U.S. Benefits Plan Description

Transcription

1 Benefits January 2007 U.S. Benefits Plan Description look Inside Your easy-to-use reference guide to Starbucks health coverage, tuition reimbursement, time-off plans and more

2 Responding to life s changes Your Starbucks benefits are there to help Actions to take and deadlines to meet GETTING MARRIED OR STARTING A DOMESTIC PARTNERSHIP? You have 45 days following your wedding or beginning your domestic partnership to add your spouse or domestic partner and to make other related changes to your benefits. It s easy, call Starbucks Benefits Center at (877) SBUXBEN. MOVING? It is important we have correct contact information for you. Update your address and phone number via ESS on Starbucks Portal and Starbucks Online, or call Starbucks Partner Contact Center at (866) Depending on where you move, you may need to change your plan and/or your primary care physician if enrolled in Point of Service. You can update your PCP online through Aetna Navigator by linking from or call Aetna Partner Services at (888) Don t know if we have your current address? Just check your paycheck. GETTING A DIVORCE, LEGALLY SEPARATING OR ENDING A DOMESTIC PARTNERSHIP? You have 45 days following your divorce, legal separation or end of your domestic partnership to remove your spouse or domestic partner from Starbucks coverage and make other related changes to your benefits. Just call Starbucks Benefits Center at (877) SBUXBEN. Your ex-spouse or ex-domestic partner is not eligible for Starbucks benefits coverage, even if your divorce agreement says you will continue to provide health coverage and/or life insurance. You must remove your ex-spouse or ex-domestic partner from Starbucks health coverage and dependent life insurance. Here are other changes to consider: Change the amount of your life insurance. Update your life insurance beneficiary. PREGNANT OR ADOPTING? Congratulations! Be sure to get benefits coverage for your new family member by calling (877) SBUXBEN within 60 days of the birth or 45 days of the adoption. You have just 45 days to make other benefit changes. Consider these: enrolling in or increasing your life insurance enrolling in child life insurance increasing your health care reimbursement account contributions and enrolling in or changing your dependent care reimbursement account (for salaried and nonretail hourly partners) You will also need to apply for: if you are the partner and pregnant, a leave of absence to protect your benefits eligibility while away short-term disability benefits to help you while you can t work Call Starbucks Benefits Center Leave Administration at (877) SBUXBEN. To help you achieve a healthier pregnancy, register for Moms-to-Babies Maternity Program, available to partners and dependents enrolled in a medical plan administered by Aetna. To register, call (888) Also visit Thrive, Starbucks health information and wellness site, to help you prepare for and track your pregnancy and your child s development. Link to Thrive from the Wellness page at If adopting, be sure to apply for adoption assistance benefits. See page 191.

3 Table of contents Where to Get Help 1 Eligibility and Enrollment 5 EAP/Life Management 30 Medical 35 When You Need Medical Care 65 Prescription Drugs 107 Dental 114 Vision 125 Reimbursement Accounts 131 Sick Pay 143 Short-Term Disability 146 Long-Term Disability 153 Life Insurance and AD&D 162 Time Off 179 Adoption Assistance 191 Tuition Reimbursement 194 Your Rights and Responsibilities 202 Index 234

4 VISION WHERE TO GET HELP Link to all web resources from GENERAL RESOURCES ADDRESS PHONE WEB OR Starbucks Benefits Center BENEFITS Eligibility Enrollment Adding or deleting a dependent Provider directories (Aetna, VSP) Prescription mail-order claim forms Obtaining a Certificate of Coverage for life insurance Changing beneficiaries for life insurance and AD&D Starbucks Benefits Center LEAVE OF ABSENCE Initiating a leave of absence (including family/medical, personal, military and Career Coffee Break) Applying for disability benefits Starbucks Partner Contact Center Your paycheck Your payroll deductions Your payroll taxes Paid time off Sick pay Your change of address or other personal changes Employee Assistance Program Locate EAP providers Help balancing work, life and personal issues Counseling for stress-related issues, emotional difficulties, alcohol and drug abuse, relationship issues at home or work Help finding day care Talk with experts about financial and legal concerns Receive up to three sessions per calendar year with an EAP-referred counselor at no cost to you Eligibility & Enrollment Department S Half Day Road P. O. Box 1540 Lincolnshire, IL Leave Administration P.O. Box 1423 Lincolnshire, IL Starbucks Corporation P.O. Box Seattle, WA Aetna EAP, RWAB 151 Farmington Ave. Hartford, CT (877) SBUXBEN 7:30 a.m. 4 p.m. Pacific Time Monday through Friday Relay and language translation services available (877) SBUXBEN 6:30 a.m. 3:30 p.m. Pacific Time Monday through Friday Fax: (847) (866) a.m. 5 p.m. Pacific Time Monday through Friday (800) hours a day, seven days a week TDD: (866) Link from: Link from 1

5 VISION WHERE TO GET HELP Link to all web resources from GENERAL RESOURCES ADDRESS PHONE WEB OR Starbucks Benefits Department and Health Privacy Office Submit a review for benefits eligibility Apply for adoption assistance File a life insurance or AD&D claim Exercise your rights under the Health Insurance Portability and Accountability Act (HIPAA) Starbucks medical and dental plan claims Choosing or changing your primary care physician (PCP) Precertification for hospital stays and medical services Dental plan and preauthorization for treatment Dental preferred providers Medical and Dental ID cards Current provider information Covered health care expenses Participating pharmacies and prescription formulary Health care and dependent care reimbursement accounts Moms-to-Babies Maternity Program Precertification for inpatient mental health and chemical dependency treatment Aetna Rx Home Delivery Mail-Order Pharmacy Starbucks Coffee Company Health Privacy Office Mailstop S-HR3 P.O. Box Seattle, WA (206) , or (888) 796-JAVA, ext a.m. 4:30 p.m. Pacific Time Monday through Friday Fax: (206) HealthPrivacyOffice@ starbucks.com HEALTH CARE COVERAGE ADDRESS PHONE WEB OR Aetna Partner Services Medical claims (888) P.O. Box Lexington, KY Fill your maintenance prescriptions Check on the status of your prescription mail orders Dental claims P.O. Box Lexington, KY Reimbursement account claims P.O. Box 4000 Richmond, KY COBRA contributions Aetna COBRA Direct Billing MB Farmington Ave. Hartford, CT P.O. Box Kansas City, MO a.m. 6 p.m. Pacific Time Monday through Friday For information on continuing your health care coverage under COBRA, call (800) (866) TTY: (800) a.m. to 8 p.m. Pacific Time Monday through Friday 5 a.m. to 6:30 p.m. Pacific Time, Saturday 5 a.m. to 3 p.m. Pacific Time, Sunday To locate a provider, link to Aetna DocFind from To check on a claim, link to Aetna Navigator TM from Link to Aetna Rx Home Delivery from 2

6 VISION WHERE TO GET HELP Link to all web resources from HEALTH CARE COVERAGE ADDRESS PHONE WEB York Medical Plan Medical plan information Covered health care expenses Nurse advice Claims processing Medical ID cards P.O. Box Harrisburg, PA (800) TDD (800) a.m. 6 p.m. Eastern Time Monday through Friday Kaiser Hawaii HMO Medical plan information Covered health care expenses Nurse advice Claims processing Medical ID cards Customer Service: 711 Kapiolani Blvd. Suite 400 Honolulu, Hawaii Claims Processing: 80 Mahalani Street Wailuku, Hawaii (808) , (800) a.m. 5 p.m. Monday through Friday 8 a.m. noon Saturday Hawaii Time After-hours advice nurse: (808) , (800) HMSA Medical plan information Covered health care expenses Claims processing Medical ID cards HMSA P.O. Box 860 Honolulu, HI (808) Oahu (808) Hilo, HI (808) Kailua-Kona (808) Maui (808) Kauai (800) away from HI 8 a.m. to 4 p.m. Hawaii Time Monday through Friday Vision Service Plan (VSP) Vision benefits Information on VSP doctors Filing a claim VSP 3333 Quality Drive Rancho Cordova, CA (800) a.m. 6 p.m. Pacific Time Monday through Friday Link from: Claims: P.O. Box Sacramento, CA

7 VISION WHERE TO GET HELP Link to all web resources from EDUCATION Starbucks Tuition Reimbursement Center Learn how the benefit works Confirm courses Check on application or payment status 55 East Monroe St. Suite 1930 Chicago, IL (888) :30 a.m. 6 p.m. Central Time Monday through Friday 4 Link from: LIFE INSURANCE AND DISABILITY ADDRESS PHONE WEB OR Hartford Life and Accident Insurance Company Portability or conversion options for life insurance For general questions about life insurance or AD&D, first call Starbucks Benefits Center at (877) SBUXBEN. To file a claim, call Starbucks Benefits Department at (888) 796-JAVA, ext UnumProvident Short-term disability (STD) Long-term disability (LTD) For general questions about the STD or LTD plans, or to file a claim, call Starbucks Benefits Center at (877) SBUXBEN. GOVERNMENT BENEFITS Medicare Contact the Health Care Financing Administration (HCFA) for information about Medicare benefits and how to apply Social Security Administration Learn about Social Security benefits and how to apply Understand how Social Security works Request your free Personal Earnings and Benefit Estimate Statement Locate an office in your area Claims: Hartford Life Attn: Group Life Claim Unit P.O. Box 2999 Hartford, CT Claims address: The Benefits Center P.O. Box 9500 Portland, ME Claims: (888) a.m. 3 p.m. Pacific Time Monday through Friday Portability and conversions: (877) a.m. 2 p.m. Pacific Time Monday through Friday (800) Fax: (800) a.m. 5 p.m. Pacific Time Monday through Friday (800) MEDICARE (800)

8 Eligibility and Enrollment Benefits Eligibility 6 Initial benefits eligibility 6 Enrollment deadline 8 Ongoing benefits eligibility 9 Losing benefits eligibility due to a reduction in paid hours 10 Re-establishing benefits eligibility 12 Benefits Enrollment 13 Initial benefits enrollment 13 Confirmation statement 14 If you do not enroll by the deadline 14 HC-5 requirement for partners working in Hawaii 14 Coverage Categories 15 Eligible Dependents 15 Your spouse 16 Your domestic partner 16 Your children 18 Cost Sharing 20 Payroll deductions 20 Missed payroll deductions 20 Health Risk Assessment Requirement 21 Initial enrollment in Open Choice PPO 21 5 Making Changes 22 Annual open enrollment 22 Changing positions from retail hourly to salaried or nonretail hourly 23 Changing positions from salaried or nonretail hourly to retail hourly 23 Qualified status changes 23 Benefits Eligibility While on an Approved Leave of Absence 25 Personal leave 25 Career Coffee Break 25 Family/medical and disability leave 25 Impact to benefits while on personal, family/medical and disability leave and Career Coffee Break 25 Making changes to benefits while on leave 26 Military leave 26 If coverage ends while on leave of absence 27 Payroll contributions missed while on leave of absence 28 Compassionate Benefits for Terminally Ill Partners 28 Continued life insurance 28 Health coverage continuation 28 When Your Employment Ends 29

9 VISION ELIGIBILITY AND ENROLLMENT At Starbucks, we offer health care benefits to part-time as well as full-time partners. And we believe in building flexibility into our benefits program, since we each have unique and personal benefits needs. Benefits Eligibility As a Starbucks partner, you must meet certain criteria to become eligible and maintain eligibility for Starbucks benefits. Your eligibility depends on where you work, Hawaii or the U.S. mainland. Unless otherwise noted, the information in this chapter will apply to both Hawaii and U.S. mainland partners. To be eligible for Starbucks benefits: You must be working for Starbucks or a participating company (a company that is wholly or partially owned by Starbucks Corporation and has elected to participate in this plan) and Be a regular partner on the U.S. payroll of such company You are not eligible to participate in Starbucks benefits if you are: Covered by a collective bargaining agreement that does not specifically provide for participation in this plan An independent contractor A worker leased from another company A temporary employee as defined in Starbucks Partner Resources policies Not on the U.S. payroll such as a nonresident alien with no U.S. source of income Assigned to work overseas permanently or indefinitely Not classified by Starbucks as an employee, regardless of how you might be classified by the government Initial benefits eligibility Depending on where you work, your benefits eligibility is determined based on the hours for which you are paid, your position, and/or your length of employment. Paid Hours for Initial Eligibility Paid hours for initial benefits eligibility for all U.S. partners includes hours that you are paid on pay dates that occur between the first day of the month through the last Friday of that calendar month. Remember, hours worked at the end of a month are generally paid in the following calendar month. 6

10 VISION ELIGIBILITY AND ENROLLMENT Here is when you become eligible for benefits for the first time (called initial eligibility ) following hire: ALL U.S. MAINLAND PARTNERS The first day of the second month after you have received pay for at least 160 hours over two consecutive calendar months. Hours must be paid by the last Friday of the second month to count for eligibility. RETAIL HOURLY PARTNERS WORKING IN HAWAII The first day of the month after you have completed four consecutive weeks of employment and received pay for at least 80 hours in a single calendar month. Hours must be paid by the last Friday of the month to count for eligibility. SALARIED/NONRETAIL HOURLY PARTNERS WORKING IN HAWAII The first day of the month following your most recent hire date. Starbucks will check your paid hours (and weeks of employment for partners in Hawaii) on the last Friday of every month until you attain initial benefits eligibility. Once you have established initial benefits eligibility, we send an enrollment kit to your home address. U.S. mainland partner enrollment kits are mailed prior to the benefits eligibility date. Partners working in Hawaii are mailed enrollment kits as soon as reasonably possible after eligibility is established. To check on the status of your paid hours for initial benefits eligibility, call Starbucks Partner Contact Center at (866) Another way for U.S. mainland partners to look at initial eligibility IF PAID 160 HOURS ON PAY DATES DURING October November November December December January January February February March March April April May May June June July July August August September September October BENEFITS ENROLLMENT KIT MAILED TO YOUR HOME IN EARLY December January February March April May June July August September October November IF YOU ENROLL, YOUR BENEFITS COVERAGE BEGINS January 1 February 1 March 1 April 1 May 1 June 1 July 1 August 1 September 1 October 1 November 1 December 1 7

11 VISION ELIGIBILITY AND ENROLLMENT Here is an example of how initial eligibility works. In this example, the partner was hired April 2, He was paid for 80 hours in April and 100 hours in May. EVENT U.S. MAINLAND PARTNERS RETAIL HOURLY PARTNERS WORKING IN HAWAII SALARIED/NONRETAIL HOURLY PARTNERS WORKING IN HAWAII Hire date April 2, 2007 April 2, 2007 April 2, 2007 Paid hours for benefits eligibility 180 total (80 in April in May) 80 in April Not a consideration Length of employment Not a consideration Four weeks by end of April, met four-week minimum Eligible for benefits July 1 May 1 May 1 Not a consideration Let s look at another example. Assume the partner was hired April 16, 2007, was paid 20 hours in April, 100 hours in May and 90 hours in June. EVENT U.S. MAINLAND PARTNERS RETAIL HOURLY PARTNERS WORKING IN HAWAII SALARIED/NONRETAIL HOURLY PARTNERS WORKING IN HAWAII Hire date April 16, 2007 April 16, 2007 April 16, 2007 Paid hours for benefits eligibility 120 hours, April + May, did not meet 2-month minimum of 160 hours 190 hours, May + June, met 2-month minimum of 160 hours 20 hours in April, did not meet 80 hour minimum 100 hours in May, met 80 hour minimum Not a consideration Length of employment Not a consideration Seven weeks by end of May, met four-week minimum Eligible for benefits August 1 June 1 May 1 Not a consideration Enrollment Deadline Benefits are regulated by federal law and, in the case of insured plans, state law. As a result, there are limits on the timeframe in which you must enroll and when you can make changes. It is important that you immediately review your benefit options and take action as outlined in your enrollment kit. 8

12 VISION ELIGIBILITY AND ENROLLMENT Coverage effective date If you enroll for benefits, your coverage goes into effect on the same day you become initially eligible. For Starbucks-paid life insurance and disability coverage, you must also be actively at work on the day your coverage begins. For life insurance and disability coverage you pay for, you must have also enrolled prior to your initial benefits eligibility date, otherwise your coverage takes effect the later of the date you enroll or the date your coverage is approved by the carrier. See the Life Insurance, Short-Term Disability and Long-Term Disability chapters, as well as the Benefits Enrollment section on page 13 for more information. Initial eligibility for rehired partners If you terminate and then are later rehired at Starbucks, you will need to establish initial benefits eligibility as described beginning on page 6. If it has been less than one year since you were previously covered under Starbucks benefits plan, your prior enrollment elections may be automatically reinstated once you establish initial eligibility. See Benefits Enrollment on page 13 for more information. Ongoing benefits eligibility Once you have established initial eligibility, you maintain your eligibility by remaining an active partner at Starbucks and meeting minimum paid hours criteria. The criteria that applies to you depends on where you work. If you meet the ongoing benefits eligibility criteria, then your eligibility and coverage remain intact. Here is how ongoing benefits eligibility works: ALL U.S. MAINLAND PARTNERS RETAIL HOURLY PARTNERS WORKING IN HAWAII SALARIED/NONRETAIL HOURLY PARTNERS WORKING IN HAWAII For ongoing benefits eligibility Tracking your paid hours You must be paid a minimum of 240 hours during each calendar quarter. You must be paid a minimum of 80 hours during each calendar month. Your eligibility continues as long as you are an active partner, regardless of paid hours. Your paid hours will accumulate every pay date within the quarter and are displayed on your pay stub as QTD Hours. QTD Hours are refreshed to zero at the beginning of each new quarter. Your paid hours will accumulate every pay date within the month and are displayed on your pay stub as MTD Hours. MTD Hours are refreshed to zero at the beginning of each new month. Not applicable Paid Hours for Ongoing Eligibility Paid hours for ongoing benefits eligibility includes the hours that you are paid on pay dates that occur between the first day of the calendar quarter or month, based on your work location, through the last day of the calendar quarter or month. It is important to remember that hours you work towards the end of a calendar quarter/month are generally paid in the following calendar quarter/month. Questions about eligibility? Call Starbucks Benefits Center at (877) SBUXBEN. 9

13 VISION ELIGIBILITY AND ENROLLMENT Quarterly eligibility audits for partners working on the U.S. mainland Quarterly eligibility audits are performed on the first day of each calendar quarter on January 1, April 1, July 1 and October 1. During the audit, your paid hours within the previous calendar quarter are tallied. Here is when the quarterly eligibility audits are held, and how they affect your benefits eligibility. PAID HOURS MUST EQUAL AT LEAST 240 BY THE LAST PAYCHECK RECEIVED IN CALENDAR QUARTER October, November, December January, February, March April, May, June July, August, September QUARTERLY BENEFITS ELIGIBILITY AUDIT PERFORMED ON January 1 April 1 July 1 October 1 TO MAINTAIN BENEFITS ELIGIBILITY FOR February, March, April May, June, July August, September, October November, December, January Keep this in mind: Starbucks pay periods end on Sunday. Therefore, the last day you can work that will be counted on your paycheck is the Sunday prior to your pay date. If you transfer pay cycles throughout the calendar quarter, your pay dates may change. Monthly eligibility audits for retail hourly partners working in Hawaii Monthly eligibility audits are performed on the last Friday of each calendar month. During the audit, your paid hours within the current calendar month are tallied. Losing benefits eligibility due to a reduction in paid hours If, based on the eligibility audit, it is determined that your paid hours fell below the minimum required to maintain ongoing eligibility, your benefits eligibility, coverage and payroll deductions will end as outlined below. Partners working on the U.S. mainland IF YOU ARE PAID FOR LESS THAN 240 HOURS DURING October, November, December January, February, March April, May, June July, August, September QUARTERLY ELIGIBILITY AUDIT PERFORMED ON January 1 April 1 July 1 October 1 YOUR BENEFITS ELIGIBILITY AND COVERAGE WILL END January 31 April 30 July 31 October 31 Retail Hourly Partners working in Hawaii If you are a paid less than 80 hours in a calendar month, your benefits eligibility and coverage will end on the last day of that month. 10

14 VISION ELIGIBILITY AND ENROLLMENT What happens when you lose benefits eligibility Coverage will end when your eligibility ends. Some benefits may be continued. See below for more information. COVERAGE Health coverage Short-term and long-term disability Life insurance Accidental death and dismemberment insurance Dependent care and health care reimbursement accounts Tuition reimbursement Adoption assistance WHAT HAPPENS Your coverage (and coverage for your enrolled dependents) ends when your benefits eligibility ends. You may elect to continue your coverage under COBRA and pay the full cost of the coverage plus a 2% administration fee. You will be sent a COBRA enrollment kit from Aetna shortly after your coverage ends. See the Your Rights and Responsibilities chapter for more information. Coverage ends when your benefits eligibility ends. If you have been approved for disability benefits effective prior to this date, your disability benefits will continue per plan provisions. Coverage (and coverage for your enrolled dependents) ends when your benefits eligibility ends. You have 31 days from the date your coverage ends to convert your Starbucks paid life insurance coverage to an individual policy, and to convert or port your supplemental life coverage. See the Life Insurance chapter for more information about converting and porting your coverage. Coverage ends when your benefits eligibility ends. Your participation ends as of your final contribution. If you have amounts remaining in your account, you may elect to continue your health care reimbursement account participation through the remainder of the plan year on an after-tax basis through COBRA. See Your Rights and Responsibilities chapter for more information. If you were benefits eligible when your course was approved, your course approval will stand. However, you will not be eligible for further tuition reimbursement benefits unless you re-establish benefits eligibility. Eligible adoption expenses incurred while you are not benefits eligible will not be eligible for reimbursement. 11

15 VISION ELIGIBILITY AND ENROLLMENT Re-establishing benefits eligibility If you lose eligibility because your paid hours fell below the minimum required, you can re-establish eligibility in a subsequent calendar quarter or month, as applicable, as long as you have remained an active Starbucks partner during this time. If your paid hours during a subsequent calendar quarter or month meet or exceed the minimum required for ongoing benefits eligibility, you will re-establish eligibility for benefits as shown below. Partners working on the U.S. mainland IF YOU ARE PAID FOR A MINIMUM OF 240 HOURS DURING October, November, December January, February, March April, May, June July, August, September QUARTERLY ELIGIBILITY AUDIT PERFORMED ON January 1 April 1 July 1 October 1 YOUR BENEFITS ELIGIBILITY WILL BEGIN AGAIN ON February 1 May 1 August 1 November 1 Retail Hourly Partners working in Hawaii Retail hourly partners who are paid 80 hours or more in a subsequent calendar month re-establish benefits eligibility the first of month following the month in which your paid hours equal or exceed 80. Re-establishing benefits eligibility in the same plan year If you lose eligibility, then subsequently re-establish eligibility within the same plan year, your prior enrollment elections and payroll deductions are automatically reinstated. A Confirmation Statement of your prior benefit elections will be mailed to your home shortly before your eligibility resumes for the mainland and shortly after for Hawaii. Re-establishing eligibility in a new plan year If you re-establish eligibility in a new plan year, we will mail a new Benefits Enrollment Kit to your home. If you want benefits coverage, you will need to re-enroll either online by linking to Your Benefits Resources from or by calling Starbucks Benefits Center by the deadline shown on your enrollment worksheet. What is a Plan Year? A plan year for Starbucks benefits begins on October 1 and ends the following September

16 VISION ELIGIBILITY AND ENROLLMENT If you Transfer Between Hawaii and the Mainland It s important to know how your initial and ongoing benefits eligibility will be affected following a transfer between Hawaii and the mainland: If you had not yet established initial benefits eligibility If you had established initial eligibility FROM HAWAII TO THE MAINLAND Your paid hours in Hawaii will count toward the initial eligibility calculation that applies to partners working on the mainland. Your paid hours in Hawaii will count toward the mainland quarterly eligibility audit. You will be subject to the first quarterly audit that coincides with or immediately follows the date your transfer is recorded in the payroll system. FROM THE MAINLAND TO HAWAII If applicable, your paid hours on the mainland will count toward the initial eligibility calculation that applies to partners working in Hawaii. If applicable, your paid hours on the mainland will count toward the Hawaii monthly eligibility audit. You will be subject to the first monthly audit that coincides with or immediately follows the date your transfer is recorded in the payroll system. Your benefits eligibility may also be affected when you take a leave of absence. Information about benefits eligibility while on a leave of absence begins on page 25. Benefits Enrollment You can enroll for benefits coverage upon reaching initial eligibility, during the annual open enrollment period (described on page 22) or anytime you have a qualified status change (see Making Changes on page 22). Initial benefits enrollment Once you have established initial benefits eligibility at Starbucks, you can enroll for the benefits you choose, and you can also enroll your eligible dependents. To help you make your enrollment decisions, a Benefits Enrollment Kit is mailed to your home address, as recorded in Starbucks payroll system, shortly after you establish initial benefits eligibility. Your Benefits Enrollment Kit includes a comparison of the various benefits available to you and shows your cost for coverage. When you receive your Benefits Enrollment Kit, read it, select your benefits, then access Your Benefits Resources by linking from or call Starbucks Benefits Center at (877) SBUXBEN to enroll by the deadline shown on your enrollment worksheet. If you have questions, speak to a Benefits Center representative. If you are incapacitated and unable to call to enroll, an individual with your power of attorney may call on your behalf to enroll you in benefits coverage. The coverage you elect will remain in place through the end of the plan year a plan year is October 1 through September 30 unless you have a qualified status change during the year. For more information see Making Changes on page

17 VISION ELIGIBILITY AND ENROLLMENT Initial enrollment for rehired partners If you are rehired less than 30 days from your termination date and you establish initial benefits eligibility in the same plan year (October through September) in which you terminated: Your prior benefit enrollment elections are automatically reinstated and A Confirmation Statement outlining your enrollments and payroll deductions is mailed to your home address. If you are rehired 30 days or more after your termination date and you establish initial eligibility in the same plan year: Your prior benefit enrollment elections are automatically reinstated, A Confirmation Statement outlining your benefit enrollments and payroll deductions is mailed to your home address, and You have 31 days from your coverage begin date to call Starbucks Benefits Center to either cancel or change your benefit enrollments. If you are rehired and establish initial benefits eligibility in a new plan year (for example, you terminate in August, are rehired in October and establish initial eligibility in January): A Benefits Enrollment Kit is mailed to your home address and You must enroll by the deadline to receive benefits coverage. Confirmation statement If you enroll by speaking with a Benefits Center representative, we will mail you a Confirmation Statement reflecting your benefit enrollment elections. Be sure to review your Confirmation Statement and report any corrections to Starbucks Benefits Center by the deadline shown on your Confirmation Statement. If you enroll online, you can print a confirmation statement after completing your enrollment. If you did not enroll for benefits by the deadline shown on your enrollment worksheet, this will be reflected on your Confirmation Statement. You will have a limited grace period (31 days) in which to call and enroll for benefits. If you do not enroll by the deadline If you do not enroll by the deadline shown on your Confirmation Statement, you will not be covered for the remainder of the plan year through September 30. Your next chance to enroll will be during the next annual benefits open enrollment period. However, if you have a qualified status change during the year, you may be able change your benefits during the plan year, provided you call within 45 days of your status change. For details on the kinds of changes you are allowed to make, see Making Changes on page 22. HC-5 requirement for partners working in Hawaii If you waive Starbucks medical coverage, when you become initially eligible for benefits and during each annual open enrollment thereafter, you must return a completed State of Hawaii HC-5 form to prove you have medical coverage elsewhere. If you do not return this form and continue to be eligible for Starbucks benefits, you will be automatically enrolled in Starbucks partner-only medical coverage and will be responsible for any applicable payroll contributions. 14

18 VISION ELIGIBILITY AND ENROLLMENT Double Coverage Doesn t Always Pay Off You may have the opportunity to be covered under more than one medical or dental plan at a time. Many health coverage plans including Starbucks are designed to prevent any overpayment of benefits when this happens. This is called coordination of benefits. Under this provision, the amount normally reimbursed under your health care plan is reduced to reflect payments made by another group plan. This means that in many cases you will receive little or no additional benefit from the second plan. For more information, see Coordinating Your Benefits on page 207 and keep this in mind when selecting your benefits. Coverage Categories You can choose to cover eligible dependents (see Eligible Dependents below) under the medical, dental and vision plans if you also enroll for these plans. You have four coverage categories to choose from: Partner only Partner plus spouse or domestic partner Partner plus child(ren) Partner plus family You can choose a dependent coverage category for each different health plan. For example, you can choose partner only medical coverage and partner plus child(ren) dental coverage. The cost of each benefit option varies depending on the coverage category you choose and where you work. When you enroll a dependent in any of the health plans, such as medical, dental or vision, you must also be enrolled in that same plan. In other words, you must choose the same medical plan for yourself and your enrolled dependents. If you enroll your dependents when you initially enroll, their coverage begins when your coverage begins. If your eligibility lapses because you did not maintain your ongoing paid hours requirement, coverage for your eligible dependents will also lapse. When your coverage on the active plan ends, their coverage will also end. Eligible Dependents These are the people we consider eligible for coverage under Starbucks benefits: Your spouse Your domestic partner Your children up to the end of the month in which they reach age 19 or age 23 if they are full-time students and who depend on you solely for support. When applicable law requires child coverage beyond these dates, Starbucks will comply with the law(s). 15

19 VISION ELIGIBILITY AND ENROLLMENT No Dual Coverage You may not be covered under Starbucks benefits plans as both a partner and a dependent. If you are related to or are the spouse or domestic partner of another Starbucks partner, you must carry your own coverage (unless you are a dependent child under age 19 or dependent child age 19 through 22 and considered a full-time student, or certified as a disabled dependent, in which case you may remain on your parent s coverage). No child may be covered as a dependent of more than one Starbucks partner. Your spouse To be covered under Starbucks benefits, your spouse must be your lawful spouse, which means you must be legally married. A spouse from whom you are legally separated is not eligible. If you live in a state that recognizes common-law marriages, we recognize your common-law spouse as your lawful spouse. If you cancel health coverage and/or life insurance coverage for your spouse during a plan year due to divorce, and you subsequently commence a second relationship with the same individual (either as a domestic partner or through remarriage), your spouse may not be eligible for coverage under the Starbucks benefits plans until the next plan year (October 1). Same-sex spouse limitations Most Starbucks benefits plans consider your same-sex spouse as your qualified dependent, as long as your samesex spouse meets the definition described in this section. However, there are some exceptions. Reimbursement accounts: Expenses incurred for your same-sex spouse who is not considered your tax dependent may not be reimbursed through the health care and dependent care reimbursement accounts. Taxation of same-sex spouse benefits When you enroll your same-sex spouse or your same-sex spouse s children in Starbucks health benefits, you will be taxed on the value of their coverage, as required by the Internal Revenue Service (IRS), unless the covered individuals satisfy the Internal Revenue Code definition of dependent. State income taxes may also apply. Your payroll deduction and the amount that Starbucks contributes towards your same-sex spouse s coverage are taxable to you. This is called imputed income. When you have elected same-sex spouse coverage, the imputed income is reflected on your paycheck each pay period. For more information, call Starbucks Benefits Center at (877) SBUXBEN and talk with a Benefits Center representative. Your domestic partner Starbucks covers same- or opposite-sex domestic partners as defined on the next page. Both you and your domestic partner need to satisfy all the requirements to be considered each other s domestic partner. If you enroll your domestic partner, you will be required to sign a declaration affirming your relationship and return it to Starbucks Benefits Center by the deadline provided. If you do not sign and return the declaration, your initial request to cover your domestic partner and his/her children will not become effective. 16

20 VISION ELIGIBILITY AND ENROLLMENT To be eligible for Starbucks benefits, you and your domestic partner must satisfy all of the following: Be age 18 or older Have an emotional commitment to one another Not be blood-related Live together permanently Share the common necessities of life Consider each other life partners Share financial interdependence Have joint responsibility for each other s welfare Not be legally married to or separated from each other, or anyone else If you enroll and certify an individual as your domestic partner who does not meet the criteria to be considered eligible under Starbucks plans, you will be subject to corrective action which may include termination of employment. If you cancel health coverage and/or life insurance coverage for your domestic partner during a plan year due to your relationship ending, and you subsequently commence a second relationship with the same individual (either as a domestic partner or through marriage), your domestic partner may not be eligible for coverage under Starbucks benefits plans until the next plan year (October 1). Parents, Roommates, and Siblings Are Not Dependents Your parents, roommates, sisters and brothers even if they live with you do not qualify as dependents under Starbucks benefits plans. Nor do your grandparents, nieces, nephews or anyone else who does not meet Starbucks definition of an eligible dependent. Domestic partner limitations Most Starbucks benefits plans consider your domestic partner as your qualified dependent, as long as your domestic partnership meets the definition described in this section. However, there are some exceptions. Reimbursement accounts: Expenses incurred for your domestic partner who is not considered your tax dependent may not be reimbursed through the health care and dependent care reimbursement accounts. Taxation of domestic partner benefits When you enroll your domestic partner or your domestic partner s children in Starbucks health benefits, you will be taxed on the value of their coverage, as required by the Internal Revenue Service (IRS), unless the covered individuals satisfy the Internal Revenue Code definition of dependent. State income taxes may also apply. Your payroll deduction and the amount that Starbucks contributes towards your domestic partner s coverage are taxable to you. This is called imputed income. When you have elected domestic partner coverage, the imputed income is reflected on your paycheck each pay period. For more information, call Starbucks Benefits Center at (877) SBUXBEN and talk with a Benefits Center representative. 17

21 VISION ELIGIBILITY AND ENROLLMENT Proof of dependent status If you enroll a dependent in a Starbucks benefits plan, we may ask you at anytime for proof that your dependent meets the definition of an eligible dependent as outlined above. Examples of acceptable documentation to establish your dependent s relationship include but are not limited to: Marriage certificate Domestic partner order Birth certificate Adoption order If it is determined that the individual(s) you enrolled does not qualify as a dependent, Starbucks will take corrective action, which may include termination of employment. Your children Your unmarried, dependent children are eligible for benefits until the end of the month in which they turn age 19 or age 23 if they are full-time students. Your dependent children under age 19 are eligible for coverage if they qualify for tax-free coverage under federal law. Your dependent children include: Biological children Adopted children who, at the time of adoption or placement for adoption, were under age 18 Children you financially support who live with you in a parent-child relationship This includes stepchildren, grandchildren, foster children and children for whom you are the legal guardian. This also includes children of your domestic partner, but only if you provide over half of the child s support. Dependent children age 19 or older, and under age 23, if they are full-time students and solely depend on you for financial support If you have a dependent child who fits this category, you must certify your child s full-time student status by the last day of the month in which your child turns 19. You may be required to provide proof of full-time enrollment in school. If you fail to certify full-time student status, your child s coverage will end the last day of the month in which your child turns 19. You will also be required to certify continued full-time student status annually. Specific requirements for dependent children Your unmarried, dependent children must meet the conditions below to qualify for benefits coverage. Children including legally adopted children and stepchildren, or children and stepchildren placed with you for adoption may be considered dependents if you or the child s other parent have physical custody during the greater portion of the year and provide at least 50% of their financial support during the calendar year. Full-time students may be considered dependents only if they are registered for at least 12 course credits per term at an accredited college or university, including a trade or vocational school. If the institution defines full-time student status in some way other than semester credit hours, the child is taking a course load that is considered full time by the institution and that course load is equivalent to at least 12 course credits per semester. 18

22 VISION ELIGIBILITY AND ENROLLMENT Dependent grandchildren or individuals for whom you are the legal guardian may be considered dependents if you have physical custody during the greater portion of the year, and you provide more than 50% of their financial support during the calendar year. Foster children may be considered dependents only if they will be in your custody for an entire tax year, and you provide more than 50% of their financial support during the calendar year. York Medical Plan and HMSA Preferred Provider Plan do not allow for coverage of foster children. Hartford Life and Accident Insurance Company does not offer child life insurance coverage for foster children. Mentally or physically disabled children may continue to be covered past the maximum age limits 19 and 23 if they are fully disabled. Fully disabled means your child cannot earn a living because of mental retardation or a physical handicap that started before they reached the maximum age for dependent children. The child must depend primarily on you for support and maintenance (and meet the IRS requirements for tax dependents), and at the time the child became disabled, either the child was covered under this plan as an eligible dependent or the parent who would be enrolling the child for coverage under this plan was not yet employed by Starbucks or not an eligible partner. Also, the plan may require certification of the child s disability from time to time. To apply for coverage, call Aetna Partner Services at (888) to obtain a Request for Continuation of Medical Coverage for Handicapped Child form and a Handicapped Child Attending Physician s Statement. Complete these forms in conjunction with your child s physician and submit them to Aetna for review and confirmation of eligibility. If you are enrolled in the York Medical Plan, HMSA Preferred Provider Plan or Kaiser Hawaii HMO, contact your carrier directly for information on covering disabled children. Children who are covered under a Qualified Medical Child Support Order (QMCSO) are eligible dependents for health coverage, even if you are not able to otherwise claim them as dependents for federal income tax purposes. A QMCSO is a formal court order or administrative order, and usually issued as part of a divorce decree or child support agreement that requires a parent to enroll dependent children in his or her health plan. Upon receipt of a valid QMCSO, Starbucks will enroll the dependent child(ren) in accordance with the court order. If you are not enrolled in a Starbucks health plan but are benefits eligible and we receive a valid QMSCO, Starbucks will enroll you and the dependent child in accordance with the court order. Because this order requires you to provide health care coverage for these children, they will be enrolled until the court order is removed or until they no longer meet the other eligibility requirements. For more information about QMCSOs, see Qualified Medical Child Support Order on page

23 VISION ELIGIBILITY AND ENROLLMENT Cost Sharing This table shows how benefit costs are shared between you and Starbucks. When you share the cost for coverage, your portion of the cost is taken through payroll deductions. For more information on how payroll deductions, deductibles and copays are applied under each benefit plan, see the individual chapters within this guide. STARBUCKS PAYS 100% OF THE COST Employee Assistance Program Short-term disability Long-term disability insurance for salaried and nonretail hourly partners Basic life insurance for salaried and nonretail hourly partners Tuition reimbursement Adoption assistance YOU ELECT COVERAGE AND YOU AND STARBUCKS SHARE THE COST Health coverage (medical, dental and vision) YOU ELECT COVERAGE AND PAY 100% OF THE COST Reimbursement accounts (for salaried and nonretail hourly partners) Long-term disability for retail hourly partners Supplemental partner life insurance Dependent life insurance Partner accidental death and dismemberment insurance Payroll deductions Your contributions for benefits, such as medical, dental and vision, are taken from your paycheck each pay period in the form of payroll deductions before taxes are taken out. This reduces your taxable earnings, and you pay less in income taxes. For other benefits, such as spouse or domestic partner or child life insurance, your contributions are deducted on an after-tax basis. Check out the individual plan chapters for information about how your portion is deducted from your paycheck whether before taxes or after taxes are taken. Costs for each plan may vary from year to year and you will be notified of any changes during the annual open enrollment period. In the meantime, visit Your Benefits Resources TM by linking from or call Starbucks Benefits Center at (877) SBUXBEN for information on current payroll deduction amounts. Missed payroll deductions You pay for the cost of your benefits coverage (including taxes on imputed income and additional contributions) through automatic payroll deductions. If you do not receive a paycheck because of your absence, your missed deductions will be taken from your next available paycheck. Benefit contributions are not deducted from any disability benefits or military allowance payments you may receive. If you are not on an approved leave of absence and the amount of your paycheck is not sufficient to cover the cost of your benefits, your coverage may be changed to a lower cost plan or cancelled due to non-payment. If you take an approved leave of absence, you will continue to pay the same active benefits contributions on leave as you did while you were active. Starbucks Benefits Center will send you a bill each month you are on leave as follows: Billing will begin the first of the month following the start of your leave. Beginning the first of the month following your return to work, you will transition back to active payroll deducted benefits contributions. 20

24 VISION ELIGIBILITY AND ENROLLMENT Contributions you owe for the period of time between when your leave begins and when monthly direct billing starts will be collected through payroll deductions from regular and/or vacation payments you receive while on leave or immediately following your return to work. For example, if you were on leave August 5 through September 30, your August benefit contributions would be payroll deducted upon your return to work or from any pay you receive while on leave. Starbucks Benefits Center would bill you for September contributions. If you do not maintain your benefits contribution payments while on leave, your coverage may be cancelled due to non-payment, and any unpaid contributions will be collected upon your return to work. Health Risk Assessment Requirement Beginning April 1, 2007, if you are enrolled in Open Choice PPO you must have a complete and current HealthQuotient health risk assessment on file with WebMD. If you do not, you will pay an additional coverage contribution of $15 weekly or $30 biweekly, depending on your pay frequency. To take the HealthQuotient, link from the Thrive page at Your Personal Health Information Privacy WebMD has received the highest recognition in the e-health industry for its protection of users privacy and security of their personal health information. Through your username and password, you will be the only one with access to your personal health information. Starbucks takes the privacy of your personal health information seriously. Any information you provide will remain confidential and will not be shared with Starbucks. Initial enrollment in Open Choice PPO When you enroll in Open Choice PPO for the first time, you will have 45-days from the date you enroll to complete the HealthQuotient Health Risk Assessment. If you complete HealthQuotient within the 45-day timeframe, you will not be subject to the additional coverage contribution for the remainder of that plan year. If you do not complete the HealthQuotient within the 45-day timeframe, the additional coverage contribution will begin. It will continue until you complete the HealthQuotient or you are no longer enrolled in Open Choice PPO, whichever occurs first. If you complete the HealthQuotient after the initial 45-day timeframe, the additional coverage contribution will cease effective the date your HealthQuotient was completed. If you lose and re-establish benefits eligibility If you enroll in Open Choice PPO, lose benefits eligibility and then re-established eligibility, you must have a current HealthQuotient on file when your coverage is reinstated. If you have not completed the HealthQuotient, or your HealthQuotient is more than 12-months old, the additional coverage contribution will apply and remain in effect until you update your HealthQuotient. 21

25 VISION ELIGIBILITY AND ENROLLMENT Annual re-certification If you remain enrolled in Open Choice PPO, you must update your HealthQuotient at least every plan year or the additional coverage contribution will apply. Each annual open enrollment we will check to see if you have updated your HealthQuotient in the current plan year (Oct. 1 through Sept. 30). If it has been updated in the current plan year, you will not be subject to the additional coverage contribution in the upcoming plan year. If your HealthQuotient has not been updated in the current plan year, or you have never completed the HealthQuotient, the additional contribution will begin effective October 1 and it will continue until you update your HealthQuotient. Making Changes When you enroll in or waive benefits whether you are initially eligible or during an annual open enrollment period your choices remain in effect for the entire plan year, which runs from October 1 to September 30. There are several situations that could automatically change some of your benefits or allow you to make changes to your enrollments. They are: During the annual benefits open enrollment period When you change positions from retail hourly to salaried or nonretail hourly When you change positions from salaried or nonretail hourly to retail hourly When you have what is called a qualified status change Annual open enrollment Open enrollment is a time when you may make changes to your benefit elections for yourself and your eligible dependents. Changes you can make include, but are not limited to, changing your medical plan options, adding or dropping your eligible dependents and increasing or decreasing your life insurance coverage amount. Each year, the annual open enrollment period takes place during the summer typically for three weeks in August. Enrollment changes are in effect the following plan year, from October 1 through September 30. During open enrollment, we will mail information to you at your home address on record in Starbucks payroll system. Review this information and make any changes to your benefits enrollment during the open enrollment period. You will also be sent notice of any changes to the cost of coverage for the new plan year. Annual open enrollment HC-5 requirement for partners working in Hawaii Partners working in Hawaii who choose to waive Starbucks medical coverage during annual open enrollment must return a completed State of Hawaii HC-5 form to prove you have medical coverage elsewhere. If you do not return this form and continue to be eligible for Starbucks benefits, you will be automatically enrolled in Starbucks partner-only medical coverage and will be responsible for any applicable payroll contributions. Must Re-Enroll in the Reimbursement Accounts If you are enrolled in the health care or dependent care reimbursement accounts, you will need to reenroll each year during open enrollment to continue your reimbursement accounts uninterrupted. 22

26 VISION ELIGIBILITY AND ENROLLMENT Changing positions from retail hourly to salaried or nonretail hourly The following highlights what happens to your coverage when you change from a retail hourly position to a salaried or nonretail hourly position. Please refer to the specific coverage chapters for more details. You become eligible to enroll in the health care and dependent care reimbursement accounts. You begin to accrue sick pay. You are automatically enrolled in long-term disability (LTD) coverage, paid for by Starbucks. Your coverage as a retail hourly partner will end. You are automatically enrolled in Starbucks-paid basic life insurance equal to one times your annual base pay. Your supplemental life insurance (partner supplemental and dependent life) and AD&D coverage options change from flat dollar amounts to multiples of your annual base pay. Your coverage as a retail hourly partner will end and you must re-enroll to continue coverage. Changing positions from salaried or nonretail hourly to retail hourly The following highlights what happens to your coverage when you change from a salaried or nonretail hourly position to a retail hourly position. Please refer to the specific coverage chapters for more details. You are no longer eligible to participate in the health care or dependent care reimbursement accounts. However, you may elect to continue participation in your health care reimbursement account on an after-tax basis through COBRA. See Your Rights and Responsibilities chapter for more information about COBRA. You are not eligible to accrue or use sick pay. Your Starbucks-paid long-term disability coverage ends. You can enroll in and pay for retail hourly long-term disability (LTD) insurance. Your Starbucks-paid basic life insurance ends. Your supplemental life insurance (partner supplemental and dependent life) and AD&D coverage options change from multiples of pay to flat dollar amounts. Your coverage as a salaried or nonretail hourly partner will end and you must re-enroll to continue coverage. Qualified status changes If you have what is called a qualified status change during the year, you may be able to change your benefit elections midyear if one of the following events occurs, but only if the election is consistent with the change in your status. Your changes must also correspond to any changes your spouse, domestic partner or child makes to his or her coverage under another employer s plan. For these events, your enrollment change goes into effect on the date of the event: Change in number of eligible dependents due to birth, adoption, placement for adoption or death Change in your job status, such as transferring from a retail hourly to salaried partner, which results in new coverage options 23

27 VISION ELIGIBILITY AND ENROLLMENT For these events, your enrollment change goes into effect on the first day of the month following the event: Gain or loss of eligibility for a dependent under a Starbucks plan Change in legal marital or domestic partnership status, including marriage, divorce, start or end of a domestic partnership, legal separation, annulment of a marriage or death of a spouse Loss of benefits eligibility or coverage for your spouse or domestic partner or children, or loss of all contributions by another employer for coverage End of the maximum period of COBRA coverage through another employer, if COBRA was in effect when your last benefit election went into effect (enrollment limited to health plans, if no other status change occurs) Employment status changes for your spouse or domestic partner or children (specifically, starting or ending employment; starting or returning from an unpaid leave, a strike or lockout; or a change in a family member s work site) Gain or loss of benefits eligibility due to a quarterly eligibility audit (you may elect to cancel your benefit enrollment for the remainder of the plan year, which means your next opportunity to enroll for benefits coverage will be during a subsequent annual open enrollment period) Starting or returning from an approved leave of absence, as permitted under Starbucks leave policies Medicare or Medicaid entitlement or loss of Medicare or Medicaid coverage (changes limited to health coverage and health care reimbursement account) for you, your spouse or domestic partner or children Your spouse or domestic partner or child gaining a new benefit option Court order requiring health coverage for a child A benefit change under another employer s plan elected by your spouse or domestic partner or children during the annual open enrollment (or at other times in accordance with IRS rules) Your child becoming ineligible for dependent care reimbursements, such as reaching age 13 (your change is limited to changing your dependent care reimbursement account contribution) An increase in the cost of dependent care, resulting, for example, from a change in day care providers, an increase in the fees of a provider who is not a relative, increasing a nanny s pay or other similar reasons (your change is limited to increasing your dependent care reimbursement account contribution) For this event, your enrollment change goes into effect on the date we receive notification of your change: Change in residence or work site, resulting in a loss of coverage or a change of plan options To see whether your situation is eligible for a change in benefits, or to make changes to your benefit elections, call Starbucks Benefits Center at (877) SBUXBEN within 45 days after your change in status. If you are adding a newborn child to coverage, you have 60 days from their birth date to make the change. If the 45th day (or 60th for a newborn) falls on a Saturday or Sunday or on a Starbucks Benefits Center recognized holiday, you must call on the next following business day. If you do not call and make your changes within 45 days (or 60 days to add a newborn), you will not be able to change your benefits election due to that status change. 24

28 VISION ELIGIBILITY AND ENROLLMENT Benefits Eligibility While on an Approved Leave of Absence Your eligibility for benefits while on an approved leave of absence will vary depending on the reason for your leave, your length of leave and your benefits eligibility status. Personal leave As during active employment, you must continue to be paid the minimum hours for ongoing eligibility to maintain or re-establish benefits eligibility during a personal leave. Personal leave does not extend your benefits eligibility or coverage, and does not exempt you from the ongoing eligibility audits. You may want to increase your hours before and/or after your personal leave to make up for the hours you will miss because of your absence. Refer to Ongoing benefits eligibility on page 9 for more information regarding paid hours and benefits eligibility. Career Coffee Break (Starbucks unpaid sabbatical leave) If you are benefits eligible at the start of your Career Coffee Break, you will retain your benefits eligibility while on a Career Coffee Break. Upon return to work from an approved Career Coffee Break, you will not be subject to an ongoing benefits eligibility audit until you have returned for one full calendar quarter (for mainland partners) or month (for Hawaii partners). Refer to Ongoing benefits eligibility on page 9 for more information. Family/medical and disability leave If you are benefits eligible at the start of your approved family/medical or disability leave, your benefits eligibility will be affected as follows: If your leave does not exceed 26 weeks, your benefits eligibility will continue through the end of the month in which you reach your 26th week of continuous family/medical and/or disability leave. No more than 26- weeks of benefits eligibility will be allowed for a continuous family/medical and/or disability leave. If your leave exceeds 26 weeks, your eligibility will be cancelled at the end of the month in which your leave exceeds 26 weeks. Upon return to work from an approved family/medical or disability leave, your benefits eligibility and coverage will be reinstated the first of the month following your return to work. You will not be subject to an ongoing benefits eligibility audit until you have returned for one full calendar quarter (for mainland partners) or month (for Hawaii partners). Refer to Ongoing benefits eligibility on page 9 for more information. Impact to benefits while on personal, family/medical, disability leave and Career Coffee Break The impact to your benefits enrollment depends on your benefits eligibility status during the leave and, in some cases, the length of your leave. The following provides a general summary of the impact for personal, family/ medical, disability leaves and Career Coffee Breaks. The impact to your benefits as a result of a military leave is addressed on page 26. For specific details, refer to If you take an approved leave of absence within the specific coverage chapters of this guide. 25

29 VISION ELIGIBILITY AND ENROLLMENT Your Starbucks coverage will continue as outlined below: Medical, dental and vision: Current coverage continues while considered benefits eligible. You will be required to continue your benefit contributions. The maximum coverage continuation during a Career Coffee Break is 12 months and the period of coverage continuation will reduce your available COBRA continuation period if you do not return from your Career Coffee Break. Partner and dependent life insurance, accidental death and dismemberment insurance: Current coverage continues while considered benefits eligible. You will be required to continue making contributions for coverage you elected. When coverage ends you can elect to continue coverage through conversion or portability options. The maximum coverage continuation during a Career Coffee Break is 12 months. Disability coverage: Current coverage continues while considered benefits eligible, except that STD coverage ends upon commencement of your Career Coffee Break. Retail hourly partners must continue making premium payments to continue LTD coverage. If you become disabled while on a leave, short-term disability benefits will not begin until the date you were scheduled to return from your leave. Dependent care reimbursement account: Participation is suspended effective the start of your leave. Participation is reinstated upon your return to work unless you return in a new plan year. Health care reimbursement account: You have the option to continue making your contributions while on an approved leave. If you do so, you retain your full annual election amount and may submit expenses incurred during your absence. Otherwise, participation is suspended effective the start of your leave. Your annual election is reduced by the amount of your missed contributions and expenses incurred during your leave are not eligible for reimbursement. Participation is reinstated upon your return to work unless you return in a new plan year. Contact Starbucks Benefits Center at (877) SBUXBEN to continue your participation. Employee Assistance Program: Benefit continues. Adoption assistance, tuition reimbursement: Benefits remain available while considered benefits eligible. Partner markout and discount: Benefits continue during leaves of absence to a maximum of 12 months. Making changes to benefits while on leave Generally, changes to your Starbucks coverage while on leave are not allowed unless you experience a qualified status change (see Making Changes on page 22) or during annual open enrollment. Changes to life insurance (including spouse or domestic partner and child life coverage), accidental death and dismemberment insurance, and retail long-term disability elections are only allowed when you are actively at work. Military leave Annual reserve training While on annual training leave, as during active employment, you must continue to be paid a minimum of 240 hours each calendar quarter (80 hours a month in Hawaii) to maintain or re-establish benefits eligibility. Annual reserve training does not extend your benefits eligibility or coverage, and does not exempt you from the ongoing eligibility audits. Active duty If you are called to active duty and are benefits eligible at the start of your military leave, you will retain benefits eligibility while on military leave. 26

30 VISION ELIGIBILITY AND ENROLLMENT Impact to your benefits Your Starbucks coverage will continue as outlined below: Medical, dental and vision: Length of coverage continuation depends on your length of service with Starbucks. Continuation of active health coverage will reduce your 24 months of available COBRA continuation period. If you return to work after coverage has ended, coverage may be reinstated upon your return. If you have been employed less than six months from your most recent hire date, your active coverage will continue through the end of the month in which your leave exceeds 52 weeks provided you continue to pay your contributions. If you have been employed six months or longer from your most recent hire date, your active coverage will continue through the end of the month in which your leave exceeds 78 weeks provided you continue to pay your contributions. Partner and dependent life insurance, accidental death and dismemberment and disability coverage: Continues through the 12th month of leave provided you continue to pay your premiums. When coverage ends you may elect to continue coverage through conversion or portability options. See the Life Insurance chapter for more information. Dependent care reimbursement account: Participation is suspended effective the start of your leave. Participation is reinstated upon your return to work unless you return in a new plan year. Health care reimbursement account: While on an approved military leave, you have the option to continue making your contributions for the remainder of the plan year and retain your full annual election. Otherwise, participation is suspended effective the start of your leave. Your annual election is reduced by the amount of your missed contributions and expenses incurred during your leave are not eligible for reimbursement. Participation is reinstated upon return to work unless you return in a new plan year. Contact Starbucks Benefits Center at (877) SBUXBEN to continue your participation. Employee Assistance Program: Benefit continues during your active duty military leave. Adoption assistance, tuition reimbursement: Benefit continues during your active duty military leave. Partner markout and discount: Benefits continue during your active duty military leave to a maximum of 12 months. You have 45 days from the start of Starbucks military leave to request cancellation of your Starbucks coverage. You can re-enroll in coverage upon your return from an approved military leave and must do so within 45 days of your return. Contact Starbucks Benefits Center at (877) SBUXBEN to make changes to your benefit elections. Upon return to work from an approved military leave, your benefits eligibility will be reinstated. You will not be subject to an ongoing benefits eligibility audit until you have returned for one full calendar quarter (for mainland partners) or one month (for Hawaii partners). Refer to Ongoing benefits eligibility on page 9 for more information. If coverage ends while on leave of absence Generally, coverage that ends during your leave of absence will be reinstated the first of the month following your return to work. Following a military leave, coverage reinstates on the day you return to work. The exception is when you take a Personal Leave and your coverage ended as a result of an ongoing eligibility audit. 27

31 VISION ELIGIBILITY AND ENROLLMENT Payroll contributions missed while on leave of absence If, due to your leave, your normal payroll deductions are not taken, you will be required to make up the cost of coverage for any missed deductions in order to continue your benefits coverage. See Missed payroll deductions on page 20 for more information. Compassionate Benefits for Terminally Ill Partners Being diagnosed with a terminal illness can be devastating emotionally as well as financially. To alleviate the financial burden of the cost of health coverage and life insurance for a benefits-eligible partner diagnosed with a terminal illness, Starbucks provides special assistance. If, while you are employed with Starbucks, you are diagnosed as terminally ill (life expectancy of 24 months or less) and you become disabled, you are eligible for two unique benefits: Continued life insurance coverage and a waiver of life insurance premiums After employment ends, continued health coverage through COBRA for you and your enrolled dependents, if any, fully paid by Starbucks for a period of time after employment ends Continued life insurance Your employment status will be deemed to be continued for the minimum period of time required to establish eligibility for waiver of premium under the Hartford Life and Accident Insurance Company contract, typically nine months following the date your disability began. Refer to the Life Insurance chapter for more information about life coverage continuation and waiver of premium. Health coverage continuation If your health coverage benefits terminate while you are still employed, you may elect to continue your health coverage for yourself and any enrolled dependents through COBRA. If you elect COBRA continuation, Starbucks will pay the difference between the COBRA cost and your active coverage contribution. Upon termination of employment, Starbucks will pay the full cost of COBRA coverage you have elected until your COBRA coverage period expires, you become eligible for Medicare or your death, whichever occurs first. For three months following your death, Starbucks will pay for the cost of continued COBRA coverage for your enrolled dependents. If, however, COBRA coverage would have terminated because you/your dependents reached the maximum COBRA continuation coverage period, then coverage will end when COBRA expires. To be eligible for Starbucks-paid COBRA coverage, you must have fully paid your coverage contributions through your termination of employment. 28

32 VISION ELIGIBILITY AND ENROLLMENT When Your Employment Ends The following chart outlines what happens when your employment at Starbucks ends. You will also find how your loss of eligibility affects your benefits coverage within each individual chapter of this guide. BENEFIT Medical, dental and vision coverage Dependent care reimbursement account (salaried and nonretail hourly partners only) Health care reimbursement account (salaried and nonretail hourly partners only) IMPACT Coverage ends on the last day of the month in which your separation is processed by payroll. You may elect to continue your coverage under COBRA, unless you have been terminated due to gross misconduct. For more information about COBRA, see the Your Rights and Responsibilities chapter. Your participation ends as of your final contribution. Your participation ends as of your final contribution. If you have amounts remaining in your account, you may elect to continue your participation through the end of the plan year in which you participate on an after-tax basis through COBRA. For more information about COBRA, see the Your Rights and Responsibilities chapter. Short-term and long-term Coverage ends on the last day you are actively at work at Starbucks. If you have disability been approved for disability benefits prior to your last day worked, your disability benefits will continue according to plan provisions. Life insurance Coverage ends on the last day you are actively at work at Starbucks. You have 31 days from the date you separate to convert your Starbucks paid life insurance to an individual policy, and to convert or port your supplemental life coverage. If you are permanently and totally disabled and have received a waiver of premium, your life insurance coverage continues at no cost to you. Accidental death and Coverage ends on the last day you are actively at work at Starbucks. dismemberment Employee Assistance Program Adoption assistance Tuition reimbursement Markout and discount Coverage ends on the last day of the month in which your separation is processed by payroll. You may elect to continue this benefit by electing to continue your Starbucks medical coverage through COBRA. For more information about COBRA, see the Your Rights and Responsibilities chapter. Your eligibility to apply for reimbursement ends on the last day you are actively at work at Starbucks. If you are planning to leave Starbucks and you have eligible expenses that were incurred while working at Starbucks, you must file your request for reimbursement before you terminate employment. Benefit ends on the last day you are actively at work at Starbucks. You must be actively employed at the time your reimbursement is processed by payroll to be eligible to receive a benefit from the plan. Ends on the last day you are actively at work at Starbucks. 29

33 EAP/Life Management How the Plan Works 31 What to expect when you call 31 Confidentiality 32 What the Plan Covers 32 Short-term counseling services 32 Resource and referral services 32 If You Take an Approved Leave of Absence 33 When Coverage Ends 33 If You Are No Longer a Starbucks Partner 33 How to File a Claim 34 Questions? 34 Mildly Ill Child Care 34 How the plan works 34 How to file a claim 34 Questions? 34 30

34 VISION EAP/LIFE MANAGEMENT The Employee Assistance Program (EAP) can help you with confidential personalized care including: Short-term counseling for stress-related issues, emotional difficulties, critical incidents in the workplace, alcohol and drug abuse, concerns at work or at home, family and relationship issues, parent/child concerns and most other personal concerns A full range of dependent care resources, from finding appropriate child and elder care resources, to locating summer camps or researching financial assistance for college Legal consultation and discounts on continuing legal consultation services Financial consultation The EAP offers telephone consultation and referral services, face-to-face counseling, Web-based self assessment, information and resources to help make life more manageable. EAP coverage is available to all U.S. partners, even when traveling abroad. You do not have to do anything to enroll in the EAP you and your family members may simply call the EAP at (800) when you need it. It is available 24 hours a day, seven days a week. You may also link to the EAP from How the Plan Works The EAP is administered by Aetna. When you call, you will speak with an Aetna representative who will work with you to identify your needs and determine the course of action best suited to your situation, or direct you to services that may help you. If you need to speak to a clinician right away, there are licensed or professional counselors available for consultation by phone. For counseling services, you may be referred to a counselor who is generally no more than a 30-minute drive from your home or work. In the case of an emergency, the EAP will refer you to the nearest appropriate resource. What to expect when you call When you call the EAP, here is what you can expect: First, you will speak with a customer services representative, who will ask for some personal information your name, address, phone number and other information as necessary. The representative will ask you some basic questions to help identify why you are calling and determine how the EAP may help. Then, depending on your needs, you will be offered an appointment with a counselor in your area who may help you with your life management situation or you will be transferred immediately to speak with a counselor over the phone. 31

35 VISION EAP/LIFE MANAGEMENT Confidentiality The EAP is a confidential program. When you call the EAP, your contact with the program will not be revealed to anyone including Starbucks without your permission, except as required by law. You and your enrolled dependents records are kept by the EAP and are not part of your Starbucks partner file. What the Plan Covers The EAP acts as an assessment, consultation and referral service for a large number of personal issues. Short-term counseling services Aetna provides counseling services through a network of mental health and chemical dependency counselors. Counseling visits Visits 1 3 You and your enrolled dependents may receive from one to three visits per calendar year when referred to an EAP counselor. To be covered by the EAP, you must visit the counselor to whom you are referred by the EAP. Otherwise, your counseling is not covered. More than three visits If you need more than three visits for mental health or chemical dependency care or if you need a type of care outside of EAP counseling, you may be covered by Starbucks mental health/chemical dependency benefits. See the When You Need Medical Care chapter for details. To be covered, you must be enrolled in a Starbucks medical plan administered by Aetna. Your EAP counselor will guide you in coordinating any necessary precertification. Your EAP counselor may recommend continued care be provided by a specialized provider, in which case Aetna will help you locate a network provider. If you are enrolled in Keystone Health Plan Central, HMSA, or Kaiser Hawaii HMO, refer to your health provider s guide to benefits for information regarding mental health/chemical dependency benefits. Resource and referral services Aetna provides resource and referral services that can connect you to the information and services that may help make life a little more manageable. This includes referrals to resources for services such as child care, elder care, help for everyday needs and much more. You may receive free and confidential services throughout the United States and while traveling abroad 24 hours a day, seven days a week, including holidays. If you need a translator or TDD services, these are also available at any time. Specific services offered to help you lead a more satisfying, less stressful life include, but are not limited to: Adult/elder services Contact Aetna for information on elder care, Medicare, Medicaid, estate planning, special nursing care and the aging process for assistance in taking better care of elderly parents and adult dependents. Child/family services You may use the EAP to obtain quick answers on topics like parenting and child development, child care, adoption, school selection and the college application and financial aid process. 32

36 VISION EAP/LIFE MANAGEMENT Financial consultation You may call the EAP for information, resources and referrals for a free 30-minute telephone consultation with a staff financial counselor on up to three topics per year, such as: General budget assistance Buying or leasing a car Planning for college or retirement Debt consolidation Savings and investments For more complex issues, the EAP provides for one free 30-minute initial office consultation with a local financial consultant per subject matter. The consultation is for up to three financial topics per year. Legal consultation The EAP provides one free 30-minute initial office or telephone consultation with a network attorney for up to three topics per year. If you need additional services, they are available with a 25% reduction from the provider s normal hourly rate. Legal assistance covers such topics as: Real estate matters Estate planning Family/divorce law Car accidents Criminal and government matters This program does not include advice on issues regarding your program, its employees, providers or attorneys. It does not cover matters relating to your job or business concerns. This program does not provide advice on any matter that is frivolous, harassing or would otherwise be a violation of ethical rules. Work/life resources A full range of dependent care resources including child care and elder care referrals with verified openings, information about adoption assistance, parenting tips and information regarding educational options (financial assistance for college, etc.) are available to you. If You Take an Approved Leave of Absence Your EAP coverage may continue during an approved leave of absence as long as you continue to be employed by Starbucks. When Coverage Ends If you are no longer a Starbucks partner Your EAP benefit ends on the last day of the month in which your termination is processed by payroll. 33

37 VISION EAP/LIFE MANAGEMENT How to File a Claim There are no claims associated with the EAP services. However, there may be claims associated with treatment outside the scope of services covered through the EAP. Any costs incurred outside the EAP are not covered, and you are responsible for paying the provider directly. These costs may be covered by your mental health/chemical dependency benefits, if you are enrolled in a Starbucks medical plan administered by Aetna. Refer to the When You Need Medical Care chapter for more information. If you are enrolled in Keystone Health Plan Central, HMSA, or Kaiser Hawaii HMO, refer to your health provider s guide to benefits for information regarding mental health/chemical dependency benefits. Questions? The EAP is available to answer your questions 24 hours a day, seven days a week, at (800) Mildly Ill Child Care When your child becomes ill and cannot attend school or day care, Starbucks will reimburse you 50% of the daily fee for Mildly Ill Child Care, up to a maximum of $30 per day, five days per year. All partners may participate in the Mildly Ill Child Care Program offered through the Starbucks EAP. How the plan works If you have children, it is a good idea to arrange for emergency back-up care in advance, before your child becomes ill. You may call Aetna at (800) to arrange a day care referral and register your child before a minor illness occurs. Aetna may help you find care in either a medically supervised center within a hospital or your home. Calling in advance to preregister your child increases your choices while saving you time. Or, if you want, you can arrange for emergency back-up care on your own at a facility or in your own home. Then, when your child gets sick, you simply call the day care provider directly to arrange care. How to file a claim When you receive Mildly Ill Child Care, you pay for services up front. Afterward, you may request reimbursement from Starbucks. To file a claim for Mildly Ill Child Care, take these steps: Obtain a Mildly Ill Child Care claim form from Aetna by calling (800) , or link to the EAP website from Complete the claim form and attach your child care provider receipt. Mail the form and receipt to Starbucks Benefits Department, Mail Stop S-HR3, P.O. Box 34067, Seattle, WA Starbucks will mail your reimbursement along with a blank claim form to use for future reimbursement. Questions? For answers to your questions about the Mildly Ill Child Care Program, or to receive information about arranging day care in advance, call Aetna directly at (800)

38 Medical Information About All Starbucks Medical Plans 36 What you pay 36 What is a deductible? 36 What is a copay? 36 What is the payment percentage? 37 What is a maximum lifetime benefit? 37 ID cards 37 Precertification 38 Retrospective record review 38 Concurrent review and discharge planning 38 If you take an approved leave of absence 39 When coverage ends 39 Questions? 39 About the Aetna Medical Plans 39 Transferring your deductible between plans 39 Calendar year out-of-pocket maximum 40 Claims 40 What is a recognized charge? 41 Aetna s Aexcel SM specialist network 42 About the Open Choice PPO Plan 43 About the Point-of-Service Plan 47 About the Routine Care PPO Plan 54 About the Out-of-Area Plan 58 Overview of Other Medical Plans 62 About the York Medical Plan 62 About the HMSA Preferred Provider Plan 63 About the Kaiser Hawaii HMO Plan 64 35

39 VISION MEDICAL Information About All Starbucks Medical Plans Starbucks offers you a choice of medical plans depending on where you live. The plans vary in terms of where you can receive care, which medical expenses are covered, how much the plans cost you and where they are available. You decide which plan best meets your needs. Starbucks medical plans are: PLAN AVAILABILITY ADMINISTERED BY Routine Care PPO Available in most areas Aetna Point-of-Service Available in most areas Aetna Open Choice PPO Available in most areas Aetna Out-of-Area Offered only where Aetna Point-of-Service networks are not available Aetna York Medical Plan Offered only to partners working at the York roasting plant and the York and Lancaster, PA stores Keystone Health Plan Central HMSA Preferred Provider Plan Available in Hawaii only HMSA Kaiser Hawaii HMO Available in Hawaii only Kaiser Permanente What you pay You and Starbucks share the cost of medical benefits for you and your enrolled dependents. Your contributions toward medical coverage are automatically deducted from your paycheck each pay period as outlined in the Eligibility and Enrollment chapter. In addition to these payroll deductions, you may have some out-of-pocket costs when you receive medical care. These costs include deductibles, copays and the payment percentage your medical plan may require before it starts paying benefits. What is a deductible? A deductible is the amount you pay each calendar year toward the cost of medical expenses before most of the medical plans begin paying benefits. You may have an individual, per person deductible to meet, or a family deductible that you pay for all of your covered family members combined. Additionally, if you are enrolled in a plan that requires use of a network, you will likely have a separate in-network and out-of-network deductible. In this case, in-network and out-of-network deductibles are not combined. What is a copay? Some of the medical plans have copays. A copay is a flat fee you pay for each office visit with an in-network provider. Any remaining charges for that visit are usually covered in full by your medical plan. Other services may have a copay as outlined in this guide. 36

40 VISION MEDICAL What is the payment percentage? Payment percentage refers to the percentage of a medical expense paid by either you or your Starbucks medical plan. For example, the Starbucks plan payment percentage may be 80% of a $1,000 medical procedure. Your payment percentage would be the remaining 20%. The payment percentage applies after you meet any plan deductibles. What is a maximum lifetime benefit? A maximum lifetime benefit is the most a medical plan will pay for an individual over his or her lifetime. The maximum lifetime benefit by plan is shown below: PLAN All Aetna plans combined York Medical Plan HMSA Preferred Provider Plan Kaiser Hawaii HMO MAXIMUM LIFETIME BENEFIT $2 million Unlimited $1 million Unlimited If you are enrolled in a Keystone Health Plan Central, HMSA, or Kaiser Permanente health plan, please refer to your health provider s guide to benefits for information regarding your maximum lifetime benefit. The maximum benefit that will be paid by all Starbucks medical plans administered by Aetna combined over a lifetime is $2 million per covered person. The lifetime maximum benefit includes benefits paid for mental health and chemical dependency treatment, but excludes prescription drug benefits. Each January 1, a portion of the benefits that have been paid for you or any of your enrolled dependents by all Starbucks medical plans administered by Aetna, combined during the previous calendar year, will be reinstated. The maximum annual reinstatement will be $10,000. For example, if you had a serious illness and incurred $50,000 in expenses that were paid by your medical plan, up to $10,000 of those benefits would be reinstated the following January 1. This means that only the remaining $40,000 would count toward your lifetime maximum. Each subsequent year, up to another $10,000 can be reinstated. ID cards When you enroll in a medical plan, an ID card will be mailed to your home. You need to present this card whenever you visit your doctor, medical facility or participating pharmacy for services. If you do not receive an ID card within a month after enrolling or if you need additional or replacement ID cards, call or go online as follows: PLAN ADMINISTRATOR PHONE NUMBER AVAILABLE VIA THE INTERNET Aetna (888) Yes, on Aetna Navigator TM. Link from York Medical (Keystone Health Plan Central) (800) Yes, link from 37

41 VISION MEDICAL PLAN ADMINISTRATOR PHONE NUMBER AVAILABLE VIA THE INTERNET HMSA (Hawaii) (877) Yes, link from Kaiser Hawaii HMO (800) Yes, link from Precertification All Starbucks medical plans require precertification before certain medical treatments and procedures will be covered. This verifies that you are receiving the most appropriate treatment for your condition and that your treatment is medically necessary. The responsibility for who obtains precertification depends on which plan you are enrolled in and whether your treating physician is in the plan s network. Typically, precertification is required for any inpatient hospital and convalescent facility stays, home health care, skilled nursing care and hospice care. Precertification is outlined in more detail for the Aetna plans beginning on page 90. If you are enrolled in a Keystone Health Plan Central, HMSA, or Kaiser Permanente health plan, please refer to your health provider s guide to benefits for information regarding required precertification. Remember to Precertify! All Starbucks medical plans require precertification for certain procedures, services and hospital admissions. It is a good idea to call to verify your coverage whenever you expect to incur large medical expenses. Retrospective record review Certain claims may be retrospectively reviewed by your medical plan to: Analyze potential quality and utilization issues Begin appropriate follow-up action based on identified quality or utilization issues Review all appeals of inpatient concurrent review decisions for coverage and payment of health care services Claims that may be reviewed include claims submitted for payment and medical records submitted because of potential quality and utilization concerns. Concurrent review and discharge planning With concurrent review, your medical plan assesses the need for continued inpatient hospitalization, the level of care and the quality of care. Whenever your inpatient length of stay extends beyond the length initially certified, your medical plan will conduct a concurrent review of your continued stay. Discharge planning may begin at any time during your medical plan s patient management process and immediately when post-discharge needs are identified (either during precertification or concurrent review). Your discharge plan may include a variety of services and/or benefits that you will use following your discharge as an inpatient. 38

42 VISION MEDICAL If you take an approved leave of absence Your medical coverage may continue during an approved leave of absence. See page 25 for more information. However, you will be required to continue to make your contribution payments for medical coverage during your leave of absence. Contributions for medical coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your contribution payments while on leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When coverage ends If you are no longer a Starbucks partner, your medical coverage ends on the last day of the month in which your termination is processed by payroll. If you lose benefits eligibility due to the ongoing eligibility audit, your medical coverage ends as described in the Eligibility and Enrollment chapter. You can elect to continue your coverage through COBRA as outlined in Your COBRA Rights on page 219. Questions? For answers to your questions about the medical plans or if this Benefits Plan Description or your health provider s guide to benefits does not contain complete information about the service or supply you need, call: Aetna Partner Services at (888) Keystone Health Plan Central at (800) HMSA at (877) Kaiser Hawaii HMO at (800) About the Aetna Medical Plans This section includes important information about Starbucks medical plans administered by Aetna. The majority of partners are covered under an Aetna plan. Transferring your deductible between plans If, during a calendar year, you transfer between the Open Choice PPO, Point-of-Service, Routine Care PPO or Out-of-Area plans administered by Aetna, any deductible satisfied under one plan may be applied to the deductible of a subsequent plan. Transfers between plans may occur: October 1, the beginning of a plan year As a consequence of Aetna establishing or removing a provider network When your move into or out of an Aetna network area that results in a change in your medical plan options 39

43 VISION MEDICAL Calendar year out-of-pocket maximum The calendar year out-of-pocket maximum is the most you or your enrolled dependents must pay toward covered medical expenses in a calendar year. The in-network and out-of-network annual out-of-pocket maximums are separate and not combined. The following charges are not considered when calculating your out-of-pocket maximum: Deductible amounts All copays Penalties for not obtaining required precertifications Charges in excess of recognized charges Charges for expenses not covered by the plan Expenses for nicotine-use treatment programs Expenses for temporomandibular joint disorder (TMJ) Nonpreferred prescription expenses ANNUAL OUT-OF-POCKET MAXIMUM 1 Plan In-network Out-of-network Open Choice 2 $2,000 per person $4,000 per person Point-of-Service 2 $2,000 per person $4,000 per person Routine Care PPO 2 $4,000 individual $12,000 family $8,000 individual $24,000 family Out-of-Area 2 $1,750 per person 1 In-network and out-of-network out-of-pocket maximums are separate and cannot be combined. 2 You and your enrolled dependents are responsible for any charges that exceed recognized charges. Claims When you visit an Aetna network provider, claims will be handled by your provider and you will have no paperwork to complete. You simply pay your copay when you receive services. For services that you pay a percentage of the fee, Aetna will send you an Explanation of Benefits after the claim is processed that will tell you how much of the bill you owe. Or you can view your claim online from Aetna Navigator. Link from When you visit an out-of-network, non-ppo provider for medical services, either you or your doctor must file a claim to receive benefits from the plan. For more information, see How to File a Claim on page

44 VISION MEDICAL Tools and Information at a Click Aetna Navigator Aetna Navigator provides you with online health and benefits information 24 hours a day, seven days a week. Through Aetna Navigator you can: Search the Aetna DocFind Provider Directory for a primary care physician (PCP) and other network providers Change your PCP Order replacement ID cards View benefits information, including your PCP designation View claims status and, when available, your Explanation of Benefits (EOB) Compare hospitals Get prices for various medical procedures Access information about other Aetna products and programs Link to other online health resources and tools that help you make better health decisions Print a health history for your own reference or for discussions with your doctor Obtain a claims summary and use the data for tax needs, or for determining what you may owe a particular provider Check your health care and dependent care reimbursement accounts. You can link to Aetna Navigator from What is a recognized charge? A recognized charge is the part of a charge that is recognized and covered under your medical plan. The recognized charge for a service or supply is the lower of: The provider s usual charge, or The charge your plan administrator determines to be appropriate for that service or supply, based on a national database You are responsible for paying any amount that exceeds recognized charges. When a service or supply is unusual, not often provided or provided by only a small number of providers in your area, your plan administrator will consider factors such as the complexity of the service or supply, degree of skill needed, provider specialty, range of services or supplies provided by a facility and recognized charges in other areas when determining the recognized charge. Also, in some circumstances, your plan administrator may have an agreement with a provider (directly or indirectly) that sets the rate it will pay for a service or supply, in which case the set rate will be considered the recognized charge. 41

45 VISION MEDICAL Aetna s Aexcel SM specialist network Where available, the Point-of-Service Plan and Routine Care PPO Plan will include Aetna s Aexcel network of specialists, whom you must use to receive in-network benefits. When you use these specialists, no referrals are required. AEXCEL SM LOCATIONS ARIZONA CALIFORNIA: Los Angeles and Northern Counties: San Francisco, Alameda, Contra Costa, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma CONNECTICUT DISTRICT OF COLUMBIA FLORIDA: Northern Counties: Baker, Clay, Duval, Flagler, Nassau, Saint Johns, Volusia; Central Counties: Brevard, Charlotte, Hernando, Hillsborough, Lake, Orange, Manatee, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, Sumter; Southern Counties: Miami-Dade, Broward, Indian River, Palm Beach, Martin, St. Lucie, Okeechobe GEORGIA: Atlanta ILLINOIS: Chicago (Includes Lake and Porter Counties in Indiana) MAINE MARYLAND NEW JERSEY: Northern Counties: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren NEW YORK: Metro Counties: Bronx, Dutchess, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, Westchester OHIO: Central Ohio: Columbus; Northeast Ohio: Cleveland and Toledo TEXAS: Austin, Dallas/Ft. Worth, Houston, San Antonio VIRGINIA: Northern Counties: Alexandria City, Arlington, Caroline, Clarke, Culpeper, Fairfax, Fairfax City, Falls Church City, Fauquier, Fredericksburg City, King George, Loudoun, Manassas City, Prince William, Spotsylvania, Stafford, Westmoreland WASHINGTON: Seattle/Western Washington AEXCEL SPECIALISTS Cardiology (except pediatric) Gastroenterology Orthopedics Neurology (except pediatric) Plastic surgery Urology Cardiothoracic surgery General surgery Otolaryngology (ear, nose, throat) Neurosurgery Vascular surgery The specialists chosen for the Aexcel network have been required to meet specific measures of effective care delivery and defined standards for performance. Over time, additional locations and specialties will be added. If Aexcel applies to you, your enrollment confirmation letter will indicate enrollment in Aexcel and your medical ID card will display Aexcel. When you access Aetna DocFind and select the Point-of-Service Aexcel plan or Routine Care PPO Aexcel plan, Aexcel specialists will be identified by a blue star. If you are using a specialist who is not in the Aexcel network When Aexcel is introduced in your geographic area and you have a medical condition that requires continuing treatment by your current specialist (for specialties covered by Aexcel) and your doctor is not in the Aetna Aexcel network, you can apply for continuing treatment by your current doctor for a period of time. Contact Aetna Partner Services at (888) for a Transition Coverage Request Form. 42

46 VISION MEDICAL About the Open Choice PPO Plan The Open Choice PPO plan administered by Aetna provides you with comprehensive coverage and a choice of health care providers when you receive medical care. You can visit providers or facilities belonging to the Aetna PPO network. You can visit providers or facilities outside the Aetna network and pay more out-of-pocket. This plan offers a higher level of coverage when you visit a PPO provider (in-network benefits) and a lower level of coverage if you visit a non-ppo provider (out-of-network benefits). Providers you can use Under the Open Choice PPO plan, you can visit the providers listed below for your health care needs. PPO providers: PPO providers are physicians and facilities that participate in Aetna s PPO network. When you see a PPO provider, you will get the higher in-network level of benefits. Your copay is lower when you see an Aetna PPO primary care physician. You pay a higher copay when you see a network specialist. Primary care physicians include general practitioners, family practitioners, internists and pediatricians. Specialists include any physicians who are not considered primary care physicians, such as OB/Gyns, cardiologists, neurologists, dermatologists, etc. Non-PPO providers: These practitioners and facilities are not part of the Aetna PPO network. If you visit them you will receive a lower level of benefits. Consider your options carefully before using a non-ppo provider. Services provided by out-of-network providers for mental health care and chemical dependency treatment are not covered. To locate a PPO provider when you need care: For the most up-to-date information, link to Aetna s DocFind website from Check a provider directory, available at your work location, or call Aetna Partner Services at (888) for a directory. HealthQuotient TM and the Open Choice PPO Partners who have not completed the HealthQuotient health risk assessment within the past 12 months will pay an additional $15 weekly or $30 biweekly for coverage under the Open Choice PPO. The additional contribution will end once HealthQuotient has been completed or updated. HealthQuotient is on the Thrive site by linking from Open Choice PPO coverage overview For more details on each of the services on the next page, including coverage requirements, limitations and exclusions, refer to the specific medical service in the When You Need Medical Care chapter. 43

47 VISION MEDICAL Open Choice PPO coverage overview, continued MEDICAL SERVICE Deductible Per calendar year Calendar year out-of-pocket maximum (see page 40 for details) IN-NETWORK BENEFITS Care provided by PPO providers $200 individual $600 family 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers $500 individual $1,500 family $2,000 per individual $4,000 per individual The plan pays The plan pays Physician charges (other than for mental health and chemical dependency) Primary care office visit 100% after your $20 copay 60% after deductible (nonsurgical) Specialist office visit 100% after your $35 copay 60% after deductible (nonsurgical) All other services, including 80% after deductible 60% after deductible surgical office visits Mental health (outpatient) Up to 30 visits per calendar year 100% after your $25 copay No coverage Chemical dependency (outpatient) Up to 30 visits per calendar year 100% after your $25 copay No coverage Lab & imaging expenses Billed by physician 100% (copay applies if no office visit on same day) 60% after deductible Billed by an independent 80% after deductible 60% after deductible laboratory Billed by a hospital (outpatient) 80% after deductible 60% after deductible Routine laboratory (regardless of 100% 60% after deductible where services rendered) Physical exam (preventive care) Well child visits 100% after your $20 copay; 6 visits first year of life, 2 visits second year, 1 visit every 12 months age 2 through age 6 Physical exam, age 7 100% after your $20 copay, through 49 1 exam every 24 months 60% after deductible; 6 visits first year of life, 2 visits second year, 1 visit every 12 months age 2 through age 6 60% after deductible, 1 exam every 24 months 44

48 VISION MEDICAL Open Choice PPO coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS Care provided by PPO providers The plan pays Physical exam, age 50 and over 100% after your $20 copay, 1 exam every 12 months Well woman exam 100% after your $20 copay (primary) or $35 (OB/Gyn), 1 exam every 12 months Hospital (inpatient; other than for mental health and chemical dependency) Precertification required 80% after deductible and $150 copay per admission OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays 60% after deductible, 1 exam every 12 months 60% after deductible, 1 exam every 12 months 60% after deductible and your $150 copay per admission Mental health (inpatient) Up to 30 days per calendar year Precertification required Chemical dependency (inpatient) Up to 30 days per calendar year Precertification required Hospital (outpatient) Surgery center (outpatient) Birthing centers 80% after deductible and $150 copay No coverage per admission 80% after deductible and $150 copay No coverage per admission 80% after deductible 60% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible Emergency care 2 Hospital ER If admitted, you will be covered under Hospital (inpatient) 80% after your $100 copay 80% after your $100 copay Urgent care Urgent care clinic 80% after your $50 copay 80% after your $50 copay Hearing Exam 100% after your $35 copay 60% after deductible Aids ($1,600 maximum benefit 100% 100% every three years) Alternative care visit Maximum calendar year benefit of $ % after your $20 copay 100% after your $20 copay 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 2 Nonemergency use of the emergency room is not covered. 45

49 VISION MEDICAL Open Choice PPO coverage overview, continued MEDICAL SERVICE Chiropractic visit Maximum 15 visits per calendar year Family planning Including contraceptive devices, sterilization, abortion and fertility drugs Durable medical equipment Convalescent care Maximum 60 days per calendar year Precertification required Skilled nursing care Maximum 70 shifts of private duty nursing per calendar year Precertification required Home health care Maximum 120 visits per calendar year IN-NETWORK BENEFITS Care provided by PPO providers OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays The plan pays 100% after your $35 copay 60% after deductible Covered as any other illness or injury 60% after deductible based on provider of service 80% after deductible 60% after deductible 80% after deductible and $150 copay 60% after deductible and $150 per admission (waived if admitted copay per admission (waived within 3 days of hospitalization) if admitted within 3 days of hospitalization) 80% after deductible 60% after deductible 100% after deductible 60% after deductible Precertification required Hospice care Precertification required 100% after deductible 60% after deductible Short-term rehabilitation (physical, speech and occupational therapy) Maximum 60 visits per calendar 80% after deductible 60% after deductible year, all therapy combined Nicotine-use treatment Maximum lifetime benefit of $ % after your $20 copay per office 100% after your $20 copay per visit; 100% (no deductible) for other office visit; 100% (no deductible) services for other services 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 46

50 VISION MEDICAL Open Choice PPO coverage overview, continued MEDICAL SERVICE Mouth, jaw and teeth treatment See Hospital on page 45 for hospital facility charges TMJ or MPD treatment Maximum lifetime benefit of $3,000 IN-NETWORK BENEFITS Care provided by PPO providers OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays The plan pays 100% after office visit copay 60% after deductible 50% (no deductible) 50% (no deductible) Precertification required 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. In some locations, the availability of Aetna PPO providers for durable medical equipment, convalescent and skilled nursing care, home health care, hospice care, medical laboratory and short-term rehabilitation may be inadequate as determined by Aetna. In these cases, Aetna may elect to pay in-network benefits for services delivered by non-ppo providers. Call Aetna Partner Services at (888) if you have a need for these services and find availability of PPO providers to be limited. About the Point-of-Service Plan The Point-of-Service plan offers you a choice of how you receive medical care. You can visit a provider or facility belonging to the Aetna network. You can visit providers or facilities outside the network. How you receive care determines the level of coverage you receive. In-network benefits When you enroll in the Point-of-Service plan, you must choose a primary care physician (PCP) for each person you wish to cover. You can choose the same PCP for yourself and your dependents, or you can choose a different PCP for each family member. You must notify Aetna of your PCP selection before your first visit. You receive the higher in-network level of benefits only when your medical care is provided by (or coordinated in advance by) your PCP. If you or your enrolled dependents need to see a specialist, you must first contact your PCP for treatment or to receive a referral to a specialist. Even if you are new to the plan and have already received treatment from a network specialist, you must receive a referral from your PCP to receive the in-network level of benefits. For more information about PCPs and how to choose one, see Your primary care physician on page 48. The in-network level of benefits also may be available without a referral from your PCP if specialty care is received from Aexcel SM network specialists or from network OB/Gyns. (See page 42 for details on Aetna s Aexcel specialist network and page 49 concerning OB/Gyn referrals.) 47

51 VISION MEDICAL Out-of-network benefits You will receive the lower out-of-network level of benefits from the Point-of-Service plan if you: Receive care from physicians and facilities that are not part of the Aetna network (except upon referral and with pre-approval from Aetna). Do not designate a PCP with Aetna before receiving care. Do not receive a referral from your PCP for care provided by a specialist (other than an Aexcel SM specialist or network OB/Gyn). See a specialist in Aetna s network who is not an Aexcel SM specialist (for certain specialties and locations). Providers you can use Under the Point-of-Service plan, you can visit any or all of the providers listed below. Primary care physician: Your PCP belongs to the Aetna network of providers and should be your first stop when you need medical care. Your PCP can provide routine medical services or referrals to specialists, if necessary. If your care is not coordinated by your PCP or you do not select a PCP, you will receive the out-ofnetwork level of benefits (for all services). In-network providers: In-network providers are physicians or facilities that belong to Aetna s network. Seeing an in-network provider who is referred by your PCP means you will get the in-network level of benefits. For certain specialties in some locations, you must use an Aexcel SM specialist to receive in-network benefits. In some cases, a visit to an out-of-network provider may be reimbursed at the in-network level if you have been referred by your PCP and the service has been approved by Aetna. Out-of-network providers: These practitioners and facilities are not part of the Aetna Point-of-Service network. Services provided by out-of-network providers for physical exams, mental health care, chemical dependency treatment and preventive care are not covered. Alternative care providers: You may visit certain licensed practitioners of your choice for acupuncture or other alternative care. You are covered for up to $500 per calendar year for all alternative care. See Alternative Care on page 66 for more details. Your primary care physician (PCP) Under the Point-of-Service plan, you must select a primary care physician (PCP) for yourself and every covered dependent when you enroll. Your PCP will coordinate all your medical care to ensure that you receive the highest level of benefits called in-network benefits. If you do not select a PCP or your care is not coordinated by your PCP, you will receive lower, out-of-network benefits. Aetna s PCP Network The PCPs belonging to the Aetna network must keep their credentials current. They must continually meet strict standards related to education, quality of care, accessibility and cost. To locate a PCP and other network providers, link to Aetna s DocFind website from 48

52 VISION MEDICAL About your PCP As your personal doctor, your PCP manages all health care provided to you. Your PCP handles your routine medical needs and coordinates other care by referring you to specialists and treatment facilities if medically necessary. Your PCP must be a member of the plan s network of providers and practice as a family or general practitioner, an internal medicine doctor (internist), or a pediatrician. To receive the in-network level of benefits from the Point-of-Service plan, you must see your PCP or receive a PCP referral to a specialist. (If you live in an area where the Aexcel SM specialist network is available, you can selfrefer to an Aexcel specialist. See page 42 for details.) You must notify Aetna of your PCP selection before your first visit. Self-Refer to OB/Gyn Care Women covered under the POS plan can visit a network gynecologist without a referral from a PCP for a routine well-woman exam, Pap smear or any gynecological care, including follow-up treatment. Your gynecologist may also refer you for other gynecological services without requiring you to return to your PCP. Choosing your PCP You must select a PCP for yourself and each dependent you wish to cover when you enroll in the Point-of-Service plan. You may choose the same PCP for yourself and your dependents or you may choose a different PCP for each person. To select a PCP, simply follow the steps below. For the most up-to-date information, access Aetna s DocFind website from for a list of network providers. Or, check a provider directory, available at your work location, or call Aetna Partner Services at (888) for a directory. Decide what kind of doctor you want as your PCP family practitioner, general practitioner, internist or pediatrician. If your current doctor is a PCP in Aetna s network, you can select that doctor as your PCP. Call Aetna and advise them of your selection before your first visit or designate your PCP online at Aetna Navigator (link from Changing your PCP You can change your PCP at any time and as often as you like. Just call Aetna Partner Services at (888) or access Aetna Navigator TM. Link from PCP changes take effect the day you call. PCP changes requested via take effect once you receive confirmation from Aetna via reply , typically within two business days. Aetna will mail new ID cards to you reflecting your new PCP the next business day. Note that you must change your PCP before seeing a new doctor requests to change PCPs after an office visit will not be retroactive to cover the visit. 49

53 VISION MEDICAL PCP Specialist Referrals In most cases, your PCP must refer you to a specialist to receive the in-network level of benefits under the Point-of-Service plan. To receive a referral, you do not necessarily have to visit your PCP in person in some cases you may be able to receive a referral over the phone. You do not need a PCP referral if you live in an area where Aetna s Aexcel SM specialist network is available and you need care from an Aexcel designated specialty. Female members may self-refer to any network OB/Gyn for routine well woman services. If your PCP leaves the network If your PCP leaves the provider network or retires, you will need to select a new PCP. Aetna will mail a notice to you advising you that your current PCP is no longer in the network, provided your PCP has notified Aetna. If you are currently receiving treatment, you may be able to continue to receive care through your current provider. Contact Aetna Partner Services at (888) to receive more information on transitional care. Point-of-Service coverage overview For details on each of the services below, including coverage requirements, limitations and exclusions, refer to the specific medical service in the When You Need Medical Care chapter. MEDICAL SERVICE IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS 1 Deductible Per calendar year $150 individual $450 family $500 individual $1,500 family Calendar year out-of-pocket maximum (see page 40 for details) $2,000 per individual $4,000 per individual Primary care physician designation and care coordination required Yes Aexcel SM specialist required 2 Yes No The plan pays No The plan pays Physician charges (other than for mental health and chemical dependency) Primary care office visit 100% after your $20 copay 50% after deductible Specialist office visit 100% after your $35 copay 50% after deductible Out-of-network specialist referred 100% after your $35 copay N/A by PCP 1 All other services 80% after deductible 50% after deductible 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 2 If you live in an area where Aetna s Aexcel SM network is available, you must use Aexcel SM designated specialists to receive in-network benefits. 50

54 VISION MEDICAL Point-of-Service coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS 1 The plan pays The plan pays Mental health (outpatient) Up to 30 visits per calendar year 100% after your $25 copay No coverage Chemical dependency (outpatient) Up to 30 visits per calendar year 100% after your $25 copay No coverage Lab & imaging expenses Billed by physician 100% (copay applies if no office visit on same day) 50% after deductible Billed by an independent laboratory 80% after deductible 50% after deductible Billed by a hospital (outpatient) 80% after deductible 50% after deductible Routine laboratory (regardless of 100% Not covered where services rendered) Physical exam (preventive care) Well child visits 100% after your $20 copay; 6 visits first year of life, 2 visits second year, 1 visit every 12 months age 2 through age 6 Physical exam, age 7 100% after your $20 copay, through 49 1 exam every 24 months Physical exam, age 50 and over 100% after your $20 copay, 1 exam every 12 months Well woman exam 100% after your $20 copay (primary) or $35 (OB/Gyn), 1 exam every 12 months Hospital (inpatient; other than for mental health and chemical dependency) Precertification required 80% after deductible and $150 copay per admission Mental health (inpatient) Up to 30 days per calendar year 80% after deductible and $150 Precertification required copay per admission Chemical dependency (inpatient) Up to 30 days per calendar year Precertification required 80% after deductible and $150 copay per admission 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. Not covered Not covered Not covered Not covered 50% after deductible and $150 copay per admission No coverage No coverage 51

55 VISION MEDICAL Point-of-Service coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS 1 Hospital (outpatient) Surgery center (outpatient) Birthing centers Emergency care 3 Hospital ER If admitted, you will be covered under Hospital (inpatient) The plan pays The plan pays 80% after deductible 50% after deductible 80% after deductible 50% after deductible 80% after deductible 50% after deductible 80% after your $100 copay 80% after your $100 copay Urgent care Urgent care clinic 80% after your $50 copay 80% after your $50 copay Hearing Exam 100% after your $35 copay Not covered Aids ($1,600 maximum benefit 100% 100% every three years) Alternative care visit Maximum calendar year benefit of $500 Chiropractic visit Maximum 15 visits per calendar year Family planning Including contraceptive devices, sterilization, abortion and fertility drugs Durable medical equipment Convalescent care Maximum 60 days per calendar year Precertification required 100% after your $20 copay 100% after your $20 copay 100% after your $35 copay 50% after deductible Covered as any other illness or injury based on provider of service 50% after deductible 80% after deductible 50% after deductible 80% after deductible and $150 copay per admission (waived if admitted within 3 days of hospitalization) 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 3 Nonemergency use of the emergency room is not covered. 50% after deductible and $150 copay per admission (waived if admitted within 3 days of hospitalization) 52

56 VISION MEDICAL Point-of-Service coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS 1 The plan pays The plan pays Skilled nursing care Maximum 70 shifts of private duty 80% after deductible 50% after deductible nursing per calendar year Precertification required Home health care Maximum 120 visits per 100% after deductible 50% after deductible calendar year Precertification required Hospice care Precertification required 100% after deductible 50% after deductible Short-term rehabilitation (physical, speech and occupational therapy) Maximum 60 visits per calendar year, 80% after deductible 50% after deductible all therapy combined Nicotine-use treatment Maximum lifetime benefit of $ % after your $20 copay per office visit; 100% (no deductible) for other services 100% after your $20 copay per office visit; 100% (no deductible) for other services Mouth, jaw and teeth treatment See Hospital on page 51 for 100% after your office visit copay 50% after deductible hospital facility charges TMJ or MPD treatment Maximum lifetime benefit 50% (no deductible) 50% (no deductible) of $3,000 Precertification required 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. Out-of-Area Dependent plan If you are covered by the Point-of-Service plan and your covered dependent does not live in your home, you must select a PCP in your dependent s local area, if one is available. Otherwise, your dependent may be covered by the Out-of-Area Dependent plan. The Out-of-Area Dependent plan generally provides the same coverage as outlined under Out-of-Network Benefits as shown in the Point-of-Service coverage overview on pages 50-53, except that services are covered at a higher 80% level of benefit, rather than 50%. Call Aetna Partner Services at (888) if you have questions about the Out-of-Area Dependent plan benefits. 53

57 VISION MEDICAL Out-of-Area Dependent coverage overview MEDICAL SERVICE Physician charges Physical exam (preventive care) Hospitalization (inpatient) Emergency care 2 Calendar year out-of-pocket maximum (see page 40 for details) THE OUT-OF-AREA DEPENDENT PLAN The plan pays 80% 1 after $100 deductible Not covered 80% 1 after $100 deductible 80% 1 after $100 deductible $2,000 per person 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 2 Nonemergency visits to the emergency room are not covered. When you visit a provider or facility for medical services, either you or your doctor must file a claim to receive benefits. For more information, see How to File a Claim on page 104. About the Routine Care PPO Plan The Routine Care PPO plan administered by Aetna is an economical plan that provides you with comprehensive routine care and hospitalization coverage if you become seriously ill or injured. The Routine Care PPO plan offers you a choice of health care providers when you receive medical care. You can visit providers or facilities belonging to the Aetna PPO network. You can visit providers or facilities outside the network and pay considerably more out-of-pocket. The plan offers a higher level of coverage when you visit a PPO provider or a significantly lower level of coverage if you visit a non-ppo provider. Providers you can use Under the Routine Care PPO plan, you may visit the providers listed below for your health care needs. PPO providers: PPO providers are physicians or facilities that participate in Aetna s PPO network. When you see a PPO provider, you will get the higher in-network level of benefits. Your copay is lower when you see a primary care physician in Aetna s PPO network. You pay a higher copay when you see an Aetna network specialist. Primary care physicians include general practitioners, family practitioners, internists and pediatricians. Specialists include any physicians who are not considered primary care physicians, such as OB/Gyns, cardiologists, neurologists, dermatologists, etc. If you live in an area where Aetna s Aexcel SM specialist network is available, you must use Aexcel designated specialists to receive in-network benefits. Non-PPO providers: These practitioners and facilities are not part of the Aetna PPO network. If you visit them for care, you will receive a significantly lower level of benefits. Consider your options carefully before using a non-ppo provider. Services provided by out-of-network providers for mental health care and chemical dependency treatment are not covered. 54

58 VISION MEDICAL To locate a PPO provider when you need care, simply follow the steps below: For the most up-to-date listing, link to Aetna s DocFind website from Or, check a provider directory, available at your work location, or call Aetna Partner Services at (888) for a directory. Decide what kind of doctor you want to see. Routine Care PPO coverage overview For details on each of the services below, including coverage requirements, limitations and exclusions, refer to the specific medical service in the When You Need Medical Care chapter. MEDICAL SERVICE IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS 1 Care provided by PPO providers Care provided by non-ppo providers Deductible $200 individual $1,000 individual Per calendar year $600 family $3,000 family Calendar year out-of-pocket maximum $4,000 individual $8,000 individual (see page 40 for details) $12,000 family $24,000 family Aexcel SM specialist required 2 Yes No The plan pays The plan pays Physician charges (other than for mental health and chemical dependency) Primary care office visit 100% after your $25 copay 30% after deductible (nonsurgical) Specialist office visit (nonsurgical) 100% after your $35 copay 30% after deductible All other services, including 70% after deductible 30% after deductible surgical office visits Mental health (outpatient) Up to 30 visits per calendar year 100% after your $35 copay No coverage Chemical dependency (outpatient) Up to 30 visits per calendar year 100% after your $35 copay No coverage Lab & imaging expenses Billed by physician 100% (copay applies if no office visit on same day) 30% after deductible Billed by an independent 70% after deductible 30% after deductible laboratory Billed by a hospital (outpatient) 70% after deductible 30% after deductible Routine laboratory (regardless of 100% 30% after deductible where services rendered) 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 2 If you live in an area where Aetna s Aexcel SM network is available, you must use Aexcel designated specialists to receive in-network benefits. 55

59 VISION MEDICAL Routine Care PPO coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS Care provided by PPO providers The plan pays Physical exam (preventive care) Well child visits 100% after your $25 copay; 6 visits first year of life, 2 visits second year, 1 visit every 12 months age 2 through age 6 Physical exam, age 7 100% after your $25 copay, through 49 1 exam every 24 months Physical exam, age 50 and over 100% after your $25 copay, 1 exam every 12 months Well woman exam 100% after your $25 copay (primary) or $35 (OB/Gyn), 1 exam every 12 months Hospital (inpatient; other than for mental health and chemical dependency) Precertification required 70% after deductible and $700 copay per admission Mental health (inpatient) Up to 30 days per calendar year 70% after deductible and $150 Precertification required copay per admission Chemical dependency (inpatient) Up to 30 days per calendar year Precertification required Hospital (outpatient) Surgery center (outpatient) Birthing centers 70% after deductible and $150 copay per admission OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays 30% after deductible; 6 visits first year of life, 2 visits second year, 1 visit every 12 months age 2 through age 6 30% after deductible, 1 exam every 24 months 30% after deductible, 1 exam every 12 months 30% after deductible, 1 exam every 12 months 30% after deductible and $700 copay per admission No coverage No coverage 70% after deductible 30% after deductible 70% after deductible 30% after deductible 70% after deductible 30% after deductible Emergency care 3 Hospital ER If admitted, you will be covered under Hospital (inpatient) 70% after your $100 copay 70% after your $100 copay 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 3 Nonemergency use of the emergency room is not covered. 56

60 VISION MEDICAL Routine Care PPO coverage overview, continued MEDICAL SERVICE IN-NETWORK BENEFITS Care provided by PPO providers OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays The plan pays Urgent care Urgent care clinic 70% after your $50 copay 70% after your $50 copay Routine hearing Exams and aids Not covered Not covered Alternative care visit Not covered Not covered Chiropractic visit Not covered Not covered Family planning Including contraceptive devices, Covered as any other illness or 30% after deductible sterilization, abortion and fertility drugs injury based on provider of service Durable medical equipment 70% after deductible 30% after deductible Convalescent care Maximum 60 days per calendar year Precertification required 70% after deductible and $700 copay per admission (waived if admitted within 3 days of hospitalization) 30% after deductible and $700 copay per admission (waived if admitted within 3 days of hospitalization) Skilled nursing care Maximum 70 shifts of private duty nursing per calendar year 70% after deductible 30% after deductible Precertification required Home health care Maximum 120 visits per calendar year 100% after deductible 30% after deductible Precertification required Hospice care Precertification required 100% after deductible 30% after deductible Short-term rehabilitation (physical, speech and occupational therapy) Maximum 60 visits per calendar year, all therapy combined 70% after deductible 30% after deductible 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 57

61 VISION MEDICAL Routine Care PPO coverage overview, continued MEDICAL SERVICE Nicotine-use treatment Maximum lifetime benefit of $500 Mouth, jaw and teeth treatment See Hospital on page 56 for hospital facility charges TMJ or MPD treatment Maximum lifetime benefit of $3,000 IN-NETWORK BENEFITS Care provided by PPO providers OUT-OF-NETWORK BENEFITS 1 Care provided by non-ppo providers The plan pays The plan pays 100% after $25 copay per office 100% after $25 copay per office visit; 100% (no deductible) for visit; 100% (no deductible) for other other services services 70% after your office visit copay 30% after deductible 50% (no deductible) 30% (no deductible) Precertification required 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. In some locations, the availability of Aetna PPO providers for durable medical equipment, convalescent and skilled nursing care, home health care, hospice care, medical laboratory and short-term rehabilitation may be inadequate as determined by Aetna. In these cases, Aetna may elect to pay in-network benefits for services delivered by non-ppo providers. Call Aetna Partner Services at (888) if you have a need for these services and find availability of PPO providers to be limited. About the Out-of-Area Plan If you live outside of the Aetna network area for the Point-of-Service plan generally more than 20 miles or 20 minutes from two primary care physicians (PCPs) you are eligible for the Out-of-Area plan. You must meet an annual deductible before the plan starts paying benefits usually 80% of covered services. However, you do not need to pay a deductible for routine/preventive care, including physical exams, immunizations, Pap smears and mammograms. Providers you can use For care other than mental health or chemical dependency treatment, the Out-of-Area plan allows you to visit any licensed physician or hospital of your choice. You choose your provider at the time you need care. However, if you are in a location where Aetna has a network of providers, you and Starbucks will pay less for care when you use a participating provider. You may visit certain licensed practitioners of your choice for acupuncture or other alternative care. You are covered for up to $500 per calendar year for all alternative care. For mental health and chemical dependency treatment, you must visit an Aetna network provider. 58

62 VISION MEDICAL Out-of-Area coverage overview For details on each of the services below, including coverage requirements, limitations and exclusions, refer to the specific medical service in the When You Need Medical Care chapter. MEDICAL SERVICE THE OUT-OF-AREA PLAN 1 Deductible $100 per individual Per calendar year $300 maximum per family Calendar year out-of-pocket maximum $1,750 per individual (see page 40 for details) The plan pays Physician charges (other than for mental health and chemical dependency) Office visits 80% after deductible Lab & imaging expenses Billed by physician 80% after deductible Billed by an independent laboratory 80% after deductible Billed by a hospital (outpatient) 80% after deductible Routine Pap smear and mammograms 100%, not subject to deductible Other routine laboratory 100%, not subject to deductible Physical exam (preventive care) Well child visits 100% no deductible, for 6 visits first year of life, 2 visits second year, 1 visit per year age 2 through age 6 Physical exam, age 7 through % no deductible, one exam every 24 months Physical exam age 50 and older 100% no deductible, one exam every 12 months Well woman exam once every 12 months 100%, no deductible Mental health (outpatient) Up to 30 visits per calendar year 100% after your $25 copay Chemical dependency (outpatient) Up to 30 visits per calendar year Requires use of Aetna network providers no coverage for out-of-network providers 100% after your $25 copay Requires use of Aetna network providers no coverage for out-of-network providers Hospital (inpatient; other than for mental health and chemical dependency) Precertification required 80% after deductible 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 59

63 VISION MEDICAL Out-of-Area coverage overview, continued MEDICAL SERVICE THE OUT-OF-AREA PLAN 1 The plan pays Mental health (inpatient) Up to 30 days per calendar year 80% after deductible and $150 copay per admission Precertification required Chemical dependency (inpatient) Up to 30 days per calendar year Precertification required Hospital (outpatient) Surgery center (outpatient) Birthing centers Requires use of Aetna network providers no coverage for out-of-network providers 80% after deductible and $150 copay per admission Requires use of Aetna network providers no coverage for out-of-network providers 80% after deductible 80% after deductible 80% after deductible Emergency care 3 80% after deductible Urgent care 80% after deductible Hearing Exam Not covered Aids ($1,600 maximum benefit every three years) 100%, no deductible Alternative care visit Maximum calendar year benefit of $500 80% after deductible Chiropractic visit Maximum 15 visits per calendar year 80% after deductible Family planning Including contraceptive devices, sterilization, 80% after deductible abortion and fertility drugs Durable medical equipment Convalescent care Maximum 60 days per calendar year Precertification required 80% after deductible 80% after deductible 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. 3 Nonemergency use of the emergency room is not covered. 60

64 VISION MEDICAL Out-of-Area coverage overview, continued MEDICAL SERVICE THE OUT-OF-AREA PLAN 1 The plan pays Skilled nursing care Maximum 70 shifts of private duty nursing per 80% after deductible calendar year Precertification required Home health care Maximum 120 visits per calendar year 80% after deductible Precertification required Hospice care Precertification required 100% after deductible Short-term rehabilitation (physical, speech and occupational therapy) Maximum 60 visits per calendar year, all therapy 80% after deductible combined Nicotine-use treatment Maximum lifetime benefit of $500 80% after deductible Mouth, jaw and teeth treatment See Hospital on page 59 for hospital facility 80% after deductible charges TMJ or MPD treatment Maximum lifetime benefit of $3,000 50%, no deductible Precertification required 1 You and your enrolled dependents are responsible for any charges that exceed recognized charges. Typically, you must pay for services when you receive them, then file a claim for reimbursement from the plan. 61

65 VISION MEDICAL Overview of Other Medical Plans About the York Medical Plan The York Medical plan provides medical coverage only when you visit the doctors and facilities that are part of the Keystone Health Plan Central network of providers. For detailed information about the York Medical plan, please refer to the Keystone Health Plan Central Certificate of Coverage, available from Starbucks Benefits Center at (877) SBUXBEN or from Partner Resources at the York roasting plant in York, Pennsylvania. The Certificate of Coverage is considered a component of the contract and will be used as the source document when processing claims. Providers you can use To receive coverage through the York Medical plan, you must select a primary care physician (PCP) from the Keystone Health Plan Central provider network. Your PCP will coordinate all your care. You may choose the same PCP for yourself and your enrolled dependents or you may choose a different PCP for each person. You will receive your plan ID cards once you and all your enrolled family members have designated a PCP. You must notify Keystone Health Plan Central of your PCP selections before your first visit. If you need to see a specialist, you must first contact your PCP for treatment or referral to the specialist. Even if you are new to the plan and have previously received treatment from a network specialist, you will need a referral from your PCP to receive benefits under the York Medical plan. If you do not select a PCP or do not receive a specialist referral from your PCP in advance of any specialist care, or if you visit an out-of-network provider, you will not receive any benefits from the York Medical plan. For more information about PCPs and when you may self-refer to an OB/Gyn for female care, see the Certificate of Coverage issued by Keystone Health Plan Central. Covered medical services Generally, all care must be provided at the Keystone Health Plan Central facilities and prescribed by the Keystone Health Plan Central staff to be covered. Brochures and enrollment information outlining details of the Keystone Health Plan Central plan are available upon request at no cost to you. Contact Starbucks Benefits Center at (877) SBUXBEN or Partner Resources at the York roasting plant in York, Pennsylvania. The brochures and enrollment materials describe: The nature of services provided Conditions of eligibility for services Circumstances under which services may be denied Procedures to obtain services Procedures for review of claims for services which have been denied either totally or in part 62

66 VISION MEDICAL About the HMSA Preferred Provider Plan The HMSA Preferred Provider Plan is available to eligible partners working in Hawaii. With this plan, you have a choice of receiving care in- or out-of-network. When you use HMSA network providers, however, your costs are lower. You do not pay a deductible for most in-network services. Routine physicals are covered at 100%, up to plan limits. And you just pay a copay for most prescription drugs. For detailed information about the HMSA Preferred Provider Plan, please refer to HMSA Preferred Provider Plan Guide to Benefits, available from Starbucks Benefits Center at (877) SBUXBEN. The HMSA Preferred Provider Plan Guide to Benefits is considered a component of the contract and will be used as the source document when processing claims. Providers you can use You can see any licensed provider and be covered. When you use HMSA providers, more of your costs are covered and the deductible does not apply. For example, the plan covers 90% of the cost of a doctor office visit from a network provider. If you use a provider not in the network, the plan covers 70% of the cost after you meet the $100 deductible for single coverage, or $300 for family coverage. You can find a list of participating providers online at and link to Hawaii Medical Plans. You can also request a printed copy of an HMSA provider directory by calling HMSA directly at (808) Covered medical services The plan covers a wide range of services, including doctor office visits, preventive care, hospitalization, emergency care and prescription drugs. Brochures and enrollment information outlining details of the HMSA Preferred Provider Plan are available upon request at no cost to you. Contact Starbucks Benefits Center at (877) SBUXBEN. The brochures and enrollment materials describe: The nature of services provided Conditions of eligibility for services Circumstances under which services may be denied Procedures to obtain services Procedures for review of claims for services which have been denied either totally or in part 63

67 VISION MEDICAL About the Kaiser Hawaii HMO Plan The Kaiser Hawaii HMO Plan is available to eligible partners and their dependents working in the Hawaii service area of Oahu, Maui, Kauai, and Hawaii (except for certain service areas as determined by Kaiser). You are covered for medically necessary services within the Hawaii service area at Kaiser Permanente facilities. To be covered, your care must be provided and arranged by a Kaiser Permanente physician. There is no deductible and you pay only a $14 copay for most services. For detailed information, please refer to the Kaiser Hawaii HMO Plan Group Medical and Hospital Service Agreement, available from the Starbucks Benefits Center at (877) SBUXBEN. The Group Medical and Hospital Service Agreement is considered a component of the contract and will be used as the source document when processing claims. Receiving care You ll need to present your Kaiser Permanente ID card to receive care and services. Please carry it with you at all times. We encourage you to choose your own Kaiser Permanente primary care physician (PCP), who will provide and coordinate all the medical services you need. This allows for greater continuity of care and provides you the opportunity to choose someone with whom you feel comfortable. You also have the freedom to change your PCP at any time. You ll need a referral to see a specialist for the first time. Your PCP can refer you to a specialist when it s medically necessary. For more information about your Kaiser Permanente ID card, selecting a PCP, and for a list of services and departments you can self-refer to, please refer to your Kaiser Permanente Member Handbook or visit and link to Hawaii Medical Plans. Covered medical services Generally, all care must be provided by Kaiser Permanente providers and facilities to be covered. Brochures and enrollment information outlining details of the Kaiser Hawaii HMO Plan are available upon request at no cost to you. Contact Starbucks Benefits Center at (877) SBUXBEN. The brochures and enrollment materials describe: The nature of services provided Conditions of eligibility for services Circumstances under which services may be denied Procedures to obtain services Procedures for review of claims for services which have been denied either totally or in part 64

68 When you need medical care Alternative Care 66 Chemical Dependency Treatment 67 Chiropractic Care 70 Convalescent Care 70 Doctor s Office Visits 71 Aetna s Aexcel SM specialist network 74 Durable Medical or Surgical Equipment 75 Emergency and Urgent Care 76 Family Planning Services 78 Hearing Exam and Hearing Aids 79 Home Health Care 80 Hospice Care 81 Hospitalization 82 Laboratory, X-ray and Imaging Expenses 83 Medical Necessity 83 Mouth, Jaws and Teeth Conditions 88 Nicotine-use Treatment 89 Physical Exam (Preventive Care) 89 Precertification 90 Pregnancy-related Coverage 94 Moms-to-Babies Maternity Program 94 Preventive Gynecological Exam (Well Woman) 96 Short-Term Rehabilitation (Physical, Speech and Occupational Therapy) 96 Skilled Nursing Care 97 Surgery 98 TMJ or MPD Treatment 100 What Is Not Covered 101 How to File a Claim 104 Questions? 106 Mental Health Treatment 84 65

69 VISION WHEN YOU NEED MEDICAL CARE In this section, you can find information about Starbucks medical plan coverage administered by Aetna. Alternative Care Starbucks Point of Service, Open Choice PPO and Out-of-Area medical plans cover expenses for alternative medical care, which includes: Acupuncture Holistic treatment and therapy Homeopathic care Naturopathic treatment and therapy Coverage includes charges for the diagnostic and therapeutic services provided by: Medical doctors (M.D.) Osteopaths (D.O.) Naturopathic physicians (N.D.) Acupuncturists (L.Ac.) Covered services include those provided within the scope of a provider s professional license, such as laboratory and diagnostic tests and procedures, including those necessary to treat an illness or injury. Typically, you pay for alternative care treatment when you receive it, then submit a claim for reimbursement from Aetna. Refer to How to File a Claim on page 104 for information on submitting a claim for reimbursement. The maximum benefit paid by the plan is $500 per covered person per calendar year. Alternative care providers you can use You can visit any provider you choose you do not need to obtain precertification or referrals to see an alternative care provider. And, if you use a provider from Aetna s network of natural therapy professionals, you will enjoy a discounted fee. Alternative health care network Aetna s network of natural therapy professionals is available to Starbucks partners who are enrolled in an Aetna-administered medical plan. You can access many types of alternative health-related providers, including chiropractors, acupuncturists, massage therapists and nutritional counselors who have agreed to provide their services to Aetna members at reduced rates. You will want to confirm the provider you select and the services you receive are covered under Starbucks Alternative Care benefit. Members can also receive discounts on health-related products, including over-the-counter vitamins, herbal and nutritional supplements and natural products. To obtain more information and to request a directory of Aetna s network of natural therapy professionals, call Aetna Partner Services at (888) or visit Aetna DocFind by linking from 66

70 VISION WHEN YOU NEED MEDICAL CARE What is not covered These alternative care services and items are not covered by Starbucks medical plans. For a list of additional services not covered by Starbucks medical plans, see page 101. Vitamins, minerals, homeopathic preparations and herbs, whether or not they were prescribed by an alternative care provider Expenses for treatment of nicotine use covered under the Starbucks plans administered by Aetna (refer to Nicotine-use Treatment on page 89 for more information) Expenses for services provided by a licensed massage therapist Chemical Dependency Treatment What the plans cover You are covered for medically necessary chemical dependency treatment as long as you remain enrolled in a Starbucks medical plan administered by Aetna. The plan has a calendar year maximum benefit of up to 30 chemical dependency inpatient days and 30 outpatient visits per calendar year. Each day of inpatient hospitalization counts as one treatment day. Every two days of partial hospitalization, intensive outpatient, residential treatment and outpatient care count as one treatment day. Covered chemical dependency treatment includes: Inpatient hospitalization Partial hospitalization Intensive outpatient treatment Residential treatment Outpatient care You are required to use an Aetna network provider and to precertify all care other than routine outpatient care for services to be covered. The exception is in the case of an emergency. Before seeking chemical dependency treatment, consider using the Employee Assistance Program (EAP) (see page 30) to receive information, consultation, resources and up to three counseling sessions per calendar year with a network counselor at no cost to you. Inpatient Covered expenses for treatment in a hospital or treatment facility include: Treatment of the medical complications of alcoholism or drug abuse Treatment of alcoholism or drug abuse Room and board at the semiprivate room rate Other necessary services and supplies Some convalescent facility expenses There is no coverage if you receive out-of-network inpatient treatment, in-network inpatient treatment that is not precertified or if Aetna determines the treatment is not medically necessary. 67

71 VISION WHEN YOU NEED MEDICAL CARE Partial hospitalization, intensive outpatient care and residential treatment When you require care that is more intensive then outpatient visits but not as acute as inpatient hospitalization, the plan covers alternative levels of care, including partial hospitalization, intensive outpatient care and residential treatment. Partial hospitalization refers to care delivered on a daily basis, rather than 24 hours, in a hospital or other facility. The patient returns home each evening. Intensive outpatient care refers to care delivered on an outpatient basis, generally in a hospital or other facility setting, more than two times per week. Care is generally provided in a structured group format. Residential treatment refers to 24-hour-a-day sub-acute care, supervision and support in a licensed residential facility under the supervision of licensed or certified mental health professionals. Outpatient Generally, outpatient care is individual, family or group counseling. Outpatient care also includes medication management services. This type of care does not require precertification. Nonroutine outpatient visits (such as psychological testing and intensive outpatient treatment) need to be precertified. For answers to your questions about outpatient services that require precertification, call Aetna at (888) Use network providers To be covered, you must visit an Aetna network provider. There is no coverage available for treatment received from providers who are not in the network, except in the case of an emergency. If you receive emergency treatment, you must call Aetna within two business days. The Aetna network has a full range of providers, including hospitals, day hospital programs, halfway houses, outpatient centers, residential treatment centers, clinics, psychiatrists, psychologists, clinical social workers, marriage counselors and other behavioral care providers. You can obtain a list of network providers by linking to Aetna s DocFind online provider directory from or by calling Aetna at (888) Precertification You are required to precertify the following types of care in order for them to be covered: Nonroutine outpatient care (e.g., intensive outpatient treatment or psychological testing) All facility-based care, including inpatient, residential treatment and partial hospitalization care If you proceed with treatment that has not been precertified when precertification is required, you will be responsible for the full cost of your care. You do not need to precertify routine outpatient office visits for counseling or medication management. For answers to your questions about outpatient services that require precertification, call Aetna at (888)

72 VISION WHEN YOU NEED MEDICAL CARE How to obtain precertification To precertify care, call Aetna at (888) Aetna provides confidential and professional consultation 24 hours a day, seven days a week. An Aetna clinical case manager will help you identify the most appropriate care and providers. Aetna will review your condition and precertify a length and level of treatment. You may be referred to a network provider who is generally no more than 30 minutes from your home or work location. In the case of an emergency, Aetna will refer you to the nearest appropriate resource. If your condition requires ongoing nonroutine outpatient care or facility-based care, Aetna s clinical case manager will regularly review your condition to assess your ongoing treatment needs, assist in treatment planning and determine benefit coverage. After each review, Aetna will send you a letter informing you if additional treatment has been precertified. When you need emergency care If you need emergency chemical dependency treatment, call Aetna at (888) before getting care. Aetna will direct you to the nearest appropriate facility for treatment. If the situation is so urgent that you cannot contact Aetna before getting treatment, you must see a qualified, licensed provider for care. However, you or someone representing you should call Aetna at (888) within two business days of receiving the care. If Aetna is not contacted or if Aetna determines your condition was not an emergency or treatment was not medically necessary, your care will not be covered. What Is Emergency Care? Emergency care means services needed to treat a condition for which delay in notification or certification could seriously jeopardize your life or health. It is also a condition in which you or your doctor feels may cause life or bodily danger to yourself or others if you do not seek care immediately. What is not covered The following services are not covered by your chemical dependency benefits. For a list of additional services not covered by Starbucks medical plans, see page 101. Services, treatments or supplies provided by an out-of-network provider without precertification by Aetna, except for emergency treatment as determined by Aetna Services, treatments or supplies primarily for rest, custodial, domiciliary or convalescent care Diagnosis and treatment for personal growth and/or development, or in conjunction with professional precertification Marriage counseling, except for the treatment of a mental health or substance abuse condition 69

73 VISION WHEN YOU NEED MEDICAL CARE Ancillary services such as: Vocational rehabilitation Activities of daily living training Sleep therapy Employment counseling Treatment, training or education therapy for learning disabilities and other developmental disorders Other educational services Services, treatment or supplies obtained through or required by any governmental agency or program, whether federal, state or local excluding Medi-Cal Services, treatment or supplies caused by a third party against whom you have a claim for damages, unless you provide Aetna with a lien against your claim for damages Psychological examination, testing or treatment to satisfy an employer s, prospective employer s or other party s requirements for gaining employment, licensing or insurance or for the purposes of judicial or administrative proceedings, including parole or probation proceedings Psychological testing, except when conducted for the purpose of diagnosing a mental health or substance abuse condition, and with the prior approval of Aetna Treatment of obesity or weight reduction, or for the cessation of smoking, including supplies Stress management therapy without a covered psychiatric diagnosis Treatment of pain, except for medically necessary treatment of pain with psychological or psychosomatic origins as determined by Aetna Treatment for a chronic mental condition except for: Stabilization of an acute episode of such disorder Management of medicine Questions? For questions about your mental health/chemical dependency benefits, contact Aetna at (888) Chiropractic Care Chiropractic care is covered as a specialist visit under the Open Choice PPO, Point-of-Service and Out-of-Area plans. Under the Point-of-Service plan, you do not need to obtain a referral for this benefit as long as you use a chiropractor contracted with Aetna. The plans cover up to 15 visits per calendar year. Convalescent Care A convalescent facility is an institution licensed to provide care for people recuperating from a sickness or injury. Professional nursing care is provided by either a registered nurse (R.N.) or licensed practical nurse (L.P.N.). Physical restoration services are also designed to help patients care for themselves in their daily living. 70

74 VISION WHEN YOU NEED MEDICAL CARE Precertification for convalescent care is required. See Precertification on page 90 for more information. A convalescent facility provides 24-hour nursing care by licensed nurses supervised full-time by a physician or R.N. It keeps a complete medical record on each patient, has a utilization review plan and charges for its services. A convalescent facility is not an inpatient mental health/chemical dependency treatment facility or hospital. See page 84 for information about mental health care and page 67 for information about chemical dependency treatment coverage. What the plans cover Starbucks medical plans cover medically necessary services and supplies when you are confined to a convalescent facility, including: Room and board, including general nursing care, up to the semiprivate 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 convalescent facility, not including private or special nursing or doctor s services Medical supplies Convalescent care is covered for up to 60 days per calendar year. What is not covered Convalescent facility care is not covered by Starbucks medical plans for the treatment of drug addiction, chronic brain syndrome, alcoholism, senility, and any other mental disorder. For a list of additional services not covered by Starbucks medical plans, see page 101. Doctor s Office Visits When you need to see a physician for the treatment of a sickness or injury, the services you receive in the doctor s office or hospital are covered under Starbucks medical plans, as long as you make the required copay or meet any annual calendar year deductible. What the plans cover Covered services include any medically necessary diagnostic lab work and x-rays ordered by your doctor, provided within the doctor s office and billed by your doctor. Lab and x-ray services billed by a provider other than your doctor will be covered at your plan s payment percentage for that provider, after your copay or deductible has been satisfied. For example, lab and x-ray services billed by a hospital are paid as a hospital expense. 71

75 VISION WHEN YOU NEED MEDICAL CARE Specialty care Under Starbucks medical plans, a specialist is any physician other than: Your PCP (under the Point-of-Service plan) A primary care physician (under the Open Choice or Routine Care PPO plans), including a: General practitioner Family practitioner Internist Pediatrician Depending on your medical plan, where you live and what type of specialist you need to see, you may need to obtain a referral or seek care from a physician in the Aetna Aexcel SM network as outlined below: TO RECEIVE IN-NETWORK BENEFITS UNDER THE YOU MUST Point-of-Service plan In locations where the Aexcel specialist network is not Receive a referral from your PCP and obtain care available from an Aetna network specialist In locations where the Aexcel specialist network applies A referral is not required, but you will need and you need care from one of the Aexcel specialties to obtain care from an Aexcel specialist when seeking care from one of the 11 specialties In locations where the Aexcel specialist network applies Receive a referral from your PCP and obtain care and you need care from a specialty not included in Aexcel from an Aetna network specialist Routine Care PPO plan In locations where the Aexcel specialist network is not Obtain care from an Aetna network specialist available In locations where the Aexcel specialist network applies Obtain care from an Aexcel designated specialist and you need care from one of the Aexcel specialties when seeking care from one of the 11 specialties In locations where the Aexcel specialist network applies Obtain care from an Aexcel network specialist and you need care from a specialty not included in Aexcel Open Choice PPO plan Obtain care from an Aetna network specialist 72

76 VISION WHEN YOU NEED MEDICAL CARE Here are some examples of how this works for a location where Aexcel applies: FOR PARTNERS IN THE POINT-OF-SERVICE PLAN Partner location Specialty care needed How partner seeks care SEATTLE, WA Aexcel applies Cardiology Aexcel specialty Obtains care from an Aexcel specialist with no referral from the PCP required SEATTLE, WA Aexcel applies Audiology Not an Aexcel specialty Obtains a referral from the PCP and obtains care from an Aetna network specialist DENVER, CO Aexcel not available Any specialty Obtains a referral from the PCP and obtains care from an Aetna network specialist FOR PARTNERS IN THE ROUTINE CARE PPO OR OPEN CHOICE PLAN Partner location Specialty care needed How partner seeks care DALLAS, TX Orthopedics Obtains care from an Aexcel specialist Aexcel applies DALLAS, TX Audiology Obtains care from an Aetna network specialist Aexcel applies Not an Aexcel specialty DENVER, CO Aexcel not available Any specialty Obtains care from an Aetna network specialist Not sure if Aexcel applies to you? Check your Aetna medical ID card. Remember, when Aexcel applies, it is your responsibility to make sure you are obtaining care from an Aexcel specialist. 73

77 VISION WHEN YOU NEED MEDICAL CARE Aetna s Aexcel SM specialist network Where available, the Point-of-Service and Routine Care PPO plan will include Aetna s Aexcel network of specialists, whom you must use to receive in-network benefits when obtaining care from one of the included specialties. When you use these specialists, no referrals are required. AEXCEL SM LOCATIONS ARIZONA CALIFORNIA: Los Angeles and Northern Counties: San Francisco, Alameda, Contra Costa, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma CONNECTICUT DISTRICT OF COLUMBIA FLORIDA: Northern Counties: Baker, Clay, Duval, Flagler, Nassau, Saint Johns, Volusia; Central Counties: Brevard, Charlotte, Hernando, Hillsborough, Lake, Orange, Manatee, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, Sumter; Southern Counties: Miami-Dade, Broward, Indian River, Palm Beach, Martin, St. Lucie, Okeechobe GEORGIA: Atlanta ILLINOIS: Chicago (Includes Lake and Porter Counties in Indiana) MAINE MARYLAND NEW JERSEY: Northern Counties: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren NEW YORK: Metro Counties: Bronx, Dutchess, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, Westchester OHIO: Central Ohio: Columbus; Northeast Ohio: Cleveland and Toledo TEXAS: Austin, Dallas/Ft. Worth, Houston, San Antonio VIRGINIA: Northern Counties: Alexandria City, Arlington, Caroline, Clarke, Culpeper, Fairfax, Fairfax City, Falls Church City, Fauquier, Fredericksburg City, King George, Loudoun, Manassas City, Prince William, Spotsylvania, Stafford, Westmoreland WASHINGTON: Seattle/Western Washington AEXCEL SM SPECIALISTS Cardiology (except pediatric) Gastroenterology Orthopedics Neurology (except pediatric) Plastic surgery Urology Cardiothoracic surgery General surgery Otolaryngology (ear, nose, throat) Neurosurgery Vascular surgery The specialists chosen for the Aexcel network have been required to meet specific measures of effective care delivery and defined standards for performance. Over time, additional locations and specialties will be added. If Aexcel applies to you, your enrollment confirmation letter will indicate enrollment in Aexcel and your medical ID card will display Aexcel. When you access DocFind and enter your plan, only Aexcel specialists will be identified by a blue star. If you are using a specialist who is not in the Aexcel network When Aexcel is introduced in your geographic area and you have a medical condition that requires continuing treatment by your current specialist (for specialties covered by Aexcel) and your doctor is not in the Aetna Aexcel network, you may apply for continuing treatment by your current doctor for a period of time. Contact Aetna Partner Services at (888) for a Transition Coverage Request Form. 74

78 VISION WHEN YOU NEED MEDICAL CARE Seeing an Aexcel SM Specialist When you need specialty care, you can confirm that the specialist is part of the Aexcel network by linking to Aetna s DocFind online provider directory from Aexcel specialists are identified with a blue star next to their names. Note that if you see a specialist who is not part of the Aexcel network (even with a PCP referral), you will receive the lower, out-of-network level of benefits (even if the specialist is a member of the overall Aetna network). If You Are Currently Receiving Specialist Treatment If you are in an active course of treatment with a non-aexcel specialist when the Aexcel network becomes available where you live, you can request that Aetna approve coverage through the completion of your treatment with your current specialist. You can continue to see your current specialist without approval, but you would receive the out-of-network level of benefits. To receive maximum benefits, you would need to switch to an Aexcel specialist. Durable Medical or Surgical Equipment Durable medical and surgical equipment is defined as equipment that is: Made to withstand prolonged use Made for and mainly used in the treatment of a disease or injury Suited for use in the home Not normally of use to persons who do not have a disease or injury Not for use in altering air quality or temperature Not for exercise or training What the plans cover Starbucks medical plans cover medically necessary durable medical equipment, such as oxygen tents, wheelchairs, crutches, hospital beds and artificial limbs and eyes. Medically necessary prosthetics and orthotics require precertification. At Aetna s discretion, rental or purchase of the equipment will be covered, depending on which is most cost effective. What is not covered Charges for more than one piece of equipment intended for the same or similar purpose are not covered. For a list of additional items not covered by Starbucks medical plans, see page

79 VISION WHEN YOU NEED MEDICAL CARE What Are Prosthetics? A prosthetic is a medical device that replaces all or part of internal body organs or external body parts lost or impaired as a result of disease or injury. Emergency and Urgent Care Emergency care and urgent care are defined differently. It is important that you understand the differences in order to use your plan effectively. Emergency care Emergency care is defined as treatment given in a hospital s emergency room immediately after you suddenly and severely get sick, experience acute pain or suffer an injury. Your condition, sickness or injury should lead a reasonable person to believe that failing to get immediate medical care could result in: Placing your health in serious jeopardy Serious impairment to bodily function Serious dysfunction of a body part or organ In the case of pregnancy, serious jeopardy to the health of the fetus If you have a true life-threatening medical emergency, get care immediately from the nearest source. Benefits are paid at the same level regardless of whether the emergency room is within a network facility. If you are enrolled in the Point-of-Service plan, you will need to call your PCP within two business days of receiving emergency care. There is no coverage if you visit an emergency room for a condition that does not meet one of the four criteria listed above. What the plans cover Medically necessary emergency care received in the emergency room of a hospital is covered by Starbucks medical plans. The plans also cover ambulance service for transportation to the emergency room for emergency treatment. If you are in the Point-of-Service plan, contact your PCP within two business days after admission to the emergency room to receive the higher in-network level of coverage. What is not covered Nonemergency care received in the emergency room is not covered under any Starbucks medical plan. If you are enrolled in the Point-of-Service plan, your care will be covered if you were referred to the emergency room by your PCP. For a list of additional services not covered by Starbucks medical plans, see page

80 VISION WHEN YOU NEED MEDICAL CARE Urgent care Urgent care is defined as a sudden illness, injury or condition that: Is severe enough to require prompt medical attention to avoid serious deterioration of the covered person s health Includes a condition that would subject the covered person to severe pain that could not be adequately managed without urgent care or treatment Does not require the level of care provided in the emergency room of a hospital, and Requires immediate outpatient medical care that cannot be postponed until the covered person s physician becomes reasonably available What the plans cover Services received from an urgent care provider to evaluate and treat an urgent condition are covered by Starbucks medical plans. Benefits are paid at the same level whether you see a network or non-network provider. If you are in the Point-of-Service plan, call your PCP to let him or her know you have received urgent care. What is an urgent care provider? An urgent care provider is: A freestanding medical facility that: Provides unscheduled medical services to treat an urgent condition if the person s physician is not reasonably available Routinely provides ongoing unscheduled medical services Is run by a staff of physicians with at least one physician on call at all times A physician s office, but only one that: Has contracted with Aetna to provide urgent care and is included in the provider directory as a Preferred Urgent Care Provider An urgent care provider is not the emergency room or outpatient department of a hospital. Treatment by an Urgent Care Provider You should not seek medical care or treatment from an urgent care provider if your illness, injury or condition is an emergency condition. Go directly to the emergency room of a hospital or call 911 (or the local equivalent) for ambulance and medical assistance. 77

81 VISION WHEN YOU NEED MEDICAL CARE Family Planning Services The family planning services listed below are covered by Starbucks medical plans if provided by a doctor or hospital. If you are in the Point-of-Service plan, you must be referred by your PCP to receive the higher innetwork level of coverage, unless you live in an area served by Aetna s Aexcel SM network, in which case you can self-refer to an Aexcel specialist: Vasectomy for voluntary sterilization Tubal ligation for voluntary sterilization Voluntary abortion Therapeutic abortion Oral and injectable fertility drugs (some fertility drugs may be covered under the prescription drug benefit depending on the drug and how it is administered) Fitting of contraceptive devices, injectable contraceptives, Norplant and charges for the administration or injection of contraceptives, and surgical implantation or removal and re-implantation of Norplant capsules in the upper arm If you are in the Routine Care PPO or Point-of-Service plan and live in an area served by the Aetna Aexcel network, if seeking care from a designated specialty be sure to see an Aexcel specialist for these services or for general surgery. See page 42 for more information. Reversal of a sterilization procedure and artificially assisted reproduction, such as in vitro fertilization, artificial insemination and embryo transfer procedures are not covered. For a list of additional services not covered by Starbucks medical plans, see page 101. For information on outpatient surgery performed in a hospital, see Hospitalization on page 82. Oral Contraceptives You may be covered for oral contraceptives. See the Prescription Drugs chapter for more details. What About Infertility Treatment? Starbucks medical plans cover the diagnoses and treatment of an underlying medical condition, such as an ovarian cyst. Artificially assisted reproductive technologies, such as in vitro fertilization and artificial insemination, are not covered by the plans. If you are considering adoption, see the Adoption Assistance chapter for information about that benefit. 78

82 VISION WHEN YOU NEED MEDICAL CARE Hearing Exam and Hearing Aids The Open Choice PPO and Point-of-Service plans provide coverage for routine hearing exams and/or hearing aids. The Out-of-Area plan provides coverage for hearing aids. Routine hearing exams (unless medically necessary) and hearing aids are not covered under the Routine Care PPO plan. A routine hearing exam is an audiometric exam performed by one of the following: Certified otolaryngologist Certified otologist Legally licensed or credentialed audiologist who performs the exams at the written direction of a legally qualified otolaryngologist or otologist What the plans cover Hearing exams Open Choice PPO and Point-of-Service plans Coverage is limited to one exam every 24 months. If you are enrolled in the Point-of-Service plan, the exam must be provided by an Aetna network provider. A referral by your PCP is not required. The routine hearing exam benefit does not cover any ear or hearing exam to diagnose or treat a disease or injury. (See your family physician or PCP for these services.) Hearing aids Coverage under the Open Choice PPO, the Point-of-Service and the Out-of-Area plans includes charges for the purchase and repair of medically necessary hearing aids when prescribed by a physician to correct hearing loss or impairment. You are covered for one hearing aid per ear. The maximum payable under this benefit is $1,600 during the three-year period immediately following the fitting of the hearing aid(s). What is not covered The following hearing services are not covered by Starbucks medical plans: Drugs or medicines Any hearing care service or supply covered under any workers compensation law or other law of similar purpose, whether benefits are payable on all or part of the charges Any hearing care service or supply that does not meet professionally accepted standards Any exams given while you are confined to a hospital or other facility for medical care Exams in any way related to employment For a list of additional items not covered by Starbucks medical plans, see page

83 VISION WHEN YOU NEED MEDICAL CARE Home Health Care Home health care provides for the care and treatment of a sickness or injury in the patient s home as part of a home health care plan. This care and treatment must be prescribed in writing by your doctor. Precertification is required for home health care under all Starbucks medical plans. See Precertification on page 90 for more information. A home health care agency provides you with skilled nursing and other therapeutic services, is supervised full time by a physician or an R.N. and meets licensing standards. What the plans cover Home health care expenses are covered by Starbucks medical plans as long as all three of these criteria are met: 1. Charges are made by a home health care agency, 2. The care is given under a home health care plan, and 3. The care is given to you in your home. Covered charges include: Part-time or intermittent care by a registered nurse (R.N.) or a licensed practical nurse (L.P.N.) if an R.N. is not available Part-time or intermittent home health aide services for patient care Physical, occupational and speech therapy Charges for medical supplies, drugs and medicines and lab services are covered to the extent they would have been covered if a person had been confined in a hospital or convalescent facility. The maximum number of covered home health care visits is 120 per calendar year. Each visit by a nurse or therapist counts as one visit. Each home health aide visit of up to four hours counts as one visit. What is not covered Home health care coverage does not include the following: Services or supplies not part of the home health care plan Services of a person who usually lives with you or is a member of your or your spouse or domestic partner s family Services of a social worker Transportation For a list of additional services not covered by Starbucks medical plans, see page

84 VISION WHEN YOU NEED MEDICAL CARE Hospice Care Hospice care is care for terminally ill people with six or less months to live in conjunction with a hospice care program. A hospice care program is designed to provide medically necessary supportive care to terminally ill persons and their families. Licensed hospice care agencies and facilities provide care 24 hours a day, including skilled nursing services, medical social services and psychological and dietary counseling. The facility also provides other services, including doctor services, physical or occupational therapy, part-time home health aide services and inpatient care in a facility when needed for pain control and acute/chronic symptom management. Precertification is required before receiving hospice care under all Starbucks medical plans. See Precertification on page 90 for more information. What the plans cover Covered hospice care includes the charges listed below. Charges for care provided by a hospice facility, hospital, convalescent facility or doctor for: Inpatient care, including: Semiprivate room and board Services and supplies for pain control Services and supplies for other acute and chronic symptom management Outpatient care, including services and supplies provided when you are not confined as a full-time inpatient Charges for care provided by a hospice care agency for outpatient care, including: Part-time or intermittent nursing care by an R.N. or L.P.N. for up to eight hours in any given day Medical social services, under a doctor s direction, for assessment of your social, emotional and medical needs, as well as your home and family situation Help identifying and using community resources Psychological and dietary counseling Consultation or case management services by a doctor Physical and occupational therapy Part-time or intermittent home health aide services for up to eight hours a day Medical supplies, drugs and medicines prescribed by a doctor Charges for care delivered by other providers not employed by the hospice care agency: A doctor for consultation or case management services A physical or occupational therapist 81

85 VISION WHEN YOU NEED MEDICAL CARE A home health care agency for: Necessary physical or occupational therapy Part-time or intermittent home health aide services up to eight hours per day Medical supplies, drugs and medicines prescribed by a doctor Psychological and dietary counseling What is not covered The following hospice expenses are not covered by Starbucks medical plans: Bereavement counseling Funeral arrangements Pastoral counseling Financial or legal counseling, including estate planning or the drafting of a will Homemaker or caretaker services, including companion services, transportation, housecleaning or other maintenance Respite care furnished during a period of time when your family or usual caretaker cannot, or will not, attend to the patient s needs For a list of additional services not covered by Starbucks medical plans, see page 101. Hospitalization For purposes of Starbucks medical plans, a hospital is a place that mainly provides inpatient facilities for the surgical and medical diagnosis, treatment and care of sick and injured people. It is supervised by a staff of physicians, provides 24-hour-a-day registered nurse (R.N.) services and charges for its services. A hospital is not a nursing home, treatment facility for mental health/chemical dependency or convalescent facility. Outpatient hospital care Starbucks medical plans cover medically necessary hospital charges for services and supplies, including lab and x-rays that are given to you when you are not hospitalized as a full-time inpatient. Point-of-Service Plan Participants Notify Your PCP Remember, if you are in the Point-of-Service plan and you are hospitalized for an emergency and your PCP did not refer you, you must notify your PCP within two business days. Inpatient hospital care Starbucks medical plans provide coverage for these services when you need medically necessary inpatient hospital care: Daily room and board, based on the hospital s semiprivate room rate Diagnostic lab work and x-rays 82

86 VISION WHEN YOU NEED MEDICAL CARE Anesthetics and oxygen Other inpatient hospital services and supplies For specifics on how surgeon s fees are covered, see Surgery on page 98. You must obtain precertification before being admitted to the hospital on a full-time, inpatient basis, except for maternity stays. See Precertification on page 90 for details. Aetna Patient Advocacy Program The Patient Advocate team is a support program that provides health care education and guidance through outbound nurse calls to partners and their dependents participating in a Starbucks medical plan administered by Aetna. The voluntary program also identifies individuals who might benefit from nurse outreach. Specially trained nurses contact members by telephone before and after scheduled overnight hospital stays (except in the case of maternity stays). Patient Advocate nurses also make calls to members who may be experiencing a deterioration or significant change in their health. Although individuals selected for outreach are identified through Aetna s claim system records, their right to privacy and confidentiality is always protected. Maternity stays Inpatient maternity stays do not require precertification. Maternity stays will be covered for a minimum of 48 hours following a normal delivery, and a minimum of 96 hours following a Cesarean section, without precertification. If the mother and child are discharged earlier, benefits will be paid for two post-delivery home visits by a health care provider. Laboratory, X-ray and Imaging Expenses Starbucks medical plans cover laboratory, x-ray and imaging expenses related to the treatment or diagnosis of an illness or injury. The coverage level for laboratory, x-ray and imaging expenses varies depending on the provider of the service (e.g., your physician, an independent laboratory or a hospital) as outlined in the coverage overviews located in the Medical chapter. Please see page 92 for information on imaging services that require precertification. For laboratory and x-ray expenses related to a routine physical exam, refer to Physical Exam on page 89. Medical Necessity Under Starbucks plans administered by Aetna, medically necessary services or supplies are those Aetna determines to be necessary for the diagnosis, treatment or care of a sickness or injury. The plans will only pay benefits for charges that have been shown to be medically necessary. To be considered medically necessary, the service or supply must be for treatment, care or diagnosis that is: As likely to help your sickness or injury as any other alternative treatment or care Equal in quality to, and is not costlier than, any other alternative treatment, care or diagnosis 83

87 VISION WHEN YOU NEED MEDICAL CARE When determining medically necessary services or supplies, Aetna considers things like the patient s health condition, reports and guidelines published by nationally recognized health care organizations and professionals, information from medical literature and more. For mental health and chemical dependency services, medically necessary is defined as an indication that a patient s condition is severe enough to warrant treatment, the intensity of the treatment is appropriate to the patient s condition and the treatment is likely to result in an optimal clinical outcome. Aetna considers a service, treatment or supply to be medically necessary if it meets all of the following criteria: It is appropriate for the symptoms, diagnosis and treatment of a particular disease or condition defined under the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) of the American Psychiatric Association (DSM-IV ) or its replacement. It is provided in accordance with generally accepted standards of mental health/chemical dependency professional practices. It is not delivered mainly for the convenience of the patient, the patient s family or the provider. The type, level and length of treatment, services or supplies are needed to provide safe and adequate care and are reasonably likely to improve the patient s condition and not merely maintain the current level of functioning. For inpatient stays, this means that the patient s symptoms or condition require that the patient cannot receive safe and adequate care as an outpatient or in another less intensive setting. What Is Not Considered Medically Necessary? The following items are not considered medically necessary: Services or supplies that do not require the technical skills of a medical, mental health or dental professional Services or supplies furnished mainly for the personal comfort or convenience of the patient, caretaker, family, health care provider or health care facility Services or supplies provided while you are being treated as an inpatient but when you could receive treatment, care or diagnosis as an outpatient. Mental Health Treatment What the plans cover You are covered for medically necessary mental health treatment as long as you remain enrolled in a Starbucks medical plan administered by Aetna. Covered mental health treatment includes: Inpatient hospitalization Partial hospitalization Intensive outpatient treatment Residential treatment Outpatient care 84

88 VISION WHEN YOU NEED MEDICAL CARE You are required to use an Aetna network provider and to precertify all care other than routine outpatient care in order for services to be covered. The exception is in the case of an emergency. Before seeking mental health treatment, consider using the Employee Assistance Program (EAP) to receive information, consultation, resources and up to three counseling sessions per calendar year with a network counselor at no cost to you. Inpatient care Inpatient care is the highest level of skilled psychiatric and chemical dependency services provided in a facility, such as a free-standing psychiatric hospital, a psychiatric unit of a general hospital or a detoxification unit in a hospital. Settings that are eligible for this level of care are licensed at the hospital level and provide 24-hour medical and nursing care. Your covered expenses for treatment in a hospital or treatment facility include: Treatment of mental health disorders Room and board at the semiprivate room rate There is no coverage if you receive out-of-network inpatient treatment or in-network inpatient treatment that is not precertified, or if Aetna determines the treatment is not medically necessary. Partial hospitalization, intensive outpatient care and residential treatment When you require care that is more intensive then outpatient visits but not as acute as inpatient hospitalization, the plan covers alternative levels of care including partial hospitalization, intensive outpatient care and residential treatment. Partial hospitalization refers to care delivered on a daily basis, rather than 24 hours, in a hospital or other facility. The patient returns home each evening. Intensive outpatient care refers to care delivered on an outpatient basis, generally in a hospital or other facility setting, more than two times per week. Care is generally provided in a structured group format. Residential treatment refers to 24-hour-a-day sub-acute care, supervision and support in a licensed residential facility under the supervision of licensed or certified mental health professionals. Outpatient care Generally, outpatient care is individual, family or group counseling. Outpatient care also includes medication management services. This type of care does not require precertification. Nonroutine outpatient visits (such as psychological testing and intensive outpatient treatment) need to be precertified. For answers to your questions about outpatient services that require precertification, call Aetna at (888) Use network providers To be covered, you must visit an Aetna network provider. There is no coverage available for treatment received from providers who are not in the network except in the case of an emergency. If you receive emergency treatment, you must call Aetna within two business days. 85

89 VISION WHEN YOU NEED MEDICAL CARE The Aetna network has a full range of providers, including hospitals, day hospital programs, halfway houses, outpatient centers, residential treatment centers, clinics, psychiatrists, psychologists, clinical social workers, marriage counselors and other behavioral care providers. You can obtain a list of network providers by linking to Aetna s DocFind online provider directory from or by calling Aetna for assistance at (888) Precertification You are required to precertify the following types of care in order for them to be covered: Nonroutine outpatient care (e.g., intensive outpatient treatment or psychological testing) All facility-based care, including inpatient, residential treatment and partial hospitalization care If you proceed with treatment that has not been precertified when precertification is required, you will be responsible for the full cost of your care. You do not need to precertify routine outpatient office visits for counseling or medication management. How to obtain precertification To precertify care, call Aetna at (888) Aetna provides confidential and professional consultation 24 hours a day, seven days a week. An Aetna clinical case manager will help you identify the most appropriate care and providers. Aetna will review your condition and precertify a length and level of treatment. You may be referred to a network provider who is generally no more than 30 minutes from your home or work location. In the case of an emergency, Aetna will refer you to the nearest appropriate resource. If your condition requires ongoing nonroutine outpatient care or facility-based care, an Aetna clinical case manager will regularly review your condition to assess your ongoing treatment needs, assist in treatment planning and determine benefit coverage. After each review, Aetna will send you a letter informing you if additional treatment has been precertified. Maximum benefits per calendar year and conversion of inpatient days The plan has two calendar year maximum benefits, one for inpatient treatment and a second for outpatient care. Your calendar year maximum inpatient benefit includes inpatient hospitalization, partial hospitalization, intensive outpatient and residential treatment. Each day of inpatient hospitalization counts as one inpatient day. Every two days of partial hospitalization, intensive outpatient and residential treatment count as one inpatient day. Your calendar year maximum outpatient visit benefit applies to routine and nonroutine outpatient care. If you exhaust this benefit and require additional outpatient visits, you may be eligible to convert up to 10 inpatient days each calendar year to additional outpatient visits when precertified by Aetna in advance and when necessary to treat a serious mental illness. If precertified, you may convert one inpatient day into two outpatient office visits. 86

90 VISION WHEN YOU NEED MEDICAL CARE When you need emergency care If you need emergency mental health treatment, call Aetna at (888) before getting care. Aetna will direct you to the nearest appropriate facility for treatment. If the situation is so urgent that you cannot contact Aetna before getting treatment, you must see a qualified, licensed provider for care. However, you or someone representing you should call Aetna at (888) within two business days of receiving the care. If Aetna is not contacted, or if Aetna determines your condition was not an emergency or treatment was not medically necessary, your care will not be covered. What is emergency care? Emergency care means services needed to treat a condition for which delay in notification or certification could seriously jeopardize your life or health. It is also a condition in which you or your doctor feels you may cause life or bodily danger to yourself or others if you do not seek care immediately. What is not covered The following services are not covered by your mental health benefits. For a list of additional services not covered by Starbucks medical plans, see page 101. Services, treatments or supplies provided by an out-of-network provider without precertification by Aetna, except for emergency treatment as determined by Aetna Services, treatments or supplies primarily for rest, custodial, domiciliary or convalescent care Diagnosis and treatment for personal growth and/or development, or in conjunction with professional precertification All prescription and nonprescription drugs, except for drugs prescribed by a network provider in the course of a patient s treatment as an inpatient Marriage counseling, except for the treatment of a mental health or substance abuse condition Ancillary services such as: Vocational rehabilitation Activities of daily living training Sleep therapy Employment counseling Treatment, training or education therapy for learning disabilities and other developmental disorders Other educational services Services, treatment or supplies obtained through or required by any governmental agency or program, whether federal, state or local excluding Medi-Cal 87

91 VISION WHEN YOU NEED MEDICAL CARE Services, treatment or supplies caused by a third party against whom you have a claim for damages, unless you provide Aetna with a lien against your claim for damages Psychological examination, testing or treatment to satisfy an employer s, prospective employer s or other party s requirements for gaining employment, licensing or insurance or for the purposes of judicial or administrative proceedings, including parole or probation proceedings Psychological testing, except when conducted for the purpose of diagnosing a mental health or substance abuse condition, and with the prior approval of Aetna Treatment of obesity or weight reduction, or for the cessation of smoking, including supplies Stress management therapy without a covered psychiatric diagnosis Treatment of pain, except for medically necessary treatment of pain with psychological or psychosomatic origins as determined by Aetna Sex therapy, treatment for sexual deviance or diagnosis or treatment in conjunction with sexual reassignment procedures Treatment for a chronic mental condition except for: Stabilization of an acute episode of such disorder Management of medicine Mouth, Jaws and Teeth Conditions Starbucks medical plans cover expenses for services and supplies related to the treatment of certain conditions of the teeth, mouth, jaws, jaw joints or supporting tissues (including bones, muscles and nerves). The services may include care provided by a dentist. All treatment must be medically necessary and coordinated, in advance, through your PCP or attending doctor. Following are the types of care covered by Starbucks medical plans: Inpatient hospital services and supplies for surgery necessary to: Treat a fracture, dislocation or wound Remove cysts, tumors or other diseased tissue Nonsurgical treatment of infections or diseases, except for treatment related directly to the teeth Dental work, surgery and orthodontic treatment (when directly related to an injury sustained while you are covered under the plan) needed to remove, repair, replace, restore or reposition the following: Natural teeth damaged, lost or removed (any of these teeth must have been free from decay or in good repair and firmly attached to the jaw bone at the time of injury) Other body tissues of the mouth fractured or cut These treatments must be received in the same calendar year or during the calendar year following an accident. If crowns, dentures, fixed bridgework or appliances are installed due to an injury, covered expenses include only the initial placement necessary to replace lost teeth. 88

92 VISION WHEN YOU NEED MEDICAL CARE Nicotine-use Treatment Starbucks medical plans cover treatment of nicotine use as long as you are not a full-time inpatient in either a hospital or treatment facility. The treatment must be provided by a physician. Covered services include acupuncture, hypnotherapy and over-the-counter smoking-cessation aids, such as nicotine patches and gum. If you are enrolled in the Point-of-Service, Open Choice PPO, your per-visit copay is $20. If you are enrolled in the Routine Care PPO medical plan, your per-visit copay is $25. If you are enrolled in the Out-of-Area medical plan, your plan pays 80% after the deductible. Prescription drugs are covered under the prescription drug benefit when there is not an over-the-counter equivalent. Prescription drug costs do not apply against your $500 nicotine-use treatment benefit. The lifetime maximum benefit for this treatment is $500. What is not covered Expenses not covered by the plan, even if you use a network provider, include the following: Nicotine replacement products, such as Habitrol, which are covered under the prescription drug benefit and for which there is not an over-the-counter equivalent Vitamins, minerals or other supplements Books or tapes Smoking cessation programs, unless direct physician supervision is provided For a list of additional services not covered by Starbucks medical plans, see page 101. Physical Exam (Preventive Care) Routine physical exams are regular checkups given by a doctor. They are preventive exams, not intended to diagnose or treat a sickness or injury. Physicals must include a complete written medical history, a check of all body systems and a review and discussion of the exam results with the patient, parent or guardian. What the plans cover Covered services include the following: Doctor s consultation Lab work, x-rays and other tests received as part of your doctor s exam Materials for immunizations (vaccines and immunizations for overseas travel are not covered) 89

93 VISION WHEN YOU NEED MEDICAL CARE Routine physical exam frequency AGE First year of life Second year of life Age 2 through 6 Age 7 through 49 Age 50 and over FREQUENCY 6 exams 2 exams 1 exam every 12 months 1 exam every 24 months 1 exam every 12 months There is no coverage for out-of-network routine physical exams or preventive services under the Point-of-Service plan. What is not covered The following preventive care services are not covered under Starbucks medical plans for routine/preventive care: Services for the diagnosis or treatment of a suspected or identified injury or disease Exams given while you are confined to a hospital or other facility for medical care Services not given by or under the direct supervision of a doctor Medicines, drugs, appliances, equipment or supplies Psychiatric, psychological, personality or emotional testing or exams Exams in any way related to employment Premarital exams Vision, hearing or dental exams A doctor s office visit solely in connection with immunization or testing for tuberculosis When enrolled in the Point-of-Service plan, any service or supply furnished by an out-of-network provider For a list of additional services not covered by Starbucks medical plans, see page 101. Precertification Precertification must be obtained for the following services to be covered by the Starbucks medical plans: All hospital stays (emergency, urgent and nonurgent), except maternity Certain outpatient surgical and diagnostic procedures (see page 92) Convalescent facility admissions Home health care Skilled nursing care Hospice care For precertification of mental health care, see page 84; for chemical dependency treatment, see page 67. Penalties for not precertifying hospital stays and certain outpatient surgical and diagnostic procedures apply to all Aetna plans. 90

94 VISION WHEN YOU NEED MEDICAL CARE Precertification for hospital stays Under Starbucks medical plans administered by Aetna, all hospital admissions (except inpatient maternity stays) must be precertified by Aetna: For nonurgent hospital admissions, precertification must be obtained from Aetna at least 14 days before your scheduled admission. A nonurgent hospital admission is one that is neither an emergency nor an urgent admission. For urgent hospital admissions, precertification must be obtained from Aetna before you enter the hospital. An urgent hospital admission is due to the onset or change in a sickness, the diagnosis of a sickness or an injury that does not require emergency admission, but is severe enough to require hospitalization on an inpatient basis within two weeks. For emergency hospital admissions, precertification must be obtained by calling Aetna (or your PCP if you are enrolled in the Point-of-Service plan) within two business days after the admission. An emergency hospital admission is when a doctor admits you to the hospital immediately after you suddenly and unexpectedly get sick or suffer an injury. The condition must require immediate hospitalization e.g., if you are not admitted as a full-time hospital inpatient, you could lose a limb, be permanently physically injured or die. See page 76 for more information about emergency care. Obtaining precertification In most cases, if you are in the Open Choice PPO, Routine Care PPO or the Point-of-Service plan, your network physician or PCP (or specialist referred by your PCP) will obtain precertification for you by calling Aetna at the number on your ID card. You are responsible for making sure that precertification has been obtained within the timeframes described above. You can call Aetna to confirm precertification. If you are seeing a specialist not referred by your PCP, an out-of-network physician or are in the Out-of-Area plan, you are responsible for obtaining precertification by calling Aetna at the number on your ID card within the timeframes described above. Once approved, Aetna will send a precertification notice to your home within two business days. If precertification is not obtained Under all the Starbucks medical plans, if precertification for a hospital stay is not obtained, you will be responsible for paying certain charges, and in some cases, subject to a $400 penalty. Here is how it works: If precertification was requested and denied, Starbucks medical plans will not cover hospital room and board expenses. You are responsible for paying these charges. All other eligible hospital expenses will be paid under normal plan benefits. If precertification was not requested and your hospitalization was determined to be medically necessary, Starbucks medical plans will cover hospital room and board expenses. However, the first $400 of hospital expenses will not be covered unless you are enrolled in the Point-of-Service plan and are receiving care from your PCP or PCP-referred or Aexcel SM specialist, or if you are enrolled in the Open Choice or 91

95 VISION WHEN YOU NEED MEDICAL CARE Routine Care PPO plan and receiving care from a network provider. Normal plan benefits will apply to remaining charges. If precertification was not requested and any of your hospitalization stay was deemed medically unnecessary, Starbucks medical plans will not cover hospital room and board expenses for the portion of your stay determined to be not necessary. You will be responsible for paying these room and board charges, as well as the first $400 of other hospital expenses. Normal plan benefits will apply to remaining charges related to the confinement that are determined to be medically necessary. Extending your hospital stay If your physician feels it is medically necessary to keep you hospitalized longer than was initially certified, your physician or hospital must call the number on your Aetna ID card to extend your stay. This must be done by the end of the last day previously certified. Written notice of the number of days newly certified will be sent promptly, by Aetna, to the hospital with a copy to you and your physician. Independent physical examinations Aetna has the right to have a doctor of its choice examine you while precertification or a claim for benefits is pending or under review. This will be done within a reasonable time and at no cost to you. Precertification for certain outpatient surgical and diagnostic procedures Certain surgical and diagnostic procedures require precertification from Aetna before you receive treatment. Though these procedures are typically performed on an outpatient basis, you must obtain precertification whether they are performed on an inpatient or outpatient basis. These procedures require precertification: Allergy immunotherapy allergy treatment Bunionectomy surgery to remove bunions Carpal tunnel surgery surgery of the wrist nerves Colonoscopy exam of the large intestine Computerized axial tomography (CAT) scan of the spine study of the spine Coronary angiography x-ray of the heart arteries and chamber Dilation and curettage (D&C) exam of the cervix and removal of the uterine tissue lining Hemorrhoidectomy removal of hemorrhoids Knee arthroscopy scope exam of the knee joint Laparoscopy (pelvic) scope exam of the abdomen Magnetic resonance imaging (MRI) of the spine study of the spine Magnetic resonance imaging (MRI) of the knee study of the knee Septorhinoplasty surgery of the nose Tympanostomy insertion of tubes in the ear Upper GI endoscopy scope exam of the esophagus, stomach and small intestines 92

96 VISION WHEN YOU NEED MEDICAL CARE Obtaining precertification For nonemergency procedures, precertification must be obtained from Aetna at least 14 days before your scheduled procedure or, if this is not possible, as soon as is possible before the date the procedure is scheduled. For emergency procedures, precertification must be obtained by calling Aetna (or your PCP if you are enrolled in the Point-of-Service plan) before the procedure (if possible) or within two business days after the procedure. In most cases, if you are in the Open Choice PPO, Routine Care PPO or the Point-of-Service plan, your network physician or PCP (or specialist referred by your PCP or self-referred Aexcel SM specialist) will obtain precertification for you by calling Aetna at the number on your ID card. You are responsible for making sure that precertification has been obtained before services are received. You can call Aetna to confirm precertification. If you are seeing a specialist not referred by your PCP (except for Aexcel specialists), an out-of-network physician or are in the Out-of-Area plan, you are responsible for obtaining precertification by calling Aetna at the number on your ID card. Once approved, Aetna will send a precertification notice to your home within two business days. If the required precertification is not obtained for any of the procedures listed above, the first $200 of expenses incurred in connection with the procedure will not be covered. Precertification for convalescent, home health care, skilled nursing care or hospice care Precertification is required before benefits will be paid for any of the following services: Convalescent facility admissions Home health care expenses Skilled nursing care Hospice care expenses Obtaining precertification In most cases, if you are in the Open Choice PPO, Routine Care PPO or the Point-of-Service plan, your network physician or PCP (or specialist referred by your PCP) will obtain precertification for you by calling Aetna at the number on your ID card. You are responsible for making sure that precertification has been obtained before you incur expenses or receive services. You can call Aetna to confirm precertification. If you are seeing a specialist not referred by your PCP, other than an Aexcel SM specialist, an out-of-network physician or if you are in the Out-of-Area plan, you are responsible for obtaining precertification by calling Aetna at the number on your ID card. Once approved, a precertification notice will be sent to your home by Aetna within two business days. If your doctor recommends services or supplies or a period of confinement beyond those initially approved, you must obtain precertification for the additional treatment or confinement. Aetna will mail to your home written notice of the additional services or confinement they have certified. 93

97 VISION WHEN YOU NEED MEDICAL CARE If precertification is not obtained Under the Point-of-Service, Open Choice PPO and Routine Care PPO medical plans, if precertification for convalescent facility admissions, home health care, skilled nursing care or hospice care is not obtained as described above, you will be responsible for paying certain charges, and in some cases, subject to a $400 penalty. Here is how it works: If precertification was requested and denied, Starbucks medical plans will not cover convalescent or hospice care facility room and board expenses. You are responsible for these charges. You are also responsible for the first $400 of expenses related to convalescent care, home health care, hospice or skilled nursing care. After that, normal plan benefits will apply to the remaining charges. If precertification was not requested and your confinement or services were determined to be medically necessary, Starbucks medical plans will cover convalescent or hospice care facility room and board expenses. However, the first $400 of expenses related to convalescent care, home health care, hospice or skilled nursing care will not be covered unless you are enrolled in the Point-of-Service plan and are receiving care from your PCP or PCP-referred or Aexcel SM specialist, or if you are enrolled in the Open Choice or Routine Care PPO plan and receiving care from a network provider. After that, normal plan benefits will apply to the remaining charges. If precertification was not requested and any of your confinement or services were deemed medically unnecessary, Starbucks medical plans will not cover any convalescent care, home health care, hospice care or skilled nursing care expenses that are deemed medically unnecessary. You are responsible for all charges incurred. Pregnancy-related Coverage Starbucks provides comprehensive prenatal and pregnancy-related benefits that are designed to give you the medical attention you need during your pregnancy. If you have previous group health coverage that pays any pregnancy benefits, Starbucks medical plans will subtract the coverage amount paid by your former plan for the same expenses. In addition, all Starbucks medical plans, except the Routine Care PPO, cover one routine ultrasound per pregnancy. Additional ultrasounds are covered only when medically necessary. Planning to Become Pregnant or Pregnant Now? Visit Thrive, Starbucks health information and wellness site, for information to help you plan and prepare for your pregnancy and baby. Visit the Pregnancy section of the site and calculate your due date, learn about your choices for prenatal and birth care, learn about development of the baby week-by-week, choose a birth class and birth partner, and more. After your baby arrives, visit Child Health Manager and track your baby s development. Link to Thrive from Moms-to-Babies Maternity Program Aetna s Moms-to-Babies Maternity Program is designed to provide you with the best chance for a healthy baby and uncomplicated delivery. This voluntary program is designed to provide special prenatal care to women with high-risk pregnancies. 94

98 VISION WHEN YOU NEED MEDICAL CARE Obstetric nurse case managers are assigned to work closely with you and your obstetrician to ensure you receive the most appropriate and timely specialty care for your condition. Any additional tests or services you may require must be approved by your obstetric nurse case manager to be covered. Once you learn you are pregnant, call Moms-to-Babies at (888) to register for the program. At that time, you can also complete the risk survey so you can later receive a summary of your results. You will also receive free educational materials. If needed, you will be contacted by a Prenatal Case Manager. Registration is also available online at Aetna Navigator by linking from Coverage for nurse midwives Services of a nurse midwife will be covered under the Out-of-Area plan, and in-network under the Open Choice PPO, Point-of-Service and Routine Care PPO plans, when the nurse midwife is: Licensed or certified in accordance with the requirements of the state or jurisdiction of practice Practicing within the scope of the license or certification Rendering a service covered under Starbucks medical plan Practicing within a physician s group that is part of Aetna s network of providers If you live in a state that permits nurse midwives to practice independently (i.e., not with a physician group) and you choose to receive care from an independent nurse midwife, coverage will be at the lower out-of-network level under the Open Choice PPO, Point-of-Service and Routine Care PPO plans. Add Your Baby Within 60 Days of Birth If you intend to cover your newborn under Starbucks health plans, you must enroll the child by calling Starbucks Benefits Center at (877) SBUXBEN within 60 days of the newborn s birth. See Making Changes on page 22 for more information. Hospitalization for maternity stays Inpatient maternity stays do not require precertification (hospital expenses only). Maternity stays will be covered for a minimum of 48 hours following a normal delivery, and a minimum of 96 hours following a Cesarean section, without precertification. If the mother and child are discharged earlier, benefits will be paid for two postdelivery home visits by a health care provider. Home births are not covered. 95

99 VISION WHEN YOU NEED MEDICAL CARE Preventive Gynecological Exam (Well Woman) A routine preventive well woman gynecological exam is covered by Starbucks medical plans once every 12 months. If you are enrolled in the Point-of-Service plan, you must visit a network provider, either your PCP or a network OB/Gyn. You may see a network OB/Gyn of your choice once every 12 months without being referred by your PCP. A network OB/Gyn can refer you to a specialist, prescribe required medication, etc. If you need a follow-up visit, you may return directly to this OB/Gyn. For a list of network OB/Gyns, refer to the Aetna provider directory or link to Aetna s DocFind website from What the plans cover Covered services include: Pelvic examination Pap smear Routine mammogram What is not covered These well woman services are not covered under Starbucks medical plans. For a list of additional services not covered by Starbucks medical plans, see page 101. Services for the diagnosis or treatment of a suspected or identified injury or disease Exams given while you are confined to a hospital or other facility for medical care Services not given by or under the direct supervision of a doctor Medicines, drugs, appliances, equipment or supplies Exams in any way related to employment Premarital exams When enrolled in the Point-of-Service plan, any service or supply furnished by an out-of-network provider Short-Term Rehabilitation (Physical, Speech and Occupational Therapy) Under Starbucks medical plans, you are covered for up to 60 visits per calendar year of short-term rehabilitation services provided on an outpatient basis. These services include: Physical therapy Occupational therapy Speech therapy The therapy must be part of a medically necessary treatment plan and provided by a doctor, or under the supervision of a doctor and provided by a physical therapist, occupational therapist or speech therapist. 96

100 VISION WHEN YOU NEED MEDICAL CARE Short-term rehabilitation coverage is expected to result in the following: Improvement or restoration of a body function that has been lost due to injury, disease or a congenital defect for which a surgery has been performed Significant improvement of the condition within 60 days from the date the therapy starts What is not covered These rehabilitation services are not covered under Starbucks medical plans. For a list of additional services not covered by Starbucks medical plans, see page 101. Services received while in the hospital Services provided by a physical, occupational or speech therapist who lives in your home or is a part of your or your spouse s or domestic partner s family Treatment of delays in speech development unless resulting from disease, injury or congenital defect (disease is defined as an illness or medical condition that caused or significantly contributed to the delay in speech development) Special education including lessons in sign language designed to teach one whose speech has been lost or impaired to function without that speaking ability Services not part of a specific treatment plan Speech therapy, except when intended to restore an existing speech function lost through disease or injury Skilled Nursing Care Starbucks medical plans provide coverage for medically necessary skilled nursing services prescribed by your doctor and provided by one of the following providers: Registered nurse (R.N.) Licensed nurse practitioner (L.P. N.) Nursing agency All Starbucks medical plans require precertification to obtain skilled nursing care. See Precertification on page 90 for more information. Skilled nursing care includes: Visiting nursing care by an R.N. or L.P.N. this means a visit of less than four hours for the purpose of performing specific skilled nursing tasks Private duty nursing by an R.N. or L.P.N. up to 70 shifts per calendar year if you or your covered dependent s condition requires skilled nursing services and visiting nursing care is not adequate (each period of skilled nursing up to eight hours will be considered one shift) What is not covered The following types of skilled nursing care are not covered by Starbucks medical plans. For a list of additional services not covered by Starbucks medical plans, see page 101. Nursing care that does not require the education, training and technical skills of an R.N. or L.P.N. such as transportation, meal preparation, charting of vital signs and companionship Any private-duty nursing care provided while staying in a hospital or other health care facility 97

101 VISION WHEN YOU NEED MEDICAL CARE Care provided to help you with daily living activities, such as bathing, feeding, grooming or dressing Care provided solely for the purpose of skilled observation unless it is care for one four-hour period per day for less than 10 consecutive days following: A change in patient medication The need for urgent or emergency medical services provided by a doctor, or the onset of symptoms indicating the likely need for such urgent or emergency medical services Surgery Release from inpatient confinement Any service provided solely to administer oral medication, except where applicable law requires that such medication be given by an R.N. or L.P.N. Surgery Starbucks medical plans cover medically necessary outpatient and inpatient surgery. Outpatient surgery Starbucks medical plans cover charges made by the doctor and outpatient medical facility for medically necessary services and supplies that are given to you when you receive surgery on an outpatient basis, including: Surgeon s fees Diagnostic lab work, x-rays and imaging services Anesthetics and oxygen Inpatient surgery Coverage is provided for these medically necessary services when you need inpatient surgical care: Surgeon s fees Daily room and board, based on the hospital s semiprivate room rate Diagnostic lab work and x-rays Anesthetics and oxygen Other inpatient hospital services and supplies The plan covers recognized charges for reconstructive breast surgery and, if applicable, insertion of a breast prosthesis following a medically necessary mastectomy. The plans also cover charges for surgical reduction or augmentation of the nondiseased breast to achieve symmetry with the reconstructed breast. When you are admitted to the hospital as a full-time inpatient, you must obtain precertification for your hospitalization. This applies to all Starbucks medical plans. See page 90 for more information. What is not covered The plans do not cover plastic surgery, reconstructive surgery (except as noted above), cosmetic surgery or any other services and supplies intended to improve, alter or enhance appearance whether or not for psychological or emotional reasons. The exceptions are to improve the function of a body part (except teeth or supporting 98

102 VISION WHEN YOU NEED MEDICAL CARE structures) malformed from a severe birth defect, disease or surgery, or to repair an injury that occurs while you are covered under this plan. However, to be covered, surgery to repair an injury must be completed in the calendar year of the accident causing the injury or the next calendar year. Sex-change operations or implants or treatment for gender disorders due to sexual dysfunction are not covered. Therapy, supplies and counseling for sexual dysfunctions that do not have a physiological or organic basis are not covered. For a list of additional services not covered by Starbucks medical plans, see page 101. Precertification for certain outpatient surgical and diagnostic procedures Certain surgical and diagnostic procedures require precertification from Aetna before you receive treatment. See page 90. Call Aetna About Any Hospital Procedures It is a good idea to call Aetna about any outpatient hospital procedures recommended to you. That way, you will know if the procedure requires precertification. Call Aetna Partner Services at (888) for more information. Transplant surgery When you need transplant surgery, you are covered by Aetna s National Medical Excellence (NME) program. The NME program coordinates all solid and bone marrow transplants and other specialized care. When you are referred to a facility more than 100 miles from your home, the NME program will pay benefits for travel and lodging expenses. Participation in the NME program is required to assure in-network benefit levels for transplant surgery services. Who is covered You are considered an NME patient if you: Require any of the NME procedures or treatments covered under Starbucks medical plans Agree to have the procedure or treatment performed in a hospital designated by Aetna as the most appropriate medical facility Travel expenses The NME program will cover your expenses, as well as those of a companion for transportation (airfare or mileage reimbursement) between home and the medical facility where you will receive the services related to a transplant. The definition of a companion is someone whose presence is necessary to enable you as an NME patient to: Receive services in connection with NME procedures Travel to and from a designated medical facility 99

103 VISION WHEN YOU NEED MEDICAL CARE Lodging expenses Lodging expenses are covered, up to $50 per person per night, for you and a companion while traveling between home and the medical facility where you will receive the services related to a transplant. A hospital or other temporary residence may be considered your home if it is the location: From which you travel to begin your treatment period at the medical facility To which you travel after being discharged at the end of a treatment period Maximum benefits Certain restrictions apply to the NME program benefits. All travel and lodging benefits related to a transplant procedure are limited to $10,000. Benefits are paid for related expenses incurred from the time you become an NME patient until the earlier of: One year after the day the procedure is performed, or The date you no longer receive any services from the medical facility related to the procedure. Benefits paid for travel and lodging expenses are not factored into your lifetime maximum medical benefits. Limitations Travel and lodging expenses do not include charges considered covered medical expenses under Starbucks medical plans. Travel expenses do not include expenses incurred by more than one companion who is traveling with you. Lodging expenses do not include expenses incurred by more than one companion per night. TMJ or MPD Treatment Treatment related to temporomandibular joint disorder (TMJ) or myofacial pain dysfunction (MPD) must be medically necessary and coverage does not include the cost of surgery. If you are enrolled in the Point-of-Service plan, a referral from your PCP is required. Covered services for these and similar diagnoses include: Splints Guards Mandibular orthopedic repositioning appliances What is not covered The following TMJ and MPD charges are not covered by Starbucks medical plans. For a list of additional services not covered by Starbucks medical plans, see page 101. Charges to remove, repair, replace, restore or reposition teeth lost or damaged in the course of biting or chewing Charges to repair, replace or restore fillings, crowns, denture or bridgework Periodontic treatment 100

104 VISION WHEN YOU NEED MEDICAL CARE Dental cleaning, in-mouth scaling, planing or scraping Myofunctional therapy, including: Muscle therapy Training to correct or control harmful habits Diagnosis and nonsurgical treatment of a jaw joint disorder except as spelled out above Preauthorization Preauthorization of TMJ or MPD treatment will inform you and your dentist, in advance, of what the plan covers for the proposed treatment. To obtain preauthorization, you or your dentist will need to submit to Aetna your dentist s proposed course of treatment. In most cases, x-rays and similar diagnostics are required as well. A review will be performed by a dental consultant to confirm that the treatment is medically necessary and appropriate. What Is Not Covered The items in this list are not covered by Starbucks medical plans administered by Aetna. Please note this is not a complete list. Refer to each specific service to see what else is not covered under Starbucks medical plans. General Charges for which you are not legally obligated to pay Charges you incurred before your coverage begins or after it ends Charges for the treatment of any condition related to or arising from previous or current employment or occupation, or serving in the armed forces Charges you or your enrolled dependents incurred for illness or injury while incarcerated in a penal institution Expenses in excess of the recognized charge Charges for services and supplies that are not considered medically necessary by Aetna for the diagnosis, care or treatment of the condition (this applies even if they are prescribed, recommended or approved by your doctor or dentist) Charges for treatment, services or supplies that are not prescribed, recommended and approved by your attending doctor or dentist Charges for hospital room and board charges exceeding the semiprivate rate unless a private room is medically necessary or, under the Point-of-Service plan, when a private room is requested by your PCP and approved by Aetna Charges for personal comfort items Charges for emergency room treatment for conditions that are not considered medical emergencies or, under the Point-of-Service plan, have not been referred by your PCP Charges for treatments for learning disabilities or developmental delays 101

105 VISION WHEN YOU NEED MEDICAL CARE Charges for care to provide surroundings free from exposure to factors that can worsen your disease or injury Charges for or related to these types of treatment: Primal therapy Rolfing Psychodrama Megavitamin therapy Bioenergetic therapy Carbon dioxide therapy Charges for broken appointments or completion of claim forms Charges for or related to sex-change surgery or to any treatment of gender identity disorders (related counseling may be covered under the mental health plan) Any services related to or rendered in connection with a noncovered service Treatment of the mouth, jaws and teeth except as specifically described in the section TMJ or MPD Treatment on page 100 Orthopedic shoes and nonmedically necessary devices to support the feet Education, special education or job training for any reason, whether or not given in a facility that also provides medical or psychiatric treatment Vitamins, minerals or dietary supplements Weight loss and nutritional counseling programs Drugs or supplies used for the treatment of erectile dysfunction, impotence, or sexual dysfunction or inadequacy, including but not limited to: Sildenafil citrate Phentolamine Apomorphine Alprostadil Any other drug that is in a similar or identical class, has a similar or identical mode of action or exhibits similar or identical outcomes (this exclusion applies whether or not the drug is delivered in oral, injectable or topical including but not limited to gels, creams, ointments and patches forms) Performance, athletic performance or lifestyle enhancement drugs or supplies 102

106 VISION WHEN YOU NEED MEDICAL CARE Coverage Policy Bulletins Want more information about Aetna s medical assessment of certain treatments and medications? Refer to the Coverage Policy Bulletins available on Aetna Navigator. Simply link from and select Coverage Policy Bulletins. You will find an alphabetic listing of hundreds of procedures, Aetna s position regarding medical necessity and a listing of the sources Aetna used to develop their position. Although these bulletins will not specifically address coverage under Starbucks plans, they will provide some insight into Aetna s analysis of these procedures. Custodial care Custodial care, as determined by Aetna, includes room and board and other institutional care. The patient does not have to be disabled. Custodial care means services and supplies furnished mainly to help in the activities of daily life, such as: Bathing, dressing, feeding, preparation of meals or special diets, and housekeeping Assistance in walking or getting in and out of bed Supervision over medication that can normally be self-administered Eye and vision care Eye and vision care includes exams, eyeglasses or contact lenses, vision perceptive training and cosmetic eye surgery, including surgery to correct refractive error. See the Vision chapter for details on coverage available through VSP. Experimental procedures A drug, a device, a procedure or treatment will be determined to be experimental or investigational if any of the criteria below applies: There are insufficient outcomes data available from controlled clinical trials published in the peer-reviewed literature to substantiate its safety and effectiveness for the disease or injury involved. If required by the FDA, approval has not been granted for marketing. A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental, investigational or for research purposes. The written protocol or protocols used by the treating facility, the protocol or protocols of any other facility studying substantially the same drug, device, procedure or treatment, or the written informed consent used by the treating facility or by another facility studying the same drug, device, procedure or treatment states that it is experimental, investigational or for research purposes. However, services or supplies (other than drugs) received in connection with a disease will not be excluded from coverage if Aetna determines that both of the situations below apply: The disease can be expected to cause death within one year, in the absence of effective treatment. 103

107 VISION WHEN YOU NEED MEDICAL CARE The care or treatment is effective for that disease or shows promise of being effective for that disease as demonstrated by scientific data. In making this determination, Aetna will take into account the results of a review by a panel of independent medical professionals selected by Aetna. This panel will include professionals who treat the type of disease involved. Also, this exclusion will not apply with respect to drugs that: Have been granted treatment investigational new drug (IND) or Group c/treatment IND status Are being studied at the Phase III level in a national clinical trial sponsored by the National Cancer Institute Are demonstrated as being effective or showing promise of being effective for the disease based on available scientific evidence, as determined by Aetna Occupational injuries or diseases An occupational disease or injury is one that arises out of or in the course of any work for pay or profit. Only nonoccupational accidental injuries and diseases are covered by Starbucks medical plans. A disease is nonoccupational, regardless of cause, if proof is furnished that the person is covered under any type of workers compensation law but is not covered for that disease under such law. How to File a Claim If you visit an in-network provider, your provider will bill Aetna directly. There are no claim forms for you to complete. You may be required to file a claim if you visit a provider not contracted with Aetna. Your claim must give proof of the nature and extent of the loss. Mail your claim to the address shown on your Aetna ID card. Claim forms may be requested online at Select U.S.A., then Enroll in Benefits, then Health, Insurance, then Request Materials. If you prefer, you can make your request by speaking with a Starbucks Benefits Center representative at (877) SBUXBEN. The deadline for filing a claim for any benefits is 90 days after the date of the loss causing the claim. If, through no fault of your own, you are not able to meet the deadline for filing a claim, your claim will still be accepted if you file as soon as possible. Unless you are legally incapacitated, late claims will not be covered if they are filed more than two years after the date of service. You may check on the payment status of your claim by calling Aetna Partner Services at (888) or by registering for Aetna Navigator available through If you believe there is an error in the determination of your claim, you may file an appeal. See Benefits Claims on page 210 for more information regarding appeals. 104

108 VISION WHEN YOU NEED MEDICAL CARE View Your Claims Status Online On Aetna Navigator, you can view the claim payment status for your medical, mental health, chemical dependency, dental and pharmacy claims by covered family member and by date of service. If the claim processing has been completed, you may view details about how the claim was paid, including whether a deductible or copay applied, the negotiated rate from your provider and the date of payment. Claim procedure Urgent care claims (including mental health and chemical dependency emergency claims) If the service, supply or procedure requires advance approval before a benefit will be payable and if Aetna or your physician determines that you have an urgent care claim, you will be notified of the decision not later than 72 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). An urgent care claim is any claim for treatment that, if not provided in a timely manner, could seriously jeopardize your life or health or your ability to regain maximum function or, in the opinion of a physician with knowledge of the medical condition, would subject you to severe pain that cannot be adequately managed without the claimed care or treatment. Other claims (pre-service and post-service) You will be notified of the claim decision not later than: For services requiring precertification or preauthorization before a benefit is payable (pre-service claims), 15 days after receipt of the claim For services already delivered to the patient (post-service claims), 30 days after receipt of the claim These time periods may be extended up to an additional 15 days due to circumstances outside Aetna s control. In that case, you will be notified of the extension before the end of the initial 15- or 30-day 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 Aetna s 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 Aetna, but which otherwise fail to follow the plan s 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 claim) and of the proper procedures to be followed. The notice may be oral unless you request written notification. 105

109 VISION WHEN YOU NEED MEDICAL CARE Ongoing course of treatment If you are receiving an ongoing course of treatment, you will be notified in advance if Aetna intends to terminate or reduce benefits for the 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. If you disagree with the claim determination If your claim for benefits is denied, either in whole or in part, you may appeal the claim denial by following the process described in Appealing Denial of Claims on page 211. Questions? If you have questions about your medical plan, call: Aetna Partner Services at (888) Keystone Health Plan Central at (800) HMSA at (877) Kaiser Hawaii HMO at (800)

110 Prescription Drugs How the Plan Works 108 What Is a Copay? 109 What Is a Prescription Drug? 109 What is a formulary? 109 Participating pharmacies 110 Nonparticipating pharmacies 111 Aetna Rx Home Delivery Program 111 What Is Not Covered 111 If You Take an Approved Leave of Absence 112 When Coverage Ends 112 How to File a Claim 113 Claim procedure 113 Questions?

111 VISION PRESCRIPTION DRUGS As long as you are enrolled in a Starbucks medical plan administered by Aetna, the prescription drug plan will cover you and your enrolled dependents when you need a prescription filled. How the Plan Works If you are enrolled in the Open Choice PPO, the Point-of-Service plan or the Out-of-Area plan, you can visit any pharmacy to fill your prescription. However, if you visit a pharmacy that participates in Aetna s network, you will pay less for your prescriptions. If you are covered under the Routine Care PPO plan, you must visit a participating pharmacy to receive coverage for any prescription filled. Aetna contracts with a number of large nationwide pharmacy chains, as well as local independent pharmacies, so you have lots of options when it comes to filling a prescription. And, to save even more money not to mention a chunk of your time you can use Aetna Rx Home Delivery if your prescription is for a maintenance medication written for a 31-day to 90-day supply. Maintenance medications are those prescription drugs that are taken on a routine, ongoing basis. Examples of maintenance medications include oral contraceptives and heart or diabetes medications. Prescription drug coverage overview PARTICIPATING PHARMACY NONPARTICIPATING PHARMACY AETNA RX HOME DELIVERY Up to 30-day supply Up to 30-day supply 31- to 90-day supply Open Choice PPO pays 100% after you pay: $30 copay for brand-name nonformulary 50% after you pay your out-of-network medical plan annual deductible 1 100% after you pay: $60 copay for brand-name nonformulary $15 copay for brand-name formulary $30 copay for brand-name formulary $10 copay for generic $20 copay for generic Point-of-Service plan pays 100% after you pay: $35 copay for brand-name nonformulary 50% after you pay your out-of-network medical plan annual deductible 1 100% after you pay: $70 copay for brand-name nonformulary $20 copay for brand-name formulary $40 copay for brand-name formulary $10 copay for generic $20 copay for generic Routine Care PPO pays 100% after you pay: $50 copay for brand-name nonformulary Not covered 100% after you pay: $100 copay for brand-name nonformulary $35 copay for brand-name formulary $70 copay for brand-name formulary $20 copay for generic $40 copay for generic 1 Does not count toward the out-of-pocket maximum. 108

112 VISION PRESCRIPTION DRUGS Prescription drug coverage overview, continued PARTICIPATING PHARMACY NONPARTICIPATING PHARMACY AETNA RX HOME DELIVERY Up to 30-day supply Up to 30-day supply 31- to 90-day supply Out-of-Area plan pays 100% after you pay: $35 copay for brand-name nonformulary 50% after you pay your medical plan annual deductible 1 100% after you pay: $70 copay for brand-name nonformulary $20 copay for brand-name formulary $40 copay for brand-name formulary $10 copay for generic $20 copay for generic 1 Does not count toward the out-of-pocket maximum. Routine Care PPO Plan Coverage If you are covered under the Routine Care PPO plan, you will need to have your prescriptions filled at a participating pharmacy to receive coverage. What Is a Copay? The prescription drug copay is the amount you pay to the participating pharmacy each time a prescription drug is dispensed to you. The copay applies to each prescription or refill. For medications dispensed as packaged kits, the copay applies to each kit. What Is a Prescription Drug? A drug, biological, compounded prescription or contraceptive device which, by federal law, may be dispensed only by prescription and which is required to be labeled Caution: Federal law prohibits dispensing without a prescription An injectable contraceptive drug prescribed to be administered by a paid health care professional An injectable drug prescribed to be self-administered or administered by any other person except one who is acting within his or her capacity as a paid health care professional (covered injectable drugs include insulin) Disposable needles and syringes which are purchased to administer a covered injectable prescription drug Disposable diabetic supplies What is a formulary? A formulary is a list of generic and brand-name drugs that are included in your medical plan s list of preferred medications. Drugs on the formulary list have gone through an extensive review process. Your prescription drug copay is lower when you use the formulary. If you are enrolled in a Starbucks medical plan administered by Aetna, you will be sent a list of formulary drugs after your enrollment or you can visit Aetna s website by linking through If you are enrolled in a Keystone Health Plan Central, HMSA, or Kaiser Hawaii HMO, refer to your health provider s guide to benefits for formulary information. 109

113 VISION PRESCRIPTION DRUGS Generic vs. brand-name drugs Prescription drugs are either generic or brand-name medicines. Generic drugs have the same active ingredients as brand-name drugs, and are dispensed in the same form (tablet, capsule, liquid, etc.) and recommended dosage as the brand-name equivalent. The difference is that generics cost substantially less. Brand-name drugs are produced by the original manufacturer and usually cost much more than a generic alternative, when available. You pay a higher copay for brand-name drugs than for generics. The highest drug copay is for nonformulary brand-name drugs, which are drugs that are not on the formulary list. Mandatory generics Starbucks medical plans administered by Aetna will automatically substitute a generic medication, when available, for any brand-name drug prescribed by your doctor. If you choose to buy a brand-name drug when a generic is available, you pay the brand-name nonformulary copay (highest copay) plus the difference in the cost between the generic and the brand-name drug (not to exceed the cost of the drug). If your doctor indicates that the prescription must be dispensed as written and has prescribed a brand-name drug, you will still pay the highest copay amount, but will not have to pay the difference in cost between the generic and the brand-name drug. If the pharmacy is unable to supply the generic drug at the time the prescription is presented, you will pay just the generic copay. Participating pharmacies When you visit a participating pharmacy there are a few advantages: you will pay less and you will not need to submit a claim form. Simply present your Aetna Medical ID card at the time you are ordering your prescription and make the necessary copay. Pharmacies participating in the Aetna network include a variety of independent pharmacies, as well as local and national chains. Here is a listing of some of the national chain pharmacies belonging to Aetna s pharmacy network, although it is subject to change. To view a complete list of participating pharmacies near you, link to Aetna s DocFind website at check your work location for a directory or call Aetna Partner Services at (888) to request a directory be mailed to you. Albertsons Pharmacy CVS Pharmacy Costco Pharmacy Eckerd Drug Fred Meyer Pharmacy Kmart Pharmacy Kroger Pharmacy Osco Drug Rite Aid Pharmacy Safeway Pharmacy Shop Rite Pharmacy Target Pharmacy Walgreens Pharmacy Wal-Mart Pharmacy 110

114 VISION PRESCRIPTION DRUGS Nonparticipating pharmacies When you visit a pharmacy that does not belong to Aetna s pharmacy network, you will pay more to have your prescriptions filled. You will need to pay the full cost of your prescriptions when they are filled and submit a claim to Aetna to be reimbursed. You can request a claim form by calling Starbucks Benefits Center at (877) SBUXBEN. Return your completed claim form and attached pharmacy receipt to Aetna at the address shown on the claim form. Aetna Rx Home Delivery Program The mail-order drug program is part of your prescription drug benefit and is an easy, lower-cost way to obtain prescription drugs you use on a regular basis, such as oral contraceptives, diabetic or heart medicine. You can receive up to a 90-day supply by mailing in your copay with your prescription. Once your initial prescription is filled through Aetna Rx Home Delivery, you can easily order refills over the phone, through the mail or online by selecting the link for Aetna Rx Home Delivery from Prescriptions filled through Aetna Rx Home Delivery generally take from one to two weeks to arrive. Aetna Rx Home Delivery mail-order claim forms may be requested online at Select U.S.A., then click Aetna Home Rx under the Benefits Links section. If you prefer, you may make your request by speaking with a Starbucks Benefits Center representative at (877) SBUXBEN. For more information about filling a new prescription through Aetna Rx Home Delivery, call the program directly at (866) For questions about coverage of a particular medication, call Aetna Partner Services at (888) What Is Not Covered These drugs or supplies are not covered by your prescription drug benefits: Devices of any type, unless specifically included as prescription drugs Drugs entirely consumed at the time and place they are prescribed A supply for less than 31 days of any drug dispensed by a mail-order pharmacy Contraceptive drugs, except oral contraceptives (see Family Planning Services on page 78 for information on contraceptive devices, injectable contraceptives and Norplant) Appetite suppressants Nutritional supplements Immunization agents Biological sera and blood products Imitrex, if more than 48th kit or 96th vial dispensed to a person in any given year Any drug that has an over-the-counter equivalent Self-injectable allergy sera/extracts A supply for more than 30 days per prescription for each refill, unless provided by Aetna Rx Home Delivery Any refill of a drug if it is more than the number of refills specified by the prescriber 111

115 VISION PRESCRIPTION DRUGS Any refill of a drug dispensed more than one year after the date of the prescription Any drug provided by a health care facility or while you are an inpatient in any health care facility Administration or injection of any drug Drugs or supplies used for the treatment of erectile dysfunction, impotence or sexual dysfunction or inadequacy, including but not limited to: Sildenafil citrate Phentolamine Apomorphine Alprostadil Any other drug that is in a similar or identical class, has a similar or identical mode of action or exhibits similar or identical outcomes (this exclusion applies whether or not the drug is delivered in oral, injectable or topical including but not limited to gels, creams, ointments and patches forms) Performance, athletic performance or lifestyle enhancement drugs or supplies Nonprescription drugs, vitamins, herbs, etc. Illegal drugs Experimental drugs Immunizations for foreign travel Drugs prescribed by an unlicensed health care provider Any item not covered under the medical plans If You Take an Approved Leave of Absence Your medical coverage may continue during an approved leave of absence as outlined on page 25. However, you will be required to continue to make your contribution payments for medical coverage during your leave of absence. Contributions for medical coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your contribution payments while on leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When Coverage Ends If you are no longer a Starbucks partner, your prescription drug coverage ends on the last day of the month in which your termination is processed. If you lose benefits eligibility due to the ongoing eligibility audit, your prescription drug coverage ends as described in the Eligibility and Enrollment chapter. You may elect to continue your coverage through COBRA as outlined in Your COBRA Rights on page 219. If you are waiting for ordered and undelivered prescriptions when your coverage ends, and you were eligible and enrolled at the time your prescriptions were ordered, your ordered and undelivered prescriptions will be covered. 112

116 VISION PRESCRIPTION DRUGS How to File a Claim When you use a participating pharmacy, the pharmacy will file your claims for you. You will simply pay your copay at the time you obtain your prescription. If you fill a prescription at a nonparticipating pharmacy or prior to receiving your Aetna Medical ID card, you will need to submit a claim for reimbursement. To submit a claim, complete the employee section of the prescription drug claim form, attach your prescription receipt and mail it to the address shown on the claim form. Claim forms, including mail-order drug, may be requested online at select U.S.A., then Enroll in benefits, then Health, Insurance, then Request Materials. If you prefer, you can make your request by speaking with a Starbucks Benefits Center representative at (877) SBUXBEN. If you are enrolled in a Keystone Health Plan Central, HMSA, or Kaiser Hawaii HMO, refer to your health provider s guide to benefits for claims procedures. Claim procedure If you submit a claim for reimbursement, you will be notified of the claim decision not later than 30 days after receipt of the claim. This time period may be extended up to an additional 15 days due to circumstances outside Aetna s control. In that case, you will be notified of the extension before the end of the initial 30-day period. For example, it 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 Aetna s claim decision no later than 15 days after the end of that additional period (or after receipt of the information, if earlier). If your claim is denied, either in whole or in part, you can appeal the claim denial by following the process described on page 211. Questions? For general questions about your prescription drug benefits, call Starbucks Benefits Center at (877) SBUXBEN. If you have specific questions related to coverage of a prescription drug, call Aetna Partner Services at (888) To find out more about having a new prescription filled through the mail-order program or to ask questions about your mail-order refill, call Aetna Rx Home Delivery directly at (866)

117 Dental How the Plan Works 115 Calendar year deductible 115 Recognized charges 115 ID cards 115 Providers you can use 115 Covered Dental Services 116 What are necessary services? 119 What is not necessary? 119 Maximum benefit per calendar year 120 Precertification 120 What Is Not Covered 121 Treatment of the mouth, jaws and teeth 121 TMJ or MPD treatment 121 Other items not covered 121 If You Take an Approved Leave of Absence 122 When Coverage Ends 122 How to File a Claim 123 Urgent care claims 123 Other claims (pre-service and post-service) 124 Ongoing course of treatment 124 If you disagree with the claim determination 124 Questions?

118 VISION DENTAL Starbucks dental plan, administered by Aetna, helps you pay for a wide range of dental expenses. Pay less when you visit an Aetna preferred dentist. To receive dental coverage, you must be enrolled in the dental plan, as described in the Eligibility and Enrollment chapter. When you receive dental care you may also have some out-of-pocket costs. Your dental plan may require you to pay these expenses before benefits are paid. How the Plan Works Starbucks dental plan covers the cost of preventive dental care. The plan also covers charges for dental services and supplies, if you need treatment for a dental disease or injury, and orthodontia expenses. After satisfying a calendar year deductible, the plan pays 100%, 80% or 50% of recognized charges, depending on the type of service you receive. You pay the remaining balance. If your dentist s charges exceed recognized charges, you pay the balance due after any plan payments. If you use an Aetna preferred dentist, all charges are considered within recognized charges. Calendar year deductible A deductible is the amount you pay each calendar year before benefits are paid for covered dental expenses. The deductible does not apply to preventive services. The calendar year deductible is $50 per covered person. The maximum calendar year deductible for your entire family is $150. Recognized charges A recognized charge for a service or supply is the lowest of: The provider s usual charge for furnishing it, The charge Aetna determines to be appropriate, based on such things as the cost for the same or a similar service or supply and the way in which it was billed, for example, and The charge Aetna determines to be in the 85th percentile of the charges for that service or supply within the geographic area where it was furnished. ID cards After you enroll, Aetna will mail an ID card to your home. Take this card with you every time you visit the dentist. If you do not receive an ID card within your first month of coverage, contact Aetna Partner Services at (888) Providers you can use You can receive care through any licensed dentist. However, if you choose to receive care from a dentist in Aetna s preferred dentist network you will pay less for dental care. You do not need to select a preferred dentist at the time you enroll, but you will save money each time you visit a preferred dentist for dental care. 115

119 VISION DENTAL Using a preferred dentist When you receive dental care from an Aetna preferred dentist, you are billed a lower, preferred fee. Therefore, your portion is also lower, and you save money! Here is an example. SERVICE NON-PREFERRED DENTIST PREFERRED DENTIST Major service crown $1,050 $812 Plan pays 50% $525 $406 You pay remaining 50% $525 $406 Savings using a preferred dentist $119 You can locate a preferred dentist by linking to Aetna s DocFind website from referring to the directory at your work site or ordering a directory from Aetna Partner Services at (888) Covered Dental Services Starbucks dental plan covers treatments that are necessary, considered appropriate, used nationwide and meet broadly accepted national standards of dental practice. You may be required to pay for services when you receive them, then file a claim for reimbursement from the plan. The coverage you receive under this plan for preventive, basic and major dental care and orthodontia is summarized in the overview chart on the next pages. Report Fraud! If you suspect fraud or abuse involving health benefits, call Aetna s fraud hotline toll free at (800) or Aetna at [email protected]. Your Health Care Reimbursement Account Covers Dental Expenses If you have a health care reimbursement account and have out-of-pocket dental expenses, you may be reimbursed for these expenses from your account. Out-of-pocket expenses include your dental deductibles and payment percentage and may include charges not covered by the dental plan. Refer to the Reimbursement Accounts chapter for more information. 116

120 VISION DENTAL Starbucks dental plan coverage overview TYPE OF SERVICE THE PLAN PAYS YOU PAY Preventive services include: Oral exams and cleanings (limited to 2 exams and cleanings per calendar year) X-rays for diagnosis, and One full-mouth series in a 36-month period One set of bitewings two times per calendar year Topical application of fluoride for enrolled dependents under age 20 (up to 2 times per calendar year) Space maintainers for persons under age 20 Sealants for permanent teeth for persons under age 15 (limited to once in a 3-year period per tooth) Basic services include: Extractions Fillings Root canals and other endodontic treatments General anesthetic for covered dental services Antibiotic drugs Oral surgery (if you are enrolled in the York Medical plan, you may receive coverage through your medical plan if referred by your PCP) Relining or rebasing dentures Repair or recementing of crowns, inlays, bridgework or dentures Periodontic treatment when medically necessary 100%*, not subject to deductible 80%* after a $50 calendar year deductible Aetna preferred dentist Nonpreferred dentist $0 any amount exceeding recognized charges the remaining 20% the remaining 20% plus amounts exceeding recognized charges * The plan will pay this percentage of recognized charges. You and your enrolled dependents are responsible for any charges that exceed recognized charges. If you use an Aetna preferred dentist, the charges will be considered within recognized charges. 117

121 VISION DENTAL Starbucks dental plan coverage overview, continued TYPE OF SERVICE THE PLAN PAYS YOU PAY Major services include: Inlays, onlays, gold fillings or crowns (includes precision attachments for dentures) First installation of fixed bridgework to replace one or more natural teeth extracted while you are covered (includes inlays and crowns as abutments) First installation of removable dentures to replace one or more natural teeth extracted while you are covered (includes adjustments for the 6-month period following the date they were installed) Replacement of an existing removable denture or fixed bridgework by new fixed bridgework, or the adding of teeth to existing fixed bridgework in compliance with the prosthesis replacement rule 50%* after $50 calendar year deductible Aetna preferred dentist the remaining 50% Nonpreferred dentist the remaining 50% plus amounts exceeding recognized charges Orthodontia services include: Orthodontic appliances Impressions Orthodontic x-rays and services 50%* up to a $1,500 lifetime maximum per individual the remaining 50% of the $1,500 lifetime maximum and any remaining balance the remaining 50% of the $1,500 lifetime maximum and any remaining balance plus amounts exceeding recognized charges * The plan will pay this percentage of recognized charges. You and your enrolled dependents are responsible for any charges that exceed recognized charges. If you use an Aetna preferred dentist, the charges will be considered within recognized charges. 118

122 VISION DENTAL What are necessary services? Necessary services or supplies for Starbucks dental plan are those Aetna determines are necessary for the diagnosis, treatment or care of a sickness or injury. The plan will pay benefits for charges that have been shown to be necessary. To be considered necessary, the service or supply must be for treatment, care or diagnosis that is: As likely to help your sickness or injury as any other alternative treatment or care Equal in quality to, and is not costlier than, any other alternative treatment, care or diagnosis When determining necessary services or supplies, Aetna considers factors such as the patient s health condition, reports and guidelines published by nationally recognized health care organizations and professionals, information from medical literature and more. Prosthesis replacement rule Starbucks dental plan covers certain replacements or additions to existing dentures or bridgework, as long as: The replacement or addition of teeth is required to replace teeth extracted after the existing denture or bridgework was installed. You must have been covered by Starbucks dental plan when the tooth was extracted. The present denture or bridgework cannot be repaired and is at least five years old. The existing denture is temporary, only exists to replace any natural teeth extracted while you were covered under Starbucks dental plan and cannot be made permanent. Replacement by a permanent denture must be necessary and must take place within 12 months from the date the temporary denture was first installed. Replacement (e.g., bridge, implants, etc.) of congenitally missing teeth is covered as a major service provided the service is completed when the jaw is done growing and the solution is now permanent. The service must be completed before the member s 21st birthday to be covered. What is not necessary? The following items are not considered necessary: Services or supplies that do not require the technical skills of a medical or dental professional Services or supplies furnished mainly for the personal comfort or convenience of the patient, caretaker, family, health care provider or health care facility Services or supplies provided while you are being treated as an inpatient but when you could receive treatment, care or diagnosis as an outpatient Services or supplies furnished because of the setting when they could be safely and adequately provided in a physician s or dentist s office or another less costly setting 119

123 VISION DENTAL Maximum benefit per calendar year The maximum benefit that will be paid by Starbucks dental plan for preventive, basic and major services each calendar year per covered person is: $1,000 for the first calendar year you are covered $2,000 for each calendar year after that The maximum lifetime benefit that will be paid for orthodontia services is $1,500 per covered person. Special Rules That Apply to Your Maximum Benefit If you lose benefits eligibility during one plan year and re-establish eligibility the following plan year, your maximum benefit will be $1,000 for the first calendar year after re-establishing eligibility. If you lose benefits eligibility on October 31 and re-establish eligibility January 1 or later of the following calendar year, your coverage will be reinstated with a $2,000 maximum benefit. If you lose and re-establish benefits eligibility between January 1 and September 30 of the same plan year, your maximum dental benefit will be reinstated at the level it was when you lost eligibility. Precertification Precertification is required for any dental services that exceed $350. This typically includes most basic and all major and orthodontic services. The purpose of precertification is to inform you and your dentist, in advance, of what the plan covers for the proposed treatment prior to any coordination of benefits. If alternative services and supplies may be used to treat your dental condition, the plan will cover the least costly, professionally appropriate treatment. To obtain precertification, you or your dentist will need to submit to Aetna your dentist s proposed course of treatment and estimated charges. As part of the precertification process, Aetna may require you to have an oral exam, at no cost to you. Call Aetna Partner Services at (888) for more information. If you do not secure precertification before starting a dental course of treatment, you may not receive optimal benefits from the plan. Plan ahead and find out what is covered before you start basic or major dental treatments. Coordination of Benefits If you are part of a two-income family, you may be covered under more than one dental plan. To avoid duplicating benefits, most dental plans including Starbucks have what is called a coordination of benefits provision. See page 207 for examples of how this works. 120

124 VISION DENTAL What Is a Course of Treatment? A course of treatment is a planned program of one or more services or supplies needed to treat your dental condition. Your dentist must have diagnosed the condition during an oral exam, but the treatment itself may be given by one or more dentists. The course of treatment starts on the date you first receive treatment to correct or treat the dental condition. However, some services may be provided before you obtain precertification, such as emergency treatments, oral exams (including prophylaxis) and x-rays. What Is Not Covered The following services are not covered by the dental plan but may be covered, at least in part, by your Starbucks medical plan, if enrolled. Treatment of the mouth, jaws and teeth Starbucks medical plans administered by Aetna may cover eligible expenses for treatment of certain conditions of the teeth, mouth, jaws, jaw joints or supporting tissues (including bones, muscles and nerves). TMJ or MPD treatment Starbucks dental plan does not cover temporomandibular joint disorder (TMJ) or myofacial pain dysfunction (MPD) treatments. Nonsurgical treatments may be covered by Starbucks medical plans administered by Aetna if treatment is medically necessary. Other items not covered Starbucks dental plan also does not cover the following items: Treatment by someone other than a dentist (however, some treatments by a licensed dental hygienist supervised by a dentist are covered, including scaling of teeth, cleaning of teeth and topical application of fluoride) Services or supplies that are cosmetic in nature, including charges for personalization or characterization of dentures Replacement of a lost, missing or stolen prosthetic device Services or supplies to increase vertical dimension, including dentures, crowns, inlays, onlays, bridgework and any other appliance or service intended to increase vertical dimension Charges for which you are not legally obligated to pay Charges for the treatment of any condition related to or arising from previous or current employment or occupation, or serving in the armed forces Expenses in excess of recognized charges, as determined by Aetna Charges for services and supplies that are not necessary for the diagnosis, care or treatment of the condition, as determined by Aetna (this applies even if they are prescribed, recommended or approved by your doctor or dentist) 121

125 VISION DENTAL Charges for treatment, services or supplies that are not prescribed, recommended and approved by your attending doctor or dentist Surgical procedures to correct malocclusion Experimental procedures (defined below) Occupational diseases or injuries (defined below) What Is an Experimental Procedure? A drug, a device, a procedure or treatment will be determined to be experimental or investigational if: There are insufficient outcomes data available from controlled clinical trials published in the peerreviewed literature to substantiate its safety and effectiveness for the disease or injury involved; or If required by the FDA, approval has not been granted for marketing; or A recognized national medical or dental society or regulatory agency has determined, in writing, that it is experimental, investigational or for research purposes. What Is an Occupational Disease or Injury? An occupational disease or injury is one that arises out of or in the course of any work for pay or profit. Only nonoccupational accidental injuries and diseases are covered by Starbucks dental plan. A disease is nonoccupational, regardless of cause, if proof is furnished that the person is covered under any type of workers compensation law but is not covered for that disease under such law. If You Take an Approved Leave of Absence Your dental coverage may continue during an approved leave of absence as outlined on page 25. However, you will be required to continue to make your contribution payments for dental coverage during your leave of absence. Contributions for dental coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your contribution payments while on leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When Coverage Ends If you are no longer a Starbucks partner, your dental coverage ends on the last day of the month in which your termination is processed. If you lose benefits eligibility due to the ongoing eligibility audit, your dental coverage ends as described in the Eligibility and Enrollment chapter. You may elect to continue your coverage through COBRA as outlined in Your COBRA Rights on page

126 VISION DENTAL If you are waiting for ordered and undelivered services when your coverage ends, and you had ordered certain dental services or supplies while you were covered, the plan will cover those ordered and undelivered services. These include: Dentures Fixed bridgework Crowns These supplies will be covered only if they are installed or delivered within 30 days after your coverage under Starbucks dental plan ends. Ordered services means you have had impressions taken for dentures, crowns or fixed bridgework, or your teeth have been prepared for fixed bridgework or crowns. How to File a Claim Usually, dentists will automatically submit a claim directly to Aetna for services you have received. Aetna will reimburse the dental office for what the plan covers and you will be responsible for paying the dental office the balance due. You may be asked to sign and submit a claim form periodically in order for the dental office to continue to automatically bill Aetna. You may need to submit claims for any basic or major dental services you receive except when you use an Aetna preferred dentist. File your claims with Aetna within 90 days of receiving your treatment. To submit a claim, complete the employee section of the claim form, attach an itemized bill and mail it to the address shown on your Aetna Dental ID card. Or, have your dental office complete the provider portion of the claim form and submit it directly to Aetna at the address shown on your ID card. Claim forms may be requested online at Select U.S.A., then Health, Insurance, then Enroll in Benefits, then Request Materials. If you prefer, you can make your request by speaking with a Starbucks Benefits Center representative at (877) SBUXBEN. Urgent care claims If the service, supply or procedure requires advance approval before a benefit will be payable and if Aetna or your health care provider determines that you have an urgent care claim, you will be notified of the decision not later than 72 hours after the claim is received. What Is Urgent Care? A claim involving urgent care is any claim for dental care or treatment in which the standard claim determination waiting period could seriously jeopardize the life or health of the individual or the ability of the individual to regain maximum function, or in the opinion of a dentist with knowledge of the individual s medical condition would subject the individual to severe pain that cannot be adequately managed without the care or treatment that is being reviewed. 123

127 VISION DENTAL 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) You will be notified of the claim decision not later than: 15 days after receipt of the claim for services requiring precertification or preauthorization before a service is rendered (pre-service claims) 30 days after receipt of the claim for services already delivered to the patient (post-service claims) These time periods may be extended up to an additional 15 days due to circumstances outside Aetna s control. In that case, you will be notified of the extension before the end of the initial 15- or 30-day 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 Aetna s 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, dental condition and service or supply for which approval is requested and which are submitted to Aetna, but which otherwise fail to follow the plan s 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 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 are receiving an ongoing course of treatment, you will be notified in advance if Aetna intends to terminate or reduce benefits for the 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. If you disagree with the claim determination If your claim for benefits is denied, either in whole or in part, you may appeal the claim decision by following the process described in Appealing Denial of Claims on page 211. Questions? For answers to your questions about the Starbucks dental plan, call Aetna Partner Services at (888)

128 Vision How the Plan Works 126 Finding a VSP network provider 126 Visiting a VSP network provider 126 Visiting a non-vsp provider 126 What the Plan Covers 127 Eye exams 127 Prescription glasses and contacts 127 Laser VisionCare SM program 128 Additional discounts 129 What Is Not Covered 129 If You Take an Approved Leave of Absence 129 When Coverage Ends 129 How to File a Claim 130 When you visit a VSP network provider 130 When you visit a non-vsp provider 130 Claim procedure 130 Questions?

129 VISION VISION Starbucks vision plan provides you and your enrolled dependents coverage for eye exams, prescription glasses and contacts. The plan is offered through VSP, which has a national network of eyecare providers. To receive vision coverage, you must be enrolled for vision benefits as described in the Eligibility and Enrollment chapter. How the Plan Works When you visit a VSP network provider, you will typically receive a higher level of coverage from the plan. If you choose to visit a non-vsp provider, you will still have coverage but may not receive as high of a benefit. In addition, with a non-vsp provider you must pay for services up front and submit a claim to VSP for reimbursement. Finding a VSP network provider There are several ways to access a VSP network provider. Refer to the VSP network provider directory at your work location. Call VSP at (800) , tell them you are a Starbucks partner and request a listing of VSP network providers in your area. Link to VSP s website from Visiting a VSP network provider To visit a VSP network provider just follow the steps outlined below. Select a provider in the VSP directory. Call and make an appointment, identifying yourself as a VSP member. Pay your copays for your exam and prescription glasses (lenses and frame) or contacts if you are purchasing them. Pay for any discounted lens options, such as tints, coatings and progressive lenses not covered by the plan, and any amount exceeding the VSP frame allowance. There is no ID card for the vision plan. When you are making your appointment with a VSP network provider, simply let them know you are a VSP member. Your provider will confirm your eligibility prior to your appointment. Visiting a non-vsp provider You get the best value from your VSP benefit when you visit a VSP network provider. However, you may visit any licensed optometrist, ophthalmologist or dispensing optician. If you decide not to see a VSP provider, copays still apply. You will also receive a lesser benefit and typically pay more out of pocket. You are required to pay the provider in full at the time of your appointment and then submit a claim for reimbursement to VSP. See How to File a Claim on page

130 VISION What Is a Copay? Your copay is the flat fee you pay out of pocket each time you receive vision care or purchase eyewear, such as glasses or contacts. You may incur additional out-of-pocket costs beyond what is covered by the vision plan. What the Plan Covers The vision plan covers specific vision services and eyewear as described in this section. Your coverage varies depending on whether you see a VSP network provider or a non-vsp provider. Eye exams The vision plan covers one eye exam per calendar year. Prescription glasses and contacts Prescription glasses and contacts are covered by the vision plan as follows: Lenses and frames One pair of frames is covered once every two calendar years. Up to one pair of lenses is covered per calendar year. Tints, coatings, progressive lenses and other lens options are not covered, but may be purchased at a 20% discount from your VSP network provider. Contacts One pair of elective contacts is covered per calendar year. However, if you choose to purchase elective contacts instead of glasses, you are not covered for glasses in the same calendar year. Additionally, you are not eligible for frames until the second calendar year following the year you receive coverage for your elective contacts. For example, if you choose contacts in 2005, frames will not be covered until One pair of medically necessary contacts is covered in full by the plan per calendar year if required for certain medical conditions and approved by VSP. Medically necessary means that your eye doctor has determined that contacts are medically required to correct your vision, which cannot be corrected by glasses. Health Care Reimbursement Accounts Cover Vision Expenses If you are a salaried or nonretail hourly partner participating in a health care reimbursement account and pay any out-of-pocket vision expenses, you may be reimbursed for these expenses from your health care reimbursement account. Out-of-pocket expenses include copays and items not covered by the vision plan. See the Reimbursement Accounts chapter for more information. 127

131 VISION VISION Vision plan coverage overview SERVICES Eye exams One per calendar year Frames One pair every 2 calendar years Lenses Up to one pair of lenses per calendar year, excluding tints, coating and other lens options Contacts Medically necessary and instead of glasses Contacts Elective and instead of glasses WHEN YOU VISIT A VSP NETWORK PROVIDER Copay applies You pay $10 copay per exam The plan pays remaining balance The plan pays up to $125 retail frame allowance (and you will receive a 20% discount on any cost over your $125 allowance) You pay any charges over the frame allowance You pay $25 copay plus any charges for cosmetic lens options not covered by the plan The plan pays remaining balance for single vision, lined bifocal and lined trifocal lenses You pay $25 material copay The plan pays remaining balance The plan pays up to $125, applies to your contacts and contact lens exam (evaluation and fitting charges) You pay any remaining balance WHEN YOU VISIT A NON-VSP PROVIDER Copay applies You pay exam charges in full The plan reimburses you up to $40 The plan reimburses you up to $50 You pay any remaining balance You pay lens cost in full The plan reimburses you up to: $40 for single vision $60 for lined bifocal $80 for lined trifocal $125 for lenticular (when medically necessary and pre-authorized by VSP) You pay lens cost in full The plan reimburses you up to $210, less any applicable copay You pay lens cost in full The plan reimburses you up to $125 Laser VisionCare SM program VSP s Laser VisionCare SM program includes comprehensive information on laser vision correction surgery, as well as giving you substantial savings on the procedure. VSP has arranged for you to receive PRK, LASIK and Custom LASIK services at a discounted fee averaging 15% less than you might otherwise pay. To use Laser VisionCare SM, visit VSP s website by linking from or call your VSP network provider to check if he or she is participating in the program. Schedule a screening and consultation with your VSP network provider. If, in consultation with your VSP network provider, you decide to proceed with laser vision correction, your VSP network provider will coordinate your care with a VSP laser surgeon. If you do not use a VSP network provider, you will not receive these discounted fees. 128

132 VISION Additional Discounts VSP network providers also offer the extra discounts and savings listed below. You receive a 20% discount on noncovered pairs of prescription glasses (lenses and frame) and sunglasses. Services must be received within 12 months of your last covered eye exam and be received from the same VSP network provider who provided your last covered eye exam. You receive up to 20% savings on lens extras such as scratch-resistant and anti-reflective coatings and progressives (no-line bifocals and trifocals). You receive a 15% discount on a contact lens exam (fitting and evaluation) when obtained from a VSP network provider. You also receive a 15% discount on annual supplies of certain brands of contacts. You receive laser vision correction discounts. Call VSP Member Services at (800) for more information. What Is Not Covered The vision plan does not cover vision services and eyewear if they are covered, in whole or in part, under any medical plan. In addition, the following items are not covered by the vision plan: Orthoptics or vision training and any associated supplemental testing Plano nonprescription lenses Two pairs of glasses instead of bifocals Replacement of lenses and frames paid for by the plan that were lost or broken Medical or surgical treatment of the eyes Corrective vision services, treatments and materials of an experimental nature If You Take an Approved Leave of Absence Your vision coverage may continue during an approved leave of absence as outlined on page 25. However, you will be required to continue to make your contribution payments for vision coverage during your leave of absence. Contributions for vision coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your contribution payments while on a leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When Coverage Ends If you are no longer a Starbucks partner, your vision coverage ends on the last day of the month in which your termination is processed. 129

133 VISION VISION If you lose benefits eligibility due to the ongoing eligibility audit, your vision coverage ends as described in the Eligibility and Enrollment chapter. You may elect to continue your coverage through COBRA as outlined in Your COBRA Rights on page 219. How to File a Claim When you visit a VSP network provider Your VSP network provider takes care of all the paperwork for you, so you do not need to file a claim if you visit someone in the VSP network. When you visit a non-vsp provider When you visit any non-vsp provider, you must pay for services at the time you receive them and then submit a claim for reimbursement up to the plan coverage amount. To file a claim, you do not need a form. Just send an itemized receipt to VSP. The receipt should include: A list of services received Your name, current address, phone number and Social Security number The patient s name, address, phone number and date of birth The name of Starbucks as your employer Your relationship to the VSP member, such as self, spouse, domestic partner or child Send the claim within six months of visiting the non-vsp provider to: VSP P.O. Box Sacramento, CA Claim procedure VSP will notify you of its decision within 30 days after your claim is filed. If, because of matters beyond the control of VSP, a decision cannot be made within 30 days, then the time period may be extended an additional 15 days. In that case, VSP will notify you before the end of the initial 30-day period that an extension is required. If the extension is required because you fail to submit the information necessary, VSP will send you a notice describing the information it requires. You will then have at least 45 days from the date you receive the notice to provide the required information. VSP s 15-day extension will begin after you have submitted the required information, provided you did so within the time frame specified by VSP. If you do not provide the required information, VSP may decide your claim without it. If your claim is denied, either in whole or in part, you may appeal by following the process described on page 211. Questions? For answers to your questions about the vision plan, call VSP Member Services at (800)

134 Reimbursement Accounts How the Plans Work 132 Estimate your tax savings online 132 Evaluating the best tax advantage 132 Participating in the plans 133 Annual open enrollment 133 Rules you should know 134 Health Care Reimbursement Account 134 What the account covers 134 What is not covered 135 If you take an approved leave of absence 136 When coverage ends 136 Continuing participation through COBRA 137 How to file a claim 137 Dependent Care Reimbursement Account 138 What the account covers 139 What is not covered 140 If you take an approved leave of absence 140 When coverage ends 141 How to file a claim 141 Questions?

135 VISION REIMBURSEMENT ACCOUNTS Starbucks offers eligible partners the opportunity to participate in health care and dependent care reimbursement accounts. With these accounts, you can set aside before-tax dollars up to defined limits to pay for qualifying health care and dependent care expenses. How the Plans Work To participate in the reimbursement accounts, you must be a salaried or nonretail hourly partner and eligible for Starbucks benefits coverage. Once you establish eligibility, you can enroll in either the health care reimbursement account (HCRA), the dependent care reimbursement account (DCRA), or both. The two plans are similar in how they work, but they are separate accounts and differ in some important ways. If you enroll, Starbucks will automatically deduct your contributions from your paychecks before taxes are withheld and deposit them in your reimbursement account(s). You do not pay taxes on the money you put into the account or on the money taken out of the account in the form of reimbursements (including Social Security and Medicare [FICA] taxes, federal income tax and, in most areas, state and local income taxes). Because the dollars you contribute are not taxed, the IRS imposes limits on how those dollars may be reimbursed to you. For example, the IRS determines what is considered a qualifying expense, the last day you can file your claims and who is considered a qualifying dependent. When you have a qualifying expense, you must submit a claim to Aetna for reimbursement from your account. Estimate your tax savings online You can estimate your reimbursement account tax savings using Aetna s FSA (Flexible Spending Account) Advisor online at Select FSA Savings Calculator. There is also a savings calculator on Your Benefits Resources, the site you use to enroll. Evaluating the best tax advantage Before you enroll in a reimbursement account, weigh the tax advantages. You may find that it is more tax advantageous for you to claim a deduction or credit on your federal income tax rather than use a reimbursement account. For example, if you have medical expenses totaling more than 7.5% of your adjusted gross income each year, you may be able to deduct them as medical expenses on your tax return. If you have dependent children, you may already be taking advantage of the federal child and dependent care tax credit. To see whether Starbucks reimbursement accounts make more sense for your personal tax situation, obtain a copy of the IRS publications 502 (Medical and Dental Expenses) and 503 (Child and Dependent Care Expenses) and talk with a tax advisor. These publications are available from Starbucks Benefits Center at (877) SBUXBEN or online at or There are several tax considerations to keep in mind when deciding whether or not to participate in Starbucks reimbursement accounts. You cannot claim a tax deduction or take a tax credit for the same expenses that you have been reimbursed for through your reimbursement account. Tax credits and tax deductions reduce your income tax at the time you file your tax return. Reimbursement accounts reduce your income tax withholding throughout the year. 132

136 VISION REIMBURSEMENT ACCOUNTS Participating in a reimbursement account may reduce your Social Security benefits in the future. Finally, tax laws require Starbucks to review reimbursement account contributions to ensure the accounts do not favor highly compensated partners. Depending on the results of this review and your pay, some or all of the contributions made by highly compensated partners during the plan year may become taxable (see Nondiscrimination testing on page 139 for more information). Starbucks will notify you if this applies to you. Which method is best for you reimbursement accounts, tax credits or deductions? It all depends on your personal tax situation. You may want to talk to a tax advisor before you make a decision. Participating in the plans When you are first eligible for benefits, enrollment materials that guide you through the enrollment process will be mailed to your home address. Estimate the amount you will spend on qualifying health care and dependent care expenses in a plan year and determine if reimbursement accounts make more sense than using the medical expense deduction or child care tax credit. If you initially establish benefits eligibility in the middle of a plan year or you have a qualified status change, remember to forecast your expenses and contributions over fewer pay periods. Your maximum contribution will be based on a per-pay-period maximum. What Is a Plan Year? The plan year is October 1 through September 30. You can be reimbursed for health care or dependent care expenses incurred during the plan year, as long as Aetna receives your claims by the following December 31. A plan year differs from a calendar year, so you will need to keep this in mind when planning your annual health care or dependent care enrollment and when you are preparing your income tax returns. If you enroll in the reimbursement accounts, your calendar-year-to-date contributions will appear on your paycheck stub beginning one or two pay periods following the date your enrollment was processed. Your total contribution amount for the calendar year will appear on your W-2 form at the end of the year. Aetna will mail a statement of your account balance to your home at least twice a year. If you experience a qualified status change during the year, such as adding a newborn or changing dependent care providers, you may be able to change your reimbursement account contributions. See Making Changes on page 22. Annual open enrollment Each year, during the annual benefits open enrollment period, you have the opportunity to participate in the reimbursement accounts for the upcoming plan year. During this time, you can enroll for the first time, re-enroll or change the amount you are contributing. If you do nothing, your previous contribution election will automatically be reset to $0. Even if you do not want to make any changes to the amount you are contributing, you must re-enroll each annual open enrollment period to continue participation. 133

137 VISION REIMBURSEMENT ACCOUNTS You can check your account balance anytime online at Aetna Navigator TM (link from Rules you should know Certain IRS rules apply to reimbursement accounts: Use it or lose it. If you have money left in your reimbursement accounts at the end of the plan year, you lose that balance. You cannot apply the balance to the next plan year or receive a refund. Submit your claims before December 31. The money you contribute during a plan year October 1 to September 30 must be used for eligible expenses incurred during that same plan year. Aetna must receive your claims for the previous plan year s eligible expenses by December 31. You cannot combine accounts. You cannot apply your health care contributions toward dependent care expenses, or vice versa. Health Care Reimbursement Account (HCRA) If you have health care expenses not covered by your medical, dental or vision plan, you may be able to pay for these expenses with before-tax dollars through the HCRA. You can participate in the HCRA even if you are not enrolled in a Starbucks medical plan. Each year, you can contribute between approximately $100 and $5,000 to an HCRA as follows: FREQUENCY OF PAYCHECK MINIMUM PER PAYCHECK MAXIMUM PER PAYCHECK Weekly $1.92 $96.15 Biweekly $3.84 $ Only specific types of expenses can be reimbursed by your account and unused balances are forfeited at the end of the year. What the account covers You can be reimbursed for qualifying health care (medical, prescription drugs, dental, vision and over-the-counter drugs) costs for you, your children and your spouse even if you or they are not covered by Starbucks health plans. Health care expenses for your domestic partner or same-sex spouse are reimbursable only if your domestic partner or same-sex spouse also qualifies as your dependent for federal tax purposes. Qualifying health care expenses are those you have incurred that are not covered under any health plan you are enrolled in. They may include, but are not limited to: Deductibles, coinsurance amounts and copays for medical, prescription drug, dental and vision plans Over-the-counter drugs (drugs and medications that do not require a doctor s prescription) Artificial limbs and eyes Braille books and magazines for the visually impaired if they cost more than regular books Contact lenses and contact lens supplies Crutch purchase or rental 134

138 VISION REIMBURSEMENT ACCOUNTS Eye care and eyewear (excluding accessories) Guide dogs or other animals trained to assist a visually or hearing impaired individual Unreimbursed hearing aid expenses Unreimbursed prescribed contraceptives (birth control pills, etc.) Special education for mentally impaired or physically disabled individuals Syringes, needles or other medical supplies Travel and lodging to receive medical care Unreimbursed orthodontia expenses Wheelchairs used for the relief of sickness or disability For specifics on what your HCRA will cover, call Starbucks Benefits Center at (877) SBUXBEN to request a copy of IRS publication 502, (Medical and Dental Expenses) or access or Special Rule for Orthodontia Typically, treatment for orthodontia ranges from a few months to several years. The IRS has recognized that orthodontia billing practices differ from other health care billing practices. One orthodontia invoice may include expenses for multiple visits, often well into the future. For this reason, the IRS allows you to submit orthodontia claims for reimbursement at the time you pay the invoice, even if all the treatment sessions have not yet occurred. However, the expenses on the invoice must be related to the current plan year (October 1 through September 30). What is not covered Some expenses that cannot be reimbursed by the HCRA include, but are not limited to: Expenses incurred before your enrollment begins or after it ends Expenses incurred while on an approved leave of absence, unless you have continued to make your contributions during your leave Health care coverage premiums Items covered under a plan you or your family is enrolled in at the time the expense is incurred Cosmetic surgery or services Health club membership dues Dietary supplements, including vitamins Special education for mentally impaired or physically disabled persons if the education is intended to relieve the disability Long-term care or insurance premiums 135

139 VISION REIMBURSEMENT ACCOUNTS Reimbursement Following an Election Change If you change your HCRA election midyear due to a qualified status change, you will be reimbursed up to your annual contribution election in effect at the time your expenses were incurred. For example: You enrolled for the HCRA and contribute $1,500 annually. You already filed claims and received reimbursement for the full $1,500 by February 1. Then, on April 20, you marry (a qualified status change) and increase your annual HCRA contribution amount from $1,500 to $2,000. You are now able to submit claims for reimbursement for up to $500 for services incurred from your enrollment date through the end of the plan year, September 30. If you take an approved leave of absence While you are on an approved leave of absence, you have two options for your HCRA: Continue your contributions by arranging for a lump sum payroll deduction of your contributions while on your leave or by making payments during your leave. When you do so, your annual contribution election remains available to you and eligible expenses you incur while on leave may be reimbursed. To continue your participation and contributions during your leave, contact Starbucks Benefits Center at (877) SBUXBEN. Suspend your contributions during your leave. If your contributions are suspended, two things happen: your annual election is reduced by the missed contributions and any expenses you incur while on leave may not be reimbursed from your account. If you don t contact Starbucks Benefits Center to continue your contributions, your contributions will automatically be suspended. Upon your return to work you may be eligible to change your contributions if you had a qualified status change during your leave. You must make your enrollment change within 45 days of your return to work. For more information, see Making Changes on page 22. When Coverage Ends If you are no longer a Starbucks partner, your payroll deductions for the HCRA automatically end. You can submit claims against your remaining annual contribution election until the December 31 following the end of the plan year for claims incurred before your termination date. If you lose benefits eligibility due to the ongoing eligibility audit, your contributions will be suspended as described in the Eligibility and Enrollment chapter. If you re-establish benefits eligibility within the same plan year, your contributions will automatically reinstate on the first paycheck following the date you re-establish eligibility. 136

140 VISION REIMBURSEMENT ACCOUNTS Continuing participation through COBRA You can continue your HCRA coverage through COBRA as described in Your COBRA Rights on page 219. You may only continue coverage for your HCRA through the end of the plan year if you have amounts remaining in your account as of the date of your termination. If your HCRA is overspent (you have received reimbursements in excess of the amount that you have contributed), you cannot continue coverage. If you choose to continue your HCRA contributions through COBRA, your annual contribution amount remains the same and you can continue to submit claims and be reimbursed for services incurred during the period you are covered through COBRA. Your COBRA contributions will include a 2% administration fee and the contributions are on an after-tax basis. How to file a claim Two ways to file a claim for reimbursement Three ways to obtain a claim form Filing a claim for eligible over-thecounter medications and supplies Where to locate claim submission guidelines When you can submit a claim How much is reimbursed Submit a HCRA claim form to Aetna with appropriate documentation. Automatic claim filing. If enrolled in a Starbucks medical or dental plan administered by Aetna, your out-of-pocket expenses (e.g., deductibles, copays) are automatically reimbursed to you. (Do not use automatic claim filing if you have enrolled a domestic partner or samesex spouse who is not a tax dependent in Starbucks medical and/or dental coverage and/or when you or your dependents have coverage under another medical or dental plan outside Starbucks.) Call Starbucks Benefits Center at (877) SBUXBEN to request automatic claim filing or elect streamlined administration during your online enrollment. Download or print from Downloads on the Benefits page at Link to Your Benefits Resources from the Benefits page at Log in, select Health, Insurance..., then Request Materials. Speak with a Starbucks Benefits Center representative at (877) SBUXBEN. Submit your itemized receipt with a Flexible Spending Account OTC (Over-the-Counter) Health Care Reimbursement form. This form can be obtained in the same ways as a regular reimbursement claim form (see above). Online at As soon as you incur expenses and have an itemized receipt, but no later than the December 31 immediately following the end of the plan year (September 30). The amount of your qualifying expenses up to the amount you elected to contribute for the full plan year (October through September), even if your expense exceeds your yearto-date contributions. If you are reimbursed for the full year amount before the end of the plan year, your payroll contributions will continue through September

141 VISION REIMBURSEMENT ACCOUNTS How to file a claim (continued) Two options for reimbursement Frequency of claim processing Viewing your account balance and claim status Claim filing deadline If your claim is denied, in whole or in part By check mailed to the address on file (if elected streamlined administration) or, if you submitted your claim via a claim form, to the address on your claim form. Automatically deposited into your personal checking or savings account if you request electronic funds transfer (EFT). To request direct deposit of your reimbursement, submit a completed EFT Authorization for Direct Deposit Form to Aetna available from Starbucks Benefits Center at (877) SBUXBEN or Aetna Partner Services at (888) Your request will take affect about 10 days after your enrollment form is received and remain on file until you change it, even if you don t participate in the reimbursement account for a year or more. To change your banking information, you must submit a new EFT Authorization form. Claims are processed at least twice per month. Link to Aetna Navigator TM from Claims for the plan year (October through September) must be received by Aetna no later than the December 31 immediately following the last day of the plan year to be considered for reimbursement. You can appeal the claim denial within certain time limits by following the process described in Appealing Denial of Claims on page 211. Dependent Care Reimbursement Account (DCRA) If you have dependent care expenses for your child(ren) under age 13 or a disabled adult family member, you can enroll in the DCRA and pay for these expenses with before-tax dollars. Each year, you can contribute up to the following limits to your DCRA (unless you are a highly compensated partner as defined by the Internal Revenue Service; see Nondiscrimination testing on page 139 for more information): Up to $5,000 per plan year if you are married and file a joint federal tax return, or if you are single Up to $2,500 per plan year if you are married and file a separate return Here is what that looks like on a pay-period basis: FREQUENCY OF PAYCHECK MINIMUM MAXIMUM IF SINGLE OR MARRIED FILING JOINTLY Weekly $1.92 $96.15 $48.07 Biweekly $3.84 $ $96.15 MAXIMUM IF MARRIED FILING SEPARATELY Only qualified dependent care expenses may be reimbursed by your DCRA and any unused balances are forfeited at the end of the year. 138

142 VISION REIMBURSEMENT ACCOUNTS Nondiscrimination testing Each year, Starbucks is required to test the DCRA for compliance with IRS discrimination regulations. These regulations place limits on the percentage that highly compensated partners (as defined by the IRS) can contribute to the plan as compared to nonhighly compensated partners. In order to pass this test, the maximum contribution highly compensated partners can make to the DCRA is limited to $2,000 per plan year. Starbucks conducts a forecast test early in the plan year to see if the plan is expected to pass the test. If the plan fails the forecast test, highly compensated partner contributions may be reduced further until the forecast test is passed. You will be notified if your contributions must be adjusted. Although limiting the amount highly compensated partners can contribute to the DCRA and using a forecast test are proactive efforts by Starbucks, it does not guarantee that at the end of the plan year the DCRA plan will pass the discrimination test. If the plan fails the test, some or all of the contributions made by highly compensated partners during the plan year may become taxable. What the account covers You can use the DCRA to pay for dependent care costs that allow you and your spouse, if you are married to work outside of your home, attend school full time or look for work. The dependent care services may be provided in your home or another location, but not by someone who is your child under age 19 or considered your dependent for income tax purposes. If the services are provided by a dependent care facility that cares for more than six people, it must be licensed and meet state and local regulations. Services must be for the physical care of your dependent(s), not for things like education, meals and so on. You can use the account to pay for the dependent care costs of: Your dependent child(ren) under age 13 who must be your qualifying child tax dependent (as defined by the IRS) or if there has been a divorce or other legal separation of the parents you must be the custodial parent Your spouse, who is physically or mentally incapable of caring for himself or herself and spends at least eight hours a day in your home Any other person who is physically or mentally incapable of caring for himself or herself, spends at least eight hours a day in your home and is also your tax dependent or a child for whom you are the custodial parent Eligible expenses include: Costs for a day care center, if the center complies with all state and local laws Tuition for nursery school, if the school complies with all state and local laws Costs for family or adult day care facilities Wages paid to a nanny or companion in or outside of your home For more information on what your DCRA may reimburse, call Starbucks Benefits Center at (877) SBUXBEN to request a copy of IRS publication 503, (Child and Dependent Care Expenses) or access 139

143 VISION REIMBURSEMENT ACCOUNTS Paying for Services in Advance Many day care providers require payment in advance of providing services. This plan does not allow reimbursement for dependent care services until they have been incurred. So, if your dependent care provider bills in advance for future services, you will need to wait until that billing period has passed before you submit your claim. In these instances, you may want to request that your provider bill you more frequently in order to receive more timely reimbursements from the plan. Day Care Rates You may be able to change your contribution amount midyear if your day care costs change, for example, because you change day care providers, you experience a change in your day care provider s or nanny s rates, or the hours of care change. When your day care costs change, call Starbucks Benefits Center at (877) SBUXBEN within 45 days. What is not covered Your DCRA will not reimburse: Wages for dependent care paid to someone whom you claim as a dependent on your federal income tax return Dependent care given during your (and your spouse s) nonscheduled work hours Any school costs for a dependent of school age, including kindergarten and summer school services (if the cost of schooling cannot be separated from the child care aspect of the program, the entire cost may be eligible) Overnight camp Nursing home expenses for dependents who do not live with you Dependent care for a child age 13 or over, unless they are incapacitated Child and Dependent Care Tax Credit In some cases, you may get a better tax advantage with the federal child and dependent care tax credit than with the dependent care reimbursement account. See a tax advisor to find out which works best for your situation. If you take an approved leave of absence While on your approved leave of absence, your contributions are suspended. You will not be able to be reimbursed for expenses incurred during your leave of absence. If you re-establish benefits eligibility within the same plan year, your prior per paycheck contributions will be reinstated and your annual contribution election amount will be reduced by the contribution amount missed during your leave of absence. If you return from your approved leave in a subsequent plan year, you will need to re-enroll for the reimbursement accounts. 140

144 VISION REIMBURSEMENT ACCOUNTS You may be eligible to change your DCRA contributions upon your return to work if you had a qualified status change during your leave. You must make your enrollment change within 45 days of your return to work. For more information, see Making Changes on page 22. When Coverage Ends If you are no longer a Starbucks partner, your DCRA payroll deductions automatically end. You can continue to submit claims until you have used up your DCRA balance, provided the claims are eligible reimbursable expenses incurred within the plan year even after your termination from Starbucks. If you lose benefits eligibility due to the ongoing eligibility audit, your contributions will be suspended as described in the Eligibility and Enrollment chapter. If you re-establish benefits eligibility within the same plan year, your contributions will automatically reinstate on the first paycheck following the date you re-establish eligibility. How to file a claim To file a claim for reimbursement Three ways to obtain a claim form Where to locate claim submission guidelines When you can submit a claim How much is reimbursed Two options for reimbursement Submit a DCRA claim form to Aetna with appropriate documentation including the tax identification number of your dependent care provider. Download or print from Downloads on the Benefits page at Link to Your Benefits Resources from the Benefits page at Log in, select Health, Insurance..., then Request Materials. Speak with a Starbucks Benefits Center representative at (877) SBUXBEN. Online at As soon as you incur expenses and have an itemized receipt, but no later than the December 31 immediately following the end of the plan year (September 30). The amount of your eligible expenses up to your current account balance (what you have contributed to date). If your claim exceeds your account balance, the remainder will be reimbursed once additional payroll contributions are recorded in your account. By check mailed to the address on file (if elected streamlined administration) or, if you submitted your claim via claim form, to the address on your claim form. Automatically deposited into your personal checking or savings account if you request electronic funds transfer (EFT). To request direct deposit of your reimbursement, submit a completed EFT Authorization for Direct Deposit Form to Aetna available from Starbucks Benefits Center at (877) SBUXBEN or Aetna Partner Services at (888) Your request will take affect about 10 days after your enrollment form is received and remain on file until you change it, even if you don t participate in the reimbursement account for a year or more. To change your banking information, you must submit a new EFT Authorization form. 141

145 VISION REIMBURSEMENT ACCOUNTS How to file a claim (continued) Frequency of claim processing Viewing your account balance and claim status Claim filing deadline If your claim is denied, in whole or in part Claims are processed at least twice per month. Link to Aetna Navigator from the Benefits page at Claims for the plan year (October through September) must be received by Aetna no later than the December 31 immediately following the last day of the plan year to be considered for reimbursement. You can appeal the claim denial within certain time limits by following the process described in Appealing Denial of Claims on page 211. Questions? For answers to your general questions about reimbursement accounts, call Starbucks Benefits Center at (877) SBUXBEN. If you enroll in a reimbursement account and have questions specific to your account, call Aetna Partner Services at (888)

146 Sick Pay How the Plan Works 144 If You Change Positions 145 If You Are No Longer a Starbucks Partner 145 Questions?

147 VISION SICK PAY Sick pay replaces your regular pay for the occasional day off needed because of illness or injury, to attend medical or dental appointments or to care for an ill family member. Retail hourly partners are not eligible for sick pay (except as legally required) but may be eligible for short-term disability if absent more than three days. How the Plan Works If you are a salaried or nonretail hourly partner, you accrue.0192 hours of sick pay for each hour paid for regular, vacation and sick pay. You don t accrue sick pay during a leave of absence. Sick pay continues to accrue until you reach the maximum accumulation of 520 hours. Once you accumulate 520 hours of sick pay, sick pay will stop accruing until unused hours fall below 520. Partners working in locations with legally mandated sick pay requirements will receive sick pay as required. You can use your accrued sick pay after 90 days of employment with Starbucks. When you miss work due to your illness, a family member s illness or a doctor s appointment, you can use your accrued sick pay to replace your regular pay. Family members include your child, stepchild, foster child, grandchild, parents, stepparents, grandparents, spouse and domestic partner. Your sick pay is paid to you at your current rate of pay. To receive sick pay, you will need to record the time and submit it to payroll, indicating the number of hours of sick pay you have used. Here are some examples of when you can receive sick pay: Absent for a doctor or dentist appointment or to take a family member to a doctor or dentist appointment Ill or injured and cannot work Absent to care for your ill or injured family member, including your spouse or domestic partner who has just given childbirth Below are some examples of when you cannot use sick pay for your absence. For a parent/teacher conference or other school function. Your family member is not suffering from an illness or injury that requires your care. A child has been placed with you for adoption or foster care. This list is illustrative only and is not meant to represent every situation where use of sick pay would be inappropriate. If you are unsure about your specific situation, please discuss it with your Partner Resources manager. Salaried partners report sick pay only when absent for a full day. If you are sick for more than three days, you may be eligible to receive benefits from Starbucks short-term disability (STD) plan as outlined in the Short-Term Disability chapter. 144

148 VISION SICK PAY Cannot Donate Sick Pay Sick pay donation to help another Starbucks partner who is experiencing a medical crisis or emergency is not available. No I.O.U.s Please You can use only the sick pay that you have already accrued. In other words, if you have accrued only four hours of sick pay and miss an eight-hour day because you are sick, you will be paid only for the four hours. If You Change Positions If you change from retail hourly to salaried or nonretail hourly, you will begin to accrue sick pay starting on the date you change positions. If you change from salaried or nonretail hourly to retail hourly, you are not eligible for sick pay in your new position. If You Are No Longer a Starbucks Partner If you leave employment with Starbucks for any reason, you will not be paid for any accrued and unused sick pay. If you are later rehired by Starbucks, your prior sick pay balance will not be reinstated. Questions? Speak with your manager, or you can also contact Starbucks Partner Contact Center at (866)

149 Short-Term Disability How the Plan Works 147 Calculating Your Benefit 148 Average weekly earnings 148 Other disability income benefits 148 What Is Not Covered 149 When Your STD Benefits Begin and End 150 Maximum benefit period 150 If you have a recurrent disability 150 If You Take an Approved Leave of Absence 151 When Coverage Ends 151 How to File a Claim 151 Questions?

150 VISION SHORT-TERM DISABILITY Starbucks provides you with continued income for up to 26 weeks if you are sick or injured and cannot work. As long as you are eligible for Starbucks benefits, you are covered by the short-term disability (STD) plan. Your STD coverage is automatic you do not need to do anything to enroll. How the Plan Works If you have a sickness or injury and are totally medically disabled and cannot work, you may be eligible for shortterm disability (STD) benefits. You must be eligible for Starbucks benefits on the date your disability commences as determined by UnumProvident, the plan administrator. The STD plan will cover you for the first 26 weeks of your total medical disability. A total medical disability means, because of your sickness or injury, you are unable to perform the material and substantial duties of your regular occupation at Starbucks. However, if you work in another occupation while unable to perform your duties at Starbucks, you will not be considered totally medically disabled. You will receive STD benefits if you require the regular care of a doctor, suffer a loss of income and provide proof of your total medical disability. You may receive STD benefits if you are unable to work due to your pregnancy or childbirth generally for six to eight weeks following delivery. For information regarding your maternity benefits, call Starbucks Benefits Center at (877) SBUXBEN. If you can not work because of a covered sickness or injury, the STD plan will replace 66-2/3% of your average weekly earnings, up to $2,250 per week. The plan pays benefits starting on the fourth day of absence. STD benefits are paid to you weekly. Any STD benefits payable for less than a week will be paid to you at the rate of 1/7th of the STD weekly benefit for each day of your total disability. STD benefits are not considered earnings for Bean Stock, S.I.P. and Future Roast 401(k) plan purposes. Actively-at-Work Provision If you are not actively working at Starbucks on the day you become initially eligible for benefits, your STD coverage will go into effect once you return to work at least one full day. Coverage for Hawaii partners Partners working in Hawaii are eligible for Temporary Disability Insurance in lieu of short-term disability. Starbucks TDI coverage may provide you with continued partial income for up to 26 weeks if you cannot work due to a non-occupational total medical disability. As long as you satisfy the State of Hawaii s eligibility requirements, you are automatically covered by TDI you don t need to enroll. 147

151 VISION SHORT-TERM DISABILITY Calculating Your Benefit How are your short-term disability benefits determined? Here is an example. Your average weekly earnings are $500 Calculate ²/3 of this amount x Which equals your STD benefit of = $333 Average weekly earnings Under the STD plan, your average weekly earnings are defined as the average weekly gross pay you received from Starbucks over the 26 weeks before the date you became disabled. If you have been employed for less than 26 weeks, gross pay will be averaged over your period of employment. Eligible performance-based bonuses paid over the 12 months immediately preceding your disability will be included when calculating your average weekly earnings (total eligible bonuses in the 12-month period divided by 52). For disabilities commencing on or after October 1, 2007, other than tips imputed for retail hourly partners included in average weekly earnings, your earnings under the STD plan do not include any commissions, stipends, ineligible bonuses, overtime pay or other extra compensation or income from sources other than Starbucks. If you are at a vice president job level or above, your average weekly earnings are defined as your weekly gross base salary in effect on the date you became disabled plus your average performance bonus over the 12 months immediately preceding the date you became disabled. Periods of approved leaves of absence during the 26 weeks preceding your disability are excluded when determining your average weekly earnings. Periods of unapproved leaves of absence are included with weekly earnings of $0. Other disability income benefits Your STD benefits will be reduced by any other disability income benefits you receive or are entitled to receive, even if you do not receive benefits because of your failure to initiate a claim. These include, but are not limited to, state disability programs that cover the same disabilities as Starbucks STD plan. If you work in California, New York, New Jersey or Rhode Island, you may be eligible to receive state disability benefits. You must apply for those state benefits before you send your claim to UnumProvident. Contact your state disability office to apply for state disability. If you work in New York, you do not need to apply separately for state disability; UnumProvident will pay both your state disability and Starbucks STD benefits. Here is an example of how other disability income benefits affect your STD benefit. Your average weekly earnings are $500 Calculate ²/3 of this amount x Which equals your STD benefit before reduction of = $333 Subtract other sources of disability income (from your state, Social Security, etc.) $275 STD plan pays the difference = $58 148

152 VISION SHORT-TERM DISABILITY What About Federal Income Taxes? You have the choice to have a flat 28% deducted from your weekly disability benefit to cover federal income taxes or you can complete a W-4 at the time you file your disability claim and specify the amount of federal taxes you want withheld from your disability benefit. If you choose to waive all federal withholding, you are responsible for paying federal taxes on your disability earnings at the end of the year. Social Security and Medicare (FICA) taxes will be withheld from your benefit as required by law. What Is Not Covered The STD plan does not cover any loss of income that results from the following: Illness or injury sustained while acting within the course of employment with Starbucks or another employer, unless your illness or injury has been denied by workers compensation as a noncovered condition Loss of a professional license, occupational license or certification not related to a covered illness or injury Treatment not medically necessary (except for disabilities due to organ donation, which are covered) Procedures under clinical investigation or considered experimental by health professionals Reversal of a sterilization procedure Plastic, reconstructive or cosmetic surgery (except for breast reconstruction following a medically necessary mastectomy) or any other service intended to improve, alter or enhance appearance except when provided to improve the function of a body part (except teeth or supporting structures) malformed by a severe birth defect, disease or surgery, or to repair an injury that occurs while employed by Starbucks Sex change treatment or surgery for implants due to sexual dysfunction, except when of a physiological or organic basis or if due to a gender identity disorder War, any act of war (declared or undeclared) or from service in any of the regular U.S. armed forces Active participation in a riot, or committing or attempting to commit an assault or felony When you are being treated solely by a chiropractor, homeopathic physician, naturopath or similar alternative care provider You Must Apply For a Leave of Absence When you apply for short-term disability benefits, you will be required to apply for a leave of absence. Also see the Time Off chapter for information on Starbucks leave of absence programs. During your leave of absence, it is likely you are not receiving a paycheck from Starbucks. In order to continue your benefits, you will need to make your benefit contribution payments during your leave of absence. Contributions will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you fail to make your benefit contribution payments while on leave of absence, your coverage may be cancelled. Benefit contributions include your share of the cost for medical, dental, vision and, if you are a retail hourly partner, optional LTD coverage. They also include the cost of any supplemental life and AD&D coverage you have elected. For more information, contact Starbucks Benefits Center at (877) SBUXBEN. 149

153 VISION SHORT-TERM DISABILITY When Your STD Benefits Begin and End Your benefits begin on the fourth day of injury or sickness. If you become disabled while not actively working (e.g., on an unpaid leave of absence), you are not eligible to receive short-term disability benefits until the day you were scheduled to return. Your benefits will continue as long as you visit a doctor (as frequently as is medically necessary) to effectively manage and treat your disabling condition. Your treatment provider must be licensed to practice medicine, be practicing within the scope of his or her license and not be your spouse, domestic partner, child, parent or sibling. You must be under the care of a provider whose specialty or experience is appropriate for treatment of the disabling condition. Your STD benefits end on the earliest of the following dates: The date you are no longer considered disabled under this plan The date you are no longer totally medically disabled The date you fail to provide adequate evidence of your continued disability as requested by UnumProvident The date you return to work in any occupation for which you are gainfully employed The end of the maximum benefit period 26 weeks The date of your death Using Vacation and/or Sick Pay During Your Disability During the three days before your disability benefits begin, you are required to use any available sick pay or vacation time. You may also use your available sick pay or vacation time in lieu of receiving short-term disability benefits. For more information, contact Starbucks Benefits Center at (877) SBUXBEN. Maximum benefit period The STD plan may pay you benefits for up to 26 weeks. This 26-week maximum benefit period only applies to one continuous period of a total disability. If you have a recurrent disability If you return to work from a disability for which you received STD benefits and you become disabled again, your second absence may count against your previous 26-week maximum benefit period. In this case, your disability would be treated as a continuation of the previous disability. Your benefits will resume with no waiting period. Your recurrent disability will count against your previous maximum benefit period if you returned to work for less than: 30 consecutive days and your second disability was due to the same cause or causes One full day and your second disability was due to an unrelated cause 150

154 VISION SHORT-TERM DISABILITY If You Take an Approved Leave of Absence To learn how your short-term disability coverage may continue during an approved leave of absence, see Benefits Eligibility While on an Approved Leave of Absence on page 25. If you are disabled at the time your leave begins and you are receiving disability benefits, your disability benefits will continue through the duration of your approved medical disability up to the maximum duration of 26 weeks. When Coverage Ends If your employment at Starbucks terminates, your STD coverage ends the day you are no longer an active partner at Starbucks. If you become disabled before your termination date, your STD benefits will continue through the duration of your approved medical disability up to the maximum duration of 26 weeks. If you lose benefits eligibility due to the ongoing eligibility audit, your coverage ends as described in the Eligibility and Enrollment chapter. If you become disabled before you lose your coverage due to an eligibility audit, your STD benefits will continue through the duration of your approved medical disability up to the 26- week maximum. How to File a Claim To receive STD benefits, you or someone acting on your behalf must file a claim. Take the steps outlined below. Claims will be processed by UnumProvident Call Starbucks Benefits Center at (877) SBUXBEN to request a short-term disability claim form. Complete your portion of the claim form. Have your doctor complete the physician section of the claim form. Mail your completed claim form to: UnumProvident The Benefits Center P.O. Box 9500 Portland, ME Or fax to: (800) A UnumProvident representative will contact you once your claim is received. If approved, you can expect a disability check within two to three weeks of receipt of your claim at UnumProvident. UnumProvident may request additional information from you or your doctor certifying your continued total disability. UnumProvident may require that you be independently examined by a physician, other health professional or vocational expert of their choice and interviewed by an authorized UnumProvident representative. UnumProvident may require this independent examination as often as reasonably necessary. The independent examination will be paid by Starbucks. 151

155 VISION SHORT-TERM DISABILITY UnumProvident will notify you in writing if a claim or any part of a claim is denied. The denial letter will state: The specific reason(s) for the denial with reference to the applicable plan provision(s) A description of any additional material or information that is necessary to complete the claim An explanation of why the additional material or information is necessary A statement describing your access to documents A statement describing your appeal rights If you are not satisfied with the reason(s) for the denial, you or your representative may ask to have the claim reviewed by UnumProvident. Your appeal must be in writing and must be sent to UnumProvident within 180 days of your denial notice. Your appeal should include all supporting materials or information that will help UnumProvident review the claim. UnumProvident will review your appeal and all new information submitted and notify you or your representative of its decision promptly. In some cases, UnumProvident may request that you provide additional information to assist in the review. Questions? For general questions about the STD plan or how to file a claim, call Starbucks Benefits Center at (877) SBUXBEN. For the status of your ongoing claim payments, call UnumProvident directly at (800) Phone lines are open from 5 a.m. to 5 p.m. Pacific Time, Monday through Friday. You can also visit UnumProvident on the Web: You can check on status of claims, as well as get other useful information. 152

156 Long-Term Disability How the Plan Works 154 Definition of Disability 154 Partners other than vice president job level and above 154 Vice president job level and above 155 Calculating Your Benefit 155 If you are a retail hourly partner 155 If you are a salaried or nonretail hourly partner 155 Average monthly earnings 156 Partial disability benefits 156 Other disability income benefits 157 If You Take an Approved Leave of Absence 160 When Coverage Ends 160 How to File a Claim 160 If You Die 161 Questions? 161 What Is Not Covered 157 Pre-existing conditions 157 Self-reported symptoms and mental illness limitations 158 When Your LTD Benefits Begin and End 158 Maximum benefit period 159 If you have a recurrent disability

157 VISION LONG-TERM DISABILITY The long-term disability plan provides you with benefits that replace part of your income when you cannot work for more than 26 weeks due to a total medical disability resulting from a sickness or injury. How the Plan Works Starbucks long-term disability plan picks up where short-term disability (STD) leaves off after you have been disabled for a continuous 26-week period. It can replace part of your income if you are totally medically disabled and cannot work. You must be eligible on the date your disability commences as determined by UnumProvident, the plan administrator, in order to receive LTD benefits. If you are not actively working at Starbucks at the time you initially become benefits eligible for example, if you are on a leave of absence or taking a sick day your LTD coverage will go into effect once you return to work at least one full day. Your eligibility for coverage under the long-term disability plan depends on your position at Starbucks: If you are a retail hourly partner, you have the option to enroll in the LTD plan and pay for your coverage through automatic payroll deductions. If you are a salaried or nonretail hourly partner, your enrollment in the LTD plan is automatic and your coverage is paid for by Starbucks. During the first 26 weeks of disability, called the elimination period, you will be considered totally medically disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury and are under the regular care of a physician. The short-term disability plan may pay you benefits during the elimination period. You will receive an LTD benefit from UnumProvident as long as you provide proof that you are under the regular care of a doctor and medically disabled due to sickness or injury and have suffered a loss of income of 20% or more. Definition of Disability Partners other than vice president job level and above For the first 24 months of disability, you are disabled when: You are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, and You have a 20% or more loss in your indexed basic monthly earnings due to the same sickness or injury. After the first 24 months of disability, you will continue to receive LTD benefits beyond 24 months if you are also: Working in any occupation and continue to have a 20% or more loss in your basic monthly earnings due to your sickness or injury, or Not working and, due to the same sickness or injury, are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You are not required to have a 20% or more loss in your indexed monthly earnings due to the same injury or sickness to be considered disabled during the elimination period. 154

158 VISION LONG-TERM DISABILITY The loss of a professional or occupational license or certification does not, in itself, constitute disability. Vice president job level and above You are disabled when: You are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, and You have a 20% or more loss in your indexed basic monthly earnings due to the same sickness or injury. You are not required to have a 20% or more loss in your indexed monthly earnings due to the same injury or sickness to be considered disabled during the elimination period. The loss of a professional or occupational license or certification does not, in itself, constitute disability. Calculating Your Benefit If you are a retail hourly partner Your LTD plan replaces 60% of your average monthly earnings, up to a maximum benefit of $500 per month. Your minimum monthly benefit is the greater of: $100 10% of your monthly benefit before reductions for other disability income benefits you may receive, such as workers compensation or Social Security If you decline LTD coverage when you first become eligible for benefits, you will be required to provide evidence of good health (EOGH) if you want to elect LTD coverage at any other time. EOGH is proof of your good health as certified by your doctor. If your application for LTD coverage is approved, your coverage will begin on the day the application is approved. If any statements you make on your application are not complete and/or not true at the time you made them, UnumProvident can reduce or deny any claim or cancel your coverage from your original coverage date. If you are totally medically disabled and receiving short-term disability benefits, you will need to continue paying your LTD premiums, if enrolled. However, once you begin receiving LTD benefits (after 26 weeks of disability), you no longer are required to pay your LTD premiums. Call Starbucks Benefits Center at (877) SBUXBEN for more information. If you are a salaried or nonretail hourly partner Your LTD plan replaces 60% of your average monthly earnings, up to a maximum benefit of $7,500 per month. If you are in a vice president job level or above, the maximum benefit is $15,000 per month. Your minimum monthly benefit is the greater of: $100 10% of your monthly benefit before reductions for other disability income benefits you may receive, such as workers compensation or Social Security 155

159 VISION LONG-TERM DISABILITY If your job level is vice president or above, the premium paid by Starbucks for your LTD coverage is included in your gross wages. Average monthly earnings Under the LTD plan, your average monthly earnings are defined as the average monthly gross pay you received from Starbucks over the 26 weeks before the date you became disabled. Your earnings under the LTD plan do not include any commissions, tips, stipends, bonuses, overtime pay or other extra compensation or income from sources other than Starbucks. If you are an in a vice president job level or above, your average monthly earnings are defined as your monthly gross base salary in effect on the date you became disabled plus your average performance bonus over the 12 months immediately preceding the date you became disabled. Partial disability benefits Starbucks LTD plan encourages you to return to work as soon as you and your doctor determine you are able. During the time you are partially disabled, UnumProvident may pay you a reduced benefit in addition to your regular earnings. Once your doctor releases you to return to work part-time, your partial disability benefit will be determined as outlined below. 1. UnumProvident will adjust your average monthly earnings to account for inflation. Adjustments will be made annually on the anniversary of your benefit payments and will be based on the lesser of 10% or the current annual percentage increase in the Consumer Price Index (CPI). Your adjusted average monthly earnings are called indexed predisability earnings. 2. If you are capable of earning at least 20% (but no more than 80%) of your indexed predisability earnings, then you become eligible for a partial disability benefit. UnumProvident will calculate your benefit as follows: During the first 12 months of your partial disability, if you work while partially disabled, you will receive your LTD benefit plus your disability earnings, up to 100% of your LTD indexed predisability earnings. After the first 12 months of your partial disability, if you work while partially disabled, your LTD benefit will be reduced in proportion to your loss of earnings. What Are Disability Earnings? Disability earnings include the income you receive while you are disabled and working and earnings you did not receive but could have if you had been working to the full extent to which you were capable. For example, if your doctor releases you to return to work 30 hours a week and you choose to work only 20 hours a week, the plan will consider your disability earnings to be equivalent to 30 hours a week. 156

160 VISION LONG-TERM DISABILITY Other disability income benefits Your gross LTD benefits will be reduced by any other disability income benefits you receive or are entitled to receive due to your disability. Other disability income benefits include, but are not limited to: Benefits from state disability or workers compensation, unemployment or sick pay Benefits from any other group insurance coverage Social Security disability or retirement benefits for you or your dependents The amount you receive from a third party (after subtracting attorney s fees) by judgment, settlement or otherwise In calculating your monthly benefit from the LTD plan, UnumProvident will estimate the amount of any other income benefits if they have not yet been determined or if a denial is being appealed. This estimate will be used to reduce the amount of your monthly LTD benefit payments. If you do not want UnumProvident to use an estimate, you must complete and return the Agreement Concerning Benefits form to UnumProvident. This agreement states that you promise to reimburse UnumProvident for any overpayment caused by a later reward of other income benefits. For more information, call UnumProvident at (800) What Is Not Covered The LTD plan does not cover any loss of income that results from the following: Loss of a professional license, occupational license or certification Commission of a crime for which you have been convicted under state or federal law War or any act of war (declared or undeclared) Active participation in a riot Intentionally self-inflicted injuries, while sane or insane A pre-existing condition UnumProvident will not pay a benefit for any period of disability during which you are incarcerated. Pre-existing conditions The LTD plan will not cover any disability caused by, contributed to or resulting from a pre-existing condition and occurring in the first 12 months after your LTD coverage began. This 12-month period is called the pre-existing condition exclusion period. If you become ineligible for coverage as a result of an approved leave of absence and if you were previously insured under the plan for at least 12 consecutive months, you do not need to satisfy a new pre-existing condition exclusion period when you become eligible for coverage again. However, if you terminate employment and are rehired, a new pre-existing condition exclusion period will apply. If you are a retail hourly partner and voluntarily declined or cancelled your coverage and you later enroll in the plan, you will be required to submit evidence of good health. If your evidence of good health application is approved, the pre-existing condition exclusion will not apply to you. See If you are a retail hourly partner on page 155 for more information about evidence of good health. 157

161 VISION LONG-TERM DISABILITY A pre-existing condition is a sickness or injury for which you received treatment, consultation, care or services including diagnostic measures or were prescribed drugs or medicines, or you had symptoms for which an ordinarily prudent person would have consulted a health care provider in the three months before your most recent initial benefits eligibility date. Self-reported symptoms and mental illness limitations Payment of LTD benefits is limited to 24 months of disability primarily based on self-reported symptoms or caused by or contributed to by a mental illness. However, if you are confined to a hospital or institution at the end of the 24 months, this limitation will not apply while you are continuously confined. If you are disabled when discharged, you will receive a monthly LTD benefit for a recovery period of up to 90 days. If you are reconfined at any time during the recovery period and remain confined for at least 14 days in a row, you will receive an LTD benefit for the additional admission and for one additional recovery period up to 90 days. What Is Considered Mental Illness? Mental illness is defined as a psychiatric or psychological condition regardless of cause, such as schizophrenia, depression, manic depressive or bipolar illness, anxiety, personality disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs or other similar methods of treatment. What Are Self-reported Symptoms? Self-reported symptoms are the manifestations of your condition, which you tell your physician, that are not verifiable using tests, procedures or clinical examinations generally accepted in the practice of medicine. Examples include, but are not limited to, headaches, pain, fatigue, stiffness, soreness, ringing in the ears, dizziness, numbness and loss of energy. When Your LTD Benefits Begin and End Your LTD benefits begin when your short-term disability (STD) benefits end after 26 weeks of a total medical disability and after your LTD has been approved by UnumProvident. Your LTD benefits will continue until one of the following occurs: You are no longer medically disabled under the terms of the plan. Your monthly disability earnings exceed 80% of your predisability earnings. You reach the end of the maximum benefit period. You fail to provide proof of your continued medical disability, as requested by UnumProvident. You die. 158

162 VISION LONG-TERM DISABILITY You are not in a vice president job level or above and you are able to work part-time in your regular occupation during the first 24 months of LTD payments, or any gainful occupation after 24 months, but choose not to. You are in a vice president job level or above and you are able to work part-time in your regular occupation, but choose not to. Maximum benefit period How long you can receive benefits from the LTD plan depends on your age when you become totally medically disabled. The following chart shows your maximum benefit periods: AGE AT DISABILITY MAXIMUM BENEFIT PERIOD Under age 60 To age months months months months months months months months months 69 and over 12 months When you reach the maximum benefit period, your LTD benefits will end. If you are overpaid, UnumProvident has the right to recover any overpayments resulting from errors UnumProvident makes in processing a claim, your receipt of deductible sources of income and fraud. UnumProvident will determine your repayment method. If you have a recurrent disability What happens if you try to return to work and become disabled again? A recurrent disability is a disability which is caused by a worsening in your condition and due to the same cause(s) as your prior disability for which you received a monthly LTD benefit. If you are receiving LTD benefits, recover and return to active employment in your regular occupation, then suffer a relapse, certain provisions apply. 159

163 VISION LONG-TERM DISABILITY If the relapse is a result of the same or related cause and occurs within 12 months of your return to work, and you were continuously enrolled in the LTD plan during this time, your disability is considered a continuation of your earlier disability. Benefit payments will resume with no waiting period. If the relapse occurs more than 12 months after your return to work, it is considered a new disability. You must be disabled for a new 26-week period before you are eligible to receive LTD benefit payments. If You Take an Approved Leave of Absence Your long-term disability coverage may continue during an approved leave of absence as outlined on page 25. Retail hourly partners who purchase LTD coverage will be required to continue to make their premium payments for LTD coverage during a leave of absence. Premiums for LTD coverage will be collected (depending on the length of the leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon the partner s return to work. If the partner does not make premium payments while on leave of absence, coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When Coverage Ends If you are no longer a Starbucks partner, your LTD coverage ends on the last day you are actively at work. If you lose benefits eligibility due to the ongoing benefits eligibility audit, your coverage ends as described in the Eligibility and Enrollment chaper. How to File a Claim Because UnumProvident is the administrator for both the STD and LTD plans, you do not need to file a claim for LTD benefits for nonwork-related injuries and illnesses. If your LTD claim is approved, you will go from receiving weekly STD benefit payments to receiving monthly LTD benefit payments. If you are a partner working in Hawaii and receiving TDI benefits, you will need to apply for LTD benefits before completing the 26-week waiting period. If you are disabled from an injury or illness that is work-related, you will need to file a claim for LTD benefits. Call Starbucks Benefits Center at (877) SBUXBEN to initiate your claim. UnumProvident will notify you of its decision within 45 days after your claim is filed. If, because of matters beyond the control of UnumProvident, a decision cannot be made within 45 days, then UnumProvident has an additional 30 days to make its decision. If the matters preventing a decision have not been resolved after the 30- day extension, UnumProvident may extend its decision a final 30 days. If an extension is needed, UnumProvident will send you a notice explaining why the extension is required and by what date it expects to make a decision regarding your claim. If the extension is required because you fail to submit the information necessary to decide the claim, UnumProvident will send you a notice describing the information it requires to decide your claim. You will then have at least 45 days from the date you receive the notice to provide the required information. UnumProvident s 30-day extension will begin after you have submitted the required information, provided you did so within the time frame specified by UnumProvident. If you do not provide the required information within the time frame specified, UnumProvident may decide your claim without that information. 160

164 VISION LONG-TERM DISABILITY If your claim for benefits is denied, either in whole or in part, you may appeal the claim denial by following the process described on page 211. If You Die A survivor benefit equal to three times your gross monthly LTD benefit is paid to your eligible survivors if all of the conditions below apply: You die while you are receiving or are entitled to receive a monthly LTD benefit. Your disability had continued for 180 or more consecutive days. UnumProvident receives proof of your death. Benefits will be paid to your eligible survivors, in this order: 1. Your spouse 2. Your children under age 25, in equal shares 3. Your estate The survivor benefits are reduced by any overpayment that may exist on your claim. Taxes Your LTD payments may be subject to taxes, including federal and state income taxes, as well as unemployment taxes. You may want to talk to a tax advisor for more information. If your job level is vice president or above, your LTD payment is not taxable because you paid taxes on the LTD premium paid by Starbucks. Questions? For general questions about the LTD plan and how to file a claim, call Starbucks Benefits Center at (877) SBUXBEN. For the status of your ongoing claim payments, call UnumProvident directly at (800) Phone lines are open from 5 a.m. to 5 p.m. Pacific Time, Monday through Friday. You can also visit UnumProvident on the Web: You can check on status of claims, as well as get other useful information. 161

165 Life Insurance and AD&D Life Insurance How the Plans Work 163 Partner Life Insurance 163 Retail hourly partners 163 Salaried or nonretail hourly partners 163 Imputed income 164 Reduction in benefits 165 When coverage begins 165 Spouse or Domestic Partner Life Insurance 165 Child Life Insurance 166 Evidence of Good Health 166 How Benefits Are Paid 168 Partner life insurance 168 Spouse or domestic partner or child life insurance 168 Accelerated death benefit 169 If You Take an Approved Leave of Absence 169 When Coverage Ends 170 Portability and conversion of coverage 170 Waiver of premium 171 How to File a Claim 172 Accidental Death & Dismemberment How the Plan Works 174 Your Coverage Options 174 If you are a retail hourly partner 174 If you are a salaried or nonretail hourly partner 174 How Benefits Are Paid 175 AD&D benefits coverage overview 175 Exposure and disappearance 175 Seat belt coverage 176 Coma benefit 176 Adaptive home and vehicle benefit 176 Reduction in Benefits 177 Beneficiary Designation 177 What Is Not Covered 177 If You Take an Approved Leave of Absence 178 When Coverage Ends 178 How to File a Claim 178 Questions? 178 Questions?

166 VISION LIFE INSURANCE Having financial protection in the event of death means more security for your family members. To help you prepare, Starbucks offers you three life insurance plans: partner life insurance, spouse or domestic partner life insurance and child life insurance. How the Plans Work Partner life insurance provides benefits to your designated beneficiary(ies) if you die. The more others depend on you and your income, the more partner life insurance you may need. Your coverage level is the amount that is paid to your beneficiary(ies) if you die. Starbucks gives you the option to purchase life insurance coverage for your spouse or domestic partner. You may choose spouse or domestic partner life insurance only if you are covered by partner life insurance. You have the option to purchase life insurance coverage for your child(ren). Children must be at least 15 days old to be covered. You can choose child(ren) life insurance only if you are covered by partner life insurance. All three Starbucks life plans partner, spouse or domestic partner and child are insured by Hartford Life and Accident Insurance Company. Partner Life Insurance Your partner life insurance coverage depends on your position at Starbucks. Retail hourly partners You can enroll in partner supplemental life insurance and pay for your coverage through automatic payroll deductions. Your payroll deductions for coverage are taken before taxes are withheld. You can choose to purchase one of the following amounts of partner supplemental life insurance coverage for yourself: $10,000 $25,000 $50,000 Salaried or nonretail hourly partners Basic life You are automatically covered for partner life insurance coverage at one times your annualized base pay, paid for by Starbucks. If you are an executive at Starbucks (vice president job level and above), you are provided life insurance coverage at three times your annualized base pay. 163

167 VISION LIFE INSURANCE Supplemental life You can also purchase additional levels of coverage. Your payroll deductions for coverage are taken before taxes are withheld. Your partner supplemental life insurance coverage options are: One times base pay Two times base pay (maximum for executives) Three times base pay Four times base pay Your life insurance cost and coverage amount are calculated before annual open enrollment and are shown on your open enrollment worksheet. Your coverage amount is based on your annualized base pay at that time, rounded up to the next highest $1,000. The maximum amount of partner basic and supplemental life insurance coverage combined that you can carry through Starbucks plan is $750,000; executives may carry a maximum of $2,000,000. Your cost will remain constant until the next annual open enrollment. If your base pay changes during the year, any benefit paid to your beneficiary(ies) will be based on your actual pay at the time life insurance benefits become payable. You need to be actively at work at the time a pay change goes into effect for your life insurance coverage to reflect that change. Otherwise, the change will take effect when you actively return to work. What Is Annualized Base Pay? Your annualized base pay is your gross earnings prior to any before-tax deductions. It does not include any commissions, tips, stipends, bonuses, overtime pay or other compensation. Imputed income You may be taxed on the value of partner life insurance coverage (basic and supplemental combined) that exceeds $50,000 and is paid for by Starbucks. The amount of imputed income is shown on your paycheck stub as Taxable Life. Beneficiary Designations You are asked to designate beneficiaries for coverage on your life insurance at the time you enroll in Starbucks benefits. You can change your beneficiary(ies) at any time by calling Starbucks Benefits Center at (877) SBUXBEN and speaking with a representative or by going online to 164

168 VISION LIFE INSURANCE Reduction in benefits The amount of your death benefit is reduced once you reach age 65, as shown below. AT AGES YOUR DEATH BENEFIT IS REDUCED BY THE PERCENTAGE OF LIFE INSURANCE BENEFIT PAYABLE IS 65 through 69 35% 65% (rounded to the next highest $500) 70 and over 55% 45% (rounded to the next highest $500) Any reduction in your death benefit may also reduce your spouse or domestic partner and child life insurance coverage amounts, if enrolled, in order to satisfy the rule that your dependent life insurance coverage cannot be more than 50% of your partner life insurance coverage. (See Spouse or Domestic Partner Life Insurance below and Child Life Insurance on the next page for more information.) Actively-at-Work Provision If you are not actively working at Starbucks at the time you initially become eligible for benefits or when your coverage is reinstated following re-establishment of benefits eligibility (for example, when you are on a leave of absence or taking a sick day), your life insurance coverage will go into effect once you return to work at Starbucks at least one full day (four hours or more). When coverage begins Provided you meet the actively-at-work provision, your life insurance begins as outlined below: Starbucks-provided basic partner life insurance for salaried and nonretail hourly partners begins on your initial benefits eligibility date or, if you transfer from a retail hourly position to a salaried or nonretail hourly position, the effective date of your transfer. Supplemental partner life coverage that you elect and pay for begins on your initial benefits eligibility date or position transfer date, provided you enroll before that date. If you enroll during the 31 days following your eligibility/transfer date, coverage will begin on the date you enroll. Spouse or Domestic Partner Life Insurance You can elect spouse or domestic partner coverage only if you are enrolled in partner life insurance. You can elect spouse or domestic partner coverage of $5,000, $10,000, $25,000, $50,000 or $100,000 depending on the amount of your partner life insurance coverage. By law, the amount of life coverage you elect for your spouse or domestic partner cannot exceed 50% of your total partner life insurance coverage amount. You pay the full cost of spouse or domestic partner life insurance through automatic payroll deductions taken after taxes are withheld. If your spouse or domestic partner is also a partner at Starbucks and is eligible for benefits coverage, you cannot cover him or her as a dependent under the life insurance plan. Additionally, certain states do not recognize domestic partners or same-sex spouses as eligible for coverage under Starbucks life insurance plan. 165

169 VISION LIFE INSURANCE What Is a Domestic Partner? Your domestic partner is your unmarried same- or opposite-sex life partner with whom you have a committed relationship as outlined in the Eligibility and Enrollment chapter. If you enroll your domestic partner for life insurance coverage, you may be asked to provide additional information verifying your domestic partnership. Deferred Effective Date for Dependents If your spouse or domestic partner and/or child is confined at home, in a hospital or elsewhere because of a disability on the date coverage or a change in coverage would otherwise begin, spouse or domestic partner and/or child life coverage will not begin until your dependent is discharged and engages in normal activities for at least 15 consecutive days. Child Life Insurance You can elect child life insurance only if you are enrolled in partner life insurance. You can elect child coverage of $5,000 or $10,000 depending on the amount of your partner life insurance coverage. By law, the amount of child life insurance coverage you elect cannot exceed 50% of your total partner life insurance coverage amount. If you elect less than $10,000 child life insurance, you can increase coverage each open enrollment by $5,000. The maximum child life insurance is $10,000. The cost for this coverage is the same regardless of the number of children you cover. You pay the full cost of child life insurance through automatic payroll deductions taken after taxes are withheld. Evidence of Good Health Evidence of good health (EOGH) is proof of good health as certified by a licensed doctor and approved by Hartford Life. You or your covered spouse or domestic partner may be required to provide EOGH in certain instances for coverage under the life insurance plans. When asked to provide EOGH, you will need to complete a Personal Health Statement that gives information about your health and medical history, so that Hartford Life may determine whether you qualify for certain levels of coverage. You may also be asked to undergo a physical exam, which may be at your cost. If you are ever required to provide EOGH, a form will be mailed to your home requesting additional information. Until your or your spouse or domestic partner s good health is confirmed by Hartford Life, coverage will be the highest level of life insurance coverage per your election available that does not require EOGH. If good health is confirmed, the additional coverage you have requested will go into effect on the date of the approval. Your payroll deductions will increase beginning the first paycheck received following your approval date. If you die within two years of the date you provided EOGH, Hartford Life has the right to review and deny the claim if you failed to disclose important information about your health. 166

170 VISION LIFE INSURANCE WHEN YOU MUST PROVIDE EVIDENCE OF GOOD HEALTH Event Upon initial eligibility Partner Supplemental Life Salaried and Nonretail Hourly Elect three or four times your annualized base pay Partner Supplemental Life Retail Hourly N/A Spouse or Domestic Partner Life Elect coverage over $25,000 Open enrollment or qualifed status change Other Elect to increase coverage Elect to increase coverage Elect to increase coverage You are a vice president or above and elect any amount of coverage Enrolling in and increasing child life insurance does not require evidence of good health. WHEN YOU DO NOT NEED TO PROVIDE EVIDENCE OF GOOD HEALTH Event Upon initial eligibility Lose and re-establish eligibility in the same plan year Re-establish eligibility in the plan year immediately following your loss of eligibility Open enrollment or qualified status change Partner Supplemental Life Salaried and Nonretail Hourly Enroll for one or two times your annualized base pay Prior coverage is reinstated at the level in effect immediately preceding your loss of eligibility Elect coverage equal to or less than the amount previously approved by Hartford, if your enrollment is within 12 months from your loss of eligibility Partner Supplemental Life Retail Hourly Elect any amount Prior coverage is reinstated at the level in effect immediately preceding your loss of eligibility Elect coverage equal to or less than the amount previously approved by Hartford, if your enrollment is within 12 months from your loss of eligibility Spouse or Domestic Partner Life Elect $25,000 or less Prior coverage is reinstated at the level in effect immediately preceding your loss of eligibility Elect coverage equal to or less than the amount previously approved by Hartford, if your enrollment is within 12 months from your loss of eligibility You reduce coverage You reduce coverage You reduce coverage Other N/A N/A You elect coverage within 45 days of your spouse or domestic partner s loss of life coverage with his or her employer, either through loss of employment or the employer s cancellation of group coverage* * Hartford Life will require proof of your spouse or domestic partner s prior coverage, including the date of termination. 167

171 VISION LIFE INSURANCE How Benefits Are Paid Benefits are paid to your designated beneficiary(ies) if you die. Benefits are paid to you if your covered dependent dies. Partner life insurance Naming your beneficiaries When you enroll for partner life insurance, you will be asked to name your beneficiary(ies). You will need to speak with a Benefits Center representative after completing your enrollment or designate your beneficiary(ies) online at You may change your life insurance beneficiary(ies) at any time by calling Starbucks Benefits Center at (877) SBUXBEN and speaking with a representative or by going online to Your beneficiary(ies) cannot be changed by power of attorney. How beneficiaries are paid When Hartford Life receives notice of your death, the amount of life insurance benefit is paid to your named beneficiary(ies). Hartford Life has the right to review and deny the claim if you fail to disclose important information about your health as described in Evidence of Good Health on page 166 or if payment of the claim is forbidden by law. Unless you have given different instructions, your insurance benefit is paid as listed below: If more than one beneficiary is named, each is paid equal shares. If any named beneficiary dies before you, that person s share is divided equally among the named beneficiaries who survive you. If no beneficiary is named, or if no named beneficiary survives you, Hartford Life may pay: The executors or administrators of your estate Your surviving relatives in the following order: 1. Your spouse or domestic partner 2. Your children in equal shares 3. Your parents in equal shares Your domestic partner may be required to provide evidence of your domestic partner relationship prior to payment of benefits. Spouse or domestic partner or child life insurance If your dependent dies while covered under Starbucks life insurance plan, you will receive his or her life insurance benefit. Hartford Life has the right to review and deny the claim if your spouse or domestic partner or child failed to disclose important information about his or her health as described in Evidence of Good Health on page 166 or if payment of the claim is forbidden by law. (The review of a child s evidence of good health applies to children enrolled prior to October 1, 2001, who were required to provide evidence of good health to obtain/increase coverage.) 168

172 VISION LIFE INSURANCE Name Your Beneficiary! It is very important for you to name your life insurance beneficiary(ies) when you enroll for coverage. Be sure to keep your beneficiary designation current because it governs the distribution of benefits from Starbucks life insurance plans if you die. As a Starbucks partner, all Starbucks life insurance policies are made in your name, even the spouse or domestic partner or child life insurance policies covering your dependents. Accelerated death benefit Accelerated death benefits are available to you, your covered spouse or domestic partner and child(ren) who are covered under the Starbucks life insurance plan. If you are under age 60 and diagnosed as being terminally ill with less than 24 months to live, you may request that a portion of your life insurance be paid as an accelerated death benefit. Accelerated death benefits are paid as a lump-sum amount that cannot exceed 50% of your total coverage amount. The amount of your life insurance coverage must be at least $10,000 for you to be eligible for this benefit. The minimum accelerated death benefit amount is $3,000 and the maximum is $175,000. Only one lump-sum payment will be made. At the time of death, your beneficiary(ies) receive the remainder of the death benefit. Contact a tax attorney for information about tax implications of the accelerated death benefit. Partners diagnosed with a terminal illness should refer to Compassionate Benefits for Terminally Ill Partners on page 28. Your Hartford Life Insurance Booklet Has Details Keep in mind this section only summarizes your Starbucks life insurance plan benefits. You can learn all the details a complete description of the terms, conditions and limitations of your coverage in the Hartford Life Insurance Booklet issued by Hartford Life and Accident Insurance Company. If there is a discrepancy between this document and the Hartford Life Insurance Booklet, the Hartford Life Insurance Booklet will govern. The Hartford booklet may be requested online at Select U.S.A., then Enroll in Benefits, then Health, Insurance, then Request Materials. If you prefer, you may make your request by speaking with a Starbucks Benefits Center representative at (877) SBUXBEN. If You Take an Approved Leave of Absence Your partner life insurance, spouse or domestic partner life insurance and child life insurance may continue during an approved leave of absence as outlined in Benefits Eligibility While on an Approved Leave of Absence on page 25. You will be required to continue to make your premium payments for life insurance coverage during your leave of absence. Premiums for life insurance coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your premium payments while on leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. 169

173 VISION LIFE INSURANCE When Coverage Ends If you change positions from salaried/nonretail hourly to retail hourly, your life insurance coverage options change from a multiple of your annualized base pay to flat dollar amounts and you will need to make new life insurance elections by speaking with a Benefits Center representative at (877) SBUXBEN to continue coverage. Refer to the Partner Life Insurance section on page 163 for more information. If you are no longer a Starbucks partner, your Starbucks life insurance coverage ends on the last day you are actively at work at Starbucks. You can elect to continue your life coverage through the portability option or you can convert 100% of your coverage into a personal policy with Hartford Life as outlined below. The portability option allows you to continue your life insurance coverage and that of your dependents under a group term plan, while the conversion option allows you to convert your coverage to an individual policy. If you lose benefits eligibility due to the ongoing benefits eligibility audit, your life insurance coverage ends as described in the Eligibility and Enrollment chapter. You can elect to continue your coverage through the portability option or you can convert 100% of your coverage into a personal policy with Hartford Life, as described in this section. Portability and conversion of coverage When your life insurance coverage ends you can continue coverage for you and your enrolled dependents through the portability option. Or you can choose to convert coverage to an individual policy. When you can elect portability or conversion, the amounts that can be continued or converted, the application process and application deadlines are outlined below. Starbucks-paid Basic Life Insurance (one times pay for salaried and nonretail hourly partners, three times pay for executives) Partner-paid Partner Supplemental Life Insurance Spouse or Domestic Partner Life Insurance PORTABILITY OPTION FOR INSURANCE PREVIOUSLY ENROLLED IN Not an option Yes, up to $250,000 Yes, up to $50,000 You must also port your partner life insurance Your dependent must continue to meet the definition of a dependent under Starbucks plans CONVERSION OPTION FOR INSURANCE UP TO THE AMOUNT PREVIOUSLY ENROLLED IN Yes Yes Yes, when you lose coverage under Starbucks plan and/or when your dependent no longer meets the definition of a qualified dependent and loses coverage under Starbucks plan 170

174 VISION LIFE INSURANCE Child Life Insurance Type of coverage PORTABILITY OPTION FOR INSURANCE PREVIOUSLY ENROLLED IN Yes You must also port your partner life insurance Your dependent must continue to meet the definition of a dependent under Starbucks plans Term life CONVERSION OPTION FOR INSURANCE UP TO THE AMOUNT PREVIOUSLY ENROLLED IN Yes, when you lose coverage under Starbucks plan and/or when your dependent no longer meets the definition of a qualified dependent and loses coverage under Starbucks plan Individual policy Deadline to apply How to obtain a quote and apply If you die during the conversion period Rates similar to Starbucks group rates Premium based on age and will remain the and may be modified from time to same until the policy expires or death time Must apply and pay the applicable Must apply and pay the applicable premium quarterly premium within 31 days of within 31 days of when Starbucks group when Starbucks group coverage ended coverage ended Call Hartford Life at (877) Call Hartford Life at (877) No benefit available Hartford life will pay, upon proof of death, the amount you or your dependent was entitled to convert when death occurs within the 31-day conversion period In choosing whether or not the portability option is right for you, here are a few things to keep in mind. You can only elect the portability option if you are under age 65 and do not lose eligibility due to retirement as defined by the Social Security Act, as amended. Your coverage is reduced by 75% at age 65. Your coverage ends at age 75, when you can convert to an individual policy. Waiver of premium If you become medically disabled before age 60, your basic and supplemental coverage may continue after a ninemonth waiting period with all premiums waived (including dependent coverage premiums) until you are age 65. To receive a premium waiver, you must meet the definition of disability as outlined in Hartford s Life Insurance Booklet and be approved for waiver of premium by Hartford Life. During the first nine months of your disability, you can continue paying premiums for your life insurance and submit an application for a waiver of premium. It is recommended that you convert your life insurance coverage at the time your benefits eligibility ends to ensure continued coverage during the nine-month waiting period for 171

175 VISION LIFE INSURANCE a waiver of premium. If you elect the portability option, you will not be eligible for waiver of premium. If your application is accepted, you pay no more premiums (after the nine-month period) and you remain covered for the duration of your disability, until you reach age 65. If your application for waiver is denied and you had converted your coverage after you became ineligible for benefits, you can continue to pay premiums for your life insurance coverage under the conversion option. If you did not elect to convert your coverage after becoming ineligible for benefits and continued to be disabled (as defined by Hartford Life) for nine consecutive months, you can still apply for a waiver of premium. If your application is approved, your coverage will be reinstated and you will pay no premium for the period of time you are disabled. If your application is denied, your coverage remains cancelled. For purposes of this plan, disabled means that you: Are prevented by disability for nine consecutive months from doing any work for which you are or could become qualified by education, training or experience, or Have a life expectancy of 24 months or less. To receive a waiver of premium, proof of your total disability must be submitted to Hartford Life within one year of your last day of active full-time work. During the first two years of your disability, Hartford Life may request you have additional physical exams to verify your continued disability. After the first two years, you will be asked to have an annual physical exam to confirm your continued disability. If you die while you are disabled and before you qualify for a waiver of premium, your life insurance will be paid to your beneficiary(ies) as long as you: Were continuously disabled from your last day of active full-time work until the time you died or the policy terminated, and Proof of your disability is given to Hartford Life within one year from your last day of active full-time work. If you are no longer disabled or you reach age 65, your waiver of premium ends. You may elect the conversion option at that time. How to File a Claim Starbucks Benefits Department must be notified immediately in the event of your or your covered dependent s death by calling Starbucks Benefits Department. A claim form must be completed in full and mailed, along with the death certificate, to Starbucks, Attn: Benefits Department at P.O. Box 34067, Mail Stop S-HR3, Seattle, WA Call Starbucks Benefits Department at (888) 796-JAVA, ext , with any questions. If your claim for life insurance benefits is denied, in whole or in part, you or your beneficiary(ies) may appeal the claim decision by following the process described in Appealing Denial of Claims on page

176 VISION LIFE INSURANCE Questions? If you have general questions about the life insurance plans or if you want to order a Hartford Life Insurance Booklet, call Starbucks Benefits Center at (877) SBUXBEN. You may also request a Hartford booklet online at Select U.S.A., then Enroll in Benefits, then Health, Insurance, then Request Materials. For information on how to file a life insurance claim, call Starbucks Benefits Department at (888) 796-JAVA, ext For help with the portability or conversion options, call Hartford Life directly at (877) between 5 a.m. and 3 p.m. Pacific Time, Monday through Friday. 173

177 VISION ACCIDENTAL DEATH & DISMEMBERMENT Starbucks offers accidental death and dismemberment (AD&D) insurance, which provides financial protection in the case of an accidental injury or death. Your participation in the plan is entirely voluntary and you pay the full cost of coverage through automatic payroll deductions. If you are eligible for Starbucks benefits, you can enroll in AD&D insurance. AD&D is offered through Hartford Life and Accident Insurance Company. How the Plan Works If you are injured or die in a covered accident, your AD&D benefits will pay you or your beneficiary(ies) some or all of your AD&D coverage amount, depending on your loss. Your Coverage Options Your coverage options under the AD&D plan depend on your position at Starbucks. If you are a retail hourly partner You can purchase AD&D coverage in one of these amounts: $10,000, $25,000, or $50,000 If you are a salaried or nonretail hourly partner You can purchase AD&D coverage in one of these amounts: One times base pay Two times base pay Three times base pay Four times base pay Five times base pay What Is AD&D Based On? If you are a salaried or nonretail hourly partner, your AD&D coverage is based on your annualized base pay, rounded up to the next highest $1,000. Your annualized base pay is your gross earnings prior to any before-tax deductions. It does not include any commissions, tips, stipends, bonuses, overtime pay or other compensation. Your AD&D cost and coverage amount are calculated before the annual open enrollment period each year and are reflected on your enrollment worksheet. Your cost will remain constant until the next annual open enrollment. If your base pay changes during the year, any benefit you actually receive will be based on your actual pay at the time AD&D benefits become payable. The maximum amount of AD&D coverage available to you through Starbucks is $750,

178 VISION ACCIDENTAL DEATH & DISMEMBERMENT How Benefits Are Paid Your AD&D insurance pays lump-sum benefits to you if you lose a limb, your hearing or your sight in a covered accident or to your beneficiary(ies) if you die in a covered accident if your loss occurs within 365 days after the date of the accident. A written notice of claim must be submitted to Starbucks, Attn: Benefits Department, within 20 days after the loss occurs. If notice cannot be given within that time, it must be given as soon as reasonably possible. If you die as the result of a covered accident, your beneficiary(ies) will receive your AD&D benefit in addition to any group life insurance benefits. The following chart describes how some of the AD&D benefits are paid. The maximum benefit payable is 100% of your AD&D coverage for all losses combined due to the same accident. AD&D benefits coverage overview For your loss* of The AD&D plan will pay this percentage of your AD&D benefits to you or your beneficiary(ies) Life 100% Both hands or both feet or sight of both eyes 100% One hand and one foot 100% Speech and hearing 100% Either hand or foot and sight of one eye 100% Movement of both upper and lower limbs quadriplegia 100% Movement of both lower limbs paraplegia 75% Movement of both upper and lower limbs of one side of the body hemiplegia 50% Either hand or foot 50% Sight of one eye 50% Speech or hearing 50% Thumb and index finger of either hand 25% * Loss means with regard to (a) hands and feet: actual severance through or above the wrist or ankle joints; (b) sight, speech or hearing: the entire and irrecoverable loss thereof; (c) thumb and index finger: actual severance through or above the metacarpophalangeal joints; and (d) movement of limbs: complete and irreversible paralysis of such limbs. Exposure and disappearance Should a vehicle, aircraft or boat you are traveling on disappear because of an accidental forced landing, stranding, sinking or wreck, and your body is not recovered within one year from the disappearance, you will be presumed to have died. Accidental death benefits will be payable provided you would have been covered for injury resulting from the accident. Benefits will also be payable if a covered injury results from exposure to the elements due to the same causes. 175

179 VISION ACCIDENTAL DEATH & DISMEMBERMENT Seat belt coverage If you die in an accident while riding or operating a registered automobile and while wearing a seat belt, the amount of the benefit payable for accidental death will be increased by 10% up to a maximum of $10,000. The accident must be unintentional and your use of a seat belt must be verified in the police report. Automobile includes a four-wheeled, private passenger car, station wagon, van, SUV or similar vehicle that is not being used as a common carrier for the transportation of passengers for hire. The additional seat belt coverage will not apply if you were driving the vehicle while under the influence of drugs or alcohol. Coma benefit If, as the result of your accidental injury, you become comatose within 31 days of the accident and remain comatose for at least 30 days, you will be paid a monthly benefit. The monthly benefit will be 1% of your accidental death and dismemberment benefit remaining after other benefits have been paid. A coma is a complete and continuous state of unconsciousness and an inability to respond to external or internal stimuli. The coma benefit will continue until the earlier of: The end of the month in which you die, The end of the month in which you recover from the coma, or 100% of your coverage amount has been paid. Adaptive home and vehicle benefit If you suffer a loss, other than loss of life, you may be eligible for assistance with the cost of home and/or automobile alterations to make them accessible to you. For example, wheelchair ramps may be installed if you are confined to a wheelchair. The alterations must be made within two years from the date of your accident, made to your principal residence and/or private automobile and be required to make your residence accessible to you and/or your private automobile drivable or ridable for you. Home alterations must be made by someone with experience in such alterations and recommended by a recognized organization associated with your type of injury. Similarly, vehicle modifications must be carried out by someone with experience in such matters and approved by the Motor Vehicle Department. The amount available under the adaptive home and vehicle benefit will be the lesser of: 2.5% of your accidental death and dismemberment coverage The actual cost $2,

180 VISION ACCIDENTAL DEATH & DISMEMBERMENT Reduction in Benefits The amount of AD&D benefits you are entitled to is reduced once you reach age 65, as shown below. IF YOU ARE INJURED OR DIE IN AN ACCIDENT YOUR AD&D BENEFIT IS REDUCED BY THE PERCENTAGE OF AD&D BENEFIT PAYABLE IS At age 65 through 69 35% 65% (rounded to the next higher $500) At age 70 and over 55% 45% (rounded to the next higher $500) Beneficiary Designation When you enroll in AD&D insurance, you will need to designate one or more beneficiaries. To designate your AD&D beneficiary(ies), call Starbucks Benefits Center at (877) SBUXBEN and speak with a benefits representative or go online to Accidental death benefits are paid to your beneficiary(ies). Accidental dismemberment benefits are paid directly to you. What Is the Difference? What is the difference between AD&D and partner life insurance? AD&D pays benefits if you are injured or die in an accident, while partner life insurance pays benefits if you die, whatever the cause. If you die as a result of an accident, your beneficiary(ies) will receive benefits from both plans, if you were covered by both plans at the time of your death. What Is Not Covered Starbucks AD&D plan does not cover losses resulting from: An intentionally self-inflicted injury, a suicide or attempted suicide, whether sane or insane War or an act of war (declared or undeclared) An injury sustained while full time in the armed forces of any country or international authority An injury sustained while riding on any aircraft, except a civil or public aircraft (with a current and valid airworthiness certificate and piloted by a person with a valid and current pilot s license for the aircraft) or a military transport aircraft An injury sustained while committing or attempting to commit a felony An injury sustained while riding on any aircraft if you are a: Pilot, crew member or student pilot Flight instructor or examiner If you are an active flight crew member employed by Starbucks and are enrolled in AD&D coverage, this exclusion will not apply to you while you are performing your job as a flight crew member. 177

181 VISION ACCIDENTAL DEATH & DISMEMBERMENT If You Take an Approved Leave of Absence Your AD&D coverage may continue during an approved leave of absence, as outlined on page 25. However, you will be required to continue to make your premium payments for AD&D coverage during your leave of absence. Premiums for AD&D coverage will be collected (depending on your length of leave) through either direct billing from Starbucks Benefits Center or retroactive payroll contributions upon your return to work. If you do not make your premium payments while on leave of absence, your coverage may be cancelled. Call Starbucks Benefits Center at (877) SBUXBEN for more information. When Coverage Ends If you change positions from salaried/nonretail hourly to retail hourly, your AD&D coverage options change from a multiple of your annualized base pay to flat dollar amounts and you will need to make new AD&D elections by speaking with a Benefits Center representative at (877) SBUXBEN to continue coverage. Refer to Your Coverage Options on page 174 for more information. If you are no longer a Starbucks partner, your AD&D coverage ends on the last day you were actively at work at Starbucks. If you lose benefits eligibility due to the ongoing benefits eligibility audit, your AD&D coverage ends as described in the Eligibility and Enrollment chapter. How to File a Claim Starbucks must be notified immediately in the event of an accidental injury or death. Call Starbucks Benefits Department at (888) 796-JAVA, ext , and Starbucks will send a claim form to you or your beneficiary(ies) to complete and return to Starbucks. Claims for AD&D benefits are processed by Hartford Life. Hartford Life will distribute your AD&D benefits to you or your beneficiary(ies). If your claim for AD&D benefits is denied, you or your beneficiary(ies) may appeal the claim decision by following the process described in Appealing Denial of Claims on page 211. Questions? If you have general questions about the AD&D plan, call Starbucks Benefits Center at (877) SBUXBEN. To find out the status of an outstanding AD&D claim, call Hartford Life directly at (888)

182 Time Off Holidays 180 How the plan works 180 Personal Days 181 How the plan works 181 Unused personal days 181 Vacation 181 How the plan works 181 Accrual program 182 Grant program 183 Transition between accrual and grant programs 185 Paid Time Off 185 Bereavement 185 Jury and witness duty 186 Leaves of Absence (Unpaid Time Off) 186 Family/medical leave 186 Pregnancy disability leave 187 Disability leave 188 Military leave 188 Personal leave 189 Career Coffee Break (sabbatical leave) 189 Pay while on a leave of absence 190 Health coverage and insurance benefits while on a leave of absence 190 Questions?

183 VISION TIME OFF At Starbucks, you have time off available which includes holidays, personal days and vacation time. Time away from work gives us time to relax and recharge, returning to our jobs more productive. If you have to miss work because of a sickness or injury, refer to the sick pay and disability chapters. Holidays Starbucks observes the following six holidays: New Year s Day Memorial Day Independence Day Labor Day Thanksgiving Day Christmas Day How the plan works If you are a retail hourly partner, you are paid 1.5 times your base hourly rate of pay for any hours you work on a holiday. Salaried and nonretail hourly partners not working a holiday are paid straight time for the holiday. However, if you are an hourly partner working in a roasting plant, the observed holiday must fall on a regularly scheduled work day and you must work the last scheduled shift before the holiday and the first scheduled shift after the holiday to receive pay for the holiday. If you obtain pre-approval to extend the holiday by one or more shifts, then you must work the last scheduled shift before your pre-approved time off and the first scheduled shift after your pre-approved time off to receive pay for the holiday. If you must work the holiday, you may be paid overtime or have an opportunity to take an alternative day off as follows: If you are a nonretail hourly partner, you are paid 1.5 times your base hourly rate for hours worked on the holiday. In addition, you receive straight time pay for the holiday. You cannot take a paid day off in lieu of the holiday. If you are a salaried exempt or salaried non-exempt partner and you work on a holiday, you receive regular pay for the holiday and can take a paid day off within the 60 days following the holiday. When you take the holiday, submit a time card (or enter information into the POS system if you work in a store) indicating your holiday pay. Unpaid time off before or after a holiday must be approved in advance. Partners on an unpaid leave of absence do not receive holiday pay. 180

184 VISION TIME OFF Personal Days Starbucks awards one paid personal day every six months, as follows: January 1, if employed by the preceding October 3, to be used before the following July 1 July 1, if employed by the preceding April 3, to be used before the following January 1 How the plan works Hours paid for a personal day are based on the average number of hours paid over a period of time before the personal day is used. The maximum hours paid for a day is eight except for partners whose regular schedule is four ten-hour days or three twelve-hour days, in which case the maximum is 10 or 12, respectively. Partners on an unpaid leave of absence are not eligible to use a personal day. Unused personal days Use it or lose it. If you do not use a personal day within the six months after it has been awarded to you, you will lose it. Unused personal days may not be carried over into the next six-month period and are not paid to you upon termination. Vacation Starbucks has two vacation plans: the accrual program and the grant program. Which vacation plan you have depends on where you work and your job at Starbucks. This is because there are different state laws in place that impact how your vacation plan is structured. At all times, Starbucks will follow applicable law to the extent the law provides benefits more generous than those provided here. How the plan works The accrual program is for: Retail hourly partners and Salaried and nonretail hourly partners working in California, Colorado, Illinois, Louisiana, Massachusetts. The grant program is for: Salaried and nonretail hourly partners, except partners working in California, Colorado, Illinois, Louisiana, Massachusetts. Take the Time Because time off is so important to our physical and mental health, vacation time may not be borrowed, advanced, donated or paid to you as cash in lieu of time off. 181

185 VISION TIME OFF Accrual program This program is for all retail hourly partners, salaried and nonretail hourly partners working in California, Colorado, Illinois, Louisiana, Massachusetts. You earn or accrue vacation hours based on the actual number of hours you work. You continue to accrue vacation time as long as you are an active Starbucks partner, even while you are receiving holiday pay, taking sick time or a personal day. However, you do not accrue additional vacation time when taking vacation. Vacation hours are paid to you at your current rate of pay at the time you take your vacation and are paid on your normal paycheck. You can start using your accrued vacation once you have been at Starbucks six months, or earlier if required by law. Talk to your manager about any vacation time you plan to take so schedules can be adjusted, if necessary. In general, retail hourly partners should plan on taking their vacations during months other than November and December. Accrual schedule You accumulate vacation time based on your actual hours worked. If you work less than 40 hours a week, you will accrue vacation time on a prorated basis. You continue to accrue vacation time each pay period until you reach the maximum accrual limit, as shown below. Once you reach your vacation accrual limit, you stop accruing additional vacation time until you use some and your vacation accrual balance drops below the maximum accrual limit. The vacation accrual schedule and maximum accrual limits shown in the following charts apply to partners who are classified as working 40 hours per week. If you are classified as working less than 40 hours a week, you will accrue vacation time on a prorated basis. Retail hourly partners COMPLETED MONTHS OF SERVICE FROM MOST RECENT HIRE DATE ANNUAL VACATION ACCRUAL Less than hours 40 hours 12 but less than hours 80 hours 60 or more 120 hours 120 hours MAXIMUM ACCRUAL LIMIT 182

186 VISION TIME OFF Salaried and nonretail hourly partners working in California, Colorado, Illinois, Louisiana or Massachusetts COMPLETED MONTHS OF SERVICE FROM MOST RECENT HIRE DATE ANNUAL VACATION ACCRUAL Less than hours 80 hours 36 but less than hours 120 hours 60 but less than hours 160 hours 120 or more 200 hours 200 hours MAXIMUM ACCRUAL LIMIT If you are on a leave of absence You do not earn vacation time while you are on a leave of absence from Starbucks. If you are on an unpaid leave of absence, you are required to use unused vacation time concurrent with any or all of your unpaid leave (unless the leave is for your own serious health condition and you are receiving short-term disability benefits). If you are no longer a Starbucks partner Your unused accrued vacation time will generally be paid to you upon termination provided you have at least one hour of unused accrued vacation time. In this case, your unused vacation time is included in your final paycheck. There is one exception: if you have less than six months (182 days) of service when you leave Starbucks, you will not receive your unused accrued vacation time, except as required by law. Your unused vacation time may not be used to extend your termination date. If you are later rehired at Starbucks, you will begin to accrue vacation time again from your most recent date of hire. Your prior service will not count. Grant program This program is for salaried and nonretail hourly partners working in states other than California, Colorado, Illinois, Louisiana and Massachusetts. About the plan Annually, on October 1, you are granted your full year s vacation to be used by the following September 30. Any unused granted vacation time remaining each September 30 is lost. You cannot carry over your unused vacation time from one year to the next. Vacation hours are paid to you at your current rate of pay at the time you take your vacation and are paid on your normal paycheck. You can start taking your granted vacation after you have been at Starbucks six months. Talk to your manager about any vacation time you plan to take so schedules can be adjusted, if necessary. 183

187 VISION TIME OFF Grant schedule The following schedule applies to full-time partners who are classified as working 40 or more hours per week. Partners who are classified as working less than 40 hours a week receive a prorated grant based on their regular part-time schedule. COMPLETED MONTHS OF SERVICE FROM MOST RECENT HIRE DATE Less than hours 36 but less than hours 60 but less than hours 120 or more 200 hours ANNUAL VACATION GRANT Service anniversary and vacation grant If, due to your length of service at Starbucks, you will pass from one service anniversary level to the next within the upcoming vacation year (October 1 through September 30), you will be awarded a blended grant. This means your vacation grant will be adjusted to reflect the number of days in the vacation year at one grant level and the remaining days in the vacation year at the next higher grant level. Here is an example: This partner will complete 36 months of service on April 1, On October 1, 2007, his vacation grant takes into account that in the next 12 months he will have 183 days at the 80-hour grant level and 182 days at the 120-hour grant level. The partner s October 2007 grant calculation is as follows: GRANT LEVEL GRANT HOURS 183 days at 80 hours a year days at 120 hours a year + 60 Vacation grant on October 1, Vacation grants are rounded up to the next full hour for nonretail hourly partners and up to the next full eight-hour day for salaried partners. Grant for new partners If your hire date falls on or after October 1, but before March 1, you will receive a prorated grant upon completion of six months service. If you are a nonretail hourly partner, your grant is rounded up to the next full hour. If you are a salaried partner, your grant is rounded up to the next full eight-hour day. On the following October 1, you will receive your first full year s vacation grant. If your hire date falls in the month of March, you will receive a full year s vacation grant on October 1. If your hire date falls on or after April 1, but before October 1, your first full year s vacation benefit will be granted after completing six months of service. 184

188 VISION TIME OFF If you are on a leave of absence If you are on a leave of absence (other than a Career Coffee Break) from Starbucks, your vacation grant will not be adjusted for the time you are on leave. If you are on an approved unpaid leave of absence, you are required to use unused vacation time concurrent with any or all of your unpaid leave (unless the leave is for your own serious health condition and you are receiving short-term disability benefits). If you take a Career Coffee Break, you will receive a pro-rated vacation grant upon your return to work when your return to work is in a new vacation year. For example, if you begin your Career Coffee Break in June and return January 2, you would receive a pro-rated vacation grant in January equal to 9/12 of your annual grant. If you are no longer a Starbucks partner Any unused granted vacation time is forfeited. Your unused vacation time may not be used to extend your termination date and may not be used in the final four weeks of employment. If you are later rehired by Starbucks, your vacation grant will be based on your most recent date of hire. Your prior service will not count. Transition between accrual and grant programs If you move between states or have a job change resulting in a change in your vacation plan, your vacation will be affected as follows: From accrual to grant program From grant to accrual program ACCRUED VACATION Unused balance paid at time of transfer Begin accruing vacation time October 1 following your transfer GRANTED VACATION Receive a prorated grant (if eligible) for remainder of vacation year (October September) to be used by September 30 Unused granted vacation reclassified as accrued vacation Paid Time Off In addition to vacation and personal days, you may take time off with pay for bereavement, jury duty or witness duty with approval from your manager and your Partner Resources generalist. This benefit is effective immediately upon hire. Bereavement If you experience a death in your immediate family, you will receive up to two consecutive days off with pay to attend the funeral. If overnight travel is required, up to an additional two consecutive days (for a total of four days) of time away from work will be paid. If you are notified of the death while working, you may leave work immediately and will also be paid for the remainder of your shift. A family member includes your spouse, domestic partner, parent, step-parent, grandparent, child, stepchild, grandchild, step-grandchild, sibling or your spouse s or domestic partner s parent, grandparent, sibling or child. 185

189 VISION TIME OFF In order to receive time off for bereavement, you must submit a written request to, and receive approval from, your manager. A retail hourly partner s daily pay for bereavement will be based on the average number of hours worked per day over a specified period of time. All other partners will be paid their regular salary for the week in which bereavement time is taken. Jury and witness duty Serving on a jury or being a witness is a fundamental responsibility of citizenship. If summoned to serve on a jury or if subpoenaed to testify as a witness, you should immediately provide your manager with a copy of the summons or subpoena and make arrangements for the time away from work. Starbucks will pay you for up to 10 consecutive work days missed for jury or witness duty. Pay under this policy is available only if you actually missed work or a scheduled shift as a result of the jury or witness duty. If you have been selected to serve on a jury and it is anticipated to exceed two weeks in duration, contact your Partner Resources generalist to discuss your status. Leaves of Absence (Unpaid Time Off) Starbucks offers unpaid leaves of absence for extended periods of time, depending on the reason why you need time off. The types of leaves are: Family/medical leave Pregnancy disability leave Disability leave Military leave Personal leave Career Coffee Break (sabbatical leave) Family/medical leave Starbucks intends for its family/medical leave to provide benefits consistent with the federal Family and Medical Leave Act of At all times, Starbucks will follow applicable state law to the extent state law provides benefits more generous than those provided here. Family/medical leave is available if you are absent: Due to a serious health condition that prevents you from working, including an on-the-job injury, Due to pregnancy or childbirth, To care for a family member with a serious health condition, or To stay home to care for a newborn child, newly adopted child or newly placed foster child. For purposes of this policy, a family member is considered your spouse, domestic partner, parent or child. A child is defined as a biological, adopted, foster or stepchild under age 18, or as otherwise defined by state and federal law, or a child over age 18 who is incapable of self-care because of a mental or physical disability. 186

190 VISION TIME OFF Eligibility To be eligible for family/medical leave, you must have been continuously employed by Starbucks for at least 90 days and actively working during that time. If eligible, you have up to 12 weeks of family/medical leave every 12 months. Starbucks calculates the amount of time you have available by reviewing the 12-month period preceding your first day of leave. The amount of family/medical leave taken in the prior 12 months will be subtracted from 12 weeks to determine the amount of leave currently available to you. Requesting family/medical leave A request for family/medical leave must be made at least 30 days in advance. If advance notice cannot be provided because the reason for leave is sudden and unexpected, notice should be provided as soon as possible. If less than 30 days notice is provided, you will be asked to provide a written explanation. Notice must be provided to your manager and to Starbucks Benefits Center Leave Administration by calling (877) SBUXBEN. If family/medical leave is requested due to a serious health condition or to care for an ill family member, you will receive paperwork that must be completed by your (or the family member s) health care provider. It is your responsibility to ensure that all paperwork is completed and returned within the time frame provided. Failure to complete and return the necessary paperwork may delay the commencement of your leave or, if leave has already begun, may result in a determination that the leave is unauthorized or denied. Duration of leave Family/medical leave is limited to 12 weeks every 12 months. In certain circumstances, additional leave may be approved. You will be required to submit detailed medical documentation of your inability to work. Starbucks will review the additional medical documentation and determine on a case-by-case basis whether you may receive additional time away from work as a reasonable accommodation of a disability. Refer to Disability leave on the next page. Reinstatement When family/medical leave ends, you will be returned to work in the same position held when leave began or to a similar position with similar pay, benefits and other terms and conditions of employment. You are required to contact your manager at least two weeks in advance of your return to work to ensure that you are scheduled for work. Additionally, if you have been unable to work due to your own serious health condition, you may be required to provide medical documentation of your fitness to return to work. Pregnancy disability leave Pregnancy disability leave is provided to you if you are unable to work due to pregnancy or childbirth. Pregnancy disability leave will be administered in accordance with applicable state law. No eligibility restrictions apply. Unless otherwise prohibited by state law and upon satisfaction of eligibility requirements, pregnancy disability leave will also be counted as family/medical leave under Starbucks policy. 187

191 VISION TIME OFF Disability leave A leave of absence may be granted to accommodate a disability, provided the leave is reasonable and does not impose an undue hardship on Starbucks operations. If your disabling condition also qualifies as a serious health condition under Starbucks family/medical leave policy, your request for disability leave will be treated as a request for family/medical leave. Disability leave may be approved if family/medical leave is not available. Generally, medical documentation verifying the reason for and the expected duration of the leave will be required. Your failure to submit medical documentation may result in denial of leave and/or separation from employment. Upon receipt of the required medical documentation, Starbucks will conduct a review to determine whether the leave may be reasonably accommodated. Starbucks will also reasonably accommodate your return to work by reinstating you into a suitable position. Military leave Starbucks abides by all applicable federal and state laws in providing members of our military services with an unpaid leave of absence to attend to military duties. If you are a member of the military and receive notice of annual reserve training or active duty, you must immediately notify your manager to arrange for the time away from work. You may also be required to provide a copy of the military orders. Eligibility You are immediately eligible for military leave upon hire. Requesting military leave To request a military leave, contact Starbucks Benefits Center Leave Administration at (877) SBUXBEN. You will be asked to complete a Military Leave of Absence Notification form and return it to Starbucks Benefits Center Leave Administration prior to your leave start date. Military allowance When you are called to active duty, Starbucks will pay the difference between your Starbucks pay and your military pay when your military pay is less than your Starbucks pay. An hourly partner s average weekly pay will be calculated on the basis of earnings for 26 weeks (or less if employed less than 26 weeks) prior to the commencement of military leave. The military allowance will be paid for the duration of the military leave, up to 78 weeks for a partner with at least six months of continuous service with Starbucks or up to 52 weeks for a partner with less than six months of continuous service. A partner participating in annual reserve training or a partner whose military pay exceeds his or her regular pay with Starbucks will not be eligible for the allowance. In those instances, you may elect to use vacation time to substitute for any or all of the unpaid military leave. 188

192 VISION TIME OFF Reinstatement When your military service ends and your combined periods of military leave from Starbucks have not exceeded five years, you may be reinstated in the same or like position. You should contact your manager and/or Partner Resources generalist at the end of your military leave to make arrangements for your return to work. Personal leave An unpaid leave of absence for personal reasons is available in exceptional circumstances. To be eligible, you must have been continuously employed with Starbucks for at least 90 days. Personal leave is limited to 30 days and only one personal leave will be granted every three years. A personal leave of absence must be approved by both your manager and Partner Resources generalist or district manager (for retail partners). A partner on personal leave will be required to use unused vacation pay to substitute for any or all of the unpaid personal leave. Personal leave is not available to attend school or to extend family/medical leave, disability leave or paid vacation. Career Coffee Break (sabbatical leave) A Career Coffee Break leave is available to a partner with an interest in taking a break to travel, spend extended time with family and friends or pursue volunteer interests or additional education. Eligibility You are eligible for a Career Coffee Break after completing 10 years of continuous service and have a performance rating of meets expectations or better. Additional Career Coffee Breaks will be available to you after working seven consecutive years after the end of each leave. Requesting a Career Coffee Break You should request a Career Coffee Break at least six months prior to the requested leave commencement date. The request should be submitted in writing to your manager, with a copy to your Partner Resources generalist. Contact Starbucks Benefits Center Leave Administration at (877) SBUXBEN to initiate your leave. You will be required to complete and return a Starbucks Leave of Absence Request form signed and approved by your immediate manager and zone/department vice president. The decision to grant the leave will depend on various factors, including your position, the timing and length of leave requested and current and future business needs. At all times, Starbucks retains sole discretion in determining whether a Career Coffee Break will be permitted. Employment with another company is not an appropriate use of the Career Coffee Break and generally will result in separation from employment with Starbucks. Duration The maximum duration for any approved Career Coffee Break leave is 12 consecutive months. The 12 months will be reduced by the amount of time you were absent due to an approved leave of absence taken during the 12 months preceding your leave. You will be required to use all vacation pay available while on leave. Sick pay and personal days are not available while on a Career Coffee Break. 189

193 VISION TIME OFF You may apply for a Career Coffee Break leave to follow a family/medical or personal leave, provided you apply for the Career Coffee Break at least six months prior to the first day of absence from work. When combined with any other type of leave or vacation, the total duration of the absence may not exceed 12 consecutive months. Reinstatement At the end of your leave, Starbucks will make every reasonable effort to reinstate you to your same or similar position. A position, however, is not guaranteed except when your total absence does not exceed six months. While on leave, you are encouraged to stay in contact with your manager and Partner Resources generalist. If your prior position is not available, you should begin the process to secure an alternate position well in advance of the end of your leave. Pay while on a leave of absence Leaves of absence are unpaid. However, you may be required to substitute any accrued but unused sick pay if the reason for the leave is due to your own serious health condition or to care for an eligible family member with a serious health condition. If sick pay is not available or if the leave is for another qualifying purpose, you may be required to use vacation time for any or all of the unpaid leave. A partner eligible for short-term disability benefits may receive partial reimbursement of lost wages if taking family/medical leave due to his or her own serious health condition. A partner who is unable to work because of an on-the-job injury or illness may be eligible for time-loss compensation through workers compensation insurance. Health coverage and insurance benefits while on a leave of absence Refer to the Eligibility and Enrollment chapter for information about benefits, including health coverage, while on a leave of absence. Questions? For more information about what happens to your benefits coverage and eligibility while on a leave of absence, refer to the Eligibility and Enrollment chapter. If you have questions about time-off benefits, speak with your manager or Partner Resources generalist or Starbucks Partner Contact Center at (866) To apply for a leave of absence or to obtain more information, contact Starbucks Benefits Center at (877) SBUXBEN. 190

194 Adoption Assistance Adoption Expense Reimbursement 192 How the plan works 192 Taxation 192 How to file a claim 192 Adoption Allowance 193 How the plan works 193 Taxation 193 How to request payment 193 Questions?

195 VISION ADOPTION ASSISTANCE Making a decision to adopt a child and then turning that desire into reality can be a complicated, challenging and expensive process. Starbucks Adoption Assistance Program is designed to assist you with the costs of adopting. Adoption Expense Reimbursement How the plan works All partners eligible for benefits are also eligible for adoption expense reimbursement. To be reimbursed for qualifying adoption expenses, you must be benefits eligible at the time your adoption expense is incurred. For more information about benefits eligibility, see the Eligibility and Enrollment chapter. The adoption expense reimbursement benefit will reimburse you up to $4,000 per attempted or successful adoption, up to a lifetime maximum of $12,000 per partner, to help pay for qualifying expenses related to the adoption of a child(ren) under age 18. This includes the adoption of a foster child, a child from overseas or a child with special needs. Qualified expenses include reasonable and necessary adoption fees, legal fees, court costs and traveling expenses while away from home that are directly related to and for the principal purpose of the legal adoption of a child(ren). If you and your spouse or domestic partner are both employed by Starbucks, only one of you is eligible for reimbursement for the same incurred expenses under this program, up to a lifetime maximum of $12,000 per couple. Taxation The adoption expense reimbursement benefit is intended to meet the requirements of Section 137 of the Internal Revenue Code (currently set to expire December 31, 2010). By doing so, the benefit may be excludable from your gross income (if it is excludable, it will not be taxed). Unreimbursed adoption expenses may also be eligible for a tax credit up to IRS defined limits. Because the amount of the exclusion or tax credit will depend on your personal situation, you should check with a tax adviser on these provisions. Starbucks will withhold Social Security and Medicare (FICA) taxes on the amount of the benefit you receive. Federal income taxes will not be withheld but may be owed if you do not qualify for the tax exclusion. State and local taxes may be withheld depending on where you live. The adoption benefit will be reported on your W-2 in Boxes 3 and 5 (Social Security, Medicare) and Box 13 with the code T. How to file a claim Complete an adoption reimbursement request form and submit it to Starbucks Coffee Company, Attn: Benefits Department, P.O. Box 34067, Mail Stop S-HR3, Seattle, WA Adoption reimbursement request forms, as well as a copy of the plan document, are available upon request from Starbucks Benefits Department at (888) 796-JAVA, ext

196 VISION ADOPTION ASSISTANCE Adoption Allowance How the plan works All partners are eligible for the adoption allowance benefit. The adoption allowance provides up to two weeks of pay when you are not working to travel to pick up an adopted child and to settle the child in your home. A week of pay is calculated by averaging your weekly regular hours paid to you over the 26 weeks immediately preceding the adoption placement and multiplying it by your rate of pay in effect at the time you use the allowance. The allowance must be used within the first four weeks following the child s placement with you and is not contingent on your receiving adoption expense reimbursement benefits. The adoption allowance benefit is not available when you are adopting a child of your spouse or domestic partner. It is also not available when you are adopting a child who already lives with you (for example, a grandchild, niece or nephew, or a foster child). If you and your spouse or domestic partner are both employed by Starbucks, your combined benefit is two weeks. Taxation The adoption allowance benefit is taxable and is not considered earnings for Bean Stock, S.I.P. and Future Roast 401(k) Plan purposes, for determining life insurance or disability benefits, or for other programs. How to request payment To request an adoption allowance benefit, call Starbucks Benefits Department at (888) 796-JAVA, ext Questions? For more information about Starbucks adoption assistance program, call Starbucks Benefits Department at (888) 796-JAVA, ext

197 Tuition Reimbursement Eligibility 195 Benefits eligible status 195 Tuition Reimbursement Benefit 195 Director level or above 196 Reimbursement amount 196 Benefit taxation 196 Other educational assistance 196 Expenses Eligible for Reimbursement 197 Eligible Educational Programs 197 Eligible Educational Providers 198 Degree programs and individual courses 198 Certification programs 198 Applying for Course or Certification Pre-Approval 198 Three ways to apply 198 Application deadline and approval 198 Falsified documents or application 199 Dropped courses 199 Filing a Request for Reimbursement 199 Payment 200 Separation and rehire 200 Request for Review of Denial 200 Approved Leave of Absence 201 Termination of Employment 201 For More Information

198 VISION TUITION REIMBURSEMENT Tuition reimbursement helps to cover a portion of the cost of tuition, books and other expenses as you advance your professional development. Eligibility To participate in the tuition reimbursement program, you must: 1. Be a partner on the U.S. payroll, or a U.S. expatriate partner working for Starbucks in another country but remaining on the U.S. payroll, and 2. Have a minimum of one continuous year of service from your most recent date of hire, and 3. Be considered eligible for Starbucks benefits plans (what Starbucks refers to as benefits eligible for medical, dental, vision, etc.) on your term start date. If you have questions regarding your benefits eligibility, you may speak with a Starbucks Benefits Center representative at (877) SBUXBEN. To be eligible for reimbursement, you must be an active partner at the time your reimbursement benefit is processed by Starbucks payroll. Benefits eligible status As discussed above, you must be benefits eligible on your term start date. If you lose benefits eligibility after your term has begun, your loss of eligibility will not affect your eligibility for reimbursement of your approved course. However, you must become re-eligible for benefits before any additional courses will be approved. Tuition Reimbursement Benefit The maximum reimbursement is based on your position and length of continuous service at the beginning of each calendar year as shown below: PARTNER POSITION CONTINUOUS LENGTH OF SERVICE AS OF JANUARY 1 EACH YEAR Up to director level Less than 36 months $ but less than 60 months $ months or more $1,000 *Director and above All lengths of service $500 *Maximum calendar year reimbursement for directors and above is restricted by IRS nondiscrimination rules. MAXIMUM CALENDAR YEAR REIMBURSEMENT 195

199 VISION TUITION REIMBURSEMENT Director level or above To provide a non-taxable benefit, IRS regulations require that tuition reimbursement programs may not favor partners who are considered by the IRS to be highly compensated. By applying a maximum benefit of $500 to partners in positions of director or above, Starbucks improves its ability to pass required discrimination testing. If a partner is promoted to director during the year, the reimbursement benefit determined at the beginning of that calendar year will remain in effect for the rest of the year. The calendar year maximum benefit then becomes $500 starting on January 1 of the year following the promotion to director. Reimbursement amount Your maximum reimbursement amount is determined annually. On the first day of each January, your length of service is calculated, establishing your benefit amount for the calendar year. Benefits eligible partners who have less than one year of continuous service on January 1st do not become eligible for the tuition reimbursement benefit until their one-year anniversary date later in the calendar year. Here are a couple of examples: Jim was hired April 3, He will become eligible for a tuition reimbursement benefit on April 3, 2008, provided he remains employed the entire time and is eligible for benefits. On April 3, 2008, Jim s potential benefit would be $500 because he has less than 36 months of service. Pat s hire date was June 28, 2004, and she completed 30 months of service on January 1, This would qualify Pat for a $500 maximum benefit during the 2007 calendar year. On January 1, 2008, Pat will have completed 42 months of service, qualifying her for a $750 maximum benefit during calendar year The calendar year maximum benefit is reduced by the amount of the tuition reimbursement benefits paid to you for courses that conclude in that calendar year regardless of the date the course was approved or commenced. For example, a course approved in December 2007 for a class that concludes in March 2008 will be applied against the 2008 calendar year maximum. Benefit taxation The tuition reimbursement benefit is not subject to federal income tax. In some states, the tuition reimbursement benefit is subject to state income tax when the course is not job related. If this applies, Starbucks will withhold state income tax from your tuition reimbursement benefit. Other educational assistance The tuition reimbursement program is designed to provide financial support to help you reach your educational goals. You are encouraged to seek additional sources of financial aid to supplement the Starbucks program. Partners who receive grants, scholarships and/or Veteran s Administration benefits should fully utilize these sources of assistance prior to using Starbucks tuition reimbursement program. All financial aid must be disclosed on the tuition reimbursement application. 196

200 VISION TUITION REIMBURSEMENT Expenses Eligible for Reimbursement The cost of tuition, books, class-required supplies and required fees, such as exam or lab fees, charged to students for the approved course are eligible for reimbursement. Expenses not listed above are not eligible. These would include, but are not limited to, parking, late registration fees, purchase of a personal computer, and general school supplies. Expenses related to professional meetings, workshops, conventions, licensures, insurance costs, and preparation for tests are also not eligible. Eligible Educational Programs Degree and certification programs must directly prepare you for a job at Starbucks and be provided by an approved educational provider. Individual courses that do not prepare you for a job at Starbucks will qualify when that course is required in the pursuit of a qualifying degree. A few examples of the many eligible degrees include finance, food science, agronomy, law and music theory. All requests to modify the current approved degree and certification lists will be reviewed by Starbucks Benefits Department. If appropriate, modifications to the approved lists are made quarterly. Eligible educational programs include: Associate s, Bachelor s, Master s and Doctoral degree programs; eligible courses include all coursework required to complete an approved degree. Adult Basic Education (ABE), General Educational Development (GED) and English as a Second Language (ESL) programs. Professional Certification Programs (programs must have a measurable course completion requirement beyond attendance and participation). Examples of study programs not covered include, but are not limited to: Degrees or courses of study in areas that are not related to Starbucks business Individual courses for Continuing Education units Individual courses for sports, recreation or hobbies, unless part of an approved degree program Seminars and workshops To review the list of approved degrees and certifications, visit and select the Tuition Reimbursement tab. If your educational institution, degree and/or certification is not on this list, contact a Starbucks Tuition Reimbursement representative at (888) for more information. 197

201 VISION TUITION REIMBURSEMENT Eligible Educational Providers Degree programs and individual courses Degree programs and individual courses must be provided by a nationally or regionally accredited educational provider that results in college credit. Requests to modify the approved educational institution list will be reviewed by Starbucks Benefits Department. If appropriate, modifications are made quarterly. Accreditation is a status granted to educational institutions found to either meet or exceed academic quality standards established by an accrediting agency through an assessment process. Accreditation assures the partners and Starbucks that the course and/or educational institution meets academic quality standards, including academic core values of performance, integrity and quality assurance. Certification programs Certification programs must be provided by an agency that has met the standards of the credentialing organization and is authorized to grant certification. Applying for Course or Certification Pre-Approval You may complete your course study in class, by video, via the Internet or by self-study. Three ways to apply CAEL is our program administrator. You can submit an application to CAEL for preapproval online, by fax or by mail. Online. Link to the tuition reimbursement website from Fax or mail. A printable application form with instructions is available at For partners without Internet access, an application form can be requested from Starbucks Tuition Reimbursement Center at (888) Additional information when a paper application is submitted: Separate applications are required for courses at different schools. Separate application forms are required for different course dates. Complete additional application forms when more than four courses are being submitted for pre-approval. Incomplete applications will not be processed and will be denied, in which case a new complete application will need to be submitted. Application deadline and approval Your application must be received by Starbucks Tuition Reimbursement Center within a 51-day timeframe that begins 30 days before the first day of the term and ends 21 days after the start of the term. Applications received outside of this timeframe (i.e. too early or too late) will be denied. 198

202 VISION TUITION REIMBURSEMENT Once your application has been successfully completed and submitted to Starbucks Tuition Reimbursement Center, it will be reviewed for eligibility. If submitted via the Website, your application will be reviewed within five business days. If you fax or mail your application, it will be reviewed within 10 business days of receipt. If additional information is needed, the review process may take longer. Notification of the approval or denial of the application will be sent to you via (if provided) or home address. The status of a partner s application can be reviewed online by linking to the Starbucks Tuition Reimbursement home page from or by calling (888) and using the automated phone response system. Falsified documents or application It is your responsibility to submit copies of original, unaltered documents and fully disclose all required information (e.g. receipt of scholarship money) as required during the application and/or reimbursement processes. Falsification and/or purposeful omission of required information may result in corrective action up to and including suspension or termination of employment. Upon application approval, you pay the tuition and applicable course fees directly to the school or certification program administrator and purchase your textbooks. Upon successful course completion, submit within 60 days of the term end date a Request for Reimbursement form with grades, itemized receipts and proof of payment. Dropped courses If you drop a course, that course no longer qualifies for reimbursement. Notify Starbucks Tuition Reimbursement Center in writing via fax to (888) if you drop a class. Filing a Request for Reimbursement To be eligible for reimbursement, submit the following via fax to (888) within 60 days from the last day of the term: A copy of your Course Approval Notification sent from the Starbucks Tuition Reimbursement Program Administrator or a completed Reimbursement Request Form. Reimbursement Request Forms can be printed from the Resources page of the Starbucks Tuition Reimbursement website (link from or call (888) The original document of a passing grade report of C- or better, or a pass for a pass/fail course, or a certificate or documentation indicating achievement of professional certification for a certification program Itemized invoice of tuition and fees Itemized receipt for textbook purchases Proof of payment If a receipt clearly indicates you received a grant/scholarship, the grant/scholarship amount will be deducted from the tuition reimbursement benefit amount. Documentation that is not legible or is altered in any way will not be accepted. 199

203 VISION TUITION REIMBURSEMENT Receipts should identify the partner, partner number and the educational institution attended. The receipts must also: Provide an itemized breakdown of tuition, books and fees. (If the school does not itemize, then the receipt must have documentation from the school explaining this each time you submit for reimbursement.) Show covered expenses have been paid in full. Payment Once approved, you will be reimbursed on a regular paycheck, typically within two paychecks following the approval. You must be an active partner at the time your payment is processed by Starbucks s payroll department to be eligible for reimbursement. If you are overpaid in error for any reason, you are expected to reimburse Starbucks the full amount of the overpayment. Separation and rehire If your employment ends before the successful completion of a course and payment of the reimbursement benefit, you are not eligible for reimbursement for that course, even if you are rehired prior to course completion. Rehired partners must re-satisfy the one year of continuous service requirement upon return to Starbucks to be eligible for future tuition reimbursement. Prior periods of service do not count for establishing eligibility or the amount of available benefit. Request for Review of Denial If you believe an application for course approval or request for reimbursement was denied inappropriately, you may request a review for reconsideration. The request must: Be submitted to Starbucks Tuition Reimbursement Center in writing via mail or fax at (888) within 60 days of the original denial, and Include appropriate supporting documentation An initial review will be conducted by the program administrator, CAEL, and communicated to you within 30 days. If the application or request denial is upheld, you have 30 days from the date of the second denial to submit new information. You send the second request for review and the new information via fax to (888) The request must be submitted by the 15th of the month to be reviewed in that month. A final decision will be mailed to your home address, generally within 60 days of receipt of the second request for review. All decisions are final and not subject to further review. 200

204 VISION TUITION REIMBURSEMENT Approved Leave of Absence If you take an approved leave of absence, you will remain eligible to participate in the tuition reimbursement plan provided you meet the benefits eligibility and service requirements. Termination of Employment If your employment with Starbucks ends for any reason, including death, before you have received reimbursement, your reimbursement request will not be processed. To receive reimbursement, you must remain employed with Starbucks through the date your reimbursement is processed by Starbucks Payroll Department. For More Information Questions about the tuition reimbursement program should be directed to Starbucks Tuition Reimbursement Center at (888) Information is also available online by linking to the tuition reimbursement site from and viewing the page of frequently asked questions. 201

205 Rights and Responsibilities Plan Administrator 203 Rights of Participants 204 Plan Amendment or Termination 204 Disclaimer 204 Plan Information 205 Coordinating Your Benefits 207 Benefits Eligibility Request for Review 210 Benefits Claims 210 Appealing Denial of Claims 211 Recovery of Overpayment 216 Assignments 216 Subrogation 216 Plan Liability 217 Your ERISA Rights 217 Your COBRA Rights 219 Your Health Privacy Rights 227 Certificate of Prior Health Care Coverage 232 Qualified Medical Child Support Order 233 Questions?

206 VISION YOUR RIGHTS AND RESPONSIBILITIES In this chapter, you can see at a glance who serves as the administrator of each benefit, how the coverages are financially structured and what your rights and responsibilities as a plan member are under ERISA, COBRA and other laws. Effective March 1, 1987, Starbucks adopted the Starbucks Corporation Group Health and Welfare Plan, which included medical, dental, and vision coverage. Effective October 1, 1994, Starbucks adopted the Starbucks Corporation Dependent Care Reimbursement Account as part of the Starbucks Corporation Group Health and Welfare Plan. Effective October 1, 1997, the Group Health and Welfare Plan provided the following types of insured and self-insured benefits: medical benefits, including mental health, chemical dependency, and employee assistance benefits; dental benefits; vision benefits; a health care reimbursement account; a dependent care reimbursement account; optional long-term disability coverage; and optional accidental death and dismemberment coverage. For purposes of the annual report filed pursuant to ERISA, this Plan was assigned plan number 501. Effective June 1, 1987, Starbucks adopted the Starbucks Corporation Group-term Life and Disability Plan. This Plan provided the following types of insured benefits: long-term disability benefits; group-term life insurance benefits, including optional coverage for partners, spouses and domestic partners, and children. For purposes of the annual report filed pursuant to ERISA, this Plan was assigned plan number 503. Effective July 1, 1990, Starbucks adopted the Starbucks Corporation Premium Plus Plan. This Plan was a cafeteria plan that permitted partners to elect pretax salary reduction contributions to the benefit programs included in the Group Health and Welfare Plan and the Group Term Life and Disability Plan. For purposes of the annual report filed pursuant to ERISA, this Plan was assigned plan number 506. Effective October 1, 1999, Starbucks merged the Starbucks Corporation Group Term Life and Disability Plan and the Starbucks Corporation Group Health and Welfare Plan into the Starbucks Corporation Premium Plus Plan and renamed the merged plans as the Starbucks Corporation Welfare Benefits Plan (the Plan ). The Plan continues to use plan number 506 for purposes of the annual report filed pursuant to ERISA. This book serves as the legal plan document and summary plan description of the Plan. Plan Administrator Starbucks may appoint a person or committee to serve as the plan administrator. If no person or committee is appointed, then Starbucks shall serve as the plan administrator. The principal duty of the plan administrator is to see that the Plan is carried out, in accordance with its terms, for the exclusive benefit of persons entitled to participate in the Plan. The administrative duties of the plan administrator include, but are not limited to, interpreting the Plan, prescribing applicable forms and procedures, determining eligibility for and the amount of benefits, and authorizing benefit payments and gathering information necessary for administering the Plan. The plan administrator may delegate any of these administrative duties to one or more persons or entities, provided that such delegation is in writing, expressly identifies the delegate(s) and expressly describes the nature and scope of the delegated responsibility. The plan administrator may also employ and engage such persons, counsel and agents and obtain such administrative, clerical, medical, legal, audit and actuarial services as it may deem necessary in carrying out the provisions of the Plan. 203

207 VISION YOUR RIGHTS AND RESPONSIBILITIES Each participant must provide the plan administrator with such information as the plan administrator may require in connection with the administration of the Plan. All forms and other communications from any participant or other person to the plan administrator required or permitted under the Plan must be in the form prescribed from time to time by the plan administrator, must be mailed by first-class mail or delivered to the location specified by the plan administrator, and will be deemed to have been given and delivered only upon actual receipt by the plan administrator. Starbucks will bear the incidental costs of administering the Plan, to the extent they are not paid from partner contributions. Rights of Participants The adoption and maintenance of Starbucks benefits plans is not a contract of employment between Starbucks and any partner. Nothing contained in the plan documents, insurance contracts, trusts, summary plan descriptions or any other related documents gives any partner the right to remain employed by Starbucks or interferes with Starbucks right to discharge any partner at any time. Similarly, nothing in the documents described above gives Starbucks the right to require any partner to remain employed by the company or interferes with the partner s right to end employment with Starbucks at any time. Plan Amendment or Termination Starbucks or any other authorized person reserves the right to amend the Plan at any time and for any reason. In some cases, an amendment may be retroactive. Although Starbucks adopted the Plan with the intention that it is to be continued indefinitely, the company also reserves the right to terminate the Plan at any time, and for any reason. Disclaimer Except where such power and authority is given to an insurance company, the plan administrator has the power and discretionary authority to carry out its duties under the Plan, including, without limitation, the discretionary authority to construe and interpret the terms and provisions of the Plan, to decide all questions of eligibility for and the amount of benefits under the Plan, to decide all issues of fact or law, to prescribe such forms as it deems necessary or appropriate for the proper administration of the Plan, and to appoint such other persons as it deems necessary or appropriate to act on its behalf or to assist it in carrying out its duties. Any interpretation or construction of or action by the plan administrator with respect to the Plan and its administration shall be conclusive and binding on any and all affected parties and persons. With respect to health coverage administered by Aetna (medical, dental, prescription drugs, mental health, chemical dependency and Employee Assistance Program) and reimbursement accounts (health care and dependent care), Aetna, as claim fiduciary, has the discretionary authority to determine entitlement to benefits for each claim received and to construe the terms of the Plan. With respect to coverages that are insured, the insurance company has the discretionary authority to determine entitlement to benefits for each claim received and to construe the terms of the insurance contract. 204

208 VISION YOUR RIGHTS AND RESPONSIBILITIES The provisions of the Plan shall not be construed to limit a participant s choice of treatment or services. Each participant shall be solely responsible for deciding the care that he or she receives and shall make such decision independent of any determination by the Plan. Failure to enforce any provision of the Plan or group contract at any time does not mean that the right to enforce that provision at another time has been waived. The Plan shall be construed in accordance with applicable federal law and to the extent otherwise applicable, the laws of the State of Washington, except to the extent provided otherwise in the governing documents for the fully-insured coverages. If any provision of the Plan is held illegal or invalid for any reason, such determination shall not affect the remaining provisions of the Plan which shall be construed as if the illegal or invalid provision had never been included. Starbucks does not represent or guarantee that any particular federal or state income, payroll, personal property, Social Security or other tax consequences will result from participation in the Plan. A participant should consult with professional tax advisors to determine the tax consequences of participation. In the event any benefit under the Plan is payable to a person who is under legal disability or is in any way incapacitated so as to be unable to manage his or her financial affairs, the plan administrator may direct payment of such benefit to such person or to a duly appointed guardian, committee or other legal representative of such person, or in the absence of a guardian or legal representative, to a custodian for such person under a Uniform Gifts to Minors Act or to any relative of such person by blood or marriage, for such person s benefit. Any payment made in good faith pursuant to this provision shall fully discharge Starbucks and the Plan of any liability to the extent of such payment. In the event an incorrect amount is paid to or on behalf of a participant or beneficiary, any remaining payments may be adjusted to correct the error. The plan administrator may take such other action it deems necessary and equitable to correct any such error. PLAN INFORMATION Starbucks Employer Identification Number is STARBUCKS CORPORATION WELFARE BENEFITS PLAN INFORMATION Plan Number 506 Plan Year October 1 through September 30 Plan Starbucks Corporation, c/o Benefits Department Administrator 2401 Utah Avenue South, Mail Stop S-HR3, and Sponsor Seattle, WA (206) Agent for Starbucks Corporation, c/o General Counsel Service 2401 Utah Avenue South, Mail Stop S-LA1, of Legal Seattle, WA Process (206)

209 VISION YOUR RIGHTS AND RESPONSIBILITIES Plan Funding Funded from Starbucks general assets or partner contributions Paid first through partner contributions with remaining claims paid from Starbucks general assets: Medical Prescription Drugs Dental Vision Mental health/chemical dependency Employee Assistance Program Paid through insurance contract with premiums paid partially from Starbucks general assets and partially through partner contributions: Long-term disability claims are paid under an insurance contract with UnumProvident Corporation Partner group term life claims are paid under an insurance contract with Hartford Life and Accident Company Medical claims are paid under an insurance contract with Keystone Health Plan Central, HMSA and Kaiser Permanente Paid through contributions made by partners: Health care and dependent care reimbursement accounts Paid through insurance contracts and insurance premiums paid by partners: Voluntary partner group term life insurance Voluntary spouse or domestic partner group term life insurance Voluntary child group term life insurance Voluntary long-term disability Nature of Service Aetna, Inc.: Processes claims for medical, dental, prescription drugs, mental health/ chemical dependency, Employee Assistance Program, reimbursement accounts; claims fiduciary Keystone Health Plan Central: Provides medical and prescription drug insurance (York) HMSA: Provides medical and prescription drug insurance (Hawaii) Kaiser Permanente: Provides medical and prescription drug insurance (Hawaii) VSP: Processes claims for vision UnumProvident Corporation: Provides insurance and processes claims for long-term disability Hartford Life and Accident Company: Provides insurance and processes claims for partner, spouse or domestic partner and child group term life insurance and AD&D CIGNA International provides medical insurance (expatriates, international travelers) For address and phone numbers of these providers, see the Where to Get Help chapter. Paid through insurance contract with premiums paid by Starbucks: Medical claims are paid under insurance contracts with CIGNA International 206

210 VISION YOUR RIGHTS AND RESPONSIBILITIES Coordinating Your Benefits Your Starbucks benefits plans, like many other plans, have a coordination of benefits (COB) provision. Under this provision, the amount normally reimbursed under your Starbucks plan may be reduced to reflect payments made by any other plan under which you re covered. If you or your dependents are covered under more than one plan, the COB rules determine which plan pays first (primary) and which plan pays second (secondary). When Starbucks plan is primary As a general rule, if the COB rules of both plans agree that Starbucks plan is primary and the other plan is secondary, Starbucks plan will pay benefits first. After Starbucks plan has paid benefits, you must submit the claim to your secondary plan(s) to receive any additional benefits. When Starbucks plan is secondary As a general rule, if the COB rules determine that Starbucks plan is secondary, the expenses covered under Starbucks plan are reduced by the amount paid by the primary plan. In this case, you ll want to send your claim to your primary plan first. After your primary plan has paid benefits, you must submit your claim to Starbucks plan, and it will pay any additional benefits to bring the total benefit paid to the amount Starbucks plan would have paid if it were the primary plan. (If you are enrolled in the York Medical Plan, HMSA Preferred Provider Plan or Kaiser Hawaii HMO, consult your health plan s guide to benefits for coordination of benefits provisions.) In many cases, this means that Starbucks plan will pay nothing. Here are two examples. Example #1: Your spouse or domestic partner has a cavity filled for a fee of $60. He has dental coverage through his employer. Therefore that plan is primary. He is also covered as your dependent through Starbucks plan. So Starbucks is secondary coverage. PLAN COVERAGE COORDINATION-OF-BENEFIT ORDER PLAN PAYABLE Coverage under Starbucks plan: 80% of $60 = $48 Less coverage by spouse s plan: Secondary $48 Primary ($48) 80% of $60 = $48 Payable by Starbucks plan $0 207

211 VISION YOUR RIGHTS AND RESPONSIBILITIES Example #2: Your dependent child has a root canal for a fee of $650.Your child has dental coverage through your spouse s plan (primary) and Starbucks plan (secondary). PLAN COVERAGE COORDINATION-OF-BENEFIT ORDER PLAN PAYABLE Coverage under Starbucks plan: 80% of $650 = $520 Less coverage by spouse s plan: Secondary $520 Primary ($325) 50% of $650 = $325 Payable by Starbucks plan $195 No Dual Coverage Remember, if you and your spouse or domestic partner both work for Starbucks, you may not have dual coverage. In other words, you cannot be covered both as a Starbucks partner and as a dependent of your spouse s or domestic partner s plan and vice versa. If each of you is covered by Starbucks benefits as partners and not as a dependent of the other s coverage then certain rules apply. Your children can only be covered as dependents under one of your Starbucks plans not enrolled under both parents coverage. You can cover one child under one partner and another child under the other partner. How to determine which plan is primary Let s say you are covered by a Starbucks benefits plan and another group plan, such as your spouse s or domestic partner s medical plan. The COB rules listed below apply The other plan is primary if it has no coordination of benefit provision. The Starbucks plan covering you as a Starbucks partner is primary and pays benefits before the other plan covering you as a dependent. The plan covering your spouse or domestic partner as an employee is primary and pays benefits for your spouse first if the Starbucks plan covers your spouse as a dependent. Coverage for dependent children is determined as listed below. The plan of the parent whose birthday falls earlier in the year regardless of the birth year is primary and pays benefits first. If both parents have the same birthday, the plan covering one parent for a longer period of time is primary and pays benefits first. If the other plan does not have the parents birthday rule described above but instead has a rule based on parental gender, that gender rule will determine the order of benefits. 208

212 VISION YOUR RIGHTS AND RESPONSIBILITIES 5. Coverage for dependent children of parents who are separated or divorced is determined as listed below. If there is a court decree that gives both parents joint custody of the child without stating which parent is responsible for the child s health care expenses, the parents birthday rules, specified in (4) above, will determine the order of benefits. If there is a court decree making one parent financially responsible for the medical, dental or other health care expenses of the child, that parent s plan will be primary and pay benefits first. This rule supersedes the birthday rule (4) above. If there is no court decree and the parent with custody of the child has not remarried, that parent s plan is primary and pays benefits before the plan of the parent without custody. If there is no court decree and the parent with custody of the child has remarried, that parent s plan is primary and pays benefits first. The stepparent s plan is secondary and pays benefits second, if that stepparent s plan covers the child as a dependent. The benefits of the parent without custody will pay last. 6. The plan that covers you under a right of continuation pursuant to federal or state law such as COBRA is secondary and pays benefits after the plan that doesn t cover you under this kind of continuation. If the other plan doesn t have a continuation provision, then this exception does not apply. 7. The plan that covers you as an active employee, or as a dependent of an active employee, is primary and pays benefits first. The plan that covers you as a laid-off or retired employee, or as a dependent of such a person, is secondary and pays benefits second. If the other plan doesn t have a provision about laid-off or retired employees, then this exception doesn t apply. 8. If rules (1) through (7) above do not establish any order of payment, the plan that has covered you the longest is primary and will pay benefits first. Effect of Medicare Coverage will not be changed at any time when Starbucks compliance with federal law requires your Starbucks benefits for you or your dependents to be figured before benefits are figured under Medicare. For example, if you are actively working and enrolled in a Starbucks benefits plan but eligible for Medicare because of age alone, the Starbucks plan will remain primary in most circumstances. Your coverage under Starbucks plans may be changed, however, if you or a covered dependent becomes eligible for Medicare under other circumstances. A partner or dependent is eligible for Medicare if he or she: Is covered under it Is not covered under it because of having: Refused it Dropped it Failed to make proper request for it If Medicare will be primary: The total amount of regular benefits under all Starbucks plans will be figured. (This will be the amount that would be payable if there were no Medicare benefits.) If this is more than the amount Medicare 209

213 VISION VISION YOUR RIGHTS AND RESPONSIBILITIES provides for the expenses involved, Starbucks plan will pay the difference. Otherwise, Starbucks plan will pay no benefits. This will be done for each claim. Charges used to satisfy a partner s or a dependent s Medicare Part B deductible will be applied under Starbucks plan in the order received by Aetna. Two or more charges received at the same time will be applied starting with the largest first Submitting claims If your dependent is covered under another benefits plan and your Starbucks plan is secondary, you must submit your claim to the other plan first. Certain information may be requested from you in order to apply the COB rules. Usually, your Starbucks benefits will not be paid until proof of payment, such as an Explanation of Benefits (EOB), is received from the primary plan. Benefits Eligibility Request For Review If you believe that an incorrect decision has been made regarding your eligibility to enroll in, change or terminate any of Starbucks benefits available to you, you may ask the plan administrator to review the decision. You have 60 days in which to submit a request for review. Your appeal must: Be in writing, Provide specific information regarding the basis for your appeal, and Include all supporting documentation. Your written request for review must be received no later than 60 days after the date on which your benefits were affected. For example, if your benefits terminate on April 30 because you were not paid enough hours to maintain eligibility, you will have until June 29 (60 days) to submit your request for review. If you miss a deadline and your benefits are affected or enrollment denied, you will have 60 days after the deadline in which to submit your request for review. Requests that are received late may not be eligible for review. The plan administrator will provide you with written notice of its decision within 60 days of the date it receives your appeal. If special circumstances require an extension of time to review your appeal, you ll be notified of the extension within the initial 60-day review period. An extension will provide the plan administrator 60 additional days in which to respond. If, upon review, the eligibility determination you are requesting be reviewed is upheld, you ll be provided an explanation of the reason(s), as well as references to the plan provisions on which the decision is based. The decision of the plan administrator is final and is not subject to further review or appeal. Benefits Claims How to request a review of a claim Each of the various claims administrators or insurance carriers (e.g., Aetna or UnumProvident) has different procedures in place for requesting a review of a benefit determination. These procedures are described in the applicable section of this book, or may be set forth in the Explanation of Benefits issued by the administrator or carrier. 210

214 VISION YOUR RIGHTS AND RESPONSIBILITIES If you submit a claim that is denied and you believe the denial was made in error, first contact the administrator or carrier directly, and follow its specific procedures on how to request a review of a benefit determination. If you have followed the third-party administrator or insurance carrier s procedures for benefit review and believe the result is incorrect, you may file a written appeal as outlined in the section that follows. Appealing Denial of Claims When a claim is denied in whole or in part If a claim for benefits is wholly or partially denied, notice of the decision shall be furnished to the partner, or in the case of partner life insurance or long-term disability survivor benefits, to the beneficiary. Notice of determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. This written decision will: Give the specific reason or reasons for the claim determination, Make specific reference to plan or policy provisions on which the determination is based, Provide a description of any additional material or information necessary to complete the claim and an explanation of why it is necessary, Provide an explanation of the review procedure including time limits for appealing the determination, and your right to obtain information about those procedures and the right to sue in federal court, and Disclose any internal rule, guidelines, protocol or similar criterion relied on in making the claim determination (or state that such information will be provided free of charge upon request). You have the right to file a written appeal. During the appeal process, you will have the opportunity to submit written comments, documents or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the initial claim determination will consider all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. If your appeal is denied If, upon appeal, your request is denied, the denial will contain the following information: The specific reason(s) for the appeal determination, A reference to the specific plan provision(s) on which the determination is based, A statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request), A statement describing your right to bring a civil suit under federal law, and A statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination. 211

215 VISION YOUR RIGHTS AND RESPONSIBILITIES Your denial may also contain a statement that, You or 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 and your State insurance regulatory agency. Time frames for submitting your appeal The time frames for filing your written appeal and for the plans, insurance carriers or claims administrators consideration and response are outlined below by benefit. Who Is Your Authorized Representative? An authorized representative means a person you authorize, in writing, to act on your behalf or a person given authority by court order 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 always act as your authorized representative. Filing a health claim appeal (medical, prescription drug, dental, vision, mental health, chemical dependency) The following pertains to Starbucks self-insured health plans administered though Aetna and VSP. If you are enrolled in a Keystone Health Plan Central, HMSA, or Kaiser Permanente health plan, refer to your health provider s guide to benefits for health claim appeal procedures. You (or your authorized representative acting on your behalf) have 180 days following receipt of an adverse benefit determination to file a written appeal. CLAIMS APPEALS FOR Medical claims, mental health and chemical dependency claims Prescription drug claims Dental claims Vision claims SHOULD BE SENT TO Aetna, Inc. Starbucks Partner Services, Attn: Appeals P.O. Box Lexington, KY Aetna, Inc. Starbucks Partner Services, Attn: Appeals P.O. Box Lexington, KY VSP Member Appeals 3333 Quality Drive Rancho Cordova, CA If the claim involves urgent care, you or your authorized representative may request an expedited review of the claim denial by calling the plan s Member Services number as shown on the next page: 212

216 VISION YOUR RIGHTS AND RESPONSIBILITIES PLAN ADMINISTRATION COVERAGE TYPE PHONE NUMBER Aetna, Inc. Medical, prescription drug, mental health, chemical dependency (888) Aetna, Inc. Dental (888) VSP Vision (800) All necessary information, including the appeal decisions, will be communicated between you and your authorized representative and the plan by telephone, facsimile or other similar method. You or your authorized representative may appeal urgent care claim denials either orally or in writing. All necessary information, including the appeal decision, will be communicated between you or your authorized representative 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. If you are dissatisfied with the appeal decision on a claim involving urgent care, you can file a second level appeal with Aetna. You will be notified of the decision not later than 36 hours after the appeal is received. What Is Urgent Care? Urgent care is defined as a sudden illness, injury, or condition that: Is severe enough to require prompt medical attention to avoid serious deterioration of the covered person s health, Includes a condition that would subject the covered person to severe pain that could not be adequately managed without urgent care or treatment, Does not require the level of care provided in the emergency room of a hospital, and Requires immediate outpatient medical care that cannot be postponed until the covered person s physician becomes reasonably available. For all other denials, you will be notified of the appeal decision not later than: For services requiring precertification or preauthorization (pre-service claims), 15 days after the request for review is received For services already delivered to the patient (post-service claims), 30 days after the request for review is received Second level claims appeal If you are not satisfied with an appeal decision, you can file a second level appeal within 60 days of receipt of the level one appeal decision. You will be notified of the decision no later than 15 days for pre-service claims or 30 days for post-service claims after the appeal is received. Please note: If your claim involves urgent care, you will be notified of the decision not later than 36 hours after the appeal is received. 213

217 VISION YOUR RIGHTS AND RESPONSIBILITIES External review for Aetna claims denied based on lack of medical necessity, or claims for services deemed experimental or investigational You can, at your option, obtain an external review of a claim denied by Aetna when: You have exhausted the appeal process for denied claims as outlined above, and you have received a final denial, The final decision was based upon Aetna s determination that the proposed or rendered service or supply is not medically necessary or is experimental or investigational, and The cost of the service or treatment at issue, for which you are financially responsible, exceeds $500. What Is External Review? An external review is a review by a neutral independent physician with the appropriate expertise in the area at issue, of claim denials based upon lack of medical necessity, or the experimental or investigational nature of a proposed service or treatment. If you meet the eligibility requirements listed above, you will receive written notice of your right to request an external review at the time the final decision on your appeal has been rendered. Either you or your authorized representative will be required to submit to Aetna the request for External Review, subject to verification procedures that the Plan may establish. Your request for external review must be submitted to Aetna, in writing, within 60 calendar days after you receive the final determination on your appeal. Upon receipt of your request, Aetna will contact an independent review organization (IRO), which will then select an independent physician with appropriate expertise in the area at issue. The independent physician may consider any appropriate credible information submitted by you with the request, and must follow the plan s contractual documents and plan criteria governing the benefits. You will generally be notified of the external review decision within 30 days of your request. The notice will state whether the prior Aetna determination was upheld or reversed, and briefly explain the basis for the determination. The decision of the external reviewer will be binding on Aetna, Starbucks and the Plan. An expedited review is available when your treating physician certifies that a delay (i.e., waiting a full 30 days) in receipt of the service or treatment would jeopardize your health. You are responsible for the cost of compiling and sending the information that you wish to be reviewed by the IRO to Aetna. Aetna is responsible for the cost of sending the information to the IRO and the professional fee charged by the IRO. Filing a life or accidental dismemberment insurance claim appeal You, your authorized representative or your beneficiary has 60 days from your receipt of Hartford Life s adverse determination of a life or accidental dismemberment claim to file a written appeal. Your appeal should be sent to Hartford Life at the address provided in Hartford Life s notice. 214

218 VISION YOUR RIGHTS AND RESPONSIBILITIES A decision will be made by Hartford Life no more than 60 days after receipt of the request for review, except in special circumstances (such as the need to hold a hearing), but in no case more than 120 days after the request for review is received. Hartford s written decision will include specific reasons for their decision and specific references to the plan provisions on which the decision is based. Filing a long-term disability claim appeal You or your beneficiary (in the case of a survivor benefit) has 180 days from your receipt of UnumProvident s notice of adverse benefit determination to file a written appeal. Your appeal request should be sent to the address provided in UnumProvident s notice. The review will be conducted by UnumProvident and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker s subordinate. In the case of a claim denied on the grounds of a medical judgment. UnumProvident will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the plan in connection with the denial of your claim, UnumProvident will provide you with the names of such expert, regardless of whether the advice was relied upon. A decision will be made by UnumProvident no more than 45 days after receipt of your request for review, except in special circumstances. If special circumstances require an extension of time to decide your appeal, UnumProvident may extend the review period by an additional 45 days (90 days in total). We will notify you in writing if an additional 45 day extension is needed. If an extension is needed because you failed to submit the information necessary to decide the appeal, the extension notice will specifically describe the required information and you will have at least 45 days from receipt of the notice to provide it. If you submit the required information within the extension period, UnumProvident will have 45 days from receipt of your information to decide your appeal. If you do not provide the information requested by UnumProvident within the time specified, UnumProvident may decide your appeal without that information. You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U. S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. A notice that your request on appeal is denied will contain the following information: (a) the specific reason(s) for the appeal determination, (b) a reference to the specific Plan provision(s) on which the determination is based, (c) a statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request), (d) a statement describing your right to bring a civil suit under federal law, 215

219 VISION YOUR RIGHTS AND RESPONSIBILITIES (e) a statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination, and (f) a statement that You or 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 and your State insurance regulatory agency. Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim. Requesting a reconsideration of a health care and dependent care reimbursement claim You have 180 days from receipt of Aetna s benefit determination to request a reconsideration of a reimbursement claim. Your request should be sent to: Aetna FSA P.O. Box 4000 Richmond, KY Aetna will make a decision within 30 days after receipt of your request for review. Recovery of Overpayment If a benefit payment exceeds the amount you are entitled to receive, the plan has the right to require the return of the overpayment on request. Or, the plan may reduce any future benefit payments by the amount of the overpayment. Assignments In general, you cannot voluntarily assign your benefit payments under Starbucks benefits plans to anyone other than your health care providers. This prevents garnishments, attachments and voluntary or involuntary assignments for the benefit of creditors. Subrogation If you or your enrolled dependents have health care expenses or disability income due to an injury or sickness caused by a third party, your Starbucks benefits plans have certain rights for the recovery of benefits from you or that third party. In this way, the Starbucks plan is protected from paying benefits for a sickness or injury caused by another person or persons. Starbucks plan has the right of subrogation to all rights of recovery by you or your enrolled dependents against: A third party Your insurance carrier if there s a claim under the uninsured or underinsured auto coverage provision of an auto insurance policy 216

220 VISION YOUR RIGHTS AND RESPONSIBILITIES The plan has the right to be reimbursed for the amounts it has paid for health care expenses or disability income due to an injury or sickness caused by another party or persons from any amounts you receive by judgment, settlement or otherwise from: A third party Your insurance carrier Any other person or entity, including the auto insurance carrier who provides your uninsured or underinsured auto insurance coverage You or your enrolled dependents or a person authorized by law to represent you if you are not legally capable must sign and deliver any documents that are required, and do whatever else is necessary or reasonably requested by Starbucks to follow through on the plan s rights of subrogation as described above. The Plan s right to recover from you any amounts received by judgment, settlement or otherwise means that the Plan has a first priority lien to recover from the judgment, settlement or otherwise and all such amounts shall be presumed to be for the recovery of medical expenses. The Plan s first priority lien will apply regardless of whether you or your enrolled dependents are or were made whole from the judgment, settlement or otherwise, whether before or after the Plan s subrogation recovery. The Plan precludes the operation of the made-whole and common fund doctrines. Plan Liability Your Starbucks benefits plans will pay benefits only for expenses incurred while this coverage is in force. Except as described in any extended benefits provision, no benefits are payable for expenses incurred before your coverage has started or after your coverage has ended even if the expenses were incurred as a result of an accident, injury or death that occurred, began or existed while coverage was in force. An expense for a service or supply is incurred on the date the service or supply is furnished. When a single charge is made for a series of services, each service will bear a pro-rata share of the expense. Aetna (for medical, dental, prescription drug, mental health and chemical dependency claims) will determine the prorata share. Only that pro-rata share of the expense will be considered to have been an expense incurred on the date of such service. Your ERISA Rights As a participant in certain benefits plans, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended ( ERISA ). ERISA provides that 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 worksites and union halls 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. Upon written request to the plan administrator, obtain copies of all documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and other plan information. The administrator may make a reasonable charge for the copies. 217

221 VISION YOUR RIGHTS AND RESPONSIBILITIES Receive a summary of the plan s annual financial reports. The plan administrator is required by law to provide each participant with a copy of this summary annual report. Receive a copy of the procedures used by the plan for determining a Qualified Medical Child Support Order (QMCSO). Prudent action by plan fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of your benefits plans. The people who operate your plans, called fiduciaries of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. Discrimination No one, including Starbucks or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining any plan benefit or exercising your rights under ERISA. Enforce your rights 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 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 example, if you request materials 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 plan administrator s control. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the plan s decision or lack thereof concerning the status of a Medical Child Support Order, you may file suit in federal court. If it should happen that plan fiduciaries misuse the plan s 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 that your claim is frivolous. Questions? If you have any questions about your plans, you should contact the appropriate 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 Employee Benefits Security Administration, U.S. Department of Labor, toll-free at (866) 444-EBSA (3272), or The Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C

222 VISION YOUR RIGHTS AND RESPONSIBILITIES You can also obtain certain publications about your rights and responsibilities under ERISA by calling the Employee Benefits Security Administration toll-free at (866) 444-EBSA (3272). You can also find additional information about your rights under ERISA and other important information by visiting the Employee Benefits Security Administration website at Your COBRA Rights If you or your enrolled dependents are no longer eligible for Starbucks group health plan coverage (including your medical, dental, vision, mental health, chemical dependency or health care reimbursement benefits), you may be eligible to continue your group health plan coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).You pay for the cost of COBRA coverage entirely, plus a small administrative fee. You can receive group health plan benefits for up to 18 or 29 months after you lose coverage, and your enrolled dependents can receive benefits for up to 18, 29 or 36 months. Eligibility You and your enrolled dependents may choose to continue your Starbucks group health plan coverage under COBRA, depending on the circumstances under which you lose coverage. To be eligible for COBRA coverage, you or your dependents must be covered under Starbucks group health plans on the date you lose eligibility for that coverage. You don t need to provide evidence of good health to elect COBRA coverage. You As a Starbucks partner covered by the group health plans, you have a right to elect COBRA coverage if you lose your coverage due to one of the reasons, called qualifying events, listed below. You terminate employment with Starbucks. Your work hours are reduced. You were contributing to a health care reimbursement account and move to a position that is not eligible for reimbursement accounts. In this case, you will be able to continue participation in a health care reimbursement account through COBRA. COBRA coverage may not be available if you are terminated for gross misconduct, including theft. Military Leave If you take military leave, you may elect to continue coverage as mandated by the Uniformed Services Employment and Reemployment Rights Act of 1994 ( USERRA ). Generally, the procedures for electing, paying for and receiving continuation coverage under USERRA are similar to continuation coverage under COBRA. For more information on military leave and how it may affect your benefit coverage refer to the Eligibility and Enrollment chapter. 219

223 VISION YOUR RIGHTS AND RESPONSIBILITIES Your spouse or domestic partner Your spouse or domestic partner is eligible to continue health care coverage under COBRA if they lose coverage due to any of the qualifying events listed below. You terminate employment with Starbucks. Your work hours are reduced. You are divorced or legally separated, or you end a domestic partner relationship. You become entitled to Medicare benefits. You die. Again, COBRA coverage is not available to your spouse or domestic partner if you are terminated for gross misconduct, including theft. If you and your spouse or domestic partner both work for Starbucks, and one of you loses group health plan coverage, only the partner who loses group health plan coverage along with any dependent children who lose coverage because of the event is eligible for COBRA coverage. Your dependent children Your children may be eligible for COBRA coverage if they lose group health plan coverage due to any of the qualifying events listed below. You terminate employment with Starbucks. Your work hours are reduced. You are divorced or legally separated, or you end a domestic partner relationship. You become entitled to Medicare benefits. You die. Your children may also be eligible for COBRA coverage if they no longer qualify as a dependent child under Starbucks group health plans due to any of the circumstances listed below. They reach age 19, unless a full-time student and you have certified their student status. They reach age 23, even as a full-time student. They get married. They are under the custody of your spouse or domestic partner after a divorce or legal separation, unless you are ordered by a court to continue coverage. COBRA coverage is not available to your dependent children if you are terminated for gross misconduct, including theft. If your child s group health plan was provided because of a Qualified Medical Child Support Order (QMCSO), and coverage ends because it is no longer required under the order, contact Starbucks Benefits Center at (877) SBUXBEN to find out whether your child is eligible for COBRA coverage. 220

224 VISION YOUR RIGHTS AND RESPONSIBILITIES Are Addresses Up to Date? Make sure Starbucks has your current address on file, as well as the addresses of your covered dependents if different from yours. If your covered dependent loses eligibility, we need to know where to send a COBRA Notification Letter so your dependent knows his or her available options. It is your responsibility to ensure current addresses are on file for you and your covered dependents. Contact Starbucks Benefits Center at (877) SBUXBEN with any address change information. COBRA notification and enrollment By law, Starbucks is responsible for notifying you or your dependents if you or they lose group health plan coverage due to any of the reasons listed below. You terminate employment with Starbucks. Your work hours are reduced. You become entitled to Medicare benefits. You die. However, you, your spouse or domestic partner, or your dependent child must provide notice to Starbucks Benefits Center at (877) SBUXBEN within 60 days after the qualifying event when your enrolled dependents have lost group health plan coverage due to any of the qualifying events listed below. You divorce or legally separate or you end a domestic partner relationship. Your child no longer qualifies as a dependent child under Starbucks health care plans. Starbucks does not track the marital, student or dependent status or the ages of your children. We will not contact you when your child no longer qualifies for coverage. If you or your dependent fails to notify Starbucks within 60 days after the qualifying event or, if later, within 60 days after the date coverage is lost, COBRA continuation is not available. If you cancel your spouse or domestic partner s coverage in anticipation of a divorce or end of a domestic partnership, your spouse or domestic partner will still be eligible for continuation coverage, provided you or your spouse or domestic partner notifies Starbucks Benefits Center within 60 days of the date of divorce. After you or Starbucks receive notification of the loss of health care coverage, you ll receive a COBRA Enrollment Form to elect to continue your group health plan coverage. Enrollment If you choose to enroll for COBRA, you or your dependents have 60 days to fill out and return a COBRA Enrollment Form to Aetna. The 60-day time frame begins on the day that you receive the COBRA notification letter or the date on which coverage is lost, whichever is later. If Aetna does not receive the COBRA Enrollment Form within the 60-day time frame, Starbucks group health plan coverage for you and/or your dependents will end and COBRA coverage will not be available. 221

225 VISION YOUR RIGHTS AND RESPONSIBILITIES What Is a COBRA Date? Your COBRA date is the last day of the month in which you qualify for regular Starbucks group health plan coverage. After this date, you ll stop receiving Starbucks coverage and may elect to continue coverage through COBRA, where you pay the entire cost of coverage. A COBRA date may be the last day of the month: In which your termination of employment with Starbucks is recorded Following the period in which your paid hours are reduced to below eligibility levels for Starbucks benefits coverage In which you and your spouse or domestic partner divorce or legally separate Before you become entitled to Medicare benefits In which you die In which your child no longer qualifies as a dependent child under Starbucks group health plan For example, if your last day of work before leaving Starbucks is September 3, your COBRA date is September 30. Coverage you may continue under COBRA If you or your dependents lose group health plan coverage and want to continue it under COBRA, you may elect coverage that is equal to or less than the coverage you had before you became eligible for COBRA coverage. You have two choices to continue group health plan coverage. You may elect to continue the same group health plan coverage you are currently enrolled in. You may elect to continue some, but not all, of the group health plan coverage you are currently enrolled in. For example, you may elect to continue only the medical portion of your group health plan coverage. Or, if you have other medical coverage, you may only want to continue your dental coverage. Each person eligible for COBRA coverage you, your spouse or domestic partner or child may make a separate election to continue coverage or not. Each person chooses which coverage to continue and for how long. Health care reimbursement account continuation under COBRA With the health care reimbursement account (HCRA), you elect to pay for your noncovered eligible health care expenses for you and your eligible dependents (if any) with before-tax dollars. You and your enrolled dependents may continue HCRA participation with after-tax dollars until the end of the plan year (September 30) in which your COBRA qualifying event occurs. However, COBRA continuation of HCRA is not available if, as of the date of your COBRA qualifying event, you have been reimbursed from your HCRA more than you have contributed. For example, let s say you elected $2,000 for your HCRA for the year. If, as of your qualifying event you had received reimbursements totaling $1,000, but you had contributed only $450, then COBRA continuation is not available. This is because you would owe $1,550 in COBRA premiums to maintain your remaining $1,000 benefit. 222

226 VISION YOUR RIGHTS AND RESPONSIBILITIES Dual coverage If you or your enrolled dependents have coverage under another group health plan on the COBRA date, you may still elect COBRA. Impact of electing COBRA on other rights In considering whether to elect continuation coverage, you should take into account that a failure to continue your group health plan coverage will affect your future rights under federal law. First, you may lose the right to avoid having pre-existing condition exclusions applied to you by other group health plans if you have more than a 63-day gap in group health plan coverage; election of continuation coverage may reduce the likelihood that you would incur such a gap. Second, you will lose the guaranteed right to purchase individual health insurance policies that do not impose such pre-existing condition exclusions if you do not receive continuation coverage for the maximum time available to you. Finally, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse s employer) within 30 days after your group health plan coverage ends. You will also have the same special enrollment right at the end of continuation coverage if you receive continuation coverage for the maximum time available to you. When COBRA coverage begins COBRA coverage starts on the day after the COBRA date. If you receive your COBRA Enrollment Form after the COBRA date, your COBRA coverage will be retroactive to the day after the COBRA date provided Aetna receives your enrollment form and payment by the deadlines outlined in this section. Aetna administers COBRA enrollment and premium collection for all Starbucks health plans, including Keystone Health Plan Central, HMSA, Kaiser Permanente and Vision Services Plan. Consider COBRA If you need group health plan coverage after losing your Starbucks coverage, make sure you send your COBRA Enrollment Form to Aetna within 60 days of either the COBRA date or when you receive your COBRA Notification Letter from Starbucks, whichever is later. Duration of COBRA coverage You may enroll in COBRA coverage for up to 18 or 29 months depending on your situation. Your enrolled dependents spouse, domestic partner or children may enroll for up to 18, 29 or 36 months, depending on your situation. Your COBRA coverage may end however, prior to 18, 29 or 36 months as outlined on page months You and your enrolled dependents may continue group health plan coverage under COBRA for up to 18 months if you lose Starbucks group health plan coverage for one of the reasons listed below. You terminate employment with Starbucks. Your working hours are reduced. 223

227 VISION YOUR RIGHTS AND RESPONSIBILITIES 29 months You and your enrolled dependents may continue COBRA coverage for up to 29 months 11 months beyond the initial 18-month coverage period if any covered family member electing COBRA is disabled on the COBRA date, or becomes disabled during the 60 days following the COBRA date. The disabled person must meet the Social Security definition of disability as described under Title II or XVI of the Social Security Act. You must provide proof of the disability to Aetna within 60 days of obtaining Social Security s verification and before the end of the initial 18-month COBRA period. You must pay higher rates for the additional 11 months of COBRA coverage 150% of the total cost. COBRA coverage will end on the earlier of these two dates: The end of the month in which you are no longer disabled (beyond the 18-month coverage period) The end of the 11-month additional COBRA period (29-month total COBRA period) 36 months Your enrolled dependents may receive up to 36 months of COBRA coverage if one of the following situations occurs during their initial 18 months of COBRA coverage, or if you lost Starbucks benefits eligibility due to one of the situations listed below. You divorce, legally separate or end your domestic partner relationship. You become entitled to Medicare benefits. You die. Your child no longer qualifies as a dependent child under Starbucks group health plans. Only your affected dependents may elect to extend their COBRA coverage, after the original COBRA date, up to 36 months due to a second qualifying event. Please contact Aetna at (800) within 60 days of the second event, if it is a legal divorce or a child no longer qualifying as a dependent. Cost of COBRA coverage If you or your enrolled dependents elect COBRA coverage, you must pay the full cost of the group health plan coverage, including what Starbucks paid while you were eligible for benefits or actively employed. Your cost for COBRA is 102% of the total cost. The additional 2% covers the cost to administer COBRA coverage. If you are disabled and elect to continue COBRA for 29 months, you ll pay an increased premium after the 18th month of coverage. This increased premium is 150% of the total cost. For more information on COBRA coverage during a disability, refer to 29 months above. A new COBRA premium rate is determined each October 1 and will be included in your COBRA Notification Letter. Or, you can call Starbucks Benefits Center at (877) SBUXBEN to find out the current COBRA premium rates. You pay your COBRA premiums on a monthly basis. The monthly premiums start on the first day of the month in which COBRA coverage starts. 224

228 VISION YOUR RIGHTS AND RESPONSIBILITIES When COBRA premiums are due After you or your enrolled dependents have enrolled in COBRA coverage, you have 45 days to send in your first COBRA premium. This payment must include any COBRA premiums retroactive to your COBRA date the date you lost Starbucks health care coverage. Here s an example of how it works. Your COBRA date was January 31. You enrolled in COBRA continuation of coverage by March 12. You must pay your COBRA premium by April 27, or 45 days after you enrolled. Your first payment must include premiums for both February and March the retroactive months and April, the current month. COBRA coverage will not begin until Aetna receives your premiums. Once Aetna has received your enrollment information, they ll bill you on a monthly basis for future COBRA premiums. Your premium payments are due by the first day of each coverage month. You are granted a 30-day grace period. Aetna will not accept payments postmarked after the 30-day grace period has expired. Here s an example of how it works. Your premium for the month of April is due by April 1. Your 30-day grace period extends through April 30. Aetna will not accept payments postmarked after April 30. Your COBRA coverage ends retroactively on March 31. What if I Get Sick Before I Receive a COBRA Enrollment Form? If you receive your COBRA Enrollment Form after the COBRA date, but you or your dependents need to see a doctor before then, go ahead. Your COBRA coverage is retroactive to the day after the COBRA date, provided that Aetna receives your enrollment form and payment by the deadlines outlined in this section. When COBRA coverage ends If you or your enrolled dependents elect COBRA coverage, your group health plan coverage will continue for the 18-month, 29-month or 36-month period described in the previous section. However, COBRA coverage will end for you or your enrolled dependents even before the full COBRA coverage period as soon as any circumstance listed below occurs. You resume coverage under Starbucks benefits plans because you re-establish eligibility under the plans. You stop making timely payments of your monthly COBRA premiums. 225

229 VISION YOUR RIGHTS AND RESPONSIBILITIES You or your dependents obtain coverage under another group health plan that doesn t have any pre-existing condition limitations affecting you or your enrolled dependents. You or your dependents become entitled to Medicare benefits. Starbucks no longer offers group health plan coverage. For example, if you terminate employment with Starbucks, start working for another company and become covered under that company s group health plan with no pre-existing condition limitation affecting you your COBRA coverage under the Starbucks plan will end on the first day of the month following the date your group health plan coverage starts with the other company. See Certificate of Prior Health Care Coverage on page 232 for information on how your Starbucks coverage may offset any pre-existing condition limitations. You must inform us if you or your dependents obtain coverage under another group health plan. Conversion option When COBRA coverage ends, you and your enrolled dependents may convert your medical coverage to an individual medical policy with: Aetna, if enrolled in an Aetna plan Keystone Health Plan Central, if enrolled in the York Medical plan HMSA, if enrolled in the HMSA Preferred Provider Plan Kaiser Permanente, if enrolled in the Kaiser Hawaii HMO You should know that the coverage and rates of an individual medical policy are significantly different than what may be available through Starbucks plans and COBRA coverage. Dental and vision conversion is not available. If you ve participated in COBRA for the 18-month or 36-month maximum, you ll receive a notification of your conversion rights. You must apply for the medical conversion policy in writing within 31 days to Aetna or within 30 days to Keystone Health Plan Central, HMSA or Kaiser Permanente after your COBRA coverage has ended. Changes in COBRA coverage If Starbucks changes its group health plan coverage for example, by increasing deductibles or no longer reimbursing a certain type of expense COBRA coverage will also change at the same time. In some cases, if you are receiving COBRA coverage, you may be required to switch to another form of group health plan coverage. And, as your COBRA coverage changes, your COBRA premiums may change to reflect the cost of your group health plan coverage. Starbucks reserves the right to change the terms and conditions of its group health plans and COBRA coverage at any time, subject to applicable legal requirements. Starbucks also reserves the right to terminate COBRA coverage at any time and for any reason, to the extent permitted by law. Annual open enrollment At each annual open enrollment for active partners, each person receiving COBRA coverage may elect to change coverage. In addition, each dependent whose coverage started on the COBRA date has the same change options at open enrollment as active partners. Your enrolled dependents can make different coverage choices from you and your other enrolled dependents. 226

230 VISION YOUR RIGHTS AND RESPONSIBILITIES All changes at open enrollment are subject to the same terms and conditions that apply for active partners. If Starbucks changes the options available at open enrollment, the new options will be explained in the open enrollment materials. If you or your covered dependent marries, enters into a domestic partner relationship or has a child while covered under COBRA, the new dependent may enroll as a spouse, domestic partner or child under the same special enrollment terms and conditions as active partners eligible for Starbucks benefits. Coverage for newly acquired dependents continues under the same terms and conditions as the covered person. However, the maximum COBRA coverage period for such new enrollees may not extend beyond the end of the original covered person s maximum COBRA period. Additionally, the newly added dependent will not be able to make a separate election in a subsequent annual open enrollment. In the case of a new COBRA enrollee who is either a newborn or newly adopted child, the COBRA coverage period will be 18 months, or 36 months if a second qualifying event occurs within their first 18 months of COBRA coverage. Your Health Privacy Rights 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. Introduction The Health Insurance Portability and Accountability Act (HIPAA) requires a health plan to notify plan participants and beneficiaries of its practices to protect the confidentiality of their health information. This notice describes the ways self-insured health benefits within the Starbucks Corporation Welfare Benefits Plan (the Health Program ) may use and disclose health information about you and your rights to review and control disclosure of this information. The Health Plan needs to create, receive, maintain and disclose records that contain health information about you and your enrolled family members to administer its plan and provide you with health care benefits (e.g., medical, prescription drug, dental, vision, health care reimbursement account). The Health Plan is required by law to maintain the privacy of your health information, to provide you with notice of its legal duties and privacy practices with respect to health information and to follow this notice. To help protect the privacy of your health information, Starbucks, as the sponsor of the Health Plan, has appointed a Health Privacy Official and developed privacy policies and procedures. Our Health Privacy Official has authority to enforce the health privacy policy at Starbucks. The Health Plan is required to: Protect the privacy of certain health information, and Provide you with notice describing its legal duties, your legal rights and its privacy practices with respect to your health information. 227

231 VISION YOUR RIGHTS AND RESPONSIBILITIES This notice is intended to satisfy the notice requirements under the Health Insurance Portability and Accountability Act (HIPAA) with respect to health information created, received or maintained by the Health Plan. What s included in this notice The notice outlines how the Health Plan may use or disclose your health information and your rights with respect to your health information. For example, the Health Plan uses your information to facilitate payment of health services. You have certain rights, such as the right to review your health information and suggest correction of any errors. Use and disclosure The following are the different ways the Health Plan may use and disclose your health information. Most of these disclosures are not made to or from Starbucks, but to and from your health care providers and the Health Plan s third-party administrators who facilitate payment and other health care operations (e.g., Aetna and others). Not every use or disclosure in a category is listed, but the ways in which the Health Plan is permitted to use and disclose information falls within one of the categories. For treatment. Your health information may be disclosed to health care providers including doctors, nurses, laboratory technicians, medical students and other health care personnel involved in your treatment. For example, the Health Plan may disclose your prescription medication information to a pharmacy to identify potential adverse drug reactions. For payment. Your health information may be disclosed so claims for health care treatment, services and supplies you receive from health care providers may be paid according to the Health Plan s terms. For example, the Health Plan may receive and maintain information about surgery you received to allow the Health Plan to process a hospital s claim for reimbursement of surgical expenses resulting from your surgery. For health care operations. The Health Plan may use and disclose your health information to enable it to operate more efficiently or verify that all of the Health Plan s participants receive their health benefits. For example, the Health Plan may use your health information for patient care management or to perform population-based studies designed to manage health care costs. In addition, the Health Plan may use or disclose your health information to conduct compliance reviews, audits, actuarial studies and/or for fraud and abuse detection. The Health Plan may also combine health information about many Health Plan participants and disclose it to Starbucks in summary fashion so that it can decide what coverages the Health Plan should provide. To Starbucks as plan sponsor. The Health Plan may disclose your health information to designated Starbucks partners so they can carry out their Health Plan-related administrative functions, including the uses and disclosures described in this notice. Such disclosures are to designated members of the Health Privacy Office, who are required to safeguard your health information. To a business associate. Certain services are provided to the Health Plan by third party administrators and other third parties known as business associates. For example, the Health Plan may enter information about your health care treatment into an electronic claims processing system maintained by the Health Plan s business associate so your claim may be paid. In doing so, the Health Plan will disclose your health information to its business associate so it can perform its claims payment function. However, the Health Plan will require its business associates, through contract, to appropriately safeguard your health information. 228

232 VISION YOUR RIGHTS AND RESPONSIBILITIES As required by law. The Health Plan will disclose your health information when required to do so by federal, state or local law, including those that require the reporting of certain types of wounds or physical injuries. Treatment alternatives and health-related benefits and services. The Health Plan may use and disclose your health information to tell you about possible treatment options or alternatives and health-related benefits and services that may be of interest to you. Individuals involved in your care or payment of your care. The Health Plan may disclose your health information to a close friend or family member involved in or who helps pay for your health care. The Health Plan may also advise a family member or close friend about your condition, your location (for example, that you are in a hospital) or your death. Other use and disclosure situations The Health Plan may also use or disclose your health information in accordance with the law: To facilitate organ or tissue donation or transplantation, if you are an organ or tissue donor To the military command authorities if you are a member of the armed forces and the information is deemed necessary To workers compensation carriers to the extent necessary to comply with workers compensation laws To public health agencies for public health activities (for example, to avert a serious threat to health or safety; to prevent or control disease, injury or disability; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and to report reactions to medications or problems with products) For law enforcement purposes (for example, to identify or locate a suspect, material witness or missing person) To coroners, medical examiners or funeral directors (for example, to identify a person or cause of death) For national security and intelligence agencies (for example, for intelligence, counterintelligence and other national security activities authorized by law, and to enable them to provide protection to certain individuals or conduct special investigations) To correctional institutions or law enforcement officials if the person is in custody To a health oversight agency for audits, investigations, inspections and licensure needed for the government to monitor the health care system To law enforcement officials about victims of abuse, neglect or domestic violence For judicial and administrative proceedings (such as to respond to court orders or subpoenas) For research purposes in limited circumstances For other uses and disclosures that are outside of the categories described in this notice, but only with your written authorization. Generally, if you authorize the plan to use or disclose your health information, you may revoke the authorization, in writing, at any time. 229

233 VISION YOUR RIGHTS AND RESPONSIBILITIES Your rights You have rights with regard to your health information. If you wish to exercise any of the following rights, please contact Starbucks Benefits Department and Health Privacy Office at (888) 796-JAVA, ext Specifically, you have the right to: Inspect and copy your health information. To review your health information that is in the possession or under the control of the Health Plan, and to obtain a copy of such information, you must make your request in writing and pay a reasonable fee for the copies. In certain circumstances, the Health Plan may deny your request to review your health information. Request to amend your health information. If you believe your health information is incorrect or incomplete, you may ask the Health Plan to amend the information if it is information that is kept by or for the Health Plan. In certain situations, the Health Plan may deny your request to amend your health information. Receive a record of disclosures of your health information. You have the right to request an accounting of certain disclosures of your health information, but the request cannot include dates before April 14, Restrict disclosure of your health information. You have the right to request a restriction or limitation on how the Health Plan uses or discloses your health information for treatment, payment, health care operations or to those involved in your care or payment for your care. For example, you could ask that the Health Plan not use or disclose information about a specific surgery that you had. Note: The Health Plan is not required to agree to your request. Request confidential communications. You have the right to request that the Health Plan communicate with you about health matters in a certain way or at a certain location. For example, you can request that the Health Plan only contact you by mail. The Health Plan will accommodate your reasonable requests. Obtain a copy of this notice. You have the right to obtain a paper copy of this notice upon request. File a complaint. If you believe your privacy rights have been violated, you may complain to Starbucks by contacting Starbucks Benefits Department and Health Privacy Office at (888) 796-JAVA, ext , or by writing to Starbucks Health Privacy Office, Starbucks Corporation, Mailstop S-HR3, P.O. Box 34067, Seattle, WA You may also file a complaint with the Federal Department of Health and Human Services. The Health Privacy Official will assist you. We will not retaliate against you for filing such a complaint. Changes to this notice The Health Plan reserves the right to change the privacy practices described in this notice, in accordance with the law. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, you will receive a revised notice mailed to your home address. Until such time, the Health Plan will comply with this notice. Specially protected health information Federal and state law may impose additional privacy and confidentiality restrictions on the use and disclosure of mental health, AIDS/HIV, drug addiction, alcoholism, and other chemical depenency treatment, developmental disabilities and/or genetic information and records. 230

234 VISION YOUR RIGHTS AND RESPONSIBILITIES Contact information If you have questions, please call Starbucks Benefits Department and Health Privacy Office, at (888) 796-JAVA, ext , or write the Health Privacy Office at Starbucks Corporation, Attn: Health Privacy Office, Mailstop S-HR3, P.O. Box 34067, Seattle, WA Representations Starbucks will not use or further disclose protected health information (PHI) received from the Health Program other than as permitted or required by the above notice. Further, Starbucks will: Ensure that any agent, including a business associate or subcontractor, to whom it provides PHI received from the Health Program agrees to the same restrictions and conditions that apply to Starbucks with respect to such PHI, Not use or disclose PHI received from the Health Program for employment-related actions and decisions or in connection with any other benefit or benefits plan of Starbucks (or its affiliates), Report to the Health Privacy Office any use or disclosure of PHI received from the Health Program that is inconsistent with the permitted uses or disclosures of which it becomes aware, To the extent required by HIPAA, allow Health Program participants to access their own PHI received from the Health Program, consider (and incorporate, where appropriate) participant-requested amendments to such PHI and, upon request, provide Health Program participants with an accounting of the disclosures of their PHI, Make Starbucks internal practices, books and records relating to the use and disclosure of PHI received from the Health Program available to the U.S. Department of Health and Human Services for purposes of determining the Health Program s compliance with HIPAA, and If feasible, return or destroy all PHI received from the Health Program that Starbucks still maintains in any form and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible. Starbucks will provide adequate firewalls, in accordance with HIPAA, between the Health Program and the components comprised of the remaining benefits provided under the Plan (i.e., the fully-insured group health plan benefits and non-group health plan benefits). In addition, Starbucks will ensure that it is adequately separated from the Health Program. Accordingly, Starbucks will restrict access to PHI to partners who (1) perform functions directly on behalf of the Health Program or (2) have access to PHI on behalf of Starbucks for its use in Health Program administrative functions. Such partners may use and disclose PHI for Health Program administrative functions, and they may disclose PHI to other such partners for Health Program administrative functions (but the PHI disclosed must be limited to the minimum amount necessary to perform the Health Program administrative function). Such partners may not disclose PHI to partners other than those described in the foregoing sentence except as permitted by HIPAA. Sanctions for using or disclosing PHI in violation of these provisions may be imposed in accordance with Starbucks discipline policy, up to and including termination. 231

235 VISION YOUR RIGHTS AND RESPONSIBILITIES To the extent required by HIPAA, Starbucks will implement steps to reasonably and appropriately safeguard electronic protected health information ( ephi ) created, received or maintained on behalf of the Health Program, as well as policies and procedures to ensure that its creation, receipt, maintenance, or transmission of ephi complies with the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ephi. Starbucks will ensure that adequate separation between the Health Program and the components comprised of the remaining benefits provided under the Plan and between the Health Program and Starbucks be maintained and supported by reasonable and appropriate security measures. Starbucks will ensure that any agent, including a business associate or subcontractor, to whom Starbucks provides ephi received from the Health Program agrees to the same restrictions and conditions that apply to Starbucks with respect to such ephi. Starbucks will further require any agents, including a business associate or subcontractor, to whom Starbucks provides ephi received from the Health Program, to notify Starbucks of any security incident as defined under HIPAA. Health information not covered by this notice The notice does not apply to certain activities listed below, although other protections may apply: Any health information you or your health care provider submits to Starbucks for workers compensation claims, leave of absence eligibility and short- and long-term disability benefits Employment-related activities, such as drug testing and fitness-for-duty physicals Please recognize that health information you voluntarily disclose to your coworkers, supervisor or manager, Partner Resources generalist or Starbucks Business Conduct Helpline is not protected by the nature of your volunteering this information. You should receive a separate notice of privacy practices from your health care providers, such as your physician, that will describe their privacy practices. Certificate of Prior Health Care Coverage The group health plan coverage you obtain after you leave Starbucks may have a pre-existing condition limitation. Under the Health Care Insurance Portability and Accountability Act (HIPAA) you may be able to shorten or eliminate that limitation if you can show that you had previous group health plan coverage. But, if the gap between the date you lose your coverage under Starbucks group health plan including COBRA coverage and the date when coverage starts under your new plan is 63 days or more, you may lose the right to take credit for your previous group health plan coverage. When you lose eligibility for group health plan coverage, a certificate will be mailed to you detailing your prior group health plan coverage under Starbucks benefits plans shortly after your benefits end. You ll want to keep this certificate for future reference. By presenting it at the time you enroll under a new group health plan, you may reduce the amount of time you need to wait before you are covered for certain pre-existing conditions. Contact Starbucks Benefits Center at (877) SBUXBEN for more information. 232

236 VISION YOUR RIGHTS AND RESPONSIBILITIES Qualified Medical Child Support Order A Qualified Medical Child Support Order (QMCSO) is a court order compelling a parent to enroll a child in the employer s group health plan. A QMCSO may be issued as part of a divorce proceeding or court-ordered child support. A QMCSO must include: Your name and last known mailing address, as well as the name and address of each child covered by the QMCSO (except the name and mailing address of the appropriate government agency may be substituted for the address of the child) A reasonable description of the type of coverage to be provided by the plan for each child, or the manner in which the type of coverage is determined The period to which the QMCSO applies When Starbucks Benefits Department receives a medical child support order, it will promptly notify you and each child named in the order. Starbucks will inform all parties what Starbucks procedures are for determining whether the order is a QMCSO. If it s determined that the court order is a QMCSO, and the child is enrolled, you may incur additional payroll deductions. Starbucks Benefits Department will promptly decide whether the order is a QMCSO and notify you and each child of its decision. The child named in the QMCSO will be treated as a covered dependent under the Plan. Any benefit paid under a QMCSO to reimburse a child or the custodial parent or legal guardian will be made to the child or to that custodial parent or legal guardian. Participants and beneficiaries can obtain, without charge, a copy of the procedures governing qualified medical child support order determinations by contacting Starbucks Benefits Department at (888) 796-JAVA, ext Questions? To find out more about your rights and responsibilities under Starbucks benefits plans, call Starbucks Benefits Center at (877) SBUXBEN. 233

237 VISION INDEX A abortion (see family planning) accelerated death benefit (life insurance), 169 accidental death & dismemberment insurance (AD&D), beneficiary designation, 177 coverage overview, 175 exclusions, 177 file claim appeal, 178 actively-at-work provision life insurance, 165 long-term disability, 154 short-term disability, 147 acupuncture (see alternative care) adoption assistance, adoption allowance, 193 adoption expense reimbursement, 192 adult/elder services (EAP), 32 Aetna Aexcel SM specialist network, 42, Aetna coverage policy bulletins, 103 Aetna Navigator, 41 Aetna Patient Advocacy Program, 83 Aetna Partner Services, 2 Aetna Rx Home Delivery Mail Order Pharmacy, 2, 111 alcoholism treatment, 32, 67 allergy immunotherapy, 92 alternative care, 66 annual open enrollment, 22 COBRA coverage, 226 appeals, 211 assignment of benefits, 216 B behavioral health chemical dependency, mental health, beneficiaries AD&D, 177 life insurance, 164, 168 benefit claims appeal denial, 211 filing (see claims, filing) request review, benefit coordination, 207 benefits eligibility, 6 coverage effective date, 9 initial, 6 8 losing due to reduction in paid hours, ongoing, 9 reestablishing, 12 rehires, 9 request for review, 210 while on leave of absence, benefits enrollment, 13 annual open enrollment, 22 initial, 13 missed deadline, 14 status changes, bereavement (see paid time off) birth control (see family planning) brand-name drugs, 110 C Career Coffee Break (sabbatical), 189 CAT scan, 92 carpal tunnel, 92 certificate of prior health care coverage, 232 chemical dependency treatment, emergency care, 69 exclusions, inpatient, 67 maximum benefits per calendar year, 67 outpatient, 68 precertification, 68 providers, 68 child care dependent care reimbursement account, , mildly ill, 34 providers/facilities (see EAP), 31 tax credit, 140 child life insurance, 166 chiropractic care, 70 claims, appeal denial of claims, 211 claims, filing AD&D, 178 adoption expense reimbursement, 192 dental, 123 dependent care reimbursement account, EAP,

238 VISION INDEX claims, filing (cont d) health care reimbursement account, life insurance, 172 long-term disability, medical, 104 mental health/chemical dependency, 104 prescription drugs, 113 short-term disability, tuition reimbursement, vision, 130 claims, request review, compassionate benefits for terminally ill partners, 28 continued life insurance, 28 continued health coverage, 28 Consolidated Omnibus Budget Reconciliation Act (COBRA), 219 conversion option, 226 coverage, 222 changes, 226 cost, 224 duration, eligibility, enrollment, 221 notification, 221 open enrollment, 226 premiums, 225 contact lenses, contraception (see family planning) convalescent care, precertification, 93 conversion COBRA, 226 life insurance, coordination of benefits, 207 dental, 120 copay, definition of medical, 36 prescription drugs, 109 vision, 127 cosmetic surgery, 98, 135, 149 cost of benefits, cost sharing, 20 counselor (EAP), 31 course of treatment (dental), 121 coverage categories, coverage continuation (COBRA), coverage effective date, 9 crisis counseling (EAP), 31 custodial care, 103 D death benefits AD&D, life insurance, 168 long-term disability, 161 deductible dental, 115 medical, 36, 44, 50, 54, 55, 59, 62, 63, 64 dental plan, course of treatment, 121 covered services, deductibles, 115 exclusions, how to file a claim, 123 ID cards, 115 maximum benefit per calendar year, precertification, 120 providers, recognized charges, 115 dependent care reimbursement accounts, , coverage, 139 exclusions, 140 filing a claim, 141 nondiscrimination testing, 139 request reconsideration of a claim, 216 tax savings, dependent eligibility, proof of, 18 Dependent Out-of-Area plan, 53 dependents coverage, 15 definition of, dual coverage, 16 enrolling, 15 loss of dependent status, 23 24, 221 depression treatment, 32, 84 86, 158 diagnostic, medical, precertification, disability long-term disability, short-term disability, disability leave, benefits eligibility while on, divorce, coverage continuation, inside front cover, 220 doctor s office visits, 71 domestic partner coverage for, 16 17

239 VISION INDEX domestic partner (cont d) definition of, 17 imputed income, 17 drugs, prescription, drug abuse (see chemical dependency) durable medical or surgical equipment, 75 E EAP, eligible dependents, spouse, 16 domestic partner, children, eligibility benefits, 6 13 initial, 6 8 losing due to reduction in paid hours, ongoing, 9 10 reestablishing, rehires, 9 COBRA, dependents, 15 request for review, 210 while on leave of absence, emergency care chemical dependency, 69 medical, 76 mental health, 87 emergency room/urgent care, employee assistance program (EAP), how it works, 31 how to file a claim, 34 plan coverage, resource and referral services, when coverage ends, 33 enrollment annual open enrollment, 22 initial benefits enrollment, 13 14, 21 equipment, medical or surgical, 75 ERISA rights, 217 evidence of good health (EOGH) life insurance, 166 long-term disability, 155 exclusions AD&D, 177 alternative care, 67 chemical dependency, convalescent care, 71 dental, dependent care reimbursement account, 140 durable equipment, 75 emergency care, 76 family planning, 78 general medical, health care reimbursement account, 135 hearing services, 79 home health care, 80 hospice care, 82 infertility treatment, 78 long-term disability, mental health, 87 mouth, jaw and teeth conditions, 88, , 121 nicotine-use treatment, 89 physical exam, 90 prescription drugs, preventive gynecological exam (well woman), 96 short-term disability, 149 short-term rehabilitation, 97 skilled nursing, 97 surgery, transplant, 100 vision, 129 experimental procedures medical, dental, 122 exposure and disappearance (AD&D), 175 eye and vision care, exclusions, 129 eye exam, 127 filing a claim, 130 glasses and contacts, 127 Laser VisionCare SM program, 128 F family/medical leave, 186 benefits eligibility while on, 25 family planning, 78 family related events, inside front cover family status changes, financial consultation (EAP), 33 formulary drug,

240 VISION INDEX G generic drugs, 110 gynecological exam, 96 H Hartford Life and Accident Insurance Company, 4, 19, 28, 163, 174, 206 health care reimbursement accounts, coverage, exclusions, 135 filing a claim, 137 request reconsideration of a claim, 216 special rule for orthodontia, 135 health coverage continuation (COBRA), Health Insurance Portability and Accountability Act (HIPAA), certificate of prior coverage, 232 health privacy rights, 227 hearing exam, 79 hearing aids, 79 HMSA Preferred Provider Plan, 63 holidays, 180 holistic treatment (see alternative care) home health care, 80 precertification, homeopathic care (see alternative care) HealthQuotient, 21 22, 43 hospice care, 81 precertification, 93 hospitalization inpatient chemical dependency, 67, 85 medical, mental health, 85 maternity stays, 83, 95 outpatient chemical dependency, 68, 85 medical, 82 mental health, 85 precertification chemical dependency, medical, mental health, how to file a claim AD&D, 178 dental, dependent care reimbursement account, health care reimbursement account, life insurance, 172 long-term disability, medical, prescription drugs, 113 short-term disability, tuition reimbursement, vision, 130 I ID cards dental, 115 medical, immunizations (see physical exams) imputed income domestic partners, 17 life insurance, 164 same-sex spouse, 16 infertility treatment (see family planning) initial benefits enrollment, 13 initial eligibility, 6 8 J jaw conditions, 88, , 121 jury duty (see paid time off) K Kaiser Hawaii HMO Plan, 64 Keystone Health Plan Central, 62 L laboratory expenses, 83 Laser VisionCare SM Program, 128 leave of absence Career Coffee Break (sabbatical), 189 benefits eligibility while on, 25 disability, 188 benefits eligibility while on, 25 family/medical, 186 benefits eligibility while on, 25 military, 188 benefits eligibility while on, 26 personal, 189 pregnancy disability, 187 legal consultation (EAP), 33 life insurance, accelerated death benefit,

241 VISION INDEX Life Insurance (cont d) actively-at-work provision, 165 child coverage, 166, 168 conversion option, designating beneficiaries, 164, 169 evidence of good health, 166, 167 how to file a claim, 172 how to file claim appeal, 214 partner coverage, , 168 payment of benefits, 168 portability option, spouse/domestic partner coverage, , 168 waiver of premium, 171 life management (see EAP) lifetime benefit medical, 37 nicotine use, 46, 58, 61 orthodontia, 120 TMJ or MPD treatment, 47, 58, 61 long-term disability, actively-at-work provision, 154 beginning and end of benefits, 158 calculating benefits, disability defined, exclusions, 157 how to file a claim, 160 how to file a claim appeal, 215 if you die, 161 maximum benefit period, 159 mental illness limitations, 158 partial disability, 156 recurrent disability, 159 self-reported symptoms, 158 loss of benefits eligibility, 10 dependent status, 23 24, 221 M mailing address, change of, 1, 221 mail order prescriptions, 2, 111 mandatory generics, 110 maternity, 83, 95 maximum benefits per calendar year alternative care, 66 chemical dependency, 32, 67, 85, 86 chiropractic care, 70 convalescent care, 71 dental, 120 home health, 80 mental health, short-term rehabilitation, 96 skilled nursing, 97 maximum lifetime benefit medical, 37 orthodontia, 120 medical necessity, definition of dental, 119 medical, mental health/chemical dependency, medical plans, 36 annual out-of-pocket maximum, 40 concurrent review and discharge planning, 38 during leave of absence, 39 HMSA Preferred Provider, 63 coverage overview, 63 ID cards, Kaiser Hawaii HMO, 64 coverage overview, 64 maximum lifetime benefit, 37 Open Choice PPO, 43 coverage overview, Out-of-Area, 58 coverage overview, Point-of-Service, 47 coverage overview, precertification, 38 retrospective record review, 38 Routine Care PPO, 54 coverage overview, what you pay, 36 when coverage ends, 39 York medical, 62 coverage overview, 62 Medicare, 4 mental health treatment, emergency care, 87 exclusions, inpatient, 85 intensive outpatient, 85 network providers, 85 outpatient, 85 partial hospitalization, 85 precertification, residential treatment, 85 mental illness limitations (LTD), 158 mildly ill child care,

242 VISION INDEX military leave, 188 benefits eligibility while on, 26 missed deadline for enrollment, 14 missed payroll deductions, 20 Moms-to-Babies Maternity Program, 94 monthly eligibility audits (Hawaii), 10 mouth conditions, 88, , 121 MPD treatment, 100, 121 preauthorization, 101 MRI, 92 N naturopathic care (see alternative care) nicotine-use treatment, 89 nondiscrimination testing (see dependent care reimbursement) nurse midwives, 95 O OB/GYN exam, 96 self-referral, 49 occupational injuries or diseases, 104, 122, 149 occupational therapy (see short-term rehabilitation) ongoing benefits eligibility, 9 Open Choice PPO plan, 43 open enrollment (annual) benefits, 22 COBRA coverage, 226 reimbursement accounts, 133 oral contraceptives, 78, 108 orthodontia, , 135 Out-of-Area plan, 58 out-of-pocket maximums, medical Open Choice PPO, 40, 44 Point-of-Service, 40, 50 Out-of-Area Dependent, 54 Routine Care PPO, 40, 55 Out-of-Area, 40, 59 outpatient surgical and diagnostic precertification, 92 overpayment, recovery, 216 P paid hours, 6, 9 initial benefits eligibility, 6 9 ongoing benefits eligibility, 9 10 paid time off bereavement, 185 holidays, 180 jury and witness duty, 186 personal days, 181 vacation, parenting (EAP), 32, 33 participant rights, 204 Patient Advocacy, Aetna, 83 payment percentage, definition, 37 payroll deductions, 20 PCP (see primary care physician) personal days, 181 personal leave, 189 benefits eligibility while on, 25 pharmacies participating, 110 nonparticipating, 111 physical exam, physical therapy (see short-term rehabilitation) plan administrator, plan document, 203 plan liability, 217 plan year definition, 12 reimbursement accounts, 133 Point-of-Service plan, 47 portability option (life insurance), precertification chemical dependency, 68, 85 convalescent care, 71, 80, 93 dental, 120 diagnostic procedures, 90, 92 extended hospital stays, 90, 92 home health care, 80, 90, 93 hospice care, 81, 90, 93 hospital stays, 83, medical plans, mental health, outpatient surgical procedures, 92 skilled nursing care, 90, 93, 97 TMJ or MPD treatment, 101 pre-existing condition limitation long-term disability, preferred dentist, pregnancy-related coverage, 94 hospitalization, 83, 95 nurse midwives, 95 premium, waiver of,

243 VISION INDEX prescription drugs, brand name, 110 claims filing, 113 copay, 109 coverage overview, definition, 109 exclusions, formulary, 109 generics, 110 mail-order (see home delivery), 111 participating pharmacies, 110 what is not covered, preventive care, 89 well woman exams, 96 preventive gynecological exam, 96 primary care physicians (PCP), choosing or changing, 49 prior coverage, certificate of, 232 prosthetics dental, 119 medical, prosthesis replacement rule (dental), 119 providers directories, 1 4 alternative care, 66 chemical dependency, 68 dental, HMSA Preferred Provider, 63 Kaiser Hawaii HMO, 64 mental health, Open Choice PPO, 43 Out-of-Area, 58 Point-of-Service, 48 Routine Care PPO, 54 vision, 126 York medical, 62 psychologists, psychiatrists, Q qualified medical child support order (QMSCO), 233 quarterly eligibility audits, 10 R recognized charges medical, 41 dental, 115 reconstructive surgery, 98 recovery of overpayment, 216 re-establishing benefits eligibility, 12 rehabilitation, short-term, 96 rehire, benefits eligibility, 9 reimbursement accounts, annual open enrollment, 133 automatic reimbursement, 138, 141 claim filing deadline, 134, , dependent care, 138 electronic funds transfer, 138, 141 evaluating tax advantages, 132 health care, 134 IRS rules you should know, 134 plan year, 133 request review of claims, 210 resource and referral services (EAP), retrospective review of records, 38 Routine Care PPO plan, 54 routine physical exam, well woman exam, 96 S sabbatical leave (see Career Coffee Break) self-reported symptoms (LTD), 158 short-term counseling, 32, 85 short-term disability (STD), actively-at-work provision, 147 beginning and ending, 150 calculating your benefit, 148 exclusions, 149 maximum benefit period, 150 recurrent disability, 150 short-term rehabilitation, 96 sick pay, 144 skilled nursing care, 97 precertification, 90, 93, 97 smoking cessation (see nicotine-use) Social Security Administration, 4 specialist referrals, Aetna Aexcel SM, 42, Point-of-Service, specialty care, 72 Aetna Aexcel SM specialist network, 42, speech therapy (see short-term rehabilitation) spouse life insurance,

244 VISION INDEX spouse, definition, 16 same-sex, 16 Starbucks Benefits Center, 1 Starbucks Benefits Department and Health Privacy Office, 2 Starbucks Partner Contact Center, 1 Starbucks Tuition Reimbursement Center, 4 state disability benefits, 148, 157 status changes, 23 sterilization (see family planning) stress management (see EAP), 30 subrogation, 216 supplemental life insurance, 11, 23, 29, 167, 170 surgeon s fees, 98 surgery, 98 inpatient, 98 outpatient, 92, 98 precertification, 92, transplant, T teeth conditions, 88, , 121 terminally ill, 28, 81, 169 time off, TMJ treatment, 100, 121 preauthorization, 101 total medical disability, definition long-term, short-term, 147 transplant surgery, tuition reimbursement, applying for a benefit, eligibility, 195 filing a claim, reimbursement amount, 196 request for review, 200 U unpaid time off (leaves of absence), UnumProvident Corporation, 4 urgent care dental, 123 medical, V vacation, accrual program, grant program, transition between accrual and grant, 185 vision plan, coverage overview, 128 exclusions, 129 filing a claim, 130 providers, 126 VSP, 3 W waiver of premium (life insurance), well child visits, 44, 51, 56, 59 well woman exam, 96 witness duty (paid time off), 186 work-related injuries and illness, 104, 122, 149 X x-ray and imaging expenses, 83 Y York Medical Plan,