ACTION REQUIRED!You must actively enroll during Open Enrollment to have most benefits in 2020. Read this guide for the paw-ticulars.
SALARIED PARTNERS
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2020 Open EnrollmentGuideOpen enrollment is Dec. 2 to 15, 2019
ACTION REQUIRED!You must enroll in the following plans to have coverage beginning February 1, 2020. If you don’t enroll, coverage in these plans will end on January 31, 2020.
• Medical, dental and vision
• Health savings account (HSA)
• Flexible spending accounts (FSA)
• Voluntary critical illness, accident and hospital indemnity insurance
See page 4 for more information about the default benefits that will apply if you miss the December 15 enrollment deadline.
2020 Open Enrollment checklistUse this checklist to help you enroll in your 2020 benefits by December 15.
Bury your nose in this Open Enrollment Guide • Get an overview of benefit changes for 2020 and what you need to
do to enroll.
Access other resources to learn about your 2020 benefits • Review the resources available on the Benefitfocus website. Go to
www.mypetcobenefits.com and click on the Login Here button.
• Get information about the new medical and dental plans administered by Collective Health at http://join.collectivehealth.com/petco or call 844-516-3836 starting December 2 to speak to a Member Advocate.
Enroll in your 2020 benefits from December 2 to 15 • Go to www.mypetcobenefits.com and click on the Login Here button to
enroll in your 2020 benefits using Benefitfocus.
• Call the Petco Benefits Service Center at 855-847-6067 to enroll in your 2020 benefits over the phone or get answers to your benefit questions. Representatives are available Monday-Friday from 8 a.m. to 8 p.m. ET.
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InsideWelcome to Open Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Take paws and find out what’s new for 2020. . . . . . . . . . . . . . . . . . . . . . . . . 1
2020 Open Enrollment action items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Enroll in your 2020 benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Default benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Prescription drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Teladoc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Health savings account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Flexible spending accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Life & AD&D insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Disability insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Legal assistance plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Voluntary benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Petco preventive care and Petco insurance . . . . . . . . . . . . . . . . . . . . . . . . . 18
Dependent eligibility reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Other valuable benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Sign-up for text message alerts!
Sign-up for text message alerts on your smartphone to receive notifications from Petco about benefit program
deadlines and events. Petco does not charge for text message alerts sent to you. You may incur charges from your wireless carrier
for text messages. Check with your wireless carrier for possible charges.
To sign up, text BENE9 to 31996. To stop, text STOP to 31996.
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Welcome to Open EnrollmentYou talked. We listened.We’re making exciting changes to our benefits in 2020, many of which are in response to your feedback and the results of the benefits satisfaction survey completed earlier this year.
You told us you needed more affordable medical plans with easier access to care. We heard you and Petco is making a significant investment in the health plans to lower your costs and make it easier to get the care you and your family need. You also told us you want better tools and resources to make it easier to understand and use your healthcare benefits. We are putting healthcare resources right at your fingertips that you can access 24/7 from your smartphone or computer.
• Affordable premiums – ALL medical plans have lower premiums in 2020 – that means you’ll have more left in your paycheck for other important things in your life
• Affordable care – we’re adding low-cost copays for the basics like doctor visits and prescriptions
• Accessible care – all Collective Health PPO Plan participants will have access to Teladoc for $0 copay (and $49/visit for HSA participants until the deductible is met) – that’s right, a doctor is just a click away on your smartphone or computer at no cost to you
• Simpler care – transparency tools and other great features are coming your way in 2020 under the Collective Health Plans – these tools take the guesswork out of finding the best quality care at the lowest price and it’s easy to use on the Collective Health app or website
This guide will walk you through what you need to know about your 2020 benefit choices. With new medical and dental options starting Feb. 1, 2020, you must act and enroll in your benefits by December 15, 2019. If you miss the enrollment deadline, most benefits will end on January 31, 2020.
Lower medical plan premiums in 2020In response to your feedback, all Petco medical plans will have lower premiums in 2020.
Take paws and find out what’s new for 2020We’re making some important changes and enhancements to our benefits program for 2020 to simplify your healthcare experience and raise the bar in how we support our partners.
Telemedicine through Teladoc with option to have $0 copay for doctor visitsWhen you enroll in a Collective Health medical plan, you can use Teladoc, giving you convenient 24/7 video access to doctors who can diagnose, treat and write prescriptions to your local pharmacy for most non-emergency conditions. You’ll have a $0 copay for doctor visits if you enroll in the Enhanced or Value PPO plans. If you enroll in the HSA Plan, you will pay $45 per visit until you satisfy your deductible, and then doctor visits are offered at no charge. To learn more about Teladoc, see page 9.
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New medical and dental plan options through Collective HealthWe are partnering with Collective Health as the administrator of our new medical and dental plans replacing the Anthem Blue Cross medical plans and the Cigna dental plans. With Collective Health, you’ll have access to enhanced tools and valuable resources to help you understand your benefits and make smart enrollment choices. For medical, see page 5. For dental, see page 14.
Save more money with a health savings accountIf you enroll in the HSA plan, Petco contributes to your HSA up to $250 ($62.50 every quarter) for employee-only coverage and up to $500 ($125 every quarter) if you cover at least one dependent. You can contribute pre-tax dollars up to $3,300 for employee only and $6,600 for employee + dependents coverage. If you are age 55 or older in 2020, you can contribute an additional $1,000 to your HSA. See page 11 for more information about the HSA.
Healthcare FSA maximum is increasingIn 2020, you can set aside up to $2,750 in a healthcare FSA or a limited use FSA. If you are enrolled in the CDHP with HSA, you can open a limited use FSA to pay for eligible dental and vision expenses only. See page 12 for more information about the FSAs.
HRA ends on January 31, 2020Beginning February 1, 2020, Petco will no longer provide a health reimbursement account (HRA) for employees enrolled in a Petco medical plan. You may continue to submit expenses for reimbursement through April 30, 2020 for eligible expenses incurred by January 31, 2020.
In lieu of an HRA, Petco has redesigned the medical plans to provide affordable access to healthcare by lowering medical plan premiums and introducing affordable copays for visits to a doctor or urgent care center.
New voluntary benefits through TransamericaVoluntary critical illness, accident and hospital indemnity will be offered through Transamerica. You can enroll during this year’s Open Enrollment without evidence of insurability. See page 17 for more information about voluntary benefits.
Grand Rounds medical expert second opinion serviceIf you enroll in a Collective Health medical plan, you will have access to Grand Rounds at no additional charge. Grand Rounds can help you get a second opinion or personalized care plan for any diagnosis from a world-leading expert. See page 6 for more information about Grand Rounds.
Get Care price transparency toolCollective Health members have access to the Get Care price transparency tool making it simple to make value-based care decisions by finding high-quality, cost effective facilities and doctors in their area.
Walmart and Sam’s Club added to the VSP networkStarting February 1, 2020, you have network coverage for your vision needs at Walmart and Sam’s Club. See page 13 for more information about vision benefits.
Go to mypetcobenefits.com and click on Login Here to view medical plan premiums for the 2020 plan year.
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2020 Open Enrollment action itemsIf you don’t take action during Open Enrollment, you cannot make changes to most benefits until the next Open Enrollment (for 2021), unless you have a life event change during the year such as a marriage or the birth or adoption of a child.
Can Change/Enroll Only During Open EnrollmentIf you are eligible, you can add or change these benefits during Open Enrollment or continue current coverage in 2020:
Voluntary employee and dependent life Short-term disability
Voluntary accidental death & dismemberment Long-term disability
Legal assistance plan
Can Change/Enroll at Anytime*If you are eligible, you can elect or change these benefits at any time:
401(k) Plan Petco preventive care
Auto & home insurance Petco insurance
Required Elections During Open EnrollmentIf you are eligible, you must enroll in these benefits during Open Enrollment if you want coverage in 2020:
Medical Health savings account Accident
Dental Flexible spending accounts Hospital Indemnity
Vision Critical Illness
* After eligibility effective date.
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Enroll in your 2020 benefitsEnroll onlineThe easiest way to choose your benefits for 2020 is through the Benefitfocus website.
• Go to mypetcobenefits.com and click on Login Here
• For new users, follow the onscreen instructions to create an account on the Benefitfocus website
Call the Petco Benefits Service CenterYou can call the Petco Benefits Service Center to enroll in your benefits or get answers to your benefit questions.
• Call 855-847-6067 M-F from 8 a.m. to 8 p.m. ET
Default benefitsIf you do not take action during Open Enrollment, you will not have medical, dental, vision, health savings account, flexible spending accounts or voluntary benefits (critical illness, accident, hospital indemnity) effective February 1, 2020.
If you miss the enrollment deadline, your benefits effective February 1, 2020 will default to the coverages shown here.
BENEFIT DEFAULT COVERAGE
Basic life and AD&D• Salaried partners & Directors• Officers
1X annual earnings, max $250,000 paid by Petco3X annual earnings, max $1,000,000 paid by Petco
Voluntary employee and dependent life Current coverage
Voluntary AD&D Current coverage
Basic short-term disability• Salaried partners• Directors• Officers
60% of earnings, max $500 per week, paid by Petco60% of earnings, max $2,000 per week, paid by Petco67% of earnings, max $3,500 per week, paid by Petco
Buy-up short-term disability• Salaried partners
Current coverage
Basic long-term disability• Salaried partners & Directors• Officers
60% of earnings, max $11,500 per month, paid by Petco67% of earnings, max $22,000 per month, paid by Petco
Buy-up long-term disability• Salaried partners Current coverage
Petco preventive care Current coverage
Petco insurance Current coverage
Legal assistance plan Current coverage
Employee Assistance Program Covered
2020 Default Benefits
Medical Petco has completely redesigned the medical plans for 2020 reducing premiums across the board, and partnering with Collective Health to bring innovation and an improved experience to understanding and using healthcare. Here’s what you need to know about our new plans.
If you live in CA, CO, DC, GA, MD, OR, VA or WA, you have three additional medical plans through Kaiser Permanente. Your eligibility to select a Kaiser Permanente plan is determined by your home zip code.
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Enhanced PPO Plan• Highest premiums
• Lowest deductible
• Copays for doctor visits, urgent care andgeneric drugs
• Telemedicine doctor visit through Teladochas a $0 copay
Value PPO Plan• Lowest premiums
• Highest deductible
• Copays for doctor visits, urgent care andgeneric drugs
• Telemedicine doctor visit through Teladochas a $0 copay
HSA Plan• Premiums in-between Enhanced and
Value PPO plans
• High deductible
• Must meet the deductible before theplan begins to pay for services otherthan preventive care. After you’ve metthe deductible, you’ll pay 20% for mostcovered services
• Telemedicine doctor visit through Teladochas a $45 copay before the deductible ismet and a $0 copay after the deductibleis met
• Petco will make quarterly contributionsinto your HSA up to $250 per planyear for employee only coverage andup to $500 per year for employee +dependent(s)
Note: While the HSA plan may be a good choice for someone who is a low utilizer of healthcare and has predictable expenses, it might not be the right plan for everyone. Contact a Collective Health Member Advocate at 844-516-3836 for assistance evaluating the medical plans available to make the best choice for you.
Transition of careIf you are currently receiving care for an ongoing medical condition (including pregnancy) from an Anthem Blue Cross provider who is not in the Blue Shield network, you may be eligible for transition assistance for a limited period of time. Contact Collective Health on or after Dec. 2, 2019 at 844-516-3836 and speak to a Member Advocatewho can assist you.
Nicotine Use Surcharge Smoking is the leading preventable cause of serious disease. If you make the healthy choice not to use nicotine, you can avoid a $15 per pay period nicotine use surcharge on your medical contribution. You will be required to state your nicotine use status when you make your enrollment elections. This applies to partners and eligible dependents.
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Collective HealthEffective February 1, 2020, Collective Health will replace Anthem Blue Cross and CIGNA as the administrator for Petco’s medical and dental plans. Collective Health utilizes the Blue Shield medical provider network and the Delta Dental provider network.
Why Collective Health?Collective Health is passionate about delivering an exceptional overall experience when it comes to managing your healthcare. They combine technology and industry expertise to help members better understand their benefits and navigate through their healthcare needs.
With Collective Health’s unique platform, you will be able to view your medical, pharmacy and dental claims all in one place (excluding Kaiser plans and the dental HMO). You can work online or with a Member Advocate to ask questions, submit claims, or use their transparency tool to find providers who are highly-ranked among their peers for delivering quality healthcare. These tools can also help you compare costs between providers and/or procedures in your area to help you make the most effective decision for your health and your wallet.
Contact Collective Health Beginning Dec. 2, 2019
http://join.collectivehealth.com/petco
844-516-3836M-F, 6 a.m.-6 p.m. PST
Search for the Collective Health mobile app on the App Store or Goggle Play
Finding Blue Shield network providersBlue Shield has an extensive provider network with significant overlap of in-network providers with Anthem Blue Cross. To find out if your provider is part of the Blue Shield network or to find a new in-network provider, use the Collective Health online portal above and go to “Find Care.” If you have questions or need assistance finding in-network providers, contact Collective Health by phone or email noted above.
Member AdvocatesCollective Health’s Member Advocates can:
• Help you understand your coverage
• Give you a single place to review yourclaims history
• Answer your questions
• Connect you to programs that meet your uniqueneeds including mental health support, healthcoaching, expert medical advice and more.
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Collective Health Medical PlansPlan Feature Enhanced PPO Plan Value PPO Plan HSA Plan
Plan Year Deductible• Employee• Family
$1,000$2,000
$4,000$8,000
$2,000$4,0001
Petco Contribution to HSA• Employee• Family
n/an/a
n/an/a
$250 ($62.50 quarterly)5
$500 ($125 quarterly)5
Plan Year Out-of-Pocket Max• Employee• Family
$6,000 $12,000
$6,000 $12,000
$4,000 $8,000
In-Network YOU PAY
In-Network YOU PAY
In-Network YOU PAY
Preventive Care $03 $03 $03
Telemedicine Virtual Doctor Visitthrough Teladoc
$03 $03 $45 (until plan year deductible is met)
$0 (after plan year deductible is met)
Office Visit • PCP• Specialist
$25 copay$50 copay
$40 copay$80 copay
20%2
20%2
Urgent Care $100 copay $100 copay 20%2
Emergency Room 20%2 30%2 20%2
Diagnostic Testing 20%2 30%2 20%2
Outpatient X-Ray and Lab 20%2 30%2 20%2
Hospitalization• Inpatient Semi-Private Room• Inpatient Physician
20%2
20%2
30%2
30%2
20%2
20%2
Outpatient Treatment (PT, OT, ST) 20%2 30%2 20%2
Mental Health/Substance Abuse• Inpatient• Outpatient
20%2
20%230%2
30%220%2
20%2
Pharmacy Retail• Specified Preventive Drugs4
• Generic• Brand Formulary• Brand Non-Formulary
30-day supply 100% covered3
$10 copay20%3
30%3
30-day supply 100% covered3
$10 copay30%3
30%3
30-day supply 100% covered3
20%2
20%2
20%2
Pharmacy Mail Service• Specified Preventive Drugs4
• Generic• Brand Formulary• Brand Non-Formulary
90-day supply 100% covered3
$20 copay20%3
30%3
90-day supply 100% covered3
$20 copay30%3
30%3
90-day supply 100% covered3
20%2
20%2
20%2
1) The family deductible must be met before any person receives benefits.2) Coinsurance you pay after you meet the plan year deductible unless otherwise noted.3) Plan year deductible waived.4) As specified in essential drug list. 5) Beginning 02/01/2020.
2020 medical plans at-a-glanceCollective Health Medical Plans: See the Collective Health Summary of Benefits & Coverage (SBC) for the applicable medical plan available on the Benefitfocus website for details on Collective Health medical plan benefits.
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Kaiser Permanente Medical PlansPlan Feature Enhanced Plan Value Plan HSA Plan
Plan Year Deductible• Employee• Family
$1,000$2,000
$4,000$8,000
$2,000
$4,0001 ($2,8002 CA)
Petco Contribution to HSA• Employee• Family
n/an/a
n/an/a
$250 ($62.50 quarterly)6
$500 ($125 quarterly)6
Plan Year Out-of-Pocket Max• Employee• Family
$6,000 $12,000
$6,000 $12,000
$4,000 $8,000
Kaiser Network Providers YOU PAY
Kaiser Network Providers YOU PAY
Kaiser Network Providers YOU PAY
Preventive Care $04 $04 $04
Telemedicine Virtual Doctor Visit through Kaiser
$04 $04 $0
Office Visit • PCP• Specialist
$25 copay$50 copay
$40 copay$80 copay ($50 copay CA)
20%3
20%3
Urgent Care $100 copay ($25 copay CA) $100 copay ($40 copay CA) 20%3
Emergency Room 20%3 30%2 20%3
Diagnostic Testing 20%3 30%3 20%3
Outpatient X-Ray and Lab 20%3 30%3 20%3
Hospitalization• Inpatient Semi-Private Room• Inpatient Physician
20%3
20%3
30%3
30%3
20%3
20%3
Outpatient Treatment (PT, OT, ST) 20%3 30%3 20%3
Mental Health/Substance Abuse• Inpatient• Outpatient
20%3
20%330%3
30%320%3
20%3
Pharmacy Retail• Specified Preventive Drugs5
• Generic• Brand Formulary• Brand Non-Formulary
30-day supply 100% covered4
$10 copay20%4 ($100 max CA)
30%4 (20%,3 $100 max CA)
30-day supply 100% covered4
$10 copay30%4 ($100 max CA)30%4 ($100 max CA)
30-day supply 100% covered4
20%3 ($50 max CA)20%3 ($100 max CA)20%3 ($100 max CA)
Pharmacy Mail Service• Specified Preventive Drugs5
• Generic• Brand Formulary• Brand Non-Formulary
90-day supply 100% covered4
$20 copay20%4 ($100 max CA)
30%4 (20%,3 $100 max CA)
90-day supply 100% covered4
$20 copay30%4 ($100 max CA)30%4 ($100 max CA)
90-day supply 100% covered4
20%3 ($50 max CA)20%3 ($100 max CA)20%3 ($100 max CA)
1) The family deductible must be met before any person receives benefits.2) In CA, a covered family member needs to meet a $2,800 plan year deductible before the plan starts sharing costs for that family member under the HSA Plan.3) Coinsurance or copay you pay after you meet the plan year deductible unless otherwise noted.4) Plan year deductible waived.5) As specified in essential drug list. 6) Beginning 02/01/2020.
2020 medical plans at-a-glanceKaiser Permanente Medical Plans: You must live in a Kaiser Permanente service area in CA, CO, DC, GA, MD, OR, VA or WA. You must use Kaiser network providers only except for certain emergency situations. Benefits in RED are for California residents only. See the Kaiser Summary of Benefits & Coverage (SBC) for your state available on the Benefitfocus website for details on Kaiser medical plan benefits.
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Prescription drugsAll medical plans include prescription drug coverage.
Prescription drugs with a Collective Health medical planWhen you enroll in a medical plan administered by Collective Health, you automatically receive prescription drug coverage through CVS. The CVS pharmacy network has more than 68,000 pharmacies nationwide, including 9,900 CVS pharmacies plus many national and independent retail pharmacies.
Prescription drugs with a Kaiser Permanente medical planWhen you enroll in the Kaiser medical plan, you automatically receive prescription drug coverage through Kaiser. Many Kaiser Permanente facilities have pharmacies in the building. You can refill prescriptions in person, online or by phone.
Refill in person: Bring your prescription to a Kaiser pharmacy.
Online: Visit kp.org/rxrefill to order your prescription refills online after you register at kp.org/registernow.
Phone: Call the pharmacy refill phone number highlighted on your prescription label.
Specified Preventive DrugsCertain generic preventive medications (like birth control) are covered at no cost and not subject to annual deductibles provided certain requirements are met.
Generic DrugsGeneric drugs have the lowest costs and are considered identical to their brand name equivalents by the FDA in terms of efficacy and safety.
Brand FormularyDrugs on the brand formulary are designated as preferred based on their cost effectiveness and, in some cases, efficacy. If you or your provider choose a brand formulary medication when a generic is available, you’ll pay the difference in cost between the generic and the brand formulary drug.
Brand Non-FormularyBrand name drugs not on the brand formulary have the highest copays. When you fill a prescription, you can ask the pharmacist whether a generic or brand formulary drug of your medication is available. If you or your provider choose a brand non-formulary medication when a generic is available, you’ll pay the difference in cost between the generic and the brand nonformulary drug.
TeladocIllness doesn’t always happen from 9 to 5 or when you’re close to home. Teladoc provides you with 24/7 access to a national network of U.S. board certified doctors when you are enrolled in a Collective Health medical plan. And depending on your medical plan enrollment, the service may be free.
You can connect with a Teladoc physician from anywhere—home, work or on the road. Teladoc doctors diagnose non-emergency medical problems, recommend treatment, and can even call in any necessary prescriptions to your pharmacy.
Teladoc doctors can treat a range of conditions including:
• Respiratory infections • Allergies
• Ear infections • Cold and flu
• Urinary tract infections • Sore throat
2020 Medical Plan Your Cost Per Visit
Enhanced PPO Plan $0
Value PPO Plan $0
HSA PlanBefore deductible: $45
After deductible: $0
Get started using Teladoc beginning Feb. 1, 2020
Once you receive your Collective Health medical ID card, set up an
account at teladoc.com.
Complete your medical history.
Request a consultation with a Teladoc doctor and a board-certified physician
will call or video chat with you.
If you are enrolled in the Enhanced or Value PPO Plan, you pay $0. If you are enrolled in the HSA Plan, you pay $45
until your deductible is met, and $0 after your deductible is met.
Feel good all over with FREE doctor visits from Teladoc.
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Health savings accountIf you enroll in the HSA Plan through Collective Health or Kaiser, you have the option to contribute to a health savings account (HSA). The HSA offers tax savings and can be used to cover eligible medical, pharmacy, dental and vision expenses now or in the future. Unlike money in an FSA, the funds in your HSA roll over each year and continue to build. Your HSA funds are also portable, so if you leave Petco, you can take your account balance with you.
Key things to know about a health savings account
HRA ends on January 31, 2020See page 2 for information about the HRA ending on January 31, 2020.
Petco contributes to your HSA up to $250 ($62.50 per quarter) for employee-only coverage and up to $500 ($125 per quarter) if you cover at least one dependent.
You decide when to spend (or save) your HSA dollars. Any unused money remaining in your account at the end of the plan year rolls over for you to use to pay for eligible expenses now or save for the future.
In 2020, you can contribute pre-tax dollars up to $3,300 for employee only and up to $6,600 if you cover at least one dependent. If you are 55 or older in 2020, you can contribute an additional $1,000.
You can contribute to an HSA if your are enrolled in the HSA Plan and you are not covered by any other medical plan, Medicare, Medicaid, TRICARE or a healthcare FSA. Also you cannot be claimed as a dependent on another person’s tax return.
You can use your HSA to pay for eligible medical, dental and vision expenses.
You can adjust your HSA payroll contributions at any time during the year.
Your HSA earns interest, and once the balance reaches a certain amount (typically $2,000), you can choose to invest the amount above $2,000 similar to how the 401(k) plan works.
Medical ID cardsIf you enroll in a Collective Health medical plan, you will receive a new medical/prescription drug ID card in January 2020.
If you enroll in a Kaiser Permanente medical plan for the first time in 2020, you will receive a new medical/prescription drug ID in January 2020 from Kaiser.
Dental ID cardsIf you enroll in the Standard or Enhanced Dental Plan administered by Collective Health, you will receive a new dental ID card in January 2020.
If you enroll in the Delta Dental HMO, you will receive a new dental ID card directly from Delta Dental in January 2020.
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Flexible spending accountsHealthcare flexible spending accountA healthcare FSA gives you a tax break on many medical, dental and vision expenses that are not covered by other plans. By anticipating your expenses and arranging for deductions to be made from your paycheck each pay period, you lower your tax bill. You can set aside up to $2,750 in 2020 on a pre-tax basis to cover eligible medical, dental and vision expenses
Limited use flexible spending accountIf you enroll in the HSA Plan and open a health savings account, you can open a limited use FSA to set aside a portion of your earnings on a pre-tax basis to pay for dental and vision expenses only. You can set aside up to $2,750 in 2020 on a pre-tax basis to cover eligible dental and vision expenses not reimbursed by any other health plan.
Dependent daycare flexible spending accountA dependent daycare FSA allows you to pay for eligible day care or elder care expenses while you are working. You can set aside up to $5,000 each plan year on a pre-tax basis to cover the cost of dependent day care expenses.
The amount you contribute to a dependent daycare FSA cannot be greater than your income or your spouse’s income, whichever is less. If your spouse contributes to a dependent care FSA through his or her employer, your combined contributions may not exceed $5,000.
Healthcare Flexible Spending Account
Annual maximumcontribution
Up to $2,750 in 2020
Eligible expenses Medical, dental and vision care expenses not paid by your health insurance and on the IRS list of approved expenses.
Pairs with Enhanced or Value PPO Plan
If you don’t use it Up to $500 carry over to next year and any additional funds will be forfeited
Limited Use Flexible Spending Account
Annual maximumcontribution
Up to $2,750 in 2020
Eligible expenses Dental and vision care expenses not paid by your health insurance or reimbursed through a health savings account
Pairs with HSA Plan
If you don’t use it Up to $500 carry over to next year and any additional funds will be forfeited
Dependent daycare Flexible Spending Account
Annual maximum contribution
Up to $5,000 in 2020 per married couple filing jointly ($2,500 max for married, filing separately.)
Eligible expenses Dependent day care expenses that make it possible for you to work
If you don’t use it Any funds remaining at the end of the plan year are forfeited
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VisionVision benefits provided through Vision Service Plan (VSP) are designed to help reduce the cost of eyeglasses, contact lenses and other vision services.
You have two options available: VSP Standard Vision and VSP Enhanced Vision.
Your benefits are highest when you visit a VSP provider. If you see a non-VSP provider, you’ll have to file your own claim forms and you’ll likely pay more out-of-pocket. The benefits shown in the table below are from VSP network providers.
Benefit FeatureVSP Standard Vision Using VSP Provider
VSP Enhanced Vision Using VSP Provider
Eye Exam (Once each plan year) Covered in full with $10 copay Covered in full with $10 copay
Frames Once every other plan year
Covered up to a $130
retail allowance; plus 20% off any out-of-pocket costs
Once every plan year
Covered up to a $175
retail allowance; plus 20% off
any out-of-pocket costs
Lenses (Once each plan year)
• Single vision, lined bifocal, lined trifocal Covered in full with $25 copay Covered in full with $10 copay
Lens OptionsScratch resistant coating, ultraviolet coating, tint, standard polycarbonate, anti-reflective coating, other add-ons and services
20% to 25% off retail cost 20% to 25% off retail cost
Contact Lenses (Once each plan year in lieu of frames and lenses)
• Contact lens exam (fitting and evaluation)
• Contact lenses
Covered in full with copay not to exceed $60
Covered up to $130 allowance
Covered in full with copay not to exceed $60
Covered up to $175 allowance
Vision Benefits At-a-Glance
To find VSP providers in your area, call VSP at 800-877-7195 or visit vsp.com.
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DentalStandard and Enhanced Dental PlansCollective Health administers the Standard and Enhanced Dental Plans through Delta Dental. Both plans give you access to Delta Dental’s network of preferred dentists. If you use a Delta Dental network dentist, your preventive care is covered at 100% and you’ll pay less out-of-pocket costs for other services because network dentists provide services at pre-negotiated rates.
The main differences between the Standard and Enhanced Dental Plans are a higher plan year maximum ($1,500 vs. $2,000) and orthodontia coverage is only available with the Enhanced Dental Plan.
To find Delta Dental network dentists, go to http://join.collectivehealth.com/petco and click on “Find Care.” You can also call Collective Health at 844-516-3836 for assistance.
Delta Dental HMO PlanThe Delta Dental HMO Plan requires you to visit your selected primary care dentist in order to receive benefits. You must choose a dentist for each covered family member. Preventive services are covered at no charge. You pay a fixed copay for other dental services. To find a DeltaCare USA dentist, go to www.deltadentalins.com and click on Find a Dentist.
Collective Health Dental Plans Delta DentalBenefit Feature Standard Dental Plan Enhanced Dental Plan Delta Dental HMO
Plan Year Deductible $50 per person, $150 per family
$50 per person, $150 per family
None
Plan Year Maximum Benefit $1,500 $2,000 No Maximum Benefit
Diagnostic/Preventive Services• Preventive Care
• Oral Exams, X-rays
No charge, no deductible
No charge, no deductible
No charge, no deductible
No charge, no deductible
No charge1,2
No charge
Basic Services• Oral Surgery
• Restorative (fillings)
• Endodontics (root canals)
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
$12—$125 copay
$0—$115 copay
Up to $430 copay
Major Services• Crowns
• Dentures
50% after deductible
50% after deductible
50% after deductible
50% after deductible
Up to $500 per unit
$525—$715 copay
Orthodontia• Adolescent Benefit (to age 19)• Adult Benefit
Not covered
Not covered
50% after deductibleup to $1,500 lifetime max
Not covered
$1,530—$2,505 copay
$1,730—$2,705 copay
1) $12 copay per tooth for sealants and a $170 copay for space maintainers.
2) $30 copay (child) or $45 copay (Adult) for prophylaxis beyond the limit of 2 per year with no copay.
3) Additional charges for evaluation, treatment plan, banding (placement of braces) and retention.
Dental Benefits At-a-Glance
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Life and AD&D insuranceBasic life and accidental death & dismemberment (AD&D)You receive basic life and AD&D as shown in the table below. Life insurance pays benefits upon your death. AD&D insurance pays benefits if your death is the result of a covered accident. If you die from an accidental injury, your beneficiary will receive both the life and AD&D benefit. Basic life and AD&D will decrease to 65% of the original coverage amount at age 65 and 50% of the original coverage amount at age 70.
Voluntary life insurance for you and your dependentsYou can purchase voluntary life to increase your own coverage or add coverage for your spouse/domestic partner or children. Voluntary life for yourself or your spouse/domestic partner will decrease to 65% of the original coverage amount at age 65 and 50% of the original coverage amount at age 70.
Coverage Coverage Amount MaximumGuaranteed Issue
(if enrolling when first eligible)
Voluntary Employee Life• Salaried partners & Directors• Officers
1X to 5X annual earnings1X to 5X annual earnings
$500,000$1,000,000
Lesser of 3X annual earnings or $500,000Lesser of 3X annual earnings or $750,000
Voluntary Spouse/Domestic Partner LifeYou must elect voluntary employee life in order to elect coverage for your spouse/domestic partner.
$10,000 to $250,000 Lesser of $250,000 or 100% of yourvoluntary employee life amount
$30,000 if enrolling when first eligible
Voluntary Child LifeYou must elect voluntary employee life in order to elect coverage for your child(ren).
$5,000, $10,000, $15,000 or $20,000
$20,000 $20,000
Voluntary AD&D insurance for you and your dependentsYou may also purchase voluntary AD&D for yourself and your family. If your death is the result of a covered accident, your beneficiaries receive the full amount of your voluntary AD&D Insurance. If you are seriously injured in a covered accident, all or part of your voluntary AD&D benefit is paid to you. The amount payable depends on the nature of the injury. If you select an option that includes coverage for your family, coverage for family members is a percentage of your coverage.
Coverage for Coverage Amount
You $10,000 to $500,000 in $10,000 increments
Family members• Spouse/domestic partner only• Child(ren) only• Spouse/domestic partner and child(ren)
• 50% of your coverage amount• 15% of your coverage amount• Spouse/domestic partner: 40% of your coverage amount
child(ren): 10% of your coverage amount
Coverage Coverage Amount
• Salaried partners & Directors• Officers
1X annual earnings, max $250,000 paid by Petco3X annual earnings, max $1,000,000 paid by Petco
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Disability insuranceShort-term disability insuranceBasic short-term disability: Petco provides basic short-term disability (STD) equal to 60% of your eligible earnings up to $500 per week1. Benefits begin on the 8th day for illness and the 1st day for accidents and continue up to 180 days. Partners in California, Hawaii, New Jersey, New York and Rhode Island are also covered under a state disability plan. Short-term disability benefits from Petco are reduced by payments you receive from state plans.
Buy-up short-term disability: You can purchase additional coverage equal to 67% of your eligible earnings up to $1,500 per week. Officers and Directors are not eligible for Buy-up coverage.
Long-term disability insuranceBasic long-term disability: Petco also provides you with basic long-term disability (LTD) equal to 60% of your eligible earnings up to $11,500 per month2. Benefits begin after 180 days of disability and continue until you are no longer disabled or reach age 65 (if you become disabled at age 60 or younger). If you become disabled after age 60, benefits continue according to a schedule. Refer to the Summary Plan Description for more information.
Buy-up long-term disability: You can purchase additional coverage equal to 67% of your eligible earnings up to $11,500 per month. Officers and Directors are not eligible for Buy-up coverage.
1. Up to $2,000 per week for Directors and up to $3,500 per week for Officers.
2 For Officers, basic LTD is equal to 67% of eligible earnings up to $22,000 per month.
Legal assistance planHyatt Legal Plans provides access to a national network of more than 12,000 attorneys. If you prefer, you may use your own attorney and be reimbursed according to a set fee schedule.
The attorney fees for covered services are fully paid when you use a network attorney. There are no limits on the number of times you may use the plan, and there are no dollar limits on your use of a plan attorney for covered services. Services provided to you, your spouse/domestic partner and children under the age of 26 include:
• Wills and estate planning • Personal bankruptcy
• Traffic ticket defense • Juvenile court proceedings
• Power of attorney • Purchase or sale of home
• Consumer protection • IRS audit
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Additional information about each voluntary plan including costs and coverage options is included on the Benefitfocus website.
If you currently have a voluntary benefits policy through Voya, payroll deductions will end January 31, 2020. If you wish to keep your Voya coverage, contact Voya at 877-236-7564 to find out if you can set up direct billing arrangements.
Voluntary benefitsThe voluntary plans offered through Transamerica provide additional financial protection with premiums paid through the convenience of payroll deduction. During this year’s Open Enrollment, evidence of insurability requirements for critical illness insurance are waived.
Benefit Plan or Coverage Option
Critical IllnessYou pay the cost with after-tax contributions.
Pays a one-time lump sum benefit amount upon the diagnosis of a covered disease or illness such as a heart attack, stroke, cancer, major organ transplant, coronary bypass surgery and more. You can use the money for any purpose.
• Coverage for you: $5,000, $10,000 or $20,000
• Coverage for your spouse or domestic partner: 50% of your coverage amount
• Coverage for your child(ren): 50% of your coverage amount
AccidentYou pay the cost with after-tax contributions.
Pays a specified benefit for specific injuries resulting from a covered accident.
You can choose from two coverage options. The amount the plan pays depends on the type of injury. Examples include:
• Fractures: $280 to $4,000
• Hospital confinement: $225 per day up to 365 days
• Burns: $300 to $6,000
• Coverage is available for yourself and your eligible family members.
Hospital IndemnityYou pay the cost with after-tax contributions.
Pays a cash benefit of $150 each day you are confined to a hospital up to 31 days maximum. Optional riders include $150 per day cash benefit if you are confined to an intensive care unit up to 30 days and a $1,500 additional hospital confinement, one day per calendar year. How you use the money is up to you—groceries, rent bills or whatever you need. Coverage is available for yourself and your eligible family members.
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Petco preventive careThe Petco preventive care plan pays you back for routine exams, tests, vaccinations and basic treatments.
Petco insuranceWith Petco insurance, you’ll enjoy the peace of mind that your furry family members are protected, and money won’t be the first concern when your pet is in the exam room. Pet insurance covers unexpected accidents, illness and costly veterinary bills. You can customize your coverage for a fit that’s right for you.
Annual Services Value
Monthly price $20 per pet
(max: 5 pets)*
Benefits total value Up to $600**
Benefits overview
Two routine vet checkups
Blood test
Vaccination or titer testing
Microchipping
Health certificate
Behavioral exam
Heartworm or FeLV/FIC test
Urine test
Deworming
Fecal test
Max. reimbursement
$50
$50
$50
$40
$40
$30
$30
$25
$25
$20
Additional perks
Unlimited Ask-a-Vet online consultation
Flea, tick and heartworm care
Wellness welcome kit
$150 value
$60
$30
* Applies to dogs and cats only.
** Based on annual average of the aggregate total of all services.
Have questions?Contact customer support by phone at 833-898-7387 or send an email to [email protected].
To enroll, go to mypetcobenefits.com and click on the Login Here button.
Dependent Eligibility RemindersYou are responsible for making sure your covered dependents are eligible.Your eligible dependents are your:
• Legal spouse
• Same-sex domestic partner (opposite-sex domestic partners are eligible if one partner is at least 62 years old)
• Child* under age 26 or disabled, dependent child incapable of self-support due to mental or physical disability, if the child becomes disabled prior to reaching age 26
Your eligible children include:
• Natural born child
• Stepchild, legally adopted child or child for whom you have been appointed legal guardianship by a court of law
• Child for whom the Plan has received a Qualified Domestic Child Support Order.
* For Voluntary Child Life and family coverage under Voluntary AD&D, children are eligible up to age 19, or age 26 if a full-time student.
Spouse/domestic partner surchargePetco partners who cover a spouse or eligible domestic partner on a Petco medical plan—when he or she is eligible for medical coverage outside of Petco’s plan (other than coverage through Medicare or Medicaid)—must pay a $50 surcharge per pay period.
The surcharge is in addition to normal payroll contributions for medical coverage. If you are adding a spouse or domestic partner to your coverage, you will be required to state whether your spouse or domestic partner is eligible for medical coverage outside of Petco’s plan when you make your enrollment elections.
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Other valuable benefitsThere’s more to your benefits than medical, dental and vision. As a valued Petco partner, here are a few other great benefits to take advantage of:
Petco 401(k) PlanThe Petco 401(k) Plan helps you build financial security for your future. You become eligible to participate on the first day of month following 6 months of service during which you worked at least 500 hours. You must be age 21 to participate.
You can contribute up to $19,500 in 2020 to your 401(k) account1. If you are age 50 or older in 2020, you can contribute up to an additional $6,500 under the catch-up provision.
Below Directors: Petco matches 100% of the first 1% that you contribute plus 50% of the next 5%. So if you earn $30,000 annually and contribute 6% to your 401(k) account, you’ll receive a $1,050 matching contribution from Petco.
Directors and Officers: Petco matches 100% of the first 1% that you contribute plus 50% of the next 2%. So if you earn $125,000 annually and contribute 3% to your 401(k) account, you’ll receive a $2,500 matching contribution from Petco.
Contact Fidelity to get started at 800-835-5095. The plan number is 49089.
Employee Assistance ProgramWhen the going gets tough, turn to the Employee Assistance Program (EAP). Administered by ComPsych and paid by Petco, the EAP offers up to five 50-minute confidential counseling sessions and referrals.
Get help with drug or alcohol dependency, emotional problems, stress, relationship issues, legal or financial concerns and more. Other services include health and wellness articles and resources, and child and elder care referrals. All Petco partners and family members are eligible and can access EAP services by calling 877-EAP-4PET (TDD: 800-697-0353), or by visiting guidanceresources.com.
Store discountAs a valuable member of the Petco team, you and your eligible family members receive a discount on in-store purchase when you present a Partner Discount card. Cards are available from your Store Leader (store partners), Hiring Manager (regional partners) or Human Resources (distribution and support center partners).
Example discounts include:• 40% discount on select premium and alternate food brands
• 20% discount on other merchandise and services.
• 20% discount on Petco private brand items, salon and Vetco (all services).
• Free puppy and basic dog training for Petco partners (20% discount for eligible family members). 20% discount on intermediate dog training courses.
1 Contributions for highly compensated partners (as defined by the IRS) may be lower due to IRS testing.
b
———————————————— 2020 Open Enrollment Key Dates ————————————————
Petco Carmel Mountain 0581 11160 Rancho Carmel Dr. San Diego, CA 92128
Sam Sample1234 Anywhere St.San Diego, CA 00000
2020 OpenEnrollment
PRESORTEDFIRST-CLASSUS POSTAGE
PAIDACTION MAIL
Get hopping!2020 Petco benefits Open Enrollment is Dec. 2 to 15, 2019.
Dec. 2 to 15, 2019 Annual Open Enrollment period for 2020. To enroll or make changes to your benefits, go to mypetcobenefits.com or call 855-847-6067.
This guide provides an overview of some of the benefit plans offered by Petco. It is not intended to be all inclusive. In the event of any conflict
between this guide and the official plan documents and contracts, the official plan documents and contracts will govern. Petco reserves the
right to change or modify its benefit plans as appropriate without advance notice. This guide does not represent a contract of employment.
Jan. 31, 2020 If you did not take action during Open Enrollment, your medical, dental, vision, health savings account, flexible spending accounts and certain voluntary benefits will end.
Jan. 2020 • All partners enrolled in a Collective Health
medical or dental plan will receive new ID cards in the mail.
• If you enroll in the Delta Dental HMO, you will receive a new dental ID card in the mail from Delta Dental.
• If you are a new HSA or FSA participant, you will receive a new debit card in the mail.
Feb. 1, 2020 Your 2020 benefit elections begin.
