDICAL CHAPTER Under California Medical Options (Page 104): Delete the first bullet. Beginning January 1, 2011, the Health Net Select POS will no longer be offered. Under Health Net and Kaiser Permanente HMOs (Page ), the chart has changed in the following ways. Replace the rows shown below with the following changes: Annual Out-of-Pocket Maximum KAISER PERMANENTE $2,500 individual/ $7,500 family KAISER PERMANENTE STANDARD HMO $2,500 individual/ $5,000 family $2,500 individual/ $7,500 family STANDARD HMO Routine Office Visit $25 copay $25 copay Specialty Care $35 copay $35 copay Allergy Testing $25 copay $25 copay Allergy Injections $5 copay $5 copay Outpatient Surgery Hospital Copay $750 copay plus 20% $350 copay in a hospital or ambulatory surgery center; if performed in a PCP office: $25; specialist office: $35 $375 copay plus 10% 80% covered; if performed in a PCP office: $25; specialist office: $35 $500 copay per year plus 20% 90% covered; if performed in a PCP office: $25; specialist office: $35 $250 copay per year plus 10% HABLA ESPAÑOL? Si necesita asistencia en relación con el contenido del Resumen del Informe Anual, por favor, llame al Centro de Opciones de Beneficios (Benefits Choice Center) al y pida hablar con un representante que hable español. Para obtener una copia de los informes anuales completos o de cualquiera de sus partes, escriba o llame a la oficina de Home Depot U.S.A., Inc., que es el patrocinador de los planes: Home Depot U.S.A., Inc. Atención: Benefits Dept. Bldg C Paces Ferry Road, Atlanta, GA , ext El precio para cubrir el costo de las copias será de $2.50 por cada informe anual ó 25 centavos por cualquiera de sus partes.

6 Inpatient Surgery In-area emergency care (when not followed by admission) KAISER PERMANENTE 80% covered after hospital copay CHANGES TO THE SPENDING ACCOUNTS CHAPTER Under Eligible Expenses for Spending Accounts Health Care Spending Account (page 160), replace the seventh bullet in the first column with: Medicine or other prescription drugs, including birth control pills and over the counter drugs, used primarily for medical care if prescribed by a physician Under Eligible Over-the-Counter Drugs (Page 160), over-the-counter drugs are no longer eligible expenses through the Health Care Spending Account. Delete this entire section. CHANGES TO THE DISABILITY SALARIED CHAPTER Under Supplemental Disability Insurance (page 193), delete this entire section. CHANGES TO THE PLAN ADMINISTRATION CHAPTER KAISER PERMANENTE STANDARD HMO 90% covered after hospital copay 80% covered after hospital copay STANDARD HMO 90% covered after hospital copay $200 copay 80% covered 90% covered Ambulance $100 copay $100 copay Urgent Care Clinic or Center Visit $25 copay at Kaiser facilities $75 copay Skilled Nursing Facility Mental Health Outpatient Mental Health Inpatient $750 copay plus 20% Outpatient Detoxification Inpatient Detoxification Outpatient therapy Inpatient therapy $750 copay plus 20% $12 copay group $375 copay plus 10% $5 copay group $375 copay plus 10% $5 copay group 80% covered; limited to 100 days per year $500 copay per year plus 20% 90% covered; limited to 100 days per year $250 copay per year plus 10% $25 copay individual $25 copay individual $500 copay per year plus 20% $500 copay per year plus 20% $250 copay per year plus 10% $250 copay per year plus 10% Under Plan Administrative Summary (Pages ), beginning January 1, 2011, Minnesota Life will be the administrator of the Basic Life and AD&D, Basic Dependent Life, Voluntary Life and AD&D and Voluntary Dependent Life Insurance plans and Liberty Mutual will be the administrator of the short- and long-term disability plans. Delete the Metropolitan Life Insurance information. Minnesota Life (Life and AD&D) 400 Robert Street N St. Paul, MN Liberty Life Assurance Company of Boston Group Benefits Disability Claims P.O. Box 7211 London, KY Under Medical, Dental and Vision Claim Administrators (Page 280), add the following medical plan administrators: Blue Cross Blue Shield PO Box Louisville, KY Kaiser Permanente Colorado - Claims PO Box Denver, CO Kaiser Permanente Mid-Atlantic - Claims PO Box 6233 Rockville, MD Kaiser Permanente Ohio - Claims PO Box 5316 Cleveland, OH Resumen de Sus Beneficios. Este documento prove un resumen en ingles de sus derechos y beneficios bajo el programa de beneficios a empleados de Home Depot. Si tiene dificultad entendiendo cualquier parte de este resumen, puede comunicarse con el Benefits Choice Center ( BCC ) al o ir a la pagina de Internet del BCC: Tambien puede dirigir sus preguntas al Departamento de Beneficios de Home Depot a la siguiente direccion: Building C-18, 2455 Paces Ferry Road, Atlanta, GA The Company reserves the right to amend or terminate these benefits at any time Homer TLC, Inc. All Right Reserved Your Benefits Resources TM is a registered trademark of Hewitt Associates. 6