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your 2017BENEFITSnew hire enrollment guidePLUS benefits PACKAGE
Welcome to JCPenney!ContentsAt JCPenney, we’re proud to offer quality benefits to you and your family.Benefits and Actions Needed . . . . 3This New Hire Enrollment Guide provides highlights of the benefits forwhich you are eligible. You can find additional information and resources onJCPenney’s benefits website, PowerLine.The Basics . . . . . . . . . . . . . . . . . . 4Please be aware that as a newly hired associate, you must enroll for benefitswithin your first 30 days of employment to have coverage for the remainderof the year.* If you’re newly eligible for the PLUS benefits package, you mustenroll by the deadline listed on your PowerLine enrollment letter.DENTAL . . . . . . . . . . . . . . . . . . . . 9MEDICAL . . . . . . . . . . . . . . . . . . . 5PRESCRIPTION DRUGS . . . . . . . . . . . 8VISION . . . . . . . . . . . . . . . . . . . . 10FLEXIBLE SPENDING ACCOUNTS . . . . . 11401(k) SAVINGS PLAN . . . . . . . . . . . .12lIFE AND aD&D INSURANCEYour Benefit optionsAs a new JCPenney associate, you are eligible for a number of benefits—some arepaid in part or in full by you, while others are provided at no cost to you.Benefits you may elect: MedicalDentalVision401(k) Savings PlanFlexible Spending Accounts (FSAs)Supplemental Life InsuranceAD&D InsuranceSupplemental Long-Term DisabilityEmployee Stock Purchase Plan (ESPP)Legal ServicesHospitalization InsuranceAccident InsuranceCritical Illness InsuranceCommuter Benefit Benefits automatically providedat no cost to you: disability. . . . . . 13. . . . . . . . . . . . . . . . . 14Employee Stock Purchase Plan . . .15OTHER BENEFITS. . . . . . . . . . . . . 16ADDITIONAL JCPENNEY-PROVIDEDBENEFITS . . . . . . . . . . . . . . . . . 17Time off . . . . . . . . . . . . . . . . . . . 19Basic Life InsuranceShort-Term DisabilityBasic Long-Term DisabilityAssociate DiscountAdoption AssistanceBusiness Travel AccidentAdvocacy ServicesEmployee Assistance Program (EAP)My Time OffIncidental Time OffLeaves of Absence* Only applies to Health & Welfare benefits. 401(k) may be elected at any time; enrollment for ESPP occurs four times per year.2017 New Hire Guide, PLUS Benefits2
Benefits and Actions NeededPLUS BenefitsStart Date or Eligibility DateAction NeededPage401(k) Savings PlanDate of hire if you are at least 21 years oldEnroll any time via PowerLine12Accident Insurance31st day of employmentEnroll within 30 days of hire date via PowerLine16AD&D Insurance31st day of employmentEnroll within 30 days of hire date via PowerLine13Adoption AssistanceDate of hireSee policy on PowerLine18Advocacy ServicesDate of hireNo action—it’s automatic18Associate DiscountDate of hireActivate your card during your first week of employment17Business Travel AccidentDate of hireNo action—it’s automatic18Commuter BenefitDate of hireEnroll in this benefit at any time.Information is located on PowerLine16Critical Illness Insurance31st day of employmentEnroll within 30 days of hire date via PowerLine16DentalDate of hireEnroll within 30 days of hire date via PowerLine9Disability, Long-Term, BasicDate of hireNo action—it’s automatic14Disability, Long-Term, Supplemental31st day of employmentEnroll within 30 days of hire date via PowerLine14Disability, Short-TermFirst day of the third month of employmentNo action—it’s automatic14Employee Assistance Program (EAP)Date of hireIt’s automatic if medical is elected18Employee Stock Purchase Plan (ESPP)U.S. or Puerto Rico based associate, six monthsof service at start of enrollment windowEnroll during any of four annual enrollment periodsat www.NetBenefits.com15Flexible Spending Accounts (FSAs):Health Care and Dependent Day Care31st day of employmentEnroll within 30 days of hire date via PowerLine11Health Savings Account (HSA)First of the month following date of hireAccount opened automatically if you enroll in an HSAmedical plan. Change your contribution amount any time.6Hospitalization Insurance31st day of employmentEnroll within 30 days of hire date via PowerLine16Leaves of AbsenceMeet state, FMLA or military leave requirementsand have satisfactory or better job performanceNotify your Manager and request LOA by calling thePowerLine Absence Management Center 1-888-890-890020Legal Services31st day of employmentEnroll within 30 days of hire date via PowerLine16Life Insurance, BasicDate of hireNo action—it’s automatic13Life Insurance, Supplemental31st day of employmentEnroll within 30 days of hire date via PowerLine13MedicalDate of hireEnroll within 30 days of hire date via PowerLine5Time Off, MTOThe first deposit to your MTO account will be theNo action—it’s automaticfirst day of the third month of employment19Time Off, IncidentalVaries by type of incidental time offNo action—it’s automatic20Vision31st day of employmentEnroll within 30 days of hire date via PowerLine102017 New Hire Guide, PLUS Benefits3
The BasicsEligibilityWhen you are hired and classified asa full-time associate, you are eligiblefor the PLUS benefits package. Ifyour full-time status changes, you willremain eligible for PLUS benefits forthe remainder of the current and thefollowing calendar year. Subsequentbenefits eligibility determinations occurduring the “Annual Look-Back Period,”a 52-week period that ends in earlyOctober each year.To remain eligible for the Plus benefits,you must work 1,560 hours (average 30or more hours each week) during theAnnual Look-Back Period. Eligibility forsome benefits included in this guide mayrequire you to work, on average, 35 ormore hours each week.Who You Can CoverWhen you elect benefits, you can alsocover eligible dependents under certainplans. Eligible dependents include your: Spouse Children or stepchildren under age 26 Incapacitated childrenDependent VerificationProviding you and your eligibledependents with Health and Welfarebenefits is important to JCPenney. Sinceeveryone shares in the cost of coverage,participants who enroll dependents inJCPenney medical and dental plans arerequired to provide documents to verifythat their dependents meet the eligibilityrequirements.Once you enroll your dependents forcoverage, PowerLine will mail you adependent eligibility verification kitoutlining the steps you need to taketo establish that your dependents areeligible for coverage. Coverage foryour dependents is contingent on yousuccessfully completing the process.Paying for CoverageMedical, dental, vision and hospitalizationinsurance deductions, as well as HealthSavings Account (HSA) or FlexibleSpending Account (FSA) contributionsare taken out of your pay on a before-taxbasis and will lower your taxable income.All other deductions to pay for benefitsare taken on an after-tax basis.Changing Your CoverageThe benefits you elect are effectivethrough Dec. 31, 2017, so choose yourbenefits coverage carefully. As a rule, onceyou are enrolled, you may not change,add or drop your benefit choices until theAnnual Enrollment period (which usuallyoccurs in October or November, forcoverage the following year).Certain changes may be allowed duringthe year if you have a qualified statuschange that is reported to PowerLine(either online or by phone) within 60 daysof the qualified status change.A qualified status change is defined by theIRS and may include, but is not limited to: Change in legal marital status,marriage, divorce, legal separation,death of spouse Change in number of dependents—birth,adoption or placement for adoption Change in dependent’s age Change in place of residence or worksiteIf you enroll new dependents, you mustverify their eligibility. PowerLine will sendverification information to your homeafter enrollment.Annual Earnings for BenefitsAnnual Earnings for Benefits (AEB)is used to determine your medicalpremiums, as well as your benefits forBasic and Supplemental Life Insurance,Basic and Supplemental Long-TermDisability, AD&D Insurance, BusinessTravel Accident and bonus.As a new hire, your AEB is calculatedbased on your current annualized basepay, rounded up to the next 1,000. Infollowing years, your AEB is the greaterof: Current calendar year annualizedpay bonus paid year-to-date ORgross wages for the prior calendar year.Earnings used to calculate AEB areobtained annually in mid-August.2017 New Hire Guide, PLUS Benefits4
YOUR MEDICAL OPTIONSJCPenney’s medical plans, administeredby Cigna, can help protect your physicaland financial health. Choose either theHRA 1000, HSA 1500 or HSA 2000.If you enroll for medical coveragewithin 30 days of hire, your coveragewill be effective on your hire date, butyour premiums will not begin untilyour 31st day of employment. Onceenrolled, the carrier will be notified, andproviders will be able to verify yourcoverage. All medical plans includeprescription drug coverage, a low-costtelemedicine option and 100 percentcovered in-network preventive care. Seethe Preventive Care Guidelines in theBenefits Toolbox on PowerLine for a fulllist of covered preventive care services.If your or your covered spouse’smedical claims indicate treatment forany of five serious health conditions(asthma, diabetes, COPD, congestiveheart failure or coronary artery disease),you may be contacted to enroll in aHealth Management Program. A 50per person, per month surcharge willbe added to your medical premiumsif you and/or your covered spouse areidentified for a Health ManagementProgram and you do not completethe program within 90 days of beingidentified.Your Medical Plan BenefitsHRA 1000HSA 1500HSA 2000100% covered100% covered100% coveredYou Only 1,000 1,500 2,000You Spouse, Children or Family 2,000Preventive Care (in-network)All coverage levelsAnnual Deductible (in-network) 3,000 4,0002You pay 20%You pay 30%You pay 30%You Only 5,000 6,000 6,250You Spouse, Children or Family 10,000 12,000 12,5003You Only 200 HRA 500 HSANoneYou Spouse or Children 400 HRA 750 HSANoneYou Family 600 HRA 1,000 HSANoneNone; you cannotcontribute to an HRAUp to IRS limits: 3,400individual/ 6,750 family(including JCP contribution)Up to IRS limits: 3,400individual/ 6,750 family12Co-Insurance (in-network; after you meet the deductible)All coverage levelsAnnual Out-of-Pocket Maximum (in-network)3Account Contributions from JCPenney4Account Contributions from You1 Individual deductible: 1,000 or shared family deductible: 2,000.2 There is no individual deductible when you cover a dependent. The deductible may be met by one or more family members.3 Once an individual has expenses equal to the “You Only” out-of-pocket maximum, future expenses for that individual will be paid 100 percent bytheNewplan.2017Hire Guide, PLUS Benefits4 JCPenney contributions are pro-rated for new hires.5
Advantages of a Health Savings Account (HSA)An HSA offers you more flexibility in how you spend and saveyour healthcare dollars. L ike with a Flexible Spending Account (FSA), you can useyour HSA to pay current medical, prescription drug, dentaland vision expenses. But unlike an FSA, your unused HSAfunds roll over each year so you can use them for futurehealthcare expenses, even in retirement. Premiums for the HSA 1500 and HSA 2000 medical plansare lower than the HRA 1000 plan. Any funds over 1,000 in your HSA can be invested. You benefit from tax savings in three ways:1. Y ou contribute to your HSA before taxes are withheldfrom your paycheck, which lowers your taxable income.Your HSA will be administered by HealthEquity.HSA Contribution Limits for 2017The IRS limits how much you can contribute to your HSA eachyear, but there’s no limit to how large your account can growover the years. The contribution limits for 2017 are: Y ou Only coverage: Up to 3,400(For the HSA 1500, this includes JCPenney’s contribution) You Spouse, Children or Family coverage: Up to 6,750(For the HSA 1500, this includes JCPenney’s contribution) Those age 55 and older may make an additional 1,000catch-up contribution2. Your money grows tax-free as long as it is in your HSA.3. You don’t pay taxes when you use your HSA to covereligible healthcare expenses.A full list of eligible expenses can be found in the AnnualEnrollment Toolbox on PowerLine and atwww.irs.gov/publications/p502.Interesting Facts About HSAs in the U.S.:16.7 millionIndividualHSAs30.2 billion TotalHSA Assets843 Average One-YearAccount Balance7,223 Average Ten-YearAccount BalanceSource: Devenir Group2017 New Hire Guide, PLUS Benefits6
Compare Health AccountsHRAs, HSAs, FSAs—they may sound alike, but each has its own unique benefits and requirements.Health ReimbursementAccount (HRA)Health SavingsAccount (HSA)Healthcare FlexibleSpending Account (FSA)Who can contribute?JCPenney onlyYou and JCPenney*You onlyWhen are funds available?Total annual amount is availableon Jan. 1.Your contributions and any moneyfrom JCPenney are deposited eachpay period. You may use funds asyour account balance allows.Total annual election is availableon Jan. 1.HRA funds are automaticallypulled from your account topay medical deductibles andco-insurance.Pay medical, prescription drug,dental and vision deductibles,co-pays and co-insurance by usingyour HSA debit card or payingonline. Or reimburse yourself forqualified out-of-pocket expensesby funds transfer.Pay medical, prescription drug,dental and vision deductibles,co-pays and co-insurance byusing your FSA debit card orpaying online. Or reimburseyourself for qualified out-ofpocket expenses by fundstransfer.YesNo (except in limitedcircumstances)Unused funds remain in youraccount for future use.You will lose unused funds atthe end of the year.What happens to the fundsYou will forfeit any unused fundsin my HRA or HSA if Iin your account.change medical plans? Unused funds always remain inyour HSA and are yours to usefor future medical expenses. If you do not enroll in an HSAmedical plan in 2017, you cannotmake any additional contributionsto your account.N/ACan I take the account withNome if I leave JCPenney?YesNoCan I invest funds?NoYes, for amounts over 1,000NoCan I make catch-upcontributions if I’m age 55or older?NoYes, up to an additional 1,000NoHow do I use the moneyin my account?Can I make mid-yearchanges to my contribution N/Aamount?What happens to unusedfunds on Dec. 31?Unused funds roll over to the nextyear, as long as you remain in theHRA 1000 plan.* Both you and JCPenney may contribute to the HSA 1500; only you contribute to the HSA 2000.2017 New Hire Guide, PLUS Benefits7
PRESCRIPTION DRUGSAll three medical options includeprescription drug coverage, administeredby Express Scripts.Preventive drugs are not subject to themedical plan deductible, and some areeven available at no cost to you. See the2017 Preventive Drug List on PowerLinefor details.Under the HSA 1500 and HSA 2000 planoptions, non-preventive prescriptions aresubject to the medical plan deductible.This means you must meet the annualdeductible before the plan beginspaying for a portion of your prescriptiondrug costs.You may fill your prescriptions at a retailpharmacy or through Express Scripts’convenient mail order service. Ifyou fill certain maintenance drugprescriptions at the retail pharmacyinstead of through mail order, you willpay a 15 surcharge in addition to thecost of your prescription. The surchargeapplies after two retail pharmacy fillsand does not apply to your deductibleor out-of-pocket maximum.Your Prescription Drug Benefits1HRA 1000HSA 1500 or HSA 2000PreventiveNo cost2 or you pay 10%( 5 min.3/ 25 max.)No cost2 or you pay 10%, no deductible ( 5 min.3/ 25 max.)GenericYou pay 20% ( 10 min.3/ 100 max.)After medical deductible, you pay 20% ( 10 min.3/ 100 max.)Formulary brandYou pay 30% ( 25 min.3/ 100 max.)After medical deductible, you pay 30% ( 25 min.3/ 100 max.)Non-formulary brandYou pay 40% ( 50 min.3/ 200 max.)After medical deductible, you pay 40% ( 50 min.3/ 200 max.)PreventiveNo cost2 or you pay 10%( 10 min.3/ 50 max.)No cost2 or you pay 10%, no deductible ( 10 min.3/ 50 max.)GenericYou pay 20% ( 25 min.3 / 200 max.)After medical deductible, you pay 20% ( 25 min.3/ 200 max.)Formulary brandYou pay 30% ( 50 min.3/ 200 max.)After medical deductible, you pay 30% ( 50 min.3/ 200 max.)Non-formulary brandYou pay 40% ( 100 min.3/ 400 max.)After medical deductible, you pay 40% ( 100 min.3/ 400 max.)Network PharmaciesHome Delivery Mail OrderPharmacy Out-of-Pocket Maximum4You Only 1,600Combined with medical out-of-pocket maximumYou Spouse,Children or Family 3,200Combined with medical out-of-pocket maximum1 Certain prescription drugs are not covered under the Prescription Drug Program. The list of excluded drugs may change from time to time. See the Prescription Drug ExclusionsList on PowerLine or contact Express Scripts for details.2 Certain preventive medications are covered at 100 percent. All preventive prescriptions are available without a deductible requirement. See the Preventive Drug List on PowerLine for details.3 Or actual cost, whichever is less.4 Certain specialty drugs used to treat complex, chronic and often costly conditions have a variable co-pay depending on the drug. If you are receiving medications through thespecialty pharmacy, Accredo, please contact Accredo Customer Service to determine how your specialty drug might affect your pharmacy out-of-pocket maximum.2017 New Hire Guide, PLUS Benefits8
YOUR DENTAL OPTIONSYou can choose from three dental plan options, all administered by Aetna. The Dental Basic option provides preventive and basic services only. The Dental Plus option offers basic services, plus major services and orthodontia. The DMO option (not available in all locations) offers basic, major and orthodontiaservices without a deductible, but only within Aetna’s DMO network.If you enroll for dental coverage within30 days of hire, your coverage will beeffective on your hire date, but yourpremiums will not begin until your 31stday of employment. Once enrolled, thecarrier will be notified, and providers willbe able to verify your coverage.Your Dental BenefitsDental BasicDental PlusDMO1You Only 50 50 0You Spouse,Children or Family 150 150 0 1,000 2,000No maximumPreventive care(Oral exams, cleanings,X-rays, etc.)JCPenney pays 100%2(no deductible)You pay 0JCPenney pays 100%2(no deductible)You pay 0JCPenney pays 100%You pay 0Basic care(Fillings, extractions,sealants, etc.)JCPenney pays 70%2(after deductible)You pay 30%JCPenney pays 80%2(after deductible)You pay 20%JCPenney pays 100%You pay 0Major care(Bridgework, crowns,inlays, etc.)Not coveredYou pay 100%JCPenney pays 50%2(after deductible)You pay 50%JCPenney pays 50%You pay 50%OrthodontiaNot coveredYou pay 100%JCPenney pays 50%2(no deductible), up to 2,000per person, per lifetimeYou pay 50%JCPenney pays 50%(no deductible). Limitedto one complete course oftreatment per lifetimeYou pay 50%Annual DeductibleAnnual Maximum Benefit (the most the plan will pay in benefits)All coverage levelsExamples of Covered Services1 You must use an Aetna DMO provider.2 Reasonable and customary limits.2017 New Hire Guide, PLUS Benefits9
YOUR VISION OPTIONSTake care of your eyes and keep yourvision crystal clear with vision coveragethrough VSP. You and your family canget quality vision care and prescriptioneyewear through an extensive networkof providers nationwide, as well asJCPenney Optical.You may use your JCPenney associatediscount along with your VSP benefits atJCPenney Optical to save even more. Ifyou prefer, you can receive benefits froma provider outside the VSP network, butyour costs may be higher.Your Vision Benefits1In-NetworkOut-of-NetworkJCPenneyOptical12 months12 months12 months 20 co-pay 20 co-pay( 45 allowance) 20 co-pay2( 75 allowance)Single vision 0 co-payUp to 30 allowanceBifocal 0 co-pay (lined) Up to 50 allowanceTri
enroll by the deadline listed on your PowerLine enrollment letter. your Benefit oPtions As a new JCPenney associate, you are eligible for a number of benefits—some are paid in part or in full by you, while others are provided at no cost to you. . (including JcP contri
