Walgreens Voluntary Group Term Life Insurance Plan · Walgreens Voluntary Group Term Life Insurance Plan Summary Plan Description This Summary Plan Description booklet describes the

Walgreens Voluntary Group Term Life Insurance Plan

Summary Plan Description

Prepared by the Walgreens HR Shared Services Department for eligible employees of the Walgreens family of companies

Walgreens Voluntary Group Term Life Insurance Plan Summary Plan Description

This Summary Plan Description booklet describes the life insurance benefits available to Walgreens employees covered by the Voluntary

Group Life Insurance Plan, as in effect as of January 1, 2016 (the “Plan”). You should read the information provided in this booklet so that

you will have a full understanding of the benefits provided and the other relevant terms and conditions of the Plan. Throughout this

document the term “Company” means Walgreen Co. and its subsidiaries and affiliates whose team members are eligible to participate in

the Plan, unless the context is limited to a particular subsidiary or business unit. See “Administrative Facts about the Plan” at the end of

this booklet for the name of the legal entity of the Company that is the official plan sponsor of the Plan, and therefore the Company for

purposes of formal approvals and governmental filings.

The benefits of this plan are governed by the terms of the insurance policy providing the benefits, in effect at the time of a claim. This

Summary Plan Description is meant to provide details on the important features of the plan. Copies of these Plan documents can be

obtained by contacting the Plan Administrator listed at the end of this booklet. In the event of any discrepancy between this booklet and

the provisions of the insurance policies, the provisions of the insurance policies will govern.

Please understand that the Company reserves the right to amend, modify or terminate this Plan, including any benefits provided under

this Plan or the amount of required contributions, if any, at any time and for any reason. You will be notified of any changes to the Plan

within a reasonable amount of time, but not always prior to the time the change goes into effect. To determine the proper benefits at

any given time, it is necessary to consult the Summary Plan Description booklet (or insurance policies) that are in effect at the relevant

time.

Noticia Importante

Este boletín contiene un resumen, escrito en inglés, de sus derechos y beneficios bajo este Plan. Si es difícil comprender cualquiera parte

de este boletín, por favor de ponerse en contacto Live Well Benefits Center at 855-564-6153.

Important Notice

This booklet contains a summary in English of your plan rights and benefits under this Plan. If you have difficulty understanding any part of this booklet, contact Live Well Benefits Center at 855-564-6153.


Introduction This booklet explains the details of the Walgreens Voluntary Group Term Life Insurance Plan. The Voluntary Group Term Life Insurance Plan is offered by The Prudential Insurance Company of America and administered for them by the Live Well Benefits Center. Please read this booklet so you understand how the Plan works and see if term life insurance is the right choice for you and your family.

The Plan pays a benefit equal to the amount of coverage you’ve been approved for in the event of your death. Premiums are based on 5-year age brackets, and your cost will increase on January 1 of the year you and/or your spouse/domestic partner move from one age bracket to another. Coverage for you and your family is available under this Plan. You pay the full cost of coverage through payroll deductions at a group rate.

Eligibility To be eligible for coverage you must:

be a full-time salaried team member, actively working at least 30 hours per week for at least 30 days, or

be a full-time hourly team member, actively working at least 30 hours per week for at least 90 days, and

not be covered by any other Walgreens voluntary life insurance coverage, and

be actively at work or on approved paid time off or a regularly scheduled day off on your initial date of coverage. If you do not meet this requirement on the date of your initial eligibility or any increase in benefit, that coverage will be deferred until you return to work for one full day.

You are not eligible for coverage if you are:

a Company team member and have voluntary term life coverage available through a different plan.

a team member of Healthcare Clinics whose payroll is not processed within Walgreens payroll system.

a team member who is covered by a collective bargaining agreement, unless the agreement specifically provides your right to coverage by this Plan.

a temporary or seasonal team member.

Continued Eligibility You must continue to work an average of 30 hours or more per week for the most recent 52 weeks, or the number of weeks since your original eligibility, if less, to be eligible to participate in the Plan.

Who Can Participate You can apply for coverage for your eligible family members at the same time you enroll. No person may be covered as a family member of more than one team member under this Plan. An insured team member may not be covered as a family member of another insured team member. Family members who are eligible for coverage include your spouse or same-sex domestic partner and children, as follows:

Your eligible spouse means the person with whom you satisfy the requirements of being a marital spouse under the laws of the state or territory of the United States where the relationship was entered into.

Your eligible same-sex domestic partner means the person of the same-sex with whom you have a dedicated relationship meeting all of the following criteria:

Is the person named on your application for coverage:

Neither of you is married, legally separated or involved in another domestic partnership, civil union or other comparable relationship established by law;

You have shared the same principal residence for at least six months prior to enrollment and intend to continue to do so;

You both reside in the United States, including any US territories;

You maintain an intimate, committed relationship of mutual caring and support;

You agree to share, and are both responsible for, basic living expenses during your domestic partnership and will permit anyone who is owed these expenses to collect from either partner;

You are not related by blood to a degree of closeness that would prohibit legal marriage under the applicable law in effect in the state where you legally reside.

To be eligible for Plan benefits, spouses and same-sex domestic partners must satisfy the above requirements both at the time of Plan enrollment and at the time a claim for Plan benefits is made, and confirming documentation may be required at either or both of these times, including – in the case of same-sex domestic partners - an affidavit confirming that the above requirements are met at all relevant times. The team member is solely responsible for confirming that his/her spouse or domestic partner meets these eligibility requirements at the time of enrollment and thereafter.

Your children. Eligible children are your children, as

defined below, from live birth to their 26th

birthday.

Eligible children include:

Your natural children

Legally adopted children

Children placed with you for adoption prior to legal adoption

Stepchildren

Children of your eligible partner

Children for whom you are the legal guardian

Foster children who depend on you for maintenance and support

Call the Live Well Benefits Center at 855-564-6153 with any questions regarding family member eligibility.

Children first becoming eligible after you have enrolled for the child coverage rider are automatically covered.

2 Questions? Call the Live Well Benefits Center at 855-564-6153

Dependent Coverage Deferral If your covered family member (spouse/partner or child) is home or elsewhere confined for medical reasons on the day his or her coverage is scheduled to go into effect, the coverage will be deferred until medical release from such confinement. This restriction does not apply to children born after the child coverage option is in effect for your certificate.

Enrollment When to Enroll

If you meet the eligibility requirements, you can enroll, cancel or change coverage at any time. However, any enrollment or increase in coverage at any time other than within 62 days of becoming newly eligible for coverage or a qualified change in life event, is subject to passing Evidence of Insurability (EOI, or proof of good health), and is not eligible for “Conditional Guaranteed Issue”. If your EOI is approved, your change in coverage will be effective on the first day of the month, after EOI is approved.

See the “Conditional Guaranteed Issue” section on the next page to determine how your enrollment time can affect your coverage amount.

Change in Life Event A qualified change in life event is an event that changes one or more of the following:

Your legal marital or same-sex domestic partnership status

The number of your eligible children

The employment status of you, or of your spouse/partner The status of an individual as an eligible family member

under the Plan

Examples of qualified change in life events that apply are:

Marriage or divorce Commencement or termination of domestic partnership

The birth or adoption of a child

Death of a spouse/partner or child

A dependent’s loss of eligibility under the Plan

If you, your spouse/partner, or children experience a “qualified change in life event” that makes one of you eligible for coverage, then you may be eligible to enroll in, or change your coverage within 62 days, and receive the Conditional Guaranteed Issue benefit under this plan. However, your change must be consistent with the change in life event.

You must apply for a change in coverage by submitting your request within 62 days of the qualified change in life event. If you do not make this request within 62 days, any changes will be subject to Evidence of Insurability. Please see the section titled “When Coverage Begins” to determine your effective date of coverage.

How to Enroll To enroll in the Walgreens Group Term Life Insurance Plan, go to Your Live Well Rewards Center website at www.livewellrewardscenter.com to apply online, or call 855-564-6153. You will be notified by Your Live Well Rewards Center at if additional documents are required (such as marriage or birth certificates, affidavit of domestic partnerships, or health questionnaires).

When Coverage Begins Your new coverage or increase in coverage will be effective the first day of the month following the date your application is received, reviewed and approved, as long as:

You are working on the date your coverage would begin (if not, coverage is deferred until the day after your return to work for one full day.)

Any family member who is newly covered must not be confined at home or elsewhere for medical reasons on the day his or her coverage would otherwise begin. The coverage is deferred until the family member is medically released from such confinement. (This restriction does not apply to children’s coverage for children born after you have added the child coverage rider.)

Verifying Coverage Once your coverage begins, the Company will start after-tax payroll deductions. It is your responsibility to make sure that your premium is deducted from your paycheck. Your coverage is not in effect if there are no premium deductions taken from your paycheck. If your deductions do not begin within two pay periods from your effective date of coverage, or your deduction amount is incorrect, contact the Live Well Benefits Center by calling 855-564-6153. If, due to a leave of absence or other circumstances, the amount of your pay from the Company is not sufficient for the company to deduct full premiums for your voluntary coverage under this Plan, you must contact the Live Well Benefits Center at 855-564-6153 to make arrangements to pay directly for your Plan coverage. If you fail to do so, your coverage will terminate after a period of 60 days of unpaid or partial-paid coverage.

Payment of premiums does not activate coverage for any period during which you do not meet the actively working requirement or during which your family member is confined at home or elsewhere for medical reasons.

Your Insurance Certificate You can obtain a copy of the insurance certificate for your coverage from Your Live Well Rewards Center at www.livewellrewardscenter.com, or by calling the Live Well Benefits Center at 855-564-6153 to request a copy. If there are any discrepancies between the insurance certificate and this Summary Plan Description, the terms of the certificate will apply.


Be sure to check with the Live Well Benefits Center if you do not receive notice of either approval or denial within 60 days of the time you submitted your application. You can also look at your paycheck stub and verify the correct premium deductions are being taken from your pay. It is your responsibility to make sure the proper deductions are being taken.

Changing Your Coverage

You can change your coverage amounts, add or drop dependents or cancel coverage at any time, on Your Live Well Rewards Center website www.livewellrewardscenter.com, or by calling the Live Well Benefits Center at 855-564-6153. Please note that any new coverage or increases in coverage more than 62 days after the date you become newly eligible or experience a qualified Change in Life Event is subject to passing Evidence of Insurability (EOI), and is not eligible for “Conditional Guaranteed Issue”.

Naming a Beneficiary A beneficiary is the person who will be paid the life insurance benefit if the covered person dies. Be sure to designate your beneficiary(ies) on Your Live Well Rewards Center website, www.livewellrewardscenter.com, when you enroll. You are automatically considered the beneficiary for your covered spouse/partner and children – you cannot change this designation. In the event of a covered family member’s loss, the benefit will be paid to you. You can designate or change beneficiaries for coverage on yourself, at any time (unless you provide otherwise in your original designation). To designate or change your beneficiary, go to Your Live Well Rewards Center at www.livewellrewardscenter.com, or call the Live Well Benefits Center at 855-564-6153. You will need your beneficiary’s full name, address, birthdate and Social Security Number. Any beneficiary change will take effect on the date that the designation is completed online or through the Live Well Benefits Center. However, a beneficiary change will not apply if it is received by the carrier after benefits have been issued for a claim. If you fail to name a beneficiary on Your Live Well Rewards Center website, or if all named beneficiaries die before you, benefits will be paid to your estate as determined by the laws of your state of residency. Previous beneficiary designations made on paper or the website of a previous plan vendor will not apply to any benefits for claims incurred 1/1/2016 or later.

However, if a properly executed beneficiary is not designated on Your Live Well Rewards Center website, and the circumstances are such that you were not notified prior to your death of this requirement to submit a new beneficiary designation, then the plan administrator and claims administrator shall award the Plan benefit based on the most recent beneficiary designation on file, if any (rather than to your estate). If you live in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin) and are married, you must obtain consent from your spouse if you designate anyone other than your spouse as your beneficiary.

Plan Features Conditional Guaranteed Issue The “conditional guaranteed issue” is the amount of coverage you can get for yourself and your eligible family members without providing Evidence of Insurability (EOI). (In other words, it is the amount of coverage that will be issued to you without regard to your health history or conditions.)

Guaranteed issue for you and your covered spouse/partner only applies when you (and your spouse/partner) are first eligible or have a qualified change in life event. If you marry or enter a domestic partnership after you are first eligible or experience another qualified change in life event, the guaranteed issue for your spouse/partner will be available to them if you enroll them within 62 days of the event.

If you apply for amounts higher than the conditional guaranteed issue amounts (for yourself and/or your covered spouse/partner), you will be notified by Your Live Well Rewards Center that you must also submit a completed health history information sheet to the insurance carrier so it can be determined if you can be issued the higher amounts based on your responses. If the higher amounts are not approved, you will still receive the guaranteed issue amount, if you apply within 62 days of your initial eligibility or qualified change in life date.

If you do not enroll when you are first eligible or experience a qualified change in life event, you and your eligible spouse/partner will be notified by Your Live Well Rewards Center that you must submit a completed health history information sheet to the insurance carrier (for any amount of coverage), so it can be determined if you can be issued coverage based on your responses.


Amount of Coverage Available The chart below outlines the coverage available and the conditional guaranteed issue amounts.

Minimum Amount

Maximum Amount

Conditional Guaranteed

Issue

Team Member

$1,000 Lesser of $750,000 or 7 x annual base

salary

$200,000

Spouse/ Partner

$1,000 Lesser of $750,000 or the dollar

amount of the team member’s combined company-paid and voluntary coverage

$40,000

Child(ren) $2,500 Lesser of $25,000 or the dollar amount of the team member’s combined company-paid and voluntary

coverage

$25,000

In addition to the above limits, the following rules apply to coverage amounts:

The coverage amounts for you and your eligible spouse/partner must be a multiple of $1,000. Children’s coverage amounts must be a multiple of $2,500.

Annual base salary for salaried team members is your annualized base salary calculated each month, and does not include any bonus or incentive pay. Annual base salary for hourly paid-team members is calculated each month by multiplying your 52-week average hours (or average since the date of hire, if less than 52 weeks) by your hourly rate.

Executives eligible for the Walgreens Life Insurance Plan for Executives may have an additional limit applied to the maximum amount of voluntary coverage they may elect – as company-paid and voluntary live insurance coverage is combined to determine the maximum coverage amount. See the Life Insurance Plan for Executives Summary Plan Description for these limits.

Texas residents only: Your company-paid and voluntary life insurance is limited by law to a combined amount not to exceed 7 times your annual salary.

What is Not Covered There are limitations on the benefits that will be paid under certain circumstances. These limitations are as follows:

Suicide: If a covered person dies by suicide (whether sane or insane*) within two years of the date he or she becomes covered by this plan, there will be no benefit payable. In addition, if a covered person has increased coverage, the increased amount will not be payable if death occurs due to suicide in the two years following the increase. Premiums paid for any excluded coverage will be refunded.

* In Missouri, suicide while sane is the only limitation.

Error in Age: If the age the insurance carrier or its’ administrator has for a covered person is incorrect, the beneficiary will receive the coverage amount that the premiums would have purchased at the covered person’s correct age.

During the team member or family member’s lifetime, a premium adjustment will be made immediately if any discrepancy is found in either the team member’s or spouse/partner’s age or cost.

Contestability During the First 2 Years: False information given on the application can cause a claim to be denied or coverage rescinded during that two year period.

Accelerated Death Benefit If you become terminally ill, with a life expectancy of 36 months or less (as defined by the life insurance certificate) you may be eligible to receive up to 75% of your coverage amount (with a maximum of $250,000). The balance of the coverage is paid to the named beneficiary upon the death of the insured. Refer to the group insurance certificate for details about limits and exclusions. Accelerated death benefits may be considered taxable income. Please consult your tax advisor for information.

Plan Costs Team Member and Eligible Spouse/Partner Premiums Premiums for you and your eligible spouse/partner are based on each of your separate ages and tobacco use. Premiums will increase as you and/or your insured spouse/partner move from one age bracket to another. Your premium increase will take effect on the January 1st of the year you and/or your spouse/partner move into the next higher age bracket. You will not receive a separate notice about this change. In addition, each year you and/or your spouse/partner will need to designate your tobacco status on the live Well Benefits center website.


The current rates for each $1,000 of coverage for you and your spouse/partner are listed in the chart below.

Non-Tobacco/Nicotine User

Monthly Premium Per $1,000 of Coverage

Age Monthly Rate Age Monthly Rate

< 25 $0.050 55-59 $0.533

25-29 $0.060 60-64 $0.690

30-34 $0.080 65-69 $1.270

35-39 $0.090 70-74 $2.060

40-44 $0.124 75-79 $3.420

45-49 $0.186 80-84 $5.790

50-54 $0.285 85 & Over $5.790

Tobacco/Nicotine User

Monthly Premium Per $1,000 of Coverage

Age Monthly Rate Age Monthly Rate

< 25 $0.090 55-59 $0.780

25-29 $0.110 60-64 $1.200

30-34 $0.150 65-69 $2.310

35-39 $0.160 70-74 $3.750

40-44 $0.180 75-79 $4.788

45-49 $0.270 80-84 $8.106

50-54 $0.420 85 & Over $8.106

To calculate the amount taken out of each paycheck for team member and spouse/partner coverage:

Find your and/or your spouse/partner’s age bracket in the rate charts.

Multiply the number of $1,000 units of coverage (Example: $5,000 = 5 units) by the amount listed under “Monthly Rate”. This will give you your monthly premium.

If you are paid weekly or bi-weekly, you can convert the monthly premium to your pay frequency to find your approximate cost per paycheck.

Team Member Only Coverage Example A 35-year-old non-tobacco/nicotine user team member elects $50,000 of coverage. The premium from each paycheck is calculated as follows:

Units of Coverage ($50,000 = 50 units) 50 x Rate for Team Member’s Age (age 35) x $ 0.09 Monthly Premium $ 4.50

How to Calculate Your Weekly or Biweekly Premium

First calculate your Monthly Rate

Multiply your Monthly Rate by 12 to find your Annual Rate

Biweekly

Divide the Annual Rate by 26 (the number of biweekly pay periods in a year)

Weekly Divide the Annual Rate by 52 (the number of weeks in a

year)

Child(ren) Premiums Premiums for covered children are the same regardless of age or number of eligible children. The maximum coverage is $25,000 (10 units) or the amount of coverage of the team member, if less than $25,000.

When you pay the child premium, every eligible child in your family is covered for the amount you’ve selected. The premium shown is for each $2,500 unit of child coverage.

Premiums per $2,500 of Children's Coverage = $ 0.50/month

To calculate the amount taken out of each paycheck for children’s coverage:

Multiply the number of units of coverage by $0.50. This will give you your monthly premium.

If you are paid biweekly or weekly, you can convert the monthly premium to your pay frequency to find your cost per paycheck.

Children’s Coverage Example If you have $15,000 of coverage on your child(ren), the premium from each paycheck is calculated as follows:

Units of Coverage ($15,000 = 6 units) 6

x Rate for Child (ren) Coverage x $ 0.50 Monthly Premium $ 3.00

To calculate the biweekly or weekly premium, follow the steps above.

Note: Prudential has the right to increase or decrease the premiums for coverage. Any change will affect all participants in a group. Any change would be effective January 1st of a year.

Premium Rates for Tobacco/Nicotine Users You will be subject to higher Tobacco/Nicotine-User rates if you and/or your spouse/partner have used any tobacco/nicotine product or e-cigarette in the last three months, and therefore must declare your tobacco/nicotine user status during initial enrollment or Open Enrollment. There are two ways to avoid these higher rates, as follows:

Submit your tobacco/nicotine-free status during initial enrollment or Open Enrollment. If the tobacco/nicotine-free status for you or your spouse/partner changes during the year, and you or your spouse/partner are no longer tobacco-free, you must change your tobacco/nicotine status at that time by contacting the Live Well Benefits Center at 855-564-6153.


Complete the Alere Quit For Life® smoking cessation program, which includes five phone calls. Once you complete this program during the calendar year, your premiums will be adjusted so that you will be charged the lower, non-tobacco/nicotine user rates. Also, if your personal physician recommends that you not participate in this program but proposes a reasonable alternative standard for you to avoid the surcharge, that recommendation will be considered. Contact Alere at 1-877-620-QUIT (1-877-620-7848), or go online to www.quitnow.net for more information.

When Coverage Ends You must inform Your Live Well Rewards Center of any changes in eligibility for you, your spouse, domestic partner or children. Contact Your Live Well Rewards Center at www.livewellrewardscenter.com, or call the Live Well Benefits Center at 855-564-6153. Coverage for you and your covered family members ends on the earliest of:

The last day of the month your employment with the Company ends

The last day of the month you do not average the required 30 or more hours per week in the most recent 52 week period, or since your date of hire, if less. (See the “Eligibility” section for details on ongoing eligibility.)

The end of the month you fail to pay the required premiums. If, due to a leave of absence or other circumstances, the amount of your pay from the Company is not sufficient for the company to deduct full premiums for your voluntary coverage under this Plan, you must contact the Live Well Benefits Center at 855-564-6153 to make arrangements to pay directly for your Plan coverage. If you fail to do so, your coverage will terminate after a period of 60 days of unpaid or partial-paid coverage.

The date the Company no longer offers this coverage to team members

Dependent Coverage Your spouse/partner’s coverage will end if you become legally separated, divorced or your domestic partnership has terminated.

A covered child’s insurance will terminate when he or she no longer meet the eligibility requirements.

How to Continue Coverage Once your active employment ends or you otherwise fail to meet the eligibility requirements for coverage, you and your covered family members each have the right to purchase an individual permanent policy, without regard to health history or condition. The premium for an individual policy will be different from your premium through the Company since it is not term coverage. Instead, it is the insurance carrier’s standard rate for you and your spouse/partner's or your children’s age group for permanent insurance. An application must be made for the individual policy within the 31 days following the date coverage ends. Contact the Live Well Benefits Center at 855-564-6153 to obtain information on an

individual policy. In the event of legal separation, divorce or termination of a domestic partnership, your spouse/partner may convert his or her coverage to an individual policy. Your children who no longer qualify for coverage because of their age may also convert to an individual policy. To continue or convert coverage after payroll deduction payments end, contact Your Live Well Rewards Center at www.livewellrewardscenter.com, or call the Live Well Benefits Center at 855-564-6153.

Coverage During a Leave Paid Disability Leave If you are placed on a paid disability leave, your coverage continues and premiums are deducted from your disability check. If your disability benefits are not enough to cover your premium, you need to arrange to pay for coverage with Live Well Benefits Center by calling 855-564-6153.

Unpaid Disability Leave If you are on an approved unpaid disability leave or personal leave of absence, your coverage ends unless you make arrangements with the insurance carrier to continue coverage, by calling the Live Well Benefits Center at 855-564-6153.

Family/Medical Leave (FMLA) If you are on a family/medical leave (FMLA), and you want to continue coverage, you must contact the Live Well Benefits Center at 855-564-6153 to make arrangements to pay your premiums to them directly as provided under the “How to Continue Coverage” section. The Company will not pay your premiums during a leave. You are responsible for informing the Live Well Benefits Center at 855-564-6153, when you return to work.

Total Disability Total Disability is defined as:

you are not working at any job for wage or profit; and

due to sickness, injury or both, you are not able to perform for wage or profit, the material and substantial duties of any job for which you are reasonably fitted by your education, training or experience.

You can receive an extension to continue coverage for you and your covered dependents without paying a premium until you are age 65, if you meet all of the following requirements:

you are under age 60 at the time you initially become totally disabled;

your disability has lasted 6 months or more;

you remain totally disabled, and you provide proof of this to the insurance carrier that is acceptable to them.

You must contact the Live Well Benefits Center by calling 855-564-6153 to file an extension. The extension will only begin after the insurance carrier has approved your application and you must pay premiums until the extension is approved. When your total disability extension coverage ends, you and your covered dependents can covert to an Individual Policy.

http://www.livewellrewardscenter.com/


Claims Procedures If a covered family member dies, contact the Live Well Benefits

Center at 855-564-6153 or visit Your Live Well Rewards Center

at www.livewellrewardscenter.com. The Live Well Benefits

Center will take the necessary steps to begin your claim for

benefits under the Plan. If you, the Walgreens team member,

die while covered by this Plan, your beneficiary should notify

your Walgreens manager, and the Human Resources Records

Department at 800-825-5467, to initiate this claim and review

other Walgreens benefits that may be available.

Filing Claims The claims procedures and rights described below are based on the rules and regulations under the federal law called the Employee Retirement Income Security Act of 1974 (ERISA). Those rules, and comparable rules in other states, ordinarily will require that claims be decided within the time periods specified for claims decisions under ERISA.

If you or your beneficiary (collectively, the “claimant”) believe you are entitled to any benefits or otherwise entitled to have the Plan administered in a manner different from the manner in which it is being applied, the claimant may file a written document with the Insurance Carrier asserting the claim. A claim must be in writing and addressed as follows:

The Prudential Insurance Company of America Group Life Claim Division PO Box 8517 Philadelphia, PA 19101

Any Evidence of Insurability (EOI) appeals for term life insurance should be sent to Your Live Well Rewards Center at www.livewellrewardscenter.com, or by calling the Live Well Benefits Center at 855-564-6153.

Required claim forms must be used in asserting a death benefit claim. They are available from the Insurance Carrier at the above address or may be requested by calling the Live Well Benefits Center at 855-564-6153. No claimant can be assured of a proper response to an initial claim unless the claim complies with these requirements and is sent in a timely fashion to the Insurance Carrier. In asserting a claim, the claimant should explain in detail the nature of the claim and the basis for the claim. Please refer to policy provisions that support the claim. In this regard, as explained below, the claimant is entitled to request Plan documents and information. The claimant is encouraged to make use of this right in preparing the claim as the claim will be presented more effectively.

Initial Claims Determination When a decision is made regarding the claim, the claimant will be notified of the decision in writing. The Insurance Carrier will make its decision based on the information submitted by the claimant within 90 days after the claim is submitted (45 days if the claim is disability related). By notice to the claimant before this period ends, the Insurance Carrier may extend this deadline by up to 90 additional days (30 additional days if the claim is disability-related) if it determines that a decision cannot be made during the initial period for reasons beyond the control of the Insurance Carrier. An extension notice will specify the length of the extension and inform the claimant that a decision cannot be made within the deadline because of reasons beyond the control of the Insurance Carrier. For disability-related claims, a second extension of up to an additional 30 days may be declared. If such an extension is necessary, the notification shall include a description of the circumstances requiring the extension and an estimate of the decision date.

Claim Denials If the claim is denied, the claimant will be sent a notice from the Insurance Carrier that will:

Be written in a manner that the claimant should understand Include the specific reasons for the denial

Refer to the provisions of the Plan on which the determination was based

Describe any additional material or information necessary to perfect the claim and explain why the additional material is necessary

Explain the Plan’s review procedures including relevant deadlines; and include a statement of the claimant’s right to bring a civil action under ERISA after receiving a final determination upon appeal.

Appealing a Denied Claim To appeal a claim denial, the claimant must notify the Insurance Carrier within 60 days of receiving notice of the claim denial (180 days if the claim is disability related). The claimant may submit written comments, documents, records, and other information and will be given reasonable access to, and copies of, all documents, records, and other information relevant to the claim. To be assured of a proper response to the appeal, it must be directed to the Insurance Carrier.

Insurance Carrier’s Review of Appeal The appeal will be conducted by the Insurance Carrier, and the reviewer will be a named fiduciary who is neither the individual nor a subordinate of the individual who made the initial denial. This reviewer will not give deference to the initial benefit determination and will take into account all comments, documents, records, and other information that the claimant submits relating to the claim, without regard to whether the information was submitted or considered in the initial benefit determination.


Potential Review of Appeal by the Plan Administrator If either the Plan Administrator or the Insurance Carrier determines that the appeal presents material issues that are outside the expertise or purview of the Insurance Carrier (such as hours worked, employment status or new or unique procedural or Plan interpretation issues), then the Insurance Carrier’s decisions will be subject to further review by the Plan Administrator. The claimant will be notified if such a further review will be performed. Unless the claimant is instructed that additional information is needed for this review, the claimant will not be required to submit any further information to the Plan Administrator (although the claimant may do so if he/she wishes). The Plan Administrator’s decision will be based on all information submitted by the claimant and any other information as the Plan Administrator deems relevant.

Notice of Decision on Appeal Regardless of whether the Plan Administrator gets involved in the decision, the claimant will be notified of the benefit determination within 60 days of the receipt of the appeal (45 days if the claim is disability-related). By notice to the claimant before this period ends, the Insurance Carrier or the Plan Administrator, as the case may be, may extend this deadline by up to 60 additional days (45 additional days if the claim is disability-related) if it determines that a decision cannot be made during the initial period for reasons beyond the control of the Insurance Carrier. An extension notice will specify the length of the extension and inform the claimant that a decision cannot be made within the deadline because of reasons beyond the control of the Plan.

If the decision on appeal is denied, the Insurance Carrier (or the Plan Administrator) will provide the claimant with a notice of the denial that will: Be written in a manner that the claimant should

understand Include the specific reasons for the denial Refer to the provisions of the Plan on which the

determination was based Inform the claimant that, upon request and free of charge,

the claimant is entitled to reasonable access to and copies of, all documents, records, and other information relevant to the claim, and

Notify the claimant of his/her right to bring legal action under ERISA.

General Claims/Appeals Information Both in the context of initial claims determination and in the context of reviewing appeals, there may be situations where the Insurance Carrier or the Plan Administrator needs additional information from the claimant before it can make its determination. If that is the case, the claimant will be notified of the specific information that is needed and/or any unresolved issues that need to be resolved, and the claimant will be given a reasonable period of time to supply the needed information (generally 45 days). In such situations, the deadlines for responding to the claim or appeal may be put on hold while the receipt of this additional information is pending.

The Insurance Carrier and the Plan Administrator will apply their judgment to claims and appeals in a manner that they deem to be consistent with the Plan and any rules, regulations or prior interpretations of the Plan. The Insurance Carrier and the Plan Administrator will make their decisions in a manner that they believe will apply the Plan consistently to similarly situated participants.

The authority granted to the Insurance Carrier and the Plan Administrator to construe and interpret the Plan and make benefit determinations, including claims and appeals determinations, shall be exercised by them (or persons acting under their supervision) as they deem appropriate in their sole discretion. Benefits under this Plan will be paid or provided to the claimant only if the Insurance Carrier or the Plan Administrator, as the case may be, decides in its discretion that the claimant is entitled to them. All such benefit determinations shall be final and binding on all persons, except to the limited extent to which the Insurance Carrier’s decisions are subject to further review by the Plan Administrator.

You must first use the claim and appeal rights described above before you may properly assert any claims in court. If you fully exhaust these rights, but remain dissatisfied with the outcome of your appeal, you may be entitled to challenge the decision in an ERISA Section 502(a) benefit claim.

No such legal action may be commenced any later than two years, or later if required by state or federal law, after the date you are informed of the decision on your appeal.

Statement of ERISA Rights

ERISA provides that all plan participants shall be entitled to:

Receive Information about the Plan and Benefits

Examine, without charge, at the Plan Administrator’s office and at other specified locations, all documents governing the Plan, including insurance policies/contracts and collective bargaining agreements (if applicable), and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.*

Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance policies/contracts and collective bargaining agreements (if applicable), and copies of the latest annual report (Form 5500 Series) and updated summary plan description.* The Plan Administrator may make a reasonable charge for the copies and will inform the claimant in advance of the cost.


* To view or receive a copy of any Plan documents, you should send a written request (noting the specific document(s) of interest) to the following address: Health and Welfare Committee Walgreen Co. 108 Wilmot Road, MS#1825 Deerfield, IL 60015-5143

Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

Receive information about the Plan and benefits.

Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer, your union (if applicable), or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

Enforcement of Your Rights If a claim for a welfare benefit is denied or ignored, in whole or in part, you or, following your death, your beneficiary, has a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps the claimant can take to enforce the above rights. For instance, if a request is made for a copy of Plan documents or the latest annual report from the Plan and they are not received within 30 days, a suit may be filed in a Federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay the claimant up to $110 a day until the materials are received, unless the materials were not sent because of reasons beyond the control of the Administrator. If a claim for benefits is denied or ignored, in whole or in part, a suit may be filed in a state or federal court, but only after you have exhausted your claims and appeals rights described above. In addition, if the claimant disagrees with the Plan’s decision, or lack thereof, concerning the qualified status of a domestic relations order or a medical child support order, a suit may be filed in federal court, after you have exhausted your claims and appeals rights described above. If it should happen that Plan fiduciaries misuse the Plan’s money, or if a claimant is discriminated against for asserting his or her rights, the claimant may seek assistance from the U.S. Department of Labor, or may file suit in a federal court. The court will decide who should pay court costs and legal fees. If the claimant is successful the court may order the person sued to pay these costs and fees. If the claimant loses, the court may order the claimant to pay these costs and fees, for example, if it finds the claim is frivolous.

Assistance with Your Questions If a claimant has any questions about the Plan, he or she should contact the Plan Administrator. (See the “Administrative Facts” section.)

The Plan Administrator is available to answer your general questions. However, raising questions or making an inquiry in this fashion will not satisfy the claims procedure requirements described above. (See the section titled “Claims Procedures”.) If a claimant wishes to file a formal claim or appeal a claim denial, the claimant must follow these formal claims procedure requirements.

If you, or your beneficiary have any questions about this statement or about your rights under ERISA, or if assistance is needed in obtaining documents from the Plan Administrator, you, or your beneficiary should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. Certain publications about rights and responsibilities under ERISA may also be obtained by calling the publications hotline of the Employee Benefits Security Administration at 866-444- 3272 or www.dol.gov/ebsa.

http://www.dol.gov/ebsa


Administrative Facts Plan Name: Walgreens Voluntary Group Term Life

Insurance Plan

Plan Sponsor: Walgreen Co. The term “Walgreens” or “Company” used in this booklet include Walgreen Co. or any United States subsidiary or parent corporation of Walgreen Co. that is a participating employer under this Plan.

The Company has arranged with the insurance carrier to make this life insurance coverage available. The Company also assists employees and their family members who wish to obtain this insurance coverage by performing payroll withholding and other supporting functions. The Plan has been established and is maintained by the insurance carrier. In order to assist employees in obtaining information about this Plan and because there is a possibility that ERISA can apply to this Plan despite its voluntary nature, the Company has made this summary available and has filed the Plan’s annual report on Form 5500.

Plan Year: January 1 - December 31

Employer I.D. Number (EIN): 36-1924025

Plan Number: 501

Plan Type/Funding Method: Benefits are provided by the insurance carrier, the Prudential Life Insurance Company of America, and funded by premiums paid by participants.

Type of Administration: Insurer Administration

Plan Administrator: The policy is administered by the Insurance Carrier.

The Company has no authority or discretion regarding the payment of or determination of Plan benefits. While an insurance policy is in force, the Insurance Carrier is responsible for processing benefit claims and paying benefits in accordance with the terms of the insurance policy issued to the insured.

Insurance Carrier: The Prudential Insurance Company of America 751 Broad Street Newark, New Jersey 07102

Administration Office for Carrier: Your Live Well Rewards Center www.livewellrewardscenter.com

855-564-6153

Plan Administrator & Agent for Service of Process: Health and Welfare Committee Walgreen Co. 108 Wilmot Road, MS#1825 Deerfield, IL 60015-5143

Amendment, Termination Rights, and Questions:

The Company, and as applicable the insurance carrier, reserve the right to alter, amend or cancel this Plan at its sole discretion at any time. Modifications to the Plan, including amendment and termination, will be implemented at the written direction of the Chief Executive Officer, Executive Chairman of the Board or the Chief Human Resources Officer of the Company.

The establishment of this Plan, or any modifications to it, does not create a contract or a guarantee of employment or coverage, nor does it give any company or person a legal or equitable right against the Company, its shareholders, directors, or officers.

01/2016

Documents

Walgreens Voluntary Group Term Life Insurance Plan · Walgreens Voluntary Group Term Life Insurance Plan Summary Plan Description This Summary Plan Description booklet describes the