3M Retiree Health Reimbursement Arrangement (HRA) Plan …

3M Retiree Health Reimbursement

Arrangement (HRA) Plan ? Non-Medicare

Eligible

Summary Plan Description

Effective January 1, 2019

Contents

Introduction .......................................................................................................... 1 Overview ........................................................................................................... 1 HRA Information................................................................................................ 2

Customer Service ................................................................................................ 3 Overview ........................................................................................................... 3

Eligibility ............................................................................................................... 5 Retiree Eligibility................................................................................................ 5 Ineligible Retirees.............................................................................................. 7 Dependent Eligibility.......................................................................................... 8 Ineligible Dependents........................................................................................ 9 Consequences of Coverage of Ineligible Individuals ...................................... 10

Enrolling in the Plan ........................................................................................... 11 Overview ......................................................................................................... 11

Reimbursement Account ................................................................................... 12 Overview ......................................................................................................... 12 Crediting of Accounts ...................................................................................... 12 Reimbursements ............................................................................................. 13

Eligible Expenses for Reimbursement............................................................... 14 Overview ......................................................................................................... 14 Ineligible Expenses ......................................................................................... 14

HRA Credits ....................................................................................................... 15 Overview ......................................................................................................... 15 HRA Interest Credits ....................................................................................... 15 Credits ............................................................................................................. 16

Claims Procedures............................................................................................. 17 Reimbursement from Reimbursement Account .............................................. 17 Denied Reimbursement from Reimbursement Account ................................. 17

Coordination of Benefits .................................................................................... 20 Overview ......................................................................................................... 20

Suspending Your Coverage............................................................................... 21 Overview ......................................................................................................... 21

When Coverage Ends........................................................................................ 22 Overview ......................................................................................................... 22

Continuing Your Coverage ................................................................................ 24 General Notice of COBRA Continuation Coverage ........................................ 24 COBRA Eligibility ? COBRA Qualified Beneficiaries ...................................... 24

3M Retiree HRA Plan ? Non-Medicare Eligible SPD

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January 2019

COBRA Qualified Beneficiaries ...................................................................... 24 Notification of Qualifying Events ..................................................................... 25

Employee Retirement Income Security Act (ERISA) Statement of Rights........ 29 About Your ERISA Rights ............................................................................... 29

Important Plan Information ................................................................................ 32 Plan Administrator ........................................................................................... 32 Claims Administrator ....................................................................................... 32 Enrollment Administrator................................................................................. 33 Benefit Determinations.................................................................................... 33 Amendment or Termination ............................................................................ 33 Benefit Adjustments ........................................................................................ 34 Recovery of Overpayment .............................................................................. 34 Assignment Prohibited .................................................................................... 34 Misconduct ...................................................................................................... 35 Right to Information......................................................................................... 35 Funding ........................................................................................................... 35 Plan Expenses ................................................................................................ 35 Governing Law ................................................................................................ 36 Unclaimed Property......................................................................................... 36 Satisfaction of Claims...................................................................................... 36 Collective Bargaining Agreement.................................................................... 36 Privacy of Protected Health Information ......................................................... 36 Participating Employers .................................................................................. 36 General Plan Information ................................................................................ 37

Appendix A ? Transition Credits ........................................................................ 39 Description of Eligible Class ........................................................................... 39 Calculation of Credits ...................................................................................... 39 Transitional Credits ......................................................................................... 40

Appendix B ? Retiree Medical Credits ............................................................... 41 Description of Eligible Class ........................................................................... 41 Calculation of Retiree Medical Credits (RMCs) .............................................. 41 Retiree Medical Credits................................................................................... 43

Appendix C ? Retiree Medical Savings Account Credits................................... 45 Description of Eligible Class ........................................................................... 45 Calculation of Retiree Medical Savings Account Credits (RMSAs) ................ 45 Retiree Medical Savings Account Credits....................................................... 48

3M Retiree HRA Plan ? Non-Medicare Eligible SPD

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Introduction

Overview

This is the summary plan description ("SPD" or "Summary") for the 3M Retiree Health Reimbursement Arrangement (HRA) Plan?Non-Medicare Eligible ("Plan"). The official terms of the Plan are contained in a plan document for the Plan. If there are any differences or disagreements between this Summary and the plan document, the plan document will control.

To fully understand your benefits, you must read this Summary carefully. It is important that you read the entire Summary. You should keep this Summary for future reference. Share this Summary with your family, particularly any dependents covered under this Plan, and make sure they have read it along with yourself and understand it and your responsibilities. One of your responsibilities is to timely provide any required notice or information as described in this Summary and other benefit communications. Another responsibility is to make sure the Enrollment Administrator has your current mailing address and to timely notify 3M of any change in your address. Failure to follow the terms of the Plan or satisfy any Plan requirements can result in delay, reduction, denial or termination of coverage and/or benefits.

You will notice that certain terms and/or phrases are capitalized throughout this Summary. These terms and/or phrases are important and you should remember them. The capitalized terms and phrases are defined in the Summary.

Neither the receipt of this Summary nor its use of the term "you" indicate that you are eligible to participate in the Plan or receive benefits under the Plan. Only those individuals who satisfy the eligibility requirements and other criteria contained in the Plan are eligible to participate in the Plan. Further, participation in the Plan is not a guarantee of benefits under the Plan.

The information in this Summary may not be relied on as tax advice for any purpose. 3M does not guarantee any specific tax consequences. Ultimately, it is your responsibility to determine whether coverage and benefits provided under this Plan are excludable for tax purposes. For information on how applicable tax law may apply to your personal situation you should consult your own qualified tax advisor.

Neither the terms of the Plan nor the benefits provided under the Plan shall be a term of employment of any individual. This Summary and the Plan shall not be deemed an employment contract. Participation in the Plan does not constitute a guarantee of employment.

3M Retiree HRA Plan ? Non-Medicare Eligible SPD

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January 2019

HRA Information

The 3M health reimbursement account is an arrangement that you can use to get reimbursed for certain eligible expenses. The arrangement is not a health insurance plan. Nor is it a major medical plan. Instead the arrangement is designed to work in conjunction with a personal health insurance plan by allowing you to get reimbursed for eligible insurance premiums.

As such, you will need to be enrolled in a personal health insurance plan to be reimbursed. You should be aware that the premiums for only certain types of personal health insurance plans are reimbursable. You should carefully read the section titled "Eligible Expenses for Reimbursement" to understand what types of premiums are reimbursable. You are responsible for making sure the premiums for the personal health insurance plan you purchase are reimbursable.

You should be aware that there are deadlines for enrolling in personal health insurance. For example, personal health insurance plans typically offer annual open enrollment periods and/or mid-year special enrollment periods, which allow individuals to enroll in coverage during a specified period of time. Consequently, if you are planning on retiring or already have done so and will no longer be covered by a 3M group health plan, you should investigate the enrollment deadlines for the personal health insurance coverage you are considering to ensure that you do not have a gap in coverage. 3M is not responsible for any gap in coverage you may experience.

3M does not endorse or recommend any particular personal health insurance plan. Individuals are encouraged to investigate personal health insurance plans themselves and make their own informed decision about which personal health insurance plan is best for them. The personal health insurance plan that you select is your own individual plan and is not sponsored or maintained by 3M and is not part of any plan or program established or maintained by 3M.

For more information on personal health insurance plans, you may want to read the 3M Health Insurance Resource Guide.

3M Retiree HRA Plan ? Non-Medicare Eligible SPD

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January 2019

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