Y O U R 2 0 1 4 2 0 1 5 BENEFITS GUIDE PART-TIME NON-EXEMPT ASSOCIATES This guide provides information about the Staples benefit choices you have as a part-time non-exempt associate. Take a look for more about Eligibility 1 Electing Your Coverage 2 Your Benefits-At-a-Glance 3 Medical 4 Dental 7 Vision 8 Disability and Life 9 Savings and Stock Plans 10 Voluntary Programs 12 Contact Information 13 Rules and Limitations 14 This guide summarizes the benefit plans in general terms only. Plan documents and summary plan descriptions determine the plan provisions. You should go to www.staples.com/benefits or contact the vendors directly for more information.
eligibility Eligibility You are eligible for these benefits effective 60 days after your hire date. You may elect fixed benefit, dental, vision and life insurance coverage for your dependents as well. Eligible dependents include: Your legal spouse, including same-sex spouses in states that recognize same-sex marriage Important Note: The fixed benefit, dental, disability and life insurance plans are underwritten by Aetna Life Insurance Company. Exclusions and limitations may apply. Please also see the state rules and limitations on pages 14 and 15. Changing Your Coverage During the Year You may only change or drop your fixed benefit, dental or vision coverage if you have a qualifying life event due to the gain/loss of coverage, change in employment status (e.g., to full-time), marriage, divorce, birth/adoption or death. You have 30 days from the date of the event to make a change (60 days for a birth or adoption). Complete a Benefit Change Form (available on www.staples.com/benefits) and submit it to HR Services to change coverage. Your same-sex domestic partner as well as his/ her children if you cover your domestic partner Your children under age 26 and Your children age 26 and older who are not able to care for themselves due to physical or mental disability and are on SSDI. For more details about same-sex domestic partner eligibility, go to www.staples.com/benefits. Note that the fixed benefit plan is not available to associates who live in Massachusetts, North Dakota or Washington or who live and work in New Hampshire. 1
elect enroll Electing Your Coverage To be covered under the fixed benefit, dental, vision, disability, life or legal services plans, you must enroll during the annual open enrollment period or within 45 days of your hire date if you are a new associate. Your coverage becomes effective as of the first Sunday following 53 days of service, provided your first payroll deduction has been made. Any coverage you elect for your dependents begins when your coverage begins, unless you enroll them at a later date due to a qualifying life event. Before you enroll, read your Aetna Voluntary enrollment kit, which explains the features, limitations and exclusions of your plan. To access your Aetna Voluntary enrollment kit, go to www.staples.com/benefits or to www.aetna.com and follow the links to log in. Your login is 777674 and your password is AAHC. Follow the links to the Document Library, and click on Enrollment Kit. You can also get a printed copy of the enrollment kit by calling 1-888-772-9682. Note: If you have a status change (e.g., full-time to part-time), your coverage is effective the Sunday following the date of your status change. How to Enroll 1. Go www.staples.com/benefits and select Part-time non-exempt. Then, click Associate Connection in the upper right. 2. Enter your 7-digit Employee Number and password. If you forget your password, click Forgot Password on the login page and follow the prompts. 3. Click Benefits Enrollment. 4. Click Select to see your current choices. 5. Click Edit next to each benefit option to enter your 2014-2015 plan year elections. 6. When you are done, click Submit at the bottom of the screen. 7. Do a final review of your elections and click Submit again. 8. When you see the message Your enrollment is complete, your elections have been saved. 9. Print out your confirmation page for future reference. If You Need Help. For enrollment assistance, contact HR Services by calling 1-888-490-4747 or submitting an ehelpdesk ticket. You will receive a confirmation statement at your home address documenting your elections. To make a correction to your elections, mark the changes on your confirmation statement and fax it to HR Services at 508-305-1300 within 14 days of the issue date. 2
benefit summary Your Benefits At-a-Glance As a part-time associate, you have the following benefit options available from July 1, 2014 through June 30, 2015. Read this guide for more information about each plan or contact HR Services or the vendors directly if you have questions. (See page 13 for phone numbers and websites.) Plan/Benefits Your Coverage Choices Medical Aetna Fixed Benefit Plan Single This plan does not provide creditable coverage; for more, see page 4 You plus child(ren) You plus spouse/domestic partner Family Dental Aetna Dental Plan Single You plus child(ren) You plus spouse/domestic partner Family Vision EyeMed Basic Plan Single EyeMed Enhanced Plan You plus child(ren) You plus spouse/domestic partner Family Short-term Option to buy coverage with: Whether to elect coverage for yourself disability $50 benefit maximum/week and what benefit maximum to choose $125 benefit maximum/week Life and $20,000/life for yourself Whether to elect coverage for yourself accidental $20,000/accidental death for yourself and/or your dependents death insurance Option to buy life insurance for your dependents The above benefits must be elected during the annual open enrollment period, within 45 days of your hire date if you are hired during the year, or within 20 days of your status change to part-time. Our Savings and Stock Plans Staples also gives you the opportunity to save and invest for the future with the following plans. Plan Features Your Choices 401(k) Option to set aside pre-tax dollars for the Whether to participate Savings Plan future and receive a Staples matching How much to contribute contribution How to invest your account Employee Stock Option to share in the company s success by Whether to participate Purchase Plan purchasing Staples stock at a 15% discount How much to contribute to purchase stock 3
medical Aetna Fixed Benefit Plan Staples offers a fixed benefit plan through Aetna. You may use any licensed You decide whether to elect coverage through the fixed benefit plan and which dependents to cover. provider and any certified hospital for medical care, but you are eligible for discounts if you use an Aenta in-network provider. The plan also includes prescription drug benefits and discounts at more than 59,000 retail pharmacies nationwide. Important Notes Due to state regulations, this coverage is NOT available to associates who live in Massachusetts, North Dakota or Washington or who live and work in New Hampshire. Your coverage is not effective until your first deduction is taken from your paycheck (on the second Friday after your coverage becomes effective). For example, if you became eligible for coverage on Sunday, the 2nd, your first deduction would not be taken until Friday, the 14th. So, you would be reimbursed for medical visits on or after Sunday, the 9th, but not for that first week when you became eligible. Keep this in mind when you are making appointments. Also, if a deduction was not taken for a certain week (for example, you did not work or worked fewer hours), the plan will not pay benefits incurred during that week unless you repay the deduction amount to Aetna within 45 days. The fixed benefit plan is not considered creditable coverage for the purposes of health care reform. As a result even if you have coverage through this plan you may still be assessed a federal penalty when you file your taxes (unless you have coverage under another medical plan). To find out more about health care reform, the Health Insurance Marketplace plans and/ or the tax penalty, go to www.healthcare.gov. Marketplace Plan Subsidies. Remember that you may have lower cost health care options through the Health Insurance Marketplace. You may also be eligible for subsidies based on your household income. Go to www.healthcare.gov for more information. 4
medical How the Aetna Plan Works Under the fixed benefit plan, the plan reimburses a set amount for the services you receive during the year. You do not pay a deductible for medical services or prescription drugs. Any maximums are per visit or per day. See the chart below to see how the plan pays benefits. Plan Reimbursement Physician office visit* Hospital admission Outpatient services Diagnostic Surgery Emergency Accident services $80/visit (up to 7 visits/person/year) $800/admission (up to 2 admissions/person/year) plus $550/day for inpatient benefits or $1,100/day for ICU benefits $100 (up to 3/person/year) $500 (up to 2/person/year) $325 (up to 2/person/year) $300 (up to 2/person/year) *includes diagnostic, chiropractic, maternity You may go to any provider or facility for services. The difference is whether discounts may apply and how you pay for the care. In-Network Out-of-Network Discounts Your cost is based on the negotiated Your cost is based on the full cost discount for the service for the service Claim forms You do not file a claim form You must file a claim form Payment for the service You owe nothing at the time of service You are responsible for the full cost at the time of service Physician Visit Example. We ll assume that your physician visit costs $150. If you use an in-network provider: The negotiated cost could be $100. You don t file a claim form and pay nothing at the time of the service. You are billed for $20 the $100 cost minus the $80 reimbursement from the plan. If you use an out-of-network provider: The cost is still $150. You pay $150 at the time of the service and file a claim form for the visit. You are ultimately reimbursed $80 from the plan, so your cost is $70. As you can see, it s always to your advantage to use an in-network provider because you may pay less and you do not need to pay at the time of the service or file a claim form. 5
medical Prescription Drug Benefits The fixed benefit plan pays $45 up to 12 days per year for prescription drugs. That s $540 per year! Using generic drugs whenever possible and going to a network pharmacy will save you money. You do need to consider how and when you go to the pharmacy, so here are two examples. Example 1. Let s say you have a generic prescription that costs $5. When you fill this prescription, the plan will pay $5 and you will receive $40 as reimbursement for a total of $45 that day. Example 2. Now let s assume you have a prescription that costs $75. In this case, the plan pays $45 and you are responsible for the remaining $30. The bottom line is that you can receive a total of $540 towards prescription costs but this is based on receiving $45 on 12 different days during the year. Also, you cannot combine prescriptions to receive the $45. That is, in the first example, you could only get $45 that day no matter how many prescriptions you fill. You receive the cost of one prescription and get reimbursed for any remaining amount. Pre-tax Fixed Benefit Plan Weekly Rates Single $20.14 You plus child(ren) $42.29 You plus spouse/domestic partner $45.32 Family $60.42 Healthy Living Programs Staples offers additional healthy living programs for you and your family. We encourage you to take advantage of these programs to help you learn about and manage your health throughout the year. Aetna s Informed Health Line is available if you are enrolled in the fixed benefit plan. Just call to ask about any health topic or to get advice on treating a health issue. Providers are available 24/7 by calling 1-800-556-1555. The following programs are available to all associates: Staples LifeScope Employee Assistance Plan (EAP) provides information on health topics, as well as support and referrals to help you meet your health goals. More importantly, you re eligible for THREE free consultations with a counselor for each member of your family on any topic. Call 1-800-227-2195 at any time (24/7). Staples.CorporatePerks.com is an online resource for a wide range of nutrition and wellness topics and includes fitness center discounts. Go to the site to see what s available. To find a network doctor or get more information about the fixed benefit plan, contact Aetna at: 1-888-772-9682 www.aetna.com/docfind 6
dental Aetna Dental Plan You may elect dental coverage and use any licensed dentist for care. After you pay a $50 deductible per person, the plan pays a percentage of the cost of the service (up to $750 per year, per covered person). You receive additional savings if you use a participating Aetna PPO network dentist. You decide whether to elect dental coverage and which dependents to cover. Important Notes The dental PPO network is not available in Alabama, Arkansas, Hawaii, Idaho, Louisiana, Mississippi or New Mexico. Your coverage is not effective until your first deduction is taken. That is, if you go to the dentist before a deduction for dental coverage is taken from your paycheck, that visit will NOT be covered. Keep this in mind when you are making dental appointments. Also, if a deduction was not taken for a certain week, the plan will not pay benefits incurred during that week unless you submit the missed premium to Aetna within 45 days of its being missed. The chart below shows the percentage the plan pays and the waiting period that applies before you can receive services. That is, the plan requires you to be enrolled for a certain number of months before some procedures are covered. Minimum Percentage Plan Pays* Waiting Period Before Plan Pays Check-ups/cleanings 80% None Fillings 60% 3 months Oral surgery 60% 3 months Crown and bridge repair 60% 3 months Periodontal and endodontic services 60% 12 months Crowns and bridges 50% 12 months Dentures 50% 12 months * Note that the cost you pay for a preferred provider is based on a negotiated charge. Your cost could be lower if you use a participating PPO network dentist. The cost you pay for a non-preferred provider is based on the customary charge. A non-preferred provider may require that you pay more than the customary charge and this additional amount is your responsibility. Contact Aetna if you have any questions. Pre-tax Dental Plan Weekly Rates Single $5.17 You plus child(ren) $10.74 You plus spouse/domestic partner $11.43 Family $14.81 To find a network dentist or get more information about your dental benefits, contact Aetna at: 1-888-772-9682 www.aetna.com/docfind 7
vision EyeMed Vision Plans Staples offers a choice of two EyeMed vision plans: the Basic Plan or the Enhanced Plan. EyeMed has a national provider network for exams and eyewear at excellent discounts and savings. Participating providers include LensCrafters, Pearle Vision and the vision centers at Target, Sears and JC Penney. You decide whether to elect EyeMed coverage, which plan you want and which dependents to cover. See the chart below for a summary of what s covered in-network and how. Basic Plan Enhanced Plan Annual comprehensive exam You pay a $20 copay You pay a $5 copay Eyeglass lenses You pay a $25 copay for single, You pay a $10 copay for single, bifocal, (standard plastic and polycarbonate) bifocal, trifocal and lenticular lenses trifocal, lenticular standard and premium Available once per plan year progressives polychromatic (transitions) Frames You get a $130 allowance You get a $130 allowance Available once every other plan year towards frames towards frames Contact lenses You get a $150 allowance You get a $150 allowance (instead of eyeglasses) towards contacts towards contacts Retinal imaging You pay up to a $39 copay You pay up to a $39 copay Laser eye surgery You get 15% off retail price You get 15% off retail price plus a one-time $600 allowance You may use out-of-network providers but will receive a lower benefit. Simply pay your provider and then file for a reimbursement with EyeMed. See the Benefit Summary (available on www.staples.com/benefits) for details. Important Note: Unlike the fixed benefit and dental plans, the vision deductions are due whether or not you receive services during that pay period. Any missed premiums will be deducted from future paychecks even if you had no claims. For more information about your vision Pre-tax Vision Plan Weekly Rates Basic Enhanced benefits, contact EyeMed at: Single $1.05 $2.41 1-866-299-1358 (before you enroll) or You plus child(ren) $2.09 $5.03 1-888-849-7297 (after you enroll) You plus spouse/domestic partner $2.51 $5.89 www.enrollwitheyemed.com (before you Family $3.14 $7.44 enroll) or www.eyemedvisioncare.com (after you enroll) Choose the Select network from the Find a Provider dropdown box. 8
disability life Disability and Life Programs Short-term disability pays you a weekly benefit if you become disabled while you are employed with Staples. Life insurance can provide a benefit if you or your covered dependents were to die. Short-term Disability Insurance You may elect short-term disability (STD) coverage* for yourself. If you elect coverage, you are eligible for weekly benefits while you are disabled, for up to six months. You receive 50% of your base pay up to the weekly benefit maximum. You choose your weekly benefit maximum: $50 or $125 per week. Benefits begin after a 14-day waiting period (or immediately, if hospitalized). * Some states require employers to provide STD benefits. If you work in California, New Jersey, New York or Rhode Island, you may not elect coverage through Aetna because you have state coverage. You decide whether to elect short-term disability coverage and what weekly benefit maximum to choose. You also decide whether to elect life insurance for yourself and your dependents. Life and Accidental Death Insurance If you elect coverage for yourself, you will have: $20,000 of life insurance and $20,000 of accidental death insurance. You choose a beneficiary for these coverages. That is, if you were to die as the result of an accident, your beneficiary could receive up to $40,000 from these plans. Note that benefits are reduced by 50% when you reach age 70. You may also cover your dependents if you elect coverage for yourself. Coverage levels are: $2,500 of life insurance for any dependent at least six months old and Short-term Disability Example. If you elect the $50 weekly benefit maximum, you pay $1.62 per week for the coverage (see below) and you receive up to $50 per week if you become disabled. If you elect the $125 weekly benefit maximum, you pay $3.50 per week and would receive up to $125 per week during a disability. $500 of life insurance for children from birth through six months of age. You are the beneficiary for any dependent coverage you elect. If a dependent dies, you receive the benefit. After-tax Short-term Disability Weekly Rates After-tax Life Insurance Weekly Rates $50 weekly benefit maximum $1.62 Associate only $1.54 $125 weekly benefit maximum $3.50 Associate plus dependents $1.88 9
savings stocks Savings and Stock Plans Staples offers two plans that help you save for the future and share in the ownership of our company. The chart below outlines the benefits of each plan. 401(k) Savings Plan Employee Stock Purchase Plan (ESPP) Your contributions From 1% to 50% of your pay on a pre-tax From 1% to 10% of your pay on an basis, to a maximum of $17,500 after-tax basis Additional catch-up contributions if you are at least age 50 Staples incentives A Staples match equal to 50 cents for 15% discount on Staples stock every dollar you save on the first 6% of pay purchased over a 6-month period No commission paid on purchase Dividends paid to your account in Staples stock Vesting your Immediate 100% vesting of your Not applicable right to your account contributions and any rollover contributions when you leave Staples 20% per year vesting of Staples matching contributions (100% once you have five years of vesting service) Investment options The option to choose individual investment Contributions that purchase funds (including a Staples stock fund) or Staples stock target date funds for your contributions and the Staples match Taxes No taxes apply until money is paid out Taxes are paid on any profits made from the sale of stock The discount is taxable if you sell shares before holding them for 18 months plus one day Dividends are taxable when paid Changing participation Change or restart contributions each Two offering periods per year month; stop at any time Change investment fund mix at any time Access to your savings A loan or hardship withdrawal while employed Can sell shares at any time After you leave Staples, you can roll over your Can withdraw contributions at account into another qualified account any time (e.g. 401(k), IRA) Make withdrawals once you re age 59-1/2 10
savings stocks Participation You may elect to participate in the 401(k) Savings Plan as of the first of the month following 60 days of service as long as you are at least age 21. The Employee Stock Purchase Plan has two offering periods per year: January through June and July through December. You are eligible to participate once you have 90 days of service. 401(k) Advantages A 401(k) plan can be one of your best tools for creating a secure retirement. It provides you with two important advantages: You don t pay taxes on the contributions you make or the earnings on your account until you withdraw money from your account. ESPP Advantages With the ESPP, you don t save on taxes but do get a 15% discount when you purchase Staples stock. Plus, you can sell your shares or withdraw your contributions at any time. Staples adds a match of $.50 of every dollar you contribute up to 6% of your annual eligible base pay. The result is a retirement savings plan you cannot afford to pass up. By contributing (even just a little), you ll save on taxes and get the Staples match! For more information about the 401(k) Savings Plan and the ESPP, go to www.staples.com/benefits. Once you have an account in the 401(k) Savings Plan, you can contact New York Life at: 1-800-294-3575 www.mylife.newyorklife.com Once you have an account in the Employee Stock Purchase Plan, you can contact E*Trade at: 1-800-838-0908 www.etrade.com/stockplans 11
other benefits Voluntary Programs Staples offers several voluntary programs through Marsh@Work. You pay 100% of the cost and have the convenience of automatic payroll deductions. You can only enroll in MetLaw Legal Services during the annual open enrollment period or when you are first eligible. (You can only drop coverage during open enrollment). The cost is $21.25 per month. If you elect coverage, you get advice and services for a wide range of legal matters, including document review, traffic ticket defense, wills, family issues, real estate transactions and more. You decide whether to elect coverage under any of these voluntary plans You can enroll in the following benefits at any time: Aflac Hospital Indemnity Plan an individual policy which gives you a lump sum dollar benefit in the event you become hospitalized Aflac Supplemental Dental Coverage an individual policy which gives you a lump sum dollar benefit for dental services Group home and auto insurance offering a group discount on premiums for auto, homeowners, boat and renters insurance ID TheftSmart designed to help you monitor your credit and restore your credit rating Veterinary pet insurance providing coverage for most household pets for routine care and more complex treatment Marsh@Work can provide more information about your coverage options and costs. For more information, contact Marsh@Work at: 1-800-749-4217 staplesvoluntarybenefits.com (no www ) 12
contacts For More Information Our benefits website, www.staples.com/benefits, can help with all of your benefit needs. You can find information about your benefit plans and link to the vendor sites. Just select Part-time non-exempt as your associate group. Visit today; it s easy! To contact a vendor directly or talk to HR Services, see the phone and website information in the table below. Benefit/Vendor By Phone Via the Web Aetna 1-888-772-9682 www.aetna.com Fixed Benefit Plan Dental To find a fixed benefit or dental network Life Insurance ($20,000) provider, go to www.aetna.com/docfind Accidental Death ($20,000) Short-term Disability EyeMed Vision Pre-enrollment Pre-enrollment: www.enrollwitheyemed.com 1-866-299-1358 Network: Select Customer Service Once enrolled: www.eyemedvisioncare.com 1-888-849-7297 Network: Select New York Life 401(k) 1-800-294-3575 www.mylife.newyorklife.com E*Trade ESPP 1-800-838-0908 www.etrade.com/stockplans Marsh@Work Voluntary Programs 1-800-749-4217 staplesvoluntarybenefits.com (no www ) LifeScope EAP 1-800-227-2195 www.lifescopeeap.com (login and password: staples) For a Staples contact for any/all benefits HR Services 1-888-490-4747 Submit an ehelpdesk ticket 13
rules disclosures Rules and Limitations This section is a partial list of the rules and limitations that apply to your dental, short-term disability, life insurance and accidental death insurance coverages. However, your plan may contain exceptions to this list based on state mandates or the plan design purchased. Please refer to the Aetna certificate you receive to determine which services are covered and to what extent. Dental Exclusions The following charges are not covered under the dental plan and they will not be recognized toward the satisfaction of any deductible amount (unless mandated by law): Cosmetic procedures unless needed as a result of injury Any procedure, service or supplies that are included as covered medical expenses under another group medical expense benefit plan Prescribed drugs, premedication, analgesia or general anesthesia Services provided for any type of temporomandibular (TMJ) or related structures or myofascial pain Charges in excess of the recognized charge, based on the 80th percentile of the Ingenix Medical Data Research Tables Short-term Disability Exclusions Attempted suicide, while sane or insane or unintentional self-inflicted injury or sickness, unless as the result of a medical condition Commission of or attempt to commit an act which is a felony in the jurisdiction in which the act occurred Substance abuse Occupational injury or sickness Life Insurance Exclusions Suicide or attempted suicide (while sane or insane) Accidental Death Benefit Exclusions Use of alcohol, intoxicants or drugs, except as prescribed by a physician Suicide or attempted suicide (while sane or insane) An intentionally self-inflicted injury A disease, ptomaine or bacterial infection except for that which results directly from an injury Medical or surgical treatment except for that which results directly from an injury Voluntarily inhalation of poisonous gases Commission of or attempt to commit a criminal act DISCLOSURES Important Information About the Benefits You Are Being Offered The Aetna Fixed Benefits Plan is a hospital confinement indemnity plan with other fixed indemnity benefits. This plan provides LIMITED BENEFITS. Benefits provided are supplemental and are not intended to cover all medical expenses. This plan pays you fixed dollar amounts regardless of the amount that the provider charges. You are responsible for making sure the provider s bills get paid. These benefits are paid in addition to any other health coverage you may have. This disclosure provides a very brief description of the important features of the benefits being considered. It is not an insurance contract and only the actual policy provisions will control. THIS PLAN DOES NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. 14
rules disclosures Notice to Texas Residents THIS IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED. Notice to Missouri Residents An optional rider for elective abortion has not been purchased by the group contract holder pursuant to VAMS section 376.805. An enrollee who is a member of a group health plan with coverage for elective abortions has the right to exclude and not pay for coverage for elective abortions if such coverage is contrary to his or her moral, ethical or religious beliefs. Your plan sponsor does not include coverage for elective abortions. Policy forms issued include GR-9/GR-9N, GR-29/GR-29N, GR96172, and GR96173. Additional Disclosures This material is for information only and is not an offer or invitation to contract. Insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Discount programs provide access to discounted prices and are not insured benefits. Information is believed to be accurate as of the production date; however, it is subject to change. IF YOU ARE ELIGIBLE FOR MEDICARE NOW OR IN THE NEXT 12 MONTHS, YOU SHOULD UNDERSTAND THAT: This IS NOT a Medicare Supplement Policy. This prescription drug benefit IS NOT creditable coverage under Medicare Part D. You can get a free Guide to Health Insurance for People with Medicare at www.medicare.gov. Aetna will pay benefits only for services provided while coverage is in force, and only for medically necessary, covered services. These benefits may be modified where necessary to meet state mandated benefit requirements. The information in this document is a summary of the benefit plans available to eligible Staples associates for the 2014/2015 plan year. Details are provided in the summary plan descriptions and other plan documents, which are available from Human Resources and the applicable vendors. The plan documents contain the terms and conditions for each plan and govern the operation of the plans. In the event that the content of this document or any oral representation made by any person regarding the plans conflicts with or is inconsistent with the provisions of any plan document, the provisions of the plan document control. The provision of this document and the contents thereof are not intended to and shall not create any contractual relationship or guarantee of employment for any defined period of time between Staples and any recipients of this document, including, without limitation, Staples current and former associates. Eligibility for and enrollment in Staples benefit plans are subject to all terms and conditions of the plans. Staples reserves the right to amend, modify and/or terminate any or all of the plans at any time, in its sole discretion. May 2014 15