Walgreen Health and Welfare Plan

SUMMARY PLAN DESCRIPTION

for the

Walgreen Health and Welfare Plan

Effective January 1, 2023

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Table of Contents

Introduction .................................................................................................................................. 1

IMPORTANT NOTICE .................................................................................................. 3

About This Document ...................................................................................................... 4

Eligibility..................................................................................................................................... 10

You Are Eligible If... ...................................................................................................... 10

Additional Medical Plan Eligibility Requirements for Hourly Team Members

Subject to Employer Mandate ...................................................................................... 11

Domestic Partner ........................................................................................................... 15

Imputed Income ............................................................................................................. 15

Enrollment .................................................................................................................................. 17

As a New Team Member ............................................................................................... 17

If You Leave the Company and Are Rehired .............................................................. 17

Your Dependents ............................................................................................................ 18

Social Security Numbers Generally Required for Enrollment .................................. 18

Open Enrollment............................................................................................................ 19

If You Do Not Enroll...................................................................................................... 19

Declining Enrollment and Special Enrollment Period Rules..................................... 19

Enrollment Under a Qualified Medical Child Support Order (¡°QMCSO¡±) ........... 21

Paying for Coverage .................................................................................................................. 22

Your Contribution ......................................................................................................... 22

Medical Premium Surcharge for Tobacco Users ........................................................ 22

Paying for Coverage¡ªActive Team Members............................................................ 23

When Coverage Begins .............................................................................................................. 25

New Team Members ...................................................................................................... 25

Current Team Members: For You and Your Dependents......................................... 25

Changing Your Coverage .......................................................................................................... 26

During the Year.............................................................................................................. 26

Qualified Change in Status ........................................................................................... 26

Special Enrollment Rights............................................................................................. 26

Other Changes in Circumstance................................................................................... 27

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(continued)

Special Enrollments in a Qualified Health Plan.......................................................... 28

Reduction in Hours of Service ...................................................................................... 28

How to Make Changes During the Year ...................................................................... 28

Your Medical Coverage ............................................................................................................. 33

Care Coordination and Health Pros ............................................................................ 34

Carrum Health Medical and Surgery Benefits ........................................................... 35

Overview of Medical Plan Options and Networks ...................................................... 35

Primary Care Provider (PCP) Requirements ............................................................. 36

EPO Network ¡ª Common Features Applicable to Most Options ............................ 37

UnitedHealthcare (UHC) Nexus Medical Plan Network ............................................ 38

UnitedHealthcare (UHC) Navigate Medical Plan Network ....................................... 38

UnitedHealthcare (UHC) Choice Medical Plan Network .......................................... 38

UnitedHealthcare (UHC) Core Medical Plan Network .............................................. 38

Blue Cross Blue Shield of Illinois (BCBSIL) Networks .............................................. 39

POS Network Option¡ªOptions Through Kaiser Permanente ................................. 39

HMO Network Option¡ªOnly Applicable in Certain States ..................................... 39

Emergency Room Coverage .......................................................................................... 39

Health Savings Account (HSA) Plans .......................................................................... 41

Enrollment in Medicare ................................................................................................ 41

How Health Savings Account Plans Work .................................................................. 41

Coordination with Healthcare FSA .............................................................................. 42

Tax Information ............................................................................................................. 42

Highly Compensated Individuals ................................................................................. 43

Medical Coverage in Hawaii ......................................................................................... 43

Medical Coverage in Puerto Rico ................................................................................. 43

Medical Coverage in U.S. Virgin Islands ..................................................................... 43

Rescission of Coverage .................................................................................................. 43

Continuation of Coverage Through COBRA .............................................................. 44

Your Prescription Drug Coverage ............................................................................... 44

Managing Your Health .................................................................................................. 44

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(continued)

Telehealth Services......................................................................................................... 45

Wellness Programs..................................................................................................................... 46

365 Get Healthy Here .................................................................................................... 46

$0 Copay Medication Program ..................................................................................... 46

Tobacco-Free Program .................................................................................................. 47

Healthy Living Centers.................................................................................................. 48

Health Center ................................................................................................................. 48

Pharmacy ........................................................................................................................ 48

Special Disease Management/Prevention Programs................................................... 49

Immunizations ................................................................................................................ 49

Coordination with Medicare ......................................................................................... 50

The Aon Active Health Exchange............................................................................................. 51

Your Dental Coverage ............................................................................................................... 52

What Dental Options Will Be Available? .................................................................... 52

Overview of Options ...................................................................................................... 52

Basic PPO Options¡ªBronze Option............................................................................ 53

Basic Buy-Up PPO Options¡ªSilver Option................................................................ 53

Enhanced PPO Options¡ªGold Option ....................................................................... 53

Dental Health Maintenance Organizations (¡°DHMOs¡±)¡ªPlatinum Option .......... 53

Continuation of Coverage Through COBRA .............................................................. 53

Your Vision Coverage................................................................................................................ 54

What Vision Options Will Be Available?..................................................................... 54

Overview of Options ...................................................................................................... 54

Discount Plan with Eye Exam Option¡ªBronze Plan Option.................................... 55

PPO Plan Options¡ªSilver and Gold Options ............................................................. 55

Continuation of Coverage Through COBRA .............................................................. 55

Health Coverage for Team Members Temporarily Working Outside the United

States ............................................................................................................................... 56

Your Flexible Spending Accounts (¡°FSAs¡±)............................................................................ 57

Electing How Much to Contribute ............................................................................... 57

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Annual Limitation on Use of FSAs ............................................................................... 57

How the Healthcare FSA Works .................................................................................. 58

Coordination with the Health Reimbursement Arrangement (¡°HRA¡±)

account ............................................................................................................................ 59

Qualified Change in Status ........................................................................................... 61

Eligible Healthcare FSA Expenses ............................................................................... 61

Ineligible FSA Expenses ................................................................................................ 62

Eligible and Ineligible HSA Expenses .......................................................................... 63

Payment of Eligible Healthcare FSA Expenses (including Limited Purpose

FSA)................................................................................................................................. 63

How the Dependent Care FSA Works ......................................................................... 67

Eligible Dependent Care FSA Dependents .................................................................. 68

Qualified Change in Status ........................................................................................... 68

Eligible Dependent Care FSA Expenses ...................................................................... 69

Ineligible Dependent Care Expenses ............................................................................ 70

Payment of Eligible Dependent Care Expenses .......................................................... 71

Dependent Care FSA Annual Statement of Benefits .................................................. 71

Dependent Care Tax Credit .......................................................................................... 71

Filing an FSA Claim ...................................................................................................... 71

Nondiscrimination Testing ............................................................................................ 73

Forfeitures ...................................................................................................................... 73

The Transportation (Commuter) Benefit Plan ....................................................................... 75

How to Enroll ................................................................................................................. 75

Eligible Expenses............................................................................................................ 76

Transit Pass Expenses.................................................................................................... 76

Parking Expenses ........................................................................................................... 76

How the Plan Works ...................................................................................................... 77

Determine Your Expenses ............................................................................................. 77

Before-Tax Payroll Deductions ..................................................................................... 77

Pay Your Transit Expenses ........................................................................................... 77

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