Wal-Mart 2008 Associate Benefits Book - Making Change at Walmart
Wal-Mart 2008 Associate Benefits Book - Making Change at Walmart
Wal-Mart 2008 Associate Benefits Book - Making Change at Walmart
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Your <strong>2008</strong><br />
<strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Summary Plan Description Effective January 1, <strong>2008</strong><br />
Summary Plan<br />
Description<br />
Effective January 1, <strong>2008</strong><br />
WHAT’S INSIDE...<br />
• Medical Plan<br />
• Pharmacy Benefit<br />
• Dental Plan<br />
• Life Insurance and<br />
Disability Plans<br />
• <strong>Associ<strong>at</strong>e</strong> Stock<br />
Purchase Plan<br />
• <strong>Wal</strong>-<strong>Mart</strong> Profit Sharing<br />
and 401(k) Plan<br />
...AND MUCH MORE.
<strong>2008</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Table of Contents<br />
Inform<strong>at</strong>ion Made Easy<br />
Your <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong> makes it easy for you to quickly get the inform<strong>at</strong>ion<br />
you need about your <strong>Wal</strong>-<strong>Mart</strong> benefits.<br />
Got a question about your <strong>Wal</strong>-<strong>Mart</strong> benefits When you download the <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong><br />
<strong>Benefits</strong> <strong>Book</strong> PDF from walmartbenefits.com or the WIRE, getting the answer is as easy<br />
as two clicks and a word search. To find the inform<strong>at</strong>ion you need, simply launch the<br />
PDF with Adobe® Reader® and:<br />
• Click “edit” on the top tool bar<br />
• Click “search”<br />
• Type the words or phrase th<strong>at</strong> describe the inform<strong>at</strong>ion you're looking for,<br />
such as “vaccin<strong>at</strong>ions” or “vesting,” and click “search.”<br />
You'll get instant results!<br />
Table of Contents<br />
Eligibility and Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2<br />
Claims and Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24<br />
Legal Inform<strong>at</strong>ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38<br />
The Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50<br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii . . . . . . . . . . . .78<br />
Health Savings Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82<br />
The Pharmacy Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90<br />
The Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96<br />
COBRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106<br />
Resources for Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114<br />
Cancer Insurance Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118<br />
Accident Insurance Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122<br />
Company-Paid Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . .126<br />
Optional Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130<br />
Dependent Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136<br />
Accidental De<strong>at</strong>h and Dismemberment Insurance . . . . . . . . .142<br />
Short-Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150<br />
Short-Term Disability Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158<br />
Long-Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162<br />
Truck Driver Long-Term Disability . . . . . . . . . . . . . . . . . . . . . . . .172<br />
Business Travel Accident Insurance . . . . . . . . . . . . . . . . . . . . . . .182<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan . . . . . . . . . . . . . . . . . . . . . . .190<br />
The Profit Sharing and 401(k) Plan . . . . . . . . . . . . . . . . . . . . . . .204<br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226<br />
Your Pay Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234<br />
Your Paid Time-Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236<br />
Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240
your <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong><br />
<strong>Benefits</strong> <strong>Book</strong><br />
This <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong> includes the Summary Plan Descriptions (SPDs) for the <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan and the<br />
<strong>Wal</strong>-<strong>Mart</strong> Profit Sharing and 401(k) Plan. Please take time to review each SPD to completely understand your benefits.<br />
Inform<strong>at</strong>ion obtained during calls to <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. or to any Plan service provider does not waive any provision or limit<strong>at</strong>ion of<br />
the Plan. Inform<strong>at</strong>ion given or st<strong>at</strong>ements made on a call or in an email do not guarantee payment of benefits. In addition, benefits<br />
quotes th<strong>at</strong> are given by phone are based wholly on the inform<strong>at</strong>ion supplied <strong>at</strong> the time. If additional relevant inform<strong>at</strong>ion is discovered,<br />
it may affect payment of your claim. All benefits are subject to eligibility, payment of premiums, limit<strong>at</strong>ions, and all exclusions outlined<br />
in the applicable plan documents including any insurance policies.You can request a copy of the documents governing these<br />
plans by writing to: Custodian of Records, <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department, 922 West <strong>Wal</strong>nut, Ste. A, Rogers, AR 72756-3540.<br />
Atención Asociados Hispanos: Este folleto contiene un resumen en inglés de los derechos y beneficios para todos los asociados bajo el plan<br />
de beneficios de <strong>Wal</strong>-<strong>Mart</strong>. Si Ud tiene dificultades para entender cualquier parte de este folleto puede dirigirse a la siguiente dirección:<br />
<strong>Benefits</strong> Customer Service, <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department, 922 West <strong>Wal</strong>nut, Ste. A, Rogers, AR 72756-3540<br />
o puede llamar para cualquier pregunta al (800) 421-1362, disponible 24 horas al día, los 7 días de la semana. Tenemos asociados quienes<br />
hablan Español y pueden ayudarles a Ud comprender sus beneficios de <strong>Wal</strong>-<strong>Mart</strong>.<br />
El Libro de beneficios para asociados esta disponible en Español. Si usted desea una copia en Español, favor de ver su Representante<br />
de Personal.
Eligibility and Enrollment<br />
Where Can I Find<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />
<strong>Associ<strong>at</strong>e</strong> Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />
Dependent Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5<br />
Dependents Who Are Not Eligible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6<br />
Legal Document<strong>at</strong>ion for Dependent Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6<br />
When Your Dependent Becomes Ineligible. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6<br />
When You Enroll for <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7<br />
When Coverage is Effective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9<br />
Paying for Your <strong>Benefits</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14<br />
Benefit Continu<strong>at</strong>ion If You Go On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15<br />
Changing Your <strong>Benefits</strong> During the Year: St<strong>at</strong>us <strong>Change</strong> Events . . . . . . . . . . . . . . . . . . . . 17<br />
<strong>Making</strong> St<strong>at</strong>us <strong>Change</strong> Event <strong>Change</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18<br />
If Your Job Classific<strong>at</strong>ion <strong>Change</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21<br />
Qualified Medical Child Support Orders (QMCSO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22<br />
When Your AHWP Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23<br />
If you have Medicare or will become eligible for Medicare in the next 12 months,<br />
you have more choices for your prescription drug coverage.<br />
See the Legal Inform<strong>at</strong>ion chapter for more details.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Eligibility and Enrollment<br />
Eligibility and Enrollment Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Enroll in <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong><br />
the WIRE from work or<br />
walmartbenefits.com from home<br />
If you have questions, call the<br />
<strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362<br />
Notify the <strong>Benefits</strong> Department<br />
• within 60 days of your<br />
dependent losing eligibility<br />
• within 60 days of a<br />
St<strong>at</strong>us <strong>Change</strong> Event<br />
Visit Ask Betty on the WIRE from work. Click on the “Life”<br />
tab. Go to More under Resources. Click on “Ask Betty in<br />
<strong>Benefits</strong>” and follow the instructions.<br />
Or walmartbenefits.com from home.The icon is on the<br />
main page of walmartbenefits.com.<br />
Call the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362<br />
Notify the <strong>Benefits</strong> Department<br />
if the payroll deductions for your<br />
benefits are incorrect<br />
Reinst<strong>at</strong>e coverage upon your<br />
return from a Military Leave<br />
Pay premiums for benefits<br />
while on a Leave of Absence<br />
See below for Starbridge,<br />
Accident Insurance Policy, and<br />
Cancer Insurance Policy premium<br />
payment inform<strong>at</strong>ion<br />
Pay premiums for Starbridge<br />
while on a Leave of Absence<br />
Pay premiums for your Cancer<br />
and/or Accident policy while on<br />
a Leave of Absence<br />
Send check or money order payable to the <strong>Wal</strong>-<strong>Mart</strong> Stores,<br />
Inc. <strong>Associ<strong>at</strong>e</strong>s' Health and Welfare Trust to:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department 3001<br />
P.O. Box 1039<br />
Lowell, AR 72745<br />
Please be sure to include your name, <strong>Benefits</strong> ID number,<br />
and facility number on the payment to ensure proper credit.<br />
Payments for Starbridge should be sent to:<br />
CIGNA HealthCare<br />
Attn: Accounting<br />
2222 W. Dunlap Ave., Suite 350<br />
Phoenix, AZ 85021-2866<br />
Payments for Aflac should be sent to:<br />
Aflac<br />
Attn: PHS<br />
1932 Wynnton Road<br />
Columbus, GA 31999<br />
Call the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362<br />
Call the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362<br />
You may also pay by credit card<br />
by calling (800) 421-1362 and<br />
selecting the “credit card payment”<br />
option.<br />
Eligibility and Enrollment<br />
Wh<strong>at</strong> You Need to Know About Eligibility and Enrollment<br />
• You enroll during your Initial Enrollment Period as a newly hired associ<strong>at</strong>e and during the Annual Enrollment<br />
Period and when you have a St<strong>at</strong>us <strong>Change</strong> Event.<br />
• When your Initial Enrollment Period starts depends on your job classific<strong>at</strong>ion and changes if your job<br />
classific<strong>at</strong>ion changes. If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits inform<strong>at</strong>ion is explained in<br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
• It’s important to read this chapter and understand when you need to enroll and how enrollment in<br />
certain benefits (such as life insurance and disability benefits) after your Initial Enrollment Period affects<br />
your particip<strong>at</strong>ion in th<strong>at</strong> benefit.<br />
• Medical, Dental, AD&D, and the Cancer and Accident Insurance Policy coverage cannot be changed except during<br />
the Annual Enrollment period unless you have a St<strong>at</strong>us <strong>Change</strong> Event.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362 3
The <strong>Associ<strong>at</strong>e</strong>s’<br />
Health and Welfare Plan<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan (AHWP)<br />
is a single, comprehensive employee benefit plan th<strong>at</strong><br />
offers Medical, Dental, Cancer Insurance Policy, Accident<br />
Insurance Policy, Accidental De<strong>at</strong>h and Dismemberment<br />
(AD&D), Business Travel Accident, Life Insurance,<br />
Disability, and Resources for Living (employee assistance<br />
and wellness) coverage to eligible associ<strong>at</strong>es.The eligibility<br />
for these benefits is described in this section,<br />
and the terms and conditions for these<br />
benefits are described in the applicable chapter of<br />
this <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong>. The AHWP is sponsored<br />
by <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc., and governed under<br />
the Employee Retirement Income Security<br />
Act of 1974 as amended (ERISA).<br />
If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits<br />
inform<strong>at</strong>ion is explained in Eligibility and <strong>Benefits</strong><br />
for <strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
<strong>Associ<strong>at</strong>e</strong> Eligibility<br />
The benefits you are eligible for depend on your classific<strong>at</strong>ion<br />
in the Company’s (<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. and<br />
its particip<strong>at</strong>ing subsidiaries) payroll system. See the<br />
chart, Eligibility, Enrollment and Effective D<strong>at</strong>es by<br />
Job St<strong>at</strong>us, l<strong>at</strong>er in this chapter for a list of the benefits<br />
you are eligible for and your benefits eligibility<br />
waiting period based on your job st<strong>at</strong>us.<br />
If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits<br />
inform<strong>at</strong>ion is explained in Eligibility and <strong>Benefits</strong><br />
for <strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
About Full-Time<br />
<strong>Associ<strong>at</strong>e</strong> St<strong>at</strong>us<br />
In order to be classified as Full-Time in the Company’s<br />
payroll system, an associ<strong>at</strong>e must regularly work <strong>at</strong> least<br />
34 hours per week (or 28 hours per week if classified as<br />
Full-Time or management prior to and consistently since<br />
January 1, 2002, or 20 hours per week if classified as Full-<br />
Time or management prior to and consistently since<br />
September 1, 1979). When an associ<strong>at</strong>e transitions from<br />
Full-Time to Peak-Time after January 1, 2002, the 28-hour<br />
eligibility guideline listed above no longer applies. In the<br />
event the associ<strong>at</strong>e transitions back to Full-Time, the<br />
associ<strong>at</strong>e will be required to work <strong>at</strong> least 34 hours per<br />
week. Full-Time hourly Field Logistics <strong>Associ<strong>at</strong>e</strong>s and Full-<br />
Time hourly Pharmacists who are classified as Full-Time<br />
in the Company’s payroll system are exempt from the<br />
34-hours-per-week rule.<br />
Salaried St<strong>at</strong>us<br />
As determined by the Company, hourly associ<strong>at</strong>es or<br />
associ<strong>at</strong>es in some positions may qualify for the same<br />
benefits as management associ<strong>at</strong>es if:<br />
• The job description of the hourly associ<strong>at</strong>e is substantially<br />
the same as a management associ<strong>at</strong>e of<br />
<strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary, and<br />
• St<strong>at</strong>e law mand<strong>at</strong>es th<strong>at</strong> the position be classified<br />
as hourly.<br />
Temporary <strong>Associ<strong>at</strong>e</strong>s<br />
Temporary associ<strong>at</strong>es are only eligible for<br />
Starbridge, Resources for Living, and Business Travel<br />
Accident benefits.<br />
4 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Special Eligibility<br />
Rules for Certain <strong>Benefits</strong><br />
The Company offers HMO options in some st<strong>at</strong>es.The<br />
policies for the HMO plans, as well as the insurance policies<br />
for Starbridge, Cancer Insurance Policy, Accident<br />
Insurance Policy, Dependent Life Insurance, and<br />
Accidental De<strong>at</strong>h and Dismemberment Insurance may<br />
have different eligibility requirements than requirements<br />
described in this chapter.You may obtain an explan<strong>at</strong>ion<br />
of these differences by calling (800) 421-1362.The Plan<br />
will apply the eligibility requirements described in this<br />
chapter, unless you contact the <strong>Benefits</strong> Department <strong>at</strong><br />
the number above and request th<strong>at</strong> a different eligibility<br />
provision in the policy be applied to you. For example,<br />
st<strong>at</strong>e law may require an insurance policy to include different<br />
eligibility provisions rel<strong>at</strong>ing to dependents, such<br />
as allowing coverage for a dependent child past age 23<br />
or coverage for a domestic partner.<br />
<strong>Associ<strong>at</strong>e</strong>s Who Are Not Eligible<br />
You are not eligible for the AHWP—if you are l<strong>at</strong>er found<br />
to be a common-law employee of <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. or<br />
any particip<strong>at</strong>ing subsidiary—if you are:<br />
• A leased employee;<br />
• A nonresident alien (unless covered under a specific<br />
policy for exp<strong>at</strong>ri<strong>at</strong>es or third country n<strong>at</strong>ionals who<br />
are employed by the Company);<br />
• An independent contractor;<br />
• A consultant; or<br />
• Not classified as an employee of <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
or its particip<strong>at</strong>ing subsidiaries.<br />
You are also excluded if you are a member of a collective<br />
bargaining unit whose health and welfare benefits were<br />
the subject of good faith collective bargaining.<br />
Dependent Eligibility<br />
Eligible Dependents generally are those who can be<br />
claimed on the tax return filed by your household as<br />
dependents (without regard to the dependent’s income)<br />
and are limited to:<br />
• Your legal spouse of the opposite gender, so<br />
long as you are not legally separ<strong>at</strong>ed (Peak-Time<br />
associ<strong>at</strong>es and Part-Time Truck Drivers may not<br />
cover their spouses);<br />
• Your unmarried dependent children under<br />
age 19; and<br />
• Your unmarried dependent children from age 19 to<br />
their 23rd birthday if they are full-time students <strong>at</strong> an<br />
accredited school.<br />
To be eligible, your dependent children must be one of<br />
the following:<br />
• N<strong>at</strong>ural children;<br />
• Adopted children or children placed with you<br />
for adoption;<br />
• Stepchildren who can be claimed on the tax return<br />
filed by your household as dependents (without<br />
regard to the dependent’s income) and who live with<br />
you in a parent-child rel<strong>at</strong>ionship who either live<br />
with you <strong>at</strong> least 50 percent of the year, or who are<br />
full-time students age 19 to their 23rd birthday; or<br />
• Grandchildren, nieces, nephews, and siblings, or<br />
other blood rel<strong>at</strong>ives, if you have legal custody.<br />
Peak-Time associ<strong>at</strong>es and Part-Time Truck Drivers may<br />
only cover their Eligible Dependent children and may<br />
not cover their spouses. Special rules may apply if you<br />
transition from Full-Time to Peak-Time. See If Your Job<br />
Classific<strong>at</strong>ion <strong>Change</strong>s l<strong>at</strong>er in this chapter for more<br />
inform<strong>at</strong>ion.<br />
If a court order requires you to provide medical and/or<br />
dental coverage for Eligible Dependent children, the<br />
Plan does not require th<strong>at</strong> these children qualify as<br />
dependents on the tax return filed by your household.<br />
However, the children must otherwise meet the Plan’s<br />
eligibility requirements for dependent children. For<br />
more inform<strong>at</strong>ion on how the Plan handles a Qualified<br />
Medical Child Support Order (QMCSO), see Qualified<br />
Medical Child Support Orders l<strong>at</strong>er in this chapter.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
5
If Your Child Is Incapable of Self-Support<br />
Your child generally will be eligible for coverage as long<br />
as your coverage continues and he or she is disabled,<br />
unmarried, and dependent on you as defined by the<br />
Internal Revenue Code.<br />
If your child is not able to <strong>at</strong>tend school full-time or to be<br />
gainfully employed, coverage may be continued beyond<br />
his or her 19th birthday if:<br />
• The child is physically or mentally incapable of selfsupport<br />
and is covered as an Eligible Dependent<br />
under a <strong>Wal</strong>-<strong>Mart</strong>-sponsored medical or dental Plan<br />
and/or Dependent Life Insurance as of his or her<br />
19th birthday; and<br />
• The child’s doctor provides written medical evidence<br />
of disability and inability to provide self support.<br />
Dependents<br />
Who Are Not Eligible<br />
Your dependent is not eligible under your coverage if he<br />
or she is:<br />
• Covered by the Plan as an associ<strong>at</strong>e of <strong>Wal</strong>-<strong>Mart</strong>; th<strong>at</strong><br />
is, an associ<strong>at</strong>e may be either a covered associ<strong>at</strong>e or<br />
a covered dependent, but not both <strong>at</strong> the same time.<br />
(This st<strong>at</strong>ement does not apply to Optional and<br />
Dependent Life Insurance or AD&D coverage.)<br />
• Covered by the Plan as a dependent of another<br />
associ<strong>at</strong>e of <strong>Wal</strong>-<strong>Mart</strong>. (This st<strong>at</strong>ement does not<br />
apply to Optional and Dependent Life Insurance<br />
or AD&D coverage.)<br />
• Residing outside the United St<strong>at</strong>es, except those<br />
dependents <strong>at</strong>tending college full-time outside of<br />
the United St<strong>at</strong>es. (This st<strong>at</strong>ement does not apply to<br />
Dependent Life Insurance.)<br />
• An illegal immigrant.<br />
• Not an Eligible Dependent as defined above.<br />
Legal Document<strong>at</strong>ion<br />
for Dependent Coverage<br />
You may be required to provide legal document<strong>at</strong>ion to<br />
prove the eligibility of your dependent(s).<br />
The Plan reserves the right to conduct a verific<strong>at</strong>ion<br />
audit and require associ<strong>at</strong>es to provide written document<strong>at</strong>ion<br />
of proof of dependent eligibility upon<br />
request. It is the associ<strong>at</strong>e’s responsibility to provide the<br />
written document<strong>at</strong>ion as requested by the Plan. If necessary<br />
document<strong>at</strong>ion is not provided in the time frame<br />
requested, the Plan has the right to cancel dependent<br />
coverage until the requested document<strong>at</strong>ion is<br />
received. It is the associ<strong>at</strong>e’s responsibility to notify the<br />
Plan of any changes in their dependent(s) medical coverage<br />
inform<strong>at</strong>ion.<br />
The associ<strong>at</strong>e is also responsible for any medical, pharmacy,<br />
or dental charges improperly paid after their<br />
dependent(s) becomes ineligible.<br />
When Your Dependent<br />
Becomes Ineligible<br />
You should notify the <strong>Benefits</strong> Department within 60<br />
days from the d<strong>at</strong>e your dependent becomes ineligible<br />
by calling (800) 421-1362.<br />
Your dependent then must elect COBRA continu<strong>at</strong>ion<br />
coverage within 60 days in order to qualify for COBRA<br />
coverage. See the COBRA chapter for more inform<strong>at</strong>ion<br />
regarding COBRA.<br />
You are responsible for any medical, pharmacy, or dental<br />
charges improperly paid after your dependent becomes<br />
ineligible. Refunds of associ<strong>at</strong>e contributions will be<br />
granted only if you notify the <strong>Benefits</strong> Department. Any<br />
refund will be offset by claims th<strong>at</strong> have been paid.<br />
6 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When You Enroll for <strong>Benefits</strong><br />
Once you have completed your eligibility waiting period<br />
(if applicable, see the chart l<strong>at</strong>er in this chapter th<strong>at</strong><br />
applies to your job st<strong>at</strong>us for more inform<strong>at</strong>ion), you<br />
enroll for benefits:<br />
• During your Initial Enrollment Period, which is the<br />
first time you are eligible to enroll. The timing of your<br />
Initial Enrollment Periods will vary by job st<strong>at</strong>us and<br />
will change if your job st<strong>at</strong>us changes. See the chart<br />
l<strong>at</strong>er in this chapter th<strong>at</strong> applies to your job<br />
st<strong>at</strong>us for more inform<strong>at</strong>ion.<br />
• Each year during the Annual Enrollment Period for all<br />
associ<strong>at</strong>es, usually in the fall of each year. <strong>Benefits</strong> you<br />
enroll for during the Annual Enrollment Period are<br />
effective January 1 of the next year.Your deductions<br />
are adjusted to reflect the cost of coverage changes<br />
for the next year. If an end-of-year pay period covers<br />
both the old and new year, your deductions will reflect<br />
the deduction amount for the old year through<br />
December 31 and the new deduction amount for the<br />
new year, pror<strong>at</strong>ed for the number of days covered<br />
from January 1 until the end of the pay period.<br />
• When you have a St<strong>at</strong>us <strong>Change</strong> Event. A St<strong>at</strong>us<br />
<strong>Change</strong> Event is an event th<strong>at</strong> allows you to make<br />
changes to your coverage outside of the Annual<br />
Enrollment Period and is in accordance with federal<br />
law. See St<strong>at</strong>us <strong>Change</strong> Events l<strong>at</strong>er in this chapter<br />
for more inform<strong>at</strong>ion.<br />
If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits<br />
inform<strong>at</strong>ion is explained in Eligibility and <strong>Benefits</strong><br />
for <strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
If you are eligible and do not enroll during your Initial<br />
Enrollment Period, you will not be eligible for the following<br />
benefits until the next Annual Enrollment Period<br />
unless you have a St<strong>at</strong>us <strong>Change</strong> Event :<br />
• Medical<br />
• Dental<br />
• Starbridge<br />
• HMO Plans (if available)<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
• AD&D<br />
Note th<strong>at</strong> some HMOs have different eligibility<br />
requirements. See The Medical Plan chapter for<br />
more inform<strong>at</strong>ion.<br />
If you are eligible and do not enroll during your Initial<br />
Enrollment Period, you may still enroll for the following<br />
benefits during the year by going online through the<br />
WIRE or walmartbenefits.com. However, if you do not<br />
enroll during your Initial Enrollment Period your benefits<br />
may be reduced, you may have an additional waiting<br />
period, or you may be required to provide Proof of<br />
Good Health. Proof of Good Health is required for<br />
Accident Insurance Policy and Cancer Insurance Policy<br />
regardless of when you enroll.<br />
• Optional Life Insurance<br />
• Dependent Life Insurance<br />
• Short-Term Disability<br />
• Long-Term Disability<br />
• Truck Driver Long-Term Disability<br />
• Short-Term Disability Plus<br />
Proof of Good Health includes completing a questionnaire<br />
regarding your medical history and possibly having<br />
a medical exam.The Proof of Good Health questionnaire<br />
is made available when you enroll.<br />
Confirming Your Enrollment<br />
Once you enroll for coverage, you can view your confirm<strong>at</strong>ion<br />
st<strong>at</strong>ement on the WIRE or walmartbenefits.com.<br />
If you believe there is an error regarding wh<strong>at</strong> benefits<br />
you enrolled in, you should immedi<strong>at</strong>ely contact the<br />
<strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
7
Autom<strong>at</strong>ic Re-Enrollment in <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan Options<br />
For the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, if you do not re-enroll <strong>at</strong><br />
the next Annual Enrollment Period, you autom<strong>at</strong>ically<br />
will be re-enrolled in your prior year’s coverage option.<br />
You will not be able to change this option once the new<br />
plan year has started (January 1st), unless you experience<br />
a St<strong>at</strong>us <strong>Change</strong> Event, or until the next Annual<br />
Enrollment Period.<br />
If your prior year’s coverage option is not available, you<br />
autom<strong>at</strong>ically will be re-enrolled in the option most similar<br />
to your prior year’s coverage option. Of course, you<br />
can always change your coverage options <strong>at</strong> Annual<br />
Enrollment, including dropping coverage altogether.<br />
For the 2007 Annual Enrollment Period, most of the prior<br />
coverage options have changed. As a result, if you had<br />
coverage in 2007 and do not affirm<strong>at</strong>ively change or<br />
drop this coverage <strong>at</strong> the 2007 Annual Enrollment, you<br />
autom<strong>at</strong>ically will be enrolled in the new coverage<br />
option listed in the chart. After Annual Enrollment ends,<br />
you will only be able to change this coverage option if<br />
you experience a St<strong>at</strong>us <strong>Change</strong> Event or <strong>at</strong> next year’s<br />
Annual Enrollment (<strong>2008</strong>).<br />
If you were enrolled in the Freedom Plan for 2007, you<br />
autom<strong>at</strong>ically will be enrolled in the same plan for <strong>2008</strong>.<br />
If you fail to affirm<strong>at</strong>ively enroll or re-enroll during<br />
Annual Enrollment, you will be tre<strong>at</strong>ed by the Plan as<br />
if you had consented to the autom<strong>at</strong>ic re-enrollment<br />
described in this section, and your payroll deductions<br />
will be adjusted accordingly.<br />
<strong>2008</strong> Default Coverage<br />
If your 2007 coverage is:<br />
You’ll be defaulted into<br />
this Network for <strong>2008</strong><br />
You’ll be defaulted into<br />
this Value Plan for <strong>2008</strong><br />
Standard Plan $350 Choice Network Health Care Credit $100<br />
Annual Deductible $350<br />
Out-of-Pocket Maximum $5,000<br />
Network Saver Plan $350<br />
Basic Network<br />
Network Performance Plan $350<br />
Limited Network<br />
Standard Plan $500 Choice Network Health Care Credit $100<br />
Annual Deductible $500<br />
Out-of-Pocket Maximum $5,000<br />
Network Saver Plan $500<br />
Basic Network<br />
Network Performance Plan $500<br />
Limited Network<br />
Standard Plan $1000 Choice Network Health Care Credit $100<br />
Annual Deductible $1,000<br />
Out-of-Pocket Maximum $5,000<br />
Network Saver Plan $1000<br />
Basic Network<br />
Network Performance Plan $1000<br />
Limited Network<br />
Value Plan Basic Network Health Care Credit $250<br />
Annual Deductible $1,000<br />
Out-of-Pocket Maximum $5,000<br />
Value Performance Plan<br />
Limited Network<br />
HMO is no longer<br />
available in your loc<strong>at</strong>ion<br />
Choice Network Health Care Credit $100<br />
Annual Deductible $350<br />
Out-of-Pocket Maximum $5,000<br />
Freedom Plan Basic Network No deductible change from previous year<br />
Freedom Performance Plan Limited Network No deductible change from previous year<br />
8 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When Coverage is Effective<br />
The charts on the following pages show when coverage for<br />
benefits you have enrolled in becomes effective.You must be<br />
Actively-At-Work on the day your coverage is effective for<br />
coverage to begin. However, if you are not Actively-At-Work<br />
due to a medical condition, your coverage for Medical, Dental,<br />
and Resources for Living benefits will begin whether or not<br />
you are Actively-At-Work, as long as you have reported for<br />
your first day of work. For all other benefits, if you are not<br />
Actively-At-Work for any reason other than a scheduled vac<strong>at</strong>ion<br />
on the effective d<strong>at</strong>e of your coverage, your coverage will<br />
be delayed until you return to Active Work.<br />
If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits<br />
inform<strong>at</strong>ion is explained in Eligibility and <strong>Benefits</strong> for<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
Active Work or Actively-At-Work<br />
For Medical, Dental, and Resources for Living<br />
coverage, Actively-At-Work or Active Work means you have<br />
reported to work for <strong>Wal</strong>-<strong>Mart</strong>, even if you then are out for<br />
medical reasons.<br />
For Company-Paid Life Insurance, Optional Life Insurance,<br />
Dependent Life Insurance, Accidental De<strong>at</strong>h and<br />
Dismemberment, Business Travel Accident, Short-Term<br />
Disability, Short-Term Disability Plus, Long-Term Disability, and<br />
Truck Driver Long-Term Disability coverage, Actively-At-Work<br />
or Active Work means you are Actively-At-Work with the<br />
Company on a day th<strong>at</strong> is one of your scheduled work days if<br />
you are performing, in the usual way, all of the regular duties<br />
of your job on a Full-Time basis on th<strong>at</strong> day.You will be<br />
deemed to be Actively-At-Work on a day th<strong>at</strong> is not one of<br />
your scheduled work days only if you were Actively-At-Work<br />
on the preceding scheduled work day.<br />
If you are on a Leave of Absence when your coverage is to<br />
become effective, the coverages listed above will be delayed<br />
until you return to Active Work. This does not apply to<br />
Medical, Dental, Resources for Living, the Cancer<br />
Insurance Policy and the Accident Insurance Policy.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
9
Effective D<strong>at</strong>es for <strong>Benefits</strong> Under the AHWP<br />
The following Enrollment, Eligibility, and Effective D<strong>at</strong>es by Job St<strong>at</strong>us charts provide your coverage effective<br />
d<strong>at</strong>es if you enroll during your Initial Enrollment Period. If you enroll after your Initial Enrollment Period, you may<br />
enroll during Annual Enrollment or if you experience a St<strong>at</strong>us <strong>Change</strong> Event as described in Changing Your <strong>Benefits</strong><br />
During the Year: St<strong>at</strong>us <strong>Change</strong> Events l<strong>at</strong>er in this chapter. See the rest of this chapter and the individual benefit<br />
chapters for effective d<strong>at</strong>e inform<strong>at</strong>ion. If you are an associ<strong>at</strong>e in Hawaii, your eligibility and benefits inform<strong>at</strong>ion is<br />
explained in Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii.<br />
Full-Time Hourly: 180-Day Wait<br />
Plan<br />
• Medical<br />
• HMO Plans*<br />
• Dental (enrollment is for<br />
two full calendar years)<br />
• AD&D<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
Company-Paid Life<br />
• Business Travel<br />
• Resources for Living<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Initial Enrollment Period:<br />
Between 120 and 180 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
181st day of continuous Full-Time employment (or, if hired prior to January 1, 2002, on<br />
the 91st day of continuous Full-Time employment)<br />
Cancer Insurance Policy and Accident Insurance Policy are effective on the first day of<br />
the month after your 181st day of continuous Full-Time employment. Proof of Good Health<br />
is required.<br />
Autom<strong>at</strong>ically enrolled <strong>at</strong> 180 days from hire d<strong>at</strong>e.<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
• Optional Life<br />
• Dependent Life<br />
• Short-Term Disability<br />
• Long-Term Disability<br />
• Short-Term Disability Plus<br />
(not available in California<br />
and Rhode Island)<br />
Starbridge<br />
Initial Enrollment Period:<br />
Between 120 and 180 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
If you enroll during your Initial Enrollment Period , 181st day of continuous<br />
Full-Time employment or upon approval by Prudential for Optional Life and Dependent Life.<br />
For Optional or Dependent Life Insurance:<br />
You may enroll <strong>at</strong> any time during the year, but Proof of Good Health may be required.<br />
For STD and LTD and STD Plus:<br />
You may enroll <strong>at</strong> any time during the year, but If you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will have a one-year wait and a reduction in benefits.<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days of hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
Coverage is effective on the d<strong>at</strong>e you enroll, but termin<strong>at</strong>es on the d<strong>at</strong>e th<strong>at</strong> you become<br />
eligible for medical/HMO plans. See your personnel represent<strong>at</strong>ive for details.<br />
* Some HMOs may require longer terms of employment for eligibility.<br />
10 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Management <strong>Associ<strong>at</strong>e</strong>s, Management Trainees, CA Pharmacists,<br />
Full-Time Truck Drivers, and <strong>Associ<strong>at</strong>e</strong>s Promoted to Management St<strong>at</strong>us<br />
during Initial Enrollment Period: No Wait<br />
Plan<br />
• Medical<br />
• HMO Plans*<br />
• Dental (enrollment is for<br />
two full calendar years)<br />
• AD&D<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
Company-Paid Life<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
D<strong>at</strong>e of hire or promotion to management st<strong>at</strong>us.<br />
Cancer Insurance Policy and Accident Insurance Policy are effective on the first day of the<br />
month after you enroll for coverage. Proof of Good Health is required.<br />
Autom<strong>at</strong>ically enrolled <strong>at</strong> d<strong>at</strong>e of hire. (Officers of the Company are not eligible for this benefit.)<br />
• Business Travel Accident<br />
• Resources for Living<br />
Optional Life<br />
Dependent Life<br />
Long-Term Disability<br />
Truck Driver<br />
Long-Term Disability<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
If you enroll during your Initial Enrollment Period, on your d<strong>at</strong>e of hire or promotion to<br />
management st<strong>at</strong>us or upon approval by Prudential for Optional Life and Dependent Life.<br />
For Optional or Dependent Life Insurance:<br />
You may enroll <strong>at</strong> any time during the year, but Proof of Good Health may be required.<br />
For LTD:<br />
You may enroll <strong>at</strong> any time during the year, but If you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will have a one-year wait and a reduction in benefits.<br />
For Truck Driver LTD:<br />
You may enroll <strong>at</strong> any time during the year, but if you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will be required to provide Proof of Good Health.<br />
* Some HMOs may require longer terms of employment for eligibility.<br />
STD Plus and Starbridge are not available to Management associ<strong>at</strong>es, Management Trainees, and Full-Time Truck Drivers.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
11
Full-Time Hourly Pharmacists ** , Full-Time Hourly Field Logistics <strong>Associ<strong>at</strong>e</strong>s,<br />
and Full-Time Hourly Field Supervisor Positions in Stores and Clubs:<br />
90-Day Wait<br />
Plan<br />
• Medical<br />
• HMO Plans*<br />
• Dental (enrollment is for<br />
two full calendar years)<br />
• AD&D<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
Company-Paid Life<br />
• Business Travel Accident<br />
• Resources for Living<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 90 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
91st day of continuous Full-Time employment.<br />
Cancer Insurance Policy and Accident Insurance Policy are effective on the first day<br />
of the month after your 91st day of continuous Full-Time employment. Proof of Good Health<br />
is required.<br />
Autom<strong>at</strong>ically enrolled <strong>at</strong> 90 days from hire d<strong>at</strong>e.<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
• Optional Life<br />
• Dependent Life<br />
• Short-Term Disability<br />
• Long-Term Disability<br />
• Short-Term Disability Plus<br />
(not available in California<br />
and Rhode Island)<br />
Starbridge<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 90 days form hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
If you enroll during your Initial Enrollment Period, 91st day of continuous<br />
Full-Time employment or upon approval by Prudential for Optional Life and Dependent Life.<br />
For Optional or Dependent Life Insurance:<br />
You may enroll <strong>at</strong> any time during the year, but Proof of Good Health may be required.<br />
For STD and LTD and STD Plus:<br />
You may enroll <strong>at</strong> any time during the year, but if you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will have a one-year wait and a reduction in benefits.<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
Coverage is effective on the d<strong>at</strong>e you enroll, but termin<strong>at</strong>es on the d<strong>at</strong>e th<strong>at</strong> you become<br />
eligible for medical/HMO plans. See your personnel represent<strong>at</strong>ive for details.<br />
* Some HMOs may require longer terms of employment for eligibility.<br />
** California Pharmacists are eligible for the benefits listed in the chart for Management <strong>Associ<strong>at</strong>e</strong>s earlier in this chapter.<br />
Temporary <strong>Associ<strong>at</strong>e</strong>s<br />
Plan<br />
• Business Travel Accident<br />
• Resources for Living<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
Starbridge<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
Coverage is effective on the d<strong>at</strong>e you enroll. See your personnel represent<strong>at</strong>ive for details.<br />
Life and Disability coverage is not available to Temporary associ<strong>at</strong>es<br />
12 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Peak-Time Hourly <strong>Associ<strong>at</strong>e</strong>s and<br />
Part-Time Truck Drivers: 365-Day Wait<br />
Plan<br />
• Medical<br />
• HMO Plans*<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
• Business Travel Accident<br />
• Resources for Living<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Initial Enrollment Period:<br />
Within 60 days of your one-year anniversary<br />
When Coverage is Effective:<br />
366th day of continuous employment as long as <strong>Wal</strong>-<strong>Mart</strong> is your primary employer.“Primary<br />
Employer” means the employer who will provide you with the gre<strong>at</strong>est percentage of total<br />
income this year<br />
Cancer Insurance Policy and Accident Insurance Policy are effective on the first day<br />
of the month after your 366th day of continuous Full-Time employment. Proof of Good Health<br />
is required.<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
Starbridge<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
Coverage is effective on the d<strong>at</strong>e you enroll, but termin<strong>at</strong>es on the d<strong>at</strong>e th<strong>at</strong> you become<br />
eligible for medical/HMO plans. See your personnel represent<strong>at</strong>ive for details.<br />
* Some HMOs may require longer terms of employment for eligibility.<br />
NOTE: Peak-Time associ<strong>at</strong>es and Part-Time Truck Drivers may only cover their Eligible Dependent children and may not cover their spouses.<br />
Life and Disability coverage is not available to Peak-Time hourly associ<strong>at</strong>es and Part-Time Truck Drivers.<br />
Full-Time Hourly Vision Center Managers: No Wait<br />
Plan<br />
• Medical<br />
• HMO Plans*<br />
• Dental (enrollment is for<br />
two full calendar years)<br />
• AD&D<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
Enrollment Periods and Effective D<strong>at</strong>es<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days from hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
D<strong>at</strong>e of hire or promotion to Full-Time Hourly Vision Center Manager st<strong>at</strong>us<br />
Cancer Insurance Policy and Accident Insurance Policy are effective on the first day of<br />
the month after you enroll for coverage. Proof of Good Health is required.<br />
Eligibility and Enrollment<br />
Company-Paid Life<br />
• Business Travel Accident<br />
• Resources for Living<br />
Autom<strong>at</strong>ically enrolled <strong>at</strong> hire d<strong>at</strong>e.<br />
Autom<strong>at</strong>ically enrolled as of your first day of Active Work.<br />
• Optional Life<br />
• Dependent Life<br />
• Short-Term Disability<br />
• Long-Term Disability<br />
• Short-Term Disability Plus<br />
(not available in California<br />
and Rhode Island)<br />
Starbridge<br />
Initial Enrollment Period:<br />
From the d<strong>at</strong>e of your first paycheck through 60 days of hire d<strong>at</strong>e.<br />
When Coverage is Effective:<br />
If you enroll during your Initial Enrollment Period, 1st day of continuous Full-Time<br />
employment or upon approval by Prudential for Optional Life and Dependent Life.<br />
For Optional or Dependent Life Insurance:<br />
You may enroll <strong>at</strong> any time during the year, but Proof of Good Health may be required.<br />
For STD and LTD and STD Plus:<br />
You may enroll <strong>at</strong> any time during the year, but If you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will have a one-year wait and a reduction in benefits.<br />
Not available.<br />
* Some HMOs may require longer terms of employment for eligibility.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
13
Paying for Your <strong>Benefits</strong><br />
Your contributions/premiums will be withheld from<br />
your paycheck by <strong>Wal</strong>-<strong>Mart</strong>. The first paycheck after<br />
your effective d<strong>at</strong>e should reflect deductions for each<br />
day th<strong>at</strong> you had coverage within th<strong>at</strong> pay period. If<br />
an end-of-year pay period covers both the old and<br />
new year, your deductions will reflect the deduction<br />
amount for the old year through December 31 and<br />
the new deduction amount for the new year, pror<strong>at</strong>ed<br />
for the number of days covered from January 1 until<br />
the end of the pay period.<br />
You also can contribute to a health savings account<br />
on a pre-tax basis. See the Health Savings Account<br />
chapter for more inform<strong>at</strong>ion.<br />
If your payroll deductions are not withheld for any<br />
reason, unpaid premiums must be paid in full back to<br />
your original effective d<strong>at</strong>e in order for coverage during<br />
th<strong>at</strong> period to apply. This could result in extra<br />
deductions from your paycheck.<br />
How You Pay for <strong>Benefits</strong><br />
Benefit<br />
Benefit Code<br />
on Paycheck<br />
Premiums Paid<br />
Pre-Tax<br />
Premiums Paid<br />
After-Tax<br />
Optional Life Insurance INS LIFE ■<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan INS MED ■<br />
Dental Insurance INS DEN ■<br />
Cancer Insurance Policy CANCER ■<br />
Accidental De<strong>at</strong>h and Dismemberment AD&D ■<br />
Short-Term Disability INS STD ■<br />
Short-Term Disability Plus STD+ ■<br />
Long-Term Disability INS LTD ■<br />
HMO INS MED HMO ■<br />
Starbridge STAR ■<br />
Dependent Life Insurance INS DEP LIFE ■<br />
Long-Term Disability Truck Driver INS LTD ■<br />
Accident Insurance Policy ACCIDENT ■<br />
Your payroll deductions reflect your cost for benefits<br />
for the payroll period ending on the d<strong>at</strong>e of your paycheck.<br />
So, if you are paid bi-weekly, your deductions<br />
are paying for coverage for the previous two weeks.<br />
Contributions/premiums are paid based on 26 pay<br />
periods excluding Rhode Island.<br />
14 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The deduction code used on your paycheck for<br />
each benefit is shown in the chart, How You Pay<br />
for <strong>Benefits</strong>. It’s important to check your paystub<br />
to be sure th<strong>at</strong> the proper deductions are being<br />
taken. Remember, you can view your paystub online<br />
the Monday before payday by going to “Online<br />
Paystub” on walmartbenefits.com. If the coverage<br />
and deductions you selected are not shown correctly<br />
on your paystub, call the <strong>Benefits</strong> Department<br />
immedi<strong>at</strong>ely <strong>at</strong> (800) 421-1362.<br />
Many of your <strong>Wal</strong>-<strong>Mart</strong> benefits can be paid for with pretax<br />
dollars. Purchasing with “pre-tax” dollars means your<br />
payroll deductions for coverage are deducted from your<br />
paycheck before federal and, in most cases, st<strong>at</strong>e taxes<br />
are withheld.The result is th<strong>at</strong> your pay remains the<br />
same but your taxes are lower, your benefits dollars go<br />
farther, and you get more for your money.<br />
Because Social Security taxes are not withheld on any<br />
“pre-tax” dollars you spend for benefits, these dollars<br />
will not be counted as wages for Social Security purposes.<br />
As a result, your future Social Security benefits may<br />
be reduced.<br />
Deductions for contributions th<strong>at</strong> are past due or for<br />
retroactive elections may be made on an “after-tax” basis.<br />
For inform<strong>at</strong>ion on how to pay for benefits while you are<br />
on a Leave of Absence and are not receiving a <strong>Wal</strong>-<strong>Mart</strong><br />
paycheck, see <strong>Benefits</strong> Continu<strong>at</strong>ion If You Go On a<br />
Leave of Absence in this chapter.<br />
Benefit Continu<strong>at</strong>ion If<br />
You Go On a Leave of Absence<br />
A Leave of Absence provides you with needed time<br />
away from work while maintaining eligibility for benefits<br />
and continuity of employment.To accommod<strong>at</strong>e situ<strong>at</strong>ions<br />
th<strong>at</strong> necessit<strong>at</strong>e absence from work, the Company<br />
provides three types of leave:<br />
• Family Medical Leave Act of 1993 (FMLA):<br />
An approved FMLA Leave provides you with time<br />
away from work so th<strong>at</strong> you can receive medical<br />
tre<strong>at</strong>ment and/or recover from medical tre<strong>at</strong>ment,<br />
injury, or disability. This includes disabilities, pregnancy,<br />
childbirth, and other serious health conditions.<br />
<strong>Wal</strong>-<strong>Mart</strong> will maintain Medical, Dental and RFL<br />
coverage while you are on FMLA leave, where such<br />
coverage was provided before the leave was taken.<br />
Such coverage will be maintained on the same<br />
terms and conditions as if you had continued to<br />
work during the leave period. You must make<br />
arrangements to pay your share of health benefits<br />
costs during your FMLA leave by paying those<br />
costs on a pre-tax basis before the leave or paying<br />
those costs on an after-tax basis during the leave.<br />
Upon returning from your FMLA leave, you many<br />
contact the <strong>Benefits</strong> Department in regards to the<br />
reinst<strong>at</strong>ement of your Medical, Dental, Life, and<br />
Disability coverage .<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
15
• Personal Leave: An approved Personal Leave provides<br />
you with time away from work so th<strong>at</strong> you can<br />
deal with personal situ<strong>at</strong>ions such as a family crisis,<br />
continuing your educ<strong>at</strong>ion, or caring for an ill or<br />
injured rel<strong>at</strong>ive.<br />
• Military Leave: If you volunteer for or are required to<br />
perform active, full-time U.S. military duty or to fulfill<br />
N<strong>at</strong>ional Guard or Reserve oblig<strong>at</strong>ions, you will be<br />
granted a Military Leave.<br />
You may continue or suspend coverage for yourself<br />
or your Eligible Dependent’s while on military leave<br />
of absence. You also may have a right to reinst<strong>at</strong>e<br />
coverage upon your return. Contact the <strong>Benefits</strong><br />
Department <strong>at</strong> (800)421-1362.<br />
Decisions about leaves of absence are made by the<br />
Company, not the AHWP.<br />
You should contact a member of your management<br />
team for additional inform<strong>at</strong>ion about FMLA, Personal<br />
or Military Leave, or refer to <strong>Wal</strong>-<strong>Mart</strong>’s Leave of Absence<br />
policy (PD-24) on the WIRE for more specific inform<strong>at</strong>ion.You<br />
may also contact your personnel represent<strong>at</strong>ive<br />
or any member of the People Group for any questions<br />
you may have about the applic<strong>at</strong>ion of the FMLA,<br />
Personal or Military Leave policy.<br />
Paying for <strong>Benefits</strong><br />
While On a Leave of Absence<br />
To continue coverage for the following benefits, you<br />
must make payments for the associ<strong>at</strong>e portion of the<br />
contribution by paying those costs on a pre-tax basis<br />
before the leave or paying those costs on an after-tax<br />
basis while you are on a Leave of Absence:<br />
• Medical<br />
• Dental<br />
• Cancer Insurance Policy<br />
• Accident Insurance Policy<br />
• Optional Life Insurance<br />
• Dependent Life Insurance<br />
• Accidental De<strong>at</strong>h and Dismemberment<br />
• Short-Term Disability Plus<br />
Your contribution/premium payment covers your cost<br />
for benefits for the period ending on the d<strong>at</strong>e of contribution/premium<br />
bill. So, you are paying for coverage for<br />
the previous period. Because your contribution/premium<br />
payment is for coverage you have already had, you<br />
may experience an interruption in the payment of<br />
Medical, Dental and Prescription claims. To avoid an<br />
interruption, you may also pay for coverage in advance<br />
when you pay your regular contribution/premium.<br />
For more inform<strong>at</strong>ion call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> <strong>at</strong><br />
(800) 421-1362 or (479) 621-2929.<br />
Payments for premiums may be made by check or<br />
money order and should be payable to <strong>Associ<strong>at</strong>e</strong>s’<br />
Health and Welfare Trust and mailed to:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department 3001<br />
P.O. Box 1039<br />
Lowell, AR 72745<br />
Please be sure to include your name, <strong>Benefits</strong> ID, and<br />
facility number on the payment to ensure proper credit.<br />
You may also pay by credit card by calling<br />
(800) 421-1362 and selecting the credit card payment<br />
option.<br />
Payments for Starbridge should be sent to:<br />
CIGNA HealthCare<br />
Attn: Accounting<br />
2222 W. Dunlap Ave., Suite 350<br />
Phoenix, AZ 85021-2866<br />
Payments for the Cancer Insurance Policy and/or<br />
Accident Insurance Policy should be sent to:<br />
Aflac<br />
Attn: PHS<br />
1932 Wynnton Road<br />
Columbus, GA 31999<br />
If you are on a Leave of Absence and payments are owed<br />
to the Plan, any check issued by the Company, during or<br />
after your Leave of Absence, will have the full amount of<br />
premiums deducted. Payment arrangements can be<br />
made by notifying the <strong>Benefits</strong> Department prior to your<br />
return to work.<br />
Generally, payments to continue your coverage can only<br />
be accepted from you or a family member.<br />
If your coverage is canceled, please see the applicable<br />
benefit section for how to reinst<strong>at</strong>e coverage.<br />
16 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Changing Your <strong>Benefits</strong> During<br />
the Year: St<strong>at</strong>us <strong>Change</strong> Events<br />
Your ability to change your benefit coverage <strong>at</strong> any time<br />
other than the Annual Enrollment period depends on<br />
whether the benefit is paid for with pre-tax dollars or<br />
after-tax dollars.<br />
• After-tax benefits can be changed (coverage added<br />
or dropped) <strong>at</strong> any time. After-tax benefits are<br />
Optional Life Insurance, Dependent Life Insurance,<br />
Short-Term Disability, Long-Term Disability, and Truck<br />
Driver Long-Term Disability.<br />
• Pre-tax benefits generally can only be changed during<br />
the Annual Enrollment period unless you have a<br />
St<strong>at</strong>us <strong>Change</strong> Event. Pre-tax benefits are the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, HMO plans, Dental,<br />
Accidental De<strong>at</strong>h and Dismemberment, Starbridge,<br />
Cancer Insurance Policy and Accident<br />
Insurance Policy.<br />
Because of the pre-tax n<strong>at</strong>ure of these premiums, federal<br />
tax law generally requires th<strong>at</strong> your pre-tax benefit<br />
choices remain in effect for the entire calendar year in<br />
which the choice was made. Pre-tax contributions to a<br />
health savings account can be changed on a going-forward<br />
basis <strong>at</strong> any time.<br />
However, you may make certain coverage changes if one<br />
of the following St<strong>at</strong>us <strong>Change</strong> Event s occurs. A St<strong>at</strong>us<br />
<strong>Change</strong> Event is an event th<strong>at</strong> allows you to make<br />
changes to your coverage outside of the Annual<br />
Enrollment period. Federal law generally requires th<strong>at</strong><br />
your requested election change be on account of and<br />
correspond with your change in st<strong>at</strong>us, and affect eligibility<br />
for coverage.This means th<strong>at</strong> there must be a logical<br />
rel<strong>at</strong>ionship between the event th<strong>at</strong> occurs and the<br />
change you request.<br />
These events include those listed below:<br />
Events th<strong>at</strong> change your marital st<strong>at</strong>us:<br />
• Marriage<br />
• De<strong>at</strong>h of your spouse<br />
• Divorce (including the end of a common-law marriage—in<br />
st<strong>at</strong>es where a divorce decree is required<br />
to end a common-law marriage, the Company may<br />
require this document<strong>at</strong>ion)<br />
• Annulment<br />
• Legal separ<strong>at</strong>ion<br />
Events th<strong>at</strong> change the number of your dependents:<br />
• Birth<br />
• Adoption<br />
• Placement for adoption<br />
• De<strong>at</strong>h of a dependent<br />
• Loss of custody<br />
• Your p<strong>at</strong>ernity test result<br />
• An event th<strong>at</strong> causes you or your dependent to<br />
s<strong>at</strong>isfy or no longer s<strong>at</strong>isfy the requirements for coverage,<br />
such as <strong>at</strong>tainment of age (for instance, your<br />
dependent who is not a full-time student turning<br />
19 years old), a change in student st<strong>at</strong>us, or other<br />
similar circumstance.<br />
• Employment changes<br />
• Going on or returning from an approved leave<br />
of absence.<br />
• Gaining or losing coverage due to starting or<br />
ending employment by you, your spouse, or<br />
your dependent.<br />
• A change in work schedule or st<strong>at</strong>us of you, your<br />
spouse, or your dependent th<strong>at</strong> affects your benefits<br />
eligibility or th<strong>at</strong> of your spouse or dependent.<br />
• A change in your work loc<strong>at</strong>ion th<strong>at</strong> affects your<br />
medical options (HMO participants may have a<br />
St<strong>at</strong>us <strong>Change</strong> Event based on a change in their residence).<br />
You will have 60 calendar days from your<br />
transfer to submit a request to change your coverage.<br />
If you do not submit a request to change, your<br />
coverage will autom<strong>at</strong>ically be defaulted. Please refer<br />
to the <strong>2008</strong> Default Coverage earlier in this chapter.<br />
• If you lose coverage under any other employer<br />
plan, you may change your coverage in a manner<br />
consistent to the loss. For example, if your spouse<br />
enrolls in or drops coverage during an Annual<br />
Enrollment <strong>at</strong> his or her place of employment or<br />
due to a St<strong>at</strong>us <strong>Change</strong> Event, you may change your<br />
coverage in a manner consistent with your spouse’s<br />
change in coverage.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
17
• If you change your coverage with another employer<br />
th<strong>at</strong> you have, you may change your coverage in a<br />
manner consistent with the change you made under<br />
your other employer’s plan.<br />
• If your ex-spouse enrolls in or drops coverage for<br />
your Eligible Dependent during an Annual<br />
Enrollment period <strong>at</strong> his or her place of employment<br />
or due to a St<strong>at</strong>us <strong>Change</strong> Event, you may change<br />
your coverage in a manner consistent with th<strong>at</strong><br />
change in coverage.<br />
• Loss of coverage.<br />
• You may add medical or dental coverage for you<br />
and/or your Eligible Dependents if you originally<br />
declined coverage because you and/or your<br />
dependents had COBRA coverage and th<strong>at</strong> COBRA<br />
coverage has since been exhausted (nonpayment of<br />
premiums is not sufficient for this purpose), or you<br />
and/or your dependents had non-COBRA medical<br />
coverage and the other coverage has termin<strong>at</strong>ed<br />
due to loss of eligibility for coverage (such as loss of<br />
student-only coverage available through a college<br />
due to the individual ceasing to be a student) or<br />
employer contributions towards the other coverage<br />
have termin<strong>at</strong>ed.<br />
• A change may also be allowed if there is a significant<br />
loss of coverage under the benefits available <strong>at</strong><br />
<strong>Wal</strong>-<strong>Mart</strong>, such as an HMO plan in your area discontinuing<br />
service or ceasing to oper<strong>at</strong>e. The Plan will<br />
determine whether a significant loss of coverage<br />
has occurred.<br />
• A change may be allowed if the lifetime maximum<br />
for all medical benefits under another plan has<br />
been met.<br />
• If you, your spouse, or your dependents lose<br />
coverage under a governmental plan, educ<strong>at</strong>ional<br />
institution’s plan, or tribal government plan, you<br />
can add coverage under the AMP, an HMO plan,<br />
Accident Insurance Policy, Cancer Insurance Policy,<br />
or Starbridge.<br />
• Court order.<br />
Gain of Other Coverage<br />
• If an order resulting from a divorce, legal separ<strong>at</strong>ion,<br />
annulment, or change in legal custody (including a<br />
Qualified Medical Child Support Order - see<br />
“Qualified Medical Child Support Orders” l<strong>at</strong>er in<br />
this chapter) requires you to provide medical coverage<br />
for your Eligible Dependents, you may add coverage<br />
for your Eligible Dependent (and yourself, if<br />
you are not already covered). If the order requires<br />
your spouse, former spouse, or other person to provide<br />
medical coverage for your dependent, and th<strong>at</strong><br />
other coverage is in fact provided, you may drop coverage<br />
for the dependent.<br />
• If you, your spouse, or your dependents are enrolled<br />
in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, an HMO plan,<br />
Accident Insurance Policy, Cancer Insurance Policy, or<br />
Starbridge, you can drop th<strong>at</strong> coverage to the extent<br />
you, your spouse, or your dependents become entitled<br />
to Medicare or Medicaid benefits.<br />
• If you, your spouse, or your dependents gain eligibility<br />
under a governmental plan (other than Medicare<br />
or Medicaid), you cannot drop the AMP, an HMO<br />
plan, Accident Insurance Policy, Cancer Insurance<br />
Policy, or Starbridge coverage except during the<br />
Annual Enrollment period.<br />
<strong>Making</strong> St<strong>at</strong>us<br />
<strong>Change</strong> Event <strong>Change</strong>s<br />
When you have a St<strong>at</strong>us <strong>Change</strong> Event, you must make<br />
your change within 60 days from the d<strong>at</strong>e of the event.<br />
Any changes you make as a result of the St<strong>at</strong>us <strong>Change</strong><br />
Event must be consistent with the event and the gain or<br />
loss of coverage.This means there must be a logical rel<strong>at</strong>ionship<br />
between the event and the change you request.<br />
For example, if you have a St<strong>at</strong>us <strong>Change</strong> Event th<strong>at</strong><br />
affects your dependent child’s eligibility, you can only<br />
drop or add coverage for th<strong>at</strong> child. It would not be consistent<br />
to add a spouse due to this event.<br />
If you add a spouse or dependent due to a St<strong>at</strong>us<br />
<strong>Change</strong> Event, they will be subject to the same plan limit<strong>at</strong>ions<br />
th<strong>at</strong> apply to you <strong>at</strong> th<strong>at</strong> time, if any (for example,<br />
limits concerning transplant coverage, mental/nervous<br />
disorder coverage, and routine mammogram and Pap<br />
smear coverage).<br />
<strong>Associ<strong>at</strong>e</strong>s and dependents will be subject to the same<br />
plan limit<strong>at</strong>ions as the participant who has been covered<br />
for the longer period of time.<br />
The Plan reserves the right to request additional<br />
document<strong>at</strong>ion necessary to show proof of a<br />
St<strong>at</strong>us <strong>Change</strong> Event.<br />
18 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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Medical Plan St<strong>at</strong>us <strong>Change</strong> Event <strong>Change</strong>s<br />
When you have a St<strong>at</strong>us <strong>Change</strong> Event, you may change<br />
your medical plan option or:<br />
• As a Value Plan participant, you may change your<br />
health care credit amount, Annual Deductible<br />
amount, Out-of-Pocket Maximum, Network option, or<br />
tier level (e.g., associ<strong>at</strong>e only, associ<strong>at</strong>e + spouse).<br />
• As a Freedom Plan participant, you may change your<br />
Annual Deductible amount, Network option, or tier<br />
level (e.g., associ<strong>at</strong>e only, associ<strong>at</strong>e + spouse).<br />
Your change regarding tier level (e.g., associ<strong>at</strong>e only,<br />
associ<strong>at</strong>e + spouse) must be consistent with the event<br />
and the gain or loss of coverage.<br />
If you make a change to your medical coverage, you may be<br />
required to s<strong>at</strong>isfy the new Annual Deductible and Out-of-<br />
Pocket Maximum in full (“reset”). See When a Reset Applies<br />
to Medical Plan <strong>Change</strong>s Due to a St<strong>at</strong>us <strong>Change</strong> Event for<br />
complete inform<strong>at</strong>ion.<br />
For example, <strong>Associ<strong>at</strong>e</strong> A has s<strong>at</strong>isfied his or her $500<br />
Annual Deductible in the Value Plan. <strong>Associ<strong>at</strong>e</strong> A has a<br />
St<strong>at</strong>us <strong>Change</strong> Event and elects the Value Plan with a<br />
$350 Annual Deductible. <strong>Associ<strong>at</strong>e</strong> A has changed plan<br />
options and must s<strong>at</strong>isfy the new $350 Annual<br />
Deductible in full. The previously s<strong>at</strong>isfied $500 Annual<br />
Deductible will not apply to the new Annual Deductible<br />
and Out-of-Pocket Maximum.<br />
Here’s another example: <strong>Associ<strong>at</strong>e</strong> C and <strong>Associ<strong>at</strong>e</strong> D<br />
are married. Each is enrolled in associ<strong>at</strong>e-only coverage.<br />
<strong>Associ<strong>at</strong>e</strong> C has enrolled in the Value Plan with a $500<br />
Annual Deductible and <strong>Associ<strong>at</strong>e</strong> D has enrolled in the<br />
Value Plan with a $1,000 Annual Deductible. Both have<br />
s<strong>at</strong>isfied their Annual Deductible. <strong>Associ<strong>at</strong>e</strong> D termin<strong>at</strong>es<br />
employment and enrolls under <strong>Associ<strong>at</strong>e</strong> C’s coverage.<br />
<strong>Associ<strong>at</strong>e</strong> C then changes to the Freedom Plan<br />
with the $2,500 Annual Deductible under the St<strong>at</strong>us<br />
<strong>Change</strong> Event rules. The previously s<strong>at</strong>isfied Annual<br />
Deductibles will not apply to the new Annual<br />
Deductible.Together, <strong>Associ<strong>at</strong>e</strong> C and D both must s<strong>at</strong>isfy<br />
the new $2,500 family Annual Deductible in full.<br />
If you continue the same coverage options (Annual<br />
Deductible,health care credit,Out-of-Pocket Maximum,and<br />
Network option),your Annual Deductible will not be reset.<br />
When a Reset Applies to Medical<br />
Plan <strong>Change</strong>s Due to a St<strong>at</strong>us<br />
<strong>Change</strong> Event (Annual Deductible,<br />
Out-of-Pocket Maximum, and Health<br />
Care Credit “Reset” to Zero)<br />
Benefit<br />
Does<br />
Health<br />
Care<br />
Credit<br />
Reset<br />
Does<br />
Annual<br />
Deductible<br />
Reset<br />
If you change your medical plan option<br />
(Value Plan to Freedom Plan or Freedom to Value Plan):<br />
<strong>Change</strong> to<br />
Value Plan<br />
<strong>Change</strong> to<br />
Freedom Plan<br />
If you change your Annual<br />
Deductible amount:<br />
Yes Yes Yes<br />
Not<br />
applicable<br />
Yes<br />
Does the<br />
Out-of-<br />
Pocket<br />
Maximum<br />
Reset<br />
Yes<br />
Value Plan Yes Yes Yes<br />
Freedom Plan<br />
Not<br />
applicable<br />
No, when<br />
adding<br />
participants;<br />
yes, when<br />
dropping<br />
participants<br />
If you change your health care credit amount or<br />
Out-of-Pocket Maximum:<br />
Value Plan Yes Yes Yes<br />
Freedom Plan<br />
Not<br />
applicable<br />
Not<br />
applicable<br />
No, when<br />
adding<br />
participants;<br />
yes, when<br />
dropping<br />
participants<br />
Not<br />
applicable<br />
If you change your network option (Choice, Basic or Limited)<br />
Value Plan Yes Yes Yes<br />
Freedom Plan<br />
Not<br />
applicable<br />
No, when<br />
adding<br />
participants;<br />
yes, when<br />
dropping<br />
participants<br />
No, when<br />
adding<br />
participants;<br />
yes, when<br />
dropping<br />
participants<br />
If you change your tier level (associ<strong>at</strong>e only,<br />
associ<strong>at</strong>e + spouse, etc.) when no other changes are made:<br />
Value Plan No No No<br />
Freedom Plan<br />
Not<br />
applicable<br />
Yes,<br />
if tier level<br />
is reduced<br />
Yes,<br />
if tier level<br />
is reduced<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
19
HIPAA Special Enrollment for<br />
Medical Coverage<br />
Under the Health Insurance Portability and<br />
Accountability Act (HIPAA), you also may have a right to<br />
a “special enrollment” in medical coverage under the<br />
Plan if you lose other coverage or acquire a dependent.<br />
These events are described above in the list of St<strong>at</strong>us<br />
<strong>Change</strong> Events. For example, if you are declining enrollment<br />
for yourself or your dependents (including your<br />
spouse) because of other health insurance or group<br />
health plan coverage, you may be able to enroll yourself<br />
and your dependents in this Plan if you or your dependents<br />
lose eligibility for th<strong>at</strong> coverage (or if the employer<br />
stops contributing towards your or your dependents’<br />
other coverage). However, you must request enrollment<br />
within 60 days after your or your dependents’ other coverage<br />
ends (or after the employer stops contributing<br />
toward the other coverage).<br />
In addition, if you have a new dependent as a result of<br />
marriage, birth, adoption, or placement for adoption,<br />
you may be able to enroll yourself and your dependents.<br />
However, you must request enrollment within 60<br />
days after the marriage, birth, adoption, or placement<br />
for adoption.<br />
To request special enrollment or obtain more<br />
inform<strong>at</strong>ion, read the St<strong>at</strong>us <strong>Change</strong> Events inform<strong>at</strong>ion<br />
in this chapter or contact the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362.<br />
How to <strong>Change</strong> Your<br />
Elections Due to a St<strong>at</strong>us <strong>Change</strong> Event<br />
You must advise the <strong>Benefits</strong> Department within 60 days<br />
after a St<strong>at</strong>us <strong>Change</strong> Event.<br />
You can make changes online using the WIRE <strong>at</strong> work<br />
or on walmartbenefits.com for st<strong>at</strong>us changes due to:<br />
• Marriage;<br />
• Birth;<br />
• Divorce;<br />
• Gain or loss of coverage by your spouse; or<br />
• Special enrollment period.<br />
For all other types of st<strong>at</strong>us changes, call the <strong>Benefits</strong><br />
Department <strong>at</strong> (800) 421-1362.<br />
<strong>Change</strong>s to your coverage will be effective on the event<br />
d<strong>at</strong>e of the St<strong>at</strong>us <strong>Change</strong> Event (the Cancer Insurance<br />
Policy and Accident Insurance Policy are effective the<br />
d<strong>at</strong>e your policy is issued by Aflac). If a change is made<br />
due to your going on an unpaid Leave of Absence, the<br />
change will be effective as of the effective d<strong>at</strong>e of your<br />
Leave of Absence.<br />
If you do not notify the <strong>Benefits</strong> Department of the<br />
St<strong>at</strong>us <strong>Change</strong> Event within 60 days, you will not be<br />
able to add or drop coverage until the next Annual<br />
Enrollment period.<br />
Also, if the St<strong>at</strong>us <strong>Change</strong> Event is your dependent losing<br />
eligibility, your dependent will lose the right to elect<br />
COBRA coverage for medical or dental benefits if you do<br />
not notify the <strong>Benefits</strong> Department of the event within<br />
60 days.<br />
20 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
If Your Job<br />
Classific<strong>at</strong>ion <strong>Change</strong>s<br />
If You Transition from<br />
a Full-Time Hourly, Full-Time<br />
Truck Driver, or Management Position<br />
to a Peak-Time Hourly or<br />
Part-Time Hourly Truck Driver<br />
If you are a Full-Time hourly, Full-Time Truck Driver or<br />
management associ<strong>at</strong>e who transitions to a Peak-Time<br />
hourly or Part-Time Truck Driver position between May<br />
13, 2006 and December 31, 2007, you will be entitled to<br />
continue eligibility for Full-Time medical coverage<br />
through the end of the calendar year following the year<br />
when you made the transition.<br />
If medical and/or dental coverage ends, continu<strong>at</strong>ion of<br />
coverage under COBRA may be available (see the<br />
COBRA chapter).<br />
Coverage Effective D<strong>at</strong>e for <strong>Associ<strong>at</strong>e</strong>s Who Transition from<br />
Peak-Time to Full-Time Hourly or Management<br />
If Your Transition Occurs:<br />
Less than 90 days after your<br />
d<strong>at</strong>e of hire (transitioning to<br />
Full-Time hourly pharmacists,<br />
Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisors<br />
More than 90 days after your<br />
d<strong>at</strong>e of hire (transitioning to<br />
Full-Time hourly pharmacists,<br />
Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisors<br />
D<strong>at</strong>e Coverage is Effective*<br />
You will have 60 days from the d<strong>at</strong>e of your transition to<br />
a Peak-Time hourly or Part-Time Truck Driver position to<br />
elect any other medical coverage option available to you<br />
and your spouse and/or dependents under the AHWP.<br />
You may not drop medical coverage for yourself, your<br />
spouse and/or you dependent children during the plan<br />
year. If you do not elect to change your coverage option<br />
within the 60-day enrollment period, you will continue in<br />
the same Full-Time medical coverage option.You may<br />
change elections during any future Annual Enrollment<br />
period or as the result of a St<strong>at</strong>us <strong>Change</strong> Event.<br />
If you elect to change your medical coverage option, you<br />
will be required to s<strong>at</strong>isfy the Annual Deductible and<br />
Out-of-Pocket Maximum of your new medical coverage<br />
option in full.<br />
91st day of continuous employment from your hire d<strong>at</strong>e, as long as you<br />
enroll within 60 days of the d<strong>at</strong>e you transition<br />
1st day of the pay period you transition to Full-Time employment, as long as you<br />
enroll within 60 days from the d<strong>at</strong>e of your hire<br />
Eligibility and Enrollment<br />
Less than 180 days after your<br />
d<strong>at</strong>e of hire (transitioning to<br />
Full-Time hourly associ<strong>at</strong>e)<br />
181st day of continuous employment from your hire d<strong>at</strong>e, as long as you enroll<br />
within 120–180 days from the d<strong>at</strong>e of hire or 60 days from the d<strong>at</strong>e of your transition<br />
(whichever is the longer period).<br />
More than 180 days after your<br />
d<strong>at</strong>e of hire (transitioning to<br />
Full-Time hourly associ<strong>at</strong>e)<br />
1st day of the pay period you transition to Full-Time employment, as long as you<br />
enroll within 60 days from the d<strong>at</strong>e of your transition<br />
More than 365 days after your<br />
d<strong>at</strong>e of hire (transitioning to<br />
any Full-Time hourly or<br />
Management position)<br />
If you transition from Temporary<br />
st<strong>at</strong>us to Peak-Time st<strong>at</strong>us<br />
If you were enrolled in medical coverage as Peak-Time associ<strong>at</strong>e, you will keep your<br />
current medical coverage and will not be able to add additional dependents, except for a<br />
spouse (the enrollment of a spouse must be made within 60 days from your transition).<br />
You may enroll for other coverage for which you are eligible, or add additional dependents,<br />
<strong>at</strong> the next Annual Enrollment period or upon a St<strong>at</strong>us <strong>Change</strong> Event.<br />
If you were not enrolled in medical coverage as Peak-Time associ<strong>at</strong>e, you may add a<br />
spouse or a family coverage only.You may not may not make any other change to your<br />
medical coverage until the next Annual Enrollment period or St<strong>at</strong>us <strong>Change</strong> Event.<br />
You will have an eligibility d<strong>at</strong>e from one year of the hire d<strong>at</strong>e.<br />
* See the “Eligibility, Enrollment and Effective D<strong>at</strong>e” chart for your new job st<strong>at</strong>us earlier in this chapter.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
21
If You Transition from a Management to<br />
Full-Time Hourly Position<br />
If you transition from management to hourly, your current<br />
benefits selections will remain in effect.You also will<br />
be autom<strong>at</strong>ically enrolled for Short-Term Disability and<br />
Short-Term Disability Plus coverage. If you do not wish to<br />
carry this coverage, you have 60 days to notify the<br />
<strong>Benefits</strong> Department. Any premiums paid for the coverage<br />
will be refunded.<br />
If You Transition from<br />
a Peak-Time to a Full-Time Hourly<br />
or Management Position<br />
Your eligibility waiting period will begin on your d<strong>at</strong>e of<br />
hire and is based on your st<strong>at</strong>us in the Company’s payroll<br />
system <strong>at</strong> the time you transition. See the chart<br />
“Coverage effective d<strong>at</strong>e for associ<strong>at</strong>es who transition<br />
from Peak-Time to Full-Time hourly or management”<br />
in this chapter for the d<strong>at</strong>e coverage is effective.<br />
Qualified Medical Child<br />
Support Orders (QMCSO)<br />
A QMCSO is a final court or administr<strong>at</strong>ive agency order<br />
th<strong>at</strong> requires an associ<strong>at</strong>e or other parent or guardian to<br />
provide health care coverage for Eligible Dependents<br />
after a divorce or child custody proceeding. Federal law<br />
requires the Plan to provide medical and dental benefits<br />
to any Eligible Dependent of a plan participant required<br />
by court order meeting the qualific<strong>at</strong>ions of a QMCSO.<br />
The written procedures for determining whether an<br />
order meets the Federal requirements may be obtained<br />
free of charge by contacting the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362.<br />
Once the Plan receives a QMCSO, coverage will begin the<br />
first day of the pay period after the Plan receives the<br />
order or the d<strong>at</strong>e specified in the order. If you are in your<br />
eligibility waiting period when the order is issued, you<br />
will be enrolled in Starbridge coverage. If you are eligible<br />
for the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan and did not have coverage<br />
before the order was issued, you will be enrolled in<br />
the Value Plan associ<strong>at</strong>e + child coverage and you will<br />
need to choose the Annual Deductible, Out-of-Pocket<br />
Maximum and health care credit amount, unless otherwise<br />
provided in the order. If you were enrolled for coverage<br />
before the order was received, your child will be<br />
added under your existing coverage.<br />
If the Plan receives a QMCSO and you are a Peak-Time<br />
associ<strong>at</strong>e in an eligibility waiting period, the order will<br />
be put into effect when your eligibility waiting period<br />
is s<strong>at</strong>isfied.<br />
22 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Dropping or<br />
Changing QMCSO Coverage<br />
You may drop coverage th<strong>at</strong> was put into effect due to a<br />
QMCSO if the QMCSO is termin<strong>at</strong>ed or rescinded under a<br />
court or administr<strong>at</strong>ive agency order. Coverage may be<br />
canceled effective the first day of the pay period after<br />
the Plan receives the order (or any l<strong>at</strong>er d<strong>at</strong>e, if specified<br />
in the order).<br />
You may change your Annual Deductible and/or type<br />
of coverage prior to your effective d<strong>at</strong>e if the court or<br />
administr<strong>at</strong>ive agency order does not specify the type<br />
of coverage and if you are within your Initial Enrollment<br />
Period. If you are past your Initial Enrollment Period<br />
and did not have coverage prior to the QMCSO, you<br />
will have 60 days from the d<strong>at</strong>e of the order to<br />
change your Annual Deductible and other coverage<br />
fe<strong>at</strong>ures. If you do not submit a change, your coverage<br />
will autom<strong>at</strong>ically be defaulted. Please refer to the<br />
<strong>2008</strong> Default Coverage chart earlier in this chapter.<br />
You may also change your Annual Deductible and coverage<br />
during the Annual Enrollment period, consistent<br />
with the QMCSO.<br />
When Your<br />
AHWP Coverage Ends<br />
Coverage under the <strong>Associ<strong>at</strong>e</strong> Health and Welfare Plan<br />
for you and your dependents will end on the earliest of<br />
the following:<br />
• At termin<strong>at</strong>ion of your employment;<br />
• Upon failure to pay your premiums;<br />
• On the d<strong>at</strong>e of de<strong>at</strong>h of you or your dependent;<br />
• On the d<strong>at</strong>e you, a dependent spouse, or<br />
child loses eligibility;<br />
• On the last day of an approved Leave of Absence<br />
(unless you return to work);<br />
• When the benefit is no longer offered by<br />
<strong>Wal</strong>-<strong>Mart</strong>; or<br />
• Upon misrepresent<strong>at</strong>ion or the fraudulent<br />
submission of a claim for benefits.<br />
Eligibility and Enrollment<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
23
Claims and Appeals<br />
Where Can I Find<br />
Deadlines to File a Claim or Bring a Legal Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26<br />
Appealing an Enrollment or Eligibility St<strong>at</strong>us Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26<br />
The Medical, Dental, Pharmacy, and RFL Claim Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26<br />
Inform<strong>at</strong>ion Regarding Rights of the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan and<br />
the Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28<br />
Participant’s Responsibility Regarding Right of Reduction and/or Recovery . . . . . . . . 29<br />
The Aetna Limited Network Claim Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30<br />
Starbridge Claims and Appeals Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32<br />
HMO Plan Claims and Appeals Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32<br />
Filing a Claim for Resources for Living <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32<br />
The Accident Insurance Policy and Cancer Insurance Policy Claim Process . . . . . . . . . . 32<br />
The Company-Paid, Optional, and Dependent Life Insurance and<br />
Business Travel Accident Insurance Policy Claim Process . . . . . . . . . . . . . . . . . . . . . . . . . 33<br />
The Travel Assistance Claim Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34<br />
The Claim Process for All Types of Disability Coverage Claims . . . . . . . . . . . . . . . . . . . . . . 35<br />
The Accidental De<strong>at</strong>h and Dismemberment Claim Process . . . . . . . . . . . . . . . . . . . . . . . . . 37
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Claims and Appeals<br />
As a participant in the <strong>Associ<strong>at</strong>e</strong>s Health and Welfare Plan (AHWP), you have the right to<br />
appeal a decision on the Plan eligibility and benefits. This chapter describes the process and<br />
the deadlines for appealing an Eligibility, Medical, Dental, Pharmacy, Life Insurance, Disability,<br />
AD&D, Resources for Living, or Cancer and Accident Insurance Policy claim th<strong>at</strong> has been partially<br />
or fully denied. To protect your right to appeal, it’s important to follow these processes<br />
and meet the deadlines!<br />
Claims and Appeals Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Design<strong>at</strong>e an authorized<br />
represent<strong>at</strong>ive to submit<br />
claims or appeals on your behalf<br />
Call the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362<br />
Appeal a decision on eligibility for<br />
coverage under the benefit plans<br />
Submit a claim for benefits<br />
Appeal the denial of a claim<br />
Write to:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: Appeals<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540<br />
Submit claims to the plan’s Third Party Administr<strong>at</strong>or for the Medical, Dental and Pharmacy<br />
plans; Prudential for the life insurance and the Business Travel Accident plans; The Hartford<br />
for the disability plans; MetLife for the AD&D plan; Aflac for the Cancer and Accident<br />
Insurance Policies. AXA for AXA Travel Assistance; or Medex for Medex Travel Assistance.<br />
See this chapter for addresses and phone numbers.<br />
Submit appeals for the medical plan to the <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department; Delta Dental<br />
for Dental plan appeals; Prudential for the life insurance and the Business<br />
Travel Accident plans; The Hartford for the disability plans; MetLife for the AD&D plan;<br />
Aflac for the Cancer and Accident Insurance Policies. See this chapter for addresses and<br />
phone numbers.<br />
Claims and Appeals<br />
Wh<strong>at</strong> You Need to Know About Claims and Appeals<br />
• You have the right to appeal a decision th<strong>at</strong> you or a family member is not eligible for coverage under a plan.<br />
• You submit claims for benefits directly to the Third Party Administr<strong>at</strong>or or provider of the plan option.<br />
• You have the right to appeal a benefits claim th<strong>at</strong> has been fully or partially denied.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362 25
Deadlines to File a<br />
Claim or Bring a Legal Action<br />
Unless otherwise specified in the chapter describing<br />
the applicable benefit, you or your dependent(s) must<br />
file an initial claim for benefits under the AHWP within<br />
12 months from the d<strong>at</strong>e of service (18 months if coordin<strong>at</strong>ing<br />
with another plan). You or your dependent(s)<br />
must complete the required claims and appeals<br />
process described in the Claims and Appeals chapter<br />
before you may bring legal action. You may not file a<br />
lawsuit for benefits if the initial claim or appeal is not<br />
made within the time periods set forth in the claims<br />
procedures of the AHWP.<br />
You must file any lawsuit for benefits within 180 days<br />
after the decision on appeal.You may not file suit after<br />
th<strong>at</strong> 180-day period expires.You or your dependent(s)<br />
are not required to request a voluntary review of the<br />
decision on appeal before filing a lawsuit. If you or your<br />
dependent(s) do request a voluntary review of the decision<br />
on appeal, where applicable, the time taken by the<br />
voluntary review will not be counted against the 180<br />
days you have to file a lawsuit.<br />
Appealing an Enrollment<br />
or Eligibility St<strong>at</strong>us Decision<br />
If you disagree with the Plan Administr<strong>at</strong>or’s determin<strong>at</strong>ion<br />
regarding your enrollment or eligibility st<strong>at</strong>us, you<br />
have 365 days from your eligibility enrollment event to<br />
appeal in writing to the following address:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: Appeals<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Your appeal will be handled within 60 days from<br />
the d<strong>at</strong>e it is received by the Plan, unless an extension<br />
is required.<br />
If you have submitted a claim for Medical, Dental, or<br />
Pharmacy benefits and it has been denied due to the<br />
Plan’s determin<strong>at</strong>ion regarding your enrollment or eligibility<br />
st<strong>at</strong>us, see If Your Medical, Pharmacy, or Dental<br />
Claim is Fully or Partially Denied l<strong>at</strong>er in this chapter.<br />
The Medical, Dental,<br />
and Pharmacy Claim Process<br />
This section describes the claim process th<strong>at</strong> will be<br />
followed for the following benefits only:<br />
• Medical benefits if you are covered by BlueCross<br />
BlueShield of Alabama (PPO and Limited Network),<br />
BlueAdvantage Administr<strong>at</strong>ors of Arkansas (PPO and<br />
Limited Network), BlueCross BlueShield of Illinois<br />
(PPO and Limited Network), Humana Limited<br />
Network, UnitedHealthcare Limited Network, and<br />
Aetna Limited Network. (Note, for more inform<strong>at</strong>ion<br />
about the claims process for the Aetna Limited<br />
Network, see Submitting Claims to the Aetna<br />
Limited Network l<strong>at</strong>er in this chapter.)<br />
• Dental benefits if you are covered by Delta Dental<br />
(PPO or Premier)<br />
• Pharmacy benefits if you are covered by<br />
WMS/NextRx<br />
This section does not apply to Starbridge (see<br />
Starbridge Claims l<strong>at</strong>er in this chapter), RFL (see RFL<br />
Claims l<strong>at</strong>er in this chapter) or the HMO plans (see<br />
HMO Claims l<strong>at</strong>er in this chapter).<br />
Inform<strong>at</strong>ion about your rights under the medical and<br />
dental plans can be found in Inform<strong>at</strong>ion Regarding<br />
Rights of the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan and the Dental<br />
Plan l<strong>at</strong>er in this chapter.<br />
Except where prior authoriz<strong>at</strong>ion is required, any review<br />
by the Third Party Administr<strong>at</strong>or before you file a claim<br />
for benefits or receive tre<strong>at</strong>ment is non-binding on the<br />
Plan and not subject to appeal.<br />
Where prior authoriz<strong>at</strong>ion is not required, your initial<br />
medical, dental, and pharmacy claim will be determined<br />
by the Third Party Administr<strong>at</strong>or, Delta Dental, or<br />
WMS/NextRx where applicable. Within a reasonable<br />
time, but no l<strong>at</strong>er than 30 days after a claim is made,<br />
you will receive an Explan<strong>at</strong>ion of <strong>Benefits</strong> (EOB).The<br />
EOB will detail:<br />
• The amount allowed by the Plan;<br />
• The amount applied to your Annual Deductible and<br />
Coinsurance, if any; and<br />
• The amount owed by you to the provider.<br />
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If your claim is partially or fully denied, you will receive<br />
written notice of the decision no l<strong>at</strong>er than 30 days<br />
after the Third Party Administr<strong>at</strong>or, Delta Dental, or<br />
WMS/NextRx receives your claim.The denial will include<br />
the following inform<strong>at</strong>ion:<br />
• The specific reason(s) for the denial;<br />
• Reference to provisions of the Plan on which the<br />
denial was based;<br />
• Inform<strong>at</strong>ion regarding time limits for appeal;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to obtain, upon<br />
request and free of charge, a copy of internal rules or<br />
guidelines relied upon in making this determin<strong>at</strong>ion;<br />
• If your denial is based on Medical Necessity or similar<br />
limit<strong>at</strong>ion, an explan<strong>at</strong>ion of this rule (or a st<strong>at</strong>ement<br />
th<strong>at</strong> it is available upon request); and<br />
• Notice regarding your right to bring a court action<br />
following a denial on appeal.<br />
The 30-day period may be extended for 15 days if it is<br />
determined th<strong>at</strong> an extension is necessary due to m<strong>at</strong>ters<br />
beyond the Plan’s control.You will be notified prior<br />
to the end of the 30-day period if an extension or additional<br />
inform<strong>at</strong>ion is required. If you are asked to provide<br />
additional inform<strong>at</strong>ion, you will have 45 days from the<br />
d<strong>at</strong>e you are notified to provide the inform<strong>at</strong>ion and the<br />
time to make a determin<strong>at</strong>ion will be suspended until<br />
you provide the requested inform<strong>at</strong>ion (or the deadline<br />
to provide the inform<strong>at</strong>ion, if earlier).<br />
If Your Medical, Dental, or<br />
Pharmacy Claim is Fully or Partially Denied<br />
You may request an appeal of the decision. In order for<br />
your appeal to be considered, it must:<br />
• Be in writing;<br />
• Be sent to the correct address;<br />
• Be submitted within 365 days of the d<strong>at</strong>e of the initial<br />
denial; and<br />
• Contain any additional inform<strong>at</strong>ion/document<strong>at</strong>ion<br />
you would like considered.<br />
Send your written request for review of the initial<br />
claim to:<br />
Medical/Pharmacy Appeals<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: Appeals<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Dental Appeals<br />
Appeals Committee<br />
Delta Dental of Arkansas<br />
P.O. Box 15965<br />
N. Little Rock, AR 72231-5965<br />
Your appeal will be conducted without regard to your<br />
initial determin<strong>at</strong>ion by someone other than the party<br />
who decided your initial claim.You have the right to<br />
request copies, free of charge, of all documents, records,<br />
or other inform<strong>at</strong>ion relevant to your claim.<br />
You may design<strong>at</strong>e an authorized represent<strong>at</strong>ive to submit<br />
claims or appeals on your behalf.The form required<br />
to design<strong>at</strong>e an authorized represent<strong>at</strong>ive may be<br />
requested by calling the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362 or by writing:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: Appeals<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
27
You will receive written notice of the decision on review<br />
within 60 days following receipt of your appeal.<br />
If your claim is denied on appeal (by the AHWP, Delta<br />
Dental, or Aetna (with respect to prior authoriz<strong>at</strong>ion)),<br />
you will receive a denial notice th<strong>at</strong> includes:<br />
• The specific reason(s) for the denial;<br />
• Specific reference to the provisions of the AHWP<br />
upon which the denial was based;<br />
• A st<strong>at</strong>ement describing your right to request copies,<br />
free of charge, of all documents, records, or other<br />
inform<strong>at</strong>ion relevant to your claim;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to obtain, upon<br />
request and free of charge, a copy of internal rules or<br />
guidelines relied upon in making this determin<strong>at</strong>ion;<br />
• An explan<strong>at</strong>ion of this rule (or a st<strong>at</strong>ement th<strong>at</strong> it is<br />
available upon request), if your denial is based on a<br />
medical necessity or similar limit<strong>at</strong>ion;<br />
• A description of any voluntary review procedures<br />
available; and<br />
• Notice regarding your right to bring a court action<br />
following a denial on appeal.<br />
Requesting a Voluntary<br />
Review of Your Denied Appeal<br />
If you have additional inform<strong>at</strong>ion th<strong>at</strong> was not in your<br />
appeal, you may ask for a voluntary review of the decision<br />
on your appeal within 180 days of your receipt of<br />
the denial.The same criteria and response times th<strong>at</strong><br />
applied to your appeal are generally applied to this voluntary<br />
level of review.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
Inform<strong>at</strong>ion Regarding<br />
Rights of the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan and the Dental Plan<br />
Right to Request Medical Records<br />
The Plan has the right to request medical records for<br />
any associ<strong>at</strong>e or covered individual.<br />
Plan’s Right to Recover Overpayment<br />
Payments are made in accordance with the provisions of<br />
the Plan. If it is determined th<strong>at</strong> payment was made for<br />
benefits th<strong>at</strong> are not covered by the Plan, for a participant<br />
who is not covered by the Plan, when other insurance<br />
is primary, or other similar circumstances, the Plan<br />
has the right to recover the overpayment.The Plan will<br />
try to collect the overpayment from the party to whom<br />
the payment was made. However, the Plan reserves the<br />
right to seek overpayment from you and/or your<br />
dependents. Failure to comply with this request will entitle<br />
the Plan to withhold benefits due you and/or your<br />
dependents.The Plan has the right to refer the file to an<br />
outside collection agency if internal collection efforts are<br />
unsuccessful.The Plan may also bring a lawsuit to<br />
enforce its rights to recover overpayments.<br />
Your Right to Recover Overpayment<br />
If you overpay your contributions or premiums for any<br />
coverage under the Plan (except COBRA) the Plan will<br />
refund excess contributions or premiums to you upon<br />
request. In this circumstance, any refunds you receive<br />
may be offset by any benefits paid during this period<br />
by the Plan if you or a dependent were not eligible for<br />
such coverage.<br />
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Right to Reduction,<br />
Reimbursement, and Subrog<strong>at</strong>ion<br />
The Plan has the right to:<br />
• Reduce or deny benefits otherwise payable by the<br />
Plan; and<br />
• Recover or subrog<strong>at</strong>e 100 percent of the benefits<br />
paid or to be paid by the Plan for covered persons, to<br />
the extent of any and all of the following payments:<br />
—Any judgment, settlement, or payment made or to<br />
be made because of an accident or malpractice,<br />
including but not limited to other insurance<br />
—Any auto or recre<strong>at</strong>ional vehicle insurance coverage<br />
or benefits, including but not limited to uninsured/<br />
underinsured motorist coverage<br />
—Business medical and/or liability insurance coverage<br />
or payments<br />
—Attorney’s fees<br />
Also note th<strong>at</strong>:<br />
• The Plan has first priority with respect to its right<br />
to reduction, reimbursement, and subrog<strong>at</strong>ion.<br />
• The Plan has the right to recover interest on the<br />
amount paid by the Plan because of the accident.<br />
• The Plan has the right to 100 percent reimbursement<br />
in<br />
a lump sum.<br />
• The Plan is not subject to any st<strong>at</strong>e laws, including<br />
but not limited to the common fund doctrine, which<br />
would purport to require the Plan to reduce its<br />
recovery by any portion of a covered person’s <strong>at</strong>torney’s<br />
fees and costs.<br />
• The Plan is not responsible for the covered person’s<br />
<strong>at</strong>torney’s fees, expenses, or costs.<br />
• The right of reduction, reimbursement, and subrog<strong>at</strong>ion<br />
is based on the Plan language in effect <strong>at</strong> the<br />
time of judgment, payment, or settlement.<br />
• The Plan’s right to reduction, reimbursement, and<br />
subrog<strong>at</strong>ion applies to any funds recovered from<br />
another party, by or on behalf of the est<strong>at</strong>e of any<br />
covered person.<br />
• The Plan’s right to first priority shall not be reduced<br />
due to the participant’s own negligence.<br />
Cooper<strong>at</strong>ion Required<br />
The Plan requires you, your dependents, and your represent<strong>at</strong>ives<br />
to cooper<strong>at</strong>e in order to guarantee reimbursement<br />
to the Plan from third party benefits. Failure to<br />
comply with this request will entitle the Plan to withhold<br />
benefits due to you or your dependents under the Plan.<br />
You, your dependents, and/or your represent<strong>at</strong>ives cannot<br />
do anything to hinder reimbursement of overpayment<br />
to the Plan after benefits have been accepted by<br />
you, your dependents, and/or your represent<strong>at</strong>ives.<br />
These rights apply regardless of whether such payments<br />
are design<strong>at</strong>ed as payment for, but not limited to:<br />
• Pain and suffering; or<br />
• Medical benefits.<br />
This applies regardless of whether you or your dependents<br />
have been fully compens<strong>at</strong>ed for injuries.<br />
Additionally, the Plan has the right to file suit on your<br />
behalf for the condition rel<strong>at</strong>ed to the medical expenses<br />
in order to recover benefits paid or to be paid by<br />
the Plan.<br />
Participant’s Responsibility<br />
Regarding Right of Reduction<br />
and/or Recovery<br />
To aid the Plan in its enforcement of its right of reduction,<br />
recovery, reimbursement, and subrog<strong>at</strong>ion, you<br />
and your represent<strong>at</strong>ive must, <strong>at</strong> the Plan’s request<br />
and <strong>at</strong> its discretion:<br />
• Take any action;<br />
• Give inform<strong>at</strong>ion; and<br />
• Sign documents so required by the Plan.<br />
Failure to aid the Plan and to comply with such requests<br />
may result in the Plan’s withholding or recovering benefits,<br />
services, payments, or credits due or paid under<br />
the Plan.<br />
The Plan’s right to reimbursement applies when the Plan<br />
pays medical benefits, and a judgment, payment, or settlement<br />
is made on behalf of the covered person for<br />
whom the medical benefits were paid. Reimbursement<br />
to the Plan of 100 percent of these charges shall be<br />
made <strong>at</strong> the time the payment is received by you, your<br />
dependent(s), or your represent<strong>at</strong>ive.<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
29
Right to Audit<br />
The Plan has the right to audit your and your dependent’s<br />
claims as well as providers.The Plan may reduce or<br />
deny benefits for otherwise covered services for all current<br />
and/or future claims with the provider and/or you<br />
and your dependents based on the results of an audit.<br />
Right to Salary/Wage Deduction<br />
To the extent th<strong>at</strong> the Plan may recover from you or your<br />
dependents all or part of benefits previously paid, you<br />
shall be deemed, by virtue of your enrollment in this<br />
Medical coverage, to have agreed th<strong>at</strong> the Company may<br />
deduct such amounts from your wage or salary and pay<br />
the same to the Plan until recovery is complete.<br />
If you enroll for coverage under the Plan, you will be<br />
tre<strong>at</strong>ed by the Plan as if you had consented to the applicable<br />
payroll deductions for such coverage. In addition, if<br />
you fail to affirm<strong>at</strong>ively enroll or re-enroll during Annual<br />
Enrollment, you will be tre<strong>at</strong>ed by the Plan as if you had<br />
consented to the autom<strong>at</strong>ic re-enrollment described in<br />
the Eligibility and Enrollment chapter, including the<br />
applicable payroll deductions.<br />
The Aetna Limited<br />
Network Claim Process<br />
If you are enrolled in the Aetna Limited Network, your<br />
claims may be subject to different timeframes,<br />
depending on the type of claim. Aetna also requires<br />
prior authoriz<strong>at</strong>ion for certain services. A list of these<br />
services is in the The Medical Plan chapter. Aetna will<br />
make all initial claims determin<strong>at</strong>ions on behalf of the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan (AHWP) under the<br />
procedures and timeframes described below. Your<br />
Network provider will file your claim for you, or you<br />
may file a claim directly with Aetna <strong>at</strong> the address<br />
listed on the back of your <strong>Benefits</strong> ID card or in<br />
The Medical Plan chapter of this book.<br />
Urgent Care Claims<br />
If the service you are requesting is subject to Aetna’s<br />
prior authoriz<strong>at</strong>ion requirement and is an urgent care<br />
claim as determined by Aetna or your physician, you will<br />
be notified of Aetna’s claim decision not l<strong>at</strong>er than 72<br />
hours after the claim is received.<br />
A claim involving urgent care is any claim for medical<br />
care or tre<strong>at</strong>ment with respect to which the applic<strong>at</strong>ion<br />
of the non-urgent time periods could seriously jeopardize<br />
your life or health or your ability to regain maximum<br />
function, or, in the opinion of a physician with knowledge<br />
of your medical condition, would subject you to<br />
severe pain th<strong>at</strong> cannot be adequ<strong>at</strong>ely managed without<br />
care or tre<strong>at</strong>ment.<br />
If there is not sufficient inform<strong>at</strong>ion to decide the claim,<br />
you will be notified of the inform<strong>at</strong>ion necessary to complete<br />
the claim as soon as possible, but not l<strong>at</strong>er than 24<br />
hours after receipt of the claim.You will be given a reasonable<br />
additional amount of time, but not less than 48<br />
hours, to provide the inform<strong>at</strong>ion, and you will be notified<br />
of the decision not l<strong>at</strong>er than 48 hours after the end<br />
of th<strong>at</strong> additional time period (or after receipt of the<br />
inform<strong>at</strong>ion, if earlier).<br />
Other Claims (Pre-Service and Post-Service)<br />
If the service you are requesting is subject to Aetna’s<br />
prior authoriz<strong>at</strong>ion requirement and is not urgent (a<br />
“pre-service claim”), you will be notified of Aetna’s decision<br />
not l<strong>at</strong>er than 15 days after receipt of the pre-service<br />
claim.<br />
If the service you are requesting is not subject to Aetna’s<br />
prior authoriz<strong>at</strong>ion requirement (a “post-service claim”),<br />
you will be notified of Aetna’s decision not l<strong>at</strong>er than 30<br />
days after receipt of the claim.<br />
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For either a pre-service or a post-service claim, these<br />
time periods may be extended up to an additional 15<br />
days due to circumstances outside Aetna’s control. In<br />
th<strong>at</strong> case, you will be notified of the extension before the<br />
end of the initial 15- or 30-day period. For example, they<br />
may be extended because you have not submitted sufficient<br />
inform<strong>at</strong>ion, in which case you will be notified of<br />
the specific inform<strong>at</strong>ion necessary and given an additional<br />
period of <strong>at</strong> least 45 days after receiving the notice<br />
to furnish th<strong>at</strong> inform<strong>at</strong>ion.You will be notified of Aetna’s<br />
claim decision no l<strong>at</strong>er than 15 days after the end of th<strong>at</strong><br />
additional period (or after Aetna’s receipt of the additional<br />
inform<strong>at</strong>ion, if earlier).<br />
For pre-service claims th<strong>at</strong> name a specific claimant,<br />
medical condition, and service or supply for which<br />
approval is requested and which are submitted to an<br />
Aetna represent<strong>at</strong>ive responsible for handling benefit<br />
m<strong>at</strong>ters, but which otherwise fail to follow Aetna’s procedures<br />
for filing pre-service claims, you will be notified of<br />
the failure within 5 days (within 24 hours in the case of<br />
an urgent care claim) and of the proper procedures to be<br />
followed.The notice may be oral unless you request written<br />
notific<strong>at</strong>ion.<br />
Ongoing Course of<br />
Tre<strong>at</strong>ment (Concurrent Claims)<br />
If you have received prior authoriz<strong>at</strong>ion from Aetna for<br />
an ongoing course of tre<strong>at</strong>ment, you will be notified in<br />
advance if Aetna intends to termin<strong>at</strong>e or reduce benefits<br />
for the previously authorized course of tre<strong>at</strong>ment so you<br />
will have an opportunity to appeal the decision and<br />
receive a decision on th<strong>at</strong> appeal before the termin<strong>at</strong>ion<br />
or reduction takes effect. If the course of tre<strong>at</strong>ment<br />
involves urgent care and you request an extension of the<br />
course of tre<strong>at</strong>ment <strong>at</strong> least 24 hours before its expir<strong>at</strong>ion,<br />
you will be notified of the decision within 24 hours<br />
after receipt of the request.<br />
The concurrent review process assesses the necessity for<br />
continued stay, level of care, and quality of care for individuals<br />
receiving inp<strong>at</strong>ient services. All inp<strong>at</strong>ient services<br />
extending beyond the initial certific<strong>at</strong>ion period will<br />
require concurrent review.<br />
If Your Aetna Limited Network Claim is<br />
Fully or Partially Denied<br />
If the service you request is subject to Aetna’s prior<br />
authoriz<strong>at</strong>ion requirement, Aetna also will act as the<br />
AHWP’s named fiduciary and will make appeals decisions<br />
on behalf of the AHWP. If the service you request is not<br />
subject to Aetna’s prior authoriz<strong>at</strong>ion requirement, or if<br />
the service requires prior authoriz<strong>at</strong>ion but prior authoriz<strong>at</strong>ion<br />
is not obtained (for example, you receive tre<strong>at</strong>ment<br />
first and then file a claim for reimbursement), the<br />
AHWP Appeals Committee will act as the AHWP’s named<br />
fiduciary and will make appeals decisions under the<br />
appeals procedures for medical claims described below.<br />
In order for your appeal to be considered, it must:<br />
• Be sent to the address listed in your claims denial<br />
letter; and<br />
• Be submitted within the time period listed in your<br />
claims denial letter.<br />
Appeals to Aetna for Urgent,<br />
Pre-Service, and Concurrent Claims<br />
You will have 180 days following the d<strong>at</strong>e of the initial<br />
denial to appeal a claim denied by Aetna for urgent, preservice,<br />
and concurrent care claims.You may submit written<br />
comments, documents, records, and other inform<strong>at</strong>ion<br />
rel<strong>at</strong>ing to your claim, whether or not the comments,<br />
documents, records, or other inform<strong>at</strong>ion were<br />
submitted in connection with the initial claim.You may<br />
also request th<strong>at</strong> Aetna provide you, free of charge,<br />
copies of all documents, records and other inform<strong>at</strong>ion<br />
relevant to the claim.<br />
If your claim involves urgent care, an expedited appeal<br />
may be initi<strong>at</strong>ed by a telephone call to Aetna Member<br />
Services, either <strong>at</strong> the telephone number listed on your<br />
<strong>Benefits</strong> ID Card or the expedited appeal phone number<br />
provided in the denial letter.You or your authorized represent<strong>at</strong>ive<br />
may appeal urgent care claim denials either<br />
orally or in writing. All necessary inform<strong>at</strong>ion, including<br />
the appeal decision, will be communic<strong>at</strong>ed between you<br />
or your authorized represent<strong>at</strong>ive and Aetna by telephone,<br />
facsimile, or other similar method.You will be<br />
notified of Aetna’s appeal decision not l<strong>at</strong>er than 36<br />
hours after the appeal is received.<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
31
If you are diss<strong>at</strong>isfied with an appeal decision th<strong>at</strong><br />
involves urgent care, you may file a second level appeal<br />
to Aetna on an expedited basis.The second level appeal<br />
will be processed in the same manner as the first level<br />
appeal, and you will be notified of the decision by Aetna<br />
not l<strong>at</strong>er than 36 hours after the appeal is received.<br />
For pre-service or concurrent care claims, you will be<br />
notified of Aetna’s appeal decision not l<strong>at</strong>er than 15 days<br />
after the appeal is received. If you are diss<strong>at</strong>isfied with<br />
the appeal decision, you may file a second level appeal<br />
to Aetna within 60 days of receipt of the first level appeal<br />
decision. Send your appeal request to Aetna <strong>at</strong> the<br />
address provided in your initial decision letter and Aetna<br />
will notify you of the decision not l<strong>at</strong>er than 15 days after<br />
the appeal is received.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
Starbridge Claims<br />
and Appeals Procedures<br />
If you particip<strong>at</strong>e in Starbridge, a benefit booklet will be<br />
provided by Starbridge.Th<strong>at</strong>, together with this document,<br />
will serve as the governing plan documents for<br />
Starbridge coverage and will describe their claims and<br />
appeals procedures. Contact Starbridge <strong>at</strong><br />
(800) 288-1474 for more inform<strong>at</strong>ion.<br />
HMO Plan Claims<br />
and Appeals Procedures<br />
In some facilities, <strong>Wal</strong>-<strong>Mart</strong> offers health insurance coverage<br />
through HMOs as part of the AHWP. If you particip<strong>at</strong>e<br />
in an HMO, the HMO will provide a benefit booklet<br />
th<strong>at</strong>, together with this document, will serve as the<br />
Summary Plan Description for the HMO coverage and<br />
will describe their claims and appeals procedures.<br />
Filing a Claim for<br />
Resources for Living <strong>Benefits</strong><br />
You do not have to file a claim for Resources for Living<br />
benefits.You may access the Resources for Living website<br />
or contact Resources for Living <strong>at</strong> any time. However,<br />
if you have a question about your benefits, or disagree<br />
with the benefits provided, you may contact the <strong>Wal</strong>-<br />
<strong>Mart</strong> <strong>Benefits</strong> Department or file a claim by writing to<br />
the following address:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Any appeals will be determined under the time frames<br />
and requirements set out in the procedures for filing a<br />
claim for medical benefits in this chapter.<br />
The Accident Insurance<br />
Policy and Cancer Insurance<br />
Policy Claim Process<br />
Accident Insurance Policy and Cancer Insurance Policy<br />
claims should be submitted to:<br />
Aflac<br />
1932 Wynnton Rd.<br />
Columbus, GA 31999<br />
When you submit a claim to Aflac and your claim is<br />
denied, a notice will be sent within a reasonable time<br />
period but no l<strong>at</strong>er than 30 days after Aflac receives the<br />
claim (filed in accordance with the Accident Insurance<br />
Policy or Cancer Insurance Policy). In special circumstances,<br />
an extension of time may be needed to make a<br />
decision. In th<strong>at</strong> case, Aflac may take a 15-day extension.<br />
You will receive written notice of the extension before<br />
the end of the 30-day period.<br />
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If your claim is denied, your denial will consist of a<br />
written explan<strong>at</strong>ion which will include:<br />
• The specific reason(s) for the denial;<br />
• Reference to provisions of the Plan on which the<br />
denial was based;<br />
• Inform<strong>at</strong>ion regarding time limits for appeal;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to obtain, upon<br />
request and free of charge, a copy of internal rules or<br />
guidelines relied upon in making this determin<strong>at</strong>ion;<br />
• If your denial is based on Medical Necessity or similar<br />
limit<strong>at</strong>ion, an explan<strong>at</strong>ion of this rule (or a st<strong>at</strong>ement<br />
th<strong>at</strong> it is available upon request); and<br />
• Notice regarding your right to bring a court action<br />
following a denial on appeal.<br />
If Your Aflac Claim is<br />
Fully or Partially Denied<br />
You may appeal any denial of a claim for benefits by filing<br />
a written request with Aflac. In connection with an<br />
appeal, you may request, free of charge, all documents<br />
th<strong>at</strong> are relevant (as defined by ERISA) to your claim.You<br />
may also submit with your appeal any comments, documents,<br />
records, and issues th<strong>at</strong> you believe support your<br />
claim, even if you have not previously submitted such<br />
document<strong>at</strong>ion.You may have represent<strong>at</strong>ion throughout<br />
the review procedure.<br />
An appeal must be filed with Aflac in accordance with<br />
the claim filing procedures described in your denial letter<br />
within 180 days of receipt of the written notice of<br />
denial of a claim. Aflac will render a decision no l<strong>at</strong>er<br />
than 60 days after receipt of your written appeal.The<br />
decision after your review will be in writing and will<br />
include specific reasons for the decision as well as specific<br />
references to the pertinent Plan provisions on which<br />
the decision is based. If your claim is denied, you have<br />
the right to bring action in federal court in accordance<br />
with ERISA 502(a).You cannot take any legal action until<br />
you have exhausted the Plan’s claims review procedures<br />
described above.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
The Company-Paid, Optional, and<br />
Dependent Life Insurance and<br />
Business Travel Accident Insurance<br />
Claim Process<br />
Company-Paid, Optional, and Dependent Life Insurance<br />
and Business Travel Accident Insurance claims should be<br />
submitted to:<br />
Prudential Insurance Companies of America<br />
Prudential/<strong>Wal</strong>-<strong>Mart</strong> Division<br />
P.O. Box 13644<br />
Philadelphia, PA 19176<br />
When you submit a claim to Prudential and your claim is<br />
denied, a notice will be sent within a reasonable time period,<br />
but not longer than 90 days from receipt of the claim.<br />
If Prudential determines th<strong>at</strong> an extension is necessary<br />
due to m<strong>at</strong>ters beyond control of the plan, this time may<br />
be extended for an additional 90-day period.You will<br />
receive notice prior to the extension th<strong>at</strong> indic<strong>at</strong>es the circumstances<br />
requiring the extension and the d<strong>at</strong>e by<br />
which the plan expects to render a determin<strong>at</strong>ion.<br />
If your claim is in part or wholly denied, you will receive<br />
notice of an adverse benefit determin<strong>at</strong>ion th<strong>at</strong> will:<br />
• St<strong>at</strong>e the specific reason(s) for the adverse benefit<br />
determin<strong>at</strong>ion;<br />
• Reference the specific plan provisions on which the<br />
determin<strong>at</strong>ion is based;<br />
• Describe additional m<strong>at</strong>erial or inform<strong>at</strong>ion, if any,<br />
needed to perfect the claim and the reasons such<br />
m<strong>at</strong>erial or inform<strong>at</strong>ion is necessary; and<br />
• Describe the plan’s claims review procedures and the<br />
time limits applicable to such procedures, including a<br />
st<strong>at</strong>ement of your right to bring a civil action under<br />
section 502(a) of ERISA following an adverse benefit<br />
determin<strong>at</strong>ion on review.<br />
If Your Prudential Claim<br />
is Fully or Partially Denied<br />
If your claim for benefits is denied and you would like<br />
to appeal, you must send a written appeal to Prudential<br />
<strong>at</strong> the address above within 180 days of the denial.<br />
Your appeal should include any comments, documents,<br />
records, or any other inform<strong>at</strong>ion you would<br />
like considered.<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
33
You will have the right to request copies, free of charge,<br />
of all documents, records, or other inform<strong>at</strong>ion relevant<br />
to your claim.Your appeal will be reviewed without<br />
regard to your initial determin<strong>at</strong>ion by someone other<br />
than the party who decided your initial claim.<br />
Prudential will make a determin<strong>at</strong>ion on your appeal<br />
within 45 days of the receipt of your appeal request.This<br />
period may be extended by up to an additional 45 days<br />
if Prudential determines th<strong>at</strong> special circumstances<br />
require an extension of time.You will be notified prior to<br />
the end of the 45-day period if an extension is required.<br />
If you are asked to provide additional inform<strong>at</strong>ion, you<br />
will have 45 days from the d<strong>at</strong>e you are notified to provide<br />
the inform<strong>at</strong>ion, and the time to make a determin<strong>at</strong>ion<br />
will be suspended until you provide the requested<br />
inform<strong>at</strong>ion (or the deadline to provide the inform<strong>at</strong>ion,<br />
if earlier).<br />
If your appeal is denied in whole or in part, you will<br />
receive a written notific<strong>at</strong>ion from Prudential of the<br />
denial th<strong>at</strong> will include:<br />
• The specific reason(s) for the adverse determin<strong>at</strong>ion;<br />
• References to the specific plan provisions on which<br />
the determin<strong>at</strong>ion was based;<br />
• A st<strong>at</strong>ement describing your right to request copies,<br />
free of charge, of all documents, records, or other<br />
inform<strong>at</strong>ion relevant to your claim;<br />
• A description of Prudential’s review procedures and<br />
applicable time limits;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to obtain, upon<br />
request and free of charge, a copy of internal rules<br />
or guidelines relied upon in making this determin<strong>at</strong>ion;<br />
and<br />
• A st<strong>at</strong>ement describing any appeals procedures<br />
offered by the plan and your right to bring a civil suit<br />
under ERISA.<br />
If a decision on appeal is not furnished to you within<br />
the time frames mentioned above, the claim shall be<br />
deemed denied on appeal.<br />
Voluntary Second Appeal<br />
If your appeal is denied or if you do not receive a<br />
response to your appeal within the appropri<strong>at</strong>e time<br />
frame (in which case the appeal is deemed to have been<br />
denied), you or your represent<strong>at</strong>ive may make a voluntary<br />
second appeal of your denial in writing to<br />
Prudential.You must submit your second appeal within<br />
180 days of the receipt of the written notice of denial or<br />
180 days from the d<strong>at</strong>e such claim is deemed denied.<br />
You may submit any written comments, documents,<br />
records, and any other inform<strong>at</strong>ion rel<strong>at</strong>ing to your claim.<br />
The same criteria and response times th<strong>at</strong> applied to<br />
your first appeal are generally applied to this voluntary<br />
second appeal.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
Life Insurance Gift Assignments<br />
Gift assignments of your life insurance coverage are<br />
irrevocable (for example, to a charitable trust).This type<br />
of assignment has tax consequences, so you should consult<br />
your <strong>at</strong>torney or tax professional before making<br />
such an assignment.You must notify Prudential of any<br />
gift assignment. If you make an assignment, your beneficiary<br />
design<strong>at</strong>ions will no longer apply, and you will no<br />
longer have any rights with respect to your life insurance<br />
coverage, even to change or revoke the assignment.<br />
Instead, all rights, benefits, or privileges rel<strong>at</strong>ed to your<br />
life insurance coverage will transfer to whomever you<br />
have assigned your insurance.<br />
No other life insurance assignments are permitted.<br />
The Travel Assistance Claim Process<br />
You don not have to file a claim for AXA Travel Assistance<br />
or Medex Travel Assistance benefits. However, if you have<br />
a question about your benefits or disagree with the benefits<br />
provided, you should contact AXA or Medex (as<br />
applicable) <strong>at</strong> the numbers listed in the Business Travel<br />
Accident Insurance & Travel Assistance chapter. Any<br />
claims or appeals will be determined under the same<br />
timeframes th<strong>at</strong> apply to Business Travel Accident.<br />
34 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Claim Process for All Types<br />
of Disability Coverage Claims<br />
This section describes the claim process for the Short-<br />
Term Disability Plan, the Short-Term Disability Plus<br />
Program, the Long-Term Disability Plan, and the Truck<br />
Driver Long-Term Disability Plan.<br />
Short-term disability claims should be submitted to:<br />
The Hartford<br />
Attn: Appeal Unit<br />
P.O. Box 1810<br />
Alpharetta, GA 30023-1811<br />
Short-Term Disability Plus claims should be<br />
submitted to:<br />
The Hartford<br />
P.O. Box 1810<br />
Alpharetta, GA 30023-1810<br />
Long-Term Disability and Truck Driver Long-Term<br />
Disability claims should be sent to:<br />
Disability Claim Appeal Unit<br />
Benefit Management Services—Floor B2-E<br />
The Hartford<br />
P.O. Box 2999<br />
Hartford, CT 06104-2999<br />
Once a claim has been filed, The Hartford will make a<br />
decision no more than 45 days after receipt of your<br />
properly filed claim.The time for decision may be<br />
extended for up to two additional 30-day periods provided<br />
th<strong>at</strong>, prior to any extension period, The Hartford<br />
notifies you in writing th<strong>at</strong> an extension is necessary due<br />
to m<strong>at</strong>ters beyond their control, identifies those m<strong>at</strong>ters,<br />
and gives the d<strong>at</strong>e by which it expects to render its decision.<br />
If your claim is extended due to your failure to submit<br />
inform<strong>at</strong>ion necessary to decide your claim, the time<br />
for decision may be tolled from the d<strong>at</strong>e on which the<br />
notific<strong>at</strong>ion of the extension is sent to you until the d<strong>at</strong>e<br />
The Hartford receives your response. If The Hartford<br />
approves your claim, the decision will contain inform<strong>at</strong>ion<br />
sufficient to reasonably inform you of th<strong>at</strong> decision.<br />
Any adverse benefit determin<strong>at</strong>ion will be in writing<br />
and include:<br />
• Specific reasons for the decision;<br />
• Specific references to the policy provisions on which<br />
the decision is based;<br />
• A description of any additional m<strong>at</strong>erial or inform<strong>at</strong>ion<br />
necessary for you to perfect the claim and an<br />
explan<strong>at</strong>ion of why such m<strong>at</strong>erial or inform<strong>at</strong>ion is<br />
necessary;<br />
• A description of the review procedures and time limits<br />
applicable to such procedures;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to bring a civil<br />
action under section 502(a) of ERISA after you appeal<br />
our decision and after you receive a written denial<br />
on appeal;<br />
• If an internal rule, guideline, protocol, or other similar<br />
criterion was relied upon in making the denial; either<br />
—The specific rule, guideline, protocol or other similar<br />
criterion; or<br />
—A st<strong>at</strong>ement th<strong>at</strong> such a rule, guideline, protocol or<br />
other similar criterion was relied upon in making<br />
the denial and th<strong>at</strong> a copy will be provided free of<br />
charge to you upon request.<br />
• If denial is based on medical judgment, either<br />
—An explan<strong>at</strong>ion of the scientific or clinical judgment<br />
for the determin<strong>at</strong>ion, applying the terms of the<br />
policy to your medical circumstances, or<br />
—A st<strong>at</strong>ement th<strong>at</strong> such explan<strong>at</strong>ion will be provided<br />
to you free of charge upon request.<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
35
If Your Hartford Claim<br />
is Fully or Partially Denied<br />
If your claim for benefits is denied and you would like to<br />
appeal, you must send a written appeal to The Hartford<br />
<strong>at</strong> the address shown earlier in this chapter within 180<br />
days of the denial.Your appeal should include any<br />
comments, documents, records, or any other inform<strong>at</strong>ion<br />
you would like considered.<br />
You will have the right to request copies, free of charge,<br />
of all documents, records, or other inform<strong>at</strong>ion relevant<br />
to your claim.Your appeal will be reviewed without<br />
regard to your initial determin<strong>at</strong>ion by someone other<br />
than the party who decided your initial claim.<br />
The Hartford will make a determin<strong>at</strong>ion on your appeal<br />
within 45 days of the receipt of your appeal request.This<br />
period may be extended by up to an additional 45 days<br />
if The Hartford determines th<strong>at</strong> special circumstances<br />
require an extension of time.You will be notified prior to<br />
the end of the 45-day period if an extension is required.<br />
If you are asked to provide additional inform<strong>at</strong>ion, you<br />
will have 45 days from the d<strong>at</strong>e you are notified to provide<br />
the inform<strong>at</strong>ion and the time to make a determin<strong>at</strong>ion<br />
will be suspended until you provide the requested<br />
inform<strong>at</strong>ion (or the deadline to provide the inform<strong>at</strong>ion,<br />
if earlier).<br />
If your appeal is denied in whole or in part, you will<br />
receive a written notific<strong>at</strong>ion from The Hartford of the<br />
denial th<strong>at</strong> will include:<br />
• The specific reason(s) for the adverse determin<strong>at</strong>ion;<br />
• References to the specific plan provisions on which<br />
the determin<strong>at</strong>ion was based;<br />
• A st<strong>at</strong>ement describing your right to request copies,<br />
free of charge, of all documents, records, or other<br />
inform<strong>at</strong>ion relevant to your claim;<br />
• A description of Prudential’s review procedures and<br />
applicable time limits;<br />
• A st<strong>at</strong>ement th<strong>at</strong> you have the right to obtain,<br />
upon request and free of charge, a copy of internal<br />
rules or guidelines relied upon in making this<br />
determin<strong>at</strong>ion; and<br />
• A st<strong>at</strong>ement describing any appeals procedures<br />
offered by the plan and your right to bring a civil suit<br />
under ERISA.<br />
If a decision on appeal is not furnished to you within the<br />
time frames mentioned above, the claim shall be<br />
deemed denied on appeal.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
36 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Accidental De<strong>at</strong>h and<br />
Dismemberment Claim Process<br />
You should submit Accidental De<strong>at</strong>h and<br />
Dismemberment claims to:<br />
MetLife<br />
P.O. Box 3016<br />
Utica, NY 13504-3016<br />
When you submit a claim to MetLife and your claim is<br />
denied, a notice will be sent within a reasonable time<br />
period, but not longer than 90 days from receipt of the<br />
claim. If MetLife determines th<strong>at</strong> an extension is necessary<br />
due to m<strong>at</strong>ters beyond control of the plan, this time<br />
may be extended for an additional 90-day period.You<br />
will receive notice prior to the extension th<strong>at</strong> indic<strong>at</strong>es<br />
the circumstances requiring the extension and the d<strong>at</strong>e<br />
by which the plan expects to render a determin<strong>at</strong>ion.<br />
If your claim is in part or wholly denied, you will receive<br />
notice of an adverse benefit determin<strong>at</strong>ion th<strong>at</strong> will:<br />
• St<strong>at</strong>e the specific reason(s) for the adverse benefit<br />
determin<strong>at</strong>ion;<br />
• Reference the specific plan provisions on which the<br />
determin<strong>at</strong>ion is based;<br />
• Describe additional m<strong>at</strong>erial or inform<strong>at</strong>ion, if any,<br />
needed to perfect the claim and the reasons such<br />
m<strong>at</strong>erial or inform<strong>at</strong>ion is necessary; and<br />
• Describe the plan’s claims review procedures and the<br />
time limits applicable to such procedures, including a<br />
st<strong>at</strong>ement of your right to bring a civil action under<br />
section 502(a) of ERISA following an adverse benefit<br />
determin<strong>at</strong>ion on review.<br />
If Your MetLife Claim is<br />
Fully or Partially Denied<br />
Send a written appeal to MetLife <strong>at</strong> the MetLife address<br />
above within 60 days after receipt of the denial. Your<br />
appeal letter should be signed, d<strong>at</strong>ed, and clearly st<strong>at</strong>e<br />
your position. Please include any comments, documents,<br />
records, or any other inform<strong>at</strong>ion you would<br />
like considered.<br />
Upon your written request, MetLife will provide you with<br />
a copy of the records and/or reports th<strong>at</strong> are relevant to<br />
your claim.<br />
MetLife will carefully evalu<strong>at</strong>e all the inform<strong>at</strong>ion and<br />
advise you of its decision within 60 days after the receipt<br />
of your appeal. If there are special circumstances requiring<br />
additional time to complete the review, we may take<br />
up to an additional 60 days, but only after notifying you<br />
of the special circumstances in writing. In the event your<br />
appeal is denied in whole or in part, you have the right<br />
to bring a civil action under Section 502(a) of ERISA.<br />
See Your Right to Bring Legal Action earlier in this<br />
chapter regarding the deadline to bring a legal action.<br />
Claims and Appeals<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
37
Legal Inform<strong>at</strong>ion<br />
Where Can I Find<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40<br />
Plan Amendment or Termin<strong>at</strong>ion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41<br />
Your Rights under ERISA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41<br />
Notice of Privacy Practices—HIPAA Inform<strong>at</strong>ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42<br />
Medicare and Your Prescription Drug Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Legal Inform<strong>at</strong>ion<br />
This chapter describes your legal rights as a participant in the <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare<br />
Plan, including inform<strong>at</strong>ion about the confidentiality of your personal medical inform<strong>at</strong>ion<br />
under the HIPAA Notice of Privacy Practices. You’ll also find inform<strong>at</strong>ion on the prescription<br />
drug coverage available through Medicare, Medicare Part D, and the decisions you need to<br />
make about your prescription drug coverage if you’re eligible for Medicare.<br />
Legal Inform<strong>at</strong>ion Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Contact the Plan<br />
Administr<strong>at</strong>or of the AHWP<br />
Answers to questions about<br />
the HIPAA privacy notice<br />
Answers to questions<br />
about Medicare Part D<br />
Write to:<br />
The Administr<strong>at</strong>ive Committee<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health<br />
and Welfare Plan<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Call (479) 621-2058<br />
Send an email to Privacy@wal-mart.com Call (800) 421-1362 or (479) 621-2929<br />
Visit www.medicare.gov<br />
for personalized help<br />
(800) MEDICARE [633-4227].<br />
TTY users should call (877) 486-2048<br />
Wh<strong>at</strong> You Need to Know About the<br />
Legal Inform<strong>at</strong>ion for the <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan<br />
• As a participant in the <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan, you are entitled to certain rights and protections<br />
under the Employee Retirement Income Security Act of 1974.<br />
Legal Inform<strong>at</strong>ion<br />
• The HIPAA Privacy notice in this chapter describes how medical inform<strong>at</strong>ion about you may be used and disclosed<br />
and how you can get access to this inform<strong>at</strong>ion.<br />
• The Medicare Part D notice in this chapter explains the options you have under Medicare prescription drug coverage,<br />
and can help you decide whether or not you want to enroll.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362 39
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan<br />
The Plan is an employer-sponsored health and<br />
welfare employee benefit plan governed under the<br />
Employee Retirement Income Security Act of 1974<br />
(ERISA), as amended.<br />
The terms and conditions of the <strong>Associ<strong>at</strong>e</strong>s’ Health and<br />
Welfare Plan are set forth in this book, the <strong>Associ<strong>at</strong>e</strong>s’<br />
Health and Welfare Plan Wrap Document (Wrap<br />
Document), and the insurance policies and other welfare<br />
program documents incorpor<strong>at</strong>ed into the Wrap<br />
Document.The Wrap Document, together with this book<br />
and the other incorpor<strong>at</strong>ed documents, constitutes the<br />
written instrument under which the <strong>Associ<strong>at</strong>e</strong>s’ Health<br />
and Welfare plan is established and maintained.This<br />
book also serves as a Summary Plan Description for the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan.<br />
Plan Year: January 1 through December 31<br />
Plan Number: 501<br />
Type of Plan: Welfare, including Medical, Dental, Short-<br />
Term Disability, Short-Term Disability Plus, Long-Term<br />
Disability,Truck Driver Long-Term Disability, Business<br />
Travel Accident, Accidental De<strong>at</strong>h and Dismemberment<br />
(AD&D), Company-Paid Life, Optional Life, Dependent<br />
Life, Accident Insurance Policy, Cancer Insurance Policy,<br />
and Resources for Living.<br />
Type of Administr<strong>at</strong>ion: The Committees (or their deleg<strong>at</strong>es)<br />
shall have complete discretion to interpret and<br />
construe the provisions of the Plan, make findings of<br />
fact, correct errors, and supply omissions. All decisions<br />
and interpret<strong>at</strong>ions of any of the Committees (or their<br />
deleg<strong>at</strong>es) made pursuant to the Plan shall be final,<br />
conclusive and binding on all persons and may not<br />
be overturned unless found by a court to be arbitrary<br />
and capricious. <strong>Benefits</strong> will be paid only if the Appeals<br />
Committee, or its delegee, determines in its discretion<br />
th<strong>at</strong> the claimant is entitled to them.<br />
Plan Administr<strong>at</strong>or/Named Fiduciary:<br />
The Administr<strong>at</strong>ive Committee<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
(479) 621-2058<br />
Agent for Service of Legal Process:<br />
Corpor<strong>at</strong>ion Trust Company<br />
1209 Orange Street<br />
Corpor<strong>at</strong>ion Trust Center<br />
Wilmington, DE 19801<br />
Legal process may also be served on the Plan<br />
Administr<strong>at</strong>or or Trustee.<br />
Plan Sponsor’s EIN: 71-0415188<br />
Funding for the Plans<br />
Contributions to the Plan may be made by <strong>Wal</strong>-<strong>Mart</strong><br />
Stores, Inc. out of its general assets or through the <strong>Wal</strong>-<br />
<strong>Mart</strong> Stores, Inc. <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Trust.<br />
Contributions also may be required by employees, in an<br />
amount determined by <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. in its discretion.<br />
All assets of the Plan, including associ<strong>at</strong>e contributions<br />
and any dividends or earnings of the Plan, shall be<br />
available to pay any benefits provided under the Plan or<br />
expenses of the Plan, including insurance premiums.<br />
Plan Trustees:<br />
JP Morgan<br />
3 Chase Metrotech Center, Floor 5<br />
Brooklyn, NY 11245<br />
Plan Sponsor:<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
702 SW 8th Street<br />
Bentonville, AR 72716<br />
40 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Plan Amendment or Termin<strong>at</strong>ion<br />
<strong>Wal</strong>-<strong>Mart</strong> reserves the right to amend or termin<strong>at</strong>e <strong>at</strong><br />
any time and to any extent the <strong>Associ<strong>at</strong>e</strong>s’ Health and<br />
Welfare Plan and any of the benefits (whether selfinsured<br />
or insured) described in this book.<br />
Neither the AHWP nor the benefits described in this<br />
book can be orally amended. All oral st<strong>at</strong>ements and<br />
represent<strong>at</strong>ions shall be without force or effect even if<br />
such st<strong>at</strong>ements and represent<strong>at</strong>ions are made by the<br />
Plan Administr<strong>at</strong>or, by a management associ<strong>at</strong>e of the<br />
Company, or by any member of the applicable committees<br />
of the Plan. Only written st<strong>at</strong>ements by the applicable<br />
committee of the Plan shall bind the Plan.<br />
Your Rights under ERISA<br />
As a participant in the <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare<br />
Plan, you are entitled to certain rights and protections<br />
under the Employee Retirement Income Security Act of<br />
1974, as amended (ERISA). ERISA provides th<strong>at</strong> all Plan<br />
participants shall be entitled to:<br />
Receive Inform<strong>at</strong>ion<br />
About Your Plan and <strong>Benefits</strong><br />
You have the right to:<br />
• Examine, without charge, <strong>at</strong> the Plan Administr<strong>at</strong>or’s<br />
office and <strong>at</strong> other specified facilities, such as worksites<br />
and union halls, all documents governing the<br />
Plan, including insurance contracts and collective<br />
bargaining agreements, and a copy of the l<strong>at</strong>est<br />
annual report (Form 5500 Series) filed by the Plan<br />
with the U.S. Department of Labor and available <strong>at</strong><br />
the Public Disclosure Room of the Employee <strong>Benefits</strong><br />
Security Administr<strong>at</strong>ion.<br />
• Obtain, upon written request to the Plan<br />
Administr<strong>at</strong>or, copies of documents governing the<br />
oper<strong>at</strong>ion of the Plan, including insurance contracts<br />
and collective bargaining agreements, and copies<br />
of the l<strong>at</strong>est annual report (Form 5500 Series) and<br />
upd<strong>at</strong>ed Summary Plan Description. The<br />
Administr<strong>at</strong>or may make a reasonable charge for<br />
the copies.<br />
• Receive a summary of the Plan’s annual financial<br />
report. The Plan Administr<strong>at</strong>or is required by law<br />
to furnish each participant with a copy of this<br />
annual report.<br />
Continue Group Health Plan Coverage<br />
You have the right to continue health care coverage for<br />
yourself, your spouse, or your dependents if there is a<br />
loss of coverage under the Plan as a result of a qualifying<br />
event.You or your dependents may have to pay for such<br />
coverage. Review this Summary Plan Description and the<br />
documents governing the Plan on the rules governing<br />
your COBRA continu<strong>at</strong>ion coverage rights. (See the<br />
COBRA chapter for more inform<strong>at</strong>ion.)<br />
You are entitled to reduction or elimin<strong>at</strong>ion of exclusionary<br />
periods of coverage for pre-existing conditions under<br />
your group health plan if you have creditable coverage<br />
from another plan.You should be provided a certific<strong>at</strong>e<br />
of creditable coverage, free of charge, from your group<br />
health plan or health insurance issuer when you lose<br />
coverage under the Plan, when you become entitled to<br />
elect COBRA continu<strong>at</strong>ion coverage, or when your<br />
COBRA continu<strong>at</strong>ion coverage ceases, if you request it<br />
before losing coverage, or if you request it up to 24<br />
months after losing coverage. Without evidence of creditable<br />
coverage, you may be subject to a pre-existing<br />
condition exclusion for 12 months (18 months for l<strong>at</strong>e<br />
enrollees) after your enrollment d<strong>at</strong>e in your coverage.<br />
Prudent Actions by Plan Fiduciaries<br />
In addition to cre<strong>at</strong>ing rights for Plan participants, ERISA<br />
imposes duties upon the people who are responsible for<br />
the oper<strong>at</strong>ion of the employee benefit plan.The people<br />
who oper<strong>at</strong>e your Plan, called “fiduciaries” of the Plan,<br />
have a duty to do so prudently and in the interest of you<br />
and other Plan participants and beneficiaries. No one,<br />
including your employer, your union, or any other person,<br />
can fire you or otherwise discrimin<strong>at</strong>e against you in<br />
any way to prevent you from obtaining benefits or exercising<br />
your rights under ERISA.<br />
If your claim for a benefit is denied or ignored, in whole<br />
or in part, you have the right to know why this was done,<br />
to obtain copies of documents rel<strong>at</strong>ing to the decision<br />
without charge, and to appeal any denial, all within certain<br />
time schedules.<br />
Under ERISA, there are steps you can take to enforce the<br />
above rights. For instance:<br />
Legal Inform<strong>at</strong>ion<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
41
• If you request m<strong>at</strong>erials from the Plan and do not<br />
receive them within 30 days, you can file suit in a federal<br />
court. In such a case, the court may require the<br />
Plan Administr<strong>at</strong>or to provide the m<strong>at</strong>erials and pay<br />
you up to $110 a day until you receive the m<strong>at</strong>erials,<br />
unless the m<strong>at</strong>erials were not sent because of reasons<br />
beyond the control of the Administr<strong>at</strong>or.<br />
• If you have a claim for benefits which is denied or<br />
ignored, in whole or in part, you can file suit in a st<strong>at</strong>e<br />
or federal court. Generally, you must complete the<br />
appeals process before filing a lawsuit against the<br />
Plan. However, you should consult with your own<br />
legal counsel in determining when it is proper to file<br />
a lawsuit against the Plan.<br />
• If you disagree with the Plan’s decision or lack thereof<br />
concerning the qualified st<strong>at</strong>us of a domestic rel<strong>at</strong>ions<br />
order or a medical child support order, you can<br />
file suit in a federal court.<br />
• If it should happen th<strong>at</strong> Plan fiduciaries misuse the<br />
Plan’s money, or if you are discrimin<strong>at</strong>ed against for<br />
asserting your rights, you can seek assistance from<br />
the U.S. Department of Labor, or you can file suit in<br />
a federal court.<br />
The court will decide who should pay court costs and<br />
legal fees. If you are successful, the court may order the<br />
person you have sued to pay these costs and fees. If you<br />
lose, the court may order you to pay these costs and<br />
fees; for example, if it finds your claim is frivolous.<br />
Assistance with Your Questions<br />
If you have any questions about your Plan, you should<br />
contact the Plan Administr<strong>at</strong>or. If you have any questions<br />
about this st<strong>at</strong>ement or about your rights under ERISA,<br />
or if you need assistance in obtaining documents from<br />
the Plan Administr<strong>at</strong>or, you should contact the nearest<br />
office of the Employee <strong>Benefits</strong> Security Administr<strong>at</strong>ion,<br />
U.S. Department of Labor, listed in your telephone directory,<br />
or the:<br />
Division of Technical Assistance and Inquiries<br />
Employee <strong>Benefits</strong> Security Administr<strong>at</strong>ion<br />
U.S. Department of Labor<br />
200 Constitution Avenue NW<br />
Washington, D.C. 20210<br />
You can also obtain certain public<strong>at</strong>ions about<br />
your rights under ERISA by calling the Employee<br />
<strong>Benefits</strong> Security Administr<strong>at</strong>ion public<strong>at</strong>ions hotline<br />
<strong>at</strong> (866) 444-3272 or by logging on to the Internet<br />
<strong>at</strong> www.dol.gov/ebsa.<br />
Notice of Privacy Practices—<br />
HIPAA Inform<strong>at</strong>ion<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, Dental Plan,<br />
and Resources for Living (RFL) Notice<br />
of Privacy Practices<br />
Effective d<strong>at</strong>e of this Notice: April 14, 2003<br />
THIS NOTICE DESCRIBES HOW MEDICAL INFORMA-<br />
TION ABOUT YOU MAY BE USED AND DISCLOSED<br />
AND HOW YOU CAN GET ACCESS TO THIS INFORMA-<br />
TION. PLEASE REVIEW THIS NOTICE CAREFULLY.<br />
YOU SHOULD ALSO SHARE A COPY OF THIS NOTICE<br />
WITH YOUR FAMILY MEMBERS WHO ARE COVERED<br />
UNDER THE ASSOCIATES’ MEDICAL PLAN, DENTAL<br />
PLAN, AND RFL.<br />
42 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
<strong>Wal</strong>-<strong>Mart</strong>’s Commitment to Your Privacy<br />
This Notice applies to the self-insured medical and<br />
dental plans and to RFL coverage (Plans) maintained by<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. (<strong>Wal</strong>-<strong>Mart</strong>). References to “we” and<br />
“us” throughout this Notice mean the Plans. <strong>Wal</strong>-<strong>Mart</strong><br />
also provides benefits through a health maintenance<br />
organiz<strong>at</strong>ion (HMO).The HMO in th<strong>at</strong> case possesses<br />
your health inform<strong>at</strong>ion and maintains its own notice<br />
of privacy practices.<br />
The Plans are dedic<strong>at</strong>ed to maintaining the privacy of<br />
your health inform<strong>at</strong>ion. In oper<strong>at</strong>ing the Plans, we cre<strong>at</strong>e<br />
records regarding you and the benefits we provide<br />
to you.This Notice will tell you about the ways in which<br />
we may use and disclose medical inform<strong>at</strong>ion about you.<br />
We will also describe your rights and certain oblig<strong>at</strong>ions<br />
we have regarding the use and disclosure of medical<br />
inform<strong>at</strong>ion. We are required by law to:<br />
• Maintain the privacy of your health inform<strong>at</strong>ion, also<br />
known as Protected Health Inform<strong>at</strong>ion (PHI);<br />
• Provide you with this Notice; and<br />
• Comply with this Notice.<br />
The Plans reserve the right to change our privacy practices<br />
and to make any such change applicable to the<br />
PHI we obtained about you before the change. If there<br />
is a m<strong>at</strong>erial revision to this Notice, the new Notice will<br />
be distributed to you. You may obtain a paper copy of<br />
the current Notice by contacting the Plans using the<br />
contact inform<strong>at</strong>ion listed <strong>at</strong> the end of this Notice.<br />
The current Notice is also available on the benefits<br />
website on the WIRE.<br />
How the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan, Dental Plan,<br />
and RFL May Use and Disclose Your PHI<br />
The law permits us to use and disclose your PHI for<br />
certain purposes without your permission or authoriz<strong>at</strong>ion.The<br />
following gives examples of each of<br />
these circumstances.<br />
1. For Tre<strong>at</strong>ment. We may use or disclose your PHI<br />
for purposes of tre<strong>at</strong>ment. For example, we may<br />
disclose your PHI to physicians, nurses, and other<br />
professionals who are involved in your care.<br />
2. For Payment. We may use or disclose your PHI to<br />
provide payment for the tre<strong>at</strong>ment you receive<br />
under the Plans. For example, we may contact your<br />
health care provider to certify th<strong>at</strong> you have received<br />
tre<strong>at</strong>ment (and for wh<strong>at</strong> range of benefits), and we<br />
may request details regarding your tre<strong>at</strong>ment to<br />
determine if your benefits will cover, or pay for, your<br />
tre<strong>at</strong>ment. We also may use and disclose your PHI to<br />
obtain payment from third parties th<strong>at</strong> may be<br />
responsible for such costs, such as family members<br />
or other insurance companies.<br />
3. For Health Care Oper<strong>at</strong>ions. We may use or disclose<br />
your PHI for our health care oper<strong>at</strong>ions. For example,<br />
our claims administr<strong>at</strong>ors in some st<strong>at</strong>es or the Plans<br />
may use your PHI to conduct cost-management and<br />
planning activities.<br />
4. To the Plan Sponsor. The Plans may use or disclose<br />
your PHI to <strong>Wal</strong>-<strong>Mart</strong>, the Plan Sponsor. The Plan<br />
Sponsor will only use your PHI as necessary to<br />
administer the Plan. The law only permits the Plans<br />
to disclose your PHI to <strong>Wal</strong>-<strong>Mart</strong>, in its role as the<br />
Plan Sponsor, if <strong>Wal</strong>-<strong>Mart</strong> certifies, among other<br />
things, th<strong>at</strong> it will only use or disclose your PHI as<br />
permitted by the Plan, will restrict access to your<br />
PHI to those <strong>Wal</strong>-<strong>Mart</strong> employees whose job it is<br />
to administer the Plan, and will not use PHI for any<br />
employment-rel<strong>at</strong>ed actions.<br />
5. For Health-Rel<strong>at</strong>ed Programs and Services. The<br />
Plans may contact you about inform<strong>at</strong>ion regarding<br />
tre<strong>at</strong>ment altern<strong>at</strong>ives or other health-rel<strong>at</strong>ed benefits<br />
and services th<strong>at</strong> may be of interest to you.<br />
Legal Inform<strong>at</strong>ion<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
43
6. To Individuals Involved in Your Care or Payment for<br />
Your Care. The Plans may disclose your PHI to a family<br />
member or friend who is involved in your medical<br />
care or payment for your care, provided th<strong>at</strong> you<br />
agree to this disclosure, or we give you an opportunity<br />
to object to this disclosure. However, if you are not<br />
available or are unable to agree or object, we<br />
will use our best judgment to decide whether this<br />
disclosure is in your best interest.<br />
Other Uses or Disclosures of<br />
Your PHI Without an Authoriz<strong>at</strong>ion<br />
The law allows us to disclose your PHI in the following<br />
circumstances without your permission or authoriz<strong>at</strong>ion:<br />
1. When Required by Law. The Plans will use and disclose<br />
your PHI when we are required to do so by federal,<br />
st<strong>at</strong>e, or local law.<br />
2. For Public Health Risks. The Plans may disclose your<br />
PHI for public health activities, such as those aimed<br />
<strong>at</strong> preventing or controlling disease, preventing<br />
injury, reporting reactions to medic<strong>at</strong>ions or problems<br />
with products, and reporting the abuse or neglect<br />
of children, elders, and dependent adults.<br />
3. For Health Oversight Activities. The Plans may disclose<br />
your PHI to a health oversight agency for activities<br />
authorized by law. These oversight activities,<br />
which are necessary for the government to monitor<br />
the health care system, include investig<strong>at</strong>ions,<br />
inspections, audits, and licensure.<br />
4. For Lawsuits and Disputes. The Plans may use or<br />
disclose your PHI in response to a court or administr<strong>at</strong>ive<br />
order if you are involved in a lawsuit or similar<br />
proceeding. We also may disclose your PHI in<br />
response to a discovery request, subpoena, or other<br />
lawful process by another party involved in the dispute,<br />
but only if we have made an effort to inform<br />
you of the request or obtain an order protecting the<br />
inform<strong>at</strong>ion the party has requested.<br />
5. To Law Enforcement. The Plans may release your PHI<br />
if asked to do so by a law enforcement official in the<br />
following circumstances:<br />
—Regarding a crime victim in certain situ<strong>at</strong>ions, if<br />
we are unable to obtain the person’s agreement;<br />
—Concerning a de<strong>at</strong>h we believe might have resulted<br />
from criminal conduct;<br />
—Regarding criminal conduct <strong>at</strong> our offices;<br />
—In response to a warrant, summons, court order,<br />
subpoena, or similar legal process;<br />
—To identify/loc<strong>at</strong>e a suspect, m<strong>at</strong>erial witness,<br />
fugitive, or missing person; and<br />
—In an emergency, to report a crime (including the<br />
loc<strong>at</strong>ion or victim(s) of the crime or the description,<br />
identity or loc<strong>at</strong>ion of the person who committed<br />
the crime).<br />
6. To Avert a Serious Thre<strong>at</strong> to Health or Safety. The<br />
Plans may use or disclose your PHI when necessary<br />
to reduce or prevent a serious thre<strong>at</strong> to your health<br />
and safety or the health and safety of another individual<br />
or the public. Under these circumstances, we<br />
will only make disclosures to a person or organiz<strong>at</strong>ion<br />
able to help prevent the thre<strong>at</strong>.<br />
7. For Military Functions. The Plans may disclose your<br />
PHI if you are a member of the U.S. or foreign military<br />
forces (including veterans), and if required by the<br />
appropri<strong>at</strong>e military command authorities.<br />
8. For N<strong>at</strong>ional Security. The Plans may disclose your<br />
PHI to federal officials for intelligence and n<strong>at</strong>ional<br />
security activities authorized by law. We also may disclose<br />
your PHI to federal officials in order to protect<br />
the President, other officials or foreign heads of st<strong>at</strong>e,<br />
or to conduct investig<strong>at</strong>ions.<br />
9. Inm<strong>at</strong>es. The Plans may disclose your health inform<strong>at</strong>ion<br />
to correctional institutions or law enforcement<br />
officials if you are an inm<strong>at</strong>e or under the custody<br />
of a law enforcement official. Disclosure for<br />
these purposes would be necessary: (a) for the institution<br />
to provide health care services to you, (b) for<br />
the safety and security of the institution, and/or (c) to<br />
protect your health and safety or the health and<br />
safety of other individuals.<br />
10.To Workers’ Compens<strong>at</strong>ion Programs. The Plans<br />
may release your health inform<strong>at</strong>ion for Workers’<br />
Compens<strong>at</strong>ion and similar programs.<br />
11. For Services Rel<strong>at</strong>ed to De<strong>at</strong>h. Upon your de<strong>at</strong>h, to<br />
a coroner, funeral director, or to tissue or organ don<strong>at</strong>ion<br />
services, as necessary to permit them to perform<br />
their functions.<br />
12. Research. For government-approved<br />
research purposes.<br />
44 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Uses and Disclosures<br />
Requiring Your Authoriz<strong>at</strong>ion<br />
Other uses and disclosures of your PHI th<strong>at</strong> are not covered<br />
by this Notice or the laws th<strong>at</strong> apply to us will be<br />
made only with written authoriz<strong>at</strong>ion. If you give us written<br />
authoriz<strong>at</strong>ion for a use or disclosure of your PHI, you<br />
may revoke th<strong>at</strong> authoriz<strong>at</strong>ion <strong>at</strong> any time in writing. If<br />
you revoke your authoriz<strong>at</strong>ion, we will no longer use<br />
or disclose your PHI for the reasons described in the<br />
authoriz<strong>at</strong>ion, except for the two situ<strong>at</strong>ions noted below:<br />
• We have taken action in reliance on your authoriz<strong>at</strong>ion<br />
before we received your written revoc<strong>at</strong>ion; and<br />
• You were required to give us your authoriz<strong>at</strong>ion as a<br />
condition of obtaining coverage.<br />
Stricter St<strong>at</strong>e Privacy Laws<br />
Under the HIPAA Privacy Regul<strong>at</strong>ions, the Plan is<br />
required to comply with st<strong>at</strong>e laws, if any, th<strong>at</strong> also are<br />
applicable and are not contrary to HIPAA (for example,<br />
where st<strong>at</strong>e laws may be stricter). The Plan maintains a<br />
policy to ensure compliance with these laws. Additional<br />
inform<strong>at</strong>ion regarding st<strong>at</strong>e privacy laws may be<br />
loc<strong>at</strong>ed on the WIRE.<br />
Your Rights Rel<strong>at</strong>ed to Your PHI<br />
You have the following rights regarding your PHI th<strong>at</strong><br />
we maintain:<br />
1. Right to Request Confidential Communic<strong>at</strong>ions.<br />
You have the right to request th<strong>at</strong> the Plans communic<strong>at</strong>e<br />
with you about your health and rel<strong>at</strong>ed issues<br />
in a particular manner or <strong>at</strong> a certain loc<strong>at</strong>ion if you<br />
feel like your life may be endangered if communic<strong>at</strong>ions<br />
are sent to your home. For example, you may<br />
ask th<strong>at</strong> we contact you <strong>at</strong> home r<strong>at</strong>her than work. In<br />
order to request a type of confidential communic<strong>at</strong>ion,<br />
you must make a written request to the address<br />
<strong>at</strong> the bottom of this section specifying the requested<br />
method of contact or the loc<strong>at</strong>ion where you wish to<br />
be contacted. For us to consider granting your<br />
request for a confidential communic<strong>at</strong>ion, your written<br />
request must clearly st<strong>at</strong>e th<strong>at</strong> your life could be<br />
endangered by the disclosure of all or part of<br />
this inform<strong>at</strong>ion.<br />
2. Right to Request Restrictions. You have the right to<br />
request a restriction in our use or disclosure of your<br />
PHI for tre<strong>at</strong>ment, payment, or health care oper<strong>at</strong>ions.<br />
Additionally, you have the right to request th<strong>at</strong><br />
we limit our disclosure of your PHI to individuals<br />
involved in your care or the payment for your care,<br />
such as family members and friends. We are not<br />
required to agree to your request; however, if we do<br />
agree, we are bound by our agreement except when<br />
otherwise required by law, in emergencies, or when<br />
the inform<strong>at</strong>ion is necessary to tre<strong>at</strong> you. In order to<br />
request a restriction in our use or disclosure of your<br />
PHI, you must make your request in writing to the<br />
address <strong>at</strong> the bottom of this section. Your request<br />
must describe in a clear and concise fashion: (a) the<br />
inform<strong>at</strong>ion you wish restricted; (b) whether you are<br />
requesting to limit the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan,<br />
Dental Plan’s, or RFL’s use, disclosure, or both; and (c)<br />
to whom you want the limits to apply.<br />
3. Right to Inspect and Copy. Except for limited circumstances,<br />
you have the right to inspect and copy<br />
the PHI th<strong>at</strong> may be used to make decisions about<br />
you. Usually, this includes medical and billing records.<br />
To inspect or copy your PHI, you must<br />
submit your request in writing to the address listed<br />
<strong>at</strong> the end of this section. The Plans may charge a fee<br />
for the costs of copying, mailing, labor, and supplies<br />
associ<strong>at</strong>ed with your request. We may deny your<br />
request to inspect and/or copy in certain limited circumstances,<br />
in which case you may request th<strong>at</strong> the<br />
denial be reviewed.<br />
Legal Inform<strong>at</strong>ion<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
45
4. Right to Request Amendment. You have the right to<br />
request th<strong>at</strong> we amend your PHI if you believe it is<br />
incorrect or incomplete. To request an amendment,<br />
you must submit a written request to the address<br />
listed <strong>at</strong> the end of this section. You must provide a<br />
reason th<strong>at</strong> supports your request for amendment.<br />
We may deny your request if you ask us to amend<br />
PHI th<strong>at</strong> is: (a) accur<strong>at</strong>e and complete; (b) not part of<br />
the PHI kept by or for the Plan; (c) not part of the PHI<br />
which you would be permitted to inspect and copy;<br />
or (d) not cre<strong>at</strong>ed by the Plan, unless the individual<br />
or entity th<strong>at</strong> cre<strong>at</strong>ed the PHI is not available to<br />
amend it. Even if we deny your request for amendment,<br />
you have the right to submit a st<strong>at</strong>ement of<br />
disagreement regarding any item in your record you<br />
believe is incomplete or incorrect. If you request, it<br />
will become part of your medical record and we will<br />
<strong>at</strong>tach it to your records and include it whenever we<br />
make a disclosure of the item or st<strong>at</strong>ement you<br />
believe to be incomplete or incorrect.<br />
5. Right to an Accounting of Disclosures. You have the<br />
right to request an accounting of disclosures. An<br />
accounting of disclosures is a list of certain disclosures<br />
we have made of your PHI after April 14, 2003,<br />
for most purposes other than tre<strong>at</strong>ment, payment,<br />
health care oper<strong>at</strong>ions, and other exceptions pursuant<br />
to law. To request an accounting of disclosures,<br />
you must submit a written request to the address <strong>at</strong><br />
the end of this section. You must specify the time<br />
period, which may not be longer than six years and<br />
may not include d<strong>at</strong>es before April 14, 2003. We will<br />
notify you of the cost involved and<br />
you may choose to withdraw or modify your request<br />
<strong>at</strong> th<strong>at</strong> time.<br />
6. Paper Notice. You have a right to request a paper<br />
copy of this notice, even if you have agreed to<br />
receive this notice electronically.<br />
If you believe your privacy rights have been viol<strong>at</strong>ed, you<br />
may file a complaint with the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan,<br />
Dental Plan, or RFL, or with the Secretary of the U.S.<br />
Department of Health and Human Services.To file a<br />
complaint with us, you must submit it in writing to<br />
the address listed <strong>at</strong> the end of this Section. Neither<br />
<strong>Wal</strong>-<strong>Mart</strong> nor the Plans will retali<strong>at</strong>e against you for<br />
filing a complaint.<br />
If you have questions about this notice or would like to<br />
exercise one or more of the rights listed in this notice,<br />
please contact:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: HIPAA Compliance Team<br />
922 West <strong>Wal</strong>nut, Ste. A<br />
Mail stop #3540<br />
Rogers, AR 72756-3540<br />
Email Address: Privacy@wal-mart.com<br />
Telephone: (800) 421-1362 or (479) 621-2929<br />
Medicare and Your<br />
Prescription Drug Coverage<br />
Please read this notice carefully and keep it where<br />
you can find it.This notice has inform<strong>at</strong>ion about your<br />
current prescription drug coverage with the AHWP<br />
and prescription drug coverage available for people<br />
with Medicare. It also tells you where to find more inform<strong>at</strong>ion<br />
to help you make decisions about your<br />
prescription drug coverage.<br />
• Starting January 1, 2006, new Medicare prescription<br />
drug coverage became available to everyone<br />
with Medicare. You can get this coverage if you join<br />
a Medicare Prescription Drug Plan or join<br />
a Medicare Advantage Plan (like and HMO or<br />
PPO) th<strong>at</strong> offers prescription drug coverage.<br />
All Medicare drug plans provide <strong>at</strong> least a standard<br />
level of coverage set by Medicare. Some plans<br />
may also offer more coverage for a higher<br />
monthly premium.<br />
• You have decisions to make about Medicare prescription<br />
drug coverage, such as if and when you<br />
enroll. These decisions may affect how much you<br />
pay for Medicare prescription drug coverage. Read<br />
this notice carefully – it explains the options you<br />
have under Medicare prescription drug coverage,<br />
and can help you decide whether or not you want<br />
to enroll.<br />
46 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
• Some of the <strong>Wal</strong>-<strong>Mart</strong> prescription drug plans (as<br />
described l<strong>at</strong>er in the notice under the heading<br />
“creditable coverage”) are, on average for all plan<br />
participants, expected to pay out as much as the<br />
standard Medicare prescription drug coverage<br />
will pay.<br />
• Other <strong>Wal</strong>-<strong>Mart</strong> Plan options (as described l<strong>at</strong>er in<br />
the notice under the heading “non-creditable coverage”)<br />
are, on average for all Plan participants,<br />
NOT expected to pay out as much as the standard<br />
Medicare prescription drug coverage will pay. This<br />
is important because for most people enrolled in<br />
these Plan options, enrolling in Medicare prescription<br />
drug coverage means you will get more assistance<br />
with drug costs than if you had prescription<br />
drug coverage exclusively through the AHWP.<br />
You may have heard about Medicare’s prescription drug<br />
coverage and wondered how it would affect you.The<br />
decision to enroll in the Medicare prescription coverage<br />
is up to you, but as part of your decision, you should consider<br />
whether or not your current prescription drug plan<br />
is creditable or non-creditable according to Medicare<br />
guidelines, and as described below. If your coverage is<br />
creditable, you may want to wait to enroll in Medicare<br />
prescription drug coverage because you can do so <strong>at</strong> a<br />
l<strong>at</strong>er time for the same cost. However, if your coverage is<br />
non-creditable, you may wish to enroll in Medicare prescription<br />
drug coverage as soon as you are eligible<br />
because it will be more expensive to enroll l<strong>at</strong>er.<br />
Starting January 1, 2006, prescription drug coverage<br />
became available to everyone with Medicare through<br />
Medicare prescription drug plans. All Medicare prescription<br />
drug coverage provides <strong>at</strong> least a standard level of<br />
coverage set by Medicare. Some plans also offer more<br />
coverage for a higher monthly premium.<br />
Creditable and Non-Creditable Coverage<br />
Wh<strong>at</strong> is the meaning of the term “creditable coverage”<br />
Creditable coverage means th<strong>at</strong> your current prescription<br />
drug coverage is, on average for all plan participants,<br />
expected to pay out as much as the standard<br />
Medicare prescription drug coverage will pay.<br />
Which <strong>Wal</strong>-<strong>Mart</strong> Plans are creditable coverage<br />
<strong>Wal</strong>-<strong>Mart</strong> has determined th<strong>at</strong> the following prescription<br />
drug plans are considered creditable coverage according<br />
to Medicare guidelines:<br />
• Value Plan—all deductible amounts<br />
• Freedom Plan—$1,250 individual/$2,500<br />
family deductible<br />
• HMO<br />
If your coverage is creditable, you can keep your<br />
existing coverage and not pay extra if you l<strong>at</strong>er<br />
decide to enroll in Medicare coverage.<br />
If you are enrolled in a Value Plan, Freedom Plan—$1,250<br />
individual/$2,500 family deductible, or an HMO, you can<br />
choose to join a Medicare prescription drug plan l<strong>at</strong>er<br />
without paying extra because you have existing prescription<br />
drug coverage th<strong>at</strong>, on average, is as good as<br />
Medicare’s coverage.<br />
If you are enrolled in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan and<br />
also in enroll in a Medicare prescription drug plan, the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan will coordin<strong>at</strong>e benefits with<br />
Medicare, as permitted by applicable law.<br />
If you drop your coverage with <strong>Wal</strong>-<strong>Mart</strong> and enroll in a<br />
Medicare prescription drug plan, you will have the<br />
option of re-enrolling in the <strong>Wal</strong>-<strong>Mart</strong> plan during<br />
Annual Enrollment or with a valid St<strong>at</strong>us <strong>Change</strong> Event.<br />
You should compare your current coverage, including<br />
which drugs are covered, with the coverage and cost of<br />
the plans offering Medicare prescription drug coverage<br />
in your area.<br />
Legal Inform<strong>at</strong>ion<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
47
Which <strong>Wal</strong>-<strong>Mart</strong> Plans are<br />
considered non-creditable coverage<br />
<strong>Wal</strong>-<strong>Mart</strong> has determined th<strong>at</strong> the following prescription<br />
drug plan is considered non-creditable coverage according<br />
to Medicare guidelines: Freedom Plan—$3,000<br />
individual/$6,000 family deductible.<br />
If your coverage is non-creditable, you might<br />
want to consider enrolling in Medicare prescription<br />
drug coverage.<br />
If you are enrolled in the Freedom Plan—$3,000 individual/$6,000<br />
family deductible, you may want to consider<br />
enrolling in Medicare prescription drug coverage<br />
because the coverage you have is, on average for all<br />
participants, NOT expected to pay out as much as the<br />
standard Medicare prescription drug coverage will pay.<br />
When can I enroll for<br />
Medicare prescription drug coverage<br />
Individuals can enroll in Medicare prescription drug coverage<br />
when they first become eligible for Medicare and<br />
each year from November 15th through December 31st.<br />
If you have non-creditable coverage but you don’t<br />
enroll in Medicare prescription drug coverage when<br />
you are newly eligible, you may pay more for coverage<br />
if you change your mind and join l<strong>at</strong>er. Even if<br />
you have creditable coverage under a <strong>Wal</strong>-<strong>Mart</strong> prescription<br />
drug option and drop or lose your coverage<br />
and don’t enroll in Medicare prescription drug<br />
coverage within 63 days, you may also pay more<br />
for coverage if you join l<strong>at</strong>er.<br />
Wh<strong>at</strong> Happens to my Medicare prescription<br />
drug premium if I do not enroll in Medicare<br />
If you have non-creditable coverage and you are eligible<br />
for Medicare prescription drug coverage but you wait to<br />
enroll, your monthly premium could be much higher<br />
than it would have been if you had enrolled when you<br />
were newly eligible. In addition, if you go 63 days or<br />
longer without prescription drug coverage th<strong>at</strong> is <strong>at</strong><br />
least as good as Medicare’s prescription drug coverage,<br />
your monthly premium will go up <strong>at</strong> least 1 percent per<br />
month for every month after your Initial Enrollment<br />
Period th<strong>at</strong> you did not have the coverage.You will have<br />
to pay this higher premium as long as you have<br />
Medicare prescription drug coverage. For example, if you<br />
go 19 months without coverage, your premium will<br />
always be <strong>at</strong> least 19 percent higher than wh<strong>at</strong> most<br />
other people pay.<br />
Generally, after your Initial Enrollment Period, you can<br />
only join a Medicare prescription drug plan between<br />
November 15th and December 31st of any year. This<br />
may mean the number of months you have to wait<br />
for coverage will be longer, which could make your<br />
premium higher.<br />
48 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Additional Inform<strong>at</strong>ion Available<br />
More detailed inform<strong>at</strong>ion about Medicare plans th<strong>at</strong><br />
offer prescription drug coverage is available through the<br />
“Medicare & You” handbook from Medicare.You may also<br />
be contacted directly by Medicare-approved prescription<br />
drug plans.You’ll get a copy of the handbook in the<br />
mail.You can also get more inform<strong>at</strong>ion about Medicare<br />
prescription drug plans from these sources:<br />
• Visit www.medicare.gov for personalized help<br />
• Call your St<strong>at</strong>e Health Insurance Assistance Program<br />
(see your copy of the “Medicare & You” handbook for<br />
their telephone number)<br />
• Call (800) MEDICARE [633-4227]. TTY users should<br />
call (877) 486-2048<br />
For people with limited income and resources, extra<br />
help paying for the Medicare prescription drug plan is<br />
available. Inform<strong>at</strong>ion about this extra help is available<br />
from the Social Security Administr<strong>at</strong>ion (SSA). For more<br />
inform<strong>at</strong>ion about this extra help, visit SSA online <strong>at</strong><br />
www.socialsecurity.gov, or call (800) 772-1213<br />
[TTY (800) 325-0778].<br />
Remember: Keep this notice. If you enroll in one of the<br />
Medicare prescription drug plans, you may need to give<br />
a copy of this notice when you join to show th<strong>at</strong> you are<br />
not required to pay a higher premium amount.<br />
You may receive this notice <strong>at</strong> other times in the future<br />
such as before the next period you can enroll in<br />
Medicare prescription drug coverage, and if your current<br />
coverage changes.You also may request a copy.<br />
D<strong>at</strong>e: 11/15/2007<br />
Name of Sender: AHWP<br />
Contact: <strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan<br />
Address: 922 West <strong>Wal</strong>nut, Ste. A<br />
Rogers, AR 72756-3540<br />
Phone: (479) 621-2929<br />
Legal Inform<strong>at</strong>ion<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
49
The Medical Plan<br />
Where Can I Find<br />
The <strong>Wal</strong>-<strong>Mart</strong> Medical Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52<br />
Eligibility and Enrollment in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . . 53<br />
Enrolling in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan for the First Time . . . . . . . . . . . . . . . . . . . . . . . . . 53<br />
Starbridge—Coverage During Your Eligibility Waiting Period . . . . . . . . . . . . . . . . . . . . . . 55<br />
HMO Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan—The Value Plan and Freedom Plan . . . . . . . . . . . . . . . . . . 55<br />
How the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56<br />
How the Value and Freedom Plans Pay <strong>Benefits</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56<br />
The Value Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61<br />
The Freedom Plan with Company Contributions to a Health Savings Account . . . . . . 61<br />
Helping You Manage Your Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62<br />
When Limited <strong>Benefits</strong> Apply to the Value Plan and the Freedom Plan . . . . . . . . . . . . . 63<br />
Coverage When You Travel to a Foreign Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67<br />
Coverage for Transplants and Lung Volume Reduction (LVR) . . . . . . . . . . . . . . . . . . . . . . . 67<br />
Wh<strong>at</strong> is Not Covered by the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68<br />
Services Requiring Prior Authoriz<strong>at</strong>ion by the Aetna Limited Network . . . . . . . . . . . . . 72<br />
Filing a Medical Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74<br />
If You Have Coverage Under More Than One Medical Plan . . . . . . . . . . . . . . . . . . . . . . . . . 75<br />
If You Go On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77<br />
When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77<br />
If You Leave the Company and are Then Rehired. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Medical Plan<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan Resources<br />
Find Wh<strong>at</strong> You Need Online By Phone Other Resources<br />
Contact Aetna<br />
Limited Network<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
Customer Service:<br />
(800) 250-7129<br />
Hospital Precertific<strong>at</strong>ion,<br />
providers :<br />
(888) 632-3862<br />
See “Services Requiring<br />
Prior Authoriz<strong>at</strong>ion by the<br />
Aetna Limited Network”<br />
for more inform<strong>at</strong>ion<br />
P.O. Box 14079<br />
Lexington, KY 40512-4079<br />
Contact BlueCross BlueShield<br />
of Alabama (Choice, Basic, and<br />
Limited Network)<br />
(AL, FL, GA, LA, MS, TN, WV, VA)<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
Customer Service:<br />
(800) 760-6844<br />
Hospital Prenotific<strong>at</strong>ion:<br />
(800) 248-2342<br />
450 Riverchase Parkway East<br />
Birmingham, AL 35244<br />
Contact BlueAdvantage<br />
Administr<strong>at</strong>ors of<br />
Arkansas (Choice, Basic,<br />
and Limited Network)<br />
(AK, AR, AZ, CA, CO, ID, KS, MO,<br />
MT, NV, OK, OR, UT, WA, WY)<br />
Contact BlueCross BlueShield<br />
of Illinois (Choice, Basic, and<br />
Limited Network)<br />
(CT, DE, IA, IL, IN, KY, MA, MD, ME,<br />
MI, MN, NC, ND, NE, NH, NJ, NM,<br />
NY, OH, PA, RI, SC, SD,TX, VT, WI)<br />
Contact Humana<br />
Limited Network<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
Customer Service:<br />
(866) 823-3790<br />
Hospital Prenotific<strong>at</strong>ion:<br />
(800) 451-7302<br />
Customer Service:<br />
(800) 730-8434<br />
Hospital Prenotific<strong>at</strong>ion:<br />
(800) 944-9581<br />
Customer Service:<br />
(800) 432-4807<br />
Hospital Prenotific<strong>at</strong>ion:<br />
(800) 432-4807<br />
P.O. Box 1460<br />
Little Rock, AR 72203-1460<br />
P.O. Box 805107<br />
Chicago, IL 60680-4112<br />
P.O. Box 14601<br />
Lexington, KY 40512-4601<br />
The Medical Plan<br />
Contact UnitedHealthcare<br />
Limited Network<br />
For a list of loc<strong>at</strong>ions offered,<br />
go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
Customer Service:<br />
(866) 810-1491<br />
Hospital Prenotific<strong>at</strong>ion:<br />
(866) 810-1491<br />
P.O. Box 30555<br />
Salt Lake City, UT 84130-0555<br />
Get a Network directory<br />
Go to the WIRE or<br />
walmartbenefits.com or<br />
see your personnel represent<strong>at</strong>ive<br />
Call your Third-Party<br />
Administr<strong>at</strong>or's customer<br />
service telephone number<br />
Get the cost for<br />
medical coverage<br />
Newly eligible or St<strong>at</strong>us <strong>Change</strong><br />
Event, go to walmartbenefits.com<br />
or the WIRE under the “Life” tab in<br />
Annual Enrollment<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong><br />
<strong>at</strong> (800) 421-1362<br />
For help getting your<br />
Certific<strong>at</strong>e of Creditable<br />
Coverage (COCC)<br />
from <strong>Wal</strong>-<strong>Mart</strong><br />
Call the Ask Mayo Clinic<br />
nurse line available 24/7<br />
Request a paper copy of this<br />
<strong>2008</strong> <strong>Associ<strong>at</strong>e</strong>s' Benefit <strong>Book</strong><br />
Email Ask Betty from the WIRE or<br />
walmartbenefits.com<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong><br />
<strong>at</strong> (800) 421-1362<br />
(800) 418-0758<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong><br />
<strong>at</strong> (800) 421-1362<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
51
The Medical Plan<br />
The wide variety of medical options within the Value Plan and the Freedom Plan gives you the<br />
flexibility to choose the coverage th<strong>at</strong> meets your health care and budget needs. And,<strong>Wal</strong>-<strong>Mart</strong><br />
helps you pay for medical care through the health care credit for Value Plan participants and<br />
Company contributions to the health savings account for Freedom Plan participants.Your health is<br />
your most valuable possession, and protecting it through a healthy diet, exercise, and good medical<br />
care should be one of your top priorities. By personalizing your <strong>Wal</strong>-<strong>Mart</strong> medical coverage to<br />
meet your specific needs, you take control of your and your family’s physical well-being.<br />
Wh<strong>at</strong> You Need to Know About Medical <strong>Benefits</strong><br />
• <strong>Wal</strong>-<strong>Mart</strong> offers medical coverage under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan—either the Value Plan or<br />
the Freedom Plan—or an HMO, if available in your loc<strong>at</strong>ion. If you are an associ<strong>at</strong>e in Hawaii, your<br />
eligibility for medical coverage and the medical plan options available to you are explained in the<br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii chapter.<br />
• For Temporary associ<strong>at</strong>es and associ<strong>at</strong>es who are in their eligibility waiting period, limited medical coverage<br />
is available through Starbridge.<br />
• You can build your own Value Plan medical coverage by choosing from among several Health Care Credit, Annual<br />
Deductible, and Out-of-Pocket Maximum amounts and Network options.<br />
• The Freedom Plan offers a choice of Annual Deductible amounts and Network options, as well as Company<br />
contributions to your health savings account.<br />
All of these options are group health benefits offered under the <strong>Associ<strong>at</strong>e</strong>s Health and Welfare Plan (AHWP).<br />
The <strong>Wal</strong>-<strong>Mart</strong><br />
Medical Plan Options<br />
<strong>Wal</strong>-<strong>Mart</strong> offers the following medical coverage options:<br />
• <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan (AMP)<br />
—Value Plan<br />
—Freedom Plan<br />
• HMO plans (fully insured plans offered in<br />
some facilities)<br />
• Starbridge—a limited medical plan th<strong>at</strong> pays a maximum<br />
benefit of $1,000 per participant per year for<br />
Temporary associ<strong>at</strong>es and associ<strong>at</strong>es who are in their<br />
eligibility waiting period for <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan<br />
or HMO coverage<br />
If you are an associ<strong>at</strong>e in Hawaii, your eligibility for<br />
medical coverage and the medical plan options available<br />
to you are explained in the Eligibility and <strong>Benefits</strong> for<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii chapter.<br />
In addition to coverage under one of the medical<br />
plans listed above, <strong>Wal</strong>-<strong>Mart</strong> offers the Cancer<br />
Insurance Policy—a supplemental protection plan to<br />
help cover costs associ<strong>at</strong>ed with cancer—and the<br />
Accident Insurance Policy—a supplemental plan to<br />
help cover costs associ<strong>at</strong>ed with an accidental injury.<br />
You’ll find more inform<strong>at</strong>ion about these plans in the<br />
Accident Insurance Policy and Cancer Insurance<br />
Policy chapters.<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan is self-insured; this means<br />
th<strong>at</strong> there is no insurance company to collect premiums<br />
or pay bills. Instead, particip<strong>at</strong>ing associ<strong>at</strong>es make contributions<br />
to cover a portion of the cost of the AMP benefit<br />
and the Company or the Plan’s Trust pays the rest. Claims<br />
are processed by Third Party Administr<strong>at</strong>ors. Please see<br />
your <strong>Benefits</strong> ID Card or see Medical Plan Resources <strong>at</strong><br />
the beginning of this chapter for the Third Party<br />
Administr<strong>at</strong>or office serving you.<br />
52 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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Eligibility and Enrollment<br />
in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan<br />
You are eligible to enroll in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan if<br />
you are a:<br />
• Full-Time hourly associ<strong>at</strong>e (including Full-Time hourly<br />
pharmacists, Full-Time hourly Field Logistics<br />
<strong>Associ<strong>at</strong>e</strong>s, and Full-Time hourly Field Supervisor<br />
Positions in stores and clubs)<br />
• Peak-Time hourly associ<strong>at</strong>e<br />
• Full-Time Truck Driver<br />
• Part-Time Truck Driver and <strong>Wal</strong>-<strong>Mart</strong> is your<br />
primary employer<br />
• Management associ<strong>at</strong>e or trainee<br />
For complete inform<strong>at</strong>ion about eligibility and when you<br />
can enroll in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, see the<br />
Eligibility and Enrollment chapter. If you are an associ<strong>at</strong>e<br />
in Hawaii, your eligibility for medical coverage and<br />
when you can enroll in the medical plan options available<br />
in Hawaii are explained in the Eligibility and <strong>Benefits</strong><br />
for <strong>Associ<strong>at</strong>e</strong>s in Hawaii chapter.<br />
When you enroll in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, you also<br />
select the Eligible Dependents you wish to cover, if<br />
dependent coverage is available under your job classific<strong>at</strong>ion.<br />
Choices for coverage under the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan are:<br />
• <strong>Associ<strong>at</strong>e</strong> Only<br />
• <strong>Associ<strong>at</strong>e</strong> + Spouse<br />
• <strong>Associ<strong>at</strong>e</strong> + Children<br />
• Family<br />
Peak-Time associ<strong>at</strong>es and Part-Time Truck Drivers only<br />
may cover their Eligible Dependent children, and may not<br />
cover their spouses. For inform<strong>at</strong>ion on dependent eligibility<br />
and when dependents can enroll, see the Eligibility<br />
and Enrollment chapter.<br />
The cost for medical coverage under the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan is based upon the coverage option you<br />
select and the Eligible Dependents you choose to cover.<br />
To find the associ<strong>at</strong>e cost for medical coverage<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, go to the WIRE or<br />
walmartbenefits.com. The cost of any coverage<br />
option may change from year to year.<br />
Enrolling in the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan for the First Time<br />
If you are enrolling in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan (the<br />
Value Plan or the Freedom Plan) for the first time you<br />
may be subject to a limit<strong>at</strong>ion on coverage of preexisting<br />
conditions. A pre-existing condition is a physical<br />
or mental condition for which an individual<br />
received medical care, advice, diagnosis, or tre<strong>at</strong>ment,<br />
including prescription drugs, during the six-month<br />
period before his or her “determin<strong>at</strong>ion d<strong>at</strong>e.” An individual’s<br />
determin<strong>at</strong>ion d<strong>at</strong>e is:<br />
• Usually the d<strong>at</strong>e the associ<strong>at</strong>e was employed by the<br />
Company as an eligible associ<strong>at</strong>e, if the individual was<br />
enrolled for coverage when it was first available during<br />
his or her Initial Enrollment Period ; or<br />
• The d<strong>at</strong>e the individual’s coverage under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan became effective, if the individual<br />
enrolled for coverage <strong>at</strong> any other time as a<br />
l<strong>at</strong>e enrollee.<br />
If an individual has a pre-existing condition, the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan will not cover th<strong>at</strong> condition until:<br />
• Twelve (12) months after the individual’s determin<strong>at</strong>ion<br />
d<strong>at</strong>e if the individual is enrolled for coverage during<br />
an Initial Enrollment Period or a St<strong>at</strong>us <strong>Change</strong><br />
Event (see the Eligibility and Enrollment chapter; or<br />
• Eighteen (18) months following the individual’s determin<strong>at</strong>ion<br />
d<strong>at</strong>e, if the individual is enrolled for coverage<br />
<strong>at</strong> Annual Enrollment as a l<strong>at</strong>e enrollee (not during<br />
his or her Initial Enrollment Period or a St<strong>at</strong>us<br />
<strong>Change</strong> Event).<br />
The 12-month or 18-month limit<strong>at</strong>ion period can be<br />
reduced or elimin<strong>at</strong>ed if the individual had prior creditable<br />
coverage.<br />
This pre-existing condition limit<strong>at</strong>ion does not apply to:<br />
• Pregnancy-rel<strong>at</strong>ed expenses;<br />
• Children born to the individual, adopted, or placed<br />
with the individual for adoption when the individual<br />
is eligible for particip<strong>at</strong>ion in the AMP, as long as the<br />
child is enrolled in the AMP within 60 days after the<br />
birth, adoption, or placement for adoption;<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
53
• Children born to the individual, adopted, or placed<br />
with the individual for adoption under a previous<br />
medical plan if the child had medical coverage within<br />
30 calendar days of the child’s birth, adoption, or<br />
placement for adoption and the child has not had a<br />
break in coverage of 63 days or more before enrolling<br />
in the AMP; or<br />
• The Pharmacy Benefit and mail order pharmacy.<br />
Providing a Certific<strong>at</strong>e<br />
of Creditable Coverage<br />
The 12-month or 18-month pre-existing condition<br />
limit<strong>at</strong>ion period can be reduced or elimin<strong>at</strong>ed if the<br />
individual had prior creditable coverage. Creditable<br />
coverage is prior medical coverage an individual had<br />
before joining the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan if the<br />
individual did not have a break in coverage of 63 days<br />
or more. An individual can reduce the pre-existing condition<br />
limit<strong>at</strong>ion period by providing the Third-Party<br />
Administr<strong>at</strong>or of the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan with evidence<br />
of creditable coverage.<br />
Creditable coverage includes:<br />
• Coverage under another employer’s group<br />
health plan<br />
• Coverage under an individual health<br />
insurance policy<br />
• Medicare<br />
• Medicaid<br />
• Coverage under a medical care plan for members and<br />
former members (and their dependents) of the<br />
United St<strong>at</strong>es Uniformed Services<br />
• Coverage under a medical care program of the Indian<br />
Health Service or a tribal organiz<strong>at</strong>ion<br />
• Coverage under a st<strong>at</strong>e health benefits risk pool<br />
• The Federal Employees’ Health Benefit Program<br />
• A public health plan (federal, st<strong>at</strong>e, and foreign government<br />
plans)<br />
• St<strong>at</strong>e Children’s Health Insurance Programs (SCHIP)<br />
• A health benefit plan of the Peace Corps Act<br />
When your coverage or an Eligible Dependent’s coverage<br />
ends for any reason (including the end of COBRA), the law<br />
requires your employer or prior health plan to provide<br />
you with a Certific<strong>at</strong>e of Creditable Coverage (COCC).You<br />
may also request a COCC from your prior plan for yourself<br />
or your dependent <strong>at</strong> any time.<br />
If you need to obtain a COCC from the <strong>Benefits</strong><br />
Department, please contact:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540<br />
Phone: (800) 421-1362<br />
Email:<br />
Ask Betty from the WIRE or<br />
walmartbenefits.com<br />
You also have the right to demonstr<strong>at</strong>e creditable<br />
coverage through document<strong>at</strong>ion other than a COCC,<br />
such as a Medicare identific<strong>at</strong>ion card showing Plan A<br />
or B coverage, a military identific<strong>at</strong>ion card for each individual<br />
(front and back), or other correspondence from a<br />
plan or issuer indic<strong>at</strong>ing prior health coverage including<br />
who was covered and the d<strong>at</strong>es of coverage.You must<br />
cooper<strong>at</strong>e fully with the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan to verify<br />
prior creditable coverage.<br />
Within a reasonable time after receiving the COCC or<br />
other proof of creditable coverage, the Third-Party<br />
Administr<strong>at</strong>or will:<br />
• Inform you of its decision of creditable coverage and<br />
how it will be counted towards the pre-existing condition<br />
limit<strong>at</strong>ion,<br />
• Notify you in writing of its decision regarding any<br />
pre-existing condition limit<strong>at</strong>ion period,<br />
• Explain the basis for the decision and the inform<strong>at</strong>ion<br />
the Third-Party Administr<strong>at</strong>or relied on in making the<br />
decision, and<br />
• Allow you the chance to appeal the decision and provide<br />
additional evidence of creditable coverage.<br />
See the Claims and Appeals chapter for details about<br />
your right to appeal.<br />
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If the Third-Party Administr<strong>at</strong>or l<strong>at</strong>er determines th<strong>at</strong><br />
you did not have the claimed creditable coverage, the<br />
Third-Party Administr<strong>at</strong>or may modify its initial decision<br />
if notice of the reconsider<strong>at</strong>ion is provided in writing to<br />
you, and, until the final decision is made, the Third-Party<br />
Administr<strong>at</strong>or acts in a manner consistent with the initial<br />
decision for purposes of approving access to medical<br />
services.<br />
Starbridge—Coverage During Your<br />
Eligibility Waiting Period<br />
Starbridge offers a limited medical plan for Full-Time<br />
hourly associ<strong>at</strong>es, Peak-Time hourly associ<strong>at</strong>es, and<br />
Part-Time Truck Drivers and their Eligible Dependents<br />
who are in their eligibility waiting period for the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan or an HMO plan, or who are<br />
Temporary associ<strong>at</strong>es. Starbridge covers the costs associ<strong>at</strong>ed<br />
with basic day-to-day Covered Expenses such as<br />
tre<strong>at</strong>ment for the flu or a broken bone—up to a maximum<br />
benefit of $1,000 per participant per calendar<br />
year. Starbridge does not cover preventive<br />
care or c<strong>at</strong>astrophic medical bills. Ask your personnel<br />
represent<strong>at</strong>ive for a brochure or call Starbridge<br />
Customer Service <strong>at</strong> (800) 288-1474. Starbridge is<br />
not available in Hawaii. A Starbridge Summary Plan<br />
Description will be mailed to you when you enroll.<br />
The Starbridge policy has different eligibility requirements<br />
than the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan’s normal eligibility<br />
requirements. In addition, st<strong>at</strong>e law may require an<br />
insurance policy to include different eligibility provisions<br />
for dependents, such as allowing coverage for a dependent<br />
child past age 23 or coverage for a domestic partner.<br />
You may obtain an explan<strong>at</strong>ion of these differences by<br />
calling (800) 421-1362.The <strong>Associ<strong>at</strong>e</strong>s’ Health and<br />
Welfare Plan (AHWP) will apply the eligibility requirements<br />
in the Eligibility and Enrollment chapter, unless<br />
you contact the <strong>Benefits</strong> Department <strong>at</strong> the number<br />
above and request th<strong>at</strong> a different eligibility provision in<br />
the policy be applied rel<strong>at</strong>ing to dependents.<br />
HMO Plans<br />
In addition to the options offered under the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan, HMO plans are available <strong>at</strong> some facilities. If<br />
an HMO plan is available <strong>at</strong> your facility, the plan benefits<br />
are described in m<strong>at</strong>erials provided separ<strong>at</strong>ely by the<br />
HMO provider.To find out if an HMO is available to you,<br />
contact your personnel represent<strong>at</strong>ive.<br />
HMO plans are independent organiz<strong>at</strong>ions and fully<br />
insured. The policies for HMO plans include different<br />
benefits, limit<strong>at</strong>ions and exclusions, cost sharing requirements,<br />
and other fe<strong>at</strong>ures in comparison to the AMP.<br />
These fe<strong>at</strong>ures are described in a benefits book which<br />
will be issued by the HMO. HMO plans limit payment<br />
refunds and retroactive coverage to 60 days. All HMO<br />
claim issues should be directed to the HMO plan office<br />
to be resolved.<br />
In addition, HMO plans may have different eligibility<br />
requirements than the <strong>Associ<strong>at</strong>e</strong> Medical Plan’s normal<br />
eligibility requirements. For example, st<strong>at</strong>e law may<br />
require an insurance policy to include different eligibility<br />
provisions for dependents, such as allowing coverage for<br />
a dependent child past age 23 or coverage for a domestic<br />
partner.You may obtain a description of these differences<br />
by calling (800) 421-1362.The AHWP will apply the eligibility<br />
requirements outlined in the Eligibility and<br />
Enrollment chapter, unless you contact the <strong>Benefits</strong><br />
Department <strong>at</strong> the number above and request th<strong>at</strong> a different<br />
eligibility provision in the policy be applied to you<br />
rel<strong>at</strong>ing to dependents.<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan—<br />
The Value Plan and Freedom Plan<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan offers two coverage options:<br />
• The Value Plan—you customize your own Value Plan<br />
coverage by choosing from among a variety of<br />
options for your Health Care Credit, Annual<br />
Deductible, Out-of-Pocket Maximum and Network.<br />
• The Freedom Plan with Health Savings Account—<br />
you choose your Annual Deductible amount and<br />
Network option. For inform<strong>at</strong>ion on the health savings<br />
account, see the Health Savings Account chapter.<br />
The Value Plan and the Freedom Plan both provide prescription<br />
drug coverage through the Pharmacy Benefit.<br />
For more inform<strong>at</strong>ion about the Pharmacy Benefit, see<br />
the Pharmacy Benefit chapter.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
55
How the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan Works<br />
Both the Value Plan and the Freedom Plan pay benefits<br />
for Covered Expenses. Covered Expenses are charges for<br />
services and supplies th<strong>at</strong> are:<br />
• Medically Necessary procedures, supplies, equipment,<br />
or services determined by the Plan to be:<br />
—Appropri<strong>at</strong>e for the symptoms, diagnosis, or tre<strong>at</strong>ment<br />
of a medical condition,<br />
—Provided for the diagnosis or direct care and tre<strong>at</strong>ment<br />
of the medical condition,<br />
—Within the standards of good medical practice within<br />
the organized medical community,<br />
—Not primarily for the convenience of the p<strong>at</strong>ient or<br />
the p<strong>at</strong>ient’s doctor or other provider, and<br />
—The most appropri<strong>at</strong>e procedure, supply, equipment,<br />
or service which can be safely provided:<br />
• There must be valid scientific evidence demonstr<strong>at</strong>ing<br />
th<strong>at</strong> the expected health benefits from<br />
the procedure, supply, equipment, or service are<br />
clinically significant and produce a gre<strong>at</strong>er likelihood<br />
of benefit, without a disproportion<strong>at</strong>ely<br />
gre<strong>at</strong>er risk of harm or complic<strong>at</strong>ions for the<br />
p<strong>at</strong>ient with the particular medical condition<br />
being tre<strong>at</strong>ed than other possible altern<strong>at</strong>ives;<br />
• Generally accepted forms of tre<strong>at</strong>ment th<strong>at</strong> are<br />
less invasive have been tried and found to be<br />
ineffective or are otherwise unsuitable; and<br />
• For Hospital stays,acute care as an inp<strong>at</strong>ient is necessary<br />
due to the kind of services the p<strong>at</strong>ient is<br />
receiving or the severity of the medical condition,<br />
and safe and adequ<strong>at</strong>e care cannot be received as<br />
an outp<strong>at</strong>ient or in a less intensive medical setting.<br />
• Not in excess of Usual, Customary, and Reasonable<br />
(UCR) or the Maximum Allowable Charge (MAC) as<br />
determined by the Third Party Administr<strong>at</strong>or (TPA).<br />
Third Party Administr<strong>at</strong>ors make medical claims<br />
determin<strong>at</strong>ions and process your medical claims—<br />
they do not insure any medical benefits under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan.<br />
The Maximum Allowable Charge (MAC) is the<br />
amount of a provider’s charge (whether Network or<br />
non-Network) paid to providers in a given geographic<br />
area as determined by the Third Party Administr<strong>at</strong>or.<br />
Usual, Customary, and Reasonable (UCR): usual is a<br />
fee regularly charged for a given service or supply by<br />
medical providers; customary is a fee th<strong>at</strong> is within the<br />
accepted range of usual fees charged by other<br />
providers of similar training and experience for services<br />
within the same specific and limited geographical area;<br />
and reasonable is a fee th<strong>at</strong> meets the two criteria<br />
above and is justifiable, considering the special circumstances<br />
of a particular case in question.<br />
• Not excluded under the plan—see Wh<strong>at</strong> is Not<br />
Covered Under the Plan l<strong>at</strong>er in this chapter.<br />
• Not otherwise in excess of plan limits.<br />
How the Value and<br />
Freedom Plans Pay <strong>Benefits</strong><br />
If you are enrolled in the Value Plan, you will choose a<br />
Health Care Credit amount.Your Health Care Credit is the<br />
amount of Covered Expenses per covered individual th<strong>at</strong> is<br />
paid <strong>at</strong> 100 percent by the Plan before your Annual<br />
Deductible applies.The Health Care Credit amount paid on<br />
your behalf will not exceed the Health Care Credit amount<br />
you have chosen ($100, $250, or $500). And, the Health<br />
Care Credit amount paid will not exceed any plan limits.<br />
As a Value Plan and Freedom Plan participant, you choose<br />
an Annual Deductible amount. For Freedom Plan participants,<br />
the Annual Deductible is the amount of Covered<br />
Expenses you pay each year before the plan starts paying<br />
a portion of the Covered Expenses.Value Plan participants<br />
begin paying toward the Annual Deductible after<br />
the Health Care Credit amount has been paid by the plan.<br />
Once the Annual Deductible has been met, you pay a<br />
percentage of the cost of Covered Expenses called the<br />
Coinsurance.Typically, your Coinsurance amount is 20<br />
percent of the cost of the covered expense when using<br />
in-Network providers.<br />
Value Plan participants also choose an Out-of-Pocket<br />
Maximum amount (the Freedom Plan does not have Outof-Pocket<br />
Maximum choices).The Out-of-Pocket<br />
Maximum is the maximum amount of money you pay<br />
before the plan begins paying 100 percent of Covered<br />
Expenses for the remainder of the calendar year. Annual<br />
Deductibles, Copays, and the money you pay for Network<br />
services apply to your Out-of-Pocket Maximum. For more<br />
inform<strong>at</strong>ion, see Wh<strong>at</strong> Counts Toward Your Out-of-<br />
Pocket Maximum l<strong>at</strong>er in this chapter.<br />
There is no lifetime maximum benefit for most major<br />
medical expenses unless otherwise st<strong>at</strong>ed in this chapter.<br />
56 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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How the Value and Freedom Plans Pay <strong>Benefits</strong><br />
<strong>Wal</strong>-<strong>Mart</strong><br />
Health Care Credit<br />
Value Plan<br />
The plan pays Covered Expenses up to the<br />
Health Care Credit amount you have chosen.<br />
Freedom Plan<br />
Not applicable<br />
Annual Deductible<br />
See When Preventive Care<br />
<strong>Benefits</strong> are Paid Before<br />
Annual Deductible is Met<br />
on the next page for<br />
exceptions on when Annual<br />
Deductible applies<br />
After your Health Care Credit has been exhausted, you must<br />
meet the Annual Deductible amount you have enrolled in<br />
before Coinsurance benefits are paid.The family Annual<br />
Deductible is two-times the individual Annual Deductible<br />
and can be met by two family members or any combin<strong>at</strong>ion<br />
of family members' Covered Expenses.<br />
The family Annual Deductible is a combined Annual<br />
Deductible for all family members and must be met before<br />
any benefits are payable. Eligible pharmacy charges also<br />
apply to the Annual Deductible.<br />
Per-Event<br />
Annual Deductibles<br />
An ambulance or air ambulance and emergency room<br />
Per-Event Deductible applies. See Per-Event Deductibles<br />
on the next page.<br />
An ambulance or air ambulance and emergency room<br />
Per-Event Deductible applies. See Per-Event Deductibles<br />
on the next page.<br />
Out-of-Pocket Maximum<br />
See Wh<strong>at</strong> Counts Toward<br />
the Out-of-Pocket<br />
Maximum<br />
on the next page<br />
Once your individual Out-of-Pocket Maximum amount<br />
has been met, your Covered Expenses are payable <strong>at</strong> 100<br />
percent for the rest of the calendar year.The family Out-of-<br />
Pocket Maximum is two-times the individual Out-of-Pocket<br />
Maximum and can be met by two family members or any<br />
combin<strong>at</strong>ion of family members' Covered Expenses. Once<br />
the family Out-of-Pocket Maximum is met, benefits are<br />
payable <strong>at</strong> 100 percent for the rest of the calendar year.<br />
Value and Freedom Plan Network Options<br />
If you have individual coverage, once your individual<br />
Out-of-Pocket Maximum amount has been met, your<br />
Covered Expenses are payable <strong>at</strong> 100 percent for the rest of<br />
the calendar year. If you have family coverage, the Out-of-<br />
Pocket Maximum is a combined maximum for all family<br />
members. Once the family Out-of-Pocket Maximum is met,<br />
Covered Expenses are payable <strong>at</strong> 100 percent for the rest of<br />
the calendar year.<br />
Choice Network Basic Network Limited Network (where available)<br />
In-Network Non-Network In-Network Non-Network In-Network Non-Network<br />
The Medical Plan<br />
Doctor's Visit<br />
80 percent of<br />
Covered Expenses<br />
80 percent of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
80 percent of<br />
Covered Expenses<br />
50 percent of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
80 percent of<br />
Covered Expenses<br />
50 percent of<br />
Covered<br />
Expenses and<br />
MAC or UCR<br />
guidelines apply<br />
Inp<strong>at</strong>ient Hospitaliz<strong>at</strong>ion<br />
80 percent of<br />
Covered Expenses<br />
50 percent of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
80 percent of<br />
Covered Expenses<br />
50 percent of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
80 percent of<br />
Covered Expenses<br />
50 percent of<br />
Covered<br />
Expenses and<br />
MAC or UCR<br />
guidelines apply<br />
Mental and Nervous<br />
Disorders and<br />
Substance Abuse<br />
(inp<strong>at</strong>ient and outp<strong>at</strong>ient)<br />
50 percent<br />
Outp<strong>at</strong>ient of<br />
Covered Expenses<br />
50 percent<br />
Inp<strong>at</strong>ient of<br />
Covered Expenses<br />
50 percent<br />
Outp<strong>at</strong>ient of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
40 percent<br />
Inp<strong>at</strong>ient of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
50 percent of<br />
Covered Expenses<br />
40 percent of<br />
Covered Expenses<br />
and MAC or UCR<br />
guidelines apply<br />
50 percent of<br />
Covered Expenses<br />
40 percent of<br />
Covered<br />
Expenses and<br />
MAC or UCR<br />
guidelines apply<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
57
When Preventive Care <strong>Benefits</strong> are Paid<br />
Before the Annual Deductible is Met<br />
For Value Plan and Freedom Plan participants, the following<br />
services are not subject to the Annual Deductible:<br />
• Well child visits—paid <strong>at</strong> 100 percent for children<br />
under the age of 6, up to a $1,000 lifetime maximum<br />
benefit for immuniz<strong>at</strong>ion, including office visits. See<br />
Well Child Visits in When Limited <strong>Benefits</strong> Apply<br />
l<strong>at</strong>er in this chapter.<br />
• Mammograms—Once the participant has been covered<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan for <strong>at</strong> least<br />
one continuous year, there is a $60 mammogram<br />
benefit (per calendar year) for participants age 40 and<br />
over. See Early Detection Care in When Limited<br />
<strong>Benefits</strong> Apply l<strong>at</strong>er in this chapter.<br />
• Pap smears—Once the participant has been covered<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan for <strong>at</strong> least<br />
one continuous year, there is a $60 Pap smear benefit<br />
(per calendar year). The office visit is included in the<br />
maximum payable for the Pap smear. See Early<br />
Detection Care in When Limited <strong>Benefits</strong> Apply<br />
l<strong>at</strong>er in this chapter.<br />
Wh<strong>at</strong> Counts Toward the<br />
Out-Of-Pocket Maximum<br />
For Value Plan and Freedom Plan participants, all<br />
covered charges, including Coinsurance and Annual<br />
Deductibles, count toward the Out-Of-Pocket Maximum<br />
except expenses th<strong>at</strong> are paid out of Network and<br />
exceed the UCR or MAC (see How the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan Works earlier in this chapter).<br />
Per-Event Deductibles<br />
A Per-Event Deductible is an additional Annual<br />
Deductible for certain medical services and applies prior<br />
to your Annual Deductible and Coinsurance. Once you<br />
have reached your Out-of-Pocket Maximum, Per-Event<br />
Deductibles will not apply for the rest of the calendar<br />
year.The following Per-Event Deductibles apply:<br />
• Ambulance or air ambulance Per-Event deductible.<br />
There is a $100 Per-Event Deductible per ambulance<br />
use. This is in addition to the Deductible and other<br />
Per-Event Deductibles, and may be waived upon<br />
request in the following circumstances:<br />
—Transport by ambulance or air ambulance was<br />
requested by a public servant in the performance of<br />
his or her public services duties;<br />
—Transport by ambulance or air ambulance following<br />
a motor vehicle accident;<br />
—Participant is directly admitted to the Hospital; or<br />
—Participant dies prior to Hospital admission.<br />
• Emergency room Per-Event Deductible.<br />
There is a $100 Per-Event Deductible for each<br />
emergency room visit. This is in addition to the<br />
Annual Deductible and other Per-Event<br />
Deductibles, and may be waived upon request in<br />
the following circumstances:<br />
—The participant is directly admitted to the Hospital<br />
from the emergency room; or<br />
—The participant dies prior to Hospital admission.<br />
Your Value and<br />
Freedom Plan Network Options<br />
Network providers accept the MAC and URC as payment<br />
in full, subject to the Annual Deductible and Coinsurance<br />
amounts. A non-Network provider may charge you<br />
amounts over wh<strong>at</strong> the Plan allows for Covered<br />
Expenses (for example, amounts above the MAC and<br />
UCR guidelines).<br />
Value Plan and Freedom Plan participants choose a<br />
Network option:<br />
58 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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• Choice Network: if you choose the Choice Network<br />
option, you can generally use any doctor, and the<br />
Plan will charge the same Coinsurance percentage<br />
(although there are different rules regarding<br />
Hospital stays and mental health services). If you use<br />
a Network doctor, your benefit is 80 percent of<br />
Covered Expenses. If you use a non-Network doctor,<br />
your benefit is 80 percent of UCR or MAC. Expenses<br />
th<strong>at</strong> exceed UCR and MAC will be your responsibility.<br />
However, for inp<strong>at</strong>ient Hospitaliz<strong>at</strong>ion, you must<br />
use a Network Hospital in order for your benefit to<br />
be paid <strong>at</strong> 80 percent of Covered Expenses (the Plan<br />
will pay 50 percent UCR/MAC if you use a non-<br />
Network Hospital). For mental health and substance<br />
abuse benefits, the Plan generally pays 50 percent of<br />
Covered Expenses for outp<strong>at</strong>ient services (regardless<br />
of whether you use a Network provider), and 50 percent<br />
of Covered Expenses for inp<strong>at</strong>ient services if<br />
you use a Network Provider (40 percent if you use a<br />
non-Network provider)<br />
• Basic Network: The Plan has contracted with<br />
Third Party Administr<strong>at</strong>ors to provide Networks of<br />
providers (for example doctors and Hospitals) for participants<br />
to receive medical goods and services covered<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan <strong>at</strong> discounted<br />
prices.The plan may pay a gre<strong>at</strong>er portion of your<br />
Covered Expenses if you see a Network provider.<br />
Under the Basic Network, the Plan will pay 80 percent<br />
of Covered Expenses if you use a Network provider<br />
(50 percent for mental health and substance abuse<br />
services) and 50 percent of MAC/UCR if you use a<br />
non-Network provider (40 percent for mental health<br />
and substance abuse services). Network providers do<br />
not charge you more than the UCR or MAC amount<br />
for Covered Expenses. Online provider directories are<br />
available on walmartbenefits.com or the WIRE.<br />
• Limited Network (where available): a select Network<br />
of doctors and Hospitals. By enrolling in the Limited<br />
Network option, you agree to use the doctors and<br />
Hospitals from the Limited Network, regardless of<br />
their proximity to you. Non-Network services will generally<br />
be paid <strong>at</strong> a reduced benefit level. The Plan will<br />
pay 80 percent of Covered Expenses if you use a<br />
Network provider (50 percent for mental health and<br />
substance abuse services) and 50 percent of<br />
MAC/UCR if you use a non-Network provider (40 percent<br />
for mental health and substance abuse services).<br />
The availability of Limited Networks depends on<br />
your geographic work loc<strong>at</strong>ion. In addition to the<br />
BlueCross BlueShield Choice and Basic Networks,<br />
the availability of Limited Networks depends on<br />
your geographic loc<strong>at</strong>ion.<br />
—Aetna Limited Networks (Aetna Aexcel Choice<br />
POS II and Aetna Choice POS II Open Access)<br />
Please be aware th<strong>at</strong> enrollment in an Aetna Limited<br />
Network requires you to obtain prior authoriz<strong>at</strong>ion<br />
for some services under the Plan in order for these<br />
services to be covered. See Services Requiring<br />
Prior Authoriz<strong>at</strong>ion by the Aetna Limited<br />
Network l<strong>at</strong>er in this chapter for a list of services for<br />
which Aetna requires prior authoriz<strong>at</strong>ion. See the<br />
Claims and Appeals chapter for more inform<strong>at</strong>ion<br />
on how to file claims with prior authoriz<strong>at</strong>ion.<br />
—BlueCross BlueShield Limited Networks<br />
(Blue Precision, Preferred-Care Blue,<br />
Select PPO and Found<strong>at</strong>ion)<br />
In some loc<strong>at</strong>ions BlueCross BlueShield will<br />
provide Choice, Basic, and Limited Networks.<br />
—Humana Limited Network<br />
(Humana Preferred POS—Open Access)<br />
—UnitedHealthcare Limited Network<br />
(UnitedHealthcare Choice Plus)<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
59
For more inform<strong>at</strong>ion about Limited Networks th<strong>at</strong><br />
may be available in your area, please see your personnel<br />
represent<strong>at</strong>ive or visit walmartbenefits.com<br />
or the WIRE.<br />
If your doctor leaves the Network, you may need to<br />
change providers or your benefit may be reduced.<br />
The choice of provider is solely the choice of the participant.<br />
Neither the Plan nor the Third Party Administr<strong>at</strong>or<br />
will interfere with your provider rel<strong>at</strong>ionship.<br />
The Plan does not furnish Hospital or medical services<br />
and is not liable for any act or omission of any provider<br />
or agent of such provider, including failure or refusal to<br />
render services. All medical decisions are between you<br />
and your provider. The Plan makes no represent<strong>at</strong>ions<br />
regarding the quality of care or services rendered by<br />
any provider.<br />
When Network <strong>Benefits</strong><br />
Are Paid for Non-Network Expenses<br />
Regardless of whether you have the Choice, Basic,<br />
or Limited Network option, a covered expense you<br />
have with a non-Network provider may be tre<strong>at</strong>ed<br />
as a Network Covered Expense upon request in the following<br />
circumstances:<br />
• If your dependent child(ren) under age 19 requires<br />
tre<strong>at</strong>ment <strong>at</strong> a Children’s Miracle Network Hospital;<br />
• Due to emergency tre<strong>at</strong>ment;<br />
• When there are no Network providers of the relevant<br />
specialty within 30 miles of the participant’s home<br />
(this does not apply to you if you are enrolled in the<br />
Limited Network option);<br />
• Services from a non-Network provider involving a<br />
pregnant participant will be tre<strong>at</strong>ed as Network<br />
charges for up to six weeks after delivery if she began<br />
receiving care from the provider when the provider<br />
was a Network provider and there had not been an<br />
interruption of the doctor/p<strong>at</strong>ient rel<strong>at</strong>ionship (benefits<br />
will not be paid for the pregnancy-rel<strong>at</strong>ed expenses<br />
of dependent children);<br />
• Services from a non-Network provider, until the effective<br />
d<strong>at</strong>e of the next Annual Enrollment period, for a<br />
course of tre<strong>at</strong>ment th<strong>at</strong> began when the provider<br />
was a Network provider, where there has not been an<br />
interruption of the doctor/p<strong>at</strong>ient rel<strong>at</strong>ionship;<br />
• Services for labor<strong>at</strong>ory, anesthesia, radiology, p<strong>at</strong>hology,<br />
or emergency medicine, but only if such services<br />
are received in connection with care from a Network<br />
provider or from a Network Hospital; or<br />
• Services for tre<strong>at</strong>ment received while on vac<strong>at</strong>ion or<br />
business travel, where such tre<strong>at</strong>ment either could<br />
not have reasonably been foreseen prior to the travel<br />
or the course of tre<strong>at</strong>ment began prior to the travel<br />
and for medical reasons must be continued during<br />
such travel.<br />
For the process to appeal, see the Claims and Appeals<br />
chapter for details.<br />
In addition, in each of the situ<strong>at</strong>ions listed below,<br />
your non-Network Covered Expenses may be tre<strong>at</strong>ed<br />
as Network Covered Expenses, upon request. The<br />
amounts paid by the Plan will be based on up to 200<br />
percent of UCR or MAC:<br />
• Transport by ambulance or air ambulance was<br />
requested by a public servant in the performance of<br />
his or her public service duties<br />
• Transport by ambulance or air ambulance following a<br />
motor vehicle accident<br />
• The participant is directly admitted to the Hospital<br />
from an emergency room<br />
• The participant dies prior to Hospital admission<br />
Amounts in excess of 200 percent of UCR or MAC will be<br />
your responsibility and will not count toward your<br />
deductibles or Out-of-Pocket Maximums. UCR and MAC<br />
exceptions will not be granted in circumstances other<br />
than those described above.<br />
60 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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The Value Plan<br />
The Value Plan allows you to design a medical plan<br />
option th<strong>at</strong> meets your personal health and financial<br />
needs. With its choice of Health Care Credit, Annual<br />
Deductible, and Out-of-Pocket Maximum amounts, as<br />
well as up to three Network options, the Value Plan<br />
can be designed 72 different ways. When you enroll<br />
in the Value Plan, you choose your:<br />
See How the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan Works for more<br />
inform<strong>at</strong>ion on how benefits are paid. For more inform<strong>at</strong>ion<br />
on coverage under the plan, see When Limited<br />
<strong>Benefits</strong> Apply and Wh<strong>at</strong> is Not Covered Under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan l<strong>at</strong>er in this chapter. Also,<br />
see The Pharmacy Benefit chapter for inform<strong>at</strong>ion on<br />
prescription drug coverage through the Value Plan.<br />
• Health Care Credit amount;<br />
• Annual Deductible amount;<br />
• Out-of-Pocket Maximum amount; and<br />
• Network option.<br />
The Value Plan Options<br />
Health Care Credit Per<br />
Covered Individual<br />
• $100<br />
• $250<br />
• $500<br />
Keep in Mind…<br />
A lower Health Care Credit<br />
amount will lower the cost<br />
of your coverage.<br />
Annual Deductible<br />
Single/Family<br />
• $350/$700<br />
• $500/$1,000<br />
• $1,000/$2,000<br />
• $2,000/$4,000<br />
The higher the Annual<br />
Deductible, the lower the<br />
cost of the coverage.<br />
The Freedom Plan with<br />
Company Contributions to a<br />
Health Savings Account<br />
The Freedom Plan is a qualified high deductible health<br />
plan subject to ERISA th<strong>at</strong> allows you to contribute to a<br />
health savings account. In addition, the Company contributes<br />
to your health savings account.A health savings<br />
account allows you to pay for eligible health care expenses<br />
tax free. For inform<strong>at</strong>ion about the health savings account,<br />
see the Health Savings Account chapter.<br />
Out-of-Pocket Maximum<br />
Single/Family<br />
• $2,000/$4,000<br />
• $5,000/$10,000<br />
A higher Out-of-Pocket<br />
Maximum will lower your<br />
cost of coverage.<br />
Network Option<br />
(based on availability in your area)<br />
• Choice<br />
• Basic Network<br />
• Limited Network (where available)<br />
Because Network providers have<br />
agreed to negoti<strong>at</strong>ed r<strong>at</strong>es, Network<br />
provider services will be paid <strong>at</strong> a<br />
higher benefit.<br />
When you enroll in the Freedom Plan, you choose your:<br />
• Annual Deductible ; and<br />
• Network option.<br />
See How the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan Works for more<br />
inform<strong>at</strong>ion on how benefits are paid. For more inform<strong>at</strong>ion<br />
on coverage under the plan, see When Limited<br />
<strong>Benefits</strong> Apply and Wh<strong>at</strong> is Not Covered Under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan l<strong>at</strong>er in this chapter. Also, see<br />
The Pharmacy Benefit chapter for inform<strong>at</strong>ion on prescription<br />
drug coverage through the Freedom Plan.<br />
The Medical Plan<br />
The Freedom Plan Options<br />
Annual Deductible<br />
• $1,250 single<br />
• $3,000 single<br />
• $2,500 family<br />
• $6,000 family<br />
Keep in Mind…<br />
The higher the Annual Deductible,<br />
the lower the cost of the coverage.<br />
Out-of-Pocket<br />
Maximum<br />
• $5,000 single<br />
• $10,000 family<br />
Network Option<br />
(based on availability in your area)<br />
• Choice<br />
• Basic Network<br />
• Limited Network<br />
Because Network providers have agreed<br />
to negoti<strong>at</strong>ed r<strong>at</strong>es, Network provider<br />
services will be paid <strong>at</strong> a higher benefit.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
61
Helping You Manage Your Health<br />
24-Hour Nurse Line: Ask Mayo Clinic<br />
The Ask Mayo Clinic Nurse Line is available to all associ<strong>at</strong>es<br />
and their dependents enrolled in the Value Plan or the<br />
Freedom Plan. Ask Mayo Clinic is a free 24-hour nurse line<br />
th<strong>at</strong> provides you with answers to questions about illnesses,<br />
injuries, or medical concerns any time, day or night. If<br />
you’re not sure whether your symptoms or a family member’s<br />
symptoms mean you should wait and call your doctor<br />
in the morning or go to the emergency room immedi<strong>at</strong>ely,<br />
a quick call to the experienced registered nurses <strong>at</strong><br />
Ask Mayo Clinic could help you decide wh<strong>at</strong> to do.<br />
Whether your medical situ<strong>at</strong>ion is routine or serious,<br />
Ask Mayo Clinic is a gre<strong>at</strong> place to turn for reliable<br />
health inform<strong>at</strong>ion. However, it is not a substitute for<br />
emergency response services. In a medical emergency,<br />
dial 9-1-1<br />
Keep the Ask Mayo Clinic phone number—<br />
(800) 418-0758—near your home phone as well<br />
as in your wallet or purse so you can call toll-free any<br />
time from anywhere. Keep in mind th<strong>at</strong> you and the<br />
doctor have the final decision on how to tre<strong>at</strong> your<br />
medical condition.<br />
Health Management Program<br />
<strong>Wal</strong>-<strong>Mart</strong> offers a special health management program<br />
to all associ<strong>at</strong>es and their dependents enrolled in the<br />
Value Plan or the Freedom Plan. This program helps you<br />
manage chronic health conditions, such as diabetes,<br />
coronary artery disease, heart failure, chronic obstructive<br />
pulmonary disease, and asthma. Particip<strong>at</strong>ion in a<br />
health management program is free and voluntary and<br />
does not affect an individual’s eligibility to particip<strong>at</strong>e in<br />
the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan or any benefits payable<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan. Participant inform<strong>at</strong>ion<br />
is shared only as required or allowed by st<strong>at</strong>e and<br />
federal law.<br />
Each health management program is designed to help<br />
improve p<strong>at</strong>ient care. The program can benefit you by<br />
targeting and applying some of the best known clinical<br />
tre<strong>at</strong>ments for your specific health condition. Plan participants<br />
who are selected by the program will receive<br />
one-on-one educ<strong>at</strong>ion specific to their own health care<br />
st<strong>at</strong>us, including ways to better manage and improve<br />
their condition.<br />
The program available to you is determined by the st<strong>at</strong>e<br />
you live in as shown in the chart below. For more inform<strong>at</strong>ion,<br />
contact your health management program.<br />
Your Health Management Program<br />
Active Health:<br />
Informed Care Management (ICM)<br />
Kaiser Permanente:<br />
Healthy Solutions<br />
BlueCross and<br />
BlueShield of Alabama:<br />
Care Management<br />
Phone (800) 967-4489 (888) 204-9080 (800) 896-2724<br />
Website www.activehealth.net www.yourhealthctr.com/walmart<br />
St<strong>at</strong>es Included<br />
Arkansas, Colorado, Connecticut,<br />
Delaware, Idaho, Illinois, Indiana, Iowa,<br />
Kansas, Kentucky, Maine, Maryland,<br />
Massachusetts, Michigan, Minnesota,<br />
Missouri, Montana, Nebraska, New<br />
Hampshire, New Jersey, New Mexico,<br />
New York, North Carolina, North Dakota,<br />
Ohio, Oklahoma, Pennsylvania,<br />
Rhode Island, South Carolina, South<br />
Dakota, Texas, Utah, Vermont,<br />
Wisconsin, Wyoming<br />
Alaska, Arizona, California, Nevada,<br />
Oregon, Washington<br />
Alabama, Florida,<br />
Georgia, Louisiana,<br />
Mississippi, Tennessee,<br />
Virginia, West Virginia<br />
62 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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When Limited <strong>Benefits</strong> Apply to the<br />
Value Plan and the Freedom Plan<br />
Some services are also subject to specific restrictions and<br />
limit<strong>at</strong>ions in addition to the deductibles and<br />
Coinsurance requirements. If you have a question on the<br />
coverage of a particular service, please contact the Third<br />
Party Administr<strong>at</strong>or serving you. Contact inform<strong>at</strong>ion is<br />
provided on your <strong>Benefits</strong> ID Card and on the inside back<br />
cover of this book.<br />
While the AMP covers most Medically Necessary expenses,<br />
some expenses are subject to limit<strong>at</strong>ions or restrictions.<br />
Those are described below.The limit<strong>at</strong>ions and restrictions<br />
described are in addition to other AMP rules, including<br />
Annual Deductibles, Coinsurance, and exclusions.<br />
You should also review the list of items not covered l<strong>at</strong>er<br />
in this chapter.<br />
Ambulance<br />
Coverage of ambulance or air ambulance transport<strong>at</strong>ion<br />
is limited to the nearest Hospital or nearest tre<strong>at</strong>ment<br />
facility capable of providing care if other transport<strong>at</strong>ion<br />
would thre<strong>at</strong>en the life or limb of the p<strong>at</strong>ient.This coverage<br />
also may be subject to a Per-Event Deductible. See<br />
the Per-Event Deductible section for more inform<strong>at</strong>ion.<br />
Ambulance Not Covered—Ambulance charges for the<br />
sole convenience of the participant or caregiver will not<br />
be covered.<br />
BAHA Hearing Implant Device<br />
The Plan will cover BAHA hearing implant devices where<br />
determined to be Medically Necessary. Coverage for the<br />
BAHA hearing implant device includes pre-testing,<br />
implants, preoper<strong>at</strong>ive care, and follow-up care.<br />
Birth Control/Contraceptives<br />
Services and devices covered under the<br />
contraceptive benefit:<br />
• Diaphragms: fitting and supply<br />
• Cervical cap: fitting and supply<br />
• Intrauterine device (IUD): fitting, supply, and removal<br />
• Birth control pills<br />
• Birth control p<strong>at</strong>ch<br />
• Vaginal ring<br />
• Injection (e.g. Depo Provera) given by a physician or<br />
nurse every 3 months<br />
• Implantable contraception (e.g. Implanon)<br />
Norplant is no longer available in the U.S. after 2003<br />
due to adverse side effects and difficulty in removing<br />
the device. The Plan will cover charges for removal of<br />
the device only.<br />
Services and/or devices th<strong>at</strong> are not included in the contraceptive<br />
benefit are:<br />
• Abortion<br />
• Male or female steriliz<strong>at</strong>ion<br />
• Over-the-counter birth control, including but not limited<br />
to: male condoms, female condoms, vaginal<br />
sponge, ovul<strong>at</strong>ion predictor kits, basal thermometers,<br />
and spermicides<br />
• Prescriptions for RU-486 and Plan B, or the<br />
“Morning After” pill<br />
Cochlear Implants<br />
The AMP coverage of cochlear implants is limited<br />
to $60,000 in lifetime maximum benefits paid.This<br />
includes pre-testing, implants, preoper<strong>at</strong>ive care, and follow-up<br />
care.<br />
Durable Medical Equipment (DME)<br />
(Please call your Third Party Administr<strong>at</strong>or for additional<br />
details.) To be covered, a doctor must include a diagnosis,<br />
the type of equipment needed, and expected time of<br />
usage. Examples of DME include wheelchairs, Hospitaltype<br />
beds, and walkers.The maximum per calendar year<br />
DME benefit is $5,000 in paid benefits. If equipment is<br />
rented, the total benefit may not exceed the purchase<br />
price <strong>at</strong> the time rental began.<br />
DME Not Covered— Motor driven scooters, invasive<br />
implantable bone growth stimul<strong>at</strong>ors (except in the case<br />
of spinal surgeries), oscill<strong>at</strong>ory devices for the tre<strong>at</strong>ment<br />
of lung disorders, sitz b<strong>at</strong>h, se<strong>at</strong> lift, rolling chair, vaporizer,<br />
urinal, ultra-violet cabinet, whirlpool b<strong>at</strong>h equipment, bed<br />
pan, portable paraffin b<strong>at</strong>h, he<strong>at</strong>ing pad, he<strong>at</strong> lamp,<br />
steam/hot/cold packs, devices th<strong>at</strong> measure or record<br />
blood pressure, safety roller walker, and such other medical<br />
equipment or items determined by the AMP.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
63
Foot Care<br />
For nonsurgical foot care in connection with tre<strong>at</strong>ment<br />
for the following conditions, the Plan allows $300 in paid<br />
benefits per calendar year:<br />
• Bunions<br />
• Corns or calluses<br />
• Orthotics<br />
• Fl<strong>at</strong>, unstable, or unbalanced feet<br />
• Met<strong>at</strong>arsalgia<br />
Services must be prescribed by a medical doctor<br />
(M.D.), doctor of osteop<strong>at</strong>hy (D.O.), or doctor of<br />
podi<strong>at</strong>ric medicine (D.P.M.).<br />
Open cutting surgical care (including removal of nail<br />
roots) and nonsurgical care due to metabolic and<br />
peripheral vascular disease are not subject to the $300<br />
maximum.<br />
Orthopedic shoes prescribed by a doctor are limited to<br />
$75 in paid benefits per calendar year. (Orthopedic shoes<br />
do not apply to the $300 calendar year limit.)<br />
Home Medical Supplies<br />
Coverage for home medical supplies, such as ostomy supplies,<br />
wound care supplies, and tracheotomy supplies, is<br />
limited to $2,500 in paid benefits per calendar year.<br />
Supplies must be prescribed by a medical doctor (M.D.)<br />
or doctor of osteop<strong>at</strong>hy (D.O.) to be covered. Surgical<br />
stockings are limited to six pairs per calendar year, up to<br />
$70 per pair in paid benefits. (Surgical stockings do not<br />
apply to the $2,500 calendar year limit.)<br />
Home Nursing Care<br />
In-home priv<strong>at</strong>e-duty professional nursing services will<br />
be covered if provided by a st<strong>at</strong>e-approved licensed<br />
voc<strong>at</strong>ional nurse (L.V.N.), licensed practical nurse (L.P.N.),<br />
or registered nurse (R.N.). Services cannot be rendered by<br />
a rel<strong>at</strong>ive or by someone in the same household as the<br />
p<strong>at</strong>ient. Home nursing care benefits are payable up to a<br />
maximum of $10,000 per calendar year.<br />
Hospice Care<br />
Inp<strong>at</strong>ient and outp<strong>at</strong>ient hospice care are covered up to a<br />
lifetime maximum of 180 days.<br />
Immuniz<strong>at</strong>ions<br />
See Well Child Visits.<br />
Lung Volume Reduction (LVR)<br />
Lung Volume Reduction (LVR) benefits follow the transplant<br />
guidelines. See Coverage for Transplants and<br />
Lung Volume Reduction l<strong>at</strong>er in this chapter for<br />
more inform<strong>at</strong>ion.<br />
Mammograms<br />
The first claim filed in the calendar year for a mammogram<br />
will receive the benefit. On your bill, your doctor<br />
must indic<strong>at</strong>e th<strong>at</strong> the services are for a routine visit.<br />
Females age 40 and over who have been covered under<br />
the AHWP (either the AMP and/or HMO) for <strong>at</strong> least one<br />
continuous year are eligible for one routine mammogram<br />
per calendar year, up to a maximum of $60 in paid benefits<br />
per calendar year.The mammogram benefit is not<br />
subject to the Annual Deductible.<br />
Mental and Nervous<br />
Disorders and Substance Abuse<br />
You must be enrolled in the AHWP (either the AMP<br />
and/or HMO) for one continuous year before services are<br />
eligible for payment. Services must be provided by a<br />
licensed medical doctor (M.D.), doctor of osteop<strong>at</strong>hy<br />
(D.O.), psychologist, social worker, or mental health counselor.<br />
<strong>Benefits</strong> are paid as follows:<br />
• Choice Network Outp<strong>at</strong>ient Network<br />
providers—50 percent of Covered Expenses<br />
• Basic and Limited Network Outp<strong>at</strong>ient Non-Network<br />
providers—40 percent of Covered Expenses and MAC<br />
or URC guidelines apply<br />
• Inp<strong>at</strong>ient Network Hospitals—50 percent of<br />
Covered Expenses<br />
• Inp<strong>at</strong>ient non-Network Hospitals—40 percent of<br />
Covered Expenses and MAC or URC guidelines apply<br />
NOTE: Outp<strong>at</strong>ient visits are limited to 20 per calendar<br />
year and inp<strong>at</strong>ient stays are limited to 30 days per calendar<br />
year. Expenses th<strong>at</strong> exceed Usual, Customary, and<br />
Reasonable (UCR) or Maximum Allowable Charge (MAC)<br />
will be the responsibility of the participant. Once you<br />
have reached your Out-of-Pocket Maximum, eligible<br />
In-Network charges are paid <strong>at</strong> 100 percent for the rest of<br />
the calendar year.<br />
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Mental and Nervous Disorders/Substance Abuse Not<br />
Covered: Day care centers and Day time Alcohol and<br />
Mental Health Rehabilit<strong>at</strong>ion Centers and charges for parent-child,<br />
marital, sibling, interpersonal conflicts, psychosexual<br />
disorders, and equipment and expenses rel<strong>at</strong>ed to<br />
light therapy for seasonal affective disorder.<br />
Nutritional Counseling<br />
Nutritional counseling th<strong>at</strong> is Medically Necessary for a<br />
chronic disease in which dietary adjustment has a therapeutic<br />
role when it is prescribed by a physician and furnished<br />
by a provider (e.g., a registered dietician, licensed<br />
nutritionist, or other qualified licensed health professional)<br />
recognized under the plan. <strong>Benefits</strong> are limited to<br />
three visits per condition per year.<br />
Outp<strong>at</strong>ient Physical/ Occup<strong>at</strong>ional Therapy<br />
Covered when services are:<br />
• Prescribed by a medical doctor (M.D.), doctor of<br />
osteop<strong>at</strong>hy (D.O.), or doctor of podi<strong>at</strong>ric medicine<br />
(D.P.M.), and<br />
• Provided by a licensed physical or occup<strong>at</strong>ional therapist<br />
or by one of the types of doctors listed above.<br />
The benefit is payable up to a maximum of $2,000 per<br />
calendar year in paid benefits.<br />
Pap Smears<br />
Females who have been covered under the AHWP (either<br />
the AMP and/or HMO) for <strong>at</strong> least one continuous year<br />
are eligible for one routine Pap smear and pelvic exam<br />
per calendar year, up to a maximum of $60 in paid benefits<br />
per calendar year.The Pap smear benefit is not subject<br />
to the Annual Deductible.<br />
The first claim filed in the calendar year for a Pap smear<br />
will receive the benefit. On your bill, your doctor must<br />
indic<strong>at</strong>e th<strong>at</strong> the services are for a routine visit.<br />
Pregnancy <strong>Benefits</strong><br />
Pregnancy expenses are covered the same as any other<br />
medical condition.<br />
Only one routine ultrasound per pregnancy is allowed.<br />
NOTE: Newborn charges may be considered the<br />
baby’s own, subject to the baby’s Annual Deductible<br />
and Coinsurance and/or Out-of-Pocket Maximums.<br />
For more inform<strong>at</strong>ion, call the number on the back of<br />
your <strong>Benefits</strong> ID card.<br />
NOTE: <strong>Benefits</strong> will not be paid for the pregnancyrel<strong>at</strong>ed<br />
expenses of dependent children, including<br />
complic<strong>at</strong>ions.<br />
NOTE: Group health plans and health insurance<br />
issuers generally may not, under federal law, restrict<br />
benefits for any Hospital length of stay in connection<br />
with childbirth for the mother or newborn child to<br />
less than 48 hours following a vaginal delivery, or less<br />
than 96 hours following a cesarean section. However,<br />
federal law generally does not prohibit the mother’s<br />
or newborn’s <strong>at</strong>tending provider, after consulting with<br />
the mother, from discharging the mother or her newborn<br />
earlier than 48 hours (or 96 hours as applicable).<br />
In any case, plans and issuers may not, under federal<br />
law, require th<strong>at</strong> a provider obtain authoriz<strong>at</strong>ion from<br />
the plan or the insurance issuer for prescribing a<br />
length of stay not in excess of 48 hours (or 96 hours).<br />
Prostheses<br />
Standard permanent prosthesis is limited to<br />
artificial limbs and artificial eyes. Replacement will be<br />
allowed only with a change of prescription. A board-certified<br />
prosthetician must perform replacements of<br />
artificial limbs.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
65
Rehabilit<strong>at</strong>ive Inp<strong>at</strong>ient Care<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan covers inp<strong>at</strong>ient rehabilit<strong>at</strong>ion<br />
for head and spinal cord injuries, degener<strong>at</strong>ive neurological<br />
diseases, and other trauma-rel<strong>at</strong>ed injuries,<br />
except drug- and alcohol-rel<strong>at</strong>ed diagnoses. In addition,<br />
inp<strong>at</strong>ient and day rehabilit<strong>at</strong>ion benefits are limited to<br />
120 days per condition.<br />
Specialty Care<br />
Medical care commonly provided <strong>at</strong> the following types<br />
of facilities:<br />
• Extended care facility<br />
• Long-term acute specialty facility<br />
• Subacute care facility<br />
• Skilled nursing facility<br />
• Transitional care facility<br />
<strong>Benefits</strong> are limited to a maximum of 60 calendar days<br />
per disability period.<br />
<strong>Benefits</strong> are payable when the participant is admitted to<br />
this level of care subsequent to an eligible acute care<br />
Hospital confinement.<br />
Successive periods of confinement due to the same or<br />
rel<strong>at</strong>ed causes are considered one disability period unless<br />
separ<strong>at</strong>ed by a complete recovery.<br />
Speech Therapy<br />
Therapy is limited to $5,000 in paid benefits per<br />
calendar year when:<br />
• Prescribed by a medical doctor (M.D.) or doctor of<br />
osteop<strong>at</strong>hy (D.O.), and<br />
• Provided by a licensed speech therapist.<br />
An initial plan of tre<strong>at</strong>ment, ongoing plan of tre<strong>at</strong>ment,<br />
and progress reports may be requested from the prescribing<br />
doctor.To be covered, speech therapy must be<br />
for a residual speech impairment resulting from:<br />
• A cerebral vascular accident;<br />
• Head or neck injury;<br />
• Paralysis of voice cord(s) or larynx, partial or complete;<br />
• Head or neck surgery; or<br />
• Congenital and severe developmental speech disorders<br />
in children up to age six.<br />
TMJ Dysfunction/ Orofacial Deformity<br />
Surgery is limited to a lifetime maximum of $5,000 in<br />
paid benefits per participant for:<br />
• Temporomandibular joint;<br />
• Orofacial deformities and all adjacent muscles<br />
and nerves;<br />
• Mandibular/maxillary fractures as a result of <strong>at</strong>rophy;<br />
• Jaw-rel<strong>at</strong>ed neuromuscular conditions; and<br />
• Alter<strong>at</strong>ion of the occlusal rel<strong>at</strong>ionship of the teeth<br />
and/or jaws to elimin<strong>at</strong>e pain or dysfunction.<br />
Services included in the $5,000 payable lifetime maximum<br />
include, but are not limited to:<br />
• Office visits;<br />
• Surgery and anesthesia;<br />
• Diagnostic work-ups;<br />
• Physical therapy;<br />
• Lab fees; and<br />
• Inp<strong>at</strong>ient or outp<strong>at</strong>ient facility fees.<br />
Coverage for certain temporomandibular joint tre<strong>at</strong>ments<br />
will be covered, without limit, in cases where the<br />
covered individual’s temporomandibular joint has deterior<strong>at</strong>ed<br />
due to a medical condition such as arthritis.<br />
The following services, devices, and equipment are<br />
not covered:<br />
• Continuous Passive Motion machine (CPM)<br />
• Orthodontics (may be covered under the<br />
Dental Plan)<br />
• Bridges and dentures (may be covered under the<br />
Dental Plan)<br />
• Appliances and hardware (may be covered under the<br />
Dental Plan)<br />
• Root canals (may be covered under the Dental Plan)<br />
• Implants placed in the mouth<br />
Transplants<br />
See Coverage for Transplants and Lung Volume<br />
Reduction l<strong>at</strong>er in this chapter for details.<br />
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Vision Care<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan covers the initial placement<br />
of contact lenses or one pair of glasses, up to a maximum<br />
of $140 in paid benefits ($140 is a lifetime limit per eye,<br />
per condition), following c<strong>at</strong>aract surgery, diagnosis of<br />
ker<strong>at</strong>oconus, or tre<strong>at</strong>ment of esotropia in children. In no<br />
other circumstance are contact lenses or glasses covered<br />
by the AMP.<br />
Vitamins<br />
Vitamin D analog prescriptions (calcitriol — Rocaltrol,<br />
Calcijex; Zemplar, Hectorol) are covered under the<br />
Pharmacy Benefit in order to tre<strong>at</strong> specific conditions<br />
associ<strong>at</strong>ed with chronic kidney disease.These prescriptions<br />
require a prior authoriz<strong>at</strong>ion to ensure the medic<strong>at</strong>ion<br />
is used for appropri<strong>at</strong>e situ<strong>at</strong>ions and conditions.<br />
Vitamins Not Covered: Vitamins (whether oral or<br />
injectable), minerals, nutritional supplements and dietary<br />
supplements (other than dietary supplements to tre<strong>at</strong><br />
urea cycle disorder, organic acid disorder, f<strong>at</strong>ty acid oxid<strong>at</strong>ive<br />
disorder, or carbohydr<strong>at</strong>e disorder).<br />
Well Child Visits<br />
Children under age 6 are eligible for a $1,000 lifetime<br />
wellness benefit.The office visit charge and the immuniz<strong>at</strong>ion<br />
will be paid <strong>at</strong> 100 percent up to the $1,000 maximum.<br />
Charges th<strong>at</strong> exceed UCR or MAC will be the<br />
responsibility of the participant.The benefit is not subject<br />
to the Annual Annual Deductible. Additional charges<br />
such as lab work, hearing screenings, or vision screenings<br />
are not included in the wellness benefit.<br />
Coverage When You<br />
Travel to a Foreign Country<br />
If you need medical care when traveling abroad, follow<br />
these steps:<br />
• Before you leave, contact your Third Party<br />
Administr<strong>at</strong>or <strong>at</strong> the number on the back of your<br />
<strong>Benefits</strong> ID card for coverage details. Coverage outside<br />
the United St<strong>at</strong>es may vary.<br />
• Always carry your <strong>Benefits</strong> ID card with you<br />
when you travel, and present it when you receive<br />
medical services.<br />
• For more inform<strong>at</strong>ion about emergency medical services<br />
received in a foreign country, call your Third Party<br />
Administr<strong>at</strong>or <strong>at</strong> the number on the back of your<br />
<strong>Benefits</strong> ID card.<br />
Coverage for Transplants<br />
and Lung Volume Reduction (LVR)<br />
To be eligible for transplants and lung volume<br />
reduction benefits, participants must be enrolled in<br />
the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan or an HMO plan option<br />
offered by the AHWP continuously for one year. Time<br />
enrolled in Starbridge, the Cancer Insurance Policy, or<br />
the Accident Insurance Policy does not count toward<br />
the one-year wait. <strong>Benefits</strong> are paid based on the<br />
transplant and LVR guidelines.<br />
If your doctor recommends a transplant, please<br />
ask your doctor to call the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362 or (479) 621-2830.<br />
Guidelines for Covered Transplants and LVR<br />
All Transplants (except Kidney, Cornea and<br />
Intestinal) and LVR<br />
• All transplant recipients (except for kidney, cornea<br />
and intestinal recipients) must undergo a pre-transplant<br />
evalu<strong>at</strong>ion <strong>at</strong> the Mayo Clinic. In performing this<br />
evalu<strong>at</strong>ion, the Mayo Clinic is not an agent of<br />
the Plan. It is the Plan’s intent th<strong>at</strong> this evalu<strong>at</strong>ion be<br />
made pursuant to the doctor-p<strong>at</strong>ient rel<strong>at</strong>ionship<br />
between the Mayo Clinic and the participant. Travel<br />
and lodging for the recipient and a companion and<br />
a daily allowance will be provided for required evalu<strong>at</strong>ions<br />
<strong>at</strong> the Mayo Clinic.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
67
• Liver, heart, lung, pancreas, simultaneous kidney/pancreas,<br />
multiple organ, LVR, and bone marrow transplants<br />
must be performed <strong>at</strong> the Mayo Clinic or no<br />
benefits will be paid unless travel will result in de<strong>at</strong>h.<br />
• Claims for all transplants performed <strong>at</strong> the Mayo<br />
Clinic (including pedi<strong>at</strong>ric) are covered <strong>at</strong> 100 percent<br />
with no Annual Deductible (unless you are enrolled in<br />
a Freedom Plan; federal tax laws require the Annual<br />
Deductible to be met prior to any plan payments).<br />
Additionally, travel and lodging for the recipient and a<br />
companion and a daily allowance will be provided.<br />
• The plan does not cover Experimental and/or<br />
Investig<strong>at</strong>ional transplant-rel<strong>at</strong>ed services unless<br />
those services are recommended and performed by<br />
the Mayo Clinic.<br />
• <strong>Benefits</strong> for a covered transplant procedure and rel<strong>at</strong>ed<br />
expenses, including travel and lodging, will end<br />
one-year post-transplant or after a one-year posttransplant<br />
evalu<strong>at</strong>ion is performed.<br />
• Non-transplant services rendered <strong>at</strong> the time<br />
of the doctor visit, such as lab work, X-rays, or<br />
other tests, are subject to the Annual Deductible<br />
and Coinsurance.<br />
• Travel for transplant-rel<strong>at</strong>ed services must be<br />
arranged by a Transplant Coordin<strong>at</strong>or. For travel<br />
arrangements, please call the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362 or (479) 621-2830.<br />
Kidney, Cornea, and Intestinal Transplants<br />
Kidney, cornea, and intestinal transplants can be performed<br />
<strong>at</strong> the facility of your choice. Claims will be covered<br />
<strong>at</strong> 80 percent Network or 50 percent non-Network<br />
after the Annual Deductible has been met. No travel,<br />
lodging, or daily allowance will be provided for these<br />
transplants (even if performed <strong>at</strong> the Mayo Clinic).<br />
Pedi<strong>at</strong>ric Transplant Recipients Under Age 19<br />
Pedi<strong>at</strong>ric transplant recipients under age 19 (except for<br />
kidney, cornea, and intestinal transplants) must undergo a<br />
pre-transplant evalu<strong>at</strong>ion <strong>at</strong> the Mayo Clinic. Upon<br />
approval by the Mayo Clinic, the transplant may be performed<br />
<strong>at</strong> the facility of your choice and will be covered<br />
<strong>at</strong> 80 percent Network or 50 percent non-Network after<br />
the Annual Deductible is met.Travel, lodging, and a daily<br />
allowance will be provided only if the transplant is performed<br />
<strong>at</strong> the Mayo Clinic.<br />
More About<br />
Transplant and LVR Coverage<br />
• Claims for transplants and LVR th<strong>at</strong> are not performed<br />
in accordance with the guidelines above will be<br />
denied.<br />
• Coverage is limited to transplant<strong>at</strong>ion of<br />
human organs.<br />
• The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan does not coordin<strong>at</strong>e<br />
benefits with respect to transplant and LVR benefits,<br />
other than coordin<strong>at</strong>ion with Medicare, or as otherwise<br />
required by law. If any portion of a transplant or<br />
LVR benefit could have been paid by another health<br />
plan, had the individual followed the terms of th<strong>at</strong><br />
plan, the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan will not pay any<br />
amount of the transplant or LVR benefit claim.<br />
• Transplant donor expenses are not covered, unless<br />
the recipient is a plan participant who is eligible for<br />
transplant coverage and the living donor’s expenses<br />
are not paid by his or her own medical plan or insurance.<br />
Covered donor charges will be paid according<br />
to the transplant guidelines above <strong>at</strong> the same benefit<br />
level as the recipient for up to 90 days post-transplant.<br />
Please note th<strong>at</strong> cadaver organ acquisition and<br />
procurement expenses are not covered unless the<br />
expenses are part of the provider’s base contracted<br />
r<strong>at</strong>e with the plan.<br />
Wh<strong>at</strong> is Not Covered by the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan<br />
In addition to the exclusions and limit<strong>at</strong>ions listed<br />
in the Limited <strong>Benefits</strong> section, the following list<br />
represents services and charges th<strong>at</strong> are not covered<br />
by the Plan. Network discounts will not apply to these<br />
services and charges.<br />
If you are enrolled in the Freedom Plan, you may be able<br />
to use your health savings account funds for these and<br />
other qualified medical expenses. For more inform<strong>at</strong>ion,<br />
contact your HSA administr<strong>at</strong>or.<br />
If you have a question regarding whether a<br />
particular service is covered under the Plan, please<br />
contact the customer service number on your <strong>Benefits</strong><br />
ID Card or see the inside back cover of this book for<br />
contact inform<strong>at</strong>ion.<br />
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• Acupuncture<br />
• Administr<strong>at</strong>ive Services and Interest Fees:<br />
Charges for the completion of claim forms, missed<br />
appointments, additional charges for weekend or<br />
holiday appointments, interest fees, collection fees,<br />
or <strong>at</strong>torneys’ fees.<br />
• Assistant Surgeon: Unless a Medical Doctor (M.D.) or<br />
Doctor of Osteop<strong>at</strong>hy (D.O.)<br />
• Autopsy<br />
• Biofeedback<br />
• Breast Reconstruction/Reduction: Any expenses or<br />
charges resulting from breast enlargement (augment<strong>at</strong>ion),<br />
including implant insertion and implant removal,<br />
whether male or female, are not covered except when<br />
the implant is removed as the result of implant damage<br />
or rupture. Replacement of a damaged or ruptured<br />
implant is not covered unless the original implant was<br />
placed for conditions eligible by the Plan.<br />
Any expenses or charges resulting from breast reductions,<br />
implant<strong>at</strong>ions, or for total breast removal,<br />
whether male or female, are not covered, unless<br />
directly rel<strong>at</strong>ed to tre<strong>at</strong>ment of a mastectomy (as provided<br />
below), or unless the Plan conducts a medical<br />
review and determines th<strong>at</strong> the procedure is<br />
Medically Necessary.<br />
The Women’s Health and Cancer Rights Act of 1998<br />
(Women’s Health Act) requires th<strong>at</strong> group health<br />
plans and HMO plans offering mastectomy coverage<br />
provide coverage for reconstruction of the breast on<br />
which a mastectomy was performed, surgery and<br />
reconstruction of the other breast to produce a symmetrical<br />
appearance, and prostheses and tre<strong>at</strong>ment<br />
of physical complic<strong>at</strong>ions <strong>at</strong> all stages of the mastectomy,<br />
including lymphedemas.<br />
The Women’s Health Act is effective for mastectomies<br />
performed on or after January 1, 1999, or<br />
for complic<strong>at</strong>ions arising from mastectomies performed<br />
before such d<strong>at</strong>e. The Women’s Health Act<br />
does not apply to mastectomies performed before<br />
January 1, 1999, and thus, reconstructive surgery to<br />
produce a symmetrical appearance or prosthesis will<br />
not be covered unless the participant was actively<br />
being tre<strong>at</strong>ed for the mastectomy after December<br />
31, 1998. For additional inform<strong>at</strong>ion, please call<br />
(800) 421-1362.<br />
• Charges Th<strong>at</strong> Should Have Been Included in the<br />
Primary Billing Code<br />
• Charges above Usual, Customary, and Reasonable<br />
(UCR) or Maximum Allowable Charge (MAC): See<br />
How the Medical Plan Pays <strong>Benefits</strong> earlier in this<br />
chapter concerning non-Network UCR and MAC<br />
exceptions in special situ<strong>at</strong>ions.<br />
• Charges in Excess of Plan limits<br />
• Charges or Procedures th<strong>at</strong> the Participant is not<br />
Oblig<strong>at</strong>ed to Pay<br />
• Chel<strong>at</strong>ion Therapy: Unless used for tre<strong>at</strong>ment<br />
of acute metal poisoning, digitalis toxicity, or<br />
Wilson’s disease.<br />
• Chiropractic Care: Any services performed by<br />
a chiropractor.<br />
• Complic<strong>at</strong>ions of Noncovered Devices or<br />
Procedures<br />
• Copays and/or Discounts<br />
• Cosmetic Surgery: Except for congenital abnormality,<br />
for services covered under the Women’s Health Act<br />
(see Breast Reconstruction/ Reduction above), or for<br />
conditions resulting from accidental injuries, tumors,<br />
or diseases.<br />
• Custodial or Respite Care: Custodial care is<br />
services th<strong>at</strong> are given merely as “care” in a facility or<br />
home to maintain a person’s present st<strong>at</strong>e of health,<br />
which cannot reasonably be expected to significantly<br />
improve.<br />
• Dependent Child Pregnancy (including<br />
complic<strong>at</strong>ions)<br />
• Dental Tre<strong>at</strong>ment: Charges for care of teeth and<br />
gums (including bridgework, removal of wisdom<br />
teeth, dental implants, and anesthetics or facility<br />
charges), including injuries to teeth resulting from the<br />
act of biting or chewing, except the following charges<br />
submitted by a doctor or dentist:<br />
—Prescriptions<br />
—Tre<strong>at</strong>ment of fractures/disloc<strong>at</strong>ions of the jaw resulting<br />
from an accidental injury<br />
—Accidental injury to n<strong>at</strong>ural teeth up to one year<br />
from the d<strong>at</strong>e of the accident (does not include<br />
injuries resulting from biting or chewing; may be<br />
covered under the Dental Plan)<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
69
—Anesthesia for dental tre<strong>at</strong>ment where Medically<br />
Necessary, but only where p<strong>at</strong>ient suffers from a<br />
medical condition th<strong>at</strong> prevents the p<strong>at</strong>ient from<br />
holding still (including but not limited to dystonia,<br />
Parkinson’s disease, autism)<br />
—Nondental cutting procedures in the oral cavity<br />
—Medical complic<strong>at</strong>ions which are the result of a covered<br />
dental procedure and which are in excess of<br />
Dental Plan limits.To obtain coverage:<br />
• The complic<strong>at</strong>ion must be medical in n<strong>at</strong>ure.<br />
• You must be currently enrolled in and eligible<br />
for both Medical and Dental coverage.<br />
• Dental Plan limits must be exhausted.<br />
Call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362 to see if<br />
your situ<strong>at</strong>ion meets these guidelines.<br />
• Drugs, Items, and Equipment not FDA Approved<br />
• Elective Inp<strong>at</strong>ient and Outp<strong>at</strong>ient Stays or Services<br />
Outside U.S.<br />
• Experimental, Investig<strong>at</strong>ional, and/or Tre<strong>at</strong>ments<br />
and Services th<strong>at</strong> are not Medically Necessary:<br />
Experimental and/or Investig<strong>at</strong>ional medical services<br />
are those defined as Experimental and/or<br />
Investig<strong>at</strong>ional according to protocols established by<br />
your Third Party Administr<strong>at</strong>or. Please refer to the<br />
transplant section for transplant services.<br />
• Extracorporeal Shock Wave Therapy: For plantar<br />
fasciitis and other musculoskeletal conditions.<br />
• Genetic or Chromosomal Testing (Including<br />
Counseling or therapy): Except for genetic tests th<strong>at</strong><br />
are accepted as “standard of care” for the diagnosis of<br />
disease when the genetic test is necessary to determine<br />
if an individual has a specific disease or to<br />
determine if the presence of a specific gene rel<strong>at</strong>ed<br />
to the disease would result in a change in therapy of<br />
the specific disease.<br />
• Government Compens<strong>at</strong>ion: Charges th<strong>at</strong> are compens<strong>at</strong>ed<br />
for or furnished by local, st<strong>at</strong>e, or federal<br />
government or any agency thereof, unless payment is<br />
legally required.<br />
• Growth Hormones: Except for participants:<br />
—Under age 18 when medically appropri<strong>at</strong>e (as determined<br />
by the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan); or<br />
—Age 18 and over when medically appropri<strong>at</strong>e (as<br />
determined by the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan) for HIV<br />
wasting syndrome (up to 12 weeks) or for acquired<br />
growth hormone deficiency resulting from the<br />
destruction of normal pituitary and/or hypothalamic<br />
tissue, usually from a tumor or secondary to surgical<br />
and/or radi<strong>at</strong>ion therapy.<br />
• Hair Loss: Other than services for alopecia are<strong>at</strong>a.<br />
• Hearing Devices to Enhance/Aid Senses: Charges for<br />
routine hearing tests and any electrical device to<br />
enhance any one or more of the senses, including but<br />
not limited to hearing aids.<br />
• HMO Copays<br />
• Homeop<strong>at</strong>hic/N<strong>at</strong>urop<strong>at</strong>hic Medicine and Services<br />
• Hypnosis<br />
• Injuries or Illness while being engaged in an Illegal<br />
Occup<strong>at</strong>ion, Illegal Activity Assault, Felony, or<br />
particip<strong>at</strong>ion in a Riot or Insurrection<br />
• Judgments/Settlements<br />
• L<strong>at</strong>e Claims: Charges received more than 12 months<br />
past the d<strong>at</strong>e of service, or 18 months past the d<strong>at</strong>e of<br />
service if the Plan is coordin<strong>at</strong>ing benefits with other<br />
plans. See Filing a Claim l<strong>at</strong>er in this chapter for inform<strong>at</strong>ion<br />
about coordin<strong>at</strong>ion of benefits. In the event a<br />
participant establishes th<strong>at</strong> a claim was filed within<br />
these time periods, but the claim was mistakenly filed<br />
with the Company or any Third Party Administr<strong>at</strong>or of<br />
the Plan, th<strong>at</strong> time shall not count toward the filing<br />
period above.<br />
• Massage Therapy, if Provided by a<br />
Massage Therapist<br />
• Medical Records: Charges to obtain or access medical<br />
records are not covered.<br />
• Military-Rel<strong>at</strong>ed Injury or Illness: Including injury or<br />
illness rel<strong>at</strong>ed to or resulting from acts of war,<br />
declared or undeclared.<br />
• Nonaccredited/Nonlicensed Doctors, Health Care<br />
Workers, or Institutions<br />
• Nonstandard Medical Tre<strong>at</strong>ment<br />
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• Off-Label or “Unlabeled” Drug Use: Except when<br />
Medically Necessary, which means all of the following<br />
conditions must be met:<br />
—The drug is approved by the FDA;<br />
—The drug is recognized as appropri<strong>at</strong>e for the<br />
st<strong>at</strong>ed usage by <strong>at</strong> least one of the following:<br />
the Food and Drug Administr<strong>at</strong>ion (including<br />
listing on the FDA Orphan Drug Approval Web<br />
site); the American Hospital Formulary Service<br />
Drug Inform<strong>at</strong>ion; the U.S. Pharmacopoeia<br />
Dispensing Inform<strong>at</strong>ion,Vol. I (altern<strong>at</strong>ively, in<br />
the absence of being listed in the abovenamed<br />
sources, if two articles from major peerreviewed<br />
journals th<strong>at</strong> have valid<strong>at</strong>ed and<br />
uncontested d<strong>at</strong>a, which supports the proposed<br />
use for the specific medical condition as<br />
safe and effective, this may be sufficient for the<br />
organiz<strong>at</strong>ion to consider recognition of this offlabel<br />
indic<strong>at</strong>ion); and<br />
—The drug is Medically Necessary to tre<strong>at</strong> the<br />
specific medical condition, including life-thre<strong>at</strong>ening<br />
conditions or chronic and seriously debilit<strong>at</strong>ing<br />
conditions.<br />
If the off-label drug use meets the conditions<br />
above and is therefore determined to be<br />
Medically Necessary, its use shall also be determined<br />
to be “non-investig<strong>at</strong>ional” for the purposes<br />
of benefit determin<strong>at</strong>ion.<br />
This shall not be construed to require coverage<br />
for any drug when the FDA has determined its<br />
use to be contraindic<strong>at</strong>ed or not advisable.<br />
• Out-of-Pocket Expenses<br />
• Over-the-Counter Medic<strong>at</strong>ions and Equipment:<br />
Except for claims for insulin and allergy syringes,<br />
which may be filed with WMS/NextRx.<br />
• Pain Management: Charges for inp<strong>at</strong>ient pain management<br />
programs.<br />
• Participant-Instig<strong>at</strong>ed Violent Behavior or Fight:<br />
Unless injury or illness results from a medical condition<br />
or an incident of domestic violence, or if the participant<br />
is under age 19 <strong>at</strong> the time of the injury.<br />
• Personal Care Items: Primarily for personal comfort or<br />
convenience, including but not limited to diapers,<br />
b<strong>at</strong>htub grabbers, handrails, lift chairs, over-bed tables,<br />
bedboards, incontinence pads, ramps, snug se<strong>at</strong>s,<br />
recre<strong>at</strong>ional items, home improvements and home<br />
appliances, spas, wigs, and knee braces for sports.<br />
• Pharmaceuticals not Recommended by the United<br />
St<strong>at</strong>es Pharmacopoeia Dispensing Inform<strong>at</strong>ion or<br />
American Hospital Formulary Service<br />
• Phone and Online Consult<strong>at</strong>ions<br />
• Pre-Existing Conditions: (See If You Are Enrolling<br />
in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan for the First Time<br />
earlier in this chapter for details.)<br />
• Preventive Care: (except those services covered in<br />
Limited <strong>Benefits</strong> under Mammograms, Pap Smears,<br />
and Well Child Visits)<br />
• Pulmonary Rehabilit<strong>at</strong>ion (except for<br />
transplant p<strong>at</strong>ients)<br />
• Reproductive Systems: Charges for or rel<strong>at</strong>ing to any<br />
tre<strong>at</strong>ment or service for steriliz<strong>at</strong>ion or reversal of<br />
steriliz<strong>at</strong>ion, sexual dysfunction, impotence, or family<br />
planning and any complic<strong>at</strong>ions arising therefrom.<br />
Charges for services, supplies, medical care, or tre<strong>at</strong>ment<br />
rel<strong>at</strong>ing to, arising out of, or given in connection<br />
with procedures th<strong>at</strong> facilit<strong>at</strong>e a pregnancy (but do<br />
not tre<strong>at</strong> the cause of infertility,) such as in vitro fertiliz<strong>at</strong>ion,<br />
artificial insemin<strong>at</strong>ion, embryo transfer,<br />
gamete intrafallopian transfer, zygote intrafallopian<br />
transfer, tubal ovum transfer, or preimplant<strong>at</strong>ion<br />
genetic diagnosis or tre<strong>at</strong>ment.<br />
• Routine Visits or Testing: (except those services covered<br />
in Limited <strong>Benefits</strong> under Mammograms, Pap<br />
Smears, and Well Child Visits)<br />
• Self-Inflicted Injury/Illness or Voluntary<br />
Self-Medic<strong>at</strong>ion (except as a result of a physical or<br />
mental health condition)<br />
• Services Provided by a Member of the<br />
P<strong>at</strong>ient’s Family<br />
• Services provided by a government entity<br />
while incarcer<strong>at</strong>ed<br />
• Sexual Dysfunction Services and Pharmaceuticals:<br />
Including, but not limited to, the use of Viagra or any<br />
sexual dysfunction pharmaceuticals, even if prescribed<br />
for other medical conditions.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
71
• Smoking: Smoking cess<strong>at</strong>ion programs and rel<strong>at</strong>ed<br />
medic<strong>at</strong>ions and aids (including nicotine p<strong>at</strong>ches).<br />
• Substance Abuse: Alcohol and drug programs, rel<strong>at</strong>ed<br />
medic<strong>at</strong>ions and aids, including but not limited to<br />
Day Care Centers and Daytime Alcohol and Mental<br />
Health Rehabilit<strong>at</strong>ion Centers (except those services<br />
covered in Limited <strong>Benefits</strong> under Mental and<br />
Nervous Disorders and Substance Abuse).<br />
• Surrog<strong>at</strong>e Parenting<br />
• Talking Aid: Assistive talking devises including special<br />
computers or advanced technological assistance<br />
devices (such as Delta Talker) designed to assist in<br />
therapy tre<strong>at</strong>ment to enhance motor and/or psychological<br />
abilities.<br />
• Transplant Organ Donor Expenses: Unless the recipient<br />
is a participant who is eligible for transplant coverage<br />
and the living donor’s expenses are not paid by<br />
his or her own medical plan or insurance. Also, please<br />
note th<strong>at</strong> cadaver organ procurement expenses are<br />
not covered unless the expenses are part of the<br />
provider’s contracted r<strong>at</strong>e with the Plan.<br />
• Transsexual Surgery (including hormone therapy)<br />
• Travel and Lodging except as specified under<br />
Transplant <strong>Benefits</strong><br />
• Termin<strong>at</strong>ion of Pregnancy: Charges for procedures,<br />
services, drugs, and supplies rel<strong>at</strong>ed to abortions or<br />
termin<strong>at</strong>ion of pregnancy are not covered, except<br />
when the health of the mother would be in danger if<br />
the fetus were carried to term, the fetus could not<br />
survive the birthing process, or de<strong>at</strong>h would be imminent<br />
after birth.<br />
• Under the Influence: Charges incurred directly or<br />
indirectly while under the influence of illegal drugs.<br />
• Vaccines: Charges for routine vaccin<strong>at</strong>ions except as<br />
provided in Limited <strong>Benefits</strong> under Well Child Visits.<br />
• Vitamins: Charges for vitamins (whether oral or<br />
injectable), minerals, nutritional supplements,<br />
or dietary supplements except as provided in Limited<br />
<strong>Benefits</strong> under Vitamins.<br />
• Vision Care: Charges for routine eye care including<br />
but not limited to vision analysis, eye examin<strong>at</strong>ions, or<br />
eye surgeries for nearsightedness or farsightedness<br />
correction of vision. Additionally, see the Limited<br />
<strong>Benefits</strong> section for other conditions th<strong>at</strong> are covered<br />
by the Plan.<br />
• Weight Loss Programs, Medic<strong>at</strong>ions, and Aids:<br />
Charges including medic<strong>at</strong>ions, diet supplements,<br />
counseling (including nutritional counseling), and<br />
office visits for diet programs, appetite control, weight<br />
control and tre<strong>at</strong>ment of obesity or morbid obesity,<br />
including but not limited to gastric bypass, gastric<br />
restrictive or stapling procedures, or small bowel surgery<br />
to limit resorption, even if the participant has<br />
other health conditions th<strong>at</strong> might be helped by the<br />
reduction of weight.<br />
• Wellness Care/Exams: Participants age 6 and over<br />
(except those services covered in Limited <strong>Benefits</strong><br />
under Mammograms, Pap Smears, and Well<br />
Child Visits)<br />
• Work Hardening or Similar Voc<strong>at</strong>ional Programs<br />
• Workers’ Compens<strong>at</strong>ion: Tre<strong>at</strong>ment of any compensable<br />
injury, as defined by the Workers’ Compens<strong>at</strong>ion<br />
Law is not covered, regardless of whether or not you<br />
timely filed a claim for workers’ compens<strong>at</strong>ion benefits.<br />
Services Requiring Prior<br />
Authoriz<strong>at</strong>ion by the Aetna<br />
Limited Network<br />
If you are enrolled in an Aetna Limited Plan, you are<br />
required to pre-certify (also referred to as pre-authorize)<br />
some services in order for the service to be covered. A<br />
complete list of services for which Aetna requires prior<br />
authoriz<strong>at</strong>ion can be found below. Additionally, limit<strong>at</strong>ions<br />
and exclusions of the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan (AMP)<br />
are described in When Limited <strong>Benefits</strong> Apply and<br />
Wh<strong>at</strong> is Not Covered by the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan earlier in this chapter.<br />
Prior authoriz<strong>at</strong>ion approvals from Aetna are valid<br />
for six (6) months in all st<strong>at</strong>es (prior authoriz<strong>at</strong>ions<br />
for transplants are valid for one year; see criteria below<br />
under transplants).You may also contact Aetna <strong>at</strong><br />
(800) 250-7129 if you have questions.<br />
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• All home health care services<br />
• Elective (non-emergent) transport<strong>at</strong>ion by<br />
ambulance or medical van, and all transfers via<br />
air ambulance.<br />
• IMRT for breast cancer, based on specific criteria<br />
• Injectables<br />
—Intravenous immunoglobulin (IVIG)<br />
—Darbepoetin alpha (Aranesp) and epoetin<br />
alpha (Epogen and Procrit). Call (866) 503-0857<br />
to precertify<br />
—Growth hormone<br />
—Blood clotting factors<br />
—Synagis (intake by ASRX <strong>at</strong> (866) 782-2779)<br />
—Interferons when used for Hep<strong>at</strong>itis C:<br />
• Pegasys®<br />
• Roferon A®<br />
• Peg Intron®<br />
• Intron A®<br />
• Rebetron®<br />
• Infergen®<br />
• Inp<strong>at</strong>ient confinements<br />
—Surgical and non-surgical confinements excluding<br />
vaginal or Caesarean deliveries<br />
—Skilled nursing facility<br />
—Rehabilit<strong>at</strong>ion facility<br />
—Inp<strong>at</strong>ient hospice (except Medicare)<br />
—Observ<strong>at</strong>ion stays gre<strong>at</strong>er than 23 hours<br />
• Orthoganthic surgery procedures, bone grafts,<br />
osteotomies and surgical management of the<br />
temporomandibular joint<br />
• Reconstructive procedures th<strong>at</strong> may be<br />
considered cosmetic<br />
—Blepharoplasty/canthopexy/canthoplasty<br />
—Breast reconstruction<br />
—Breast reduction/mammoplasty<br />
—Excision of excessive skin due to weight loss<br />
—Pectus excav<strong>at</strong>um repair<br />
—Rhinoplasty<br />
—Sclerotherapy or surgery for varicose veins<br />
—Surgical tre<strong>at</strong>ment of gynecomastia<br />
—Any other potentially cosmetic procedure<br />
• Requests for Network level of benefits for<br />
non-particip<strong>at</strong>ing physicians and providers for nonemergent<br />
services<br />
• Selected durable medical equipment<br />
—Clinitron and electric beds<br />
—Customized braces<br />
—Electric or motorized wheelchairs<br />
—Limb and torso prosthetics<br />
• Spinal laminectomy and spinal fusion surgery<br />
• Transplants<br />
Coverage for transplants is described in Coverage for<br />
Transplants and Lung Volume Reduction earlier in<br />
this chapter. <strong>Associ<strong>at</strong>e</strong>s are not eligible for transplant<br />
benefits during their first year of coverage.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
73
For transplants th<strong>at</strong> do not have to be performed <strong>at</strong><br />
the Mayo Clinic, you must file a prior authoriz<strong>at</strong>ion<br />
request with Aetna. Aetna is responsible for the evalu<strong>at</strong>ion,<br />
authoriz<strong>at</strong>ion, and management for these<br />
transplants, and is the claim fiduciary for these transplants.<br />
Prior authoriz<strong>at</strong>ions for transplants will be<br />
valid for one year.<br />
Aetna is also responsible for pre-service, urgent care,<br />
and concurrent care claim appeals rel<strong>at</strong>ed to transplants.<br />
Any post-service claim appeals should be<br />
directed through the <strong>Benefits</strong> Department.<br />
Note: Pedi<strong>at</strong>ric transplant evalu<strong>at</strong>ions must still be<br />
performed <strong>at</strong> the Mayo Clinic, as described in<br />
Coverage for Transplants and Lung Volume<br />
Reduction earlier in this chapter.You should contact<br />
the <strong>Benefits</strong> Department for more inform<strong>at</strong>ion.<br />
• Uvulopal<strong>at</strong>opharyng-oplasty, including<br />
laser-assisted procedures<br />
Filing a Medical Claim<br />
If you use a Network provider, the provider will often file<br />
the claim for you. If you see a non-Network provider, you<br />
may need to file a claim. If you need to file a claim, the<br />
claim should include the following inform<strong>at</strong>ion:<br />
• P<strong>at</strong>ient’s name<br />
• Provider’s name, address, and tax<br />
identific<strong>at</strong>ion number<br />
• <strong>Associ<strong>at</strong>e</strong>’s <strong>Benefits</strong> ID (See your <strong>Benefits</strong> ID Card)<br />
• D<strong>at</strong>e of service<br />
• Amount of charges<br />
• Medical procedure codes (These should be<br />
found on the bill)<br />
• Diagnosis<br />
Claims will be determined under the time frames<br />
and requirements set out in the Claims and<br />
Appeals chapter.<br />
Please see the back of your <strong>Benefits</strong> ID Card or the<br />
inside back cover of this book for the correct address<br />
to mail your claim. Failure to mail your claim to the<br />
correct address may result in the denial of your claim.<br />
In addition, you may complete a claim form loc<strong>at</strong>ed on<br />
the WIRE or walmartbenefits.com and submit the form<br />
to the appropri<strong>at</strong>e address.<br />
Failure by you or the provider to file a claim within 12<br />
months from the d<strong>at</strong>e of service (18 months from the<br />
d<strong>at</strong>e of service if coordin<strong>at</strong>ing with another plan as<br />
described below) will result in denial of your claim.There<br />
are laws th<strong>at</strong> govern the review of your claims. Claims will<br />
be determined under the same time frames and requirements<br />
set out in the Claims and Appeals chapter. See<br />
the Claims and Appeals chapter for details.<br />
Note th<strong>at</strong> you must file a prior authoriz<strong>at</strong>ion claim for certain<br />
services if you are enrolled in the Aetna Limited Plan.<br />
See Aetna section for this list. For other services, the Plan<br />
does not require prior authoriz<strong>at</strong>ion (unless indic<strong>at</strong>ed in<br />
this chapter). In those cases, prenotific<strong>at</strong>ions or prior<br />
authoriz<strong>at</strong>ions are not a guarantee of payment.<br />
When you use a Network provider, benefits will be<br />
paid directly to the provider. Payment to the provider<br />
discharges the Plan’s oblig<strong>at</strong>ions to you with respect<br />
to such benefit. This assignment does not allow the<br />
provider to pursue claims or appeals on your behalf. If<br />
benefits are paid to you, such as if you use a non-<br />
Network provider, you will be responsible for any<br />
amounts you owe to the provider. Except for assignments<br />
of payments as permitted by the Plan or as<br />
required by st<strong>at</strong>e Medicaid law, Plan benefits cannot<br />
be assigned or transferred to another party.<br />
You have the right to appeal a claim denial. See the<br />
Claims and Appeals chapter for details.<br />
If You Are Charged for<br />
Services You Did Not Receive<br />
It pays to check your medical bill! If you or your dependents<br />
are charged for a service you did not receive, follow<br />
the steps listed below and you may receive up to 40<br />
percent of the savings (in addition to having the charge<br />
removed). Such payments may be subject to federal<br />
and/or st<strong>at</strong>e tax.<br />
Step 1: Work with the provider to get the<br />
charge(s) reduced or removed.<br />
Step 2: Submit a copy of the corrected bill<br />
and a letter explaining the overcharge to:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
Attn: Self-Audit Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540, or<br />
Email: selfaudit@wal-mart.com<br />
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If you follow the steps above and the reduction in the<br />
bill results in a reduced payout to the provider, the Plan<br />
will refund 40 percent of the savings to you. The refund<br />
is limited to a maximum of $2,000 per plan year, per participant.<br />
If the bill includes a Network discount, the savings<br />
are calcul<strong>at</strong>ed on the amount paid by the Plan, not<br />
the total charge.<br />
The medical billing self-audit is for billing errors made by<br />
the provider only and must be received within 12 months<br />
from d<strong>at</strong>e of service.The refund does not apply to Dental,<br />
HMO, the Accident Insurance Policy, the Cancer Insurance<br />
Policy, or Starbridge.<br />
If You Have Coverage Under<br />
More Than One Medical Plan<br />
The AMP has the right to coordin<strong>at</strong>e with “other plans”<br />
under which you are covered so the total medical benefits<br />
payable will not exceed the level of benefits otherwise<br />
payable under the AMP. “Other plans” refers to the<br />
following types of medical and health care benefits:<br />
• Coverage under a governmental program provided<br />
or required by st<strong>at</strong>ute, including no-fault coverage to<br />
the extent required in policies or contracts by a<br />
motor vehicle insurance st<strong>at</strong>ute or similar legisl<strong>at</strong>ion,<br />
How the Plan Coordin<strong>at</strong>es<br />
with Other Plans<br />
If another plan<br />
pays primary <strong>at</strong>:<br />
And the AMP's<br />
payment is:<br />
The AMP's total<br />
benefit is:<br />
Example 1 Example 2 Example 3<br />
80 percent 80 percent 0 percent<br />
80 percent 100 percent 80 percent<br />
0 percent 20 percent 80 percent<br />
• Group insurance or other coverage for a group of<br />
individuals, including coverage under another<br />
employer plan or student coverage obtained through<br />
an educ<strong>at</strong>ional institution,<br />
• Any coverage under labor-management trusteed<br />
plans, union welfare plans, employer organiz<strong>at</strong>ion<br />
plans, or employee benefit organiz<strong>at</strong>ion plans,<br />
• Any coverage under governmental plans, such as<br />
Medicare, but not including a st<strong>at</strong>e plan under<br />
Medicaid or any governmental plan when, by law, its<br />
benefits are secondary to those of any priv<strong>at</strong>e insurance,<br />
nongovernmental program, and<br />
• Any priv<strong>at</strong>e or associ<strong>at</strong>ion policy or plan of<br />
medical expense reimbursement which is group<br />
or individual r<strong>at</strong>ed.<br />
• Any excess insurance policy.<br />
When you are covered by more than one plan, one plan<br />
is design<strong>at</strong>ed the primary plan. The primary plan pays<br />
first and ignores benefits payable under other plans<br />
when determining benefits. Any other plan is design<strong>at</strong>ed<br />
as a secondary plan th<strong>at</strong> pays benefits after the primary<br />
plan. A secondary plan reduces its benefits by<br />
those benefits payable under “other plans” and may<br />
limit the benefits it pays.<br />
You must follow the primary insurance terms in order for<br />
the Plan to pay as secondary payer.<br />
These rules apply whether or not a claim is made under<br />
the other plan. If a claim is not made, benefits under the<br />
AMP will be pended or denied until an Explan<strong>at</strong>ion of<br />
<strong>Benefits</strong> is received showing a claim made with the primary<br />
plan.The AMP will not coordin<strong>at</strong>e as a secondary<br />
payer for any Copays you pay with respect to another<br />
plan or with respect to prescription drug claims or transplants<br />
(except where the other plan is Medicare).<br />
Note:The Plan will not coordin<strong>at</strong>e benefits on the Health<br />
Care Credit. If the Health Care Credit has not been<br />
exhausted, then the Health Care Credit pays first and then<br />
the coordin<strong>at</strong>ion rules in this section apply. Once the<br />
Health Care Credit is exhausted, the coordin<strong>at</strong>ion rules in<br />
this section apply.<br />
• The Plan has first priority with respect to its right to<br />
reduction, reimbursement, and subrog<strong>at</strong>ion.<br />
• The Plan will not coordin<strong>at</strong>e benefits with an HMO or<br />
similarly managed care plan where you only pay a<br />
copayment or fixed dollar amount.<br />
• The Plan will not coordin<strong>at</strong>e with any other<br />
plan other than Medicare with respect to a<br />
covered transplant.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
75
Determining Which Plan is the Primary Plan<br />
A plan without a coordin<strong>at</strong>ing provision is always primary.The<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan has a coordin<strong>at</strong>ing<br />
provision. If all plans have a coordin<strong>at</strong>ing provision the<br />
following will apply:<br />
• No-fault coverage, personal injury protection, and<br />
medical payment coverage are always primary, and<br />
AMP is always secondary to those types of plans.<br />
• The plan covering the participant for whom the claim<br />
is made, other than as a dependent, pays first and the<br />
other plan pays second.<br />
• For dependent children’s claims, the plan of the parent<br />
whose birthday occurs earlier in the calendar year<br />
is primary.<br />
• When the birthdays of both parents are on the same<br />
day, the plan th<strong>at</strong> has covered the dependent for the<br />
longer period of time is primary.<br />
• When the parents of a dependent child are divorced<br />
or separ<strong>at</strong>ed and the parent with custody has not<br />
remarried, th<strong>at</strong> parent’s plan is primary.<br />
• When the parent with custody has remarried, th<strong>at</strong><br />
parent’s plan is primary, the stepparent’s plan pays<br />
second, and the plan of the parent without custody<br />
pays last.<br />
• When there is a court decree th<strong>at</strong> establishes financial<br />
responsibility for the health care expenses of the<br />
child, the plan th<strong>at</strong> covers the parent with financial<br />
responsibility is primary.<br />
• When none of the above establish an order of benefit<br />
determin<strong>at</strong>ion, the plan th<strong>at</strong> has covered the participant<br />
for whom the claim is made for the longest period<br />
of time will be primary.<br />
If You or a Dependent is<br />
Covered Under Medicaid<br />
If you or your dependent is a participant in the plan<br />
and is also covered under Medicaid, the plan will pay<br />
before Medicaid. The plan will not take the Medicaid<br />
coverage into account for purposes of enrollment or<br />
payment of benefits.<br />
If, while you are covered under Medicaid, benefits are<br />
required to be paid by the plan, but are first paid by the<br />
st<strong>at</strong>e plan, payment by the plan will be made as required<br />
by any applicable st<strong>at</strong>e law which provides th<strong>at</strong> payment<br />
will be made to the st<strong>at</strong>e.<br />
If You or a Dependent is<br />
Eligible or Enrolled in Medicare<br />
In general, the Social Security Act requires th<strong>at</strong> the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan (AMP) be the primary payer<br />
if you or your dependent is eligible or enrolled in<br />
Medicare Part A, or Parts A and B, and meet one of<br />
the following criteria:<br />
• You are currently employed by the Company and are<br />
age 65 or older.<br />
• You are currently employed by the Company and<br />
your spouse is age 65 or older.<br />
• You are an active participant or COBRA participant<br />
entitled to Medicare on the basis of end-stage renal<br />
disease, but only for the first 30-month period of eligibility<br />
for Medicare coverage (whether or not actually<br />
enrolled in Medicare throughout this period), unless,<br />
<strong>at</strong> the time you become entitled to such Medicare<br />
coverage, coverage under the Plan was not due to<br />
employment with <strong>Wal</strong>-<strong>Mart</strong>.<br />
• You are under age 65 and are entitled to Medicare<br />
due to disability and are covered under the Plan due<br />
to being employed by the Company.<br />
• Your dependent is under age 65 and is entitled<br />
to Medicare due to his or her disability and is<br />
covered under the Plan due to your being employed<br />
by the Company.<br />
The Plan will be secondary if you or your dependent<br />
is enrolled in Medicare and meet one of the<br />
following criteria:<br />
• You or your dependent is a COBRA participant<br />
enrolled in Medicare prior to the COBRA<br />
effective d<strong>at</strong>e.<br />
76 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
• You or your dependent is an active or COBRA participant<br />
entitled to Medicare due to end-stage renal<br />
disease, after the 30-month coordin<strong>at</strong>ion period<br />
with Medicare is exhausted.<br />
If You are Age 65 or<br />
Older and an Active <strong>Associ<strong>at</strong>e</strong><br />
If you are still working for the Company, you may continue<br />
your coverage under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan. If<br />
you also have Medicare, the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan will<br />
generally be primary and Medicare will be secondary.<br />
File your claim with the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan first.<br />
You may also elect to end your coverage under<br />
the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan and choose Medicare as your<br />
primary coverage. If you choose Medicare as your primary<br />
coverage, you may not elect this Plan as your secondary<br />
plan.<br />
St<strong>at</strong>e-Mand<strong>at</strong>ed Automobile Personal Injury<br />
or Medical Payment Coverage<br />
If you reside in a st<strong>at</strong>e where automobile no-fault coverage,<br />
personal injury protection coverage, or medical payment<br />
coverage is mand<strong>at</strong>ory, th<strong>at</strong> coverage is primary<br />
and the Plan takes secondary st<strong>at</strong>us.The Plan will reduce<br />
benefits for an amount equal to, but not less than, the<br />
st<strong>at</strong>e’s mand<strong>at</strong>ory minimum requirement.<br />
If You Go On a Leave of Absence<br />
You may continue your coverage up to the last day of<br />
an approved Leave of Absence, provided th<strong>at</strong> you pay<br />
your premiums either before the leave begins or during<br />
the leave.<br />
If your coverage has been canceled due to nonpayment<br />
of premiums and you return to Actively-At-Work st<strong>at</strong>us<br />
within one year from cancell<strong>at</strong>ion, you will autom<strong>at</strong>ically<br />
be re-enrolled for the same coverage options (or, if this<br />
coverage is not available, the coverage th<strong>at</strong> is most similar<br />
to your prior coverage).Your coverage will be effective<br />
the first day of the pay period th<strong>at</strong> you meet the Actively-<br />
At-Work requirement.<br />
If you return to work after one year or add coverage<br />
under a St<strong>at</strong>us <strong>Change</strong> Event, you will be considered<br />
newly eligible, and you may enroll for coverage<br />
within the applicable time periods described in the<br />
Eligibility and Enrollment chapter. For inform<strong>at</strong>ion<br />
regarding pre-existing condition limit<strong>at</strong>ion periods,<br />
see Enrolling in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan for the<br />
First Time earlier in this chapter.<br />
When Coverage Ends<br />
Your coverage and your dependent’s coverage termin<strong>at</strong>e<br />
on your last day of employment. However, you may be<br />
able to continue your coverage under COBRA.<br />
See the Eligibility and Enrollment chapter for a<br />
complete list of events th<strong>at</strong> may cause coverage to end.<br />
See the COBRA chapter for additional details regarding<br />
COBRA coverage.<br />
If You Leave the<br />
Company and are Then Rehired<br />
If you return to an Actively-At-Work eligible st<strong>at</strong>us<br />
for the Company within 30 days, you will autom<strong>at</strong>ically<br />
be re-enrolled for the same medical coverage options<br />
you had when you left, provided th<strong>at</strong> coverage is still<br />
available. If the prior plan is not available, you will be<br />
defaulted into the Value Plan th<strong>at</strong> is most similar to<br />
your prior coverage. See the Eligibility and Enrollment<br />
chapter for more inform<strong>at</strong>ion.<br />
If you do not return to an Actively-At-Work eligible<br />
st<strong>at</strong>us for the Company within 30 days, you will be<br />
considered newly eligible and will be subject to applicable<br />
waiting periods and limit<strong>at</strong>ions described in earlier<br />
in this chapter and in the Eligibility and Enrollment<br />
chapter. For inform<strong>at</strong>ion regarding pre-existing condition<br />
limit<strong>at</strong>ion periods, see Enrolling in the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan for the First Time earlier in this chapter.<br />
The Medical Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
77
Eligibility and <strong>Benefits</strong><br />
for <strong>Associ<strong>at</strong>e</strong>s in Hawaii<br />
Where Can I Find<br />
Special Eligibility Rules and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii . . . . . . . . . . . . . . . . . . . . . . 80<br />
The Initial Enrollment Period for Medical Coverage for Full-Time, Peak-Time,<br />
and Temporary Hawaii <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80<br />
Medical Coverage Options for Hawaii <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81<br />
St<strong>at</strong>us <strong>Change</strong> Events for Full-Time and Peak-Time Hawaii <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . 81<br />
Paying Premiums During a Leave of Absence for Hawaii <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . . . 81
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii<br />
Aloha! As an associ<strong>at</strong>e in Hawaii, you have special rules for enrolling in the medical plan and two<br />
medical plan options: Health Plan Hawaii (HMSA) and the Kaiser Found<strong>at</strong>ion Health Plan. And,<br />
because Hawaii has a st<strong>at</strong>e-mand<strong>at</strong>ed disability plan, you are not eligible for the Company<br />
Short-Term Disability Plan. Other than the eligibility and benefit differences described in this<br />
chapter, the inform<strong>at</strong>ion in this <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong>s <strong>Benefits</strong> <strong>Book</strong> applies to you.<br />
Hawaii Medical Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Health Plan Hawaii (HMSA) www.hmsa.com (808) 948-6372<br />
Kaiser Found<strong>at</strong>ion Health Plan www.kaiserpermanente.org (800) 966-5955<br />
Enroll for benefits<br />
Make changes to your benefits<br />
due to a st<strong>at</strong>us event change<br />
Complete an enrollment form<br />
and return the white and yellow<br />
copies of the form to your<br />
personnel represent<strong>at</strong>ive<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong><br />
<strong>at</strong> (800) 421-1362 or<br />
Complete an enrollment form<br />
and return the white and yellow<br />
copies of the form to your<br />
personnel represent<strong>at</strong>ive<br />
Wh<strong>at</strong> You Need to Know As a Hawaii <strong>Associ<strong>at</strong>e</strong><br />
• Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs), Peak-Time, and Temporary associ<strong>at</strong>es in Hawaii have<br />
different Initial Eligibility Periods for medical coverage.<br />
• <strong>Associ<strong>at</strong>e</strong>s in Hawaii have two medical coverage options: Health Plan Hawaii (HMSA) and the<br />
Kaiser Found<strong>at</strong>ion Health Plan.<br />
• <strong>Associ<strong>at</strong>e</strong>s in Hawaii cannot enroll in the Short-Term Disability Plan because they are eligible for a<br />
st<strong>at</strong>e-mand<strong>at</strong>ed disability plan instead.<br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
79
Special Eligibility Rules and<br />
<strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii have the same eligibility and<br />
benefits as described in this <strong>2008</strong> <strong>Associ<strong>at</strong>e</strong>s <strong>Benefits</strong><br />
<strong>Book</strong> except:<br />
• Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs), Peak-<br />
Time, and Temporary associ<strong>at</strong>es in Hawaii have different<br />
Initial Eligibility Periods for medical coverage.<br />
• <strong>Associ<strong>at</strong>e</strong>s in Hawaii have two medical coverage<br />
options: Health Plan Hawaii (HMSA) and the Kaiser<br />
Found<strong>at</strong>ion Health Plan.<br />
• <strong>Associ<strong>at</strong>e</strong>s in Hawaii have a st<strong>at</strong>e-mand<strong>at</strong>ed disability<br />
plan. For additional inform<strong>at</strong>ion, contact The Hartford<br />
<strong>at</strong> (800) 535-7073.<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii also must enroll for benefits using a<br />
paper enrollment form.<br />
The Initial Enrollment<br />
Period for Medical Coverage<br />
for Full-Time, Peak-Time, and<br />
Temporary Hawaii <strong>Associ<strong>at</strong>e</strong>s<br />
Eligibility Waiting Periods for <strong>Benefits</strong><br />
Medical coverage for Full-Time hourly associ<strong>at</strong>es (including<br />
Full-Time hourly pharmacists, Field Logistics<br />
<strong>Associ<strong>at</strong>e</strong>s, and Field Supervisor Positions in stores and<br />
clubs), Peak Time, and Temporary associ<strong>at</strong>es in Hawaii<br />
will become effective as of the earlier of:<br />
• The first day of the pay period following a period of<br />
working <strong>at</strong> least 20 hours per week for four consecutive<br />
weeks; or<br />
• Full-Time hourly associ<strong>at</strong>es in Hawaii can enroll for<br />
medical coverage 120 days after the d<strong>at</strong>e of hire.<br />
<strong>Associ<strong>at</strong>e</strong>s enrolling <strong>at</strong> this time will have a 60-day<br />
window beginning on the 120th day of continuous<br />
employment to enroll, and coverage will be effective<br />
as of the 181st day of continuous employment.<br />
• Peak-Time associ<strong>at</strong>es in Hawaii can enroll for medical<br />
coverage 60 days prior to your first anniversary of<br />
employment of working continuously for the<br />
Company. <strong>Associ<strong>at</strong>e</strong>s enrolling <strong>at</strong> this time will have a<br />
60-day window beginning 60 days prior to your first<br />
anniversary of continuous work for the Company,<br />
and coverage will be effective as of the 366th day of<br />
continuous work.<br />
• Temporary associ<strong>at</strong>es in Hawaii can enroll on the initial<br />
d<strong>at</strong>e of hire and medical coverage will become<br />
effective as of the first day of the pay period (following<br />
a period of working <strong>at</strong> least 20 hours per week<br />
for four consecutive weeks.<br />
The Initial Enrollment Period for benefits other<br />
than medical and short-term disability is the same<br />
as the Initial Enrollment Periods described in the<br />
Eligibility and Enrollment chapter.<br />
80 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Medical Coverage<br />
Options for Hawaii <strong>Associ<strong>at</strong>e</strong>s<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii have two medical coverage options:<br />
• Health Plan Hawaii (HMSA); and<br />
• The Kaiser Found<strong>at</strong>ion Health Plan.<br />
For more inform<strong>at</strong>ion about these medical options, see<br />
your personnel represent<strong>at</strong>ive.<br />
St<strong>at</strong>us <strong>Change</strong> Events<br />
for Full-Time and<br />
Peak-Time Hawaii <strong>Associ<strong>at</strong>e</strong>s<br />
Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly<br />
pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs), Peak-Time,<br />
and Temporary associ<strong>at</strong>es in Hawaii have the same<br />
St<strong>at</strong>us <strong>Change</strong> Event guidelines as described in the<br />
Eligibility and Enrollment chapter if the d<strong>at</strong>e the<br />
St<strong>at</strong>us <strong>Change</strong> Event Form is signed or the St<strong>at</strong>us<br />
<strong>Change</strong> Event is called in to the <strong>Benefits</strong> Department<br />
is within 60 days of the event d<strong>at</strong>e.<br />
If the St<strong>at</strong>us <strong>Change</strong> form is d<strong>at</strong>ed or the St<strong>at</strong>us Event<br />
<strong>Change</strong> is called in to the <strong>Benefits</strong> Department more<br />
than 60 days past the event d<strong>at</strong>e, applicable changes will<br />
be effective on the first day of the pay period in which<br />
the form is received in the <strong>Benefits</strong> office.<br />
Paying Premiums During a Leave of<br />
Absence for Hawaii <strong>Associ<strong>at</strong>e</strong>s<br />
Because the associ<strong>at</strong>e portion of your medical premium<br />
is wage based, there will be no premium due if there are<br />
no wages.The only premium due while on a Leave of<br />
Absence with no wages will be the dependent portion<br />
of your premium. All other coverages require payment as<br />
described in the Eligibility and Enrollment chapter.<br />
Under Hawaiian law, <strong>Wal</strong>-<strong>Mart</strong> is required to contribute<br />
<strong>at</strong> least 50 percent of the premium of associ<strong>at</strong>e medical<br />
coverage (but not dependent coverage). <strong>Associ<strong>at</strong>e</strong>s are<br />
required to pay the rest of the monthly coverage premium,<br />
but only up to 1.5 percent of their wages or 50 percent<br />
of the monthly cost of the premium, whichever is<br />
less. So, for example, if an associ<strong>at</strong>e’s monthly wages<br />
were $1,000, th<strong>at</strong> associ<strong>at</strong>e could not be required to pay<br />
more than $15 per month for coverage (assuming th<strong>at</strong><br />
the entire premium is <strong>at</strong> least $30 per month).<br />
Eligibility and <strong>Benefits</strong> for <strong>Associ<strong>at</strong>e</strong>s in Hawaii<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
81
Health Savings Account<br />
Where Can I Find<br />
Health Savings Account Advantages: Tax Breaks and <strong>Wal</strong>-<strong>Mart</strong> Contributions . . . . . . 84<br />
Health Savings Account Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85<br />
Opening Your Health Savings Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85<br />
Contributions to Your Health Savings Account. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86<br />
Paying Expenses Through Your Health Savings Account . . . . . . . . . . . . . . . . . . . . . . . . . . . 89<br />
Investing Your Health Savings Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89<br />
If You Leave the Company or Are No Longer Enrolled in the Freedom Plan . . . . . . . . . 89
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Health Savings Account for Freedom Plan Participants<br />
The health savings account (HSA) offers Freedom Plan participants real savings on qualified<br />
health care expenses.Th<strong>at</strong>’s because you pay for these expenses with tax-free dollars th<strong>at</strong> you<br />
choose to contribute to your account and <strong>Wal</strong>-<strong>Mart</strong>-provided dollars. Once you open your<br />
account, <strong>Wal</strong>-<strong>Mart</strong> makes an autom<strong>at</strong>ic deposit and m<strong>at</strong>ches you contributions dollar for dollar<br />
up to set limits. Depending on the Freedom Plan Annual Deductible you choose, <strong>Wal</strong>-<strong>Mart</strong> contributes<br />
up to $1,200 for individual coverage and up to $2,400 for family coverage.Your account<br />
balance earns interest, and, as the money grows from year to year, you can use it to pay for medical<br />
expenses during retirement.The health savings account helps you with medical bills today<br />
and in the future.<br />
Health Savings Account Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Establish or change<br />
your contribution amount<br />
Open your<br />
health savings account<br />
Log on to the WIRE or<br />
walmartbenefits.com and<br />
click on “<strong>Benefits</strong> Online Enrollment”<br />
You'll receive a welcome packet <strong>at</strong> your home address<br />
directly from your HSA custodian, generally during:<br />
• Early December, if you enroll during Annual Enrollment<br />
• The two to three week period after enrollment if you enroll<br />
<strong>at</strong> any other time<br />
It's your responsibility to w<strong>at</strong>ch for this packet to arrive, review<br />
the m<strong>at</strong>erial, sign the sign<strong>at</strong>ure card, and mail the inform<strong>at</strong>ion<br />
back to your HSA custodian to open your account. If you don't<br />
receive a welcome packet, call your HSA custodian.<br />
You also may open your account online <strong>at</strong><br />
www.hsamember.com or www.myhsa.usbank.com by<br />
completing Electronic sign<strong>at</strong>ure (E-sig). Please note th<strong>at</strong> if you<br />
complete E-sig and do not sign and return the sign<strong>at</strong>ure card,<br />
you will receive a debit card only—you will not receive<br />
a check book.<br />
Call <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362<br />
Health Savings Account<br />
Get a list of qualified medical<br />
expenses (I.R.C.§ 213(d))<br />
walmartbenefits.com or www.hsamember.com<br />
Call your HSA custodian:<br />
ACS/Mellon <strong>at</strong><br />
(800) 358-3494 or<br />
US Bank <strong>at</strong> (800) 358-3494<br />
Wh<strong>at</strong> You Need to Know About the Health Savings Account<br />
• You must be enrolled in the Freedom Plan in order to open a health savings account.<br />
• <strong>Wal</strong>-<strong>Mart</strong> autom<strong>at</strong>ically deposits an initial contribution equal to 20 percent of your Freedom Plan Annual<br />
Deductible amount to your health savings account once you have opened the account. In addition, <strong>Wal</strong>-<strong>Mart</strong><br />
m<strong>at</strong>ches your pre-tax contributions to the account dollar for dollar, up to 20 percent of your Freedom Plan<br />
Annual Deductible amount. You must open your account by December 1, <strong>2008</strong>, or no initial contribution from<br />
<strong>Wal</strong>-<strong>Mart</strong> will be made.<br />
• The health savings account allows you to pay for IRS-determined qualified medical expenses with tax-free dollars.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
83
Health Savings Account<br />
Advantages: Tax Breaks<br />
and <strong>Wal</strong>-<strong>Mart</strong> Contributions<br />
The health savings account offers Freedom Plan<br />
participants:<br />
• The ability to pay for qualified medical expenses with<br />
tax-free dollars through the account. The funds in the<br />
account may be used to pay for non-medical expenses,<br />
however withdrawals for expenses th<strong>at</strong> are not<br />
qualified medical expenses are subject to income tax<br />
and 10 percent additional tax.<br />
• The opportunity to select a health savings account<br />
custodian—-either Mellon or US Bank. Both are<br />
established financial institutions. ACS provides the<br />
administr<strong>at</strong>ion for both custodians.<br />
• An initial contribution from <strong>Wal</strong>-<strong>Mart</strong> equal to 20<br />
percent of the amount of your Freedom Plan Annual<br />
Deductible. Depending on the amount of your<br />
Freedom Plan Annual Deductible, the autom<strong>at</strong>ic<br />
deposit is $250, $500, $600, or $1,200.<br />
• The option to contribute pre-tax dollars to the<br />
account through payroll deductions.<br />
• Additional <strong>Wal</strong>-<strong>Mart</strong> contributions—<strong>Wal</strong>-<strong>Mart</strong><br />
m<strong>at</strong>ches your pre-tax contributions dollar for<br />
dollar, up to 20 percent of your Freedom Plan Annual<br />
Deductible amount.<br />
• Easy access to the money in your account using the<br />
debit card or checks you’ll receive after you open<br />
your account.<br />
• Interest on the balance in your account. Interest<br />
earnings will not be taxed as long as the funds<br />
remain in your account or are spent on qualified<br />
medical expenses. In addition, all HSA withdrawals<br />
for qualified medical expenses are tax-free.<br />
• Investment opportunities for your account balance,<br />
once th<strong>at</strong> balance reaches a certain amount.<br />
Earnings on investments made with your health savings<br />
account funds will not be taxed as long as the<br />
funds remain in the account or are spent on qualified<br />
medical expenses. In addition, all HSA withdrawals<br />
for qualified medical expenses are tax-free.<br />
The balance in your health savings account rolls over<br />
from year to year, increasing your savings for future medical<br />
expenses.You own the balance in your account, and<br />
can save it, invest it in funds offered through your custodian,<br />
or spend it on qualified medical expenses.<br />
84 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Health Savings<br />
Account Eligibility<br />
As a Freedom Plan participant, you are eligible to open a<br />
health savings account unless you are:<br />
• Covered under any other health plan th<strong>at</strong> is<br />
not a qualified high deductible health plan<br />
(Exception — some disease-specific and accident<br />
policies are allowed, such as the Cancer Insurance<br />
Policy and Accident Insurance Policy. In addition,<br />
disability, dental, and vision coverage is allowed);<br />
• Enrolled in Medicare (can be eligible, but not<br />
enrolled); or<br />
• Claimed as a dependent on another person’s tax return.<br />
If you are enrolled in the Accident Insurance Policy, you<br />
are not eligible for the Organ Transplant Rider offered<br />
with the Accident Insurance Policy.<br />
Other restrictions may apply. For further inform<strong>at</strong>ion,<br />
please contact your HSA custodian <strong>at</strong> (800) 358-3494.<br />
The Freedom Plan is a qualified high deductible health<br />
plan (HDHP) subject to ERISA and subject to requirements<br />
of federal law th<strong>at</strong> allow you to contribute to a<br />
health savings account. However, <strong>Wal</strong>-<strong>Mart</strong> intends for<br />
the health savings account to be exempt from ERISA by<br />
complying with the terms of the Department of Labor<br />
Field Assistance Bulletin No 2004-1 and 2006-02.<br />
Accordingly, the health savings account is not established<br />
or administered by <strong>Wal</strong>-<strong>Mart</strong> or the <strong>Associ<strong>at</strong>e</strong>s’<br />
Health and Welfare Plan. Instead the health savings<br />
account is established by the associ<strong>at</strong>e and administered<br />
by ACS on behalf of Mellon or US Bank.<br />
If you have non-qualified high deductible health plan<br />
coverage through <strong>Wal</strong>-<strong>Mart</strong> or any other employer (e.g.,<br />
your spouse’s employer), including a Flexible Spending<br />
Arrangement (FSA) or a Health Reimbursement<br />
Arrangement (HRA), you are generally ineligible to make<br />
health savings account contributions.There are exceptions<br />
to this rule for “limited purpose” FSAs/HRAs, which<br />
can only be used for dental or vision coverage, or for<br />
“post-deductible” FSAs/HRAs, which only provide coverage<br />
after you s<strong>at</strong>isfy the deductible under an HDHP. For<br />
additional inform<strong>at</strong>ion please contact your HSA custodian<br />
<strong>at</strong> (800) 358-3494 or contact your HSA custodian<br />
online (<strong>at</strong> www.hsamember.com or US Bank online <strong>at</strong><br />
www.myhsa.usbank.com).<br />
Opening Your<br />
Health Savings Account<br />
When you enroll online in the Freedom Plan, you<br />
will choose:<br />
• Your health savings account custodian—either<br />
Mellon or U.S. Bank; and<br />
• The amount you want to contribute to your account<br />
through payroll deductions. You may change your<br />
contribution amount <strong>at</strong> any time. See Establishing<br />
and Changing Your Contribution Amount l<strong>at</strong>er in<br />
this chapter.<br />
You’ll receive a welcome packet <strong>at</strong> your home address<br />
directly from the HSA custodian, generally within the<br />
following time frames:<br />
• By December 15, if you enroll during Annual<br />
Enrollment; or<br />
• Within two to three weeks after enrolling in the<br />
Freedom Plan if you enroll <strong>at</strong> any other time.<br />
It’s your responsibility to w<strong>at</strong>ch for this packet to<br />
arrive, review the m<strong>at</strong>erial, sign the sign<strong>at</strong>ure card,<br />
and return the inform<strong>at</strong>ion in the self-addressed<br />
envelope provided.When your HSA custodian receives<br />
this inform<strong>at</strong>ion, your account will be opened and you’ll<br />
receive a checkbook and a debit card.<br />
Health Savings Account<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
85
If you don’t receive a welcome packet by December 15<br />
if you enroll during Annual Enrollment or within two to<br />
three weeks after enrolling in the Freedom Plan if you<br />
enroll <strong>at</strong> any other time, please contact your HSA custodian<br />
online (800) 358-3494 or Mellon online <strong>at</strong><br />
www.hsamember.com or US Bank online <strong>at</strong><br />
www.myhsa.usbank.com.<br />
Once <strong>Wal</strong>-<strong>Mart</strong> receives confirm<strong>at</strong>ion th<strong>at</strong> your account<br />
has been opened, <strong>Wal</strong>-<strong>Mart</strong> will autom<strong>at</strong>ically deposit<br />
an initial contribution of 20 percent of your Freedom<br />
Plan Annual Deductible amount into your account the<br />
following pay period.<br />
Once you have completed your health savings account<br />
deduction selection online, your payroll-deduction<br />
contributions to the account and <strong>Wal</strong>-<strong>Mart</strong>’s m<strong>at</strong>ching<br />
contributions will begin the following pay period.<br />
See When Company Contributions Are Made l<strong>at</strong>er in<br />
this chapter for more inform<strong>at</strong>ion.<br />
Money cannot be deposited into your account until your<br />
HSA custodian receives your online electronic sign<strong>at</strong>ure<br />
or your signed sign<strong>at</strong>ure card.<br />
If you do not open your health savings account<br />
through Mellon or US Bank by December 1, <strong>2008</strong>, you<br />
will forfeit your right to the Company’s contributions for<br />
th<strong>at</strong> year, even if you are covered by a Freedom Plan<br />
during th<strong>at</strong> year.<br />
For the purposes of Company funding and payroll<br />
deductions, you are required to select either Mellon<br />
or U.S. Bank as your health savings account custodian<br />
when you enroll. However, you may move your funds to<br />
anther HSA custodian <strong>at</strong> any time. For any HSA custodian<br />
other than Mellon or U.S. Bank, pre-tax payroll<br />
deductions will not be available, you will not receive<br />
Company contributions, and all health savings account<br />
fees will be your responsibility.<br />
Health Savings Account Fees<br />
The Company will pay the fee to set up your health<br />
savings account and the monthly maintenance fees.<br />
The Company will not pay overdraft, excess contribution,<br />
lost card, or replacement check fees. If you are<br />
enrolled in COBRA, termin<strong>at</strong>e employment with the<br />
Company, or otherwise become ineligible for coverage<br />
under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan, all associ<strong>at</strong>ed fees<br />
will become your responsibility. These fees will be<br />
deducted autom<strong>at</strong>ically from your health savings<br />
account balance if any of these events occur.<br />
Contributions to Your<br />
Health Savings Account<br />
Once you have opened your health savings account,<br />
you and <strong>Wal</strong>-<strong>Mart</strong> make contributions to your account<br />
as follows:<br />
• <strong>Wal</strong>-<strong>Mart</strong> will autom<strong>at</strong>ically deposit an initial contribution<br />
equal to 20 percent of your Freedom Plan<br />
Annual Deductible into your account—you do not<br />
have to make any contributions to your health savings<br />
account to receive this initial contribution.<br />
• You make pre-tax contributions to the<br />
account through payroll deductions in any<br />
amount up to the legal limit (taking into account<br />
<strong>Wal</strong>-<strong>Mart</strong>’s contributions).<br />
• <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ches your pre-tax contributions<br />
dollar for dollar, up to 20 percent of your Freedom<br />
Plan Annual Deductible.<br />
• You also can make personal after-tax contributions<br />
to the account by mailing a check and deposit<br />
coupon to your HSA custodian, subject to the legal<br />
limit on the account. You can then deduct these<br />
amounts from your taxes up to April 15 of the<br />
following year. These after-tax contributions are<br />
not eligible for the <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ching contribution.<br />
86 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Your Contributions and<br />
the Company's Contributions to the Health Savings Account<br />
Your Freedom Plan<br />
Annual Deductible:<br />
$1,250<br />
(<strong>Associ<strong>at</strong>e</strong> Only)<br />
$2,500<br />
(Family coverage)<br />
$3,000<br />
(<strong>Associ<strong>at</strong>e</strong> Only)<br />
$6,000<br />
(Family coverage)<br />
Autom<strong>at</strong>ic Company<br />
Deposit (20 percent of<br />
Your Freedom Plan<br />
Annual Deductible):<br />
The Maximum<br />
(Before-Tax) Amount<br />
You Can Contribute<br />
Each Year:<br />
Company M<strong>at</strong>ching<br />
Contribution—<br />
$1 for $1 up to:<br />
$250 $2,400 $250 $2,900<br />
$500 $4,800 $500 $5,800<br />
$600 $1,700 $600 $2,900<br />
$1,200 $3,400 $1,200 $5,800<br />
Maximum Annual<br />
Contribution Limit<br />
(<strong>Associ<strong>at</strong>e</strong> and<br />
Company Contributions<br />
Combined):<br />
By law, the maximum annual contribution th<strong>at</strong> can be<br />
made to your account, including both the Company’s<br />
contributions and your contributions (pre- and aftertax)<br />
is:<br />
• For <strong>2008</strong>, $2,900 for individual coverage; or<br />
• For <strong>2008</strong>, $5,800 for family coverage.<br />
These amounts are indexed annually by the federal government<br />
and will likely change each year. Please contact<br />
your HSA custodian for questions regarding the contribution<br />
limits. If you are age 55 or older, see If You Are<br />
Age 55 or Older below for special contribution rules.<br />
It’s important to monitor contributions to your health<br />
savings account—there will be adverse tax consequences<br />
if your contributions exceed the annual limit<br />
th<strong>at</strong> has been set by the federal government. <strong>Change</strong>s in<br />
coverage during the year or enrollment after the beginning<br />
of the year can affect your contribution limits.<br />
Contact your HSA custodian for more inform<strong>at</strong>ion.<br />
Earning Interest on<br />
Your Health Savings Account<br />
The balance in your health savings account<br />
earns interest:<br />
• For Mellon, the interest r<strong>at</strong>e is 3.5 percent (effective<br />
January 1, <strong>2008</strong>) and is adjusted twice a year based<br />
on the LIBOR Index.<br />
• For U.S. Bank, the interest r<strong>at</strong>e depends on the<br />
balance in your account:<br />
Earning Interest on<br />
Your HSA Account<br />
Your Account<br />
Balance From:<br />
Earns:<br />
$0–$1,999 2 percent interest<br />
$2,000–$4,999 3 percent interest<br />
$5,000 and over 4 percent interest<br />
Health Savings Account<br />
For example, if you have an HSA account balance of<br />
$2,650, $1,999 of th<strong>at</strong> balance earns 2 percent interest<br />
and the rest of your balance—$651—earns 3<br />
percent interest.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
87
When Company<br />
Contributions Are Made<br />
Annually, the Company will autom<strong>at</strong>ically deposit an initial<br />
contribution equal to 20 percent of your Freedom<br />
Plan Annual Deductible into your health savings account<br />
during the first pay period ending in January, or during<br />
the next pay period after <strong>Wal</strong>-<strong>Mart</strong> receives confirm<strong>at</strong>ion<br />
from your HSA custodian th<strong>at</strong> you have opened your<br />
health savings account.The Company will also m<strong>at</strong>ch<br />
$1 for every $1 th<strong>at</strong> you contribute through payroll<br />
deductions each pay period, up to the Company m<strong>at</strong>ch<br />
limit for your coverage option, as shown in the chart<br />
Your Contributions and the Company’s Contributions<br />
to the Health Savings Account.<br />
Establishing and Changing Your<br />
Contribution Amount<br />
Payroll deductions will not be taken from your payroll<br />
check until after you complete your payroll deduction<br />
selection online and <strong>Wal</strong>-<strong>Mart</strong> receives confirm<strong>at</strong>ion<br />
from your HSA custodian th<strong>at</strong> you have opened your<br />
health savings account.You may change your contribution<br />
amount online <strong>at</strong> any time during the year on a<br />
going-forward basis.<br />
To establish your initial contribution amount or to<br />
change your contribution amount <strong>at</strong> any time, log on<br />
to the WIRE or walmartbenefits.com and click on<br />
<strong>Benefits</strong> Online Enrollment. If you need help setting up<br />
your payroll deductions, please contact <strong>Benefits</strong><br />
Customer Service <strong>at</strong> (800) 421-1362.<br />
If You Are Age 55 or Older<br />
If you are age 55 and older, you can make additional<br />
contributions to your health savings account.These are<br />
called c<strong>at</strong>ch-up contributions and can be made by payroll<br />
deductions just like your normal contribution. For<br />
<strong>2008</strong>, the c<strong>at</strong>ch-up contribution maximum is $900.<br />
If you also cover your spouse under the Freedom Plan<br />
and your spouse is age 55 or older, he or she may also be<br />
eligible to open a second health savings account and<br />
contribute c<strong>at</strong>ch-up contributions.The Company will not<br />
contribute funds or pay any fees associ<strong>at</strong>ed with the<br />
health savings account for your spouse. Please call the<br />
HSA Solution Contact Center <strong>at</strong> (800) 358-3494 for<br />
inform<strong>at</strong>ion on how to open a second health savings<br />
account for your spouse.<br />
88 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Paying Expenses Through<br />
Your Health Savings Account<br />
All funds in your health savings account belong to you<br />
and you may use the funds for wh<strong>at</strong>ever you choose.<br />
However, any funds th<strong>at</strong> are not used for qualified medical<br />
expenses will be subject to income taxes and a 10<br />
percent tax penalty if you are under the age of 65.<br />
Qualified medical expenses generally include medical,<br />
dental, and vision expenses, chiropractic care, and<br />
acupuncture. Please visit walmartbenefits.com or<br />
www.hsamember.com or www.myhsa.usbank.com to<br />
view examples of items generally considered to be medical<br />
expenses under the Internal Revenue Code (I.R.C.§<br />
213(d)). If you have questions about qualified medical<br />
expenses, please contact your HSA custodian, Mellon or<br />
U.S. Bank.<br />
Filing Your Income Tax Return<br />
Each January you will receive a 1099 Form for any distributions<br />
you receive from your health savings account in<br />
the previous calendar year.You should save all of your<br />
medical expense receipts for income tax purposes.<br />
Please consult with a tax advisor or your HSA custodian.<br />
Investing Your<br />
Health Savings Account<br />
Mellon and U.S. Bank both offer investment options<br />
within your health savings account. Once your account<br />
has reached a particular balance, any amount over th<strong>at</strong><br />
balance can be invested in the mutual funds offered <strong>at</strong><br />
no additional cost. Contact your HSA custodian for<br />
more inform<strong>at</strong>ion.<br />
If You Leave the<br />
Company or Are No Longer<br />
Enrolled in the Freedom Plan<br />
The funds in your health savings account belong to<br />
you as the account holder, even if you enroll in COBRA,<br />
change plan options, change jobs, or leave the<br />
Company. In these events (except changing plan<br />
options), all fees associ<strong>at</strong>ed with the account will<br />
become your responsibility.<br />
Health Savings Account<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
89
The Pharmacy Benefit<br />
Where Can I Find<br />
The Pharmacy Benefit for Value and Freedom Plan Participants . . . . . . . . . . . . . . . . . . . . 92<br />
How the Pharmacy Benefit Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92<br />
Pharmacy Discounts for Non-Covered Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94<br />
Filing a Pharmacy Benefit Claim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Pharmacy Benefit<br />
Prescription drugs play a crucial role in tre<strong>at</strong>ing illnesses and, for many of us, maintaining good<br />
health. When Value and Freedom Plan participants purchase prescription drugs or over-thecounter<br />
drugs from WMS/NextRx Network retail or mail-order pharmacies, they take advantage<br />
of discounted Network prices. A 34-day supply of eligible generic drugs costs only a $4 Copay<br />
for Value Plan participants and for Freedom Plan participants who have met their Annual<br />
Deductible.The Pharmacy Benefit helps you get better and stay healthy.<br />
Pharmacy Benefit Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
• Find a Network pharmacy<br />
• Get the list of<br />
Preferred Brand Name Drugs<br />
Get the list of medic<strong>at</strong>ions<br />
th<strong>at</strong> require the collection of<br />
additional inform<strong>at</strong>ion<br />
Go to the WIRE or<br />
walmartbenefits.com<br />
Go to the WIRE or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About the Pharmacy Benefit<br />
• The Pharmacy Benefit applies to the Value Plan and the Freedom Plan. <strong>Associ<strong>at</strong>e</strong>s enrolled in an HMO Plan<br />
receive pharmacy benefits through their HMO.<br />
• You must use a Network pharmacy or no benefits will be paid.<br />
Call WMS/NextRx <strong>at</strong><br />
(877) 850-0185<br />
Call WMS/NextRx <strong>at</strong><br />
(877) 850-0185<br />
The Pharmacy Benefit<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
91
The Pharmacy Benefit for Value<br />
and Freedom Plan Participants<br />
The <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan covers eligible prescriptions<br />
from both retail and mail order Network pharmacies.You<br />
are entitled to prescription coverage the d<strong>at</strong>e your medical<br />
coverage is effective.You should present your<br />
Pharmacy or <strong>Benefits</strong> ID card <strong>at</strong> a Network pharmacy.<br />
You must use a Network pharmacy or no benefits will<br />
be paid. Visit walmartbenefits.com to find<br />
inform<strong>at</strong>ion about:<br />
• Retail Network pharmacies;<br />
• Mail order Network pharmacies; and<br />
• Preferred Brand Name and Non-Preferred Brand<br />
Name Drugs.<br />
You can also call WMS/NextRx <strong>at</strong> (877) 850-0185.<br />
How the<br />
Pharmacy Benefit Works<br />
• As a Value Plan participant, you can purchase eligible<br />
prescriptions by paying the Copays shown in the<br />
Value Plan Pharmacy Benefit chart. Your <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan health care credit may not be used to<br />
purchase prescriptions.<br />
• As a Freedom Plan participant, you will pay full price<br />
for your prescriptions until you meet your medical<br />
Annual Deductible. Once you have met your medical<br />
Annual Deductible, you will pay the Copays shown in<br />
the Freedom Plan Pharmacy Benefit chart.<br />
For both Value Plan and Freedom Plan participants, once<br />
the medical Out-of-Pocket Maximum is reached, eligible<br />
prescriptions will be paid <strong>at</strong> 100%.<br />
The Value Plan Pharmacy Benefit<br />
Value Plan participants can purchase eligible prescriptions by paying the Copays below.<br />
Your <strong>Associ<strong>at</strong>e</strong>s' Medical Plan health care credit may not be used to purchase prescriptions.<br />
The Copays will be applied toward the annual medical Out-of-Pocket Maximum.<br />
Retail Prescriptions<br />
Each Copay covers up to a 34-day supply of an eligible prescription. Refills are available after 66 percent of your<br />
previous prescription for the same drug has been used.<br />
Generic Drugs $4<br />
Preferred Brand Name Drugs<br />
Non-Preferred Brand Name Drugs<br />
$30 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
$50 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
Mail Order Prescriptions<br />
If you order 1-34 days of medic<strong>at</strong>ion through the mail, you will pay the retail Copay amounts.You are unable to order 35-69 days<br />
of medic<strong>at</strong>ion through the mail. If you order 70-90 days of medic<strong>at</strong>ion through the mail, you will pay the mail order Copay<br />
amounts.<br />
Generic Drugs $8<br />
Preferred Brand Name Drugs<br />
Non-Preferred Brand Name Drugs<br />
$60 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
$100 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
1<br />
The allowed cost of a drug is determined by the <strong>Associ<strong>at</strong>e</strong>s' Medical Plan.<br />
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Your Copay will never be more than the cost of the<br />
drug submitted to the plan. If the cost is less than the<br />
Copay, you will be charged either the retail Network<br />
r<strong>at</strong>e or the Usual, Customary and Reasonable price<br />
th<strong>at</strong> is charged by the retail pharmacies under their<br />
agreement with the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan’s pharmacy<br />
benefits manager, WMS/NextRx. The Copay for a<br />
compound prescription will be determined by the<br />
primary ingredient of the compound.<br />
Types of Drugs<br />
Generic Drug—When a brand name drug’s p<strong>at</strong>ent<br />
expires, generic versions of the drug may become available.<br />
Generic versions work like the brand name drug in<br />
dosage, strength, performance and use, and must meet<br />
the same quality and safety standards. All generic drugs<br />
must be reviewed by the FDA. For more inform<strong>at</strong>ion, visit<br />
walmartbenefits.com.<br />
The Freedom Plan Pharmacy Benefit<br />
Preferred Brand Name Drug—A drug th<strong>at</strong> has been<br />
evalu<strong>at</strong>ed for safety and effectiveness when compared<br />
to similar drugs and th<strong>at</strong> is on a continually upd<strong>at</strong>ed list<br />
of drugs encouraged to be used for tre<strong>at</strong>ment of diseases<br />
and the promotion of health. For a list of Preferred<br />
Brand Name Drugs, visit walmartbenefits.com.<br />
Non-Preferred Brand Name Drug—A drug th<strong>at</strong> is not<br />
on a Preferred Brand Name Drug list. For more inform<strong>at</strong>ion,<br />
visit walmartbenefits.com.<br />
Specialty Drug—Specialty drugs are pharmaceuticals<br />
th<strong>at</strong> target and tre<strong>at</strong> specific chronic or genetic conditions.<br />
Specialty drugs include biopharmaceuticals (bioengineered<br />
proteins), blood-derived products, and complex<br />
molecules.They are available in oral, injectable, or<br />
infused forms.<br />
Freedom Plan participants will pay full price for prescriptions until the medical Annual Deductible is met.<br />
Once the medical Annual Deductible is met, the Copays shown below will apply.The Copays will be applied<br />
toward the annual medical Out-of-Pocket Maximum.<br />
Retail Prescriptions<br />
Each Copay covers up to a 34-day supply of an eligible prescription. Refills are available after 66 percent of your previous<br />
prescription for the same drug has been used.<br />
Generic Drugs $4<br />
The Pharmacy Benefit<br />
Preferred Brand Name Drugs<br />
Non-Preferred Brand Name Drugs<br />
$30 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
$50 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
Mail Order Prescriptions<br />
If you order 1-34 days of medic<strong>at</strong>ion through the mail, you will pay the retail Copay amounts.You are unable to<br />
order 35-69 days of medic<strong>at</strong>ion through the mail. If you order 70-90 days of medic<strong>at</strong>ion through the mail, you will pay<br />
the mail order Copay amounts.<br />
Generic Drugs $8<br />
Preferred Brand Name Drugs<br />
Non-Preferred Brand Name Drugs<br />
$60 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
$100 or 20 percent of the allowed cost 1 , whichever is gre<strong>at</strong>er<br />
1<br />
The allowed cost of a drug is determined by the <strong>Associ<strong>at</strong>e</strong>s' Medical Plan.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
93
Eligible Diabetic and Allergy Supplies<br />
Eligible diabetic and allergy supplies are covered<br />
through The Pharmacy Benefit.You may submit your<br />
supply claims on paper forms to WMS/NextRx. If it is an<br />
eligible claim, it will be paid in accordance with Plan<br />
terms through The Pharmacy Benefit. Please call<br />
WMS/NextRx <strong>at</strong> (877) 850-0185 to obtain a claim form<br />
or visit the WIRE or walmartbenefits.com.Your claim<br />
will be processed according to the terms set out in the<br />
Claims and Appeals chapter.<br />
Medic<strong>at</strong>ions Th<strong>at</strong> Require<br />
Additional Inform<strong>at</strong>ion<br />
Certain medic<strong>at</strong>ions require the collection of<br />
additional inform<strong>at</strong>ion by WMS/NextRx before the<br />
medic<strong>at</strong>ion is covered by the Pharmacy Benefit. A<br />
list of these medic<strong>at</strong>ions can be found on the WIRE or<br />
walmartbenefits.com. If this inform<strong>at</strong>ion is not collected<br />
<strong>at</strong> the time you fill your prescription, you may<br />
still choose to have the prescription filled, but you will<br />
be responsible for 100 percent of the cost. If you<br />
fill the prescription <strong>at</strong> your own expense, or if you<br />
disagree with the amount you paid, you may file a<br />
claim with WMS/NextRx. If it is an eligible claim, it<br />
will be paid in accordance with Plan terms through<br />
the Pharmacy Benefit. Please call WMS/NextRx <strong>at</strong><br />
(877) 850-0185 to obtain a claim form or visit<br />
the WIRE or walmartbenefits.com. Your claim will be<br />
processed according to the terms set out in the<br />
Claims and Appeals chapter.<br />
Pharmacy Discounts<br />
for Non-Covered Prescriptions<br />
<strong>Associ<strong>at</strong>e</strong>s enrolled in the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan are<br />
eligible to particip<strong>at</strong>e in the Pharmacy Discount.The<br />
Pharmacy Discount allows participants to use their pharmacy<br />
or <strong>Benefits</strong> ID card to receive, on average, a 20 percent<br />
discount on all prescriptions not covered under the<br />
Pharmacy Benefit. Actual discounts may vary from the 20<br />
percent average, depending on the prescription. Any<br />
prescriptions purchased with the Pharmacy Discount will<br />
not count toward the medical Annual Deductible or<br />
Out-of-Pocket Maximum.<br />
To use the Pharmacy Discount, present your pharmacy<br />
or <strong>Benefits</strong> ID card to the pharmacist. If the prescription<br />
is covered by the Pharmacy Benefit, the corresponding<br />
Copay will apply. If the prescription is not covered by<br />
the Pharmacy Benefit, the Pharmacy Discount will autom<strong>at</strong>ically<br />
discount the cost of the drug. If the prescription<br />
is covered under the AMP but is being filled too<br />
soon, prescribed for off-label use, or does not follow<br />
other similar plan terms, the Pharmacy Discount will<br />
not apply. Contact WMS/NextRx <strong>at</strong> (877) 850-0185 for<br />
more inform<strong>at</strong>ion.<br />
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Filing a Pharmacy Benefit Claim<br />
When you use a Network pharmacy or the mail order<br />
service, you will not need to file a claim. However, if you<br />
are unable to use your card <strong>at</strong> a Network pharmacy or if<br />
you disagree with the amount you paid, you may file a<br />
claim in writing with WMS/NextRx. If it is an eligible prescription,<br />
it will be paid in accordance with plan terms<br />
through the Pharmacy Benefit. Please call WMS/NextRx<br />
<strong>at</strong> (877) 850-0185 to obtain a claim form or visit<br />
the WIRE or walmartbenefits.com.Your claim will be<br />
processed according to the terms set out in the<br />
Claims and Appeals chapter.<br />
You will have a right to appeal a denied claim.Your<br />
appeal will be processed according to the terms set our<br />
in the Claims and Appeals chapter.<br />
The Pharmacy Plan does not coordin<strong>at</strong>e benefits with<br />
respect to prescription drug claims. If any portion of a<br />
prescription drug claim is paid by another health plan or<br />
insurance provider, the Plan will not pay any amount of<br />
the pharmacy benefit claim.<br />
The Pharmacy Benefit<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
95
The Dental Plan<br />
Where Can I Find<br />
Your Dental Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98<br />
How the Dental Plan Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98<br />
Filing a Dental Plan Claim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100<br />
When Dental Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100<br />
Wh<strong>at</strong>’s Covered Under the Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101<br />
Limited <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103<br />
Wh<strong>at</strong> is Not Covered Under the Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
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The Dental Plan<br />
The Dental Plan provides coverage for a wide range of dental services.The plan also offers you<br />
the option to use a Delta Dental Network dentist and pay less for care.Your teeth are an important<br />
part of your overall health.You pay no deductible for preventive and orthodontic services<br />
and when you use Network dentists, you’ll save money on dental care costs while protecting<br />
one of your most valuable personal and professional assets—your smile.<br />
The Dental Plan Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get a listing of<br />
Delta Dental Preferred (PPO)<br />
and Delta Dental Premier dentists<br />
www.deltadental.com or<br />
on the WIRE, select the “Life” tab then<br />
“My Health”, then “Network Directories” or<br />
walmartbenefits.com, select<br />
the “My Health” tab then “Dental Network<br />
Directories”<br />
Call Delta Dental <strong>at</strong><br />
(800) 462-5410 or<br />
The <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362<br />
Get answers to questions<br />
about your dental claims and<br />
to call Delta Dental Customer Service<br />
Get a claim form if you<br />
use a nonparticip<strong>at</strong>ing dentist<br />
www.deltadentalar.com and select<br />
“Subscriber” to cre<strong>at</strong>e your account<br />
on the WIRE, select the “Life” tab or<br />
walmartbenefits.com, select<br />
the “My Health” tab<br />
Delta Dental <strong>at</strong> (800) 462-5410<br />
The Dental Plan<br />
Wh<strong>at</strong> You Need to Know about the Dental Plan<br />
• Dental Plan coverage is available to Full-Time hourly associ<strong>at</strong>es, Full-Time Truck Drivers, and management<br />
associ<strong>at</strong>es and their Eligible Dependents.<br />
• Dental Plan coverage remains in effect for two full calendar years.<br />
• Major care and orthodontia assistance are covered after a 12-month waiting period.<br />
• Once you meet the Annual Deductible, the plan pays benefits of up to $1,100 per covered person and a<br />
lifetime maximum orthodontia benefit of $750 per covered person. The Annual Deductible does not apply<br />
for preventive or orthodontic services.<br />
• Claims are reviewed by dental consultants to help assure th<strong>at</strong> the tre<strong>at</strong>ment provided meets the guidelines<br />
of this policy.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
97
Your Dental Plan Options<br />
As a Full-Time hourly associ<strong>at</strong>e, Full-Time Truck Driver, or<br />
management associ<strong>at</strong>e, you are eligible to enroll in the<br />
Dental Plan.<br />
Please note th<strong>at</strong> once you enroll in the Dental Plan, your<br />
coverage must remain in effect for two full calendar<br />
years. For example, if you enroll on July 1, 2007, your coverage<br />
must remain in effect until December 31, 2009.You<br />
can add or remove an Eligible Dependent during the<br />
Annual Enrollment period or due to a St<strong>at</strong>us <strong>Change</strong><br />
Event (see the Eligibility and Enrollment chapter).<br />
However, you must maintain a minimum of associ<strong>at</strong>eonly<br />
coverage for two full calendar years.<br />
When you enroll in the Dental Plan, you also select the<br />
eligible family members you wish to cover:<br />
• <strong>Associ<strong>at</strong>e</strong> Only<br />
• <strong>Associ<strong>at</strong>e</strong> + Spouse<br />
• <strong>Associ<strong>at</strong>e</strong> + Children<br />
• Family<br />
For inform<strong>at</strong>ion on dependent eligibility and when<br />
dependents can be enrolled, see the Eligibility and<br />
Enrollment chapter.<br />
The Dental Plan benefit is self-insured. Self-insured<br />
means th<strong>at</strong> there is no insurance company to collect premiums<br />
or pay bills. Instead, particip<strong>at</strong>ing associ<strong>at</strong>es make<br />
contributions each pay period to cover a portion of the<br />
cost of the dental benefit and the Company or the Plan’s<br />
trust pays the rest. Claims are processed by Delta Dental<br />
of Arkansas, Inc.<br />
How the Dental Plan Works<br />
The Dental Plan covers four types of dental services:<br />
• Preventive and diagnostic care: you do not have to<br />
meet the Annual Deductible ($50 per person/$150<br />
maximum deductible per family) before benefits for<br />
preventive and diagnostic care begin. However,<br />
charges you incur for preventive and diagnostic care<br />
will not apply toward your Annual Deductible.<br />
• General care includes fillings, non-surgical periodontics,<br />
and root canal therapy and is covered after you<br />
meet the Annual Deductible.<br />
• Coverage for major care, which includes surgical<br />
periodontics, crowns and dentures, begins after you<br />
have particip<strong>at</strong>ed in the Dental Plan for 12 months<br />
and have met the Annual Deductible.<br />
• Orthodontia assistance coverage begins after you<br />
have particip<strong>at</strong>ed in the Dental Plan for 12 months;<br />
you do not have to meet the Annual Deductible<br />
before receiving benefits for orthodontia care.<br />
However, charges you incur for orthodontia care will<br />
not apply toward your Annual Deductible.<br />
After you have met the Annual Deductible (if applicable<br />
for the service you received) and completed any<br />
applicable waiting periods, the Plan pays a percentage<br />
of the Maximum Allowable Charge (MAC) for<br />
Covered Expenses.<br />
The MAC is the maximum amount of payment for covered<br />
services based on the applicable reimbursement<br />
schedules as determined by Delta Dental. Delta Dental<br />
Network providers (Delta Dental Preferred (PPO) and<br />
Delta Dental Premier dentists) agree to accept the MAC<br />
as payment in full, subject to the Annual Deductible and<br />
Coinsurance amounts. Non-Network providers may<br />
charge more than the MAC.You will be responsible for<br />
any amount charged above the MAC.<br />
The Plan pays benefits for Covered Expenses until you<br />
reach the maximum benefit limit, which is $1,100 per<br />
covered person per calendar year.<br />
This does not apply to orthodontia assistance which has<br />
a separ<strong>at</strong>e lifetime maximum benefit of $750 per covered<br />
person.<br />
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Know Wh<strong>at</strong> You’ll Owe:<br />
Get a Pretre<strong>at</strong>ment Estim<strong>at</strong>e<br />
You can find out how much the Dental Plan will pay for<br />
a procedure before the dental work is done by having<br />
your dentist submit a pretre<strong>at</strong>ment estim<strong>at</strong>e to Delta<br />
Dental. Delta Dental will inform you of the amount th<strong>at</strong><br />
will be covered under the plan and suggest an altern<strong>at</strong>e<br />
tre<strong>at</strong>ment plan if a part of your dentist’s initial tre<strong>at</strong>ment<br />
plan is ineligible for coverage. Mail pretre<strong>at</strong>ment<br />
estim<strong>at</strong>es to:<br />
Delta Dental of Arkansas<br />
P.O. Box 15965<br />
North Little Rock, AR 72231-5965<br />
You still must file a claim under the procedures set out in<br />
the Claims and Appeals chapter.This is not a guarantee<br />
of payment.<br />
Save Money by<br />
Using Network Dentists<br />
As a Dental Plan participant, you can use any dentist and<br />
receive benefits for Covered Expenses under the plan.<br />
However, you will save money and time when you use<br />
Delta Dental Preferred (PPO) or Delta Dental Premier<br />
dentists.You’ll save money because Network dentists will<br />
not charge more than the MAC for their services and<br />
also provide Delta Dental participants with discounted<br />
prices.You’ll save time because Network dentists will<br />
often file your claims for you.<br />
The Delta Dental Preferred (PPO) Network of dentists is<br />
available in some st<strong>at</strong>es.To find a Delta Dental Preferred<br />
(PPO) or Delta Dental Premier dentist near you, see<br />
Dental Plan Resources <strong>at</strong> the beginning of this chapter.<br />
Dental Plan <strong>Benefits</strong><br />
Annual Deductible<br />
Maximum <strong>Benefits</strong><br />
Preventive and Diagnostic Care<br />
$50 per person/$150 maximum Annual Deductible per family<br />
$1,100 per covered person per calendar year.<br />
This does not apply to orthodontia assistance.<br />
Delta Dental Preferred<br />
(PPO) Dentists<br />
100 percent covered;<br />
no Annual Deductible<br />
applies<br />
Delta Dental Premier<br />
Dentists<br />
80 percent of MAC;<br />
no Annual Deductible<br />
applies<br />
Non-Network Dentists<br />
80 percent of MAC;<br />
no Annual Deductible<br />
applies<br />
The Dental Plan<br />
General Care<br />
80 percent of MAC after Annual Deductible is met<br />
Major Care (12-month wait)<br />
Orthodontia Assistance (12-month wait)<br />
70 percent of MAC after Annual Deductible is met<br />
80 percent of MAC up to $750 lifetime maximum orthodontia benefit per<br />
person; no Annual Deductible applies<br />
It Pays to Use Network Dentists<br />
Delta Dental<br />
Preferred (PPO)<br />
Dentists<br />
Delta Dental<br />
Premier Dentists<br />
Dentist often files claim forms for you Yes Yes No<br />
Non-Network<br />
Dentists<br />
Dentist accepts the MAC (Maximum Allowable Charge)<br />
as payment in full, subject to Annual Deductible and<br />
Coinsurance amounts<br />
Dentist offers discounted prices for<br />
Delta Dental participants<br />
Yes Yes No<br />
Yes Yes No<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
99
Filing a Dental Plan Claim<br />
If you use a Delta Dental Network dentist, your dentist<br />
will often file the claim for you. If you use a non-Network<br />
dentist, you may need to file a claim.The dentist may be<br />
paid directly from the Dental Plan if the dentist is a Delta<br />
Dental Network dentist. If you use a non-Network dentist,<br />
the payment will be made to you.<br />
You or your dental provider must file a claim within 12<br />
months (18 months if you have other Dental Plan coverage<br />
and must coordin<strong>at</strong>e benefits with your other plan)<br />
or your claim will be denied. Please mail your claim to:<br />
Delta Dental of Arkansas<br />
P.O. Box 15965<br />
N. Little Rock, AR 72231-5965<br />
Failure to mail your claim to the correct address may<br />
result in the denial of your claim.<br />
Claims will be determined under the time frames and<br />
requirements set out in the Claims and Appeals chapter.You<br />
have the right to appeal a claim denial. See the<br />
Claims and Appeals chapter for more inform<strong>at</strong>ion.<br />
If You or a Family Member Has Coverage<br />
Under More Than One Dental Plan<br />
If you have coverage under more than one Dental<br />
Plan—for example, you have coverage under the AHWP<br />
and your spouse’s employer’s Dental Plan—the coordin<strong>at</strong>ion<br />
of benefits provisions described in If You Have<br />
Coverage Under More Than One Health Care Plan in<br />
the Medical chapter apply to and govern the coordin<strong>at</strong>ion<br />
of dental coverage benefits. Dental benefits will not<br />
exceed annual or lifetime maximums.<br />
When Dental Coverage Ends<br />
Your coverage and your dependent’s coverage ends on<br />
your last day of employment. All benefits cease on the<br />
d<strong>at</strong>e coverage ends, except for completion of oper<strong>at</strong>ive<br />
procedures in progress <strong>at</strong> the time coverage ends.<br />
Oper<strong>at</strong>ive procedures are defined as, and limited to, individual<br />
crowns, dentures, and bridges and are considered<br />
in progress only if all procedures for commencement of<br />
lab work have been completed and all oper<strong>at</strong>ive procedures<br />
are completed within 45 days of termin<strong>at</strong>ion.<br />
See the Eligibility and Enrollment chapter for a complete<br />
list of e vents th<strong>at</strong> may cause coverage to end.<br />
See the COBRA chapter for inform<strong>at</strong>ion regarding<br />
COBRA Continu<strong>at</strong>ion Coverage.<br />
If You Leave the Company<br />
If you leave the Company, you may be entitled to<br />
continue your dental coverage under COBRA. For more<br />
inform<strong>at</strong>ion, see the COBRA chapter.<br />
If you return to an Actively-At-Work st<strong>at</strong>us for the<br />
Company within 30 days, you will autom<strong>at</strong>ically be reenrolled<br />
for the same coverage options you had when<br />
you left.Your time previously enrolled will apply toward<br />
your one-year waiting period for major care and orthodontia<br />
assistance if it has not already been s<strong>at</strong>isfied.<br />
You will be credited for amounts already paid toward<br />
your Annual Deductible, and the time you were enrolled<br />
will count toward applicable one-year waiting periods.<br />
If you do not return to an Actively-At-Work st<strong>at</strong>us for the<br />
Company within 30 days, you will be considered newly<br />
eligible and will be subject to applicable waiting periods<br />
and limit<strong>at</strong>ions mentioned earlier in this chapter and in<br />
the Eligibility and Enrollment chapter, unless you had<br />
COBRA coverage during the entire period you were gone.<br />
If You Are on a Leave of Absence<br />
You may continue your coverage up to the last day<br />
of an approved Leave of Absence, provided you pay<br />
your premiums.<br />
If your coverage is canceled due to nonpayment of premiums<br />
and you return to Actively-At-Work st<strong>at</strong>us within<br />
one year, you will autom<strong>at</strong>ically be enrolled for the same<br />
coverage options.You will be credited for amounts<br />
already paid toward your Annual Deductible, and the<br />
time you were enrolled will count toward applicable<br />
one-year waiting periods.Your coverage will be effective<br />
the first day of the pay period th<strong>at</strong> you meet the Actively-<br />
At-Work requirement. If you return after one year, you<br />
will be considered newly eligible and you will have a<br />
one-year wait for major care and orthodontia assistance.<br />
Special rules may apply if you are on or return from<br />
an FMLA or Military Leave of Absence. See the<br />
Eligibility and Enrollment chapter for more inform<strong>at</strong>ion.<br />
100 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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Wh<strong>at</strong>’s Covered<br />
Under the Dental Plan<br />
The Dental Plan covers the services listed in this section.<br />
There are some limit<strong>at</strong>ions. If you have any questions<br />
about wh<strong>at</strong> is and wh<strong>at</strong> is not covered under the plan,<br />
please call Delta Dental <strong>at</strong> (800) 462-5410.<br />
Preventive and Diagnostic Care<br />
Preventive and diagnostic care is covered without having<br />
to meet the Annual Deductible.<br />
Bitewing or Periapical X-Rays: Up to four X-rays in any<br />
12-month period. Additional periapical X-rays are covered<br />
when ordered in conjunction with palli<strong>at</strong>ive tre<strong>at</strong>ment<br />
or emergency exams. Bitewing X-rays are not a<br />
benefit when done within 12 months of a full-mouth<br />
series X-rays. Only one periapical X-ray will be allowed on<br />
the same day as a root canal. Any additional periapicals<br />
will be disallowed.<br />
Complete Mouth Survey or Panoramic X-Rays:<br />
Limited to one procedure in any 60-month period.<br />
A full-mouth series is any combin<strong>at</strong>ion of 10 or<br />
more periapical and/or bitewing X-rays taken on<br />
the same d<strong>at</strong>e.<br />
Cleaning (dental prophylaxis): One prophylaxis, including<br />
cleaning, scaling, and polishing of the teeth, is covered<br />
twice during a calendar year.<br />
Fluoride Tre<strong>at</strong>ment: Covered once in any 12-month<br />
period for participants under age 19.<br />
Oral Evalu<strong>at</strong>ion: Two oral evalu<strong>at</strong>ions during a calendar<br />
year. Coverage amount will be based on the amount<br />
payable for a periodic oral evalu<strong>at</strong>ion. Emergency evalu<strong>at</strong>ions<br />
performed by dentists are not subject to the calendar<br />
year restriction, provided no other services<br />
(excluding periapical X-rays) were administered th<strong>at</strong> day.<br />
Sealants: Covered for unrestored occlusal surface, first<br />
and second permanent molars for participants under age<br />
19. Limited to one tre<strong>at</strong>ment per tooth every five years.<br />
Space Maintainers: Covered for participants under<br />
age 19.<br />
General Care<br />
After you meet the Annual Deductible,<br />
the Plan pays 80 percent of the Maximum Allowable<br />
Charge (up to the maximum benefit) for general care.<br />
Amalgam Fillings: <strong>Benefits</strong> are payable once per tooth<br />
surface in any consecutive 24-month period.<br />
Composite Resin Fillings: Restor<strong>at</strong>ions th<strong>at</strong> involve<br />
either the mesial or distal surface will be considered single-surface<br />
restor<strong>at</strong>ions unless the incisal angle is also<br />
involved. <strong>Benefits</strong> for the replacement of an existing composite<br />
resin filling are payable only if <strong>at</strong> least 24 months<br />
have passed since the existing filling was placed. <strong>Benefits</strong><br />
for composite resin fillings for molar teeth will be based<br />
on the benefit for the corresponding amalgam filling.<br />
Endodontics: Includes pulp therapy and root canal therapy.<br />
See Root Canal Therapy in Limited <strong>Benefits</strong> l<strong>at</strong>er<br />
in this chapter.<br />
Extractions: Simple extractions.<br />
Periodontic Maintenance: Periodontal prophylaxis is<br />
covered only if done 180 days after the completion of<br />
active periodontal tre<strong>at</strong>ment.Thereafter, periodontal<br />
prophylaxis is allowed once every 180 days.<br />
Prescription Drugs and Medicines: Written for dental<br />
purposes and dispensed by a licensed pharmacist.<br />
Major Care<br />
Coverage for major care is available after you complete a<br />
12-month waiting period as a participant in the Dental<br />
Plan. After you meet the Annual Deductible, the Plan<br />
pays 70 percent of the Maximum Allowable Charge (up<br />
to the maximum benefit) for major care.<br />
Crowns, Cast Restor<strong>at</strong>ions, Inlays, and Onlays:<br />
Covered only when the tooth cannot be restored by<br />
amalgam or composite resin filling.<br />
• Replacement will not be covered unless the existing<br />
crown, cast restor<strong>at</strong>ion, inlay, or onlay is more than<br />
seven years old and cannot be repaired. NOTE:<br />
Accidents as a result of biting or chewing are not<br />
an exception to the seven-year wait for crown<br />
replacements.<br />
The Dental Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
101
• Crown benefits are based on the amount payable<br />
for predominantly base metal substr<strong>at</strong>es.<br />
• For participants under age 19, benefits for<br />
crowns on vital teeth are limited to resin or<br />
stainless steel crowns.<br />
• Tre<strong>at</strong>ment is determined according to the altern<strong>at</strong>e<br />
tre<strong>at</strong>ment plan limit<strong>at</strong>ion. See Altern<strong>at</strong>ive Tre<strong>at</strong>ment<br />
Plan Limit<strong>at</strong>ion in Limited <strong>Benefits</strong> l<strong>at</strong>er in this<br />
chapter.<br />
Complete and Partial Removable Dentures: When<br />
altern<strong>at</strong>e tre<strong>at</strong>ment plans are available, the Plan will<br />
cover the least costly professionally s<strong>at</strong>isfactory course of<br />
tre<strong>at</strong>ment. For example, a bridge will be allowed only<br />
when a partial denture will not suffice.<br />
General Anesthetics and IV Sed<strong>at</strong>ion: Provided for<br />
eligible participants:<br />
• Under age four; or<br />
• In connection with certain covered oral surgical<br />
procedures; or<br />
• When Medically Necessary.<br />
Implants:<br />
Endosteal implants are covered once in a<br />
lifetime per tooth<br />
The surgical placement of an implant body is covered<br />
once in every seven consecutive year period<br />
The abutment to support a crown is covered once in<br />
every seven consecutive year period<br />
An implant supported retainer is covered once in every<br />
seven consecutive year period<br />
Implant maintenance procedure is covered once in any<br />
12 consecutive months<br />
Implant removal is covered once in a lifetime per tooth<br />
Oral Surgery: Surgical extractions and extractions of<br />
wisdom teeth. Includes preoper<strong>at</strong>ive and postoper<strong>at</strong>ive<br />
care, except for those services covered under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan. Oral sed<strong>at</strong>ion and/or nitrous<br />
oxide (analgesia) is not covered.<br />
Outp<strong>at</strong>ient or Inp<strong>at</strong>ient Hospital Costs and<br />
Additional Fees Charged by the Dentist for Hospital<br />
Tre<strong>at</strong>ment: See Hospital Charges in Limited <strong>Benefits</strong><br />
l<strong>at</strong>er in this chapter. All charges and fees are subject to<br />
the $1,100 maximum benefit per participant.<br />
Partial Fixed Bridgework: See Prosthetics and<br />
Altern<strong>at</strong>ive Tre<strong>at</strong>ment Plan Limit<strong>at</strong>ion in Limited<br />
<strong>Benefits</strong> l<strong>at</strong>er in this chapter.<br />
Surgical Periodontics: Tre<strong>at</strong>ment of the gums. Osseous<br />
surgery/soft tissue graft, provided in same arch once in<br />
any consecutive 36-month period.<br />
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Orthodontia Assistance<br />
After you have been a participant in the Dental Plan for<br />
12 months, you are eligible for orthodontia assistance for<br />
yourself (the associ<strong>at</strong>e), your spouse, and your Eligible<br />
Dependent children under age 19, or up to their 23rd<br />
birthday if they are a full-time student. <strong>Benefits</strong> are paid<br />
<strong>at</strong> 80 percent of the MAC, up to a lifetime benefit of $750<br />
per person for both Network (Delta Dental Preferred and<br />
Delta Dental Premier) and non-Network dentists. Keep in<br />
mind th<strong>at</strong> a non-Network dentist may bill you for<br />
amounts above MAC, while a Network dentist agrees to<br />
accept MAC as payment in full, subject to Annual<br />
Deductible and Coinsurance amounts.<br />
If the dentist submits a st<strong>at</strong>ement <strong>at</strong> the beginning of a<br />
period of orthodontic tre<strong>at</strong>ment showing a single<br />
charge for the entire tre<strong>at</strong>ment, benefits will be paid in<br />
the following manner:<br />
• The dentist will receive an initial payment of up<br />
to $150.<br />
• A pro-r<strong>at</strong>ed portion of the remainder will be paid<br />
every three months based on the estim<strong>at</strong>ed period<br />
for tre<strong>at</strong>ment and on continued eligibility.<br />
• The amount and number of payments are subject to<br />
change if the charge or tre<strong>at</strong>ment period changes.<br />
There are certain orthodontia assistance benefits th<strong>at</strong><br />
are not covered. See Wh<strong>at</strong> is Not Covered Under the<br />
Dental Plan l<strong>at</strong>er in this chapter.<br />
Limited <strong>Benefits</strong><br />
Altern<strong>at</strong>e tre<strong>at</strong>ment plans: When altern<strong>at</strong>e tre<strong>at</strong>ment<br />
plans are available, the Plan will cover the least costly<br />
professionally s<strong>at</strong>isfactory course of tre<strong>at</strong>ment.<br />
Hospital Charges: Outp<strong>at</strong>ient or inp<strong>at</strong>ient Hospital<br />
charges and any additional fees charged by the dentist<br />
are covered if incurred in conjunction with covered dental<br />
tre<strong>at</strong>ment and if a medical condition requires th<strong>at</strong> the<br />
tre<strong>at</strong>ment be provided in a Hospital. Emergency room<br />
charges incurred for tooth pain or an abscessed tooth<br />
are covered. If such charges or fees are incurred, then the<br />
dentist will be paid first.<br />
Prosthetics: The Plan covers the replacement or addition<br />
of teeth to dentures, partials, or fixed bridgework<br />
when needed if additional functional teeth are extracted<br />
while coverage is in effect.<br />
• A denture th<strong>at</strong> replaces another denture or fixed<br />
bridge, or a fixed bridge th<strong>at</strong> replaces another fixed<br />
bridge, will not be covered until you have been covered<br />
under the Plan for two continuous years.<br />
• The replacement of a complete or partial denture<br />
will be covered only if the existing denture or partial<br />
is <strong>at</strong> least five years old and cannot be repaired.<br />
• The replacement of a fixed bridge will be covered<br />
only if the existing bridge is <strong>at</strong> least seven years old<br />
and cannot be repaired.<br />
Root Canal Therapy: Includes bacteriological cultures,<br />
diagnostic tests, local anesthesia, and routine follow-up<br />
care. Payable once per tooth.<br />
Only one periapical X-ray will be allowed on the<br />
same day as a root canal. Any additional periapicals<br />
will be disallowed.<br />
Therapeutic pulpotomy is payable for deciduous<br />
teeth only.<br />
Retre<strong>at</strong>ment of a previous root canal is allowed once in a<br />
24-month period.<br />
Surgical/Nonsurgical Periodontics: Provided once in<br />
any consecutive 36-month period.<br />
The Dental Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
103
Transfer of Tre<strong>at</strong>ment: If you transfer from the care of<br />
one dentist to another during the course of tre<strong>at</strong>ment,<br />
or if more than one dentist renders services for one<br />
dental procedure, the Plan will pay no more than the<br />
amount it would have paid if only one dentist had<br />
rendered services.<br />
Wh<strong>at</strong> is Not Covered<br />
Under the Dental Plan<br />
Accidental Injury to Sound N<strong>at</strong>ural Teeth: These services<br />
may be covered under the Medical Plan.This exclusion<br />
does not apply to accidental injuries as a result of<br />
biting or chewing; these charges may be covered under<br />
the Dental Plan.<br />
Beyond the Scope of Licensure or Unlicensed:<br />
Services rendered by a dentist beyond the scope of<br />
his or her license, or any services provided by an unlicensed<br />
dentist.<br />
Bridgework or Dentures: Repair, relining, or recementing<br />
of bridgework or dentures during the first 6-month<br />
postdelivery period, and such services received more<br />
often than once every 5 years.<br />
Cosmetic Purposes: Services performed for cosmetic<br />
purposes or to correct congenital, hereditary, or<br />
developmental malform<strong>at</strong>ions. This exclusion does<br />
not apply to orthodontic services for the correction of<br />
malposed teeth.<br />
Experimental or Investig<strong>at</strong>ional: Charges for tre<strong>at</strong>ment<br />
or services, including Hospital care, th<strong>at</strong> is experimental,<br />
investig<strong>at</strong>ional, or inappropri<strong>at</strong>e.<br />
Initial Placement of Partial or Full Removable<br />
Dentures and Fixed Bridges: When replacing a tooth or<br />
teeth which were missing prior to the effective d<strong>at</strong>e of<br />
the participant’s coverage.<br />
Major Care: Services listed under the Major Care<br />
section during the first consecutive 12 months th<strong>at</strong> a<br />
participant is covered under the Dental Plan.<br />
Oral Sed<strong>at</strong>ion: Oral sed<strong>at</strong>ion and/or nitrous oxide (analgesia)<br />
are not covered.<br />
Orthodontia: Orthodontia will not be covered if bands<br />
were removed prior to eligibility, unless five years have<br />
elapsed before the placement of new bands.<br />
Orthodontia Care: Services in connection with tre<strong>at</strong>ment<br />
for the correction of malposed teeth during the<br />
first 12 consecutive months th<strong>at</strong> a participant is covered<br />
under the Dental Plan.<br />
Periodontal Splinting: Charges for complete occlusal<br />
adjustments or stabilizing the teeth through the use of<br />
periodontal splinting.<br />
Permanent Restor<strong>at</strong>ions: Charges for bases, liners, and<br />
anesthetics used in conjunction with permanent restor<strong>at</strong>ions<br />
(fillings).<br />
Restor<strong>at</strong>ions: Composite or acrylic restor<strong>at</strong>ions (fillings)<br />
in molar teeth. (An allowance for amalgam restor<strong>at</strong>ion<br />
will be provided.)<br />
Governmental Agency: Services provided or paid for by<br />
any governmental agency or under any governmental<br />
program or law, except charges for legally entitled benefits<br />
under applicable federal laws.<br />
104 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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Retainers: Separ<strong>at</strong>e charges for retainers (appliances<br />
which are intended to retain orthodontic rel<strong>at</strong>ionship) or<br />
harmful habit appliances such as thumb sucking or<br />
tongue thrusting are not covered.<br />
Services Undertaken Prior to Effective D<strong>at</strong>e or<br />
During the Waiting Period for Major Care or<br />
Orthodontia Services: Charges for courses of tre<strong>at</strong>ment,<br />
including prosthetics and orthodontics, which were<br />
begun prior to the effective d<strong>at</strong>e of coverage or before<br />
you are eligible to receive benefits for major care or<br />
orthodontia services.<br />
Surgical Corrections: Charges for services rel<strong>at</strong>ed to the<br />
surgical correction of:<br />
• Temporomandibular joint dysfunction (TMJ),<br />
• Orofacial deformities, and<br />
• Specified oral surgery procedures covered by the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan.<br />
Tooth Structure: Services for restoring tooth structure<br />
lost from wear, for rebuilding or maintaining chewing<br />
surfaces due to teeth out of alignment or occlusion, or<br />
for stabilizing the teeth.<br />
Other Charges Not Covered<br />
• Any procedure performed for a temporary purpose<br />
• Charges in excess of Maximum Allowable Charge<br />
• Extraoral grafts<br />
• Hypnosis or acupuncture<br />
• Oral hygiene instruction and dietary instruction<br />
• Full-mouth debridement (An allowance for prophylaxis,<br />
subject to the limit<strong>at</strong>ion, will be provided.)<br />
• Plaque control programs<br />
• Repair or replacement of an orthodontic appliance<br />
• Replacement of a lost or stolen prosthetic device<br />
• Services covered by the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan<br />
• Services for which there is no charge<br />
• Any other services not specifically listed as covered<br />
• Charges covered by Workers’ Compens<strong>at</strong>ion or<br />
Employers’ Liability Laws<br />
• Services provided by a member of the<br />
participant’s family<br />
• Charges incurred as a result of war<br />
The Dental Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
105
COBRA<br />
Where Can I Find<br />
COBRA—Continuing Medical and Dental Coverage After Coverage Ends. . . . . . . . . . 108<br />
COBRA Qualifying Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109<br />
Paying for COBRA Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110<br />
How Long COBRA Coverage Lasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111<br />
When COBRA Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
COBRA<br />
It’s important to maintain the financial protection your health care coverage provides for you<br />
and your family. If you leave <strong>Wal</strong>-<strong>Mart</strong> or a covered family member is no longer eligible, you<br />
have the option to continue medical and dental coverage through the continu<strong>at</strong>ion provisions<br />
of the Consolid<strong>at</strong>ed Omnibus Budget Reconcili<strong>at</strong>ion Act (COBRA).The Plan contracts with<br />
CONEXIS to administer COBRA. Pay <strong>at</strong>tention to the COBRA notific<strong>at</strong>ion and enrollment deadlines<br />
to take advantage of this one-time coverage continu<strong>at</strong>ion opportunity. Uninterrupted<br />
medical coverage helps you live better today and prevents you from being subject to pre-existing<br />
condition limit<strong>at</strong>ions in a medical plan you may have access to in the future.<br />
COBRA Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Contact the <strong>Benefits</strong> Department<br />
within 60 calendar days of a<br />
divorce, legal separ<strong>at</strong>ion, annulment,<br />
or dependent ineligibility<br />
Call (800) 421-1362<br />
• Contact CONEXIS,<br />
the COBRA administr<strong>at</strong>or<br />
• Pay your COBRA premium<br />
Get the Starbridge Summary Plan<br />
Description for inform<strong>at</strong>ion about<br />
COBRA under th<strong>at</strong> plan<br />
Go to www.CONEXIS.org Call (800) 570-1863<br />
COBRA<br />
Wh<strong>at</strong> You Need to Know About COBRA<br />
• If your or your Eligible Dependent’s coverage ends, you and/or your Eligible Dependents may be able to<br />
continue medical and dental coverage under COBRA.<br />
• You or your Eligible Dependent must contact the <strong>Benefits</strong> Department within 60 calendar days of the following<br />
COBRA qualifying event to request COBRA continu<strong>at</strong>ion coverage or COBRA eligibility will be lost: divorce, legal<br />
separ<strong>at</strong>ion, annulment, and dependent ineligibility.<br />
• After you provide any required notice to the <strong>Benefits</strong> Department, you will receive a Notice of Enrollment Letter<br />
th<strong>at</strong> will inform you of your right to continue coverage. You must notify CONEXIS within 60 calendar days from<br />
the d<strong>at</strong>e on the Notice of Enrollment letter if you want to continue coverage under COBRA.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
107
COBRA—Continuing<br />
Medical and Dental Coverage<br />
After Coverage Ends<br />
If you or your Eligible Dependent’s coverage under the<br />
Plan ends, you and/or your Eligible Dependents may be<br />
able to continue your medical and dental coverage<br />
under the continu<strong>at</strong>ion provisions of the Consolid<strong>at</strong>ed<br />
Omnibus Budget Reconcili<strong>at</strong>ion Act (COBRA).This coverage<br />
is called “COBRA coverage.” An event th<strong>at</strong> makes you<br />
and/or your Eligible Dependents eligible for COBRA coverage<br />
is called a qualifying event.<br />
You must have had medical or dental coverage on the<br />
day prior to your qualifying event d<strong>at</strong>e to be eligible for<br />
COBRA coverage.You can only continue the same plan<br />
and options you had on the day prior to your qualifying<br />
event d<strong>at</strong>e. If your coverage is canceled due to nonpayment<br />
of premiums while you are still an active associ<strong>at</strong>e<br />
and then you termin<strong>at</strong>e from the Company, you and any<br />
Eligible Dependents are not eligible for COBRA except<br />
for special FMLA exclusions.<br />
You do not have to show th<strong>at</strong> you are insurable to<br />
elect COBRA.<br />
If you or an Eligible Dependent has other insurance<br />
coverage, including Medicare, prior to enrolling in<br />
COBRA, you and your dependents remain eligible to<br />
enroll in COBRA.<br />
If you have HMO coverage <strong>at</strong> the time your coverage as<br />
an active associ<strong>at</strong>e ends, st<strong>at</strong>e coverage continu<strong>at</strong>ion<br />
rules may apply. If you have both st<strong>at</strong>e and COBRA continu<strong>at</strong>ion<br />
rights, those continu<strong>at</strong>ion periods will run <strong>at</strong><br />
the same time. For more inform<strong>at</strong>ion on st<strong>at</strong>e continu<strong>at</strong>ion<br />
rights, you should contact your HMO provider.<br />
For more inform<strong>at</strong>ion regarding continu<strong>at</strong>ion of<br />
Starbridge coverage, please see the separ<strong>at</strong>e Summary<br />
Plan Description for those plans provided by your<br />
Starbridge insurance carrier.<br />
COBRA does not apply to Company-Paid Life Insurance,<br />
Optional Life Insurance, Dependent Life Insurance,<br />
Short-Term Disability, Short-Term Disability Plus, Long-<br />
Term Disability, Truck Drivers Long-Term Disability, or<br />
Accidental De<strong>at</strong>h and Dismemberment benefits. Non-<br />
COBRA continu<strong>at</strong>ion rights are available for the Cancer<br />
Insurance Policy, the Accident Insurance Policy,<br />
Company-Paid Life Insurance, Optional Life Insurance,<br />
and Dependent Life Insurance. See the<br />
Cancer Insurance Policy, Accident Insurance Policy,<br />
Company-Paid Life Insurance, Optional Life<br />
Insurance, or Dependent Life Insurance chapters in<br />
this book for more inform<strong>at</strong>ion.<br />
If You Are on FMLA<br />
In certain FMLA situ<strong>at</strong>ions, you and any Eligible<br />
Dependents will be offered COBRA when you termin<strong>at</strong>e<br />
employment <strong>at</strong> the end of the leave period even if coverage<br />
was canceled due to nonpayment of premiums<br />
during the FMLA period. NOTE: If you were in an FMLA<br />
situ<strong>at</strong>ion and coverage was cancelled due to non-payment<br />
of premiums, you will only be eligible to continue<br />
coverage from your termin<strong>at</strong>ion d<strong>at</strong>e forward. Coverage<br />
eligibility will not go back to your cancell<strong>at</strong>ion d<strong>at</strong>e.<br />
108 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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COBRA Qualifying Events<br />
You are eligible for COBRA if your coverage<br />
ends because:<br />
• Your employment with <strong>Wal</strong>-<strong>Mart</strong> ends for any<br />
reason; or<br />
• You are no longer eligible for medical and/or dental<br />
coverage because the number of hours you regularly<br />
work for <strong>Wal</strong>-<strong>Mart</strong> has decreased.<br />
Your Eligible Dependents are eligible for COBRA if their<br />
coverage ends because:<br />
• Your employment with <strong>Wal</strong>-<strong>Mart</strong> ends for any reason.<br />
• They are no longer eligible for medical and/or dental<br />
coverage because the number of hours you regularly<br />
work for <strong>Wal</strong>-<strong>Mart</strong> has decreased.<br />
• You and your spouse divorce or legally separ<strong>at</strong>e, or<br />
your marriage is annulled.<br />
• Your dependent children no longer meet eligibility<br />
requirements.<br />
• You die (dependents would be eligible).<br />
If you or your Eligible Dependent has a qualifying event<br />
of divorce, legal separ<strong>at</strong>ion, annulment, and dependent<br />
ineligibility, you or your Eligible Dependent must contact<br />
the <strong>Benefits</strong> Department within 60 calendar days of<br />
the event and st<strong>at</strong>e th<strong>at</strong> you are calling to request<br />
COBRA continu<strong>at</strong>ion coverage due to a qualifying event.<br />
You must provide the following inform<strong>at</strong>ion:<br />
• Your name<br />
• Name of covered participant (if different)<br />
• Address of covered participant (if different)<br />
• Name of the dependent, if any<br />
• Qualifying event<br />
• D<strong>at</strong>e of qualifying event<br />
Contact the <strong>Benefits</strong> Department by calling<br />
(800) 421-1362 or writing to:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers AR 72756-3540<br />
FEDERAL LAW PLACES RESPONSIBILITY UPON YOU<br />
OR YOUR ELIGIBLE DEPENDENT(S) TO NOTIFY THE<br />
BENEFITS DEPARTMENT WITHIN 60 CALENDAR DAYS<br />
OF A DIVORCE, LEGAL SEPARATION, ANNULMENT, OR<br />
DEPENDENT INELIGIBILITY. IF YOU OR YOUR ELIGIBLE<br />
DEPENDENT(S) DO NOT NOTIFY THE BENEFITS<br />
DEPARTMENT, YOU AND YOUR DEPENDENT(S) WILL<br />
NOT BE ELIGIBLE FOR COBRA. YOU MUST ALSO NOTI-<br />
FY THE COBRA ADMINISTRATOR, CONEXIS, OF A SEC-<br />
OND QUALIFYING EVENT OR DISABILITY IN ORDER<br />
TO EXTEND THE PERIOD OF COBRA COVERAGE.<br />
OTHER FORMS OF NOTICE WILL NOT BIND THE PLAN.<br />
IF TIMELY NOTICE IS NOT PROVIDED, COBRA CONTIN-<br />
UATION RIGHTS WILL EXPIRE.<br />
If you or your Eligible Dependent(s) do not notify the<br />
<strong>Benefits</strong> Department, you and your dependent(s) will not<br />
be eligible for COBRA.<br />
You must also notify the COBRA administr<strong>at</strong>or, CONEXIS,<br />
of a second qualifying event or disability in order to<br />
extend the period of COBRA coverage. Other forms of<br />
notice will not bind the plan. If timely notice is not provided,<br />
COBRA continu<strong>at</strong>ion rights will expire.<br />
For termin<strong>at</strong>ion of employment, reduction in hours th<strong>at</strong><br />
results in the loss of medical and/or dental coverage, or<br />
de<strong>at</strong>h of an associ<strong>at</strong>e, the Company will provide notice<br />
to CONEXIS, the COBRA Administr<strong>at</strong>or, within 30 calendar<br />
days of the event.<br />
COBRA is provided subject to your eligibility for coverage<br />
under the law and the <strong>Associ<strong>at</strong>e</strong>s’ Health and<br />
Welfare Plan.The Plan Administr<strong>at</strong>or reserves the right to<br />
termin<strong>at</strong>e your continu<strong>at</strong>ion coverage retroactively if<br />
you are l<strong>at</strong>er determined to be ineligible.<br />
COBRA<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
109
Once notice is received from either you or the Company,<br />
CONEXIS will send a letter (Notice of Enrollment) to you<br />
and your Eligible Dependents within 14 calendar days to<br />
your last known address.This letter will offer you the<br />
opportunity to continue medical and/or dental coverage.<br />
If you or your Eligible Dependents do not receive<br />
the Notice of Enrollment letter within 14 days, call<br />
CONEXIS <strong>at</strong> (800)570-1863.<br />
You must notify CONEXIS within 60 calendar days from<br />
the d<strong>at</strong>e on the Notice of Enrollment letter if you want to<br />
continue coverage under COBRA.You can contact<br />
CONEXIS by calling (800) 570-1863 or by logging on to<br />
www.CONEXIS.org. Failure to elect COBRA continu<strong>at</strong>ion<br />
coverage during the 60-day period will waive any right<br />
to elect COBRA coverage. Note:You may be asked to provide<br />
document<strong>at</strong>ion of the qualifying event in order to<br />
receive COBRA coverage. Notify CONEXIS of any change<br />
of address if you elect COBRA coverage.<br />
Once you elect and timely pay your premium under<br />
COBRA, you may not retroactively cancel, change, or add<br />
to your COBRA coverage without a St<strong>at</strong>us <strong>Change</strong> Event<br />
outside Annual Enrollment. If a St<strong>at</strong>us <strong>Change</strong> Event<br />
occurs (such as a child is born), you will need to contact<br />
CONEXIS or submit the change in writing within 60 calendar<br />
days of the event. For inform<strong>at</strong>ion about St<strong>at</strong>us<br />
<strong>Change</strong> Events, see St<strong>at</strong>us <strong>Change</strong> Events in the<br />
Eligibility and Enrollment chapter. As long as you are<br />
on COBRA, you will have the right to make changes to<br />
your coverage during any Annual Enrollment period.<br />
You and your Eligible Dependent(s) each have separ<strong>at</strong>e<br />
election rights.You may elect COBRA coverage for all of<br />
your family members who lost coverage because of the<br />
qualifying event. A parent may elect COBRA coverage on<br />
behalf of an Eligible Dependent child. A child born to or<br />
placed for adoption with you while you are on COBRA<br />
also has COBRA rights.<br />
If you do not want to continue coverage, no further<br />
action is required.<br />
Paying for COBRA Coverage<br />
You and/or your Eligible Dependents will be responsible<br />
for both the associ<strong>at</strong>e portion of the premium and the<br />
amounts th<strong>at</strong> were previously paid by the Company, plus<br />
a 2 percent administr<strong>at</strong>ive fee (50 percent administr<strong>at</strong>ive<br />
fee in cases of the 11-month disability extension).The<br />
Notice of Enrollment letter sent to you and your Eligible<br />
Dependents following notice of a qualifying event will<br />
include the actual cost for COBRA coverage.<br />
• Initial COBRA Premium: You have 45 days from the<br />
d<strong>at</strong>e of your COBRA election to pay premiums for:<br />
—Coverage provided between the d<strong>at</strong>e of the qualifying<br />
event and the end of the month in which the<br />
election is made; and<br />
—Any premiums th<strong>at</strong> become due during the<br />
45-day period.<br />
• Continuing Premiums: Monthly premiums will be<br />
due on the first day of each month following the initial<br />
premium due d<strong>at</strong>e. You will be allowed a 30-day<br />
grace period. If the 30th day falls on a weekend or<br />
holiday, you will have until the next business day to<br />
have your payment postmarked.<br />
Claims incurred during the 30-day grace period will not<br />
be paid until premiums through the d<strong>at</strong>e of service have<br />
been received. If you do not pay these premiums, you<br />
will be responsible for claims incurred. Pharmacy benefits<br />
will not be available unless coverage is paid through<br />
the current month.<br />
As a courtesy, CONEXIS will send a COBRA premium<br />
payment invoice. Attach your payment to the invoice<br />
and mail to:<br />
CONEXIS<br />
P.O. Box 14225<br />
Orange, CA 92863-1225<br />
To pay online, log on to www.CONEXIS.org, or to pay<br />
by phone, call (800) 570-1863.<br />
Your COBRA coverage ends on the last day for which you<br />
paid your full COBRA premium on time. If your coverage<br />
ends due to non-payment of premiums, it will not<br />
start again.<br />
110 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
How Long<br />
COBRA Coverage Lasts<br />
The dur<strong>at</strong>ion of your COBRA coverage depends on<br />
the reason for the COBRA coverage as shown in the<br />
Dur<strong>at</strong>ion of COBRA Coverage chart.<br />
Dur<strong>at</strong>ion of COBRA Coverage<br />
Conditions <strong>Associ<strong>at</strong>e</strong> Dependent(s)<br />
• Your employment with the<br />
Company ends for any reason<br />
• You are no longer eligible<br />
due to a reduction in hours<br />
• Your de<strong>at</strong>h<br />
• Your marital st<strong>at</strong>us changes<br />
• Dependent(s) no longer meets<br />
eligibility requirements<br />
18 months 18 months<br />
Not<br />
applicable<br />
36 months<br />
Disability extension is obtained 29 months 29 months<br />
Second qualifying event—<br />
You must notify CONEXIS<br />
within 60 days of the second<br />
qualifying event<br />
Not<br />
applicable<br />
36 months<br />
If You Are Entitled to Medicare<br />
If you are entitled to Medicare before your employment<br />
termin<strong>at</strong>es or your hours of employment are reduced,<br />
your Eligible Dependent(s) who lose medical and/or<br />
dental coverage may receive COBRA coverage for the<br />
longer of the following:<br />
• Thirty-six (36) months from the d<strong>at</strong>e you enrolled in<br />
Medicare; or<br />
• Eighteen (18) months from the d<strong>at</strong>e of the qualifying<br />
event (the d<strong>at</strong>e of your termin<strong>at</strong>ion of employment<br />
or reduction in hours of employment).<br />
You or your Eligible Dependent(s) must notify<br />
CONEXIS within 60 days (the COBRA election period) if<br />
you are entitled to Medicare prior to the initial qualifying<br />
event d<strong>at</strong>e.<br />
If You or an Eligible<br />
Dependent is Disabled<br />
If you and/or your Eligible Dependent(s) elect COBRA<br />
coverage due to your termin<strong>at</strong>ion of employment or<br />
reduction in hours of employment and one of you is<br />
disabled, all of you may be entitled to up to 29 months<br />
of COBRA coverage. The 29-month COBRA coverage<br />
period begins on the d<strong>at</strong>e of your termin<strong>at</strong>ion of<br />
employment or reduction in hours of employment.<br />
The disability extension only applies if all of the<br />
following conditions are met:<br />
• The Social Security Administr<strong>at</strong>ion determines th<strong>at</strong><br />
you and/or your Eligible Dependent(s) is disabled;<br />
• The disability exists during the first 60 calendar days<br />
of COBRA coverage;<br />
• You and/or your Eligible Dependent(s) notify CONEX-<br />
IS of the Social Security Administr<strong>at</strong>ion’s disability<br />
determin<strong>at</strong>ion within 60 days of the l<strong>at</strong>er of:<br />
—The determin<strong>at</strong>ion, or<br />
—The qualifying event; and<br />
• You and/or your Eligible Dependent(s) submit a copy<br />
of the Social Security Administr<strong>at</strong>ion’s disability<br />
determin<strong>at</strong>ion award letter to CONEXIS during the<br />
initial 18-month COBRA coverage period.<br />
COBRA<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
111
CONEXIS will determine if you and/or your Eligible<br />
Dependents qualify for the disability extension. If the<br />
extension is given, a new invoice will be mailed to you<br />
and/or your Eligible Dependents before the end of the<br />
initial 18-month COBRA coverage period.<br />
The COBRA premium for the 18th through the 29th<br />
month of COBRA coverage generally is the amount you<br />
were paying before the qualifying event, plus the<br />
amount the Company was paying, plus a 50 percent<br />
administr<strong>at</strong>ive fee.<br />
If the disability extension applies and the disabled qualified<br />
beneficiary family member is enrolled in COBRA<br />
coverage, the COBRA premium for the entire family for<br />
the extended period can be up to 150%. However, if the<br />
disability extension applies, but the disabled qualified<br />
beneficiary family member is not enrolled in COBRA coverage,<br />
the COBRA premium for the covered family members<br />
for the extended period is limited to 102%.<br />
You or your Eligible Dependent(s) must notify CONEXIS<br />
no l<strong>at</strong>er than 30 days after the Social Security<br />
Administr<strong>at</strong>ion determines th<strong>at</strong> you or your Eligible<br />
Dependent is no longer disabled.<br />
If You Have a Second<br />
Qualifying Event While on COBRA<br />
While an associ<strong>at</strong>e cannot get an extension of COBRA<br />
coverage due to a second qualifying event, your Eligible<br />
Dependent(s) who have COBRA coverage due to your<br />
termin<strong>at</strong>ion of employment or reduction in hours of<br />
employment may receive COBRA coverage for up to a<br />
total of 36 months of COBRA coverage if a second qualifying<br />
event occurs.<br />
The following are second qualifying events:<br />
• Your de<strong>at</strong>h.<br />
• Your divorce, legal separ<strong>at</strong>ion, or annulment.<br />
• Your child is no longer eligible for medical and/or<br />
dental coverage.<br />
If a second qualifying event occurs while your Eligible<br />
Dependents have COBRA coverage, their COBRA coverage<br />
may last up to 36 months from the d<strong>at</strong>e of the first<br />
qualifying event (the d<strong>at</strong>e of your termin<strong>at</strong>ion of<br />
employment or reduction in hours of employment).<br />
TO RECEIVE THE EXTENSION OF THE COBRA<br />
COVERAGE PERIOD, YOU OR YOUR ELIGIBLE<br />
DEPENDENT(S) MUST NOTIFY CONEXIS OF THE<br />
SECOND QUALIFYING EVENT WITHIN 60 CALEN-<br />
DAR DAYS OF THE DATE OF THE EVENT. IF CONEXIS<br />
IS NOT NOTIFIED OF THE SECOND QUALIFYING<br />
EVENT DURING THE 60-DAY PERIOD, YOUR<br />
ELIGIBLE DEPENDENT(S) CANNOT GET THE COBRA<br />
COVERAGE EXTENSION AND THE COVERAGE WILL<br />
BE TERMINATED AS OF THE DATE OF THE SECOND<br />
QUALIFYING EVENT.<br />
112 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When COBRA Coverage Ends<br />
Usually, COBRA coverage ends after the 18-month, 29-<br />
month, or 36-month COBRA coverage period. See How<br />
Long COBRA Coverage Lasts to find out which COBRA<br />
coverage period applies to you. COBRA coverage may be<br />
termin<strong>at</strong>ed before the end of the 18th, 29th, or 36th<br />
month if:<br />
• The Company no longer provides medical or dental<br />
coverage to any of its associ<strong>at</strong>es;<br />
• COBRA payment is not made within 30 calendar days<br />
of the due d<strong>at</strong>e;<br />
• The participant becomes covered by another group<br />
health medical or dental plan after electing COBRA<br />
coverage unless the other plan excludes or limits<br />
coverage for a pre-existing condition, other than a<br />
pre-existing condition exclusion th<strong>at</strong> does not apply<br />
(or is s<strong>at</strong>isfied) due to the requirements of HIPAA;<br />
• The participant becomes covered by Medicare after<br />
electing COBRA coverage (only medical may be termin<strong>at</strong>ed<br />
early); or<br />
• The participant or other family member submits a<br />
fraudulent claim or fraudulent inform<strong>at</strong>ion.<br />
If your COBRA coverage is HMO coverage, you may be<br />
able to convert your coverage to an individual policy<br />
when your COBRA coverage ends. Contact your HMO<br />
for details.<br />
COBRA<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> 1(800) 421-1362<br />
113
Resources for Living<br />
Where Can I Find<br />
Using Resources for Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116<br />
When Resources for Living <strong>Benefits</strong> End. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117<br />
Filing a Claim for Resources for Living <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Resources for Living<br />
Resources for Living (RFL) is a valuable confidential counseling and health inform<strong>at</strong>ion service<br />
th<strong>at</strong>’s free to all <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>es from your hire d<strong>at</strong>e.You and your family members can call a<br />
professional counselor any time, day or night, for help with stress management, family rel<strong>at</strong>ionships,<br />
career issues, and other daily challenges. RFL also offers an online Personal Health<br />
Appraisal th<strong>at</strong> will alert you to specific potential health risks. Use Resources for Living to<br />
improve your emotional and physical health.<br />
Resources for Living Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Speak with a professional counselor<br />
in English or Spanish<br />
Call (800) 825-3555<br />
Access articles, tools, and resources<br />
across a wide range of topics<br />
Access your Personal Health Appraisal<br />
Go to www.rfl.com<br />
Go to www.rfl.com or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About Resources for Living<br />
• All <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>es are autom<strong>at</strong>ically enrolled in Resources for Living as of you d<strong>at</strong>e of hire.<br />
• <strong>Wal</strong>-<strong>Mart</strong> pays the entire cost for Resources for Living benefits for you and your family.<br />
• Resources for Living is a professional and confidential counseling and inform<strong>at</strong>ion service available 24/7.<br />
Resources for Living<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
115
Using Resources for Living<br />
Resources for Living is a professional and confidential<br />
counseling and inform<strong>at</strong>ion service th<strong>at</strong> offers counseling<br />
on a wide variety of issues, including strengthening<br />
rel<strong>at</strong>ionships and managing stress. Professional counselors<br />
are available 24 hours a day, seven days a week,<br />
365 days a year <strong>at</strong> (800) 825-3555. Counseling services<br />
are available in English and Spanish. <strong>Wal</strong>-<strong>Mart</strong> pays the<br />
entire cost of available Resources for Living benefits.<br />
All U.S. associ<strong>at</strong>es and their family members, except<br />
employees who are members of a collective bargaining<br />
unit whose health and welfare benefits were the subject<br />
of good faith collective bargaining, are autom<strong>at</strong>ically<br />
enrolled in Resources for Living. Coverage begins on<br />
your first day of employment with <strong>Wal</strong>-<strong>Mart</strong>. All benefits<br />
under this program are provided and administered by<br />
Resources for Living.<br />
Resources for Living offers resources and counseling for<br />
issues rel<strong>at</strong>ed to:<br />
• Healthy Living: Inform<strong>at</strong>ion on a variety of health<br />
issues, including fitness, nutrition, and weight management,<br />
as well as lifestyle suggestions for disease<br />
management/prevention, and a Personal<br />
Health Appraisal.<br />
The Personal Health Appraisal guides you through a<br />
series of health and wellness questions and provides<br />
you with feedback in your own individualized<br />
report. Your report will identify specific health risks<br />
based on your responses and will provide health<br />
improvement recommend<strong>at</strong>ions. The Personal<br />
Health Appraisal also provides links to rel<strong>at</strong>ed<br />
health topics, based on your feedback. To access<br />
your Personal Health Appraisal, go to www.rfl.com<br />
or walmartbenefits.com. All of your answers and<br />
feedback will be kept confidential, and your report<br />
will be password protected.<br />
• Self Mastery: Effective ways to manage stress and<br />
stay motiv<strong>at</strong>ed. Learn how to resolve conflict, manage<br />
anger, and tap into your cre<strong>at</strong>ive potential.<br />
• Family Care: Tools and resource links for identifying<br />
childcare and eldercare options in your area. Get tips<br />
for managing pregnancy, improving parenting skills,<br />
and building better families.<br />
• Rel<strong>at</strong>ionships: A wealth of inform<strong>at</strong>ion to improve<br />
rel<strong>at</strong>ionships—with your spouse, with family members,<br />
and among friends.<br />
• Everyday M<strong>at</strong>ters: Inform<strong>at</strong>ion, tools and resources<br />
for daily living, including housing and educ<strong>at</strong>ion<br />
options, budgeting and rel<strong>at</strong>ed financial concerns.<br />
• At Work: Resources to help you become more successful<br />
<strong>at</strong> work. Get tips on how to balance work<br />
and family, improve career options, and develop<br />
more effective communic<strong>at</strong>ion with your colleagues<br />
and supervisors.<br />
Resources for Living offers solutions for living well <strong>at</strong><br />
home and <strong>at</strong> work. When daily challenges make life<br />
more difficult, Resources for Living provides support,<br />
encouragement, guidance, and inform<strong>at</strong>ion.You can<br />
reach professional counselors <strong>at</strong> Resources for living<br />
anytime or anywhere.<br />
116 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Calling Resources for Living<br />
You may contact Resources for Living <strong>at</strong><br />
(800) 825-3555. When you call, Resources for Living’s<br />
consultants will take inform<strong>at</strong>ion from you and will help<br />
direct you to the appropri<strong>at</strong>e help. Counseling services<br />
are available 24 hours a day, seven days a week, 365 days<br />
a year in English and Spanish.Your contact with<br />
Resources for Living is completely confidential. No one <strong>at</strong><br />
<strong>Wal</strong>-<strong>Mart</strong> will know you have used the service, unless<br />
you tell them.<br />
You also may visit the Resources for Living website<br />
www.rfl.com or walmartbenefits.com for articles,<br />
tools and resources across a wide range of topics<br />
available to help you live well.<br />
When Resources<br />
for Living <strong>Benefits</strong> End<br />
Your Resources for Living benefit (and your family’s<br />
Resources for Living benefit) ends upon your termin<strong>at</strong>ion<br />
of employment for any reason, but your Resources<br />
for Living benefit will autom<strong>at</strong>ically be continued, <strong>at</strong> no<br />
cost, for you and your family throughout the applicable<br />
COBRA period under the <strong>Associ<strong>at</strong>e</strong>s’ Medical Plan.<br />
Filing a Claim for Resources for<br />
Living <strong>Benefits</strong><br />
You do not have to file a claim for Resources for Living<br />
benefits.You may access the Resources for Living website<br />
or contact Resources for Living <strong>at</strong> any time. However,<br />
if you have a question about your benefits, or disagree<br />
with the benefits provided, you may contact the <strong>Wal</strong>-<br />
<strong>Mart</strong> <strong>Benefits</strong> Department or file a claim by writing to<br />
the following address:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540<br />
Claims, and any appeals, will be determined under the<br />
time frames and requirements set out in the procedures<br />
for filing a claim for medical benefits in the<br />
Claims and Appeals chapter.<br />
Resources for Living<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
117
Cancer Insurance Policy<br />
Where Can I Find<br />
The Cancer Insurance Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120<br />
Eligibility and Applic<strong>at</strong>ion for the Cancer Insurance Policy . . . . . . . . . . . . . . . . . . . . . . . . 120<br />
Cancer Insurance Policy <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by Aflac, the terms of the policy will govern.<br />
You may obtain a copy of this policy by contacting Aflac.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Cancer Insurance Policy<br />
Participants in the Cancer Insurance Policy get help with expenses for eligible services,<br />
including cancer screening, Hospitaliz<strong>at</strong>ion, radi<strong>at</strong>ion and chemotherapy, and transport<strong>at</strong>ion<br />
and lodging. You can enroll in the Cancer Insurance Policy regardless of whether you have<br />
other medical coverage; however, you must provide Proof of Good Health and be approved<br />
for the Cancer Insurance Policy. <strong>Benefits</strong> are paid in addition to any other types of benefits<br />
you receive, and you’ll receive a check payable to you. For complete inform<strong>at</strong>ion on the<br />
Cancer Insurance Policy, read the Cancer Insurance Policy brochure available online or from<br />
your personnel represent<strong>at</strong>ive.<br />
Cancer Insurance Policy Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
For a brochure containing<br />
complete inform<strong>at</strong>ion on the<br />
Cancer Insurance Policy<br />
the WIRE or, walmartbenefits.com or<br />
www.aflac.com/walmart<br />
Wh<strong>at</strong> You Need to Know About the Cancer Insurance Policy<br />
• All associ<strong>at</strong>es and their Eligible Dependents can apply for coverage under the Cancer Insurance Policy<br />
when they are eligible.<br />
• If you already have cancer, you may not qualify for this coverage.<br />
See your personnel represent<strong>at</strong>ive for<br />
a brochure or<br />
Call Aflac <strong>at</strong>:<br />
(800) 366-3436 for existing<br />
New York policies<br />
(888) 792-2352 in all other st<strong>at</strong>es<br />
• For complete inform<strong>at</strong>ion about the Cancer Insurance Policy, see the Accident Insurance Policy brochure<br />
available on the WIRE and on walmartbenefits.com, from your personnel represent<strong>at</strong>ive, or by calling Aflac.<br />
Cancer Insurance Policy<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
119
The Cancer Insurance Policy<br />
The Cancer Insurance Policy provides a direct cash benefit<br />
if you or any Covered Dependents are diagnosed with<br />
cancer and for routine services while you are covered<br />
under the policy.The policy pays benefits for covered<br />
services regardless of any other insurance you may have.<br />
If you already have cancer, you may not qualify for<br />
this coverage. Proof of Good Health is required for<br />
this coverage.<br />
Your Cancer Insurance Policy coverage options are:<br />
• Level 1; and<br />
• Level 3.<br />
Both levels cover the same services; however, Level 3<br />
coverage pays higher benefits for some services.<br />
The Cancer Insurance Policy is fully insured and is<br />
offered by American Family Life Assurance Company<br />
of Columbus (Aflac). For complete inform<strong>at</strong>ion about<br />
the Cancer Insurance Policy, call Aflac or go<br />
to walmartbenefits.com.<br />
Eligibility and Applic<strong>at</strong>ion for<br />
the Cancer Insurance Policy<br />
You are eligible to apply for and enroll in the Cancer<br />
Insurance Policy if you are over age 18 and you are a:<br />
When you apply for the Cancer Insurance Policy, you also<br />
may apply to cover any Eligible Dependents if dependent<br />
coverage is available under your job classific<strong>at</strong>ion.<br />
You choose:<br />
• <strong>Associ<strong>at</strong>e</strong> Only;<br />
• <strong>Associ<strong>at</strong>e</strong> and Spouce;<br />
• <strong>Associ<strong>at</strong>e</strong> and Child; or<br />
• Family.<br />
For complete inform<strong>at</strong>ion about eligibility and when you<br />
can apply for the Cancer Insurance Policy, see the<br />
Eligibility and Enrollment chapter.<br />
The cost for coverage under the Cancer Insurance Policy<br />
is based on the coverage option you choose and the<br />
Eligible Dependents you choose to cover.<br />
Proof of Good Health for the Cancer<br />
Insurance Policy<br />
Proof of Good Health includes completing a<br />
questionnaire regarding your medical history.<br />
When you are approved for coverage, Aflac will send<br />
you a policy and a Summary Plan Description containing<br />
details on the Cancer Insurance Plan.<br />
• Full-Time hourly associ<strong>at</strong>e (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs)<br />
• Peak-Time hourly associ<strong>at</strong>e<br />
• Full-Time Truck Driver<br />
• Part-Time Truck Driver<br />
• Management associ<strong>at</strong>e<br />
120 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Cancer Insurance<br />
Policy <strong>Benefits</strong><br />
Aflac pays only for tre<strong>at</strong>ment of cancer, including direct<br />
extension metastic spread or recurrence and other diseases<br />
and conditions caused, complic<strong>at</strong>ed or aggrav<strong>at</strong>ed<br />
by, or resulting from cancer or cancer tre<strong>at</strong>ment.<br />
Your policy contains complete inform<strong>at</strong>ion on the<br />
benefits payable through this coverage.You also can call<br />
Aflac <strong>at</strong> (800) 366-3436. Here are some examples of the<br />
benefits th<strong>at</strong> are available under this policy:<br />
• Cancer Screening Wellness Benefit<br />
• Hospital Confinement Benefit<br />
• Radi<strong>at</strong>ion and Chemotherapy Benefit<br />
• Experimental Tre<strong>at</strong>ment Benefit<br />
• Anti-Nausea Benefit<br />
• Nursing Services Benefit<br />
• Skin Cancer Surgery Benefit<br />
• Transport<strong>at</strong>ion and Lodging Benefit<br />
When <strong>Benefits</strong> are Not Paid<br />
<strong>Benefits</strong> are not provided for:<br />
• Pre-malignant conditions, conditions with malignant<br />
potential, or complic<strong>at</strong>ions of any other disease,<br />
sickness, or incapacity.<br />
• Any cancer diagnosed before coverage has been in<br />
force 30 days from the Effective D<strong>at</strong>e shown in your<br />
Policy Schedule. If a covered person has cancer diagnosed<br />
during this 30-day waiting period, benefits for<br />
tre<strong>at</strong>ment of th<strong>at</strong> cancer will apply only to tre<strong>at</strong>ment<br />
occurring after two years from the Effective D<strong>at</strong>e of<br />
your policy or, <strong>at</strong> your option, you may elect to void<br />
the policy from its beginning and receive a full<br />
refund of premium.<br />
• The First Occurrence benefit is not payable<br />
under certain circumstances. See your policy for<br />
complete details.<br />
• Tre<strong>at</strong>ment in a U.S. Government Hospital unless<br />
the covered person is actually charged for such<br />
tre<strong>at</strong>ment and is legally required to pay such charge<br />
unless otherwise specified by the policy.<br />
• Immunoglobulin or colony stimul<strong>at</strong>ing factors.<br />
Cancer Insurance Policy<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
121
Accident Insurance Policy<br />
Where Can I Find<br />
The Accident Insurance Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124<br />
Eligibility and Applic<strong>at</strong>ion for the Accident Insurance Policy . . . . . . . . . . . . . . . . . . . . . . 124<br />
Accident Insurance Policy <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by Aflac, the terms of the policy will govern.<br />
You may obtain a copy of this policy by contacting Aflac.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Accident Insurance Policy<br />
An accident can cause unexpected expenses along with the injury. If you enroll in the<br />
Accident Insurance Policy and are involved in a covered accident while you’re off the job, the<br />
policy helps you pay for services necessary as a result of the accident, such as emergency<br />
room tre<strong>at</strong>ment, Hospitaliz<strong>at</strong>ion, physical therapy, and transport<strong>at</strong>ion and hotels. You’ll<br />
receive benefits from the plan in addition to any benefits you receive from other plans, such<br />
as medical, and benefits are paid directly to you. For complete inform<strong>at</strong>ion on the Accident<br />
Insurance Policy, read the Accident Insurance Policy brochure available online or from your<br />
personnel represent<strong>at</strong>ive.<br />
Accident Insurance Policy Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
For a brochure containing<br />
complete inform<strong>at</strong>ion on the<br />
Accident Insurance Policy<br />
the WIRE, or walmartbenefits.com or<br />
www.aflac.com/walmart<br />
See your personnel represent<strong>at</strong>ive<br />
for a brochure or<br />
Call Aflac <strong>at</strong> (888) 366-3436<br />
Wh<strong>at</strong> You Need to Know About the Accident Insurance Policy<br />
• All associ<strong>at</strong>es and their Eligible Dependents can apply for coverage under the Accident Insurance Policy when<br />
they are eligible.<br />
• For complete inform<strong>at</strong>ion about the Accident Insurance Policy, see the Accident Insurance brochure available on<br />
the WIRE and on walmartbenefits.com, from your personnel represent<strong>at</strong>ive, or by calling Aflac.<br />
Accident Insurance Policy<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
123
The Accident Insurance Policy<br />
The Accident Insurance Policy provides a direct cash<br />
benefit if you or any Covered Dependents undergo certain<br />
medical procedures as a result of a covered accident<br />
you have when you are off the job.The policy pays benefits<br />
for covered services regardless of any other insurance<br />
you may have.<br />
The Accident Insurance Policy is fully insured and<br />
is offered by American Family Assurance Company of<br />
Columbus (Aflac). For complete inform<strong>at</strong>ion about<br />
the Accident Insurance Policy, call Aflac or go to<br />
walmartbenefits.com.<br />
Eligibility and Applic<strong>at</strong>ion for<br />
the Accident Insurance Policy<br />
You are eligible to apply for and enroll in the Accident<br />
Insurance Policy if you are over age 18 and a:<br />
• Full-Time hourly associ<strong>at</strong>e (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs)<br />
• Peak-Time hourly associ<strong>at</strong>e<br />
• Full-Time Truck Driver<br />
• Part-Time Truck Driver<br />
• Management associ<strong>at</strong>e<br />
When you enroll in the Accident Insurance Policy, you<br />
also may apply to cover any Eligible Dependents if<br />
dependent coverage is available under your job classific<strong>at</strong>ion.You<br />
can choose:<br />
• <strong>Associ<strong>at</strong>e</strong> only;<br />
• <strong>Associ<strong>at</strong>e</strong> + spouse;<br />
• <strong>Associ<strong>at</strong>e</strong> + children; or<br />
• Family.<br />
For complete inform<strong>at</strong>ion about eligibility and when you<br />
can enroll in the Accident Insurance Policy, see the<br />
Eligibility and Enrollment chapter.<br />
The cost for coverage under the Accident Insurance<br />
Policy is based on the Eligible Dependents you choose<br />
to cover.<br />
Note: If you are enrolled in a Freedom Plan, you are not<br />
eligible for the Organ Transplant Rider included in the<br />
Accident Insurance Policy.<br />
When you are approved for coverage, Aflac will send you<br />
a policy and a Summary Plan Description containing<br />
details on the Accident Insurance Plan.<br />
Accident Insurance Policy <strong>Benefits</strong><br />
The Accident Insurance Policy provides a direct cash<br />
benefit if you or any Covered Dependents undergo certain<br />
medical procedures as a result of a covered accident<br />
you have when you are off the job.<br />
Your policy contains complete inform<strong>at</strong>ion on the benefits<br />
payable through this coverage.You also can call Aflac<br />
<strong>at</strong> (888) 366-3436. Here are some examples of types of<br />
benefits payable for services necessary as a result of a<br />
covered off-the-job accident:<br />
• Accident Emergency Tre<strong>at</strong>ment Benefit<br />
• Initial Accident Hospitaliz<strong>at</strong>ion Benefit<br />
• Accident Hospitaliz<strong>at</strong>ion Benefit<br />
• Accident Specific Sum Injuries <strong>Benefits</strong>, for<br />
disloc<strong>at</strong>ion, burns, skin grafts, eye injury, lacer<strong>at</strong>ions,<br />
fractures, concussions (brain), emergency dental<br />
work, coma (<strong>at</strong> least seven days), paralysis,<br />
surgical procedures<br />
• Major Diagnostic Exams Benefit<br />
• Physical Therapy Benefit<br />
• Transport<strong>at</strong>ion and Lodging Benefit<br />
• Accidental De<strong>at</strong>h and Accidental<br />
Dismemberment <strong>Benefits</strong><br />
• Organ Transplant <strong>Benefits</strong> (not available to Freedom<br />
Plan participants)<br />
• On-the-Job Intensive Care Unit (ICU) <strong>Benefits</strong><br />
Wellness benefits are also available after you and any<br />
covered dependents have been covered by the Accident<br />
Policy for 12 months. Only one family member per year<br />
is eligible for the wellness benefit. For more inform<strong>at</strong>ion,<br />
see your policy or call Aflac.<br />
Proof of Good Health may be required. Proof of Good<br />
Health includes completing a questionnaire regarding<br />
your medical history.<br />
124 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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When <strong>Benefits</strong> are Not Paid<br />
<strong>Benefits</strong> will not be paid for an accident th<strong>at</strong> is caused<br />
by or occurs as a result of a covered person’s acts:<br />
• Accident which occurs on the job, unless<br />
otherwise specified<br />
• Accident th<strong>at</strong> occurs while coverage is not in force<br />
• Receiving medical services rendered by an immedi<strong>at</strong>e<br />
family member<br />
• Particip<strong>at</strong>ing in any activity or event, including the<br />
oper<strong>at</strong>ion of a vehicle, while under the influence of a<br />
controlled substance (unless administered by a<br />
physician and taken according to the physician’s<br />
instructions) or while intoxic<strong>at</strong>ed (intoxic<strong>at</strong>ed means<br />
th<strong>at</strong> condition as defined by the law of the jurisdiction<br />
in which the accident occurred)<br />
• Driving any taxi for wage, compens<strong>at</strong>ion, or profit<br />
• Mountaineering using ropes and /or other equipment,<br />
parachuting, or hang gliding<br />
• Particip<strong>at</strong>ing in, or <strong>at</strong>tempting to particip<strong>at</strong>e in, an<br />
illegal activity th<strong>at</strong> is defined as a felony, whether<br />
charged or not (felony as defined by the law of the<br />
jurisdiction in which the activity takes place), or<br />
being incarcer<strong>at</strong>ed in any type of penal institution.<br />
• Intentionally self-inflicting bodily injury or <strong>at</strong>tempting<br />
suicide, while sane or insane<br />
• Having cosmetic surgery or other elective procedures<br />
th<strong>at</strong> are not Medically Necessary, as determined<br />
by Aflac, or having dental tre<strong>at</strong>ment except as<br />
a result of an injury<br />
• Being exposed to war or any act of war, declared<br />
or undeclared<br />
• Actively serving in any of the armed forces, or units<br />
auxiliary thereto, including the N<strong>at</strong>ional Guard or<br />
Army Reserve<br />
• Particip<strong>at</strong>ing in any form of flight avi<strong>at</strong>ion other than<br />
as a fare-paying passenger in a fully licensed, passenger-carrying<br />
aircraft<br />
• Particip<strong>at</strong>ing in any sport or sporting activity for<br />
wage, compens<strong>at</strong>ion, or profit, including offici<strong>at</strong>ing<br />
or coaching, or racing in any type of vehicle in an<br />
organized event<br />
Accident Insurance Policy<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
125
Company-Paid Life Insurance<br />
Where Can I Find<br />
Your Company-Paid Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128<br />
Naming a Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128<br />
Filing a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129<br />
When <strong>Benefits</strong> Are Not Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129<br />
When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by Prudential, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting Prudential.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Company-Paid Life Insurance<br />
Whether you are single or married, your loved ones will have expenses as a result of your<br />
de<strong>at</strong>h. Th<strong>at</strong>’s why <strong>Wal</strong>-<strong>Mart</strong> autom<strong>at</strong>ically provides you with life insurance <strong>at</strong> no cost to you.<br />
Your Company-Paid Life Insurance benefit can help pay for your funeral, any credit card balances,<br />
or other debts and expenses you may leave behind. <strong>Wal</strong>-<strong>Mart</strong> provides this benefit to<br />
help you help your loved ones live better.<br />
Company-Paid Life Insurance Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
<strong>Change</strong> your<br />
beneficiary design<strong>at</strong>ion<br />
Get more details<br />
about life Insurance<br />
the WIRE or<br />
walmartbenefits.com<br />
A form also is available from<br />
your personnel represent<strong>at</strong>ive.<br />
Beneficiary changes cannot be<br />
made over the phone.<br />
Call Prudential <strong>at</strong> (877) 740-2116<br />
Convert to an individual policy Call Prudential <strong>at</strong> (877) 740-2116<br />
File a claim Call Prudential <strong>at</strong> (877) 740-2116<br />
Wh<strong>at</strong> You Need to Know About Company-Paid Life Insurance<br />
• <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all Full-Time associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics<br />
<strong>Associ<strong>at</strong>e</strong>s, and Field Supervisor Positions in stores and clubs) and management associ<strong>at</strong>es with Company-Paid<br />
Life Insurance—there is no cost to you.<br />
• Your coverage amount is equal to your pay during the previous 26 pay periods (52 pay periods if paid weekly)<br />
prior to your de<strong>at</strong>h, rounded to the nearest $1,000, up to $50,000.<br />
Company-Paid Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
127
Your Company-Paid<br />
Life Insurance<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all Full-Time associ<strong>at</strong>es and<br />
management associ<strong>at</strong>es with Company-Paid Life<br />
Insurance.The Company pays for this coverage in full—<br />
there is no cost to you. No enrollment is necessary.<br />
Coverage will become effective after any applicable<br />
waiting period. See the Eligibility and Enrollment<br />
chapter for details.<br />
If you die, your beneficiary(s) can receive a lump sum<br />
payment.The payment will be equal to your pay during<br />
the previous 26 pay periods (52 pay periods if paid<br />
weekly) prior to your de<strong>at</strong>h, rounded to the nearest<br />
$1,000.The payment cannot exceed $50,000. Company-<br />
Paid Life Insurance is insured by The Prudential Insurance<br />
Company of America (Prudential).<br />
Naming a Beneficiary<br />
You must name a beneficiary(s) to receive your<br />
Company-Paid Life Insurance benefit if you die. See<br />
Company-Paid Life Insurance Resources earlier in this<br />
chapter for inform<strong>at</strong>ion on how to name a beneficiary.<br />
You can name anyone you wish. If the beneficiary(s) you<br />
have listed with the Company differs from those named<br />
in your will, the list th<strong>at</strong> the Company has prevails.<br />
The following inform<strong>at</strong>ion is needed when naming your<br />
beneficiary(s):<br />
• Beneficiary(s) name<br />
• Beneficiary(s) current address<br />
• Beneficiary(s) phone number<br />
• Beneficiary(s) rel<strong>at</strong>ionship to you<br />
• Beneficiary(s) Social Security number<br />
• Beneficiary(s) d<strong>at</strong>e of birth<br />
• The percentage you wish to design<strong>at</strong>e per beneficiary<br />
up to 100 percent<br />
The benefit will be shared equally by all beneficiaries listed<br />
unless specific percentage design<strong>at</strong>ions are elected.<br />
You can name a minor as a beneficiary; however,<br />
Prudential may not be legally permitted to pay the<br />
minor until the minor reaches legal age. You may want<br />
to consult with an <strong>at</strong>torney before naming a minor as a<br />
beneficiary. If you name a minor as a beneficiary, funeral<br />
expenses cannot be paid from the minor’s beneficiary<br />
proceeds.<br />
It’s important to keep your beneficiary inform<strong>at</strong>ion upto-d<strong>at</strong>e.<br />
Proceeds will go to whoever is listed on your<br />
beneficiary form on file with the AHWP, regardless of<br />
your current rel<strong>at</strong>ionship with th<strong>at</strong> person.<br />
Changing Your Beneficiary<br />
Your beneficiary(s) can be changed <strong>at</strong> any time by using:<br />
• the WIRE;<br />
• walmartbenefits.com;or<br />
• Forms provided by your personnel represent<strong>at</strong>ive.<br />
If You Do Not Name a Beneficiary<br />
If no beneficiary is named, payment will be made to your<br />
surviving family member(s) in the following order:<br />
1. Widow or widower; if no surviving then<br />
2. Children in equal shares; if no surviving then<br />
3. Parents in equal shares; if no surviving then<br />
4. Brothers and sisters in equal shares; if no<br />
surviving then<br />
5. Executor or Administr<strong>at</strong>or of your est<strong>at</strong>e.<br />
128 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Filing a Claim<br />
Within 12 months of the covered associ<strong>at</strong>e’s de<strong>at</strong>h,<br />
contact Prudential <strong>at</strong> (877) 740-2116, and provide the<br />
following regarding the deceased associ<strong>at</strong>e:<br />
• Name;<br />
• Social Security number;<br />
• D<strong>at</strong>e of de<strong>at</strong>h; and<br />
• Cause of de<strong>at</strong>h (if known).<br />
An original or certified copy of the de<strong>at</strong>h certific<strong>at</strong>e is<br />
required as proof of de<strong>at</strong>h. Mail the de<strong>at</strong>h certific<strong>at</strong>e to:<br />
Prudential – <strong>Wal</strong>-<strong>Mart</strong> Division<br />
P.O. Box 13644<br />
Philadelphia, PA 19176<br />
The claim will not be finalized until the de<strong>at</strong>h certific<strong>at</strong>e<br />
is received. Acceptance of the de<strong>at</strong>h certific<strong>at</strong>e is not a<br />
guarantee of payment.<br />
Claims will be determined under the time frames<br />
and requirements set out in the Claims and Appeals<br />
chapter. See the Claims and Appeals chapter for further<br />
details. You or your beneficiary has the right to<br />
appeal a claim denial. See the Claims and Appeals<br />
chapter for details.<br />
When <strong>Benefits</strong> Are Not Paid<br />
<strong>Benefits</strong> will not be paid to any beneficiary(s) who<br />
engaged in an illegal act th<strong>at</strong> resulted in the de<strong>at</strong>h<br />
of the associ<strong>at</strong>e. Instead, the benefit would go to<br />
another eligible beneficiary or to your est<strong>at</strong>e.<br />
When Coverage Ends<br />
Your Company-Paid Life Insurance<br />
coverage ends:<br />
• At termin<strong>at</strong>ion of your employment;<br />
• On the d<strong>at</strong>e of your de<strong>at</strong>h;<br />
• On the d<strong>at</strong>e you lose eligibility;<br />
• On the last day of an approved Leave of Absence<br />
(unless you return to work);<br />
• When the benefit is no longer offered by the<br />
Company; or<br />
• Upon misrepresent<strong>at</strong>ion or fraudulent submission of<br />
a claim for benefits.<br />
This policy has no cash value.<br />
Converting to an Individual Policy<br />
You can convert all or a portion of your coverage to an<br />
individual whole life policy when your coverage ends.<br />
You must request the conversion and pay the first premium<br />
within 31 days of the d<strong>at</strong>e your coverage ends.<br />
If your de<strong>at</strong>h occurs during the 31 day conversion period,<br />
the de<strong>at</strong>h benefit will be payable up to the amount<br />
th<strong>at</strong> could have been converted.<br />
To request a conversion or for inform<strong>at</strong>ion<br />
on other available options, call Prudential <strong>at</strong><br />
(877) 740-2116.<br />
For residents of Minnesota, you may elect to continue<br />
coverage <strong>at</strong> your expense if your employment is termin<strong>at</strong>ed<br />
either voluntarily or involuntarily, or if you are laid<br />
off, as long as the group policy is still in force with the<br />
employer. Coverage may be continued until you obtain<br />
coverage under another group policy or you return to<br />
work from lay-off; however, the maximum period th<strong>at</strong><br />
coverage may be continued is 18 months.<br />
If You Leave the<br />
Company and Then Are Rehired<br />
If you return to work within 30 days you will autom<strong>at</strong>ically<br />
be re-enrolled (or enrolled in the most similar option<br />
offered under the Plan).<br />
If you return to work after 30 days, you will be considered<br />
newly eligible and will be required to complete<br />
the applicable eligibility waiting period for your classific<strong>at</strong>ion.<br />
See the Eligibility and Enrollment chapter<br />
for details.<br />
Company-Paid Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
129
Optional Life Insurance<br />
Where Can I Find<br />
Enrolling in Optional Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132<br />
Naming a Beneficiary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132<br />
When Your Optional Life Insurance Coverage Begins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133<br />
An Early Payout Due to Terminal Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133<br />
When <strong>Benefits</strong> Are Not Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134<br />
When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134<br />
Filing a Claim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by Prudential, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting Prudential.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Optional Life Insurance<br />
You protect your family every day—your paycheck keeps a roof over their heads and food on<br />
the table, you use se<strong>at</strong> belts and child safety se<strong>at</strong>s, and you plan for your family’s college and<br />
retirement expenses. Wh<strong>at</strong> would happen to your family if you died Would they be forced to<br />
deal with a desper<strong>at</strong>e financial situ<strong>at</strong>ion along with emotional devast<strong>at</strong>ion In addition to<br />
your <strong>Wal</strong>-<strong>Mart</strong> provided life insurance, optional life insurance protects your family financially<br />
during a difficult time.<br />
Optional Life Insurance Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
<strong>Change</strong> your<br />
beneficiary design<strong>at</strong>ion<br />
• Get more details about life Insurance<br />
• Request an Acceler<strong>at</strong>ed Benefit<br />
• Convert to an individual policy<br />
File a claim<br />
the WIRE or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About Optional Life Insurance<br />
A form also is available from<br />
your personnel represent<strong>at</strong>ive.<br />
Beneficiary changes cannot be<br />
made over the phone.<br />
Call Prudential <strong>at</strong> (877) 740-2116<br />
Call Prudential <strong>at</strong><br />
(877) 740-2116<br />
• All Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs), Full-Time Truck Drivers, and management associ<strong>at</strong>es can<br />
enroll in Optional Life Insurance.<br />
• Depending on the coverage amount you choose and when you enroll, you may be required to provide<br />
Proof of Good Health.<br />
• You can enroll in, change or drop life insurance <strong>at</strong> any time, but if you enroll <strong>at</strong> any time other than your<br />
Initial Enrollment Period, you will have to provide Proof of Good Health.<br />
• An early payout due to terminal illness is available.<br />
Optional Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
131
Enrolling in Optional<br />
Life Insurance<br />
All Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs), Full-Time Truck<br />
Drivers, and management associ<strong>at</strong>es can enroll in<br />
Optional Life Insurance in addition to the Company-Paid<br />
Life Insurance provided by <strong>Wal</strong>-<strong>Mart</strong>.Your coverage<br />
choices for Optional Life Insurance are:<br />
• $25,000<br />
• $50,000<br />
• $75,000<br />
• $100,000<br />
• $150,000<br />
• $200,000<br />
Depending on the coverage amount you choose and<br />
when you enroll, you may be required to provide Proof<br />
of Good Health.<br />
If you die, your beneficiary(s) may receive a lump-sum<br />
payment for the coverage amount you select. Optional<br />
Life Insurance is insured by The Prudential Insurance<br />
Company of America (Prudential).<br />
The cost of Optional Life Insurance is based on the coverage<br />
amount you select and your age.<br />
You can enroll in optional life insurance <strong>at</strong> any time—<br />
Proof of Good Health is required if you enroll after your<br />
Initial Enrollment Period. Also, you can change or drop<br />
coverage <strong>at</strong> any time. However if you want to increase<br />
your coverage or re-enroll after dropping coverage, you<br />
will be required to provide Proof of Good Health.<br />
Providing Proof of Good Health<br />
Proof of Good Health is required for optional life<br />
insurance if:<br />
• The coverage amount selected is above $25,000 during<br />
your Initial Enrollment Period;<br />
• You enroll after your Initial Enrollment Period for any<br />
amount; or<br />
• You increase your coverage after your Initial<br />
Enrollment Period.<br />
Proof of Good Health includes completing a questionnaire<br />
regarding your medical history and possibly having<br />
a medical exam.The Proof of Good Health questionnaire<br />
is made available when you enroll.<br />
Naming a Beneficiary<br />
When you enroll, you must name a beneficiary(s) to<br />
receive your Optional Life Insurance benefit if you die.<br />
You can name anyone you wish. If the beneficiary(s) you<br />
have listed with the Company differs from those named<br />
in your will, the list th<strong>at</strong> the Company has prevails.<br />
The following inform<strong>at</strong>ion is needed when naming your<br />
beneficiary(s):<br />
• Beneficiary(s) name<br />
• Beneficiary(s) current address<br />
• Beneficiary(s) phone number<br />
• Beneficiary(s) rel<strong>at</strong>ionship to you<br />
• Beneficiary(s) Social Security number<br />
• Beneficiary(s) d<strong>at</strong>e of birth<br />
• The percentage you wish to design<strong>at</strong>e per<br />
beneficiary up to 100 percent<br />
The benefit will be shared equally by all beneficiaries listed<br />
unless specific percentage design<strong>at</strong>ions are elected.<br />
You can name a minor as a beneficiary. However,<br />
Prudential may not be legally permitted to pay the<br />
minor until the minor reaches legal age.You may<br />
want to consult with an <strong>at</strong>torney before naming a<br />
minor as a beneficiary. If you name a minor as a<br />
beneficiary, funeral expenses cannot be paid from<br />
the minor’s beneficiary proceeds.<br />
132 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
It is important to keep your beneficiary inform<strong>at</strong>ion<br />
up-to-d<strong>at</strong>e. Proceeds will go to whoever is listed on<br />
your beneficiary form on file with the AHWP, regardless<br />
of your current rel<strong>at</strong>ionship with th<strong>at</strong> person.<br />
Changing Your Beneficiary<br />
Your beneficiary(s) can be changed <strong>at</strong> any time by using:<br />
• the WIRE;<br />
• walmartbenefits.com;or<br />
• Forms provided by your personnel represent<strong>at</strong>ive.<br />
If You Do Not Name a Beneficiary<br />
If no beneficiary is named, payment will be made to your<br />
surviving family member(s) in the following order:<br />
1. Widow or widower; if no surviving then<br />
2. Children in equal shares; if no surviving then<br />
3. Parents in equal shares; if no surviving then<br />
4. Brothers and sisters in equal shares;<br />
if no surviving then<br />
5. Executor or Administr<strong>at</strong>or of your est<strong>at</strong>e.<br />
When Your Optional Life Insurance<br />
Coverage Begins<br />
If Proof of Good Health is required, your coverage will<br />
generally become effective the first day of the pay period<br />
in which the <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department receives<br />
approval from Prudential.<br />
If you should die before Prudential approves coverage,<br />
no optional life insurance benefit will be paid to your<br />
beneficiary(s).<br />
If Proof of Good Health is not required, your coverage<br />
will be effective on the d<strong>at</strong>e you enroll or <strong>at</strong> the end of<br />
your eligibility waiting period, whichever is l<strong>at</strong>er.<br />
You must be Actively-At-Work in order for your coverage<br />
to be effective. You will be considered Actively-At-Work<br />
on a day th<strong>at</strong> is one of your scheduled work days if you<br />
are performing in the usual way all of the regular duties<br />
of your job. See the Eligibility and Enrollment chapter<br />
for details.<br />
An Early Payout<br />
Due to Terminal Illness<br />
If you are terminally ill, you may receive up to 50 percent<br />
of the coverage amount you have chosen while you are<br />
still living. Payment may be made in a lump sum or 12<br />
monthly installments. Upon your de<strong>at</strong>h, your beneficiary(s)<br />
will receive the remaining 50%. This benefit is<br />
referred to as the Acceler<strong>at</strong>ed Benefit Option.<br />
Optional Life Insurance<br />
You are terminally ill if:<br />
• There is no reasonable prospect of recovery;<br />
• De<strong>at</strong>h is expected within 12 months; and<br />
• A doctor can certify the illness or injury as terminal.<br />
There may be some circumstances when the<br />
Acceler<strong>at</strong>ed Benefit Option will not be paid.<br />
Contact Prudential for details.<br />
Tax laws are complex. Please consult with a tax<br />
professional to assess the impact of this benefit.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
133
When <strong>Benefits</strong> Are Not Paid<br />
<strong>Benefits</strong> will not be paid to any beneficiary(s) who<br />
engaged in an illegal act th<strong>at</strong> resulted in the de<strong>at</strong>h of the<br />
associ<strong>at</strong>e. Instead, the benefit would go to another eligible<br />
beneficiary or to your est<strong>at</strong>e.<br />
No benefits will be paid to your beneficiary(s) if you die<br />
as a result of a self-inflicted injury or suicide while sane<br />
or insane during the first two years of coverage. If you<br />
increase your coverage and you die as a result of a selfinflicted<br />
injury or suicide within two years of the d<strong>at</strong>e<br />
you increase your coverage, your beneficiary(s) will<br />
receive the prior coverage amount.<br />
If your beneficiary(s) files a claim within the first two<br />
years of your approval d<strong>at</strong>e, Prudential has the right to<br />
re-examine your Proof of Good Health questionnaire. If<br />
m<strong>at</strong>erial facts about you were st<strong>at</strong>ed inaccur<strong>at</strong>ely, the<br />
true facts will be used to determine wh<strong>at</strong> amount of<br />
coverage should have been in effect, if any, and:<br />
• The claim may be denied; and<br />
• Your premiums may be adjusted.<br />
When Coverage Ends<br />
Your optional life insurance coverage ends:<br />
• At termin<strong>at</strong>ion of your employment;<br />
• Upon failure to pay your premiums;<br />
• On the d<strong>at</strong>e of your de<strong>at</strong>h;<br />
• On the d<strong>at</strong>e you lose eligibility;<br />
• On the last day of an approved leave of<br />
absence (unless you return to work);<br />
• When the benefit is no longer offered by<br />
the Company; or<br />
• Upon misrepresent<strong>at</strong>ion or fraudulent<br />
submission of a claim for benefits.<br />
Converting to an Individual Policy<br />
You can convert all or a portion of your coverage to an<br />
individual whole life policy when your coverage ends.<br />
You must request the conversion and pay the first premium<br />
within 31 days of the d<strong>at</strong>e your coverage ends.<br />
If your de<strong>at</strong>h occurs during the 31 day conversion period,<br />
the de<strong>at</strong>h benefit will be payable up to the amount<br />
th<strong>at</strong> could have been converted.<br />
To request a conversion or for inform<strong>at</strong>ion<br />
on other available options, call Prudential <strong>at</strong><br />
(877) 740-2116.<br />
For residents of Minnesota, you may elect to continue<br />
coverage <strong>at</strong> your expense if your employment is termin<strong>at</strong>ed<br />
either voluntarily or involuntarily, or if you are laid<br />
off, as long as the group policy is still in force with the<br />
employer. Coverage may be continued until you obtain<br />
coverage under another group policy or you return to<br />
work from lay-off; however, the maximum period th<strong>at</strong><br />
coverage may be continued is 18 months.<br />
If You Leave the<br />
Company and Then Are Rehired<br />
If you return to work within 30 days and you previously<br />
had Optional Life Insurance, your coverage will be reinst<strong>at</strong>ed<br />
up to $25,000 (or the most similar option offered<br />
under the Plan). Proof of Good Health will be required for<br />
coverage options above $25,000.<br />
If you return to work after 30 days, you will be<br />
considered newly eligible and will be required to<br />
complete the applicable eligibility waiting period for<br />
your job classific<strong>at</strong>ion. Proof of Good Health will be<br />
required for coverage options above $25,000. See the<br />
Eligibility and Enrollment chapter for details.<br />
134 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
If You Go on a Leave of Absence<br />
For inform<strong>at</strong>ion about making payments while<br />
on a Leave of Absence, see the Eligibility and<br />
Enrollment chapter.<br />
If your coverage is canceled for failure to pay premiums<br />
while you are on leave and you return to Actively-At-<br />
Work st<strong>at</strong>us within one year of cancell<strong>at</strong>ion, you will be<br />
required to provide Proof of Good Health for all coverage<br />
options.Your coverage will be effective the first day<br />
of the pay period th<strong>at</strong> you meet the Actively-At-Work<br />
requirement, or upon approval by Prudential.<br />
If you return to Actively-At-Work st<strong>at</strong>us after one year,<br />
you will be considered newly eligible and will be<br />
required to complete the applicable eligibility waiting<br />
period for your job classific<strong>at</strong>ion. Proof of Good Health<br />
will be required for coverage options above $25,000.<br />
Special rules may apply if you are on or return<br />
from an FMLA or Military Leave of Absence. See the<br />
Eligibility and Enrollment chapter for details.<br />
Filing a Claim<br />
Within 12 months of the covered associ<strong>at</strong>e’s de<strong>at</strong>h,<br />
the beneficiary must contact Prudential <strong>at</strong><br />
(877) 740-2116, select the Life and Disability prompt,<br />
and provide the following regarding the<br />
deceased associ<strong>at</strong>e:<br />
• Name;<br />
• Social Security number;<br />
• D<strong>at</strong>e of de<strong>at</strong>h; and<br />
• Cause of de<strong>at</strong>h (if known).<br />
• An original or certified copy of the de<strong>at</strong>h certific<strong>at</strong>e is<br />
required as proof of de<strong>at</strong>h. Mail the de<strong>at</strong>h certific<strong>at</strong>e to:<br />
Prudential—<strong>Wal</strong>-<strong>Mart</strong> Division<br />
P.O. Box 13644<br />
Philadelphia, PA 19176<br />
The claim will not be finalized until the de<strong>at</strong>h certific<strong>at</strong>e<br />
is received. Acceptance of the de<strong>at</strong>h certific<strong>at</strong>e is not a<br />
guarantee of payment.<br />
Claims will be determined under the time frames<br />
and requirements set out in the Claims and Appeals<br />
chapter.Your beneficiary has the right to appeal a claim<br />
denial. See the Claims and Appeals chapter for details.<br />
<strong>Benefits</strong> are paid according to the terms of the<br />
insurance policy. For more details, contact Prudential<br />
<strong>at</strong> (877) 740-2116.<br />
Optional Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
135
Dependent Life Insurance<br />
Where Can I Find<br />
Enrolling in Dependent Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138<br />
When Your Dependent Life Insurance Coverage Is Effective . . . . . . . . . . . . . . . . . . . . . . . 139<br />
Filing a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139<br />
When <strong>Benefits</strong> Are Not Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140<br />
When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140<br />
Converting to an Individual Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140<br />
If You Leave the Company and Then Are Rehired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141<br />
If You Go on a Leave of Absence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by Prudential, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting Prudential.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Dependent Life Insurance<br />
The loss of your spouse could mean the loss of an income or a need for child care. The loss of<br />
a child could mean medical bills and funeral expenses. While you and your family are dealing<br />
with the emotional burden the loss of a family member brings, you can receive help for the<br />
financial consequences through Dependent Life Insurance. Think about the expenses you<br />
would have if your spouse or child died. Dependent Life Insurance could ease your financial<br />
situ<strong>at</strong>ion, helping your family get through a difficult time.<br />
Optional Life Insurance Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get more details<br />
about life Insurance<br />
Convert to an<br />
individual policy<br />
File a claim<br />
Wh<strong>at</strong> You Need to Know About Dependent Life Insurance<br />
Call Prudential <strong>at</strong> (877) 740-2116<br />
Call Prudential <strong>at</strong> (877) 740-2116<br />
Call Prudential <strong>at</strong><br />
(877) 740-2116<br />
• All Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs), Full-Time Truck Drivers, and management associ<strong>at</strong>es can enroll<br />
their spouse and/or children in Dependent Life Insurance.<br />
• Proof of Good Health for your spouse is required if you enroll for a coverage amount above $5,000 during your<br />
Initial Enrollment Period or for any coverage amount if you enroll <strong>at</strong> any other time.<br />
Dependent Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
137
Enrolling in<br />
Dependent Life Insurance<br />
All Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs), Full-Time Truck<br />
Drivers, and management associ<strong>at</strong>es can enroll their<br />
spouse and/or children in Dependent Life Insurance. If<br />
your spouse and/or child(ren) dies, you may receive a<br />
lump-sum payment for the coverage amount you select.<br />
Dependent Life Insurance is insured by The Prudential<br />
Insurance Company of America (Prudential).<br />
Your coverage choices for Dependent Life Insurance are:<br />
• Spouse:<br />
—$5,000<br />
—$15,000<br />
—$25,000<br />
• Child:<br />
—$2,000 per child<br />
—$5,000 per child<br />
—$10,000 per child<br />
Depending on the coverage amount you choose and<br />
when you enroll, your spouse may be required to provide<br />
Proof of Good Health.You do not have to provide<br />
Proof of Good Health for your children.<br />
You are autom<strong>at</strong>ically assigned as the primary beneficiary<br />
of your dependent’s life insurance coverage. If<br />
you and your covered dependent(s) die <strong>at</strong> the same<br />
time, benefits will be paid to your dependent’s est<strong>at</strong>e<br />
or to a surviving rel<strong>at</strong>ive of the dependent <strong>at</strong><br />
Prudential’s option.<br />
The cost of Dependent Life Insurance for your spouse is<br />
based on the coverage amount you select and your (the<br />
associ<strong>at</strong>e’s) age.The cost of coverage for your children is<br />
based on the coverage amount your select<br />
You can enroll in Dependent Life Insurance <strong>at</strong> any<br />
time—Proof of Good Health is required for your spouse<br />
if you enroll after your Initial Enrollment Period. Also, you<br />
can change or drop coverage <strong>at</strong> any time. However if you<br />
want to increase your spouse’s coverage or re-enroll after<br />
dropping coverage, you will be required to provide Proof<br />
of Good Health for your spouse.<br />
Proof of Good Health<br />
Proof of Good Health is required for your spouse’s<br />
Dependent Life Insurance coverage if:<br />
• The coverage amount selected is above $5,000 during<br />
your Initial Enrollment Period;<br />
• You enroll after your Initial Enrollment Period for any<br />
amount; or<br />
• You increase your coverage after your Initial<br />
Enrollment Period.<br />
Proof of Good Health includes completing a questionnaire<br />
regarding your spouse’s medical history and possibly<br />
requiring your spouse to have a medical exam.The<br />
Proof of Good Health questionnaire is made available<br />
when you enroll your spouse. Proof of Good Health is<br />
not required for children.<br />
138 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When Your Dependent Life<br />
Insurance Coverage Is Effective<br />
If Proof of Good Health is required, your spouse’s coverage<br />
will generally become effective the first day of the<br />
pay period in which the <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
receives approval from Prudential. If your spouse should<br />
die before Prudential approves coverage, no Dependent<br />
Life Insurance benefit will be paid to you.<br />
If Proof of Good Health is not required, your coverage<br />
will be effective on the d<strong>at</strong>e you enroll or <strong>at</strong> the end of<br />
your eligibility waiting period, whichever is l<strong>at</strong>er.<br />
If your spouse is confined to a Hospital or home,<br />
coverage will be delayed until the spouse has a<br />
medical release.<br />
If a dependent child is born alive and dies within 60<br />
days of birth and:<br />
• Was enrolled in Dependent Life Insurance prior to<br />
the loss, Prudential will pay the enrolled benefit.<br />
• Was not enrolled in Dependent Life Insurance prior<br />
to the loss—with a live birth certific<strong>at</strong>e and a de<strong>at</strong>h<br />
certific<strong>at</strong>e—Prudential will pay a $2,000 benefit only.<br />
(Premium owed will be payroll deducted.)<br />
Filing a Claim<br />
Within 12 months of the covered associ<strong>at</strong>e’s<br />
de<strong>at</strong>h, the beneficiary should contact Prudential <strong>at</strong><br />
(877) 740-2116, select the Life and Disability<br />
prompt, and provide the following regarding the<br />
deceased associ<strong>at</strong>e:<br />
• Name;<br />
• Social Security number;<br />
• D<strong>at</strong>e of de<strong>at</strong>h; and<br />
• Cause of de<strong>at</strong>h (if known)<br />
An original or certified copy of the de<strong>at</strong>h certific<strong>at</strong>e is<br />
required as proof of de<strong>at</strong>h. Mail the de<strong>at</strong>h certific<strong>at</strong>e to:<br />
Prudential–<strong>Wal</strong>-<strong>Mart</strong> Division<br />
P.O. Box 13644<br />
Philadelphia, PA 19176<br />
The claim will not be finalized until the de<strong>at</strong>h certific<strong>at</strong>e<br />
is received. Acceptance of the de<strong>at</strong>h certific<strong>at</strong>e is not a<br />
guarantee of payment.<br />
Claims will be determined under the time frames<br />
and requirements set out in the Claims and Appeals<br />
chapter.Your beneficiary has the right to appeal a claim<br />
denial. See the Claims and Appeals chapter for details.<br />
<strong>Benefits</strong> are paid according to the terms of the<br />
insurance policy. For more details, contact Prudential<br />
<strong>at</strong> (877) 740-2116.<br />
Dependent Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
139
When <strong>Benefits</strong> Are Not Paid<br />
No benefits will be paid to you if your spouse or dependent<br />
dies as a result of a self-inflicted injury or suicide<br />
while sane or insane during the first two years of coverage.<br />
If you increase your coverage and your spouse or<br />
dependent child dies as a result of a self-inflicted injury<br />
or suicide within two years of the increase in coverage,<br />
you will receive the prior coverage amount.<br />
<strong>Benefits</strong> may not be paid to any beneficiary who<br />
engaged in an illegal act th<strong>at</strong> resulted in the de<strong>at</strong>h of the<br />
insured. Instead, the benefit may go to another eligible<br />
beneficiary or to the insured’s est<strong>at</strong>e.<br />
If you file a claim for your spouse within the first two<br />
years of your approval d<strong>at</strong>e, Prudential has the right to<br />
re-examine your Proof of Good Health questionnaire. If<br />
m<strong>at</strong>erial facts about your spouse were st<strong>at</strong>ed inaccur<strong>at</strong>ely,<br />
the true facts will be used to determine wh<strong>at</strong> amount<br />
of coverage should have been in effect, if any, and:<br />
• The claim may be denied; and<br />
• Your premiums may be adjusted.<br />
When Coverage Ends<br />
Your Dependent Life Insurance coverage ends:<br />
• At termin<strong>at</strong>ion of your employment;<br />
• Upon failure to pay your premiums;<br />
• On the d<strong>at</strong>e of your de<strong>at</strong>h;<br />
• On the d<strong>at</strong>e you or a dependent spouse or child<br />
loses eligibility;<br />
• On the last day of an approved Leave of Absence<br />
(unless you return to work);<br />
• When the benefit is no longer offered by the<br />
Company; or<br />
• Upon misrepresent<strong>at</strong>ion or fraudulent submission of<br />
a claim for benefits.<br />
Converting to<br />
an Individual Policy<br />
You can convert all or a portion of your dependent’s<br />
coverage to an individual whole life policy when your<br />
coverage ends. You must request the conversion and<br />
pay the first premium within 31 days of the d<strong>at</strong>e your<br />
coverage ends.<br />
To request a conversion or for inform<strong>at</strong>ion<br />
on other available options, call Prudential <strong>at</strong><br />
(877) 740-2116.<br />
For residents of Minnesota, you may elect to continue<br />
coverage <strong>at</strong> your expense if your employment is termin<strong>at</strong>ed<br />
either voluntarily or involuntarily, or if you are laid<br />
off, as long as the group policy is still in force with the<br />
employer. Coverage may be continued until you obtain<br />
coverage under another group policy or you return to<br />
work from lay-off; however, the maximum period th<strong>at</strong><br />
coverage may be continued is 18 months.<br />
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If You Leave the Company<br />
and Then Are Rehired<br />
If you return to work within 30 days and you previously<br />
had Dependent Life Insurance, your coverage will be<br />
reinst<strong>at</strong>ed up to $5,000 (or the most similar option<br />
offered under the Plan). Proof of Good Health will be<br />
required for spouse coverage options above $5,000.<br />
Child coverage options in any amount will be reinst<strong>at</strong>ed.<br />
If you return to work after 30 days, you will be considered<br />
newly eligible and will be required to complete the<br />
applicable eligibility waiting period for your classific<strong>at</strong>ion.<br />
Proof of Good Health will be required for spouse<br />
coverage options above $5,000. See the Eligibility and<br />
Enrollment chapter for details.<br />
If You Go on<br />
a Leave of Absence<br />
For inform<strong>at</strong>ion about making payments while on a<br />
Leave of Absence, see the Eligibility and Enrollment<br />
chapter.<br />
If your coverage is canceled for failure to pay premiums<br />
while you are on leave and you return to Actively-At-<br />
Work st<strong>at</strong>us within one year of cancell<strong>at</strong>ion, you will be<br />
required to provide Proof of Good Health for all spouse<br />
coverage options.Your coverage will be effective the first<br />
day of the pay period th<strong>at</strong> you meet the Actively-At-<br />
Work requirement, or upon approval by Prudential.<br />
If you return to Actively-At-Work st<strong>at</strong>us after one<br />
year, you will be considered newly eligible and will<br />
be required to complete the applicable eligibility waiting<br />
period for your job classific<strong>at</strong>ion. Proof of Good<br />
Health will be required for spouse coverage options<br />
above $5,000.<br />
Special rules may apply if you are on or return<br />
from an FMLA or Military Leave of Absence. See the<br />
Eligibility and Enrollment chapter for details.<br />
Dependent Life Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
141
Accidental De<strong>at</strong>h and<br />
Dismemberment (AD&D) Insurance<br />
Where Can I Find<br />
Enrolling in Accidental De<strong>at</strong>h and Dismemberment Insurance . . . . . . . . . . . . . . . . . . . . 144<br />
Naming a Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144<br />
If You Do Not Name a Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145<br />
AD&D Coverage Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145<br />
When AD&D <strong>Benefits</strong> Are Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145<br />
Additional AD&D <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147<br />
When <strong>Benefits</strong> Are Not Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148<br />
Filing a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149<br />
When AD&D Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by MetLife, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting MetLife.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) Insurance<br />
Accidents are unpredictable and unavoidable. But you don’t have to be unprepared for the<br />
financial consequences of a serious injury or de<strong>at</strong>h. Accidental De<strong>at</strong>h and Dismemberment<br />
insurance is available to you and your family, and Proof of Good Health is not required. If you<br />
choose coverage and experience a covered loss, Accidental De<strong>at</strong>h and Dismemberment benefits<br />
can help pay the cost of medical care, child care, and educ<strong>at</strong>ion expenses.<br />
Accidental De<strong>at</strong>h and Dismembertment Insurance Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
<strong>Change</strong> your<br />
beneficiary design<strong>at</strong>ion<br />
Get more details<br />
about AD&D Insurance<br />
File a claim<br />
the WIRE or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About AD&D Insurance<br />
A form also is available from<br />
your personnel represent<strong>at</strong>ive.<br />
Beneficiary changes cannot be<br />
made over the phone.<br />
Call the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362 or<br />
MetLife <strong>at</strong> (800) 638-6420<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> <strong>at</strong><br />
(800) 421-1362<br />
• All Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs), Full-Time Truck Drivers, and management associ<strong>at</strong>es have<br />
the option to enroll in AD&D insurance.<br />
• Proof of Good Health is not required for associ<strong>at</strong>e-only or family AD&D insurance, regardless of the<br />
coverage amount you choose.<br />
• AD&D insurance pays a lump-sum benefit for loss of life, limb, sight, speech, or hearing, or paralysis<br />
due to an accident.<br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
143
Enrolling in Accidental De<strong>at</strong>h<br />
and Dismemberment Insurance<br />
All Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs), Full-Time Truck<br />
Drivers, and management associ<strong>at</strong>es can enroll in<br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) insurance.<br />
AD&D insurance pays a lump-sum benefit to you or<br />
your beneficiary(s) if you or your covered dependent(s)<br />
has a loss of life, limb, sight, speech, or hearing, or<br />
becomes paralyzed due to an accident.<br />
You have two AD&D coverage decisions.You choose<br />
whom you want to cover and your coverage amount.<br />
You choose to cover:<br />
• <strong>Associ<strong>at</strong>e</strong> only<br />
• Family<br />
Your associ<strong>at</strong>e coverage amount choices for Accidental<br />
De<strong>at</strong>h and Dismemberment insurance are listed below.<br />
The coverage amount for your family will be a percentage<br />
of coverage amount you choose for yourself (see<br />
AD&D Coverage Amounts l<strong>at</strong>er in this chapter).The<br />
amounts available for you to choose as your associ<strong>at</strong>e<br />
coverage amount are:<br />
• $25,000<br />
• $50,000<br />
• $75,000<br />
• $100,000<br />
• $150,000<br />
• $200,000<br />
The amount of your benefit depends on the type of loss.<br />
See When AD&D <strong>Benefits</strong> Are Paid l<strong>at</strong>er in this chapter<br />
for more detail.<br />
You can enroll in or make changes to your AD&D insurance<br />
during your Initial Enrollment Period, the Annual<br />
Enrollment period, or when you have a St<strong>at</strong>us <strong>Change</strong><br />
Event. For more inform<strong>at</strong>ion, see the Eligibility and<br />
Enrollment chapter.<br />
Naming a Beneficiary<br />
When you enroll, you must name a beneficiary(s) to<br />
receive your AD&D insurance benefit if you die.You (the<br />
associ<strong>at</strong>e) will receive any benefits payable for your covered<br />
dependents.<br />
You can name anyone you wish. If the beneficiary(s) you<br />
have listed with the Company differs from those named<br />
in your will, the list th<strong>at</strong> the Company has prevails.<br />
The following inform<strong>at</strong>ion is needed when naming your<br />
beneficiary(s):<br />
• Beneficiary(s) name<br />
• Beneficiary(s) current address<br />
• Beneficiary(s) phone number<br />
• Beneficiary(s) rel<strong>at</strong>ionship to you<br />
• Beneficiary(s) Social Security number<br />
• Beneficiary(s) d<strong>at</strong>e of birth<br />
• The percentage you wish to design<strong>at</strong>e per beneficiary<br />
up to 100 percent<br />
The benefit will be shared equally by all beneficiaries listed<br />
unless specific percentage design<strong>at</strong>ions are elected.<br />
You can name a minor as a beneficiary. However, MetLife<br />
may not be legally permitted to pay the minor until the<br />
minor reaches legal age.You may want to consult with<br />
an <strong>at</strong>torney before naming a minor as a beneficiary. If<br />
you name a minor as a beneficiary, funeral expenses cannot<br />
be paid from the minor’s beneficiary proceeds.<br />
It is important to keep your beneficiary inform<strong>at</strong>ion upto-d<strong>at</strong>e.<br />
Proceeds will go to whoever is listed on your<br />
beneficiary form on file with the AHWP, regardless of<br />
your current rel<strong>at</strong>ionship with th<strong>at</strong> person.<br />
Changing Your Beneficiary<br />
Your beneficiary(s) can be changed <strong>at</strong> any time by using:<br />
• the WIRE;<br />
• walmartbenefits.com;or<br />
• Forms provided by your personnel represent<strong>at</strong>ive.<br />
The cost of AD&D insurance is based on the coverage<br />
amount you select and whether you choose associ<strong>at</strong>e<br />
only or family coverage.<br />
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If You Do Not<br />
Name a Beneficiary<br />
If there is no beneficiary design<strong>at</strong>ed or no surviving beneficiary<br />
<strong>at</strong> your de<strong>at</strong>h, MetLife will determine the beneficiary<br />
to be one or more of the following surviving you:<br />
1. Widow or widower; if no surviving; then<br />
2. Children in equal shares; if no surviving; then<br />
3. Parents in equal shares; if no surviving; then<br />
4. Brothers and sisters in equal shares; if no<br />
surviving; then<br />
5. Executor or Administr<strong>at</strong>or of your est<strong>at</strong>e.<br />
If two or more beneficiaries are design<strong>at</strong>ed and their<br />
shares are not specified, they will share the insurance<br />
benefit equally.<br />
Full Benefit Amount<br />
<strong>Associ<strong>at</strong>e</strong> Coverage<br />
Amount<br />
If family unit includes:<br />
Spouse Only<br />
If family unit includes:<br />
Spouse and Children<br />
AD&D Coverage Amounts<br />
The coverage amount you enroll in is the coverage<br />
amount th<strong>at</strong> applies to you, the associ<strong>at</strong>e. If you<br />
enroll in family coverage, your family members’<br />
coverage amount is a percentage of your associ<strong>at</strong>e<br />
coverage amount. The coverage amount for your<br />
family members depends on your family unit. See<br />
the chart Full Benefit Amount for inform<strong>at</strong>ion on<br />
the coverage amount for your family members.<br />
When AD&D <strong>Benefits</strong> Are Paid<br />
If you or a dependent (if you choose family coverage)<br />
sustains an accidental injury th<strong>at</strong> is the direct and sole<br />
cause of a covered loss described below (in Full Benefit,<br />
50 percent of Full Benefit, 25 percent of Full Benefit, and<br />
Two Times Full Benefit), proof of the accidental injury<br />
and covered loss must be sent to MetLife.<br />
Direct and sole cause means th<strong>at</strong> the covered loss occurs<br />
within 12 months of the d<strong>at</strong>e of the accidental injury<br />
and was a direct result of the accidental injury, independent<br />
of other causes.<br />
MetLife will deem a loss to be the direct result of an<br />
accidental injury if it results from unavoidable exposure<br />
to the elements and such exposure was a direct result<br />
of an accident.<br />
Paralysis means loss of use, without severance, of a limb.<br />
A doctor must determine th<strong>at</strong> the loss is complete and<br />
not reversible. Severance means complete separ<strong>at</strong>ion<br />
and dismemberment of the limb from the body.<br />
If family unit includes:<br />
Children Only<br />
<strong>Associ<strong>at</strong>e</strong> - 100 percent Spouse - 50 percent Spouse - 40 percent Children -10 percent Children - 25 percent<br />
$25,000 $12,500 $10,000 $2,500 $6,250<br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) Insurance<br />
$50,000 $25,000 $20,000 $5,000 $12,500<br />
$75,000 $37,500 $30,000 $7,500 $18,750<br />
$100,000 $50,000 $40,000 $10,000 $25,000<br />
$150,000 $75,000 $60,000 $15,000 $37,500<br />
$200,000 $100,000 $80,000 $20,000 $50,000<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
145
Full Benefit<br />
The following covered losses are payable <strong>at</strong> the<br />
Full Benefit:<br />
• Life<br />
• Exposure — De<strong>at</strong>h due to unavoidable<br />
exposure to the elements which was a direct<br />
result of an accident.<br />
• Disappearance — De<strong>at</strong>h will be presumed as a result<br />
of an accidental injury if:<br />
—The aircraft or other vehicle in which you and/or a<br />
dependent were traveling disappears, sinks, or is<br />
wrecked; and<br />
—The body of the person who has disappeared is not<br />
found within one year of:<br />
—the d<strong>at</strong>e the aircraft or other vehicle was<br />
scheduled to have arrived <strong>at</strong> its destin<strong>at</strong>ion,<br />
if traveling in an aircraft or other vehicle<br />
oper<strong>at</strong>ed by a common carrier; or<br />
—the d<strong>at</strong>e the person is reported missing to the<br />
authorities, if traveling in any other aircraft or<br />
other vehicle.<br />
• Both hands, both feet, or sight in both eyes—<br />
Permanent severance through or above the wrists<br />
but below the elbows and permanent severance <strong>at</strong><br />
or above the ankles but below the knees or total and<br />
irrecoverable loss of sight. Loss of sight means a permanent<br />
and uncorrectable loss of sight in the eye.<br />
Visual acuity must be 20/200 or worse in the eye or<br />
the field of vision must be less than 20 degrees.<br />
• One hand and one foot—Permanent severance<br />
through or above the wrist but below the elbow and<br />
permanent severance <strong>at</strong> or above the ankle but<br />
below the knee.<br />
• One arm or one leg—Permanent severance of one<br />
arm <strong>at</strong> or above the elbow or permanent severance<br />
of a leg <strong>at</strong> or above the knee.<br />
• Speech and hearing in both ears—The entire and<br />
irrecoverable loss of speech th<strong>at</strong> continues for six<br />
months following the accidental injury. The entire<br />
and irrecoverable loss of hearing in both ears th<strong>at</strong><br />
continues for six consecutive months following the<br />
accidental injury.<br />
• Hand or foot and sight in one eye—Permanent severance<br />
through or above the wrist but below the<br />
elbow or permanent severance <strong>at</strong> or above the ankle<br />
but below the knee, with total and irrecoverable loss<br />
of sight in one eye.<br />
• Paraplegia—Total paralysis of both lower limbs.<br />
Paralysis means loss of use of a limb, without severance.<br />
A physician must determine the paralysis to<br />
be permanent, complete and irreversible.<br />
• Hemiplegia—Total paralysis of upper and lower<br />
limbs on one side of the body.<br />
50 Percent of Full Benefit<br />
• Brain damage—Brain damage means permanent<br />
and irreversible physical damage to the brain causing<br />
the complete inability to perform all the substantial<br />
and m<strong>at</strong>erial functions and activities normal<br />
to everyday life. Such damage must manifest itself<br />
within 30 days of the accidental injury, require a<br />
Hospitaliz<strong>at</strong>ion of <strong>at</strong> least five days and persist for<br />
12 consecutive months after the d<strong>at</strong>e of the accidental<br />
injury.<br />
• Hand or foot—Permanent severance through or<br />
above the wrist but below the elbow or permanent<br />
severance <strong>at</strong> or above the ankle but below the knee.<br />
• Sight in one eye—Total and irrecoverable loss of<br />
sight in one eye.<br />
• Speech or hearing in both ears—The entire and<br />
irrecoverable loss of speech th<strong>at</strong> continues for six<br />
months following the accidental injury or the entire<br />
and irrecoverable loss of hearing in both ears th<strong>at</strong><br />
continues for six consecutive months following the<br />
accidental injury.<br />
25 Percent of Full Benefit<br />
• Loss of hearing in one ear<br />
• Thumb and index finger of the same hand—<br />
Permanent severance of each through or above the<br />
joint closest to the wrist.<br />
• Uniplegia—Total paralysis of one arm or leg.<br />
Two Times Full Benefit<br />
• Quadriplegia—Total paralysis of both upper and<br />
lower limbs.<br />
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Coma Benefit<br />
If you or your covered dependent(s) are com<strong>at</strong>ose or<br />
become com<strong>at</strong>ose within 31 days as the result of an accident,<br />
a coma benefit equal to 1 percent of the <strong>Associ<strong>at</strong>e</strong><br />
Coverage Amount will be paid for 11 consecutive<br />
months to you, your spouse, your children, or a legal<br />
guardian.The benefit is payable after 31 consecutive<br />
days of being com<strong>at</strong>ose. If you or your covered dependent(s)<br />
remains com<strong>at</strong>ose beyond 11 months, the full sum<br />
of the coverage, less any Accidental De<strong>at</strong>h and<br />
Dismemberment benefit already paid, will be made to<br />
you or your design<strong>at</strong>ed beneficiary.<br />
Coma means a st<strong>at</strong>e of deep and total unconsciousness<br />
from which the com<strong>at</strong>ose person cannot be aroused.<br />
Such st<strong>at</strong>e must begin within 31 days of the accidental<br />
injury and continue for 31 consecutive days.<br />
Additional AD&D <strong>Benefits</strong><br />
Additional benefits may be payable by the plan:<br />
• If you and/or your covered dependents suffer a loss<br />
of life as a result of a covered accident th<strong>at</strong> occurs<br />
while wearing a se<strong>at</strong> belt, a se<strong>at</strong> belt benefit may be<br />
payable; and<br />
• If you (the associ<strong>at</strong>e) lose your life, a child care<br />
benefit, child educ<strong>at</strong>ion benefit, or spouse educ<strong>at</strong>ion<br />
benefit may be payable.<br />
Se<strong>at</strong> Belt Benefit<br />
If you or your covered dependent(s) has a loss of life as a<br />
result of a covered accident th<strong>at</strong> occurs while wearing a<br />
se<strong>at</strong> belt while driving or riding in a priv<strong>at</strong>e passenger<br />
car, an additional benefit of $10,000 will be paid to you<br />
or your beneficiary(s).<br />
The following criteria must be met in order for the<br />
additional benefit to be paid.<br />
• The se<strong>at</strong> belt must have been in actual use and<br />
properly fastened <strong>at</strong> the time of the accident.<br />
• The vehicle must have been equipped with a manufacturer’s<br />
installed se<strong>at</strong>belt; this includes a properlyinstalled<br />
child safety device th<strong>at</strong> meets the requirements<br />
of st<strong>at</strong>e and federal law.<br />
A copy of the police report must be submitted with<br />
the claim.<br />
Passenger Car means any validly registered four-wheel<br />
priv<strong>at</strong>e passenger car, four-wheel drive vehicle, sportsutility<br />
vehicle, pick-up truck or mini-van. It does not<br />
include any commercially licensed car, any priv<strong>at</strong>e car<br />
being used for commercial purposes, or any vehicle used<br />
for recre<strong>at</strong>ional or professional racing.<br />
Se<strong>at</strong> belt means any restraint device th<strong>at</strong>:<br />
• Meets published United St<strong>at</strong>es Government<br />
safety standards;<br />
• Is properly installed by the car manufacturer; and<br />
• Is not altered after the install<strong>at</strong>ion.<br />
The term includes any child restraint device th<strong>at</strong> meets<br />
the requirements of st<strong>at</strong>e law.<br />
Child Care Benefit<br />
If you have a loss of life, the child care benefit will<br />
pay an overall maximum benefit of up to 5 percent of<br />
your<br />
coverage amount to cover the cost of child care. The<br />
dependent children must be under age 13 and enrolled<br />
in a child care center on the d<strong>at</strong>e of the accident or<br />
within 12 months after the accident.There is a $7,500<br />
yearly maximum.<br />
• The benefit will be paid to the surviving spouse or<br />
guardian for child care costs while your children are<br />
enrolled in a child care center. The child care center<br />
must be oper<strong>at</strong>ed in accordance with applicable laws<br />
and regul<strong>at</strong>ions and provide child care in a group<br />
setting on a regular daily basis.<br />
• The benefit will be paid when MetLife receives proof<br />
th<strong>at</strong> child care charges have been paid. <strong>Benefits</strong> will<br />
be paid quarterly.<br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
147
Child Educ<strong>at</strong>ion Benefit<br />
If you have a loss of life, an additional benefit will be paid<br />
to each of your dependent children who meet the following<br />
criteria:<br />
• Children who are enrolled as full-time students in an<br />
accredited college, university, or voc<strong>at</strong>ional school<br />
above the 12th grade level on the d<strong>at</strong>e of your<br />
de<strong>at</strong>h; or<br />
• Children <strong>at</strong> the 12th grade level who enroll in an<br />
accredited college, university, or voc<strong>at</strong>ional school<br />
within one year after the d<strong>at</strong>e of your de<strong>at</strong>h.<br />
The benefit will be paid semi-annually for up to four consecutive<br />
academic years, not to exceed a maximum of<br />
$20,000 per academic year or an overall maximum of 10<br />
percent of the <strong>Associ<strong>at</strong>e</strong> Coverage Amount. The benefit<br />
will be paid when MetLife receives proof th<strong>at</strong> tuition<br />
charges have been paid.<br />
Spouse Educ<strong>at</strong>ion Benefit<br />
If you have a loss of life, an additional benefit will be<br />
paid to your spouse as long as the following criteria<br />
are met:<br />
• Your spouse is enrolled in an accredited school on<br />
the d<strong>at</strong>e of your de<strong>at</strong>h; or<br />
• Your spouse enrolls in an accredited school within<br />
12 months after the d<strong>at</strong>e of your de<strong>at</strong>h.<br />
The benefit will be paid for up to four consecutive academic<br />
years, not to exceed a maximum of $20,000 per<br />
academic year or an overall maximum of 10 percent of<br />
the <strong>Associ<strong>at</strong>e</strong> Coverage Amount.The benefit will be paid<br />
in a lump sum when MetLife receives proof th<strong>at</strong> tuition<br />
charges have been paid.<br />
When <strong>Benefits</strong> Are Not Paid<br />
Accidental De<strong>at</strong>h and Dismemberment benefits will<br />
not be paid for any loss caused or contributed to by<br />
the following:<br />
• Intentionally self-inflicted injuries while sane<br />
or insane<br />
• Suicide or <strong>at</strong>tempted suicide<br />
• Losses th<strong>at</strong> occur in a declared or undeclared war,<br />
insurrection, rebellion, riot, or terrorist act<br />
• Service in the armed forces of any country or<br />
intern<strong>at</strong>ional authority, except the United St<strong>at</strong>es<br />
N<strong>at</strong>ional Guard<br />
• Injuries th<strong>at</strong> occur during the commission<br />
or <strong>at</strong>tempted commission of a felony by a<br />
covered participant<br />
• Infection, other than infection occurring in an<br />
external accidental wound<br />
• Physical or mental illness or infirmity, or the<br />
diagnosis or tre<strong>at</strong>ment of such illness or infirmity<br />
• Losses due to sickness or disease or voluntary<br />
intake or use by any means of poison, gas, or fumes,<br />
or alcohol in any combin<strong>at</strong>ion with any drug,<br />
medic<strong>at</strong>ion, or sed<strong>at</strong>ive unless it is taken or used as<br />
prescribed by a physician, or an “over-the-counter”<br />
drug, medic<strong>at</strong>ion or sed<strong>at</strong>ive taken as directed<br />
• Any loss where the injured party is intoxic<strong>at</strong>ed <strong>at</strong> the<br />
time of the incident and is the oper<strong>at</strong>or of a vehicle<br />
or other device involved in the incident. Intoxic<strong>at</strong>ed<br />
means th<strong>at</strong> the injured person’s blood alcohol level<br />
met or exceeded the level th<strong>at</strong> cre<strong>at</strong>es a legal presumption<br />
of intoxic<strong>at</strong>ion under the laws of the jurisdiction<br />
in which the incident occurred<br />
• Travel or flight if the airplane is being used for test or<br />
experimental purposes, military authority, or for travel<br />
or designed for travel beyond the earth’s <strong>at</strong>mosphere<br />
as determined by MetLife <strong>at</strong> its sole discretion<br />
148 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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Filing a Claim<br />
Within 90 days of the loss, call the <strong>Benefits</strong> Department<br />
<strong>at</strong> (800) 421-1362 and provide the following:<br />
• Name,<br />
• <strong>Associ<strong>at</strong>e</strong>’s Social Security number;<br />
• D<strong>at</strong>e of de<strong>at</strong>h or dismemberment; and<br />
• Cause of de<strong>at</strong>h or dismemberment (if known).<br />
MetLife will send a claim packet to you. Complete the<br />
inform<strong>at</strong>ion required and return the claim forms with an<br />
original or certified copy of the de<strong>at</strong>h certific<strong>at</strong>e, when<br />
applicable, to:<br />
MetLife Group Life Claims<br />
P.O. Box 3016<br />
Utica, New York 13504-3016<br />
<strong>Benefits</strong> can be paid in a lump sum or, upon written<br />
request, in monthly installments. If you or a covered<br />
dependent sustains more than one covered loss due to<br />
an accidental injury, the amount paid, on behalf of any<br />
such injured person, will not exceed the full amount of<br />
the benefit.<br />
Claims will be determined under the time frames and<br />
requirements set out in the Claims and Appeals chapter.<br />
You or your beneficiary has the right to appeal a claim<br />
denial. See the Claims and Appeals chapter for details.<br />
When AD&D Coverage Ends<br />
Your Accidental De<strong>at</strong>h and Dismemberment<br />
coverage ends:<br />
• At termin<strong>at</strong>ion of your employment;<br />
• Upon failure to pay your premiums;<br />
• On the d<strong>at</strong>e of your de<strong>at</strong>h;<br />
• On the d<strong>at</strong>e you or a dependent spouse or child<br />
loses eligibility;<br />
• On the last day of an approved Leave of Absence<br />
(unless you return to work); or<br />
• When the benefit is no longer offered by<br />
the Company.<br />
Accidental De<strong>at</strong>h and Dismemberment coverage cannot<br />
be converted to individual coverage after coverage ends.<br />
If You Leave the Company<br />
and Then Are Rehired<br />
If you return to work within 30 days, you will autom<strong>at</strong>ically<br />
be re-enrolled for the same coverage options (or<br />
the most similar options offered under the Plan).<br />
If you return to work after 30 days, you will be considered<br />
newly eligible and will be required to complete the<br />
applicable eligibility waiting period.<br />
See the Eligibility and Enrollment chapter for details.<br />
If You Go on a Leave of Absence<br />
For inform<strong>at</strong>ion about making payments while on a<br />
Leave of Absence, see the Eligibility and Enrollment<br />
chapter.<br />
If your coverage is canceled for failure to pay premiums<br />
while you are on leave and you return to Actively-At-<br />
Work st<strong>at</strong>us within one year of cancell<strong>at</strong>ion you will<br />
autom<strong>at</strong>ically be re-enrolled for the same coverage<br />
options you had prior to your Leave of Absence.Your<br />
coverage will be effective the first day of the pay period<br />
th<strong>at</strong> you meet the Actively-At-Work requirement.<br />
If you return to work after one year of cancell<strong>at</strong>ion, you<br />
will be tre<strong>at</strong>ed as newly eligible and you can enroll for<br />
coverage within the applicable waiting period described<br />
in the Eligibility and Enrollment chapter.<br />
Special rules may apply if you are on or return from an<br />
FMLA or Military Leave of Absence.<br />
See the Eligibility and Enrollment chapter for details.<br />
Accidental De<strong>at</strong>h and Dismemberment (AD&D) Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
149
Short-Term Disability<br />
Where Can I Find<br />
Enrolling in Short-Term Disability and When Coverage is Effective . . . . . . . . . . . . . . . . 152<br />
When You Qualify for Short-Term Disability <strong>Benefits</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153<br />
Filing a Claim for Short-Term Disability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153<br />
When Short-Term Disability <strong>Benefits</strong> Begin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154<br />
Your Short-Term Disability Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154<br />
Continuing Benefit Coverage While Disabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155<br />
When Short-Term Disability <strong>Benefits</strong> End. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156<br />
If You Leave the Company and Are Rehired. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157<br />
If You are On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by The Hartford, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting The Hartford.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Short-Term Disability<br />
Pregnancy, a scheduled surgery, or an unplanned illness or injury could keep you off the job<br />
and off the payroll for an extended period of time. Enrollment in the Short-Term Disability<br />
Plan protects part of your paycheck if you become disabled for more than 14 days. When you<br />
can’t work, the <strong>Wal</strong>-<strong>Mart</strong> Short-Term Disability Plan works for you. This income protection plan<br />
is an important part of the <strong>Wal</strong>-<strong>Mart</strong> benefit package.<br />
Short-Term Disability Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get more details about<br />
Short-Term Disability<br />
Email your question to<br />
askhartford@hartfordlife.com or<br />
walmartbenefits.com<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
If you live in California<br />
Email your questions to<br />
www.edd.ca.gov<br />
Call the st<strong>at</strong>e of California <strong>at</strong><br />
(800) 480-3287<br />
If you live in Hawaii Call The Hartford <strong>at</strong> (808) 534-7073<br />
If you live in New Jersey Call The Hartford <strong>at</strong> (800) 492-5678<br />
If you live in New York Call The Hartford <strong>at</strong> (800) 492-5678<br />
If you live in Rhode Island<br />
File a claim within 90 days<br />
of the d<strong>at</strong>e your disability began<br />
Click on the “Disability” section of<br />
walmartbenefits.com<br />
Call the st<strong>at</strong>e disability carrier <strong>at</strong><br />
(401) 462-8420<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
Short-Term Disability<br />
Wh<strong>at</strong> You Need to Know About Short-Term Disability<br />
• All Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s,<br />
and Field Supervisor Positions in stores and clubs) are eligible to enroll in Short-Term Disability coverage.<br />
Enrollment in Short-Term Disability is required to enroll in Long-Term Disability.<br />
• If you enroll after your initial eligibility period, your Short-Term Disability coverage will not begin until you<br />
complete a 12-month waiting period. Once coverage begins, benefits will be reduced during your first five<br />
Continuous years of coverage.<br />
• While you are disabled, the Short-Term Disability Plan replaces 40 percent or 50 percent of your income, depending<br />
on when you enroll for the coverage.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
151
Enrolling in Short-Term Disability<br />
and When Coverage is Effective<br />
All Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs) are eligible to<br />
enroll in Short-Term Disability coverage. Short-Term<br />
Disability coverage is insured by The Hartford in all 50<br />
st<strong>at</strong>es except California and Rhode Island. For inform<strong>at</strong>ion<br />
on coverage in California and Rhode Island, call the<br />
phone number listed in Short-Term Disability<br />
Resources <strong>at</strong> the beginning of this chapter.<br />
You must be enrolled in Short-Term Disability coverage<br />
in order to enroll in Long-Term Disability coverage.<br />
Short-Term Disability provides up to 50 percent of your<br />
Average Weekly Wage for up to 26 weeks after a 14-day<br />
waiting period if you become Totally Disabled as defined<br />
by the Plan.The maximum weekly benefit under the<br />
Short-Term Disability Plan is $600. For more inform<strong>at</strong>ion<br />
about your Average Weekly Wage, see Your Short-Term<br />
Disability Benefit l<strong>at</strong>er in this chapter.<br />
The d<strong>at</strong>e your coverage begins and the amount of your<br />
Short-Term Disability benefit depend on when you<br />
enroll for coverage:<br />
• If you enroll during your Initial Enrollment Period,<br />
your coverage begins on your effective d<strong>at</strong>e. See the<br />
Eligibility and Enrollment chapter for inform<strong>at</strong>ion on<br />
your Initial Enrollment Period and your effective d<strong>at</strong>e.<br />
• If you enroll <strong>at</strong> any time after your Initial<br />
Enrollment Period as a l<strong>at</strong>e enrollee, you are<br />
required to finish a 12-month waiting period from the<br />
d<strong>at</strong>e you enroll before your coverage is effective.You<br />
will not pay Short-Term Disability premiums during<br />
your 12-month waiting period.Your coverage will<br />
become effective on the day you meet the 12-month<br />
waiting period, provided you have been Actively At<br />
Work for the previous six-month period.<br />
Once your coverage is effective, your benefit depends on<br />
the length of time you have been covered under the<br />
plan <strong>at</strong> the time of your Total Disability:<br />
• First five continuous years of coverage—40 percent<br />
of your Average Weekly Wage.<br />
• After five continuous years of coverage—50 percent<br />
of your Average Weekly Wage up to the maximum<br />
benefit, as long as you are Actively-At-Work <strong>at</strong><br />
the end of the fifth year of coverage. Note: The five<br />
years of continuous coverage period does not<br />
include the 12-month waiting period.<br />
Short-Term Disability benefits are different in the following<br />
st<strong>at</strong>es: California, Hawaii, New Jersey, New York, and<br />
Rhode Island. For inform<strong>at</strong>ion about benefits in these<br />
st<strong>at</strong>es, call the number listed in Short-Term Disability<br />
Resources <strong>at</strong> the beginning of this chapter.<br />
If your job st<strong>at</strong>us changes from management to Full-<br />
Time hourly, you will be autom<strong>at</strong>ically enrolled for Short-<br />
Term Disability and Short-Term Disability Plus coverage<br />
as though you had enrolled during your Initial<br />
Enrollment Period. If you do not wish to carry this coverage,<br />
you have 60 days to notify the <strong>Benefits</strong> Department.<br />
Any premiums paid for the coverage will be refunded.<br />
The Cost of Short-Term<br />
Disability Coverage<br />
Your cost for Short-Term Disability is based on your biweekly<br />
earnings and your age. Premiums are deducted<br />
from all wages including bonuses.You will not be<br />
required to pay Short-Term Disability premiums while<br />
you are receiving Short-Term Disability benefits.<br />
Your Short-Term Disability costs differ in the<br />
following st<strong>at</strong>es:<br />
• California<br />
• Hawaii<br />
• New Jersey<br />
• New York<br />
• Rhode Island<br />
Coverage During a Temporary<br />
Layoff or Leave of Absence<br />
Once your Short-Term Disability coverage has begun, if<br />
you are not Actively-At-Work due to an approved Leave<br />
of Absence or a temporary layoff, you will continue to be<br />
eligible for Short-Term Disability benefits for 90 days<br />
from your last day of work.Your coverage will end on the<br />
91st day. Coverage will reinst<strong>at</strong>e if you return to Actively-<br />
At-Work st<strong>at</strong>us within one year.<br />
152 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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When You Qualify for<br />
Short-Term Disability <strong>Benefits</strong><br />
In order to qualify for Short-Term Disability benefits,<br />
you must:<br />
• Submit medical evidence provided by a qualified<br />
doctor th<strong>at</strong> you are Totally Disabled as defined by<br />
the Plan; and<br />
• Receive approval by The Hartford of your claim.<br />
The Hartford may require written proof of your disability<br />
or additional inform<strong>at</strong>ion before making a decision on<br />
your claim. A st<strong>at</strong>ement by your physician(s) th<strong>at</strong> “you<br />
are unable to work” does not in and of itself qualify you<br />
for Short-Term Disability benefits. Also note th<strong>at</strong><br />
approval of a medical Leave of Absence does not constitute<br />
approval for Short-Term Disability benefits.<br />
As defined by the plan, Total Disability means:<br />
• You are unable to perform the essential duties of Your<br />
Occup<strong>at</strong>ion according to the medical evidence provided<br />
by a qualified doctor other than you or a family<br />
member (failure to meet requirements necessary to<br />
maintain a license to perform the duties of Your<br />
Occup<strong>at</strong>ion does not mean you are Totally Disabled);<br />
• You are under the continuous care of a qualified<br />
doctor; and<br />
• The disability is due to injury, sickness, or pregnancy.<br />
If your Total Disability is the result of more than one<br />
cause, you will be paid as if they were one. The maximum<br />
benefit for any one period of disability is limited<br />
to 26 weeks.<br />
When <strong>Benefits</strong> Are Not Paid<br />
Short-Term Disability benefits will not be paid for:<br />
• Any illness or injury th<strong>at</strong> is not tre<strong>at</strong>ed by a<br />
qualified doctor;<br />
• Any loss caused by war or act of war (declared<br />
or not);<br />
• Any loss caused by illness or injury while in the<br />
armed services of any country engaged in war or<br />
other armed conflict;<br />
• Any injury caused by your commission of or <strong>at</strong>tempt<br />
to commit a felony;<br />
• Any injury caused or contributed to by your being<br />
engaged in an illegal occup<strong>at</strong>ion;<br />
• Any loss caused by any illness or injury for which<br />
workers’ compens<strong>at</strong>ion benefits are paid, or may be<br />
paid, if properly claimed; or<br />
• Any injury sustained as a result of doing any work<br />
for pay or profit.<br />
Filing a Claim for<br />
Short-Term Disability<br />
You must submit your Short-Term Disability claim<br />
within 90 days of the d<strong>at</strong>e your disability begins to<br />
assure benefits.<br />
If you experience a disabling illness or injury, or are<br />
scheduled to begin m<strong>at</strong>ernity leave, follow these steps:<br />
STEP 1: Notify your supervisor as soon as you know<br />
you will be absent from work due to an illness or injury.<br />
STEP 2: On or after your last day worked, call The<br />
Hartford <strong>at</strong> (800) 492-5678 to report the disability. You<br />
may also report your disability online by clicking on the<br />
Disability section of walmartbenefits.com. Processing of<br />
your claim cannot begin until you have stopped working.<br />
STEP 3: Ask your doctor’s office to call The Hartford to<br />
provide medical inform<strong>at</strong>ion, including the following:<br />
• Diagnosis;<br />
• Disability d<strong>at</strong>e and expected dur<strong>at</strong>ion of disability;<br />
• Restrictions and limit<strong>at</strong>ions;<br />
• Exam findings and test results; and<br />
• Tre<strong>at</strong>ment plan.<br />
STEP 4: Follow-up with your doctor to ensure<br />
inform<strong>at</strong>ion was forwarded to The Hartford.<br />
Claims will be determined under the time frames and<br />
requirements set out in the Claims and Appeals<br />
chapter.You have the right to appeal a claim denial.<br />
See the Claims and Appeals chapter for details.<br />
The Hartford may require written proof of your disability<br />
or additional medical inform<strong>at</strong>ion before your benefit<br />
payments begin.<br />
Call The Hartford the d<strong>at</strong>e you return to work.<br />
Short-Term Disability<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
153
When Short-Term<br />
Disability <strong>Benefits</strong> Begin<br />
If you are approved for Short-Term Disability benefits,<br />
the benefit will begin after a 14-day waiting period on<br />
the 15th calendar day after your Total Disability begins.<br />
Any illness protection time, vac<strong>at</strong>ion days, or personal days<br />
you have may be used to substitute for the benefit waiting<br />
period, but the time used cannot exceed 80 hours.<br />
Illness protection time is allowed up to the 15th calendar<br />
day of an illness after The Hartford approves your claim<br />
for Short-Term Disability benefits.You must repay the<br />
Company for any illness protection time, vac<strong>at</strong>ion, personal<br />
time, or other types of benefit hours taken beyond<br />
the 14-day benefit waiting period.<br />
You will not accumul<strong>at</strong>e illness protection time, vac<strong>at</strong>ion,<br />
personal time, or other types of benefit hours while you<br />
are receiving Short-Term Disability benefits.<br />
Your Short-Term Disability Benefit<br />
The amount of your Short-Term Disability benefit is<br />
based on:<br />
• Your Average Weekly Wage; and<br />
• Whether you enrolled for coverage during your<br />
Initial Enrollment Period or as a l<strong>at</strong>e enrollee<br />
(see Enrolling in Short-Term Disability earlier<br />
in this chapter).<br />
The maximum weekly benefit under the Short-Term<br />
Disability Plan is $600.<br />
Total Gross Pay includes:<br />
• Overtime;<br />
• Bonuses;<br />
• Vac<strong>at</strong>ion;<br />
• Illness protection (not including any previously paid<br />
Disability benefits); and<br />
• Personal pay for the 26 pay periods prior to the<br />
Total Disability.<br />
Your Short-Term Disability Benefit<br />
If You Enrolled<br />
During your initial Enrollment Period<br />
As a l<strong>at</strong>e enrollee and have been covered for<br />
less than five continuous years<br />
Your Benefit is<br />
50 percent of your Average Weekly Wage<br />
For example, 50 percent of $400 is a $200 benefit<br />
40 percent of your Average Weekly Wage<br />
For example, 40 percent of $400 is a $160 benefit<br />
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Average Weekly Wage<br />
Length of Employment<br />
Employed 12 months or more<br />
How Average Weekly Wage<br />
is Determined<br />
Total Gross Pay ÷ prior 52 weeks<br />
For example, the Average Weekly Wage for an associ<strong>at</strong>e with a<br />
Total Annual Gross Pay of $20,800 is $400 ($20,800 ÷ 52)<br />
Employed less than 12 months<br />
Total Gross Pay ÷ number of weeks worked<br />
For example, the Average Weekly Wage for an associ<strong>at</strong>e with a<br />
Total Gross Pay of $4,800 for 12 weeks of work is $400 ($4,800 ÷ 12)<br />
Your Short-Term Disability benefit is 40 percent or<br />
50 percent your Average Weekly Wage, depending<br />
on whether you enrolled during your Initial<br />
Enrollment Period.<br />
Your weekly benefit will be reduced by other benefits or<br />
income you (or your family) receive or are eligible to<br />
receive. Examples include, but are not limited to, income<br />
from the following:<br />
• Workers’ Compens<strong>at</strong>ion or any other governmental<br />
program th<strong>at</strong> provides disability or unemployment<br />
benefits as a result of your job with the Company<br />
• Employer-rel<strong>at</strong>ed individual policies<br />
• No-fault automobile insurance<br />
• Lump-sum payments or settlements rel<strong>at</strong>ed to<br />
the disability<br />
Please refer to the policy for a complete list of offsets.<br />
The policy can be obtained by calling The Hartford <strong>at</strong><br />
(800) 492-5678.<br />
The Hartford has the right to recover from you any<br />
amount th<strong>at</strong> is overpaid to you for Short-Term Disability<br />
benefits under this Plan.<br />
Continuing Benefit<br />
Coverage While Disabled<br />
If you wish to continue Medical, Dental, AD&D, Short-<br />
Term Disability Plus, life insurance, Cancer Insurance<br />
Policy, and Accident Insurance Policy coverage while you<br />
are receiving Short-Term Disability benefits, you must<br />
make premiums payments each pay period.These<br />
amounts will not be deducted from your Short-Term<br />
Disability benefit payments. If you fail to pay your premiums<br />
for your other benefit option(s), your benefits may<br />
be canceled. See the Eligibility and Enrollment chapter<br />
for details.<br />
The Company offers additional disability coverage—<br />
Short-Term Disability Plus—th<strong>at</strong> pays your payroll contributions<br />
for Medical, Dental, AD&D, Short-Term Disability<br />
Plus, Optional Life Insurance, and Dependent Life<br />
Insurance for up to eight weeks while you are disabled<br />
and receiving Short-Term Disability benefits. See the<br />
Short-Term Disability Plus chapter for more inform<strong>at</strong>ion.<br />
Your STD and LTD coverage will not be canceled if you<br />
are receiving payments under this policy.You will not be<br />
required to pay Short-Term Disability or Long-Term<br />
Disability premiums while you are receiving Short-Term<br />
Disability benefits.<br />
Short-Term Disability<br />
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155
When Short-Term<br />
Disability <strong>Benefits</strong> End<br />
Short-Term Disability benefit payments will end on the<br />
earliest of:<br />
• The d<strong>at</strong>e you are no longer Totally Disabled<br />
• The d<strong>at</strong>e you fail to furnish proof th<strong>at</strong> is s<strong>at</strong>isfactory<br />
to The Hartford th<strong>at</strong> you are Totally Disabled<br />
• The d<strong>at</strong>e you are no longer under the regular care of<br />
a physician<br />
• The d<strong>at</strong>e you refuse to be examined, if The Hartford<br />
requires an examin<strong>at</strong>ion<br />
• The last day of the maximum period for which benefits<br />
are payable (end of 26 weeks)<br />
• The d<strong>at</strong>e no further benefits are payable under any<br />
provision in the Short-Term Disability Plan th<strong>at</strong> limits<br />
benefit dur<strong>at</strong>ion which would include refusal to work<br />
in a similar position offered to you by <strong>Wal</strong>-<strong>Mart</strong> th<strong>at</strong><br />
you are medically able and qualified to perform, with<br />
a r<strong>at</strong>e of pay 50 percent or gre<strong>at</strong>er of your pre-disability<br />
earnings<br />
• The d<strong>at</strong>e of your de<strong>at</strong>h<br />
If you return to work within 30 days of the end of your<br />
approved disability claim, you will be reinst<strong>at</strong>ed to the<br />
disability coverage you had prior to your disability. If you<br />
do not return to work within 30 days of the end of your<br />
disability, your coverage will lapse until you return to<br />
work and meet the Actively-At-Work requirement.<br />
If You Return to Work and<br />
Become Disabled Again<br />
If you return to work for less than 30 calendar days of<br />
Full-Time Active Work and become Totally Disabled<br />
again from the same or a rel<strong>at</strong>ed condition th<strong>at</strong> caused<br />
the first period of disability, your Short-Term Disability<br />
benefits will pick up where they left off before you<br />
came back to work. There will be no additional waiting<br />
period. The combined benefit dur<strong>at</strong>ion will not exceed<br />
26 weeks.<br />
If you have returned to Full-Time Active Work for more<br />
than 30 calendar days and then become Totally Disabled<br />
from the same or a rel<strong>at</strong>ed cause, it will be considered a<br />
new disability and you will be able to receive up to<br />
another 26 weeks of benefits. A new 14-day benefit waiting<br />
period will apply.<br />
If you have returned to active Full-Time Active Work for<br />
any number of calendar days and then become Totally<br />
Disabled from a new and unrel<strong>at</strong>ed cause, it will be considered<br />
a new disability and you will be able to receive<br />
up to 26 weeks of benefits. A new 14-day benefit waiting<br />
period will apply.<br />
156 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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If You Leave the<br />
Company and Are Rehired<br />
If you leave the Company and return to work for the<br />
Company on a Full-Time basis within 30 days, you will<br />
autom<strong>at</strong>ically be re-enrolled in the same disability benefit<br />
option(s) (or the most similar options offered under<br />
the Plan).<br />
If you return to work for the Company on a Full-Time<br />
basis after 30 days, you will be considered newly eligible,<br />
and you can enroll for coverage once the applicable<br />
waiting period is met.<br />
If you return to work within 30 days and did not have<br />
disability coverage prior to your termin<strong>at</strong>ion, you will<br />
be considered a l<strong>at</strong>e enrollee if you elect disability<br />
coverage. See Enrolling for Short-Term Disability<br />
earlier in this chapter.<br />
If You are<br />
On a Leave of Absence<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to work on a Full-Time basis<br />
within one year of going on a Leave of Absence, you<br />
will autom<strong>at</strong>ically be re-enrolled in the same Short-Term<br />
Disability plan option(s) once the Actively-At-Work<br />
requirement has been met.<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to work on a Full-Time basis after<br />
one year of going on a Leave of Absence, you will be<br />
considered newly eligible, and you can enroll for Short-<br />
Term Disability coverage (including Short-Term Disability<br />
Plus) within the applicable waiting period described in<br />
the Eligibility and Enrollment chapter.<br />
Special rules may apply if you are on or return from<br />
an FMLA or Military Leave of Absence. See the<br />
Eligibility and Enrollment chapter for more inform<strong>at</strong>ion.<br />
Short-Term Disability<br />
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157
Short-Term Disability Plus<br />
Where Can I Find<br />
Enrolling in Short-Term Disability Plus and When Coverage is Effective . . . . . . . . . . . 160<br />
Short-Term Disability Plus <strong>Benefits</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160<br />
Filing a Claim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160<br />
When Short-Term Disability Plus <strong>Benefits</strong> Begin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161<br />
Continuing Benefit Coverage While Disabled. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161<br />
When Short-Term Disability Plus <strong>Benefits</strong> End. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161<br />
If You Leave the Company and Are Rehired. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161<br />
If You are On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by The Hartford, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting The Hartford.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Short-Term Disability Plus<br />
Health care insurance is an important financial safety net throughout your life. However, it<br />
becomes even more critical while you’re disabled. Enrollment in the Short-Term Disability Plus<br />
Program keeps your medical and other specified AHWP coverage in force <strong>at</strong> a time when you<br />
need your benefits the most. The Plan pays your and your family’s premiums for up to 56 calendar<br />
days while you are receiving Short-Term Disability benefits (after your 14-day Short-<br />
Term Disability waiting period). Short-Term Disability Plus coverage allows you to focus on<br />
receiving health care instead of worrying about how you are going to pay for it.<br />
Short-Term Disability Plus Program Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get more details about<br />
Short-Term Disability Plus<br />
Email your question to<br />
askhartford@hartfordlife.com or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About Short-Term Disability Plus<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
• All Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs) are eligible to enroll in Short-Term Disability Plus during their Initial<br />
Enrollment Period or <strong>at</strong> any other time. However, l<strong>at</strong>e enrollees will have a 12-month waiting period before<br />
coverage is effective.<br />
• You must be enrolled in the <strong>Wal</strong>-<strong>Mart</strong> Short-Term Disability Plan or be covered by a st<strong>at</strong>e-supplied plan (New<br />
York, New Jersey, Hawaii) in order to enroll in the Short-Term Disability Plus Program.<br />
• Short-Term Disability Plus pays your premiums for your Company-sponsored medical, dental, life insurance and<br />
other specified benefits for up to eight full weeks while you are receiving Short-Term Disability benefits.<br />
Short-Term Disability Plus<br />
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159
Enrolling in Short-Term Disability<br />
Plus and When Coverage is Effective<br />
All Full-Time hourly associ<strong>at</strong>es (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs) who have<br />
enrolled in the Short-Term Disability Plan are eligible to<br />
enroll in Short-Term Disability Plus. Short-Term Disability<br />
Plus is not available in California or Rhode Island. Short-<br />
Term Disability Plus coverage is insured by The Hartford.<br />
The d<strong>at</strong>e your coverage begins depends on when you<br />
enroll for coverage:<br />
• If you enroll during your Initial Enrollment Period,<br />
your coverage begins on your effective d<strong>at</strong>e. See the<br />
Eligibility and Enrollment chapter for inform<strong>at</strong>ion on<br />
your Initial Enrollment Period and your effective d<strong>at</strong>e.<br />
• If you enroll <strong>at</strong> any time after your Initial<br />
Enrollment Period as a l<strong>at</strong>e enrollee, you are<br />
required to finish a 12-month waiting period from<br />
the d<strong>at</strong>e you enroll before your coverage is effective.<br />
You will not pay Short-Term Disability Plus premiums<br />
during your 12-month waiting period. Your coverage<br />
will become effective on the day you meet the<br />
12-month waiting period.<br />
If you are Totally Disabled and receiving Short-Term<br />
Disability benefits, Short-Term Disability Plus coverage<br />
will pay your premiums for your Company-sponsored<br />
medical (including HMO, but not including Starbridge),<br />
dental, Optional Life Insurance, Dependent Life<br />
Insurance, AD&D, and Short-Term Disability Plus benefits<br />
for up to eight full weeks after a 14-day waiting period.<br />
Short-Term Disability Plus does not pay for the Cancer<br />
Insurance Policy or Accident Insurance Policy. See the<br />
Eligibility and Enrollment chapter for details.<br />
Short-Term<br />
Disability Plus <strong>Benefits</strong><br />
Short-Term Disability Plus benefit amounts are based on<br />
the costs of your coverage options prior to your last day<br />
worked before your Total Disability began. Should any<br />
coverage costs increase after your disability begins, you<br />
will be responsible for paying the difference in your r<strong>at</strong>es.<br />
You are responsible for your bi-weekly benefits payments<br />
even if there are delays in processing your Short-<br />
Term Disability claim.<br />
The Hartford will forward your benefit payments directly<br />
to the <strong>Associ<strong>at</strong>e</strong> Health and Welfare Plan (AHWP).The<br />
AHWP will apply this amount toward your premiums.<br />
Filing a Claim<br />
You do not have to file a claim for Short-Term Disability<br />
Plus benefits; a claim is autom<strong>at</strong>ically gener<strong>at</strong>ed by<br />
The Hartford when you file a claim for Short-Term<br />
Disability benefits.<br />
In order to receive Short-Term Disability Plus benefits:<br />
• Your Short-Term Disability claim under the AHWP<br />
must be approved by The Hartford; or<br />
• You must be receiving STD benefits through<br />
a st<strong>at</strong>e-mand<strong>at</strong>ed disability plan in New York,<br />
New Jersey, or Hawaii.<br />
For inform<strong>at</strong>ion on how to appeal a denied claim,<br />
see the Claims and Appeals chapter.<br />
The cost for Short-Term Disability Plus is based on<br />
whether or not you have medical coverage and if you<br />
cover your family members under the <strong>Associ<strong>at</strong>e</strong>s’<br />
Medical Plan.<br />
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When Short-Term<br />
Disability Plus <strong>Benefits</strong> Begin<br />
The Short-Term Disability Plus Program begins paying<br />
benefits after a 14-calendar day benefit waiting period.<br />
Continuing Benefit<br />
Coverage While Disabled<br />
Because the Short-Term Disability Plus Program pays<br />
your premiums for your Company-sponsored medical,<br />
dental, Optional Life Insurance, Dependent Life<br />
Insurance, AD&D, and Short-Term Disability Plus benefits,<br />
your coverages will remain in force. However, if you are<br />
enrolled in the Cancer Insurance Policy or Accident<br />
Insurance Policy, you must continue to pay your premiums<br />
or your coverage may be canceled.<br />
If you are receiving Short-Term Disability benefits, you<br />
are not required to pay Short-Term Disability or Long-<br />
Term Disability premiums.<br />
When Short-Term<br />
Disability Plus <strong>Benefits</strong> End<br />
The Short-Term Disability Plus Program pays your premiums<br />
for 56 calendar days after your 14-day benefit waiting<br />
period.You are responsible for your premiums after<br />
th<strong>at</strong> time. If you do not pay your premiums, your coverage<br />
will be cancelled. Benefit payments will end on the<br />
earliest of:<br />
• The day you are no longer receiving<br />
Short-Term Disability;<br />
• At the end of eight full weeks for which Short-Term<br />
Disability Plus benefits are payable; or<br />
• The day of your de<strong>at</strong>h.<br />
If You Leave the<br />
Company and Are Rehired<br />
If you return to work for the Company on a Full-Time<br />
basis within 30 days, you will autom<strong>at</strong>ically be reenrolled<br />
in the same disability coverage.<br />
If you leave the Company and return to work for the<br />
Company on a Full-Time basis after 30 days, you will be<br />
considered newly eligible, and you can enroll for disability<br />
coverage (including Short-Term Disability Plus) once<br />
the applicable waiting period is met.<br />
If You are On a Leave of Absence<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to Actively-At-Work st<strong>at</strong>us within one<br />
year of cancell<strong>at</strong>ion, you will autom<strong>at</strong>ically be reenrolled<br />
in Short-Term Disability Plus once the Actively-At-Work<br />
requirement has been met.<br />
If your coverage is cancelled and you return to work for<br />
the Company on a Full-Time hourly basis after one year,<br />
you will be considered newly eligible, and you can enroll<br />
for the Short-Term Disability Plus coverage after the<br />
applicable eligibility waiting period.<br />
Special rules may apply if you are on or return<br />
from an FMLA or Military Leave of Absence. See the<br />
Eligibility and Enrollment chapter for details.<br />
Short-Term Disability Plus<br />
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161
Long-Term Disability<br />
Where Can I Find<br />
Enrolling in Long-Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164<br />
When You Qualify for Long-Term Disability <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165<br />
When Long-Term Disability <strong>Benefits</strong> Begin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166<br />
Filing a Long-Term Disability Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166<br />
Your Long-Term Disability Benefit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167<br />
If You Are Disabled and Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169<br />
Continuing Benefit Coverage While Disabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169<br />
When Long-Term Disability <strong>Benefits</strong> End . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170<br />
If You Leave the Company and Are Rehired. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171<br />
If You are On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by The Hartford, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting The Hartford.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Long-Term Disability<br />
Your paycheck is the found<strong>at</strong>ion of your financial health. Think about how you would survive<br />
financially if you became disabled and were unable to work. Your bills would keep coming,<br />
even if your paychecks stopped. When you enroll, <strong>Wal</strong>-<strong>Mart</strong>’s Long-Term Disability Plan works<br />
with other benefits you receive during disability to replace part of your paycheck. By reducing<br />
the financial stress of a disability, you can focus on getting well and getting back to work.<br />
Long-Term Disability Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get more details about<br />
Long-Term Disability<br />
Email your question to<br />
askhartford@hartfordlife.com or<br />
walmartbenefits.com<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
File a claim Call The Hartford <strong>at</strong> (800) 492-5678<br />
File a claim if you live in California<br />
Wh<strong>at</strong> You Need to Know About Long-Term Disability<br />
Call the st<strong>at</strong>e of California <strong>at</strong><br />
(800) 480-3287 or<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> <strong>at</strong><br />
(800) 421-1362<br />
• Full-Time hourly associ<strong>at</strong>es (including Full-Time hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and Field<br />
Supervisor Positions in stores and clubs) enrolled in the Short-Term Disability Plan and management associ<strong>at</strong>es<br />
are eligible to enroll in the Long-Term Disability Plan.<br />
• If you enroll after your Initial Eligibility Period, your Long-Term Disability coverage will not begin until you complete<br />
a 12-month waiting period. Once coverage begins, benefits will be reduced during your first five continuous<br />
years of coverage.<br />
• The Long-Term Disability Plan works with any other benefits you receive while disabled to replace 40 percent or<br />
50 percent of your income, depending on when you enroll for the coverage.<br />
• Long-term Disability benefits are paid <strong>at</strong> the end of each month.<br />
Long-Term Disability<br />
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163
Enrolling in<br />
Long-Term Disability<br />
You are eligible to enroll in Long-Term Disability coverage<br />
if you are a:<br />
• Full-Time hourly associ<strong>at</strong>e (including Full-Time<br />
hourly pharmacists, Field Logistics <strong>Associ<strong>at</strong>e</strong>s, and<br />
Field Supervisor Positions in stores and clubs) who is<br />
also enrolled in the Short-Term Disability Plan; or<br />
• Management associ<strong>at</strong>e.<br />
Long-Term Disability begins paying benefits after a waiting<br />
period providing you with an income.<br />
<strong>Benefits</strong> are paid if you are Totally Disabled as defined by<br />
the plan.The maximum monthly benefit under the<br />
Long-Term Disability Plan is $15,000. Long-Term<br />
Disability coverage is insured by The Hartford.<br />
The d<strong>at</strong>e your coverage begins and the amount of your<br />
Long-Term Disability benefit depend on when you enroll<br />
for coverage:<br />
• If you enroll during your Initial Enrollment Period<br />
(see the Eligibility and Enrollment chapter for inform<strong>at</strong>ion<br />
on your Initial Enrollment Period and your<br />
effective d<strong>at</strong>e), your coverage amount will be 50 percent<br />
of your Average Monthly Wage.<br />
• If you enroll <strong>at</strong> any time after your Initial Enrollment<br />
Period as a l<strong>at</strong>e enrollee, you are required to finish a<br />
12-month waiting period from the d<strong>at</strong>e you enroll<br />
before your coverage is effective. You will not pay<br />
Long-Term Disability premiums during your<br />
12-month waiting period.Your coverage will become<br />
effective on the day you meet the 12-month waiting<br />
period, provided you have been Actively-At-Work for<br />
the previous six-month period.Your coverage amount<br />
will be 40 percent of your Average Monthly wage during<br />
your first five years of continuous coverage.<br />
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As a l<strong>at</strong>e enrollee, once your coverage is effective,<br />
your benefit depends on the length of time you have<br />
been covered under the plan <strong>at</strong> the time of your<br />
Total Disability:<br />
• First five Continuous Years of Coverage—40 percent<br />
of your Average Monthly Wage.<br />
• After five Continuous Years of Coverage—50 percent<br />
of your Average Monthly Wage up to the maximum<br />
benefit, as long as you are Actively <strong>at</strong> Work <strong>at</strong><br />
the end of the fifth year of coverage. The five years of<br />
continuous coverage period does not include the<br />
12-month waiting period.<br />
The Cost of<br />
Long-Term Disability Coverage<br />
Your cost for Long-Term Disability is based on your average<br />
monthly earnings and your age. Premiums are<br />
deducted from all wages including bonuses.You will not<br />
be required to pay Long-Term Disability premiums while<br />
you are receiving Long-Term Disability benefits.<br />
When You Qualify for<br />
Long-Term Disability <strong>Benefits</strong><br />
In order to qualify for Long-Term Disability benefits,<br />
you must:<br />
• Submit medical evidence provided by a qualified<br />
doctor th<strong>at</strong> you are Totally Disabled as defined by<br />
the Plan; and<br />
• Receive approval by The Hartford of your claim.<br />
As defined by the Plan, Total Disability means:<br />
• You are unable to perform the essential duties of<br />
Your Occup<strong>at</strong>ion (or any occup<strong>at</strong>ion after 12 months<br />
of benefit payments) according to the medical evidence<br />
provided by a qualified doctor other than you<br />
or a family member (failure to meet requirements<br />
necessary to maintain a license to perform the duties<br />
of Your Occup<strong>at</strong>ion does not mean you are Totally<br />
Disabled). Your Occup<strong>at</strong>ion includes similar job positions<br />
with the Company with a r<strong>at</strong>e of pay 50 percent<br />
or gre<strong>at</strong>er of your indexed pre-disability earnings;<br />
• You are under the continuous care of a qualified doctor;<br />
and<br />
• The disability is due to injury, sickness, or pregnancy.<br />
A st<strong>at</strong>ement by your physician(s) th<strong>at</strong> “you are unable to<br />
work” does not in and of itself qualify you for Long-Term<br />
Disability benefits.<br />
When <strong>Benefits</strong> Are Not Paid<br />
Long-Term Disability benefits will not be paid<br />
for disabilities:<br />
• Caused by your committing or <strong>at</strong>tempting to commit<br />
assault, b<strong>at</strong>tery, or a felony;<br />
• Due to war or any act of war (declared or not), insurrection,<br />
rebellions, or taking part in a riot or civil disorder;<br />
and/or<br />
• Due to, or contributed to by, a pre-existing condition.<br />
Pre-Existing Condition Limit<strong>at</strong>ion<br />
You will not receive Long-Term Disability benefits for any<br />
condition, diagnosed or undiagnosed, for which you had<br />
received tre<strong>at</strong>ment during the 365-day period prior to<br />
your effective d<strong>at</strong>e unless:<br />
• You have not been tre<strong>at</strong>ed for the pre-existing condition<br />
for more than 365 days while insured; or<br />
• You have been continuously insured on a full-time<br />
basis under the Long-Term Disability Plan for 730<br />
consecutive days prior to becoming disabled.<br />
Long-Term Disability<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
165
When Long-Term<br />
Disability <strong>Benefits</strong> Begin<br />
If you are approved for Long-Term Disability benefits,<br />
they will begin after your waiting period:<br />
• For Hourly <strong>Associ<strong>at</strong>e</strong>s: your waiting period is 180<br />
days or the end of your Short-Term Disability benefits—whichever<br />
is longer.<br />
• For Management <strong>Associ<strong>at</strong>e</strong>s: your waiting period is<br />
90 days or the end of your employer-sponsored<br />
salary continu<strong>at</strong>ion program—whichever is longer.<br />
If You Return to Work<br />
During Your Waiting Period<br />
and Become Disabled Again<br />
• For Hourly <strong>Associ<strong>at</strong>e</strong>s: if you cease to be Totally<br />
Disabled and return to work for a total of 30 calendar<br />
days or less during a waiting period, the waiting<br />
period will not be interrupted.<br />
• For Salaried <strong>Associ<strong>at</strong>e</strong>s: if you cease to be Totally<br />
Disabled and return to work for a total of six months<br />
or less during a waiting period, the waiting period<br />
will not be interrupted.<br />
Filing a Long-Term<br />
Disability Claim<br />
Hourly <strong>Associ<strong>at</strong>e</strong>s—You will receive a claim form from<br />
The Hartford if the medical inform<strong>at</strong>ion provided indic<strong>at</strong>es<br />
your Total Disability is expected to last longer than<br />
195 calendar days. The Hartford will transfer the claim<br />
from Short-Term Disability to Long-Term Disability on<br />
the 17th week of disability.<br />
Management <strong>Associ<strong>at</strong>e</strong>s—Call The Hartford <strong>at</strong><br />
(800) 492-5678 by the 45th day of your salary continuance<br />
if you believe you will need to use your Long-Term<br />
Disability benefits.The Hartford will provide additional<br />
inform<strong>at</strong>ion on how to complete your claim.<br />
<strong>Associ<strong>at</strong>e</strong>s receiving Workers’ Compens<strong>at</strong>ion benefits<br />
and enrolled for Long-Term Disability insurance may be<br />
eligible for disability benefits after their waiting period is<br />
expired. Call The Hartford <strong>at</strong> (800) 492-5678 to verify<br />
your eligibility for these benefits.<br />
Average Monthly Wage<br />
Length of Employment<br />
Employed 12 months or more<br />
How Average Monthly Wage<br />
is Determined<br />
Total Gross Pay ÷ prior 12 months<br />
For example, the Average Monthly Wage for an associ<strong>at</strong>e<br />
with a Total Annual Gross Pay of $20,800 is $1,733.33<br />
($20,800 ÷ 12)<br />
Employed less than 12 months<br />
Total Gross Pay ÷ number of months worked<br />
For example, the Average Monthly Wage for an associ<strong>at</strong>e with a<br />
Total Gross Pay of $11,900 for seven months of work is $1,700<br />
($11,900 ÷ 7)<br />
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California <strong>Associ<strong>at</strong>e</strong>s—You must:<br />
• File a claim with the St<strong>at</strong>e of California by calling<br />
(800) 480-3287 within 41 days of the d<strong>at</strong>e of<br />
your disability.<br />
• Contact the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362.<br />
Claims will be determined under the time frames and<br />
requirements set out in the Claims and Appeals chapter.You<br />
have the right to appeal a claim denial. See the<br />
Claims and Appeals chapter for details.<br />
Your Long-Term<br />
Disability Benefit<br />
The amount of your Long-Term Disability is based on:<br />
• Your Average Monthly Wage; and<br />
• Whether you enrolled for coverage during your<br />
Initial Enrollment Period or as a l<strong>at</strong>e enrollee<br />
(see Enrolling in Long-Term Disability earlier<br />
in this chapter).<br />
Total Gross Pay includes:<br />
• Overtime;<br />
• Bonuses;<br />
• Vac<strong>at</strong>ion;<br />
• Illness protection; and<br />
• Personal pay for the 26 pay periods (52 if paid<br />
weekly) prior to the Total Disability.<br />
If you have been employed less than 12 months, an<br />
annualized average of earnings will be used, excluding<br />
reimbursed expenses.<br />
Your Long-Term Disability benefit is shown below.<br />
The maximum monthly benefit under the Long-Term<br />
Disability Plan is $15,000.Your benefit will be no less<br />
than $50 for any month th<strong>at</strong> you are receiving Long-<br />
Term Disability benefits.The total of your monthly disability<br />
payment, plus all earnings, cannot exceed your<br />
Average Monthly Wage prior to your disability.<br />
Long-Term Disability benefits are paid <strong>at</strong> the end of<br />
the month.<br />
The Hartford has the right to recover from you any<br />
amount th<strong>at</strong> is overpaid to you for Long-Term Disability<br />
benefits under this plan.<br />
Long-Term Disability<br />
Your Long-Term Disability Benefit<br />
If You Enrolled<br />
During your initial Enrollment Period<br />
Your Benefit is<br />
50 percent of your Average Monthly Wage minus the amount of other<br />
benefits or income you (or your family) are eligible to receive<br />
For example, Social Security Disability benefits*<br />
As a l<strong>at</strong>e enrollee and have been covered for<br />
less than five continuous years<br />
40 percent of your Average Monthly Wage minus the amount of other<br />
benefits or income you (or your family) are eligible to receive<br />
For example, Social Security Disability benefits*<br />
*See Other <strong>Benefits</strong> or Income th<strong>at</strong> Reduce Long-Term Disability <strong>Benefits</strong> l<strong>at</strong>er in this chapter for more inform<strong>at</strong>ion.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
167
Other <strong>Benefits</strong> or<br />
Income th<strong>at</strong> Reduce<br />
Long-Term Disability <strong>Benefits</strong><br />
Your Long-Term Disability benefit amount will be<br />
reduced by other benefits or income you (or your family)<br />
receive or are eligible to receive. Examples include, but<br />
are not limited to, income from the following:<br />
• Social Security Disability Insurance<br />
• Social Security Retirement th<strong>at</strong> begins after the d<strong>at</strong>e<br />
of Total Disability<br />
• Workers’ Compens<strong>at</strong>ion<br />
• Employer-rel<strong>at</strong>ed individual policies<br />
• No fault automobile insurance<br />
• Employer retirement plan th<strong>at</strong> begins after the d<strong>at</strong>e<br />
of the Total Disability<br />
• Settlement or judgment less associ<strong>at</strong>ed costs of a<br />
lawsuit th<strong>at</strong> represents or compens<strong>at</strong>es for your<br />
loss of earnings<br />
Please refer to the policy for a complete list of<br />
offsets. The Hartford policy can be obtained by<br />
calling (800) 492-5678.<br />
You Must Apply for Social<br />
Security Disability <strong>Benefits</strong><br />
You may be eligible to receive Social Security Disability<br />
benefits after you have been disabled for five months.<br />
If your disability is expected to last, or has already lasted,<br />
five consecutive months, the Long-Term Disability<br />
policy terms require you to apply for Social Security<br />
Disability benefits If the Social Security Administr<strong>at</strong>ion<br />
denies you benefits, you will be required to follow the<br />
appeal process.<br />
Failure to file for Social Security Disability benefits<br />
could result in your Social Security Retirement benefits<br />
being reduced when you reach the age of retirement. If<br />
you qualify for Social Security Disability benefits while<br />
on Long-Term Disability and your approval d<strong>at</strong>e is<br />
retroactive, you must reimburse The Hartford for any<br />
Long-Term Disability benefits paid to you, regardless of<br />
when you actually start receiving Social Security<br />
Disability benefit payments.<br />
Reduction of LTD Benefit Example<br />
Average Monthly Wage $1,800<br />
Benefit amount (50 percent of Average<br />
Monthly Wage, subject to the $15,000 max)<br />
$900<br />
Less Social Security Disability benefit - $500<br />
Less dependent’s Social Security benefits - $250<br />
LTD Payment $150<br />
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If You Are Disabled and Working<br />
If you are disabled and working, and are currently<br />
earning less than 80 percent of your Indexed Pre-<br />
Disability Earnings, the following calcul<strong>at</strong>ion is used to<br />
determine your monthly benefit:<br />
Disabled and Working<br />
Benefit Calcul<strong>at</strong>ion<br />
A<br />
B<br />
C<br />
D<br />
(A - B) x C = D<br />
A<br />
Your Indexed Pre-Disability Monthly Earnings<br />
Your current monthly earnings<br />
The monthly benefit payable if you were<br />
otherwise Totally Disabled<br />
The disabled and working benefit payable<br />
Indexed Pre-Disability Monthly Earnings means your<br />
Pre-Disability Earnings adjusted annually by adding 7%.<br />
Pre-Disability Monthly Earnings means your regular<br />
monthly r<strong>at</strong>e of pay in effect for the 26 regular pay periods<br />
immedi<strong>at</strong>ely prior to the d<strong>at</strong>e you became Totally<br />
Disabled divided by 12. Pre-Disability Earnings includes<br />
overtime pay, bonuses, vac<strong>at</strong>ion pay, illness protection,<br />
and personal pay, but not commissions or any other<br />
fringe benefits or extra compens<strong>at</strong>ion. If you have<br />
worked for less than 12 months with the Company, your<br />
regular monthly r<strong>at</strong>e of pay will be based upon the total<br />
earnings you actually received while working for the<br />
Company immedi<strong>at</strong>ely prior to the d<strong>at</strong>e you became<br />
Totally Disabled, annualized and divided by 12.<br />
Continuing Benefit<br />
Coverage While Disabled<br />
If you wish to continue Medical, Dental, AD&D, Short-<br />
Term Disability Plus, Life Insurance, Cancer Insurance<br />
Policy, and Accident Insurance Policy coverage while you<br />
are receiving Long-Term Disability benefits, you must<br />
make premiums payments each pay period.These<br />
amounts will not be deducted from your Long-Term<br />
Disability benefit payments. If you fail to pay your premiums<br />
for your other benefit option(s), your benefits may<br />
be canceled. See the Eligibility and Enrollment chapter<br />
for details.<br />
You will not be required to pay Short-Term Disability<br />
or Long-Term Disability premiums while you are receiving<br />
Disability benefits. Your coverage will not be canceled<br />
while you are receiving disability benefits under<br />
this policy.<br />
If You Die While Receiving<br />
Long-Term Disability <strong>Benefits</strong><br />
When you die, your coverage ends; however, if you die<br />
after s<strong>at</strong>isfying the waiting period while receiving Long-<br />
Term Disability benefits, a lump-sum payment of $5,000<br />
will be paid to your surviving spouse. If you are not survived<br />
by a spouse, the payment will be made to your surviving<br />
children in equal shares. If you are not survived by<br />
a spouse or children, the payment will be payable to<br />
your est<strong>at</strong>e.<br />
Long-Term Disability<br />
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169
When Long-Term<br />
Disability <strong>Benefits</strong> End<br />
Long-Term Disability benefit payments will end on the<br />
earliest of:<br />
• The d<strong>at</strong>e you are no longer Totally Disabled<br />
• The d<strong>at</strong>e you fail to furnish proof th<strong>at</strong> is s<strong>at</strong>isfactory<br />
to The Hartford th<strong>at</strong> you are Totally Disabled<br />
• The d<strong>at</strong>e you refuse to be examined, if The Hartford<br />
requires an examin<strong>at</strong>ion<br />
• The last day of the maximum period for which benefits<br />
are payable<br />
• The d<strong>at</strong>e th<strong>at</strong> you refuse a similar position offered to<br />
you by <strong>Wal</strong>-<strong>Mart</strong> th<strong>at</strong> you are medically able and<br />
qualified to perform, with a r<strong>at</strong>e of pay 50 percent or<br />
gre<strong>at</strong>er of your pre-disability earnings<br />
• The d<strong>at</strong>e of your de<strong>at</strong>h<br />
• The d<strong>at</strong>e determined from the following<br />
Dur<strong>at</strong>ion of Long-Term Disability <strong>Benefits</strong> chart<br />
Dur<strong>at</strong>ion of Long-Term<br />
Disability <strong>Benefits</strong><br />
Age When You<br />
Become Totally Disabled<br />
<strong>Benefits</strong><br />
Termin<strong>at</strong>ion<br />
Prior to age 62 Until age 65<br />
62 4 years<br />
63 3 1/2 years<br />
If the Disability is Due<br />
to Mental Illness, Alcoholism,<br />
or Drug Addiction<br />
In order to receive Long-Term Disability benefits for<br />
more than 24 months for the following disabilities, you<br />
must be confined in a Hospital or other place licensed to<br />
provide medical care:<br />
• Mental illness (excluding demonstrable, structural<br />
brain damage)<br />
• Any condition th<strong>at</strong> results from mental illness<br />
• Alcoholism<br />
• Nonmedical use of narcotics, sed<strong>at</strong>ives, stimulants,<br />
hallucinogens, or similar substances<br />
When you are not confined, there will be a 24-month<br />
lifetime benefit for these disabilities.<br />
If You Return to Work<br />
and Become Disabled Again<br />
If you return to work for less than 180 days of active<br />
Full-Time work and become Totally Disabled again<br />
from the same or a rel<strong>at</strong>ed condition th<strong>at</strong> caused the<br />
first period of disability, the recurrent disability will be<br />
part of the same disability.<br />
If you return to work as an active Full-Time associ<strong>at</strong>e<br />
for 180 days or more, any recurrence of a disability will<br />
be tre<strong>at</strong>ed as a new disability. A new waiting period<br />
must be completed.<br />
64 3 years<br />
65 2 1/2 years<br />
66 2 1/4 years<br />
67 2 years<br />
68 1 3/4 years<br />
69 or older 1 1/2 years<br />
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If You Leave the<br />
Company and Are Rehired<br />
If you leave the Company and return to work for the<br />
Company on a Full-Time basis within 30 days, you will<br />
autom<strong>at</strong>ically be re-enrolled in the same Long-Term<br />
Disability Plan option(s) (or the most similar option<br />
offered under the Plan).<br />
If you return to active Full-Time work for the<br />
Company after 30 days, you will be considered newly<br />
eligible, and you can enroll for Long-Term Disability coverage<br />
once the applicable waiting period is met.<br />
If You are On a<br />
Leave of Absence<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to work on a Full-Time basis<br />
within one year of going on a Leave of Absence, you<br />
will autom<strong>at</strong>ically be re-enrolled in the same Long-Term<br />
Disability Plan option(s) once the Actively-At-Work<br />
requirement has been met.<br />
If your coverage is cancelled and you return to work<br />
on a Full-Time basis after one year of going on a<br />
Leave of Absence, you will be considered newly eligible,<br />
and you can enroll for Long-Term Disability coverage<br />
within the applicable waiting period described in<br />
the Eligibility and Enrollment chapter.<br />
Special rules may apply if you are on or return<br />
from an FMLA or Military Leave of Absence. See<br />
the Eligibility and Enrollment chapter for<br />
more inform<strong>at</strong>ion.<br />
Long-Term Disability<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
171
Truck Driver Long-Term Disability<br />
Where Can I Find<br />
Enrolling in Truck Driver Long-Term Disability and When Coverage is Effective . . . . 174<br />
When You Qualify for Long-Term Disability <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175<br />
When Truck Driver Long-Term Disability <strong>Benefits</strong> Begin . . . . . . . . . . . . . . . . . . . . . . . . . . 176<br />
Filing a Truck Driver Long-Term Disability Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176<br />
Your Truck Driver Long-Term Disability Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176<br />
If You Are Disabled and Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178<br />
Continuing Benefit Coverage While Disabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178<br />
When Truck Driver Long-Term Disability <strong>Benefits</strong> End . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178<br />
If You Return to Work and Become Disabled Again . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181<br />
If You Leave the Company and Are Rehired. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181<br />
If You Are On a Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by The Hartford, the terms of the policy will govern.<br />
You may obtain a copy of the policy by contacting The Hartford.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Truck Driver Long-Term Disability<br />
If a disability keeps you off the road and unable to work beyond your salary continuance period,<br />
Truck Driver Long-Term Disability benefits work with other benefits you receive to replace<br />
part of your paycheck. You have two Truck Driver Long-Term Disability options th<strong>at</strong> pay benefits<br />
for different lengths of time.<br />
Truck Driver Long-Term Disability Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Get more details about<br />
Truck Driver Long-Term Disability<br />
File a claim by the 45th day of your<br />
salary continuance<br />
File a claim within 41 days of the<br />
d<strong>at</strong>e of your disability if you live<br />
in California<br />
Email your question to<br />
askhartford@hartfordlife.com or<br />
walmartbenefits.com<br />
Wh<strong>at</strong> You Need to Know About Truck Driver Long-Term Disability<br />
• Full-Time Truck Drivers have two Truck Driver Long-Term Disability options: full-dur<strong>at</strong>ion coverage and<br />
five-year coverage.<br />
• If you enroll after your Initial Eligibility Period, your Truck Driver Long-Term Disability benefits will be<br />
reduced to 40 percent of your Average Monthly Wage during your first year of coverage and you’ll have to submit<br />
Proof of Good Health and may be required to undergo a medical exam <strong>at</strong> your own expense before you can<br />
be approved.<br />
• The Truck Driver Long-Term Disability Plan works with any other benefits you receive while disabled to<br />
replace 40 percent or 50 percent of your Average Monthly Wage, depending on when you enroll for the coverage.<br />
• Truck Driver Long-term Disability benefits are paid <strong>at</strong> the end of each month.<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
Call The Hartford <strong>at</strong> (800) 492-5678<br />
Call the st<strong>at</strong>e of California <strong>at</strong><br />
(800) 480-3287 or<br />
Call <strong>Wal</strong>-<strong>Mart</strong><strong>Benefits</strong> <strong>at</strong><br />
(800) 421-1362<br />
Truck Driver Long-Term Disability<br />
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173
Enrolling in Truck Driver<br />
Long-Term Disability and<br />
When Coverage is Effective<br />
You are eligible to enroll in Truck Driver Long-Term<br />
Disability coverage if you are a Full-Time Truck Driver.<br />
Truck Driver Long-Term Disability offers two<br />
coverage options:<br />
• Full-dur<strong>at</strong>ion coverage. Full-dur<strong>at</strong>ion coverage pays<br />
benefits for the longer of:<br />
—The period shown in the Reducing Benefit<br />
Dur<strong>at</strong>ion Table (l<strong>at</strong>er in this chapter); or<br />
—The normal retirement age under the Social<br />
Security Act shown in the Social Security Normal<br />
Retirement Age Table (l<strong>at</strong>er in this chapter).<br />
• Five-year coverage. Five-year coverage pays benefits<br />
for 60 months unless the longer of the following is<br />
less than 60 months. In this case, the monthly benefit<br />
will be payable for the shorter period.<br />
—The period shown in the Reducing Benefit<br />
Dur<strong>at</strong>ion Table (l<strong>at</strong>er in this chapter); or<br />
—The normal retirement age under the Social<br />
Security Act shown in the Social Security Normal<br />
Retirement Age Table (l<strong>at</strong>er in this chapter).<br />
Truck Driver Long-Term Disability begins paying benefits<br />
after a waiting period providing you with an income.<br />
<strong>Benefits</strong> are paid if you are Totally Disabled as defined<br />
by the Plan. The maximum monthly benefit under the<br />
Long-Term Disability Plan is $15,000. Truck Driver Long-<br />
Term Disability coverage is insured by The Hartford.<br />
Your benefit will be no less than $50 for any month th<strong>at</strong><br />
you are receiving Long-Term Disability benefits. The<br />
total of your monthly Disability payment plus all earnings<br />
cannot exceed your Average Monthly Wage prior<br />
to your Disability.<br />
The d<strong>at</strong>e your coverage is effective and the amount of<br />
your Truck Driver Long-Term Disability benefit depend<br />
on when you enroll for coverage:<br />
• If you enroll during your Initial Enrollment Period<br />
(from the d<strong>at</strong>e of your first paycheck through<br />
60 days of your hire d<strong>at</strong>e), your coverage amount<br />
will be 50 percent of your Average Monthly Wage.<br />
Your coverage will be effective on your d<strong>at</strong>e of hire.<br />
• If you enroll <strong>at</strong> any time after your Initial<br />
Enrollment Period as a l<strong>at</strong>e enrollee:<br />
—Your monthly benefit will be reduced to 40 percent<br />
of your Average Monthly Wage if you become<br />
Totally Disabled during your first continuous year<br />
of coverage.<br />
—You will be required to provide Proof of Good<br />
Health (complete a questionnaire regarding your<br />
medical history; and<br />
—You may be required to undergo a medical exam <strong>at</strong><br />
your own expense.<br />
As a l<strong>at</strong>e enrollee, your coverage will be effective the first<br />
day of the pay period after <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> receives<br />
approval from The Hartford.<br />
The Cost of Truck Driver<br />
Long-Term Disability Coverage<br />
Your cost for Truck Driver Long-Term Disability is based<br />
on your bi-weekly earnings and your age. Premiums are<br />
deducted from all wages including bonuses.You will not<br />
be required to pay Truck Driver Long-Term Disability premiums<br />
while you are receiving Truck Driver Long-Term<br />
Disability benefits.<br />
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When You Qualify for<br />
Long-Term Disability <strong>Benefits</strong><br />
In order to qualify for Truck Driver Long-Term Disability<br />
benefits, you must:<br />
• Submit medical evidence provided by a qualified<br />
doctor th<strong>at</strong> you are Totally Disabled as defined by<br />
the Plan;<br />
• Remain Totally Disabled beyond the waiting<br />
period; and<br />
• Receive approval by The Hartford of your claim.<br />
As defined by the Plan, Total Disability means:<br />
• During your waiting period and for up to 12 months,<br />
you are unable to perform the essential duties of<br />
Your Occup<strong>at</strong>ion according to the medical evidence<br />
provided by a qualified doctor other than you or a<br />
family member, and as a result you are earning less<br />
than 50 percent of your Average Monthly Wage,<br />
unless engaged in a program of rehabilit<strong>at</strong>ive<br />
employment approved by The Hartford. Failure to<br />
meet the requirements necessary to maintain a<br />
license to perform the duties of Your Occup<strong>at</strong>ion<br />
does not mean you are Totally Disabled.<br />
• After 12 months, you are unable to perform the<br />
essential duties of any occup<strong>at</strong>ion. The disability<br />
must be due to accidental bodily injury, sickness,<br />
substance abuse, or pregnancy.<br />
A st<strong>at</strong>ement by your physician(s) th<strong>at</strong> “you are unable to<br />
work” does not in and of itself qualify you for Truck<br />
Driver Long-Term Disability benefits under this Plan.<br />
If you file a claim within the first two years of your<br />
approval d<strong>at</strong>e, The Hartford has the right to re-examine<br />
your Proof of Good Health questionnaire. If m<strong>at</strong>erial<br />
facts about you were st<strong>at</strong>ed inaccur<strong>at</strong>ely, the true facts<br />
will be used to determine if and for wh<strong>at</strong> amount of<br />
coverage should have been in effect and your premium<br />
may be adjusted.<br />
When <strong>Benefits</strong> Are Not Paid<br />
Truck Driver Long-Term Disability benefits will not be<br />
paid for disabilities th<strong>at</strong> are:<br />
• Caused by your committing or <strong>at</strong>tempting to commit<br />
assault, b<strong>at</strong>tery, or a felony;<br />
• Due to war or any act of war (declared or not), insurrection,<br />
rebellions, or taking part in a riot or civil disorder;<br />
and/or<br />
• Due to, or contributed to by, a pre-existing condition.<br />
Pre-Existing Condition Limit<strong>at</strong>ion<br />
You will not receive Truck Driver Long-Term Disability<br />
benefits for any condition, diagnosed or undiagnosed,<br />
for which you had received tre<strong>at</strong>ment during the<br />
365-day period prior to your effective d<strong>at</strong>e unless:<br />
• You have not been tre<strong>at</strong>ed for the pre-existing<br />
condition for more than 365 days while insured;<br />
• You have been continuously insured on a Full-Time<br />
basis under the Truck Driver Long-Term Disability<br />
Plan for 730 consecutive days prior to becoming<br />
disabled; or<br />
• You have already s<strong>at</strong>isfied the pre-existing<br />
condition requirement of the prior plan sponsored<br />
by the Company.<br />
Truck Driver Long-Term Disability<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
175
When Truck Driver Long-Term<br />
Disability <strong>Benefits</strong> Begin<br />
If you are approved for Truck Driver Long-Term Disability<br />
benefits, they will begin after your waiting period which<br />
is the longer of:<br />
• The first 90 consecutive calendar days of any one<br />
period of Total Disability, or<br />
• The end of your Company-sponsored salary continuance<br />
program, with the exception of benefits<br />
required by st<strong>at</strong>e law.<br />
If You Return to Work<br />
During Your Waiting Period<br />
and Become Disabled Again<br />
If you are out of work for the same Total Disability in a<br />
six-month period, the 90-day benefit waiting period<br />
does not need to be s<strong>at</strong>isfied consecutively. You will be<br />
required to complete the remaining portion of the benefit<br />
waiting period.<br />
Filing a Truck Driver<br />
Long-Term Disability Claim<br />
If you believe you will need to use your Truck Driver<br />
Long-Term Disability benefits, call The Hartford <strong>at</strong><br />
(800) 492-5678 by the 45th day of your salary<br />
continuance.The Hartford will provide additional<br />
inform<strong>at</strong>ion on how to complete your claim.<br />
If you are a California associ<strong>at</strong>e, you will need to file a disability<br />
claim with the St<strong>at</strong>e of California within 41 days of<br />
the d<strong>at</strong>e of your disability by calling (800) 480-3287.<br />
Claims will be determined under the time frames and<br />
requirements set out in the Claims and Appeals chapter.You<br />
have the right to appeal a claim denial. See the<br />
Claims and Appeals chapter for details.<br />
<strong>Associ<strong>at</strong>e</strong>s receiving Workers’ Compens<strong>at</strong>ion benefits<br />
and enrolled for Long-Term Disability insurance may be<br />
eligible for disability benefits after their waiting period is<br />
expired. Call The Hartford <strong>at</strong> (800) 492-5678 to verify<br />
your eligibility for these benefits.<br />
Your Truck Driver<br />
Long-Term Disability Benefit<br />
The amount of your Truck Driver Long-Term Disability is<br />
based on:<br />
• Your Average Monthly Wage; and<br />
• Whether you enrolled for coverage during your<br />
Initial Enrollment Period or as a l<strong>at</strong>e enrollee<br />
(see Enrolling in Truck Driver Long-Term Disability<br />
earlier in this chapter).<br />
The maximum monthly benefit under the Truck Driver<br />
Long-Term Disability Plan is $15,000. Your benefit will<br />
be no less than $50 for any month th<strong>at</strong> you are receiving<br />
Truck Driver Long-Term Disability benefits. The total<br />
of your monthly disability payment, plus all earnings,<br />
cannot exceed your Average Monthly Wage prior to<br />
your disability.<br />
Truck Driver Long-Term Disability benefits are paid <strong>at</strong> the<br />
end of the month.<br />
The Hartford has the right to recover from you any<br />
amount th<strong>at</strong> is overpaid to you for Truck Driver Long-<br />
Term Disability benefits under this plan.<br />
Average Monthly Wage<br />
Length of Employment<br />
Employed 12 months<br />
or more<br />
How Average Monthly<br />
Wage is Determined<br />
Your activity pay, mileage r<strong>at</strong>e,<br />
and bonuses, paid in the 26<br />
pay period prior to the Total<br />
Disability ÷ 12 months<br />
Employed less than<br />
12 months<br />
An annualized average of your<br />
earnings, including bonuses<br />
and mileage r<strong>at</strong>e as applicable<br />
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Your Long-Term Disability Benefit<br />
If You Enrolled<br />
During your Initial Enrollment Period<br />
Your Benefit is<br />
50 percent of your Average Monthly Wage minus the amount of other<br />
benefits or income you (or your family) are eligible to receive<br />
For example, Social Security Disability benefits*<br />
After your Initial Enrollment Period<br />
40 percent of your Average Monthly Wage minus the amount of other<br />
benefits or income you (or your family) are eligible to receive<br />
For example, Social Security Disability benefits*<br />
*See Other <strong>Benefits</strong> or Income th<strong>at</strong> Reduce Long-Term Disability <strong>Benefits</strong> l<strong>at</strong>er in this chapter for more inform<strong>at</strong>ion.<br />
Other <strong>Benefits</strong> or Income<br />
th<strong>at</strong> Reduce Truck Driver<br />
Long-Term Disability <strong>Benefits</strong><br />
Your Truck Driver Long-Term Disability benefit amount<br />
will be reduced by other benefits or income you (or your<br />
family) receive or are eligible to receive. Examples include,<br />
but are not limited to, income from the following:<br />
• Social Security Disability Insurance<br />
• Social Security Retirement th<strong>at</strong> begins after the d<strong>at</strong>e<br />
of Total Disability<br />
• Workers’ Compens<strong>at</strong>ion<br />
• Employer-rel<strong>at</strong>ed individual policies<br />
• No fault automobile insurance<br />
• Employer retirement plan th<strong>at</strong> begins after the d<strong>at</strong>e<br />
of the Total Disability<br />
• Settlement or judgment less associ<strong>at</strong>ed costs of a<br />
lawsuit th<strong>at</strong> represents or compens<strong>at</strong>es for your loss<br />
of earnings<br />
Please refer to the policy for a complete list of<br />
offsets. The Hartford policy can be obtained by<br />
calling (800) 492-5678.<br />
Reduction of LTD Benefit Example<br />
Average Monthly Wage $1,800<br />
Benefit amount (50 percent of Average<br />
Monthly Wage, subject to the $15,000 max)<br />
$900<br />
Less Social Security benefit - $500<br />
Less dependent’s Social Security benefits - $250<br />
LTD Payment $150<br />
Failure to file for Social Security Disability benefits could<br />
result in your Social Security Retirement benefits being<br />
reduced when you reach the age of retirement. If you<br />
qualify for Social Security Disability or Retirement benefits<br />
while on Truck Driver Long-Term Disability and your<br />
approval d<strong>at</strong>e is retroactive, you must reimburse The<br />
Hartford for any long-term disability benefits paid to you,<br />
regardless of when you actually start receiving Social<br />
Security Disability or Retirement benefit payments.<br />
Truck Driver Long-Term Disability<br />
You Must Apply for Social<br />
Security Disability <strong>Benefits</strong><br />
You may be eligible to receive Social Security Disability<br />
benefits after you have been disabled for five months.<br />
If your disability is expected to last, or has already lasted,<br />
five consecutive months, the Truck Driver Long-Term<br />
Disability policy terms require you to apply for Social<br />
Security Disability benefits. If the Social Security<br />
Administr<strong>at</strong>ion denies you benefits, you will be required<br />
to follow the appeal process.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
177
If You Are<br />
Disabled and Working<br />
If you are disabled and working, and are currently earning<br />
less than 80 percent of your indexed pre-disability<br />
earnings, the following calcul<strong>at</strong>ion is used to determine<br />
your monthly benefit:<br />
Disabled and Working<br />
Benefit Calcul<strong>at</strong>ion<br />
A<br />
B<br />
C<br />
D<br />
(A - B) x C = D<br />
A<br />
Your Indexed Pre-Disability Monthly Earnings<br />
Your current monthly earnings<br />
The monthly benefit payable if you were<br />
otherwise Totally Disabled<br />
The disabled and working benefit payable<br />
Your Pre-Disability Earnings means your hourly activity<br />
pay, mileage r<strong>at</strong>e, and bonus in effect for the 52 weeks<br />
immedi<strong>at</strong>ely prior to the d<strong>at</strong>e you become Disabled<br />
divided by 12. Indexed Pre-Disability Earnings means<br />
your Pre-Disability Earnings increased annually by 7%.<br />
Continuing Benefit<br />
Coverage While Disabled<br />
If you wish to continue Medical, Dental, AD&D, Life<br />
Insurance, Cancer Insurance Policy, and Accident<br />
Insurance Policy coverage while you are receiving<br />
Truck Driver Long-Term Disability benefits, you must<br />
make benefits premiums payments each pay period.<br />
These amounts will not be deducted from your Truck<br />
Driver Long-Term Disability benefit payments. If you<br />
fail to pay your premiums for your other benefit<br />
option(s), your benefits may be canceled. See the<br />
Eligibility and Enrollment chapter for details.<br />
If You Die While Receiving<br />
Long-Term Disability <strong>Benefits</strong><br />
When you die, your coverage ends; however, if you die<br />
after s<strong>at</strong>isfying the waiting period while receiving Truck<br />
Driver Long-Term Disability benefits, a lump-sum payment<br />
of $5,000 will be paid to your surviving spouse. If<br />
you are not survived by a spouse, the payment will be<br />
made to your surviving children in equal shares. If you<br />
are not survived by a spouse or children, the payment<br />
will be payable to your est<strong>at</strong>e.<br />
When Truck Driver Long-Term<br />
Disability <strong>Benefits</strong> End<br />
Truck Driver Long-Term Disability benefit payments will<br />
end on the earliest of:<br />
• The d<strong>at</strong>e you are no longer Totally Disabled<br />
• The d<strong>at</strong>e you fail to furnish proof th<strong>at</strong> is s<strong>at</strong>isfactory<br />
to The Hartford th<strong>at</strong> you are Totally Disabled<br />
• The d<strong>at</strong>e you refuse an examin<strong>at</strong>ion required by<br />
The Hartford<br />
• The d<strong>at</strong>e th<strong>at</strong> you refuse a similar position offered to<br />
you by <strong>Wal</strong>-<strong>Mart</strong> th<strong>at</strong> you are medically able and<br />
qualified to perform, with a r<strong>at</strong>e of pay 50 percent or<br />
gre<strong>at</strong>er of your pre-disability earnings<br />
• The d<strong>at</strong>e of your de<strong>at</strong>h<br />
• The d<strong>at</strong>e determined from the coverage you have<br />
chosen and the following tables<br />
You will not be required to pay Long-Term Disability premiums<br />
while you are receiving Disability benefits.Your<br />
coverage will not be cancelled while you are receiving<br />
disability benefits under this policy.<br />
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Full Dur<strong>at</strong>ion Coverage<br />
Full-dur<strong>at</strong>ion coverage pays benefits for the longer of:<br />
• The period shown in the Reducing Benefit<br />
Dur<strong>at</strong>ion Table; or<br />
• The normal retirement age under the Social<br />
Security Act shown in the Social Security Normal<br />
Retirement Age Table.<br />
Five-Year Coverage<br />
Five-year coverage pays benefits for 60 months<br />
unless the longer of the following is less than 60<br />
months. In this case, the monthly benefit will be<br />
payable for the shorter period.<br />
• The period shown in the Reducing Benefit<br />
Dur<strong>at</strong>ion Table; or<br />
• The normal retirement age under the Social<br />
Security Act shown in the Social Security Normal<br />
Retirement Age Table.<br />
Reducing Benefit Dur<strong>at</strong>ion<br />
To Social Security<br />
Normal Retirement Age<br />
Age When You Become<br />
Totally Disabled <strong>Benefits</strong> Termin<strong>at</strong>ion Year of Birth Normal Retirement<br />
Prior to age 62 Until age 65 1937 or before 65<br />
62 4 years 1938 65 + 2 months<br />
63 3 1/2 years 1939 65 + 4 months<br />
64 3 years 1940 65 + 6 months<br />
65 2 1/2 years 1941 65 + 8 months<br />
66 2 1/4 years 1942 65 + 10 months<br />
67 2 years 1943 through 1954 66<br />
68 1 3/4 years 1955 66 + 2 months<br />
69 or older 1 1/2 years 1956 66 + 4 months<br />
1957 66 + 6 months<br />
Truck Driver Long-Term Disability<br />
1958 66 + 8 months<br />
1959 66 + 10 months<br />
1960 or after 67<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
179
Full-dur<strong>at</strong>ion coverage pays benefits for the longer of:<br />
• The period shown in the Dur<strong>at</strong>ion of Long-Term<br />
Disability Table; or<br />
• The normal retirement age under the Social Security<br />
Act shown in the Social Security Normal Retirement<br />
Age Table.<br />
Five-year coverage pays benefits for 60 months unless<br />
the longer of the following is less than 60 months.<br />
• The period shown in the Dur<strong>at</strong>ion of Long-Term<br />
Disability Table; or<br />
• The normal retirement age under the Social Security<br />
Act shown in the Social Security Normal Retirement<br />
Age Table.<br />
In this case, the monthly benefit will be payable for the<br />
shorter period.<br />
If the Disability is<br />
Due to Mental Illness,<br />
Alcoholism, or Drug Addiction<br />
In order to receive Truck Driver Long-Term Disability<br />
benefits for more than 24 months for the following disabilities,<br />
you must be confined in a Hospital or other<br />
place licensed to provide medical care:<br />
• Mental illness (excluding demonstrable, structural<br />
brain damage)<br />
• Any condition th<strong>at</strong> results from mental illness<br />
• Alcoholism<br />
• Nonmedical use of narcotics, sed<strong>at</strong>ives, stimulants,<br />
hallucinogens, or similar substances<br />
If you are confined in a Hospital or other place licensed<br />
to provide medical care, benefits will be payable as long<br />
as you are confined, subject to the maximum dur<strong>at</strong>ion of<br />
benefits and all other policy provisions.<br />
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If You Return to Work<br />
and Become Disabled Again<br />
If you return to work for less than six months of active<br />
Full-Time work and become Totally Disabled again from<br />
the same or a rel<strong>at</strong>ed condition th<strong>at</strong> caused the first period<br />
of disability, the recurrent Total Disability will be part<br />
of the same disability. No additional waiting period will<br />
be required.<br />
If you return to work as an active Full-Time associ<strong>at</strong>e for<br />
six months or more, any recurrence of a Total Disability<br />
will be tre<strong>at</strong>ed as a new disability. Another benefit waiting<br />
period must be met.<br />
If You Leave the<br />
Company and Are Rehired<br />
If you return to active Full-Time work for the Company<br />
within 30 days, you will autom<strong>at</strong>ically be re-enrolled in<br />
the same Truck Driver Long-Term Disability option(s)<br />
you had when you left (or the most similar option<br />
offered under the Plan).<br />
If you return to active Full-Time work for the<br />
Company after 30 days, you will be considered newly<br />
eligible and you can enroll for Truck Driver Long-Term<br />
Disability coverage.<br />
If You Are On a<br />
Leave of Absence<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to work on a Full-Time basis<br />
within one year, you will autom<strong>at</strong>ically be re-enrolled in<br />
the same Truck Driver Long-Term Disability option(s)<br />
once the Actively-At-Work requirement has been met.<br />
If your coverage is cancelled for failure to pay premiums<br />
and you return to work on a Full-Time basis after<br />
one year, you will be considered newly eligible, and you<br />
can enroll for Truck Driver Long-Term Disability coverage<br />
within the applicable waiting period described in the<br />
Eligibility and Enrollment chapter.<br />
Special rules may apply if you are on or return from an<br />
FMLA or Military Leave of Absence.<br />
See the Eligibility and Enrollment chapter for<br />
more inform<strong>at</strong>ion.<br />
Truck Driver Long-Term Disability<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
181
Business Travel Accident Insurance<br />
Where Can I Find<br />
Your Business Travel Accident Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184<br />
Naming a Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184<br />
If You Do Not Name a Beneficiary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184<br />
When Business Travel Accident <strong>Benefits</strong> Are Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184<br />
Additional Business Travel Accident <strong>Benefits</strong> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185<br />
When Business Travel Accident <strong>Benefits</strong> Are Not Paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186<br />
Filing a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186<br />
When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187<br />
AXA Travel Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187<br />
Medex Travel Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188<br />
The AHWP includes the following three types<br />
of travel assistance benefits:<br />
• Business Travel Accident Insurance provides<br />
coverage for certain injuries or de<strong>at</strong>h th<strong>at</strong><br />
occur while you are on Company-authorized<br />
business travel.<br />
• AXA Travel Assistance provides medical, travel,<br />
legal, and financial assistance services while<br />
you are traveling for business or pleasure.<br />
• Medex Travel Assistance provides medical,<br />
travel, legal, and financial assistance services<br />
when you travel intern<strong>at</strong>ionally for Companyauthorized<br />
business.<br />
This inform<strong>at</strong>ion is intended to be a summary of your benefits and may not include all policy provisions.<br />
If there is a discrepancy between this document and the policy issued by the applicable insurer under this chapter,<br />
the terms of the policy will govern. You may obtain a copy of the policy by contacting the applicable insurer.
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Business Travel Accident Insurance<br />
While you are traveling on authorized Company business, <strong>Wal</strong>-<strong>Mart</strong>’s Business Travel Accident<br />
Insurance protects you financially if you have an accident th<strong>at</strong> results in certain types of<br />
injuries or de<strong>at</strong>h. This <strong>Wal</strong>-<strong>Mart</strong>-paid coverage costs you nothing, is effective on your first day<br />
of work, and provides up to $200,000 in benefits. As you work for <strong>Wal</strong>-<strong>Mart</strong>, <strong>Wal</strong>-<strong>Mart</strong> works<br />
for you, protecting your and your family’s well-being.<br />
Business Travel Accident Insurance Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
<strong>Change</strong> your beneficiary design<strong>at</strong>ion<br />
Get more details about<br />
Business Travel Insurance<br />
Get more details about<br />
AXA Travel Insurance<br />
Get more details about<br />
Medex Travel Assistance<br />
File a Business Travel Accident<br />
Insurance claim<br />
Wh<strong>at</strong> You Need to Know About<br />
Company-Paid Business Travel Accident Insurance<br />
• <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all associ<strong>at</strong>es with Company-paid Business Travel Accident Insurance—<br />
there is no cost to you.<br />
• Business Travel Accident Insurance pays a lump-sum benefit for loss of life, limb, sight, speech, or hearing,<br />
or paralysis due to an accident you were involved in while traveling on authorized Company business.<br />
• Your coverage amount is $200,000.<br />
the WIRE or<br />
walmartbenefits.com<br />
A form also is available from<br />
your personnel represent<strong>at</strong>ive.<br />
Beneficiary changes cannot be<br />
made over the phone.<br />
Call Prudential <strong>at</strong> (877) 740-2116<br />
Call AXA <strong>at</strong> (800) 565-9320 in the U.S.;<br />
or outside the U.S., call collect <strong>at</strong><br />
(312) 935-3783<br />
www.medexassist.com Call Medex <strong>at</strong> (800) 537-2029<br />
Call <strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> <strong>at</strong><br />
(800) 421-1362<br />
Business Travel Accident Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
183
Your Business<br />
Travel Accident Insurance<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all associ<strong>at</strong>es with<br />
Company-paid Business Travel Accident Insurance.The<br />
Company pays for this coverage in full—there is no cost<br />
to you. No enrollment is necessary. Coverage will<br />
become effective on your first day of Active Work.<br />
See the Eligibility and Enrollment chapter for details.<br />
Business Travel Accident Insurance pays a lump-sum<br />
benefit to you or your beneficiary(s) if you have a loss of<br />
life, limb, sight, speech, or hearing, or become paralyzed<br />
due to an accident while traveling on authorized<br />
Company business. Business Travel Accident Insurance<br />
is insured by The Prudential Insurance Company of<br />
America (Prudential).<br />
The full benefit amount of Business Travel Accident<br />
Insurance is $200,000.<br />
Naming a Beneficiary<br />
When you enroll, you must name a beneficiary(s) to<br />
receive your Business Travel Accident Insurance benefit if<br />
you die.You (the associ<strong>at</strong>e) will receive any benefits<br />
payable for the injuries listed in When Business Travel<br />
Accident <strong>Benefits</strong> Are Paid l<strong>at</strong>er in this chapter.<br />
You can name anyone you wish. If the beneficiary(s) you<br />
have listed with the Company differs from those named<br />
in your will, the list th<strong>at</strong> the Company has prevails.<br />
The following inform<strong>at</strong>ion is needed when naming your<br />
beneficiary(s):<br />
• Beneficiary(s) name<br />
• Beneficiary(s) current address<br />
• Beneficiary(s) phone number<br />
• Beneficiary(s) rel<strong>at</strong>ionship to you<br />
• Beneficiary(s) Social Security number<br />
• Beneficiary(s) d<strong>at</strong>e of birth<br />
• The percentage you wish to design<strong>at</strong>e per<br />
beneficiary up to 100 percent<br />
The benefit will be shared equally by all beneficiaries listed<br />
unless specific percentage design<strong>at</strong>ions are elected.<br />
You can name a minor as a beneficiary. However,<br />
Prudential may not be legally permitted to pay the<br />
minor until the minor reaches legal age. You may want<br />
to consult with an <strong>at</strong>torney before naming a minor as<br />
a beneficiary. If you name a minor as a beneficiary,<br />
funeral expenses cannot be paid from the minor’s<br />
beneficiary proceeds.<br />
It is important to keep your beneficiary inform<strong>at</strong>ion upto-d<strong>at</strong>e.<br />
Proceeds will go to whoever is listed on your<br />
beneficiary form on file with the AHWP, regardless of<br />
your current rel<strong>at</strong>ionship with th<strong>at</strong> person.<br />
Changing Your Beneficiary<br />
Your beneficiary(s) can be changed <strong>at</strong> any time by using:<br />
• the WIRE;<br />
• walmartbenefits.com;or<br />
• Forms provided by your personnel represent<strong>at</strong>ive.<br />
If You Do Not Name a Beneficiary<br />
If no beneficiary is named, payment will be made to your<br />
surviving family member(s) in the following order:<br />
1. Widow or widower; if no surviving; then<br />
2. Children in equal shares; if no surviving; then<br />
3. Parents in equal shares; if no surviving; then<br />
4. Brothers and sisters in equal shares; if no<br />
surviving; then<br />
5. Executor or Administr<strong>at</strong>or of your est<strong>at</strong>e.<br />
When Business Travel Accident<br />
<strong>Benefits</strong> Are Paid<br />
If you are involved in an accident while traveling on<br />
authorized Company business and the injuries result in<br />
de<strong>at</strong>h or a loss listed below, the Plan will pay the benefit<br />
listed on the next page.<br />
Paralysis means loss of use, without severance, of a limb.<br />
A doctor must determine th<strong>at</strong> the loss is complete and<br />
not reversible. Severance means complete separ<strong>at</strong>ion<br />
and dismemberment of the limb from the body.<br />
If one or more associ<strong>at</strong>es suffer a common loss as a<br />
result of the same aircraft accident, the maximum the<br />
Business Travel Accident policy will pay for all losses is<br />
$5 million per aircraft accident.This includes an aircraft<br />
owned and oper<strong>at</strong>ed by the Company.<br />
184 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Full Benefit—$200,000<br />
• Life<br />
• Both hands, both feet, sight in both eyes—Severance<br />
through or above the wrist or ankle joint, or total and<br />
irrecoverable loss of sight.<br />
• One hand and one foot— Severance through or<br />
above the wrist or ankle joint.<br />
• Speech and hearing in both ears—Complete inability<br />
to communic<strong>at</strong>e audibly in any degree, with irrecoverable<br />
loss of hearing which cannot be corrected by<br />
any hearing aid or device.<br />
• Hand or foot and sight in one eye—Severance<br />
through or above the wrist or ankle joint, with total<br />
and irrecoverable loss of sight in one eye.<br />
• Paraplegia—Total paralysis of both lower limbs.<br />
• Hemiplegia—Total paralysis of upper and lower<br />
limbs on one side of the body.<br />
50 Percent of Full Benefit<br />
• Hand or foot—Permanent severance through or<br />
above the wrist but below the elbow or permanent<br />
severance <strong>at</strong> or above the ankle but below the knee.<br />
• Sight in one eye—Total and irrecoverable loss of<br />
sight in one eye.<br />
• Speech or hearing in both ears—Complete inability<br />
to communic<strong>at</strong>e audibly in any degree, with irrecoverable<br />
loss of hearing which cannot be corrected by<br />
any hearing aid or device.<br />
25 Percent of Full Benefit<br />
• Thumb and index finger of the same hand—<br />
Severance of each through or above the joint closest<br />
to the wrist.<br />
Two Times Full Benefit<br />
• Quadriplegia—Total paralysis of both upper and<br />
lower limbs.<br />
Additional Business<br />
Travel Accident <strong>Benefits</strong><br />
Business Travel Accident Insurance also provides three<br />
additional benefits.<br />
• $10,000 se<strong>at</strong> belt benefit<br />
• $10,000 air bag benefit<br />
• Coma benefit<br />
Se<strong>at</strong> Belt Benefit<br />
If you have a loss of life as a result of a covered accident<br />
th<strong>at</strong> occurs while wearing a se<strong>at</strong> belt while driving or riding<br />
in a priv<strong>at</strong>e passenger car, an additional benefit of<br />
$10,000 will be paid to your beneficiary(s).<br />
The following criteria must be met in order for the additional<br />
benefit to be paid.<br />
• The priv<strong>at</strong>e passenger vehicle must have been<br />
equipped with original or factory-installed se<strong>at</strong> belts.<br />
• The se<strong>at</strong> belt must have been in actual use in the<br />
prescribed manner <strong>at</strong> the time of the accident.<br />
A copy of the police report must be submitted with the<br />
claim. If it is unclear whether a se<strong>at</strong> belt was in use, the<br />
se<strong>at</strong> belt benefit will be reduced to $1,000.<br />
Air Bag Benefit<br />
If you have a loss of life as a result of a covered accident<br />
th<strong>at</strong> occurs while riding in an automobile se<strong>at</strong> equipped<br />
with a factory-installed air bag system and while wearing<br />
a se<strong>at</strong> belt, there is an additional benefit of $10,000.<br />
The following criteria must be met in order for the additional<br />
benefit to be paid.<br />
• The priv<strong>at</strong>e passenger vehicle must have been<br />
equipped with original or factory-installed air bags.<br />
• The air bag must have been in use <strong>at</strong> the time of<br />
the accident.<br />
Coma Benefit<br />
The coma benefit begins the 31st day of your coma<br />
as the result of a covered accident.The benefit is the<br />
gre<strong>at</strong>er of 2 percent of your amount of coverage per<br />
month, or $100 up to 50 months.<br />
Business Travel Accident Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
185
When Business Travel<br />
Accident <strong>Benefits</strong> Are Not Paid<br />
Business Travel Accident benefits will not be paid for<br />
the following:<br />
• Intentionally self-inflicted injuries while sane<br />
or insane;<br />
• Suicide or <strong>at</strong>tempted suicide;<br />
• Sickness, whether the loss results directly or<br />
indirectly from the sickness;<br />
• Medical or surgical tre<strong>at</strong>ment of sickness,<br />
whether the loss results directly or indirectly<br />
from the sickness;<br />
• Any bacterial or viral infection, except a pyogenic<br />
infection resulting from an accidental cut or wound<br />
or a bacterial infection resulting from accidental<br />
ingestion of a contamin<strong>at</strong>ed substance;<br />
• Losses resulting from war or act of war (declared or<br />
undeclared), including resistance to armed aggression<br />
or an accident while on full-duty with the armed<br />
services for more than 30 days (This does not include<br />
Reserve or N<strong>at</strong>ional Guard active duty for training);<br />
• Losses resulting from passengers riding in an unlicensed<br />
aircraft;<br />
• Losses resulting from flying as a crew member of<br />
an airplane, except one owned and oper<strong>at</strong>ed by<br />
the Company;<br />
• Injuries th<strong>at</strong> arise during an <strong>at</strong>tempt to commit or<br />
the commission of a felony; or<br />
• Losses resulting from being illegally intoxic<strong>at</strong>ed or<br />
under the influence of any narcotic unless under the<br />
advice of a doctor.<br />
Filing a Claim<br />
Within 12 months of the covered associ<strong>at</strong>e’s dismemberment<br />
or de<strong>at</strong>h, contact the <strong>Benefits</strong> Department <strong>at</strong><br />
(800) 421-1362 and provide the following regarding<br />
the covered associ<strong>at</strong>e’s:<br />
• Name;<br />
• Social Security number;<br />
• D<strong>at</strong>e of dismemberment or de<strong>at</strong>h; and<br />
• Cause of dismemberment or de<strong>at</strong>h (if known).<br />
• An original or certified copy of the de<strong>at</strong>h certific<strong>at</strong>e<br />
is required as proof of de<strong>at</strong>h. Mail the de<strong>at</strong>h<br />
certific<strong>at</strong>e to:<br />
Prudential - <strong>Wal</strong>-<strong>Mart</strong> Division<br />
P.O. Box 13644<br />
Philadelphia, PA 19176<br />
The claim will not be finalized until the de<strong>at</strong>h certific<strong>at</strong>e<br />
is received, where applicable. Acceptance of the de<strong>at</strong>h<br />
certific<strong>at</strong>e is not a guarantee of payment.<br />
<strong>Benefits</strong> can be paid in a lump sum or, upon written<br />
request, in monthly installments. Only one benefit, the<br />
highest, will be paid if you suffer more than one loss<br />
resulting from a single accident.<br />
186 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When Coverage Ends<br />
Your Business Travel Accident coverage ends on your last<br />
day of employment or <strong>at</strong> your de<strong>at</strong>h.<br />
If You Leave the Company<br />
and Then Are Rehired<br />
Your Business Travel Accident coverage (or the most similar<br />
option offered under the Plan) will be reinst<strong>at</strong>ed.<br />
AXA Travel Assistance<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all associ<strong>at</strong>es with<br />
Company-paid AXA Travel Assistance Insurance. The<br />
Company pays for this coverage in full—there is no cost<br />
to you. No enrollment is necessary. Coverage will<br />
become effective on your first day of Active Work.<br />
AXA Travel Assistance is a fully insured benefit provided<br />
by AXA Assistance th<strong>at</strong> provides travel assistance services<br />
to you and your Eligible Dependents when you travel<br />
for business or pleasure.<br />
The description below is a summary of services<br />
provided by AXA Travel Assistance. You should review<br />
the m<strong>at</strong>erials from AXA Assistance for more details,<br />
including any limit<strong>at</strong>ions and exclusions. Contact<br />
(800) 565-9320 in the U.S. for more inform<strong>at</strong>ion.<br />
Outside the U.S. , call collect <strong>at</strong> (312) 935-3783.<br />
Services Available Through<br />
AXA Travel Assistance<br />
Services available through AXA Travel Assistance include:<br />
• Over 600,000 pre-qualified providers in more than<br />
238 countries and jurisdictions.<br />
• Air and ground ambulance service.<br />
• Trained multilingual personnel who can advise<br />
and assist you quickly and professionally in a<br />
travel emergency.<br />
• Transport<strong>at</strong>ion services for you or family members in<br />
the event of an emergency.<br />
• Return of mortal remains.<br />
The maximum benefit amount for each covered trip<br />
is $150,000.<br />
See the m<strong>at</strong>erials from AXA Travel Assistance for<br />
more details.<br />
Any fees incurred for services will still be your responsibility.<br />
AXA Assistance just helps you arrange these<br />
services. In addition, AXA Travel Assistance does not<br />
pay your medical bills (your health coverage still pays<br />
these expenses), but AXA Assistance can help you coordin<strong>at</strong>e<br />
payment with your plan and a foreign Hospital,<br />
if necessary.<br />
Business Travel Accident Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
187
Filing a Claim<br />
You do not need to file a claim for AXA Travel<br />
Assistance benefits. You may contact AXA Assistance <strong>at</strong><br />
any time by calling (800) 565-9320 in the U.S., or call<br />
collect <strong>at</strong> (312) 935-3783 outside the U.S. However, if<br />
you have a question about your benefits, or disagree<br />
with the benefits provided, you may contact the <strong>Wal</strong>-<br />
<strong>Mart</strong> <strong>Benefits</strong> Department or file a claim by writing to<br />
the following address:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540<br />
Claims, and any appeals, will be determined under<br />
the timeframes and requirements set out in the procedures<br />
for filing a clam for medical benefits under<br />
the Claims and Appeals chapter.<br />
When Coverage Ends<br />
Your AXA Travel Assistance coverage ends on your last<br />
day of employment or <strong>at</strong> your de<strong>at</strong>h.<br />
Medex Travel Assistance<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. provides all associ<strong>at</strong>es with<br />
Company-paid Medex Travel Assistance Insurance. The<br />
Company pays for this coverage in full—there is no cost<br />
to you. No enrollment is necessary. Coverage will<br />
become effective on your first day of Active Work.<br />
Medex Travel Assistance is a travel assistance benefit<br />
provided by Medex Assistance Corpor<strong>at</strong>ion. Medex<br />
Travel Assistance provides travel assistance services to<br />
you and your Eligible Dependents when you travel for<br />
Company-authorized business intern<strong>at</strong>ionally. Services<br />
rel<strong>at</strong>ed to domestic travel or personal travel are not covered<br />
under Medex Travel Assistance.<br />
The description below is a summary of services<br />
provided by Medex Travel Assistance. You should<br />
review the m<strong>at</strong>erials from Medex Travel Assistance for<br />
more details, including any limit<strong>at</strong>ions and exclusions.<br />
Contact (800) 537-2029 for more inform<strong>at</strong>ion.<br />
188 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Services Available Through Medex Travel<br />
Assistance<br />
Services available through Medex Travel Assistance<br />
include:<br />
• Medical Assistance Services, such as medical and<br />
dental referrals, facilit<strong>at</strong>ion of Hospital payments,<br />
and medical records transfer.<br />
• Medical Evacu<strong>at</strong>ion & Rep<strong>at</strong>ri<strong>at</strong>ion Services, such<br />
as emergency medical evacu<strong>at</strong>ion, transport<strong>at</strong>ion<br />
services, and rep<strong>at</strong>ri<strong>at</strong>ion of mortal remains.<br />
• Security & Evacu<strong>at</strong>ion Services in the event of a<br />
security or political evacu<strong>at</strong>ion.<br />
Travel Assistance Services, including emergency travel<br />
arrangements, message transmittals, and replacement of<br />
travel documents.<br />
See the m<strong>at</strong>erials from Medex Travel Assistance for<br />
more details.<br />
Any fees incurred for services will still be your responsibility.<br />
Medex Travel Assistance just helps you arrange<br />
these services. In addition, Medex Travel Assistance<br />
does not pay your medical bills (your health coverage<br />
still pays these expenses), but may be able to help you<br />
coordin<strong>at</strong>e payment with your plan and a foreign<br />
Hospital, if necessary.<br />
Filing a Claim<br />
You do not need to file a claim for Medex Travel<br />
Assistance benefits. You may contact Medex <strong>at</strong> any<br />
time by calling (800) 537-2029. However, if you have<br />
a question about your benefits, or disagree with the<br />
benefits provided, you may contact the <strong>Wal</strong>-<strong>Mart</strong><br />
<strong>Benefits</strong> Department or file a claim by writing to the<br />
following address:<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Department<br />
922 West <strong>Wal</strong>nut, Suite A<br />
Rogers, AR 72756-3540<br />
Claims, and any appeals, will be determined under<br />
the timeframes and requirements set out in the procedures<br />
for filing a clam for medical benefits under the<br />
Claims and Appeals chapter.<br />
When Coverage Ends<br />
Your Medex Travel Assistance coverage ends on your last<br />
day of employment or <strong>at</strong> your de<strong>at</strong>h.<br />
Business Travel Accident Insurance<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
189
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Where Can I Find<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192<br />
Enrolling in the <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Contribution to Your Company Stock Ownership . . . . . . . . . . . . . . . . . . . . . . 192<br />
Selling Stock Through the Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193<br />
Keeping Track of Your Computershare Account. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194<br />
Borrowing Money Using Your Stock Purchase Plan Account. . . . . . . . . . . . . . . . . . . . . . . 194<br />
Naming a Joint Tenant for Your Stock Purchase Plan Account . . . . . . . . . . . . . . . . . . . . . 194<br />
Ending Your Particip<strong>at</strong>ion and Closing Your Account. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195<br />
If You Leave the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195<br />
Prospectus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196<br />
Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196<br />
Plan Administr<strong>at</strong>ion; Account Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197<br />
Plan Particip<strong>at</strong>ion and Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197<br />
Plan Contributions—Stock Purchase Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198<br />
Award Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198<br />
Stock Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199<br />
Stock Ownership; Fees; Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200<br />
Stock Certific<strong>at</strong>e Delivery And Stock Sales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201<br />
Termin<strong>at</strong>ion Of Particip<strong>at</strong>ion; Account Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201<br />
Plan Amendment And Termin<strong>at</strong>ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202<br />
Tax Inform<strong>at</strong>ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202<br />
Available Inform<strong>at</strong>ion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203<br />
Documents Incorpor<strong>at</strong>ed By Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan allows you to buy <strong>Wal</strong>-<strong>Mart</strong> stock conveniently through<br />
payroll deductions.You can have any amount from $2 to $1,000 withheld from your bi-weekly<br />
paycheck ($1 to $500 if you are paid weekly) to buy stock. <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ches 15 cents for every<br />
dollar th<strong>at</strong> you contribute to purchase stock, up to the first $1,800 in purchases each plan year.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Enroll in the plan or change<br />
your deduction amount<br />
• Access your account inform<strong>at</strong>ion<br />
• Get your account st<strong>at</strong>ement<br />
• Get a Form 1099<br />
Send money directly to<br />
Computershare<br />
Get inform<strong>at</strong>ion about setting up<br />
a line of credit for your account<br />
On the WIRE, click the “Life” tab, then<br />
“My Health,” and then “<strong>Benefits</strong> Online<br />
Enrollment” or<br />
Go to walmartbenefits.com<br />
Go to the Computershare website <strong>at</strong><br />
www.computershare.com/walmart<br />
and follow the instructions provided or<br />
Go to walmartbenefits.com and click the<br />
“Retirement and Savings Plan” icon on the<br />
“My Money” page.<br />
<strong>Associ<strong>at</strong>e</strong>s in Hawaii and Puerto Rico must<br />
complete an enrollment form from the<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan brochure.The<br />
brochure is available on the WIRE, click the<br />
“Life” tab, then “My Money,” and then<br />
“<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan”,<br />
walmartbenefits.com, or<br />
<strong>at</strong> your work facility by asking your<br />
personnel represent<strong>at</strong>ive<br />
Call Computershare <strong>at</strong> (800) 438-6278<br />
(hearing impaired: (800) 952-9245)<br />
Send check to:<br />
Computershare<br />
Attn: <strong>Wal</strong>-<strong>Mart</strong> ASPP<br />
P.O. Box 43080<br />
Providence, RI 02940-3080<br />
(Company contributions will not be made<br />
on money sent directly to Computershare.)<br />
Call USBancorp (800) 771-2265<br />
and press option 2<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Wh<strong>at</strong> You Need to Know About the <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
• All eligible associ<strong>at</strong>es can purchase <strong>Wal</strong>-<strong>Mart</strong> stock through convenient payroll deductions.<br />
• <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ches $0.15 for every $1.00 you put into the plan through payroll deductions, up to your first $1,800<br />
th<strong>at</strong> you contribute.<br />
• If you have $2,000 or more of <strong>Wal</strong>-<strong>Mart</strong> stock in your account, you may be eligible to borrow money using the<br />
stock in your Stock Purchase Account to secure a line of credit.<br />
• While you are employed, there are no fees to purchase shares of <strong>Wal</strong>-<strong>Mart</strong> stock through the Plan. You only<br />
pay a fee when you sell shares of stock.<br />
• Your account is maintained <strong>at</strong> Computershare. You can access your account online or by telephone to<br />
get your balance or sell stock.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
191
<strong>Associ<strong>at</strong>e</strong> Stock Purchase<br />
Plan Eligibility<br />
You are eligible to enroll in the <strong>Associ<strong>at</strong>e</strong> Stock Purchase<br />
Plan if you are:<br />
Not a member of a collective bargaining unit<br />
whose benefits were the subject of good faith<br />
collective bargaining.<br />
18 years old, except in Alabama and Nebraska you must<br />
be 19 years old to particip<strong>at</strong>e. <strong>Associ<strong>at</strong>e</strong>s in Puerto Rico<br />
must be 21 years old.<br />
Enrolling in the<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
You can enroll in the plan by completing an<br />
enrollment form th<strong>at</strong> is included with each associ<strong>at</strong>e<br />
stock purchase plan brochure or online using<br />
“<strong>Benefits</strong> Online Enrollment” on the WIRE or on<br />
walmartbenefits.com. Before you enroll in this plan,<br />
you should carefully review the <strong>Associ<strong>at</strong>e</strong> Stock Purchase<br />
Plan brochure or the Plan Prospectus.<br />
The decision to purchase Company stock is an individual<br />
decision to be made solely by you and your tax or financial<br />
advisor. By offering this program, the Company is not<br />
recommending, endorsing, or soliciting the purchase of<br />
Company stock. In making your decision, you should be<br />
aware th<strong>at</strong> the past performance of the Company stock<br />
is not an indic<strong>at</strong>ion or prediction of future performance.<br />
The value of Company stock may be affected by many<br />
factors including those outside the Company itself, such<br />
as economic conditions.<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Contribution to Your<br />
Company Stock Ownership<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan allows all eligible<br />
associ<strong>at</strong>es to buy <strong>Wal</strong>-<strong>Mart</strong> stock conveniently through<br />
payroll deductions.You can have any whole dollar<br />
amount from $2 to $1,000 withheld from your<br />
paycheck to buy stock ($1 to $500 for associ<strong>at</strong>es with<br />
a weekly paycheck).<br />
<strong>Wal</strong>-<strong>Mart</strong> contributes to your stock purchase by m<strong>at</strong>ching<br />
15 cents for every dollar you purchase through payroll<br />
deductions, up to your first $1,800 in purchases each<br />
plan year.The plan year runs from April through March.<br />
The Company m<strong>at</strong>ch is reflected as income on your<br />
check stub and on your W-2 form.<br />
In addition to your payroll deductions, you can contribute<br />
additional money to the <strong>Associ<strong>at</strong>e</strong> Stock<br />
Purchase Plan by sending money directly to<br />
Computershare, the plan’s administr<strong>at</strong>or <strong>at</strong>:<br />
Computershare<br />
Attn: <strong>Wal</strong>-<strong>Mart</strong> ASPP<br />
P.O. Box 43080<br />
Providence, RI 02940-3080<br />
Money sent directly to Computershare will not receive<br />
the <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ching contribution. The maximum<br />
amount (payroll deductions and money sent directly to<br />
Computershare) you can purchase through the<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan is $125,000 in stock per<br />
plan year. Dividends th<strong>at</strong> you earn on the stock are<br />
autom<strong>at</strong>ically reinvested to buy additional shares of<br />
stock for you.<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Contribution to Your Company Stock Ownership<br />
If you contribute:<br />
Your plan year payroll<br />
deduction contribution is:<br />
<strong>Wal</strong>-<strong>Mart</strong>’s<br />
m<strong>at</strong>ching contribution is:<br />
$10 bi-weekly $260 $39 $299<br />
$20 bi-weekly $520 $78 $598<br />
Total amount used to<br />
purchase <strong>Wal</strong>-<strong>Mart</strong> stock:<br />
$70 bi-weekly $1,820 $270 (<strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ches $0.15<br />
for every dollar up to $1,800)<br />
$2,090<br />
192 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The value of the stock you purchase can fluctu<strong>at</strong>e and<br />
may decline.There is no way to guarantee th<strong>at</strong> your stock<br />
will have the same value in the future th<strong>at</strong> it had when<br />
you made the purchase.When making a decision about<br />
purchasing <strong>Wal</strong>-<strong>Mart</strong> stock, consider all your investments,<br />
including other <strong>Wal</strong>-<strong>Mart</strong> stock you may own. For investment<br />
questions, consult a financial advisor.<br />
Stock Certific<strong>at</strong>es<br />
If, <strong>at</strong> any time, you decide th<strong>at</strong> you would prefer to personally<br />
hold your shares of stock, you may request th<strong>at</strong> a<br />
stock certific<strong>at</strong>e be issued to you <strong>at</strong> no charge from<br />
Computershare. Stock certific<strong>at</strong>es are negotiable securities<br />
and should be kept in a safe place.<br />
Please note th<strong>at</strong> any shares issued in stock certific<strong>at</strong>e<br />
form are no longer part of the Plan. Once the shares are<br />
taken from your <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan account,<br />
the certific<strong>at</strong>e will be tracked and tre<strong>at</strong>ed as a “general<br />
shareholder” account.<br />
While you remain an associ<strong>at</strong>e or maintain a plan<br />
account, you may send your shares back to<br />
Computershare <strong>at</strong> any time and design<strong>at</strong>e in writing th<strong>at</strong><br />
you would like those shares placed back into the Plan.<br />
If stock certific<strong>at</strong>es in your possession are lost or stolen,<br />
you may request replacement certific<strong>at</strong>es, <strong>at</strong> a cost, by<br />
completing document<strong>at</strong>ion required by Computershare.<br />
Special insurance, based on a percentage of the value of<br />
the stock certific<strong>at</strong>e, is required to protect you from the<br />
loss of those certific<strong>at</strong>es though the mail service.<br />
For more inform<strong>at</strong>ion about replacing lost or stolen<br />
certific<strong>at</strong>es or any fees th<strong>at</strong> may be incurred for the<br />
replacement of a lost certific<strong>at</strong>e, please contact<br />
Computershare directly.<br />
Selling Stock Through the Plan<br />
No fees are charged to you for buying stock; however,<br />
when you sell stock you will be charged a fee of $20 per<br />
sale plus $0.05 per share sold, unless you are making a<br />
“market order.” For market orders, you will be charged a<br />
fee of $30 per sale plus $0.05 per share sold.<br />
If you choose to sell your stock under the market order<br />
method, your stock will be sold as soon as your request<br />
can reasonably be processed <strong>at</strong> the market price in<br />
effect <strong>at</strong> the time. If the market is closed, your order will<br />
be processed <strong>at</strong> the start of the next business day.Your<br />
fee is $30 per sale plus $0.05 per share sold.<br />
Unless you specifically request a market order, the sale<br />
will be completed through a b<strong>at</strong>ch order transaction.The<br />
price for your stock will be the average price for all <strong>Wal</strong>-<br />
<strong>Mart</strong> shares sold th<strong>at</strong> day by Computershare before 1:00<br />
p.m. CST. Any sale request after 1:00 p.m. CST deadline<br />
will be processed the next business day.Your fee for this<br />
type of sale will be $20 per sale plus $0.05 per share sold.<br />
To sell stock, call Computershare <strong>at</strong> (800) 438-6278 or go<br />
to www.computershare.com/walmart. A check will be<br />
mailed to the address on your l<strong>at</strong>est payroll check and<br />
should be received within seven to 10 business days.<br />
The sale fee is autom<strong>at</strong>ically deducted from your<br />
check. Each time you sell stock, you will receive a<br />
transaction summary form along with your check. At<br />
the end of January, you’ll receive a separ<strong>at</strong>e 1099B<br />
Tax Reporting St<strong>at</strong>ement <strong>at</strong> your home to use in<br />
reporting the sale of stock on your tax return.<br />
You also can get a Form 1099 on<br />
walmartbenefits.com by clicking the<br />
“Retirement and Savings Plan” icon on the<br />
“My Money” page.<br />
It’s important to understand the tax consequences of<br />
a stock sale. If you have tax-rel<strong>at</strong>ed questions, please<br />
consult a financial advisor or tax consultant.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
193
Keeping Track of Your<br />
Computershare Account<br />
You will receive a st<strong>at</strong>ement from Computershare <strong>at</strong><br />
least annually in January th<strong>at</strong> shows the activity in<br />
your account. St<strong>at</strong>ements are usually sent to your work<br />
facility. However, if you opted to receive your st<strong>at</strong>ements<br />
online, you will receive an email informing you<br />
th<strong>at</strong> your st<strong>at</strong>ement is ready and can be found on<br />
www.computershare.com/walmart or on walmartbenefits.com.<br />
The st<strong>at</strong>ement you receive in January will<br />
contain important tax inform<strong>at</strong>ion. It is very important<br />
th<strong>at</strong> you keep your st<strong>at</strong>ement so th<strong>at</strong> you will know<br />
the difference between your purchase price and sale<br />
price if you sell shares of stock.<br />
You can access your account inform<strong>at</strong>ion by phone <strong>at</strong><br />
(800) 438-6278 (hearing impaired: (800) 952-9245)<br />
or on walmartbenefits.com or on the Computershare<br />
website <strong>at</strong> www.computershare.com/walmart.<br />
If you request replacement st<strong>at</strong>ements from<br />
Computershare, there is a $5 charge per st<strong>at</strong>ement<br />
for previous years’ st<strong>at</strong>ements. Or, you can obtain<br />
copies free of charge through the website <strong>at</strong><br />
www.computershare.com/walmart.<br />
You also can access account inform<strong>at</strong>ion and st<strong>at</strong>ements<br />
on walmartbenefits.com by clicking the “Retirement<br />
and Savings Plan” icon on the “My Money” page.<br />
Borrowing Money Using Your<br />
Stock Purchase Plan Account<br />
If you have $2,000 or more of <strong>Wal</strong>-<strong>Mart</strong> stock in your<br />
account, you may be eligible to borrow money from<br />
USBancorp using the stock in your Stock Purchase<br />
Account to secure a line of credit.This program may<br />
enable you to borrow the money you need r<strong>at</strong>her than<br />
selling your <strong>Wal</strong>-<strong>Mart</strong> stock.<br />
The line of credit is repaid through monthly payments<br />
to USBancorp. For more inform<strong>at</strong>ion call (800) 771-2265<br />
and press option 2.<br />
Decisions on applic<strong>at</strong>ions for a line of credit are the<br />
responsibility of USBancorp. Applicants may be subject<br />
to a credit check. <strong>Wal</strong>-<strong>Mart</strong> assumes no liability with<br />
respect to any negoti<strong>at</strong>ion or transaction entered into<br />
by the associ<strong>at</strong>e and USBancorp.<br />
Naming a Joint Tenant for Your<br />
Stock Purchase Plan Account<br />
If you wish, you can name a joint tenant for your stock<br />
purchase Account. However, you should keep in mind<br />
th<strong>at</strong> a joint tenant on your account has equal rights to<br />
your account, including the ability to sell shares of stock,<br />
get account st<strong>at</strong>ements, or receive inform<strong>at</strong>ion about<br />
your account.Your joint tenant also becomes the sole<br />
owner of the stock if you die. (A joint tenant is not the<br />
same as a beneficiary.) To design<strong>at</strong>e a joint tenant or to<br />
change your joint tenant, you must contact<br />
Computershare to complete the paperwork th<strong>at</strong> is legally<br />
required to make such a design<strong>at</strong>ion.There are strict<br />
legal requirements th<strong>at</strong> must be followed to remove a<br />
joint tenant from your account; therefore, you should<br />
consider carefully the implic<strong>at</strong>ion of listing a person as a<br />
joint tenant on your account.<br />
194 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Ending Your Particip<strong>at</strong>ion<br />
and Closing Your Account<br />
To cancel your payroll deductions to the <strong>Associ<strong>at</strong>e</strong> Stock<br />
Purchase Plan, complete a benefits online enrollment<br />
session on the WIRE by clicking the “Life” tab, then “My<br />
Health,” and then “<strong>Benefits</strong> Online Enrollment” or <strong>at</strong><br />
walmartbenefits.com or you may complete an enrollment<br />
form th<strong>at</strong> can be found on the back of the<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan Brochure.<br />
After you cancel your payroll deductions, you can close<br />
your account by asking Computershare to issue you a<br />
stock certific<strong>at</strong>e or by directing them to sell your stock<br />
and send you a check. Please remember th<strong>at</strong> to avoid<br />
paying a sales fee twice, cancel your payroll deductions<br />
before closing your account.<br />
If You Leave the Company<br />
If you leave the Company, you will have several options<br />
concerning the st<strong>at</strong>us of your account:<br />
• You can keep your account open without the weekly<br />
or bi-weekly payroll deduction and the Company<br />
m<strong>at</strong>ch. You can make voluntary cash purchases and<br />
benefit from having no brokers’ fee. There is an annual<br />
maintenance fee of $30 per year, which will be<br />
autom<strong>at</strong>ically deducted from your account through<br />
the sale of an appropri<strong>at</strong>e portion of a share of stock<br />
to cover the fee during the first quarter of the year.<br />
• You can close your account and receive all full<br />
shares in certific<strong>at</strong>e form and a check for any<br />
partial share ownership.<br />
• You can close your account and sell some or all of<br />
the shares in your account.<br />
In order to prevent any residual balances and to avoid<br />
paying a sales transaction charge twice, wait until you<br />
receive your final paycheck before closing your account.<br />
It is very important th<strong>at</strong> you upd<strong>at</strong>e Computershare<br />
if you have an address change after you have left<br />
the Company.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
195
PROSPECTUS<br />
This document constitutes part of a prospectus covering securities th<strong>at</strong> have been registered under the Securities Act of 1933.<br />
98,659,148 Shares<br />
WAL-MART STORES, INC.<br />
Common Stock<br />
($.10 par value per share)<br />
__________________________<br />
WAL-MART STORES, INC.<br />
2004 ASSOCIATE STOCK PURCHASE PLAN<br />
(formerly, the <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan of 1996)<br />
___________________________<br />
THESE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE<br />
COMMISSION OR ANY STATE SECURITIES COMMISSION NOR HAS THE SECURITIES AND EXCHANGE<br />
COMMISSION OR ANY STATE SECURITIES COMMISSION PASSED UPON THE ACCURACY OR ADEQUACY<br />
OF THIS PROSPECTUS. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE.<br />
No one is authorized to give any inform<strong>at</strong>ion or to make any represent<strong>at</strong>ions other than those contained in this<br />
Prospectus and, if given or made, you should not rely on them.This Prospectus is not an offer to sell or a solicit<strong>at</strong>ion of<br />
an offer to buy any of the securities referred to in any st<strong>at</strong>e where it would be unlawful. Neither the delivery of this<br />
Prospectus nor acquisition of securities described in this Prospectus implies th<strong>at</strong> there has been no change in the<br />
affairs of the Company since the d<strong>at</strong>e of this Prospectus.<br />
The d<strong>at</strong>e of this Prospectus is August 1, 2007<br />
Introduction and Overview<br />
The <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. 2004 <strong>Associ<strong>at</strong>e</strong> Stock Purchase<br />
Plan (“Plan”) is a successor to the <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan of 1996.The Plan was<br />
most recently approved by the stockholders of <strong>Wal</strong>-<strong>Mart</strong><br />
Stores, Inc. (“Company”) on June 4, 2004. Up to<br />
142,624,272 shares of the Company’s common stock, par<br />
value $.10 per share (“Stock”), were available for delivery<br />
under the Plan as of June 4, 2004. As of the d<strong>at</strong>e of this<br />
Prospectus, 98,659,148 shares of Stock remain available.<br />
Particip<strong>at</strong>ing associ<strong>at</strong>es may be referred to as “you”in<br />
this Prospectus.<br />
The Plan has two parts — the Stock Purchase Program<br />
and the Award Program.The Stock Purchase Program<br />
gives eligible associ<strong>at</strong>es an opportunity to share in<br />
Company ownership by allowing them to purchase<br />
Stock by payroll deduction. In addition, if they make or<br />
have made such payroll deductions, they may also purchase<br />
Stock from their own funds.The Award Program<br />
rewards associ<strong>at</strong>es for exceptional job performance with<br />
shares of Stock.<br />
The Company believes th<strong>at</strong> the Plan is not subject to<br />
any provisions of the Employee Retirement Income<br />
Security Act of 1974. The Plan is not qualified under<br />
Section 401(a) or 423 of the Internal Revenue Code of<br />
1986, as amended.<br />
196 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Plan Administr<strong>at</strong>ion;<br />
Account Management<br />
The Stock Option Committee (“Committee”), consisting<br />
of members of the Company’s Board of Directors,<br />
has the overall authority for administering the Plan.<br />
The Committee may deleg<strong>at</strong>e (and revoke the deleg<strong>at</strong>ion<br />
of ) some or all aspects of Plan administr<strong>at</strong>ion to<br />
the officers or managers of the Company or an affili<strong>at</strong>e<br />
or to others, subject to terms as it deems appropri<strong>at</strong>e.<br />
The Committee has selected a third-party administr<strong>at</strong>or,<br />
currently Computershare Trust Company, N.A.,<br />
(“Computershare”), to maintain accounts under<br />
the Plan.<br />
The Committee or its deleg<strong>at</strong>e must follow the terms of<br />
the Plan, but otherwise has full power and discretion to<br />
administer the Plan, including but not limited to, the<br />
power to: determine when, to whom and in wh<strong>at</strong> types<br />
and amounts contributions should be made; make contributions<br />
to eligible associ<strong>at</strong>es in any number and to<br />
determine the terms and conditions applicable to each<br />
such contribution; set a minimum and maximum dollar,<br />
share or other limit<strong>at</strong>ion on the various contributions<br />
permitted under the Plan; determine whether an affili<strong>at</strong>e<br />
should become (or cease to be) a Particip<strong>at</strong>ing<br />
Employer; determine whether (and which) associ<strong>at</strong>es of<br />
non-U.S. Particip<strong>at</strong>ing Employers should be eligible to<br />
particip<strong>at</strong>e in the Plan; make all determin<strong>at</strong>ions deemed<br />
necessary or advisable for the administr<strong>at</strong>ion of the Plan;<br />
establish, amend and revoke rules and regul<strong>at</strong>ions for<br />
the administr<strong>at</strong>ion of the Plan; and exercise any powers,<br />
to perform any acts and to make any determin<strong>at</strong>ions it<br />
deems necessary or advisable to administer the Plan. All<br />
decisions made by the Committee under the Plan are<br />
final and binding on all persons, including the Company<br />
and its affili<strong>at</strong>es, any associ<strong>at</strong>e, any person claiming any<br />
rights under the Plan from or through any participant,<br />
and shareholders of the Company.<br />
Plan Particip<strong>at</strong>ion and Eligibility<br />
If you are eligible, you can become a participant in the<br />
Plan by completing a paper enrollment form or enrolling<br />
on-line to authorize payroll deductions to be taken from<br />
your regular compens<strong>at</strong>ion and contributed to the Plan<br />
for the purchase of Stock to be held in your Plan<br />
account.You can also become a participant in the Plan if<br />
the Committee grants you an award of Stock under the<br />
Award Program.<br />
All associ<strong>at</strong>es of the Company and approved affili<strong>at</strong>es of<br />
the Company (“Particip<strong>at</strong>ing Employers”) are eligible to<br />
particip<strong>at</strong>e in the Plan, except<br />
• If you are restricted or prohibited from particip<strong>at</strong>ing<br />
in the Plan under the law of your st<strong>at</strong>e or country of<br />
residence, you may not particip<strong>at</strong>e in the Plan or<br />
your particip<strong>at</strong>ion in the Plan may be limited.<br />
• You must have <strong>at</strong>tained the age of majority in your<br />
st<strong>at</strong>e of employment to particip<strong>at</strong>e. It is your responsibility<br />
to ensure you are of sufficient age to particip<strong>at</strong>e.<br />
The Company may termin<strong>at</strong>e your particip<strong>at</strong>ion<br />
if it discovers you are not of sufficient age.<br />
• If you are a member of a collective bargaining unit<br />
whose benefits were the subject of good faith collective<br />
bargaining, you are excluded from particip<strong>at</strong>ion<br />
in the Plan, unless your bargaining agreement<br />
requires particip<strong>at</strong>ion.<br />
• If your employer is a non-U.S. affili<strong>at</strong>e, you may particip<strong>at</strong>e<br />
only if you are an approved associ<strong>at</strong>e (listed<br />
by c<strong>at</strong>egory or by individual).<br />
• If you are an officer, including those subject to subsection<br />
16(a) of the Securities Exchange Act of 1934,<br />
or otherwise subject to the Company’s Insider<br />
Trading Policy, your ability to acquire or sell shares of<br />
Stock may be restricted.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
197
If you are on a bona fide Leave of Absence from the<br />
Company or a Particip<strong>at</strong>ing Employer, you will continue<br />
to be eligible to make contributions to the Plan during<br />
your Leave of Absence, but you will not be eligible for<br />
Company m<strong>at</strong>ching contributions during th<strong>at</strong> time. If<br />
you are on a military Leave of Absence, please contact<br />
the Retirement and Savings Plans Department to see<br />
whether you are eligible to receive Company m<strong>at</strong>ching<br />
contributions during your leave. Please note th<strong>at</strong> you<br />
must make contributions from your own funds if you are<br />
not receiving a paycheck while you are on a Leave of<br />
Absence, as payroll deduction would not be available as<br />
an option. Any other circumstances which would permit<br />
you to continue to particip<strong>at</strong>e in the Plan while on a<br />
leave must be approved by the Committee.<br />
Plan Contributions—<br />
Stock Purchase Program<br />
To make payroll deduction contributions, you need to<br />
complete the enrollment form provided by your employer.Your<br />
payroll deduction contributions will continue as<br />
long as you are employed by the Company or a<br />
Particip<strong>at</strong>ing Employer unless you change or termin<strong>at</strong>e<br />
your payroll deduction authoriz<strong>at</strong>ion. Please note th<strong>at</strong> no<br />
deduction will be drawn from any paycheck in which<br />
your payroll deduction contribution exceeds your net<br />
pay after taxes are withheld.You can change or termin<strong>at</strong>e<br />
your payroll deduction authoriz<strong>at</strong>ion by notifying<br />
your employer in writing.Your request will be processed<br />
as soon as practicable.<br />
Note th<strong>at</strong> payroll deduction contributions are generally<br />
taken from your last paycheck. If you do not want to<br />
have payroll deduction contributions taken from your<br />
last paycheck, it is important th<strong>at</strong> you timely termin<strong>at</strong>e<br />
your payroll deduction authoriz<strong>at</strong>ion either by paper<br />
form or on-line. If you work in a st<strong>at</strong>e th<strong>at</strong> requires your<br />
last paycheck to be paid outside of the normal payroll<br />
cycle, payroll deduction contributions will not be taken<br />
out of your last paycheck.<br />
Payroll deductions can be as little as $2 or as much as<br />
$1,000 per bi-weekly payroll period (in whole dollars).<br />
Payroll deductions for associ<strong>at</strong>es paid on a weekly basis<br />
can be as little as $1 or as much as $500 per weekly payroll<br />
period.Your employer will make a m<strong>at</strong>ching cash<br />
contribution on your behalf when you make contributions<br />
to the Plan by payroll deduction.The m<strong>at</strong>ching<br />
contribution is currently 15 percent of the first $1,800<br />
you contribute to the Plan by payroll deduction, or up to<br />
$270 per Plan year (April 1 - March 31). For this purpose,<br />
payroll deductions are taken into account on the last day<br />
of the relevant payroll period.The m<strong>at</strong>ch is used to buy<br />
Stock for your account.<br />
If you particip<strong>at</strong>e or have particip<strong>at</strong>ed in payroll deductions,<br />
you can also voluntarily contribute cash (in U.S.<br />
dollars) from your other resources to Computershare to<br />
purchase Stock to be held in your Plan account.Your<br />
employer will not make m<strong>at</strong>ching contributions on<br />
amounts you contribute directly to Computershare. In<br />
addition, you may also deposit Stock th<strong>at</strong> you hold outside<br />
of the Plan to your Plan account by making arrangements<br />
directly with Computershare.The total of your<br />
payroll deductions and voluntary cash contributions<br />
cannot exceed $125,000 per Plan year.<br />
The Committee may change the maximum and minimum<br />
contributions, change the conditions for voluntary<br />
cash or Stock contributions, and change the amount of<br />
the m<strong>at</strong>ch <strong>at</strong> any time.<br />
Award Program<br />
Gre<strong>at</strong> Job Award<br />
Under the Gre<strong>at</strong> Job Award component,“Gre<strong>at</strong> Job” buttons<br />
were typically awarded to associ<strong>at</strong>es who demonstr<strong>at</strong>ed<br />
exceptional job performance or who provided<br />
exceptional customer service. Once you received four<br />
“Gre<strong>at</strong> Job” buttons, you were generally eligible to<br />
receive one share of Stock from the Company.<br />
198 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Gre<strong>at</strong> Job Award program was modified effective<br />
March 9, 2007 with respect to U.S. associ<strong>at</strong>es and generally<br />
May 1, 2007 with respect to associ<strong>at</strong>es in Canada. No<br />
additional “Gre<strong>at</strong> Job” buttons were (or will be) awarded<br />
after the pertinent d<strong>at</strong>e.You may surrender your buttons<br />
to your Personnel Manager through August 31,<br />
<strong>2008</strong> and you will receive one share of Stock for every<br />
four “Gre<strong>at</strong> Job” buttons surrendered, or a proportion<strong>at</strong>e<br />
share of Stock if you surrender less than four “Gre<strong>at</strong> Job”<br />
buttons.Your shares or fractional shares of Stock will be<br />
deposited in your account <strong>at</strong> Computershare. Any buttons<br />
not surrendered by August 31, <strong>2008</strong> will be cancelled<br />
on September 1, <strong>2008</strong> and will not be able to<br />
be surrendered for a share or fractional share of<br />
Stock or any other item or cash. An associ<strong>at</strong>e may not<br />
transfer in any way buttons awarded to another.<br />
Similarly, an associ<strong>at</strong>e may surrender for Stock only<br />
those buttons actually awarded to the associ<strong>at</strong>e under<br />
the Award Program.<br />
Outstanding Performance Award.<br />
Under the Outstanding Performance Award component,<br />
you can be granted an award of Stock for demonstr<strong>at</strong>ing<br />
consistently outstanding performance in your job over<br />
the period of a month, a quarter, or a year.The<br />
Committee approves all Outstanding Performance<br />
Awards, and sets maximum dollar limit<strong>at</strong>ions on these<br />
awards from time to time.<br />
Your Stock under the Outstanding Performance<br />
Award component will be given to you through an<br />
account <strong>at</strong> Computershare.<br />
Stock Purchases<br />
Your employer will send all of the payroll<br />
deductions along with any m<strong>at</strong>ching contributions<br />
to Computershare within a reasonable time following<br />
each pay period. Computershare will purchase Stock for<br />
your Account no l<strong>at</strong>er than five business days after it<br />
receives the funds. If you make a cash contribution outside<br />
of payroll deductions, Computershare will<br />
purchase your Stock no l<strong>at</strong>er than five business days<br />
after it receives the funds.<br />
Computershare makes Stock purchases for the Plan<br />
accounts on a n<strong>at</strong>ional stock exchange, from the<br />
Company, or from a combin<strong>at</strong>ion of these places.<br />
However, the Committee reserves the right to direct<br />
Computershare to purchase from a particular source,<br />
consistent with applicable securities rules and the applicable<br />
rules of any n<strong>at</strong>ional stock exchange.<br />
Typically, when Computershare purchases Stock for the<br />
Plan on a n<strong>at</strong>ional stock exchange, the shares are purchased<br />
as part of a bundled group r<strong>at</strong>her than individually<br />
for each participant. In some instances, the shares of<br />
Stock for a bundled group must be purchased for the<br />
Plan over more than one day. When shares of Stock are<br />
purchased for you as part of a bundled group, your purchase<br />
price for each share of Stock will be equal to the<br />
average price of all shares of Stock purchased within th<strong>at</strong><br />
group as determined by Computershare.<br />
If Computershare buys shares of Stock from the<br />
Company, whether authorized but unissued shares or<br />
treasury shares, the per-share price will be equal to the<br />
Volume Weighted Average Price (VWAP) as reported on<br />
the New York Stock Exchange - Composite Transactions<br />
on the d<strong>at</strong>e of purchase.The VWAP is the weighted average<br />
of all trades of the Company’s Stock for a day. While<br />
the Plan permits the Committee to design<strong>at</strong>e another<br />
methodology for valuing Stock purchased from the<br />
Company, as of the d<strong>at</strong>e of this Prospectus no other<br />
methodology has been design<strong>at</strong>ed.<br />
Non-U.S. Participants Please Note: All amounts contributed<br />
to the Plan by payroll deduction, all m<strong>at</strong>ching<br />
contributions, and any contributions made pursuant to<br />
the Award Program will be converted from your local<br />
currency to U.S. dollars prior to the time the shares of<br />
Stock are purchased. All voluntary cash contributions<br />
must be converted to U.S. dollars before being sent to<br />
Computershare to purchase shares of stock.The<br />
exchange r<strong>at</strong>e published in The <strong>Wal</strong>l Street Journal will be<br />
used to make the conversion.The exchange r<strong>at</strong>e will be<br />
set as of a d<strong>at</strong>e as soon as practicable prior to the d<strong>at</strong>e<br />
the cash is sent to the Computershare. Generally, the<br />
exchange r<strong>at</strong>e for the day prior to the day the funds are<br />
sent to Computershare is used, but th<strong>at</strong> may not be practicable<br />
in all circumstances.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
199
Stock Ownership; Fees; Risks<br />
Stock Ownership<br />
From the time th<strong>at</strong> shares of Stock are credited to your<br />
Plan account, you will have full ownership of the shares<br />
(including any fractional shares) of Stock.The Stock held<br />
in your Plan account will be registered in<br />
Computershare’s name until you request to have your<br />
Stock certific<strong>at</strong>es delivered to you from the Plan account<br />
or you sell your shares.You may not assign or transfer<br />
any interest in the Plan before shares are credited to<br />
your account. However, you may sell, transfer, assign, or<br />
otherwise deal with your shares of Stock once they are<br />
credited to your account, just like any other stockholder<br />
of the Company.There is no autom<strong>at</strong>ic lien or security<br />
interest on the shares of Stock held in your Plan account.<br />
However, if you pledge the Stock as coll<strong>at</strong>eral in connection<br />
with the Company’s Stock Secured Line of Credit<br />
Program, the lender will have a security interest in the<br />
shares of Stock held in your Plan account.<br />
Dividends; Voting<br />
Dividends on shares in your account will be autom<strong>at</strong>ically<br />
reinvested in additional shares of Stock.You will be<br />
able to direct the vote on each full share of Stock held in<br />
your Plan account, but not fractional shares.<br />
Computershare is responsible for seeing you receive <strong>at</strong><br />
no cost and as promptly as practicable (by mail or otherwise)<br />
all notices of meetings, proxy st<strong>at</strong>ements and other<br />
m<strong>at</strong>erials distributed by the Company to its stockholders.To<br />
vote the shares of Stock held in your Plan account,<br />
you must timely deliver signed voting instructions, also<br />
known as proxy instructions, to Computershare.<br />
Otherwise, the Company may elect to vote the shares<br />
provided th<strong>at</strong> doing so would comply with applicable<br />
law and any applicable listing standard of a n<strong>at</strong>ional<br />
stock exchange.<br />
Fees, Account St<strong>at</strong>ements<br />
The Company pays all fees associ<strong>at</strong>ed with the purchase<br />
of Stock. Generally, no maintenance fees or other<br />
charges will be assessed to your Plan account<br />
as long as you are employed by the Company or<br />
one of its affili<strong>at</strong>es (even if th<strong>at</strong> affili<strong>at</strong>e is not a<br />
Particip<strong>at</strong>ing Employer). However, you must pay<br />
any commissions or charges resulting from other<br />
Computershare services you request, for example<br />
brokerage commissions and other fees applicable to<br />
the sale of Stock. Computershare can tell you if a<br />
particular request would cause you to incur a charge.<br />
At least annually, you will receive a st<strong>at</strong>ement of your<br />
account under the Plan, reflecting all activity with<br />
respect to your Plan account for the period of time<br />
covered by the st<strong>at</strong>ement. You may also access<br />
inform<strong>at</strong>ion regarding your account <strong>at</strong> any time by<br />
logging onto walmartbenefits.com.<br />
Risks<br />
Many of your risks of Plan particip<strong>at</strong>ion are the same as<br />
those of any other stockholder of the Company in th<strong>at</strong><br />
you assume the risk th<strong>at</strong> the value of the Stock may<br />
increase or decrease.There are no guarantees as to the<br />
value of a share of Stock.This means th<strong>at</strong> you assume<br />
the risk of fluctu<strong>at</strong>ions in the value or market price of the<br />
Stock. Prior to deciding whether to purchase Stock<br />
through the Plan, you are encouraged to review the Risk<br />
Factors described in our most recent Annual Report,<br />
filed on Form 10-K, for the most recently completed fiscal<br />
year ending January 31st. Each of the risks<br />
described in th<strong>at</strong> Form 10-K could m<strong>at</strong>erially and<br />
adversely affect the Company’s business, financial condition<br />
and results of oper<strong>at</strong>ions and, therefore, the price<br />
of the Stock. Also, until Stock is purchased for you, your<br />
payroll deductions (as well as the corresponding m<strong>at</strong>ching<br />
contributions) are considered general assets of the<br />
Company or the Particip<strong>at</strong>ing Employer and, as such, are<br />
subject to the claims of the Company’s or Particip<strong>at</strong>ing<br />
Employer’s creditors. No interest will be paid on any contributions<br />
to the Plan. If you are a non-U.S. participant,<br />
you also assume the risk of fluctu<strong>at</strong>ion in currency<br />
exchange r<strong>at</strong>es.<br />
200 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Stock Certific<strong>at</strong>e Delivery<br />
And Stock Sales<br />
Computershare will send you, on request, a stock certific<strong>at</strong>e<br />
for any or all full shares of Stock held in your Plan<br />
account <strong>at</strong> no cost to you.<br />
You may request th<strong>at</strong> Computershare sell all or a portion<br />
of the shares of Stock (including any fractional interests)<br />
held in your Plan account <strong>at</strong> any time whether or not<br />
you want to close your Plan account.<br />
You will be charged a brokerage commission, as well as<br />
any other applicable fees, if for any reason you sell shares<br />
of Stock held in your Plan account. Any brokerage commission<br />
or fees will be <strong>at</strong> the r<strong>at</strong>es posted by<br />
Computershare from time to time.These r<strong>at</strong>es are available<br />
upon request from Computershare.<br />
The Plan offers a choice of methods by which to sell your<br />
Stock — by “market order” or “b<strong>at</strong>ch order.”<br />
If you choose to sell your Stock under the “market order”<br />
method, your Stock will be sold as soon as your request<br />
can reasonably be processed <strong>at</strong> the market price in<br />
effect <strong>at</strong> th<strong>at</strong> time. If the market is closed when you<br />
enter the request, your sale transaction will be processed<br />
<strong>at</strong> the start of the next day th<strong>at</strong> the stock market is open.<br />
If you choose to sell your Stock under the “b<strong>at</strong>ch order”<br />
method, your Stock will not be sold immedi<strong>at</strong>ely as<br />
described above. Generally, if Computershare receives<br />
your request to sell shares of Stock before 1:00 p.m.<br />
Central Time on a business day, your sale transaction<br />
will take place on the same day. If your request is<br />
received on or after 1:00 p.m. Central Time or if your<br />
request is made on a day the stock market is not open,<br />
your sale transaction will take place on the next day<br />
th<strong>at</strong> the stock market is open. The sale price for a share<br />
of Stock sold in this manner will be the average price of<br />
all shares of Stock sold by Computershare on the d<strong>at</strong>e<br />
of your sale transaction.<br />
If you are employed outside the U.S. by a Particip<strong>at</strong>ing<br />
Employer and if provided by Computershare for your<br />
country, the proceeds from the sale may be converted<br />
for a fee to another currency if you request it when you<br />
request your Stock to be sold. If the proceeds are converted<br />
to another currency, the exchange r<strong>at</strong>e th<strong>at</strong> will<br />
be used is the following business day’s market r<strong>at</strong>e on<br />
the d<strong>at</strong>e your sale transaction is executed.You will<br />
assume the risk of any fluctu<strong>at</strong>ions in currency<br />
exchange r<strong>at</strong>es.<br />
Termin<strong>at</strong>ion Of Particip<strong>at</strong>ion;<br />
Account Closure<br />
Once you become a Participant in the Plan, you will<br />
remain a Participant until your account is formally<br />
closed, or until all Stock has been taken from your<br />
account and you have termin<strong>at</strong>ed employment.<br />
If you termin<strong>at</strong>e your payroll deduction authoriz<strong>at</strong>ion or<br />
termin<strong>at</strong>e employment with the Company and all its<br />
affili<strong>at</strong>es, you may choose to continue your Plan account<br />
or you may close your Plan account, as you specify to<br />
Computershare. Specifically:<br />
• You may keep your Plan account open (without the<br />
weekly or bi-weekly payroll deduction and the<br />
Company m<strong>at</strong>ch). If you keep your account open, you<br />
may continue to make voluntary cash contributions<br />
and no brokerage commissions will be charged on<br />
the purchase of Stock. An annual maintenance fee<br />
will be charged to your account in the first quarter of<br />
each calendar year and will be paid by means of the<br />
sale of an appropri<strong>at</strong>e portion of a share of Stock. (If<br />
you are transferred to a Company affili<strong>at</strong>e th<strong>at</strong> is not<br />
a Particip<strong>at</strong>ing Employer, the Company may continue<br />
to pay the maintenance fee for you.)<br />
• If you own <strong>at</strong> least one full share of Stock, you may<br />
close your Plan account by moving your Stock into<br />
a “General Shareholder” account. You may accomplish<br />
this move either by receiving all full shares in<br />
certific<strong>at</strong>e form with a check for any partial share<br />
ownership and re-depositing them in the General<br />
Shareholder account, or Computershare can move<br />
the shares electronically <strong>at</strong> your request. You<br />
should contact Computershare for more inform<strong>at</strong>ion<br />
about the fees associ<strong>at</strong>ed with a General<br />
Shareholder account.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
201
• You may close your Plan account by having all shares<br />
of Stock in your account sold and the proceeds paid<br />
to you, or you can have certific<strong>at</strong>es for full shares<br />
(and cash proceeds of fractional shares) delivered to<br />
you instead. The proceeds of any sale of full or fractional<br />
shares will be net of brokerage commissions,<br />
sales fees and other applicable charges. Your account<br />
will be closed autom<strong>at</strong>ically if you have a termin<strong>at</strong>ion<br />
of employment and there are no shares or fractional<br />
shares in your account.<br />
If you die before your Plan account has been closed,<br />
your Plan account will be distributed per the legal document<strong>at</strong>ion<br />
submitted to Computershare or to your<br />
est<strong>at</strong>e, unless you had previously arranged with<br />
Computershare to have your stock held in a joint<br />
account. In the event you have a joint account, the joint<br />
account holder may either make arrangements with<br />
Computershare to continue to maintain a shareholder<br />
account <strong>at</strong> his or her own expense or to have the Stock<br />
(or proceeds from the sale thereof ) distributed, less any<br />
applicable fees or commissions.<br />
To add or remove a joint tenant to or from your<br />
account, call Computershare <strong>at</strong> (800) 438-6278.<br />
Plan Amendment And Termin<strong>at</strong>ion<br />
The Plan has no set expir<strong>at</strong>ion d<strong>at</strong>e.The Board of<br />
Directors of the Company (or a committee design<strong>at</strong>ed<br />
by the Board) may amend or termin<strong>at</strong>e the Plan <strong>at</strong> any<br />
time. However, if stockholder approval of an amendment<br />
is required under law or the applicable rules of a n<strong>at</strong>ional<br />
stock exchange, the amendment will be subject to th<strong>at</strong><br />
approval. No amendment or termin<strong>at</strong>ion of the Plan will<br />
cause you to forfeit (1) any funds you have contributed<br />
to the Plan th<strong>at</strong> have not yet been used to purchase<br />
Stock; (2) any shares (or fractional interests) of Stock in<br />
your Plan account; or (3) any dividends or distributions<br />
declared with respect to Stock after you have made a<br />
contribution to the Plan but before the effective d<strong>at</strong>e of<br />
the amendment or termin<strong>at</strong>ion.<br />
Tax Inform<strong>at</strong>ion<br />
The following summary of the U. S. income tax consequences<br />
of the Plan is based on the Internal Revenue Code<br />
and any regul<strong>at</strong>ions thereunder as in effect as of the d<strong>at</strong>e of<br />
this Prospectus.The summary does not cover any st<strong>at</strong>e or<br />
local income taxes or taxes in jurisdictions other than the<br />
United St<strong>at</strong>es.You should consult your tax advisor with<br />
respect to individual tax consequences before purchasing<br />
Stock under the Plan.<br />
Stock Purchases<br />
Under the Stock Purchase Program.You have no federal<br />
income tax consequences when you enroll in the Plan or<br />
when Stock is purchased for you under the Stock<br />
Purchase Program either by payroll deduction or voluntary<br />
contribution, because your contributions are made<br />
with after-tax funds.The full value of Company m<strong>at</strong>ching<br />
contributions is ordinary income to you in the calendar<br />
year of contribution and will be reported on your pay<br />
stub and your W-2. Accordingly, the Company deducts all<br />
applicable wage withholding and other required taxes<br />
from your other compens<strong>at</strong>ion (by increasing your payroll<br />
deduction) when it makes a m<strong>at</strong>ching contribution<br />
to your Plan account.The Company is entitled to a tax<br />
deduction for the amount of the m<strong>at</strong>ching contribution<br />
in the same year as you recognize the income.<br />
Gre<strong>at</strong> Job Awards Under<br />
the Award Program<br />
“Gre<strong>at</strong> Job” buttons were not taxable to you when<br />
awarded.They are taxable only when you surrender<br />
them for a share or fractional share of Stock. At th<strong>at</strong> time,<br />
the value of the share (or fractional share) will be taxable<br />
to you as ordinary income. In addition, the Company will<br />
pay you an amount it determines to be the approxim<strong>at</strong>e<br />
amount of federal and st<strong>at</strong>e income taxes you will have<br />
to pay with respect to shares (or fractional shares) you<br />
receive upon surrender of your buttons. (Note th<strong>at</strong> this<br />
additional amount will also be ordinary income to you.)<br />
202 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Outstanding Performance Awards<br />
Under the Award Program<br />
Stock grants under the Outstanding Performance Award<br />
component of the Award Program are taxable as ordinary<br />
income in the calendar year of the award, regardless<br />
of whether the Stock certific<strong>at</strong>es are given directly to<br />
you or the Stock is awarded to your Plan account.Your<br />
ordinary income will be the market value of a share of<br />
Stock on the d<strong>at</strong>e the award is granted, times the number<br />
of shares of Stock granted.The Company is entitled<br />
to a tax deduction in the same amount and in the same<br />
year as you recognize the ordinary income.<br />
Stock Sales or Certific<strong>at</strong>e Distributions<br />
You will not recognize any taxable income when you<br />
request to have certific<strong>at</strong>es delivered to you for some or<br />
all of the Stock held in your Plan account. However, when<br />
you sell or otherwise dispose of your Stock - whether<br />
through Computershare or l<strong>at</strong>er after you have received<br />
your Stock certific<strong>at</strong>es—the difference between the market<br />
value of the Stock <strong>at</strong> the time of sale and the market<br />
value of the Stock on the d<strong>at</strong>e you acquired it will be<br />
taxed as a capital gain or loss.The holding period to<br />
determine whether the capital gain or loss is long-term<br />
or short-term will begin running on the d<strong>at</strong>e you acquire<br />
the Stock.The Company will have no deduction as a<br />
result of your disposition of the Stock.<br />
Available Inform<strong>at</strong>ion<br />
To obtain additional inform<strong>at</strong>ion about the Plan or its<br />
administr<strong>at</strong>ors, please call the Retirement and Savings<br />
Plans Department <strong>at</strong> (479) 273-4664.You can also write<br />
to the Retirement and Savings Plans Department <strong>at</strong> <strong>Wal</strong>-<br />
<strong>Mart</strong> Stores, Inc., 805 Moberly Lane, Bentonville, Arkansas,<br />
72716-0295.<br />
Computershare may be contacted by calling<br />
(800) 438-6278 (1 800 GET MART), online <strong>at</strong><br />
www.computershare.com/walmart, or by writing to<br />
Computershare, Attn: <strong>Wal</strong>-<strong>Mart</strong> ASPP, P.O. Box 43080,<br />
Providence, RI 02940-3080, for all correspondence,<br />
including transactions, stock certific<strong>at</strong>es request, stock<br />
powers, voluntary purchases, and any customer service<br />
inquiries.<br />
Documents Incorpor<strong>at</strong>ed<br />
By Reference<br />
The following documents filed by the Company with the<br />
Securities and Exchange Commission (the “Commission”)<br />
(File No. 1-6991) are hereby incorpor<strong>at</strong>ed by reference<br />
and made a part of this Prospectus:<br />
• The Company’s Annual Report on Form 10-K for the<br />
fiscal year ended January 31, 2007;<br />
• The Company’s Quarterly Report on Form 10-Q for<br />
the fiscal quarter ended April 30, 2007;<br />
• The Company’s Current Reports on Form 8-K filed<br />
with the Commission on February 2, 2007, April 3,<br />
2007 and April 5, 2007;<br />
• The Company’s definitive Proxy St<strong>at</strong>ement for the<br />
2007 Annual Shareholders’ Meeting, filed with the<br />
Commission on April 19, 2007; and<br />
• The Company’s Registr<strong>at</strong>ion St<strong>at</strong>ement on Form 8-A<br />
containing a description of Company’s common<br />
stock, $0.10 par value per share.<br />
All documents filed by the Company pursuant to<br />
Sections 13(a), 13(c), 14 and 15(d) of the Securities<br />
Exchange Act of 1934 (the “Exchange Act”) on or after<br />
the d<strong>at</strong>e of this Prospectus shall be deemed to be<br />
incorpor<strong>at</strong>ed by reference in this Prospectus and to be<br />
a part hereof from the d<strong>at</strong>e of filing of such documents,<br />
except for inform<strong>at</strong>ion furnished to the Commission<br />
th<strong>at</strong> is not deemed to be “filed” for purposes of the<br />
Exchange Act (such documents, and the documents<br />
listed above, being hereinafter referred to as<br />
“Incorpor<strong>at</strong>ed Documents”). Any st<strong>at</strong>ement contained<br />
in an Incorpor<strong>at</strong>ed Document shall be deemed to be<br />
modified or superseded for purposes of this Prospectus<br />
to the extent th<strong>at</strong> a st<strong>at</strong>ement contained herein or in<br />
any other subsequently filed Incorpor<strong>at</strong>ed Document<br />
modifies or supersedes such st<strong>at</strong>ement. Any such st<strong>at</strong>ement<br />
so modified or superseded shall not be deemed,<br />
except as so modified or superseded, to constitute a<br />
part of this Prospectus.<br />
These documents and the Company’s l<strong>at</strong>est Annual<br />
Report to Stockholders are available to you without<br />
charge upon written request. Please direct your requests<br />
for documents to: <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc., Retirement and<br />
Savings Plans Department, 805 Moberly Lane,<br />
Bentonville, Arkansas, 72716-0295.<br />
The <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
203
The Profit Sharing and 401(k) Plan<br />
Where Can I Find<br />
<strong>Wal</strong>-<strong>Mart</strong> Helps You Save For Your Future. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206<br />
Profit Sharing and 401(k) Plan Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206<br />
When Particip<strong>at</strong>ion Begins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207<br />
Enrolling in the Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208<br />
Your Profit Sharing and 401(k) Plan Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208<br />
<strong>Making</strong> a Rollover from a Previous Employer’s Plan or IRA . . . . . . . . . . . . . . . . . . . . . . . . 209<br />
<strong>Making</strong> Contributions to Your 401(k) Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209<br />
Company Contributions to Your Profit Sharing Account and<br />
Company-Funded 401(k) Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211<br />
Investing Your Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213<br />
More About Owning <strong>Wal</strong>-<strong>Mart</strong> Stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215<br />
Account Balances and St<strong>at</strong>ements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216<br />
Receiving a Payout While Working for the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217<br />
If You Die: Your Design<strong>at</strong>ed Beneficiary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218<br />
If You Get Divorced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218<br />
If You Leave the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219<br />
If You Leave and Are Then Rehired by <strong>Wal</strong>-<strong>Mart</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220<br />
The Income Tax Consequences of a Payout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221<br />
Filing a Profit Sharing and 401(k) Plan Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223<br />
Administr<strong>at</strong>ive Inform<strong>at</strong>ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
The Profit Sharing and 401(k) Plan<br />
<strong>Wal</strong>-<strong>Mart</strong> has a simple and convenient plan to help you prepare for your future. The Profit<br />
Sharing and 401(k) Plan helps you save for your future in two ways. First, <strong>Wal</strong>-<strong>Mart</strong> contributes<br />
money to your Profit Sharing Account and your Company-Funded 401(k) Account—currently, a<br />
total of up to 4 percent of your eligible pay each year. Second, you can save a percentage of<br />
your pay through payroll deductions before you pay taxes on those dollars. With investment<br />
choices, tax breaks, and <strong>Wal</strong>-<strong>Mart</strong> contributions—regardless of whether or not you make contributions—this<br />
Plan takes only a few moments of thought now so you can live better l<strong>at</strong>er.<br />
The Profit Sharing and 401(k) Plan Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Enroll in or change your<br />
401(k) contribution<br />
• Enroll and make<br />
contributions to the plan<br />
• Request a rollover packet<br />
to make a rollover contribution<br />
• Get a prospectus for the<br />
investment fund options<br />
• Get a fee disclosure sheet<br />
• Get inform<strong>at</strong>ion about<br />
your plan accounts<br />
• Get a copy of your<br />
quarterly st<strong>at</strong>ement<br />
• Request a hardship<br />
withdrawal or a withdrawal<br />
after you reach age 69 1/2<br />
• <strong>Change</strong> your investment<br />
fund choices<br />
• Request a payout when<br />
you leave <strong>Wal</strong>-<strong>Mart</strong><br />
• Design<strong>at</strong>e a beneficiary<br />
Go to walmartbenefits.com or<br />
the WIRE or<br />
www.benefits.ml.com<br />
Go to www.benefits.ml.com<br />
Go to the WIRE, click the “Life” tab,<br />
then click “Beneficiary Online” bene<strong>at</strong>h<br />
“My Health “<br />
Call the Customer Service Center <strong>at</strong><br />
(888) 968-4015<br />
Call the Customer Service Center <strong>at</strong><br />
(888) 968-4015<br />
The Profit Sharing and 401(k) Plan<br />
Wh<strong>at</strong> You Need to Know About the Profit Sharing and 401(k) Plan<br />
• You are generally eligible to particip<strong>at</strong>e in the Plan on the first day of the calendar month after your first<br />
anniversary of employment if you worked <strong>at</strong> least 1,000 hours during th<strong>at</strong> first year.<br />
• <strong>Wal</strong>-<strong>Mart</strong> helps you save for your future through contributions to your Profit Sharing Account and your<br />
Company-Funded 401(k) Account.<br />
• You can contribute from 1 percent up to 50 percent of each paycheck to the plan once you are eligible. You<br />
don’t need to make contributions to receive <strong>Wal</strong>-<strong>Mart</strong> contributions.<br />
• You choose how to invest Your 401(k) Account, your Company-Funded 401(k) Account, and your Rollover<br />
Account (if applicable). After three years of service, you may also choose how to invest your Company-Funded<br />
Profit Sharing Account.<br />
• You pay no Federal income tax on your contributions, the Company’s contributions, or any investment earnings<br />
until you receive a payout.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
205
<strong>Wal</strong>-<strong>Mart</strong> Helps You<br />
Save For Your Future<br />
<strong>Wal</strong>-<strong>Mart</strong> helps you save for your retirement by making<br />
contributions to the Profit Sharing Account and<br />
Company-Funded 401(k) Account of all eligible associ<strong>at</strong>es.<br />
If you are eligible, the Company anticip<strong>at</strong>es making<br />
a contribution each year:<br />
• From 0 percent to 2 percent of your pay to your<br />
Profit Sharing Account; and<br />
• From 0 percent to 2 percent of your pay to your<br />
Company-Funded 401(k) Account.<br />
Once you are eligible, you can make contributions to<br />
Your 401(k) Account. Because you pay no Federal income<br />
tax on your contributions until you receive a payout, you<br />
lower your income tax bill today.You choose how to<br />
invest your contributions, <strong>Wal</strong>-<strong>Mart</strong>’s 401(k) contributions<br />
and any rollover contributions. And, you pay no Federal<br />
income tax on any earnings until they are paid as a distribution<br />
to you.<br />
Below is an example of how <strong>Wal</strong>-<strong>Mart</strong>’s Profit Sharing<br />
and 401(k) Plan contributions can help you prepare for<br />
your future.<br />
This example assumes th<strong>at</strong> the Company contributes 2<br />
percent of your pay to the Profit Sharing Account and<br />
the Company-Funded 401(k) Account. Please note th<strong>at</strong><br />
the Company is not oblig<strong>at</strong>ed to make such contributions<br />
and may make smaller contributions or no contributions<br />
in future plan years.<br />
Although <strong>Wal</strong>-<strong>Mart</strong>’s profit sharing and 401(k) benefits<br />
remain independent, they were combined into one Plan<br />
on October 31, 2003, so th<strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong> can offer gre<strong>at</strong>er<br />
flexibility to meet your needs. This is a summary of benefits<br />
offered under the Plan as of February 1, <strong>2008</strong>.<br />
Should any questions ever arise about the n<strong>at</strong>ure and<br />
extent of your benefits, the formal language of the plan<br />
document, not the informal wording of this summary,<br />
will govern.<br />
Profit Sharing<br />
and 401(k) Plan Eligibility<br />
All associ<strong>at</strong>es of <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. or a particip<strong>at</strong>ing<br />
subsidiary are eligible to particip<strong>at</strong>e in the Plan, except:<br />
• Leased employees;<br />
• Non-resident aliens;<br />
• Independent contractors or consultants;<br />
• <strong>Associ<strong>at</strong>e</strong>s who are active participants in any similar<br />
retirement plans sponsored by <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing<br />
subsidiary;<br />
• Anyone not tre<strong>at</strong>ed as an employee of<br />
<strong>Wal</strong>-<strong>Mart</strong> or its particip<strong>at</strong>ing subsidiaries; and<br />
• Employees who are members of a collective bargaining<br />
unit whose retirement benefits were the subject<br />
of good faith collective bargaining.<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Annual Profit Sharing and 401(k) Contributions<br />
Eligible Pay<br />
Profit Sharing<br />
contribution of<br />
2 percent of pay<br />
Company-Funded<br />
401(k) contribution<br />
of 2 percent of pay<br />
Your 401(k)<br />
contribution<br />
of 5 percent of pay<br />
Total Profit Sharing and<br />
401(k) Plan contribution<br />
$15,000 $300 $300 $750 $1,350<br />
$22,000 $440 $440 $1,100 $1,980<br />
$28,000 $560 $560 $1,400 $2,520<br />
$35,000 $700 $700 $1,750 $3,150<br />
206 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
When Particip<strong>at</strong>ion Begins<br />
If you are an eligible associ<strong>at</strong>e, you will begin particip<strong>at</strong>ing<br />
in the Profit Sharing and 401(k) Plan on the first day<br />
of the calendar month following your first anniversary of<br />
employment with <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary,<br />
if you are credited with <strong>at</strong> least 1,000 hours of service<br />
during th<strong>at</strong> first year. For example, if your hire d<strong>at</strong>e is<br />
February 15, 2007 and you work 1,095 hours by February<br />
15, <strong>2008</strong> (your first anniversary), you become a participant<br />
in the Plan on March 1, <strong>2008</strong>.<br />
If you are not credited with 1,000 hours of service during<br />
th<strong>at</strong> first year, you would begin particip<strong>at</strong>ion on the<br />
February 1 after the first plan year (February 1-January<br />
31) in which you are credited with <strong>at</strong> least 1,000 hours<br />
of service.<br />
For example, if your hire d<strong>at</strong>e is February 15, 2007 and<br />
you work only 595 hours by February 15, <strong>2008</strong> (your first<br />
anniversary), but you work 1,095 hours during the<br />
February 1, <strong>2008</strong> - January 31, 2009 plan year, you<br />
become a participant in the Plan on February 1, 2009.<br />
To begin making contributions to the Plan once you are<br />
eligible, you can enroll on walmartbenefits.com, the<br />
WIRE, or through www.benefits.ml.com (see Enrolling<br />
in the Plan l<strong>at</strong>er in this chapter). When you’re eligible,<br />
you will autom<strong>at</strong>ically be enrolled in the Plan for purposes<br />
of receiving <strong>Wal</strong>-<strong>Mart</strong>’s contributions.<br />
How Hours of Service<br />
are Credited Under the Plan<br />
For hourly associ<strong>at</strong>es, hours of service are credited<br />
as follows:<br />
• All hours worked by hourly associ<strong>at</strong>es for <strong>Wal</strong>-<strong>Mart</strong> or<br />
any particip<strong>at</strong>ing subsidiary are counted toward the<br />
1,000 hour requirement.<br />
• Paid vac<strong>at</strong>ion, illness protection time, personal time,<br />
and overtime hours are also counted.<br />
• Hours are generally credited for the plan year<br />
worked. Hours for a payroll period th<strong>at</strong> overlaps<br />
years are pror<strong>at</strong>ed between the two years.<br />
For management associ<strong>at</strong>es and truck drivers, hours of<br />
service are credited as follows:<br />
• Management associ<strong>at</strong>es and truck drivers are<br />
credited with 190 hours per month for each<br />
month in which they work for <strong>Wal</strong>-<strong>Mart</strong> or any<br />
particip<strong>at</strong>ing subsidiary.<br />
• You must work <strong>at</strong> least six months of the plan year to<br />
have 1,000 hours credited for the year. (Vac<strong>at</strong>ion pay<br />
after you leave <strong>Wal</strong>-<strong>Mart</strong> will not give you an additional<br />
190 hours of credit.)<br />
If you are a veteran and are re-employed by <strong>Wal</strong>-<strong>Mart</strong> or<br />
a particip<strong>at</strong>ing subsidiary under the Uniformed Services<br />
Employment and Reemployment Rights Act of 1994,<br />
your qualified military service may be considered service<br />
under the Plan. If you think you may be affected by this<br />
rule, call the Retirement and Savings Plans Department<br />
<strong>at</strong> (800) 421-1362 for more details.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
207
Enrolling in the Plan<br />
Shortly before you become eligible for particip<strong>at</strong>ion in<br />
the Plan, you will receive an enrollment packet.This<br />
packet tells you how you can contribute your own funds<br />
to Your 401(k) Account and explains how you can direct<br />
the investment of Your 401(k) Account.You should read<br />
it carefully before making any decisions.<br />
You can enroll and make contributions through payroll<br />
deductions online <strong>at</strong> walmartbenefits.com,<br />
the WIRE, or www.benefits.ml.com or by calling the<br />
Customer Service Center <strong>at</strong> (888) 968-4015.<br />
You can enroll <strong>at</strong> any time after you become eligible.<br />
When you enroll, you choose:<br />
• The amount of your contributions (see <strong>Making</strong><br />
Contributions to Your 401(k) Account l<strong>at</strong>er in this<br />
chapter); and<br />
• How to invest your account among the Plan’s<br />
investment options. The Plan’s investment funds and<br />
procedures are described in the enrollment packet.<br />
After you enroll, a confirm<strong>at</strong>ion st<strong>at</strong>ement will be<br />
mailed to your home address so th<strong>at</strong> you can see<br />
whether your enrollment inform<strong>at</strong>ion is correct. It will<br />
show the percentage of your pay th<strong>at</strong> you have chosen<br />
to contribute from each check and the investment<br />
fund(s) you have elected.<br />
Your Profit Sharing<br />
and 401(k) Plan Accounts<br />
The Plan contains several accounts.<br />
Under the profit-sharing portion of the Plan, you will<br />
have a Profit Sharing Account. This account holds <strong>Wal</strong>-<br />
<strong>Mart</strong>’s contributions to the profit sharing portion of the<br />
Plan, both before October 31, 2003 and after October<br />
31, 2003, and earnings on those contributions.<br />
Under the 401(k) portion of the Plan, you will have some<br />
or all of the following accounts:<br />
• Your 401(k) Account — This account holds<br />
your contributions to the Plan (including your<br />
c<strong>at</strong>ch-up contributions, if any) and earnings on<br />
those contributions.<br />
• Company-Funded 401(k) Account — This account<br />
holds <strong>Wal</strong>-<strong>Mart</strong>’s contributions to the 401(k) portion<br />
of the Plan and earnings on those contributions.<br />
• 401(k) Rollover Account —This account holds any<br />
contributions th<strong>at</strong> you rolled over to this Plan from<br />
another qualified retirement plan and earnings on<br />
those contributions.<br />
The chart on the following page provides a summary of<br />
some of the differences between these accounts. These<br />
differences are discussed in more detail throughout<br />
this chapter.<br />
Your contributions to the Plan will begin as soon as possible<br />
after your election is received.This means your contributions<br />
generally will be taken from your first paycheck<br />
after your enrollment has been processed. No contributions<br />
will be taken from your pay before you<br />
become an eligible participant in the Plan. If you submit<br />
an election but your contributions do not start, it is your<br />
responsibility to contact the Customer Service Center<br />
immedi<strong>at</strong>ely <strong>at</strong> (888) 968-4015 to ensure they received<br />
your enrollment.<br />
208 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Profit Sharing and 401(k) Account Differences<br />
Source<br />
of Contributions<br />
May<br />
Participants<br />
Choose<br />
Investments<br />
Vesting<br />
Are Hardship<br />
Withdrawals<br />
Available<br />
Are Hardship<br />
Withdrawals<br />
Available after<br />
Age 69 1/2<br />
Your 401(k)<br />
Account<br />
You Yes 100 percent Yes Yes<br />
Company-Funded<br />
401(k) Account<br />
<strong>Wal</strong>-<strong>Mart</strong> Yes 100 percent No Yes<br />
401(k) Rollover<br />
Account<br />
Profit Sharing<br />
Account<br />
You Yes 100 percent Yes Yes<br />
<strong>Wal</strong>-<strong>Mart</strong><br />
(except for rollovers<br />
you made to the Profit<br />
Sharing Plan)<br />
Yes, after<br />
3 years<br />
of service<br />
<strong>Making</strong> a Rollover from a<br />
Previous Employer’s Plan or IRA<br />
When you come to work for <strong>Wal</strong>-<strong>Mart</strong>, you may have pretax<br />
funds owed to you from a previous employer’s retirement<br />
plan (including a 401(k) plan, a profit sharing plan,<br />
a 403(b) plan of a tax-exempt employer, or a 457(b) plan<br />
of a governmental employer). If so, you may be able to<br />
have th<strong>at</strong> money rolled over to this Plan.You may also<br />
roll over pre-tax funds you have in an Individual<br />
Retirement Account (IRA). If you roll over funds to this<br />
Plan, you should keep these points in mind:<br />
• You may go ahead and roll over money to the<br />
Plan even though you have not yet become a<br />
participant in the Plan (th<strong>at</strong> is, you have not yet<br />
s<strong>at</strong>isfied the 12-month waiting period and the<br />
1,000-hour requirement).<br />
• Once you roll funds into the <strong>Wal</strong>-<strong>Mart</strong> Profit Sharing<br />
and 401(k) Plan, those funds will be subject to the<br />
rules of this Plan, including payout rules, and not the<br />
rules of your former employer’s plan or your IRA.<br />
2 years – 20 percent<br />
3 years – 40 percent<br />
4 years – 60 percent<br />
5 years – 80 percent<br />
6 years – 100 percent<br />
(rollovers are<br />
100 percent vested)<br />
*effective 1/31/<strong>2008</strong><br />
No<br />
• Your rollover contribution will be placed in your<br />
401(k) Rollover Account and will be 100 percent vested.<br />
You will also be able to direct the investment of<br />
these assets pursuant to the Plan’s guidelines.<br />
If you’re interested in making a rollover contribution to<br />
the Plan, you should contact the Customer Service<br />
Center <strong>at</strong> (888) 968-4015 and request a rollover packet.<br />
<strong>Making</strong> Contributions<br />
to Your 401(k) Account<br />
Yes<br />
After you become a participant in the Plan, you may<br />
choose to contribute from 1 percent up to 50 percent<br />
(in whole percentages) of each paycheck to Your<br />
401(k) Account. Your contributions in any calendar<br />
year, however, may not exceed a limit set by the IRS.<br />
For <strong>2008</strong>, the limit is $16,000. This amount will be<br />
increased from time to time by the IRS. (Higher paid<br />
individuals are subject to a lower limit, as well as a<br />
limit on the amount of pay th<strong>at</strong> can be taken into<br />
account under the Plan. You will be notified directly<br />
by mail if either of these limits applies to you.) You are<br />
always fully vested in your own contributions.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
209
Your contributions to the Plan are deducted from your<br />
pay before federal income taxes are withheld.This<br />
means th<strong>at</strong> you don’t pay federal income taxes on<br />
amounts you pay to the Plan (or earnings on your contributions)<br />
until they are distributed to you from the Plan.<br />
You may also save on st<strong>at</strong>e and local taxes as well,<br />
depending on your loc<strong>at</strong>ion. Please note th<strong>at</strong> your contributions<br />
are subject to Social Security taxes in the year<br />
the amount is deducted from your pay. Payouts from the<br />
Plan, however, are not subject to Social Security taxes<br />
In addition, if you contribute your own pay to Your 401(k)<br />
Account, you may be eligible for a “Saver’s Tax Credit.” If<br />
you are a married taxpayer who files a joint tax return<br />
with an adjusted gross income (AGI) of $50,000 or less or<br />
a single taxpayer with $25,000 or less in AGI on your tax<br />
return, you are eligible for this tax credit, which can<br />
reduce your taxes. For more details, your tax<br />
preparer may refer to IRS Announcement 2001-106.<br />
How Your Contribution is Determined<br />
The percentage of pay you elect to contribute to the<br />
Plan will be applied to the following pay:<br />
• Regular salary or wages, including any pre-tax<br />
dollars you use for your 401(k) contributions or to<br />
purchase benefits available under <strong>Wal</strong>-<strong>Mart</strong>’s health<br />
and welfare plan<br />
• Overtime, illness protection, vac<strong>at</strong>ion, holiday, personal,<br />
bereavement, jury duty, and premium pay<br />
• Most incentive plan payments<br />
• Holiday and fire brigade bonuses<br />
• Special recognition awards, such as the<br />
Gre<strong>at</strong> Job program<br />
Your contribution will not be withheld from:<br />
• The 15 percent <strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ch on the <strong>Associ<strong>at</strong>e</strong><br />
Stock Purchase Plan<br />
• Reimbursement for expenses like reloc<strong>at</strong>ion<br />
and G.A.P.<br />
• Equity income, including income from stock options<br />
or restricted stock rights<br />
• A final paycheck upon your termin<strong>at</strong>ion of<br />
employment th<strong>at</strong> is paid prior to the end of a<br />
normal pay cycle<br />
Changing Your<br />
401(k) Contribution Amount<br />
You can increase, decrease, stop, or begin your contributions<br />
<strong>at</strong> any time by logging on to www.walmartbenefits.com,<br />
the WIRE, or www.benefits.ml.com.You may<br />
also call the Customer Service Center <strong>at</strong> (888) 968-4015.<br />
If you call prior to 1:00 a.m. Eastern time on the Friday<br />
before the end of any pay period, your change generally<br />
will be effective on your next paycheck. <strong>Change</strong>s you<br />
make l<strong>at</strong>er in the pay period will be applied within<br />
two pay periods. If you change your contribution<br />
amount, a confirm<strong>at</strong>ion notice will be sent to your<br />
home address. If you do not receive a confirm<strong>at</strong>ion or<br />
your change is not implemented, it is your responsibility<br />
to call the Customer Service Center immedi<strong>at</strong>ely<br />
<strong>at</strong> (888) 968-4015.<br />
If You Are Age 50 or Above<br />
If you are age 50 or above (or will be age 50 by the end<br />
of the applicable calendar year) and you are contributing<br />
up to the Plan or legal limits, you are allowed to make<br />
additional contributions.These are called c<strong>at</strong>ch-up contributions<br />
and are made by payroll deduction just like<br />
your normal contributions. For <strong>2008</strong>, your c<strong>at</strong>ch-up contributions<br />
may be any amount up to the lesser of $6,000<br />
or 100 percent of your pay.Your c<strong>at</strong>ch-up contributions<br />
will be credited to Your 401(k) Account.<br />
For example, if you contribute the maximum amount of<br />
$16,000 for the <strong>2008</strong> calendar year, or if you contribute<br />
the maximum percentage of your pay allowed under the<br />
Plan, you could choose to contribute up to an additional<br />
$6,000 <strong>at</strong> any time during <strong>2008</strong>. If you are interested in<br />
making c<strong>at</strong>ch-up contributions, you can enroll online <strong>at</strong><br />
walmartbenefits.com, the WIRE,or<br />
www.benefits.ml.com, or call the Customer Service<br />
Center <strong>at</strong> (888) 968-4015.<br />
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<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
401(k) Account<br />
Contribution Limit<strong>at</strong>ions<br />
The total amount of contributions you can make to this<br />
Plan and to any other employer plan (including 403(b)<br />
annuity plans, simplified employee pensions, or other<br />
401(k) plans) is $16,000 for <strong>2008</strong>. (Your c<strong>at</strong>ch-up contributions<br />
do not count toward this limit.) This amount will<br />
be increased from time to time by the IRS. If you are contributing<br />
to more than one plan, it is your responsibility<br />
to determine if you have exceeded the legal limit. If your<br />
total contributions go over the legal limit for a calendar<br />
year, the excess must be included in your income for th<strong>at</strong><br />
year and will be taxed. In addition, you may be taxed a<br />
second time when the excess amount is l<strong>at</strong>er paid to you<br />
(after you termin<strong>at</strong>e employment). For this reason, you<br />
may wish to request th<strong>at</strong> the excess amount be returned<br />
to you. If you wish to request th<strong>at</strong> the excess be returned<br />
to you from this Plan, you must contact the Retirement<br />
and Savings Plans Department no l<strong>at</strong>er than March 1st<br />
following the calendar year in which the excess contributions<br />
were made.<br />
If You Have<br />
a Qualified Military Service<br />
If you miss work because of qualified military service,<br />
you may be entitled under the Uniformed Services<br />
Employment and Reemployment Rights Act of 1994 to<br />
make up contributions you missed during your military<br />
service (th<strong>at</strong> is, to make contributions equal to the<br />
amount you would have been eligible to make if you<br />
were working for <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary).<br />
Because you will have only a certain period of time after<br />
you return to work to make these contributions (generally<br />
three times the period of military service, up to five<br />
years), you should contact the Retirement and Savings<br />
Plans Department if you think you may be affected by<br />
these rules.<br />
Company Contributions<br />
to Your Profit Sharing Account and<br />
Company-Funded<br />
401(k) Account<br />
At the end of each plan year, <strong>Wal</strong>-<strong>Mart</strong> determines the<br />
amount of its contribution (if any) for the plan year.The<br />
contribution will be a percentage of your pay while you<br />
were a participant for such plan year.The contribution<br />
percentage can vary from year to year and may be<br />
reduced or elimin<strong>at</strong>ed in the future.<br />
Currently, <strong>Wal</strong>-<strong>Mart</strong> anticip<strong>at</strong>es making a contribution<br />
from 0 percent to 2 percent of your pay to your Profit<br />
Sharing Account and a contribution from 0 percent to 2<br />
percent of your pay to your Company-Funded 401(k)<br />
Account. All participants eligible for the contribution<br />
receive the same percentage of their plan year pay (up<br />
to IRS limits). <strong>Wal</strong>-<strong>Mart</strong>’s contributions will be made after<br />
the end of the plan year but not l<strong>at</strong>er than the due d<strong>at</strong>e<br />
(including extensions) of <strong>Wal</strong>-<strong>Mart</strong>’s tax return.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
211
Becoming Vested in<br />
Your Profit Sharing Account<br />
The vested percentage of your Profit Sharing Account<br />
is the portion th<strong>at</strong> you are entitled to receive if you<br />
leave <strong>Wal</strong>-<strong>Mart</strong>. Your account st<strong>at</strong>ements show your<br />
vested percentage.<br />
You become vested in your Profit Sharing Account<br />
(other than rollovers in th<strong>at</strong> account, which are always<br />
100 percent vested) depending on your years of service<br />
with <strong>Wal</strong>-<strong>Mart</strong>:<br />
Profit Sharing Vesting Schedule<br />
Prior to January 31, <strong>2008</strong> *<br />
Years of Service<br />
Less than 3<br />
Vested Percentage<br />
0 percent<br />
3 20 percent<br />
4 40 percent<br />
5 60 percent<br />
6 80 percent<br />
7 or more 100 percent<br />
* Applies to participants termin<strong>at</strong>ing prior to January 31, <strong>2008</strong>, even if<br />
accounts are paid out after January 31, <strong>2008</strong>.<br />
New Profit Sharing Vesting Schedule<br />
Effective January 31, <strong>2008</strong> *<br />
Years of Service<br />
Less than 2<br />
Vested Percentage<br />
0 percent<br />
2 20 percent<br />
3 40 percent<br />
4 60 percent<br />
5 80 percent<br />
6 or more 100 percent<br />
* Applies to participants actively employed on or after January 31, <strong>2008</strong>.<br />
NOTE: The new vesting schedule above is applicable to<br />
contributions for the Plan Year ending January 31, <strong>2008</strong><br />
and account balances of participants employed on or<br />
after th<strong>at</strong> d<strong>at</strong>e. If you termin<strong>at</strong>e employment before<br />
January 31, <strong>2008</strong>, your payout will be processed under<br />
the prior vesting schedule.<br />
A year of service for this purpose is a plan year<br />
(February 1 - January 31) in which you are credited<br />
with <strong>at</strong> least 1,000 hours of service under the hours of<br />
service rules (see How Hours of Service are Credited<br />
Under the Plan earlier in this chapter). If you are credited<br />
with less than 1,000 hours in a plan year, your<br />
vesting does not increase. (Please note th<strong>at</strong> years of<br />
service for this purpose are not determined by your<br />
anniversary d<strong>at</strong>e.)<br />
If you leave <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries because of<br />
retirement (<strong>at</strong> age 65 or older), de<strong>at</strong>h, or total and permanent<br />
disability, your Profit Sharing Account will be<br />
100 percent vested, regardless of your years of service.<br />
Your Profit Sharing Account will also be 100 percent<br />
vested if the Plan is ever termin<strong>at</strong>ed.<br />
To be considered for a disability payout, send the<br />
Retirement and Savings Plans Department a copy of<br />
the inform<strong>at</strong>ion from the Social Security<br />
Administr<strong>at</strong>ion showing you are eligible for disability<br />
payments and were declared disabled while still<br />
employed with <strong>Wal</strong>-<strong>Mart</strong>.<br />
Vesting in Your<br />
Company-Funded 401(k) Account<br />
You are always 100 percent vested in <strong>Wal</strong>-<strong>Mart</strong>’s contributions<br />
to your Company-Funded 401(k) Account.<br />
When You Are Eligible<br />
for a Company Contribution<br />
In order to share in <strong>Wal</strong>-<strong>Mart</strong>’s contributions for a plan<br />
year, you must:<br />
• Be credited with <strong>at</strong> least 1,000 hours of service during<br />
the plan year (February 1–January 31) for which<br />
the contribution is made; and<br />
212 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
• Be employed by <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary<br />
on the last day (January 31) of th<strong>at</strong> plan year.<br />
If you leave <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries on January<br />
30 or earlier, you will not receive a contribution for<br />
th<strong>at</strong> year. The only exception to this rule is if the last<br />
day of a plan year falls on a S<strong>at</strong>urday or Sunday. In<br />
th<strong>at</strong> event, if you are employed on the Friday immedi<strong>at</strong>ely<br />
prior to the last day of the plan year, you will<br />
be tre<strong>at</strong>ed as s<strong>at</strong>isfying this rule.<br />
<strong>Wal</strong>-<strong>Mart</strong> may be required to make contributions on<br />
your behalf for periods of qualified military service.<br />
For this to be the case, you must return to service with<br />
<strong>Wal</strong>-<strong>Mart</strong> or one of its subsidiaries <strong>at</strong> the times and in<br />
the manner required by the Uniformed Services<br />
Employment and Reemployment Rights Act of 1994.<br />
If you think this rule may apply to you, you should<br />
contact the Retirement and Savings Plans Department<br />
<strong>at</strong> (800) 421-1362.<br />
Your Pay for the Purposes<br />
of the Company Contribution<br />
For purposes of determining the amount of your <strong>Wal</strong>-<br />
<strong>Mart</strong> contributions, your pay will include:<br />
• Regular salary or wages, including any pre-tax dollars<br />
you use for your 401(k) contributions or to purchase<br />
benefits available under <strong>Wal</strong>-<strong>Mart</strong>’s health and welfare<br />
plan<br />
• Overtime, illness protection, vac<strong>at</strong>ion, holiday, personal,<br />
bereavement, jury duty, and premium pay<br />
• Most incentive plan payments<br />
• Holiday and fire brigade bonuses, the 15 percent<br />
<strong>Wal</strong>-<strong>Mart</strong> m<strong>at</strong>ch on the <strong>Associ<strong>at</strong>e</strong> Stock Purchase<br />
Plan, and special recognition awards, such as the<br />
Gre<strong>at</strong> Job program<br />
Remember th<strong>at</strong> for purposes of <strong>Wal</strong>-<strong>Mart</strong>’s contributions,<br />
your pay only includes pay you receive after you actually<br />
become eligible for the Plan.You will not receive <strong>Wal</strong>-<br />
<strong>Mart</strong>’s contribution on pay you receive before becoming<br />
a participant.<br />
Investing Your Accounts<br />
You may direct any portion of your Profit Sharing<br />
Account into any investment altern<strong>at</strong>ives under the Plan,<br />
including <strong>Wal</strong>-<strong>Mart</strong> stock, once you have completed<br />
three years of service. (A year of service is defined as having<br />
worked 1,000 hours in a plan year.) Note th<strong>at</strong><br />
rollovers in your Profit Sharing Account cannot be<br />
invested in <strong>Wal</strong>-<strong>Mart</strong> stock.<br />
If you choose to invest some or all of your Profit Sharing<br />
Account in <strong>Wal</strong>-<strong>Mart</strong> stock, be aware th<strong>at</strong> since this<br />
option is a single stock investment, it generally carries<br />
more risk than do the funds offered through the Plan.<br />
Remember th<strong>at</strong> you always have the right to direct the<br />
investment of Your 401(k) Account in the Plan.You may<br />
obtain more specific inform<strong>at</strong>ion regarding this right <strong>at</strong><br />
www.benefits.ml.com or by calling the Customer<br />
Service Center <strong>at</strong> (888) 968-4015.<br />
To help you diversify your retirement savings, the Plan<br />
offers a variety of investment options with different levels<br />
of risk and potential for increase in value.To “diversify”<br />
means th<strong>at</strong> you “put your eggs in more than one basket.”You<br />
should give careful consider<strong>at</strong>ion to the benefits<br />
of a well-balanced and diversified investment portfolio.<br />
Spreading your assets among different types of<br />
investments could help you achieve a favorable r<strong>at</strong>e of<br />
return, while lowering your overall risk of losing money.<br />
This is because market or other economic conditions<br />
th<strong>at</strong> cause one c<strong>at</strong>egory of assets, or one particular security<br />
to perform well often causes another asset c<strong>at</strong>egory,<br />
or another particular security, to perform poorly.<br />
If you invest more than 20 percent of your retirement<br />
savings in any one company, such as <strong>Wal</strong>-<strong>Mart</strong> stock, or<br />
in any one industry, your savings may not be properly<br />
diversified. Although diversific<strong>at</strong>ion does not ensure a<br />
profit or protect against loss, it is an effective str<strong>at</strong>egy to<br />
help you manage investment risk.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
213
When deciding how to invest your retirement savings,<br />
you should take into account all of your assets, including<br />
any retirement savings outside of the Plan. For example,<br />
you may own <strong>Wal</strong>-<strong>Mart</strong> stock through other means such<br />
as the <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan. No single approach<br />
is right for everyone because, among other factors, individuals<br />
have different financial goals, different time horizons<br />
for meeting their goals, and different tolerances for<br />
risk.Therefore, you should carefully consider the rights<br />
described in this inform<strong>at</strong>ion and how these rights affect<br />
the amount of money th<strong>at</strong> you invest in <strong>Wal</strong>-<strong>Mart</strong> stock<br />
through the Plan.<br />
It is also important to periodically review your investment<br />
portfolio, your investment objectives, and the<br />
investment options under the Plan to help ensure th<strong>at</strong><br />
your investments are in line with your objectives and<br />
your risk tolerance. If you would like more sources of<br />
inform<strong>at</strong>ion on individual investing and diversific<strong>at</strong>ion,<br />
you may go to the website of the Department of Labor,<br />
http://www.dol.gov/ebsa/investing.html.<br />
How Your Profit-Sharing<br />
Account is Invested<br />
Because the Profit-Sharing Account is an Employee Stock<br />
Ownership Plan, Profit Sharing assets, as a whole, are<br />
mostly invested in <strong>Wal</strong>-<strong>Mart</strong> stock. Annual contributions<br />
are invested as determined by the Retirement Plans<br />
Committee, which may include investment in <strong>Wal</strong>-<strong>Mart</strong><br />
stock. Depending on the Committee’s investment of<br />
annual contributions, which may vary from year to year,<br />
there may be periods when your Profit Sharing Account<br />
is not invested in <strong>Wal</strong>-<strong>Mart</strong> stock. After you complete<br />
three years of service, you can choose to invest your<br />
Profit Sharing Account (other than rollovers) in <strong>Wal</strong>-<strong>Mart</strong><br />
stock. If you have three years of service, but do not make<br />
an investment choice for any amounts held in your Profit<br />
Sharing Account, such amounts will continue to be<br />
invested as determined by the Committee.<br />
On your st<strong>at</strong>ements, you will see how many shares of<br />
stock are in your Profit Sharing Account and the dollar<br />
amount of any other investments in your Profit<br />
Sharing Account.<br />
If you are a termin<strong>at</strong>ed participant who had three or<br />
more years of service when you termin<strong>at</strong>ed, you also<br />
have the right to direct the investment of your Profit<br />
Sharing Account until paid. For more inform<strong>at</strong>ion, you<br />
may contact the Customer Service Center online <strong>at</strong><br />
www.benefits.ml.com or by calling (888) 968-4015.<br />
Investing The 401(k) Account: Your 401(k)<br />
Account, Your Company-Funded 401(k)<br />
Account, and Your 401(k) Rollover Account<br />
You decide how Your 401(k) Account, your Company-<br />
Funded 401(k) Account, and your 401(k) Rollover<br />
Account will be invested.You can choose:<br />
• One of the GoalManager portfolios: Aggressive,<br />
Moder<strong>at</strong>e, or Conserv<strong>at</strong>ive. These pre-mixed portfolios<br />
th<strong>at</strong> are designed to make diversified investing<br />
simple for you.<br />
• From among a menu of investment options made<br />
available by the Retirement Plans Committee. <strong>Wal</strong>-<br />
<strong>Mart</strong> stock is not an investment option with respect<br />
to Your 401(k) Account, your Company-Funded<br />
401(k) Account, and your 401(k) Rollover Account.<br />
You may choose one of the investment options or<br />
you may spread your money among the several<br />
investment choices.<br />
The investment gains or losses on your accounts will<br />
depend upon the performance of the investments<br />
you choose.<br />
A description of all investment options and the<br />
GoalManager Models is included in the enrollment packet<br />
you receive when you are eligible to enroll.You also<br />
may obtain the prospectus for each investment option,<br />
free of charge by accessing your account online <strong>at</strong><br />
www.benefits.ml.com or by calling the Customer<br />
Service Center <strong>at</strong> (888) 968-4015.<br />
If you do not make an investment choice for Your 401(k)<br />
Account, your Company-Funded 401(k) Account, and<br />
your 401(k) Rollover Account, they will be invested in the<br />
Moder<strong>at</strong>e GoalManager Model, which is a diversified mix<br />
of various funds within the Plan.<br />
214 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Changing Your Investment Choices<br />
You can change your investment choices online <strong>at</strong><br />
www.benefits.ml.com or by calling the Customer<br />
Service Center <strong>at</strong> (888) 968-4015. If you make an investment<br />
change, a confirm<strong>at</strong>ion notice will be sent to your<br />
home address unless you have chosen to receive them<br />
electronically. If you don’t receive a confirm<strong>at</strong>ion notice,<br />
it is your responsibility to contact the Customer Service<br />
Center <strong>at</strong> (888) 968-4015 to make sure your change has<br />
been implemented.<br />
If you call the Customer Service Center <strong>at</strong><br />
(888) 968-4015 prior to 3:00 p.m. Eastern time, your<br />
investment change generally will be applied on the<br />
day you call. If your call is after 3:00 p.m. Eastern time,<br />
your investment change generally will be applied on<br />
the following business day. If, however, your account<br />
is invested in <strong>Wal</strong>-<strong>Mart</strong> stock and you wish to transfer<br />
your money to another investment, there is a threeday<br />
settlement time required by the Securities and<br />
Exchange Commission before your funds can be<br />
transferred to the new investment fund. There is a<br />
two-day settlement time required for transfers from<br />
a mutual fund to <strong>Wal</strong>-<strong>Mart</strong> stock. A transfer from a<br />
mutual fund to a mutual fund occurs on the same day.<br />
Purchases and sales will generally be valued on the d<strong>at</strong>e<br />
your investment election is given effect under the Plan.<br />
Please note th<strong>at</strong> this Plan is intended to be an “ERISA<br />
Section 404(c) plan.”This means th<strong>at</strong> you assume all<br />
investment risks connected with the investment<br />
options you choose in the Plan, including the increase<br />
or decrease in market value. Neither <strong>Wal</strong>-<strong>Mart</strong>, the<br />
Retirement Plans Committee, nor the trustee are<br />
responsible for losses to your accounts as a result of<br />
investment decisions you make.<br />
Additionally, you should be aware th<strong>at</strong> most investments<br />
offered under the Plan have restrictions on market timing.<br />
Mutual fund market timing involves the purchase<br />
and sale of shares of mutual funds (including exchanges<br />
within the same fund family) within short periods of<br />
time with the intention of capturing short-term profits<br />
resulting from market vol<strong>at</strong>ility.<br />
The prospectus for each investment will describe these<br />
restrictions from time to time.The fund may assess<br />
redemption fees against a market timer, refuse to accept<br />
a market timer’s investment election or impose other<br />
consequences or restrictions. Brokers or other parties<br />
performing services for the Plan may have similar restrictions.The<br />
Plan will honor any such restrictions and those<br />
additional restrictions th<strong>at</strong> may be required or consistent<br />
with applicable law. Because market timing may<br />
adversely affect your ability to invest under the Plan,<br />
market timing should be avoided.<br />
More About<br />
Owning <strong>Wal</strong>-<strong>Mart</strong> Stock<br />
If you invest in <strong>Wal</strong>-<strong>Mart</strong> stock through the Plan, each<br />
year you will receive all of the m<strong>at</strong>erials generally distributed<br />
to the shareholders of <strong>Wal</strong>-<strong>Mart</strong>, including an<br />
instruction card telling the trustee how to vote your<br />
shares in your plan account.<br />
You can instruct the trustee, through the Company’s<br />
transfer agent, to vote <strong>Wal</strong>-<strong>Mart</strong> stock held in your plan<br />
accounts.This usually occurs in May of each year.Your<br />
instructions to the transfer agent and the trustee are<br />
kept confidential <strong>at</strong> all times.You will send your voting<br />
instructions directly to the transfer agent, who will compile<br />
the votes and notify the Retirement Plans<br />
Committee of the total votes cast.The Retirement Plans<br />
Committee will then notify the plan trustee of the total<br />
votes th<strong>at</strong> are to be cast. Neither <strong>Wal</strong>-<strong>Mart</strong> nor the<br />
Retirement Plans Committee will know how any individual<br />
participant voted (except as necessary to comply<br />
with securities laws).<br />
If you do not instruct the trustee how to vote your<br />
shares, the Retirement Plans Committee will vote these<br />
shares <strong>at</strong> its discretion. If neither you nor the Retirement<br />
Plans Committee exercise voting rights, the trustee or an<br />
independent fiduciary appointed by the trustee may<br />
vote the unvoted shares.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
215
Dividends on Your <strong>Wal</strong>-<strong>Mart</strong> Stock<br />
If you have <strong>Wal</strong>-<strong>Mart</strong> stock in your accounts, your<br />
accounts will be credited with any dividends paid by<br />
<strong>Wal</strong>-<strong>Mart</strong> with respect to its stock. Dividends alloc<strong>at</strong>ed to<br />
Your 401(k) Account, your Company-Funded 401(k)<br />
Account, or your 401(k) Rollover Account will be autom<strong>at</strong>ically<br />
reinvested in <strong>Wal</strong>-<strong>Mart</strong> stock. Dividends alloc<strong>at</strong>ed<br />
to your Profit Sharing Account will be invested as<br />
determined by the Retirement Plans Committee, except<br />
as noted below.<br />
If you are an active participant with six or more years of<br />
service, you have an option to take a cash payout of any<br />
dividend paid on <strong>Wal</strong>-<strong>Mart</strong> stock held in your Profit<br />
Sharing Account and any stock th<strong>at</strong> is held or any funds<br />
rolled over to the profit sharing plan. Also, if you are a<br />
termin<strong>at</strong>ed participant who had more than six years of<br />
service when you termin<strong>at</strong>ed and you continue to maintain<br />
your balance in the Plan after you leave, you will<br />
have the option to elect a cash payout of dividends paid<br />
on <strong>Wal</strong>-<strong>Mart</strong> stock held in your Profit Sharing Account. If<br />
you do not receive cash, your dividend will be reinvested<br />
in <strong>Wal</strong>-<strong>Mart</strong> stock <strong>at</strong> your election or, if no election is<br />
affirm<strong>at</strong>ively made, as determined by the Retirement<br />
Plans Committee.<br />
You may make an election anytime by contacting the<br />
Customer Service Center online <strong>at</strong><br />
www.benefits.ml.com or by calling (888) 968-4015.<br />
Your most recently filed election will apply to all subsequent<br />
dividends until you change your election. (You<br />
may change your election only once each business day.)<br />
Keep in mind th<strong>at</strong> your election must be made no l<strong>at</strong>er<br />
than the close of business on the day prior to the record<br />
d<strong>at</strong>e for the dividend in order to be effective for th<strong>at</strong> dividend.You<br />
will not be able to make any elections or election<br />
changes during the period from the record d<strong>at</strong>e of<br />
the dividend through the dividend pay d<strong>at</strong>e (which is<br />
usually three to four weeks after the record d<strong>at</strong>e).<br />
Each year, <strong>Wal</strong>-<strong>Mart</strong> releases the quarterly record d<strong>at</strong>es<br />
for dividend payouts.You can find this inform<strong>at</strong>ion on<br />
www.walmart.com.You may also contact Merrill Lynch<br />
if you need inform<strong>at</strong>ion about upcoming record d<strong>at</strong>es<br />
for dividends.You should keep in mind th<strong>at</strong> a dividend<br />
payout will be taxable to you.<br />
Please note th<strong>at</strong> if you request a hardship payout from<br />
Your 401(k) Account within five business days of the<br />
record d<strong>at</strong>e for a dividend and you have the right to<br />
elect a cash distribution of the dividend, tax laws<br />
require th<strong>at</strong> the dividend be autom<strong>at</strong>ically paid to you<br />
in cash.<br />
Account Balances<br />
and St<strong>at</strong>ements<br />
At least once a year, you’ll receive a st<strong>at</strong>ement on your<br />
accounts showing contributions made by you and by<br />
<strong>Wal</strong>-<strong>Mart</strong>, the performance of your investment funds,<br />
and the values of your accounts. You can easily get<br />
inform<strong>at</strong>ion about your accounts, including a quarterly<br />
st<strong>at</strong>ement, <strong>at</strong> any time online <strong>at</strong> www.benefits.ml.com<br />
or by calling the Customer Service Center <strong>at</strong><br />
(888) 968-4015. You can also request a paper copy of<br />
any quarterly st<strong>at</strong>ement <strong>at</strong> any time free of charge by<br />
calling (888) 968-4015.<br />
Fees Charged to Your Account<br />
In addition to the general expenses of the Plan, the Plan<br />
allows certain expenses to be charged to your accounts.<br />
Currently, there is an account maintenance fee of $2<br />
charged to your account balance each Spring while you<br />
are an active participant If you are a former participant<br />
with an account balance in the Plan, an annual maintenance<br />
fee of $15 will be charged to your account balance.<br />
When you leave the Company and receive a payout,<br />
Merrill Lynch will charge a $15 check processing fee.<br />
When you buy or sell shares of <strong>Wal</strong>-<strong>Mart</strong> stock within the<br />
Plan, there is a brokerage fee of five cents per share.<br />
The Plan also makes available a list of fees associ<strong>at</strong>ed<br />
with each investment option under the Plan.You may<br />
obtain a copy of this list by accessing your account <strong>at</strong><br />
www.benefits.ml.com or by calling the Customer<br />
Service Center <strong>at</strong> (888) 968-4015.You may also review<br />
the prospectus for each investment option for more<br />
inform<strong>at</strong>ion about fees associ<strong>at</strong>ed with th<strong>at</strong> investment.<br />
216 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Receiving a Payout While Working<br />
for the Company<br />
Generally, you are not entitled to a payout from the<br />
Profit Sharing and 401(k) Plan until you stop working<br />
for <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries. However, in the following<br />
limited situ<strong>at</strong>ions you may be entitled to receive<br />
a payout of some or all of your accounts while you’re<br />
still working:<br />
• In the case of a financial hardship (as defined by<br />
the IRS);<br />
• After you <strong>at</strong>tain age 69 1/2; and<br />
• In the case of a special diversific<strong>at</strong>ion payout.<br />
It’s important to understand how any type of payout<br />
from the Profit Sharing and 401(k) Plan affects your tax<br />
situ<strong>at</strong>ion. For more inform<strong>at</strong>ion, see The Income Tax<br />
Consequences of a Payout l<strong>at</strong>er in this chapter.<br />
Financial Hardship Withdrawals<br />
You may withdraw money from Your 401(k) Account<br />
(other than earnings on those contributions) and your<br />
401(k) Rollover Account if you have a “financial hardship”<br />
under IRS guidelines. For this purpose, a financial hardship<br />
may exist if the request is for:<br />
• Payment of medical care expenses not covered by<br />
insurance for you, your spouse, or your dependents; or<br />
• Costs directly rel<strong>at</strong>ed to the purchase of your primary<br />
residence (home); or<br />
• Payment of tuition, fees, and room and board<br />
expenses for up to the next 12 months of post-high<br />
school educ<strong>at</strong>ion for you, your spouse, or your<br />
dependents; or<br />
• Payments necessary to prevent eviction from, or foreclosure<br />
on, your primary residence; or<br />
• Payment for burial or funeral expenses for your<br />
deceased parent, spouse, children or dependent; or<br />
• Expenses for the repair of damage to your principal<br />
residence which would qualify for a casualty deduction<br />
under federal income tax rules.<br />
Federal tax law requires th<strong>at</strong> you must have already<br />
obtained all available age 69 1/2 in-service payouts<br />
(see below) before you can request a financial hardship<br />
payout. If you were employed with an employer affili<strong>at</strong>ed<br />
with <strong>Wal</strong>-<strong>Mart</strong> and still have an account balance in a<br />
plan th<strong>at</strong> offers loans or in-service payouts, you must<br />
similarly obtain all those payouts prior to requesting a<br />
hardship payout.<br />
Also, Federal tax laws will not allow you to contribute to<br />
this Plan and certain other retirement or stock purchase<br />
plans (including the <strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan) for<br />
six months after the d<strong>at</strong>e of your financial hardship payout.<br />
If you are a management associ<strong>at</strong>e with stock<br />
options, you may not exercise options during this sixmonth<br />
period. Also, please note th<strong>at</strong> if you request a<br />
financial hardship payout within five business days of<br />
the record d<strong>at</strong>e of a dividend and you are entitled to<br />
elect a cash payout of th<strong>at</strong> dividend, the dividend will<br />
autom<strong>at</strong>ically be distributed to you in cash.<br />
A financial hardship payout is immedi<strong>at</strong>ely taxable to<br />
you, including a 10 percent penalty tax if you are under<br />
age 59 1/2 or if the payout is not for certain medical<br />
purposes. For more inform<strong>at</strong>ion, see The Income Tax<br />
Consequences of a Payout l<strong>at</strong>er in this chapter.<br />
You can make a request for a financial hardship payout<br />
online <strong>at</strong> www.benefits.ml.com or by calling the<br />
Customer Service Center <strong>at</strong> (888) 968-4015.<br />
Withdrawals After<br />
You Reach Age 69 1/2<br />
Any time after you reach age 69 1/2, you may elect to<br />
withdraw all or any portion of your accounts (both your<br />
Profit Sharing Account and 401(k) Account), even<br />
though you are still working for <strong>Wal</strong>-<strong>Mart</strong> or its subsidiaries.<br />
Only one withdrawal may be made in any plan<br />
year. You can make a request for a payout online <strong>at</strong><br />
www.benefits.ml.com or by calling the Customer<br />
Service Center <strong>at</strong> (888) 968-4015.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
217
Special Diversific<strong>at</strong>ion Payout<br />
You may be entitled to obtain a partial payout<br />
of your Profit Sharing Account if by October 31, 2003:<br />
• You were <strong>at</strong> least age 55; and<br />
• You had <strong>at</strong> least 10 years of service with <strong>Wal</strong>-<strong>Mart</strong>.<br />
This payout option is available for six years after you initially<br />
become eligible for this option.The total amount<br />
available under this option is generally 25 percent of<br />
<strong>Wal</strong>-<strong>Mart</strong>’s contributions to the Profit Sharing Plan used<br />
to buy <strong>Wal</strong>-<strong>Mart</strong> stock from December 1986 through<br />
October 31, 2003, except th<strong>at</strong> in the sixth year it can be<br />
50 percent of such amount. (You should note th<strong>at</strong> it is<br />
not 25 percent of your entire account and th<strong>at</strong> the payout<br />
amount has historically ranged from $50 to $1,500.)<br />
If you choose this option, you must contact Merrill Lynch<br />
by April 30th of the year in which you want the payout.<br />
Payout is then made <strong>at</strong> the end of June.<br />
If You Die:<br />
Your Design<strong>at</strong>ed Beneficiary<br />
In the event of your de<strong>at</strong>h, your entire plan balance will<br />
be paid out to your beneficiary. It is very important for<br />
you to keep your beneficiary inform<strong>at</strong>ion up to d<strong>at</strong>e.<br />
Beneficiary choices should be made <strong>at</strong> “Beneficiary<br />
Online” bene<strong>at</strong>h the “My Health” section of the “Life” tab<br />
on the WIRE. If you’re married and wish to name someone<br />
other than your spouse as your design<strong>at</strong>ed beneficiary,<br />
your spouse must consent to th<strong>at</strong> design<strong>at</strong>ion.Your<br />
spouse must sign Altern<strong>at</strong>e Beneficiary Form B and the<br />
form must be notarized.To obtain Form B, talk to the personnel<br />
represent<strong>at</strong>ive <strong>at</strong> your facility. Any beneficiary<br />
design<strong>at</strong>ion you make will be effective with respect to all<br />
of your accounts in the Plan—your 401(k) accounts and<br />
your Profit Sharing Account.<br />
If you do not design<strong>at</strong>e a beneficiary, your de<strong>at</strong>h benefit<br />
will be distributed to your spouse or, if you are not married<br />
<strong>at</strong> the time of your de<strong>at</strong>h, to your living children in<br />
equal shares. If you are not married <strong>at</strong> the time of your<br />
de<strong>at</strong>h and have no living children, your benefit will be<br />
paid to your parents, then to your siblings. If none of<br />
those persons is alive <strong>at</strong> your de<strong>at</strong>h, your benefit will be<br />
paid to your est<strong>at</strong>e.<br />
Please note th<strong>at</strong> if you design<strong>at</strong>e your spouse as your<br />
beneficiary and you l<strong>at</strong>er divorce, your design<strong>at</strong>ion will<br />
not be effective after the divorce unless you reaffirm the<br />
design<strong>at</strong>ion in writing after the divorce. Similarly, if you<br />
are unmarried and l<strong>at</strong>er marry, your prior beneficiary<br />
design<strong>at</strong>ion will not be effective after the marriage<br />
unless you reaffirm the design<strong>at</strong>ion in writing after the<br />
marriage with your spouse’s consent.<br />
Since your spouse has certain rights in the de<strong>at</strong>h benefit,<br />
you should immedi<strong>at</strong>ely upd<strong>at</strong>e your beneficiary election<br />
if there is a change in your marital st<strong>at</strong>us.<br />
Beneficiary Design<strong>at</strong>ions<br />
Made Before October 31, 2003<br />
If you made a beneficiary design<strong>at</strong>ion under the 401(k)<br />
Plan before October 31, 2003, th<strong>at</strong> design<strong>at</strong>ion will continue<br />
to apply to Your 401(k) Account, your Company-<br />
Funded 401(k) Account and your 401(k) Rollover<br />
Account. Similarly, if you made a beneficiary design<strong>at</strong>ion<br />
under the Profit Sharing Plan before October 31, 2003,<br />
th<strong>at</strong> design<strong>at</strong>ion will continue to apply to your Profit<br />
Sharing Account.<br />
Any beneficiary design<strong>at</strong>ion you make after October<br />
31, 2003, however, will be effective with respect to all<br />
of your accounts in the Plan—both those in the 401(k)<br />
part of the Plan and those in the profit sharing part of<br />
the Plan.<br />
If You Get Divorced<br />
If you go through a divorce, all or part of your plan balance<br />
may be awarded to an “altern<strong>at</strong>e payee” in the<br />
court order. An altern<strong>at</strong>e payee may be your spouse or<br />
former spouse, child, or other dependent. Because there<br />
are very strict requirements for these cases, you should<br />
contact the Retirement and Savings Plans Department<br />
and get a free copy of the procedures your <strong>at</strong>torney<br />
should use in drafting the court order. After the court<br />
order is sent to the Retirement and Savings Plans<br />
Department, it must be reviewed to determine if it<br />
meets legal requirements for this type of order and will<br />
take a period of time to be processed.<br />
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<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
If You Leave the Company<br />
When you stop working for <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries,<br />
you are entitled to receive a payout of your<br />
vested accounts (both your Profit Sharing and 401(k)<br />
accounts) in the Plan. It is important to understand<br />
how any type of payout from the Profit Sharing and<br />
401(k) Plan affects your tax situ<strong>at</strong>ion. For more inform<strong>at</strong>ion,<br />
see The Income Tax Consequences of a Payout<br />
l<strong>at</strong>er in this chapter.<br />
You may elect to receive your payout 30 calendar days<br />
after your termin<strong>at</strong>ion is actually entered into <strong>Wal</strong>-<strong>Mart</strong>’s<br />
payroll system. For example, if your termin<strong>at</strong>ion is<br />
entered into and processed by the payroll system on<br />
July 20, <strong>2008</strong>, you may elect your payout on or after<br />
August 19, <strong>2008</strong>.<br />
A notice will normally be mailed to your home address<br />
after you leave <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries to inform<br />
you th<strong>at</strong> you are entitled to payment. If you have not<br />
received any inform<strong>at</strong>ion regarding your payout within<br />
60 days of your termin<strong>at</strong>ion d<strong>at</strong>e, you should contact the<br />
Customer Service Center <strong>at</strong> (888) 968-4015. Please<br />
make sure th<strong>at</strong> your address is correct on your payroll<br />
check when you leave <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary<br />
or th<strong>at</strong> you give a forwarding address during your<br />
exit interview.To obtain your payout, you will need to<br />
access your account on www.benefits.ml.com or by<br />
calling the Customer Service Center <strong>at</strong> (888) 968-4015.<br />
Your consent to the payout is not required and your payout<br />
will autom<strong>at</strong>ically be made to you:<br />
• If your total—profit sharing and 401(k) accounts—<br />
vested plan balance is or becomes $1,000 or less; or<br />
• If you are over age 65 regardless of the amount of<br />
your total vested plan balance.<br />
This payout will be made as soon as possible after the<br />
last business day of the third calendar month following<br />
the calendar month in which your termin<strong>at</strong>ion d<strong>at</strong>e is<br />
actually entered into <strong>Wal</strong>-<strong>Mart</strong>’s payroll system, unless<br />
you consent to an earlier payout as described above. In<br />
the example above, if you do not consent to payout on<br />
August 19, <strong>2008</strong>, your payout would autom<strong>at</strong>ically be<br />
made to you as soon as possible after October 31, <strong>2008</strong>.<br />
If your total vested plan balance is more than $1,000 and<br />
you are under age 65, you must consent to your payout.<br />
Payout will be made as soon as possible after your consent<br />
is received by the Customer Service Center but no<br />
earlier than 30 calendar days after your termin<strong>at</strong>ion is<br />
actually entered into <strong>Wal</strong>-<strong>Mart</strong>’s payroll system.<br />
If you wish, you can delay your payout until any d<strong>at</strong>e up<br />
to age 65, but your plan balance will be subject to an<br />
annual maintenance fee of $15 per year. If you choose to<br />
delay your payout, you will be able to continue to make<br />
changes in your investment choices just as you did while<br />
you were an active participant in the Plan.<br />
If you return to work with <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing<br />
subsidiary before your payout is completed, the payout<br />
will be canceled and no payout will be made from<br />
your account.<br />
The Amount of Your Payout<br />
The entire value of Your 401(k) Account, your Company-<br />
Funded 401(k) Account, and your 401(k) Rollover<br />
Account will be paid out to you. In addition, you will also<br />
be paid the value of the vested portion of your Profit<br />
Sharing Account.You will forfeit (give up) the remainder<br />
of your Profit Sharing Account, as explained in the<br />
Becoming Vested in Your Profit Sharing Account earlier<br />
in this chapter.<br />
The amount you will receive will be based on the value<br />
of your accounts as of the d<strong>at</strong>e the payout is made. If a<br />
cash payout is made directly to you r<strong>at</strong>her than being<br />
rolled over to an IRA or other employer plan, applicable<br />
taxes will be withheld from your check.<br />
A check processing fee of $15 will be applied to your<br />
plan balance when it is paid out to you.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
219
How You Receive Your Payout<br />
You have several options for receiving your payout.<br />
Your accounts will be distributed in a single lump sum<br />
payment directly to you, unless you elect to roll them<br />
over to an IRA or to another employer’s retirement plan.<br />
Your accounts will normally be paid to you in cash.<br />
However, you may elect to have your Profit Sharing<br />
Account distributed to you in the form of <strong>Wal</strong>-<strong>Mart</strong> stock<br />
(even if it is not invested in <strong>Wal</strong>-<strong>Mart</strong> stock <strong>at</strong> the time<br />
your payout is processed) or partly in cash and partly in<br />
<strong>Wal</strong>-<strong>Mart</strong> stock.You may also elect to have Your 401(k)<br />
Account, your Company-Funded 401(k) Account and your<br />
401(k) Rollover Account paid to you in <strong>Wal</strong>-<strong>Mart</strong> stock to<br />
the extent those accounts are invested in <strong>Wal</strong>-<strong>Mart</strong> stock<br />
<strong>at</strong> the time your distribution is processed. Any part of<br />
those accounts th<strong>at</strong> is not invested in <strong>Wal</strong>-<strong>Mart</strong> stock <strong>at</strong><br />
the time of your payout will be distributed in cash.<br />
If the total of your vested accounts is $1,000 or less, or if<br />
you are over age 65 regardless of the amount of your<br />
vested accounts, your payout will be made directly to<br />
you in a single cash payout. If you wish to take any of<br />
your payout in the form of <strong>Wal</strong>-<strong>Mart</strong> stock or if you wish<br />
to roll over your payout to an IRA or other employer<br />
plan, you must contact the Customer Service Center with<br />
your payout instructions within the time period shown<br />
in your payout notice. If you fail to contact the Customer<br />
Service Center in a timely manner, your payout will be<br />
made in a single cash payment to you.<br />
If the total of your vested accounts in the Plan is more<br />
than $1,000, your payout will not be made until you<br />
make an election as to the form of payout and consent<br />
to the distribution or until you reach age 65. To<br />
obtain your payout, you should contact The Customer<br />
Service Center.<br />
If You Leave and Are<br />
Then Rehired by <strong>Wal</strong>-<strong>Mart</strong><br />
Except for the special situ<strong>at</strong>ion described below, if you<br />
leave <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries after your<br />
particip<strong>at</strong>ion in the Plan began and are l<strong>at</strong>er rehired<br />
by <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary, you will<br />
autom<strong>at</strong>ically be eligible to particip<strong>at</strong>e on your rehire<br />
d<strong>at</strong>e. Similarly, if you leave <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries<br />
after you have met the 1,000-hour requirement<br />
but before your actual particip<strong>at</strong>ion d<strong>at</strong>e, you<br />
will become a participant on the l<strong>at</strong>er of the d<strong>at</strong>e you<br />
would have initially become a participant or your<br />
rehire d<strong>at</strong>e. If you were not a participant when you<br />
left, or had not s<strong>at</strong>isfied the 1,000-hour requirement,<br />
you will be tre<strong>at</strong>ed as a new associ<strong>at</strong>e on rehire and<br />
will be required to complete the eligibility requirements<br />
(see When Particip<strong>at</strong>ion Begins earlier in this<br />
chapter) in order to become a participant in the Plan.<br />
Special rules apply if you left <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries<br />
before February 1, 1997. In th<strong>at</strong> event, if you<br />
were 0 percent vested in the Profit Sharing Plan <strong>at</strong> the<br />
time you left, you will generally be tre<strong>at</strong>ed as a new<br />
associ<strong>at</strong>e and will be required to complete the eligibility<br />
requirements above if you were not reemployed by<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. within five or more consecutive<br />
plan years.<br />
The Nonvested Portion of<br />
Your Profit Sharing Account<br />
When you termin<strong>at</strong>e employment, the portion of<br />
your Profit Sharing Account th<strong>at</strong> is not vested (if any)<br />
will not be paid to you. This nonvested amount is<br />
called a “forfeiture.”<br />
• If you receive a total payout of your vested Plan balance<br />
after your termin<strong>at</strong>ion of employment and<br />
while your Profit Sharing Account is partially vested,<br />
the non-vested portion of your Profit Sharing<br />
Account will be forfeited on the d<strong>at</strong>e of your payout.<br />
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• If you do not receive a total payout of your vested<br />
Plan balance after your termin<strong>at</strong>ion of employment,<br />
the nonvested portion of your Profit Sharing<br />
Account will not be forfeited until you have five consecutive<br />
“breaks in service.” A break in service is a<br />
plan year (February 1 - January 31) in which you are<br />
credited with less than 500 hours of service. If you<br />
are absent from work due to the birth or adoption<br />
of a child and have worked less than 500 hours in<br />
the plan year, you will be credited with enough<br />
hours to get you up to 500 hours so th<strong>at</strong> you will<br />
not incur a break in service.<br />
The nonvested portion of your Profit Sharing Account<br />
will be reinst<strong>at</strong>ed (<strong>at</strong> its former value) if you are rehired<br />
by <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary before you<br />
have five consecutive breaks in service and you pay back<br />
to the Plan the total amount of your payout within five<br />
years after your rehire. If you return to work with <strong>Wal</strong>-<br />
<strong>Mart</strong> or a particip<strong>at</strong>ing subsidiary after five or more consecutive<br />
breaks in service, or if you chose not to repay<br />
your payout as discussed above, the nonvested portion<br />
of your Profit Sharing Account will not be reinst<strong>at</strong>ed. If<br />
you left <strong>Wal</strong>-<strong>Mart</strong> and its subsidiaries before February 1,<br />
2000, special rules apply.<br />
Forfeitures of your nonvested Profit Sharing Account are<br />
used to pay plan expenses and for certain other purposes,<br />
such as to restore account balances as discussed<br />
below. Any remaining forfeitures are added to <strong>Wal</strong>-<strong>Mart</strong>’s<br />
contribution for th<strong>at</strong> plan year and alloc<strong>at</strong>ed to the profit<br />
sharing accounts of eligible participants.<br />
If you were zero percent vested in your Profit Sharing<br />
Account when you termin<strong>at</strong>ed employment, your nonvested<br />
Profit Sharing Account will autom<strong>at</strong>ically be reinst<strong>at</strong>ed<br />
if you are rehired prior to five consecutive breaks<br />
in service.<br />
Your Prior Years of<br />
Service for Vesting Purposes<br />
Your years of service with <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing<br />
subsidiary before you left will be counted for purposes<br />
of determining your vesting in <strong>Wal</strong>-<strong>Mart</strong>’s contributions<br />
to your Profit Sharing Account after you are rehired.The<br />
only time this is not true is if you left <strong>Wal</strong>-<strong>Mart</strong> and its<br />
subsidiaries before February 1, 1997 and you were 0 percent<br />
vested in the Profit Sharing Plan <strong>at</strong> the time you left.<br />
In th<strong>at</strong> event, your years of service with <strong>Wal</strong>-<strong>Mart</strong> or a<br />
particip<strong>at</strong>ing subsidiary will not be counted unless you<br />
were rehired before five consecutive breaks in service.<br />
The Income Tax<br />
Consequences of a Payout<br />
The tax consequences of your particip<strong>at</strong>ion in the Plan<br />
are your responsibility.This explan<strong>at</strong>ion is only a brief<br />
description of the U.S. federal tax consequences rel<strong>at</strong>ed<br />
to your particip<strong>at</strong>ion in the Plan.This description is based<br />
on current law and current interpret<strong>at</strong>ions of the law by<br />
the Internal Revenue Service. Because the law is subject<br />
to change and because the applic<strong>at</strong>ion of the law may<br />
vary depending on your particular circumstances, this<br />
description is general in n<strong>at</strong>ure and you should not rely<br />
on it in determining your tax consequences.You are<br />
strongly urged to consult a tax advisor with respect to<br />
your particular situ<strong>at</strong>ion.<br />
<strong>Wal</strong>-<strong>Mart</strong> is entitled to a deduction on the amount of<br />
its contributions, as well as your contributions, to the<br />
Plan. Your contributions and <strong>Wal</strong>-<strong>Mart</strong>’s contributions<br />
to the Plan, as well as earnings on those contributions,<br />
generally are not subject to federal income taxes until<br />
paid to you.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
221
Postpone Paying Taxes<br />
on Payouts Through a Rollover<br />
Although payouts from the Plan are subject to federal<br />
income taxes, the Internal Revenue Code provides favorable<br />
tax tre<strong>at</strong>ment to payouts in certain circumstances.<br />
For example, you can postpone paying taxes on your<br />
payout if you direct the Plan to issue your check directly<br />
to an IRA or to another employer’s qualified retirement<br />
plan, a 403(b) plan, or a governmental 457 plan.This is<br />
called a direct rollover. (The check will be made payable<br />
to the IRA or other plan trustee and it will be delivered to<br />
you or your IRA or rollover institution.You will be responsible<br />
for delivering it to the IRA or other plan trustee<br />
within 60 days.) If you handle your payout in this manner,<br />
no taxes will be withheld from the amount you are<br />
rolling over and such amount will not be taxed until you<br />
l<strong>at</strong>er receive a payout from the IRA or other plan.<br />
If you do not direct your payout to be directly rolled<br />
over, federal law requires th<strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong> withhold 20<br />
percent of the payout for federal taxes, and some st<strong>at</strong>es<br />
also require withholding. In some cases, 20 percent<br />
withholding may not be enough, which could mean<br />
th<strong>at</strong> you will owe additional taxes when you file your<br />
income tax return.<br />
If you do not elect a direct rollover (and instead receive<br />
an actual plan distribution), you may still roll over those<br />
funds to an IRA or an employer’s qualified retirement<br />
plan, 403(b) plan, or governmental 457 plan, as long as<br />
you do so within 60 calendar days after you received the<br />
distribution.The amount rolled over will not be subject<br />
to federal income tax until you take it out of the IRA or<br />
other plan. If you want to roll over 100 percent of your<br />
payout to an IRA or other plan, however, you will have to<br />
use other money to replace the 20 percent th<strong>at</strong> was<br />
withheld from your payout. If you roll over only the 80<br />
percent th<strong>at</strong> you received, you will be taxed on the 20<br />
percent th<strong>at</strong> was withheld and th<strong>at</strong> is not rolled over.<br />
Early Withdrawal Penalty<br />
In addition to the income tax withholding, if you take the<br />
payout r<strong>at</strong>her than rolling it over, in most cases you will<br />
be subject to a 10 percent early withdrawal penalty by<br />
the IRS.There are some exceptions to the penalty, such<br />
as de<strong>at</strong>h, disability, retirement after age 55 and payouts<br />
for certain medical expenses. Special rules also apply to<br />
distributions made to reservists who are called to active<br />
duty in the military.You may be eligible to apply special<br />
income averaging rules th<strong>at</strong> could reduce the amount of<br />
tax you owe on your payouts.<br />
Tax<strong>at</strong>ion of Payouts of <strong>Wal</strong>-<strong>Mart</strong> Stock<br />
There are also special rules for distributions of <strong>Wal</strong>-<br />
<strong>Mart</strong> common stock. Generally, if your entire payout<br />
consists of <strong>Wal</strong>-<strong>Mart</strong> stock, no withholding is required,<br />
even if you do not elect a direct rollover. If you receive<br />
cash (in excess of $200) in addition to <strong>Wal</strong>-<strong>Mart</strong> stock<br />
and the cash is not directly rolled over, some withholding<br />
may apply but not gre<strong>at</strong>er than the amount of<br />
cash you receive.<br />
Generally, if you receive <strong>Wal</strong>-<strong>Mart</strong> common stock as part<br />
of your payout th<strong>at</strong> is not rolled over, you are taxed only<br />
on the value of the stock <strong>at</strong> the time it was purchased by<br />
the Plan. If the stock has increased in value since it was<br />
purchased by the Plan, you will not be taxed on this<br />
increased value, called “net unrealized appreci<strong>at</strong>ion,”<br />
until you actually sell the stock.You can elect, however,<br />
to be taxed on this increase in value <strong>at</strong> the time of your<br />
payout.These special tax rules apply only in certain specific<br />
situ<strong>at</strong>ions.You should consult your tax advisor to<br />
see if they apply to your payout.<br />
You should also keep in mind th<strong>at</strong> if you are eligible to<br />
elect cash payouts of dividends paid on <strong>Wal</strong>-<strong>Mart</strong> stock<br />
held in your Profit Sharing Account, the dividend is taxable<br />
to you and is not eligible for rollover. The dividend<br />
is also taxable if you request a financial hardship payout<br />
from Your 401(k) Account within five business days<br />
of the record d<strong>at</strong>e for a dividend and the dividend is<br />
autom<strong>at</strong>ically paid out to you in cash. The dividend<br />
payout is not subject to the 10 percent early withdrawal<br />
penalty discussed above. In some cases, <strong>Wal</strong>-<strong>Mart</strong> will<br />
be entitled to deduct dividends paid on shares subject<br />
to this election.<br />
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The tax tre<strong>at</strong>ment discussed above applies only to payouts<br />
to participants. Different rules may apply to payouts<br />
to beneficiaries of deceased participants and also to payouts<br />
to altern<strong>at</strong>e payees (such as former spouses and<br />
dependents of participants) under qualified domestic<br />
rel<strong>at</strong>ions orders.<br />
Filing a Profit Sharing<br />
and 401(k) Plan Claim<br />
If you think you are entitled to a benefit beyond th<strong>at</strong><br />
processed by the Plan’s recordkeeper (Merrill Lynch), you<br />
may file a claim with the Retirement and Savings Plans<br />
Department <strong>at</strong>:<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
Attn: Retirement and Savings Plans Department<br />
805 Moberly Lane<br />
Bentonville, AR 72716-0295<br />
(800) 421-1362<br />
If your claim is partially or fully denied, you will receive<br />
written notice of the decision within a reasonable time,<br />
but no l<strong>at</strong>er than 90 days after the Retirement and<br />
Savings Plans Department receives your claim.The<br />
Retirement and Savings Plans Department can extend<br />
this period for up to an additional 90 days if it determines<br />
th<strong>at</strong> special circumstances require an extension of<br />
time.You will receive notice of any extension before the<br />
expir<strong>at</strong>ion of the original 90-day period.The written<br />
notice you receive will st<strong>at</strong>e the specific reasons for the<br />
denial of your claim, a specific reference to the provisions<br />
of the Plan upon which the denial is based, and a<br />
description of the review procedures and the time limits<br />
applicable to such procedures, including your right to<br />
bring a court action following a denial on appeal.<br />
If you do not agree with the decision of the Retirement<br />
and Savings Plans Department, you can request a review<br />
of the decision by the Retirement Plans Committee.The<br />
Retirement Plans Committee has discretionary authority<br />
to resolve all questions concerning administr<strong>at</strong>ion, interpret<strong>at</strong>ion,<br />
or applic<strong>at</strong>ion of the Plan.Your request must<br />
be made in writing and sent to the Retirement and<br />
Savings Plans Department <strong>at</strong>:<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
Attn: Retirement and Savings Plans Department<br />
805 Moberly Lane<br />
Bentonville, AR 72716-0295<br />
(800) 421-1362<br />
Your request must be made within 60 calendar days of<br />
the denial.Your written request must contain all additional<br />
inform<strong>at</strong>ion th<strong>at</strong> you wish the Retirement Plans<br />
Committee to consider. If you do not request a review<br />
within this time period, you will be deemed to have<br />
waived your right to a review.<br />
The Retirement Plans Committee will promptly conduct<br />
the review. Written notice of the Retirement Plans<br />
Committee’s decision on review will be provided to you<br />
within 60 calendar days after the receipt of your<br />
request, unless special circumstances require an extension<br />
of up to 60 additional days. In those circumstances<br />
where the review is delayed to allow you to provide<br />
additional inform<strong>at</strong>ion necessary for a proper review,<br />
the length of the delay will not be included in the calcul<strong>at</strong>ion<br />
of the 60-day deadline and extension periods<br />
set forth above. The written notice of the Committee’s<br />
decision will include specific reasons for the decision<br />
and will refer to the specific provisions of the Plan on<br />
which the decision is based.<br />
Administr<strong>at</strong>ive Inform<strong>at</strong>ion<br />
Plan Name<br />
<strong>Wal</strong>-<strong>Mart</strong> Profit Sharing and 401(k) Plan<br />
Plan Sponsor and Plan Administr<strong>at</strong>or<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
Attn: Retirement and Savings Plans Department<br />
805 Moberly Lane<br />
Bentonville, AR 72716-0295<br />
(800) 421-1362<br />
As the Plan Administr<strong>at</strong>or, <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. is responsible<br />
for reporting and disclosure oblig<strong>at</strong>ions under the<br />
Employee Retirement Income Security Act of 1974<br />
(“ERISA”) and all other oblig<strong>at</strong>ions required to be performed<br />
by plan administr<strong>at</strong>ors under the Internal<br />
Revenue Code and ERISA, except for those oblig<strong>at</strong>ions<br />
deleg<strong>at</strong>ed to the Retirement Plans Committee or the<br />
trustee of the Trust. ERISA is the federal law th<strong>at</strong> imposes<br />
certain responsibilities on <strong>Wal</strong>-<strong>Mart</strong>, the Retirement Plans<br />
Committee and the trustee with respect to your retirement<br />
benefits.<br />
Subsidiaries of <strong>Wal</strong>-<strong>Mart</strong> are permitted to particip<strong>at</strong>e in<br />
the Plan.You may obtain a list of subsidiaries currently<br />
particip<strong>at</strong>ing in the Plan by contacting the Retirement<br />
and Savings Plans Department.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
223
Plan Sponsor’s Employer<br />
Identific<strong>at</strong>ion Number<br />
71-0415188<br />
Named Fiduciary<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
Retirement Plans Committee<br />
805 Moberly Lane<br />
Bentonville, AR 72716-0295<br />
As the Named Fiduciary of the Plan, the Retirement Plans<br />
Committee is generally responsible for the management,<br />
interpret<strong>at</strong>ion, and administr<strong>at</strong>ion of the Plan,<br />
including but not limited to, eligibility determin<strong>at</strong>ions,<br />
investment policies, benefit payments and other functions<br />
required, necessary, or advisable to carry out the<br />
purpose of the Plan.<br />
Plan Trustee<br />
Merrill Lynch Trust Company, FSB<br />
1600 Merrill Lynch Drive<br />
MSC-0603<br />
Pennington, NJ 08534<br />
One or more trusts hold all Plan assets, such as contributions<br />
by participants and <strong>Wal</strong>-<strong>Mart</strong>’s contributions. As<br />
trustee of the Trust, Merrill Lynch receives and holds contributions<br />
made to the Plan in trust and invests those<br />
contributions according to the policies established<br />
under the Plan.<br />
Agent for Service of Legal Process<br />
Corpor<strong>at</strong>ion Trust Company<br />
1209 Orange Street<br />
Corpor<strong>at</strong>ion Trust Center<br />
Wilmington, DE 19801<br />
Service of legal process may also be made on the Plan<br />
Administr<strong>at</strong>or or the trustee.<br />
Plan Number,<br />
Plan Year, and Type of Plan<br />
The plan number is: 003.The plan year is: February 1<br />
through January 31.The Profit Sharing and 401(k) Plan is<br />
a defined contribution plan (401(k), Profit Sharing and<br />
Employee Stock Ownership Plan).<br />
Assignment<br />
Because this is a retirement plan governed by ERISA and<br />
other federal laws, your accounts cannot be assigned or<br />
used as coll<strong>at</strong>eral for a loan, nor can your accounts be<br />
garnished or be subject to bankruptcy proceedings.They<br />
can, however, be part of a divorce settlement, as<br />
explained l<strong>at</strong>er in this summary.<br />
No PBGC Coverage<br />
ERISA cre<strong>at</strong>ed a governmental agency called the Pension<br />
Benefit Guaranty Corpor<strong>at</strong>ion (PBGC). One of the purposes<br />
of the PBGC is to provide plan benefit insurance.<br />
However, this insurance is only available to defined benefit<br />
pension plans and our Plan is a defined contribution<br />
plan.Therefore, benefits under the Plan are not insured<br />
by the PBGC.<br />
Plan Amendment or Termin<strong>at</strong>ion<br />
<strong>Wal</strong>-<strong>Mart</strong> reserves the right to amend or termin<strong>at</strong>e the<br />
Plan <strong>at</strong> any time. Amendments are made by the<br />
Retirement Plans Committee with the prior written consent<br />
of the Executive Committee of <strong>Wal</strong>-<strong>Mart</strong>’s Board of<br />
Directors. Neither the Plan nor the benefits described in<br />
this summary may be orally amended. All oral st<strong>at</strong>ements<br />
and represent<strong>at</strong>ions shall be without force or<br />
effect even if such st<strong>at</strong>ements and represent<strong>at</strong>ions are<br />
made by a management associ<strong>at</strong>e of <strong>Wal</strong>-<strong>Mart</strong> or a particip<strong>at</strong>ing<br />
subsidiary, by any member of the Retirement<br />
Plans Committee, or by Merrill Lynch.<br />
You may obtain a copy of the formal Plan document by<br />
writing to:<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores, Inc.<br />
Retirement and Savings Plans Department<br />
805 Moberly Lane<br />
Bentonville, AR 72716-0295<br />
or by contacting the Customer Service Center<br />
<strong>at</strong> (888) 968-4015.<br />
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St<strong>at</strong>ement of ERISA Rights<br />
As a participant in this Plan, you are entitled to certain<br />
rights and protections under ERISA. ERISA provides th<strong>at</strong><br />
all plan participants shall be entitled to:<br />
• Examine, without charge, <strong>at</strong> the Plan Administr<strong>at</strong>or’s<br />
office and <strong>at</strong> other specified facilities, all documents<br />
governing the Plan, including insurance contracts<br />
and collective bargaining agreements, and a copy of<br />
the l<strong>at</strong>est annual report (Form 5500 series) filed by<br />
the Plan with the U.S. Department of Labor and available<br />
<strong>at</strong> the Public Disclosure Room of the Employee<br />
<strong>Benefits</strong> Security Administr<strong>at</strong>ion.<br />
• Obtain, upon written request to the Plan<br />
Administr<strong>at</strong>or, copies of documents governing the<br />
oper<strong>at</strong>ion of the Plan, including insurance contracts<br />
and collective bargaining agreements, and copies of<br />
the l<strong>at</strong>est annual report (Form 5500 series) and upd<strong>at</strong>ed<br />
Summary Plan Description.The Plan Administr<strong>at</strong>or<br />
may make a reasonable charge for the copies.<br />
• Receive a summary of the Plan’s annual financial<br />
report. The Plan Administr<strong>at</strong>or is required by law to<br />
furnish each participant with a copy of the summary<br />
financial report.<br />
• Obtain a st<strong>at</strong>ement telling you the current balance of<br />
your account and the portion of your account th<strong>at</strong> is<br />
nonforfeitable (vested). This st<strong>at</strong>ement must be<br />
requested in writing and is not required to be given<br />
more than once every 12 months. The Plan must provide<br />
the st<strong>at</strong>ement free of charge.<br />
In addition to cre<strong>at</strong>ing rights for Plan participants, ERISA<br />
imposes duties upon the people who are responsible for<br />
the oper<strong>at</strong>ion of the Plan.The people who oper<strong>at</strong>e the<br />
Plan, called “fiduciaries” of the Plan, have a duty to do so<br />
prudently and in your interest and in th<strong>at</strong> of other Plan<br />
participants and beneficiaries. No one, including your<br />
employer, or any other person, may fire or otherwise discrimin<strong>at</strong>e<br />
against you in any way to prevent you from<br />
obtaining a pension benefit or exercising your rights<br />
under ERISA.<br />
If your claim for a benefit is denied or ignored in whole<br />
or in part, you have a right to know why this was done,<br />
to obtain copies of documents rel<strong>at</strong>ing to the decision<br />
without charge, and to appeal any denial, all within certain<br />
time schedules.<br />
Under ERISA, there are steps you can take to enforce the<br />
above rights. For instance, if you request m<strong>at</strong>erials from<br />
the Plan and do not receive them within 30 days, you<br />
may file suit in a federal court. In such a case, the court<br />
may require the Plan Administr<strong>at</strong>or or the Retirement<br />
Plans Committee to provide the m<strong>at</strong>erials and pay you<br />
up to $110 a day until you receive the m<strong>at</strong>erials, unless<br />
the m<strong>at</strong>erials were not sent because of reasons beyond<br />
the control of the Plan Administr<strong>at</strong>or or the Retirement<br />
Plans Committee. If you have a claim for benefits th<strong>at</strong> is<br />
denied or ignored, in whole or in part, you may file suit in<br />
a st<strong>at</strong>e or federal court. In addition, if you disagree with<br />
the Plan’s decision or lack thereof concerning the qualified<br />
st<strong>at</strong>us of a domestic rel<strong>at</strong>ions order, you may file suit<br />
in federal court.<br />
If it should happen th<strong>at</strong> Plan fiduciaries misuse the Plan’s<br />
money, or if you are discrimin<strong>at</strong>ed against for asserting<br />
your rights, you may seek assistance from the U.S.<br />
Department of Labor, or you may file suit in a federal<br />
court.The court will decide who should pay court costs<br />
and legal fees. If you are successful, the court may order<br />
the person you have sued to pay these costs and fees. If<br />
you lose, the court may order you to pay these costs and<br />
fees, for example, if it finds your claim is frivolous.<br />
If you have any questions about the Plan, you should<br />
contact the Plan Administr<strong>at</strong>or or the Retirement Plans<br />
Committee. If you have any questions about this st<strong>at</strong>ement<br />
or about your rights under ERISA, you should<br />
contact the nearest Regional Office of the Employee<br />
<strong>Benefits</strong> Security Administr<strong>at</strong>ion, U.S. Department of<br />
Labor, listed in your telephone directory or the Division<br />
of Technical Assistance and Inquiries, Employee<br />
<strong>Benefits</strong> Security Administr<strong>at</strong>ion, U.S. Department of<br />
Labor, 200 Constitution Avenue N.W., Washington, D.C.<br />
20210. You may also obtain certain public<strong>at</strong>ions about<br />
your rights and responsibilities under ERISA by calling<br />
the public<strong>at</strong>ions hotline of the Employee <strong>Benefits</strong><br />
Security Administr<strong>at</strong>ion.<br />
The Profit Sharing and 401(k) Plan<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
225
Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
Where Can I Find<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> Discount Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228<br />
Sam’s Club Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231<br />
Discounts on Financial Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231<br />
Financial Educ<strong>at</strong>ion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
As a <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>e, you receive a 10 percent discount on regularly priced general merchandise<br />
items <strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong> with your <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> Discount Card. You also receive discounts<br />
on financial services <strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong>. It pays to spend some time on walmartbenefits.com<br />
to learn about even more discounts available to you—for example, on cars, wireless phone<br />
service, and travel. Your work <strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong> provides much more than just your regular pay.<br />
When you take advantage of all of the <strong>Wal</strong>-<strong>Mart</strong> discounts available to you, you’ll save<br />
money—and th<strong>at</strong> helps you live better.<br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
To order or cancel your<br />
<strong>Wal</strong>-<strong>Mart</strong> Discount Card<br />
To order your<br />
<strong>Wal</strong>-<strong>Mart</strong> Long-Term Service<br />
Discount Card<br />
General inform<strong>at</strong>ion on<br />
the discount card<br />
For answers to questions about<br />
your Sam's Club membership<br />
Use the online “Discount Card<br />
Applic<strong>at</strong>ion” by:<br />
Logging on to the WIRE, clicking on<br />
the Life tab and then clicking “Discount<br />
Card Applic<strong>at</strong>ion” bene<strong>at</strong>h “My Money”<br />
To obtain a Long Term Service<br />
applic<strong>at</strong>ion go to the WIRE, under<br />
“Life” tab click on “Discount Card” or<br />
walmartbenefits.com, click<br />
“My Money”, click on “Discount Card“<br />
and print a copy for submission<br />
PD-14 available on the WIRE<br />
Contact your personnel represent<strong>at</strong>ive<br />
Call the Retirement and Savings Plans<br />
Department <strong>at</strong> (800) 421-1362 or<br />
(479) 273-4664<br />
Contact your personnel represent<strong>at</strong>ive<br />
Call the Retirement and Savings Plans<br />
Department <strong>at</strong><br />
(800) 421-1362 or (479) 273-4664<br />
See the member services desk <strong>at</strong> your local<br />
Sam's Club or call (888) SHOPSAMS.<br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
For more inform<strong>at</strong>ion about<br />
the discount money services<br />
Visit the Financial Services website <strong>at</strong><br />
www.walmart.com/financial-services<br />
Wh<strong>at</strong> You Need to Know About Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
• All <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>es and their spouses are eligible for a <strong>Wal</strong>-<strong>Mart</strong> Discount Card.<br />
• You will autom<strong>at</strong>ically receive a discount card for yourself and your spouse <strong>at</strong> your home address<br />
within seven to 14 business days after the first pay period th<strong>at</strong> you are employed <strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong>.<br />
• The <strong>Wal</strong>-<strong>Mart</strong> Discount Card provides a 10 percent discount <strong>at</strong> <strong>Wal</strong>-<strong>Mart</strong> on regularly priced general<br />
merchandise and fresh produce.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
227
<strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> Discount Card<br />
As a <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>e, you will be able to enjoy a 10<br />
percent discount on regularly priced general merchandise<br />
items, and fresh produce, purchased <strong>at</strong> any <strong>Wal</strong>-<br />
<strong>Mart</strong> store in the United St<strong>at</strong>es and from certain <strong>Wal</strong>-<br />
<strong>Mart</strong> stores abroad. The <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> Discount<br />
Card can also be used on select merchandise on<br />
www.wal-mart.com.<br />
Sam’s Club field associ<strong>at</strong>es receive a free membership to<br />
Sam’s Club and are not eligible to receive a <strong>Wal</strong>-<strong>Mart</strong><br />
Discount Card. Sam’s Club associ<strong>at</strong>es are, however, eligible<br />
to receive a 10 percent discount on fresh produce <strong>at</strong><br />
Sam’s Club with their membership card.<br />
Discount Card Eligibility<br />
You are eligible for the Discount Card if you are:<br />
• A <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>e; or<br />
• An associ<strong>at</strong>e’s spouse.<br />
You don’t need to enroll for a Discount Card—it is autom<strong>at</strong>ically<br />
ordered for you and your spouse and delivered<br />
to your home address within seven to 14 business days<br />
after the first pay period th<strong>at</strong> you are employed <strong>at</strong> <strong>Wal</strong>-<br />
<strong>Mart</strong>. It’s important th<strong>at</strong> you upd<strong>at</strong>e your Personnel<br />
Manager with your correct address. If the address is<br />
not correct, there will be a delay in receiving your<br />
Discount Card.<br />
Your Eligible Dependent children (unmarried children<br />
under age 19 or unmarried dependent children from<br />
age 19 to 23 if they are full-time students <strong>at</strong> an accredited<br />
college) can use your Discount Card and use it for<br />
their purchases. Discount cards will not be issued to<br />
dependent children.<br />
If You Get Married or<br />
Divorced After Your Hire D<strong>at</strong>e<br />
If you get married after you are hired, you can order a<br />
card for your spouse by completing an online Discount<br />
Card applic<strong>at</strong>ion (see <strong>Wal</strong>-<strong>Mart</strong> Discount Card<br />
Resources <strong>at</strong> the beginning of this chapter) or requesting<br />
it through your personnel represent<strong>at</strong>ive.<br />
Your ex-spouse is no longer eligible for the discount and<br />
his or her card must be returned. If you are not able to<br />
obtain the card, please complete the online Discount<br />
Card applic<strong>at</strong>ion (see <strong>Wal</strong>-<strong>Mart</strong> Discount Card<br />
Resources <strong>at</strong> the beginning of this chapter) to cancel<br />
the card or notify your personnel represent<strong>at</strong>ive.<br />
Same-Gender Domestic Partners<br />
If you and your partner are Civil Union Partners or<br />
Registered Domestic Partners under the st<strong>at</strong>e law of<br />
the st<strong>at</strong>e in which you work, your partner may be eligible<br />
for a Discount Card. Additionally, in Massachusetts,<br />
a same-gender spouse is eligible for a Discount Card.<br />
Federal tax law requires th<strong>at</strong> a discount received by an<br />
associ<strong>at</strong>e’s same-gender spouse, domestic partner, or<br />
civil union partner must be tre<strong>at</strong>ed as taxable income to<br />
the associ<strong>at</strong>e. St<strong>at</strong>e and local laws may have similar<br />
requirements. <strong>Associ<strong>at</strong>e</strong>s should consult their tax advisors<br />
for more inform<strong>at</strong>ion.<br />
To see if your partner or same-gender spouse is<br />
eligible for a Discount Card, go to the WIRE and<br />
review Policy PD-14.<br />
228 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
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The Proper Use of the Discount Card<br />
The use of the Discount Card is governed by<br />
policy PD-14.<br />
You are responsible for the proper use of the Discount<br />
Card by you, your spouse, and any legal dependents<br />
defined above. Please remember:<br />
• You should not lend your card to anyone who is not<br />
authorized to receive the discount privilege.<br />
• You should not use another associ<strong>at</strong>e’s Discount Card.<br />
• You should not shop for others to get the discount<br />
for them.<br />
The payment of the purchase should be made by the<br />
person who is authorized to use the Discount Card.<br />
Wh<strong>at</strong> is Not Eligible for a Discount<br />
No discount is given for the following:<br />
• Sale, clearance, or marked-down items<br />
• Most Grocery items (other than fresh produce)<br />
• Eye exams in vision centers<br />
• Items purchased with a tax-exemption ID<br />
• Items purchased for Company use when <strong>Wal</strong>-<strong>Mart</strong> is<br />
reimbursing the expense<br />
• Gasoline purchase<br />
• Items m<strong>at</strong>ched to a competitor’s ad price<br />
Items you purchase with your Discount Card should not<br />
be bought for the purpose of resale, for use in a business,<br />
or if you are going to be reimbursed for the purchase.<br />
You should report lost or stolen cards immedi<strong>at</strong>ely to<br />
prevent unauthorized use by someone else.You can<br />
complete the online Discount Card applic<strong>at</strong>ion (see<br />
<strong>Wal</strong>-<strong>Mart</strong> Discount Card Resources <strong>at</strong> the beginning of<br />
this chapter) to cancel the lost or stolen card or see your<br />
personnel represent<strong>at</strong>ive.Your new card and your<br />
spouse’s new card will be mailed to your home address<br />
and should arrive within seven to 14 business days.<br />
The discount should be applied on items returned or<br />
exchanged for lesser value merchandise.<br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
Unauthorized use of the associ<strong>at</strong>e Discount Card benefit<br />
is lost dollars to the Company, which can affect your<br />
incentive programs. Abuse of this benefit can result in:<br />
• Loss of the benefit; and<br />
• Coaching or dismissal from the Company.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
229
If You Go On a Leave of Absence<br />
While you are on an approved Leave of Absence, you will<br />
be able to use your Discount Card privilege.Your<br />
Discount Card privilege will end if you are unable to<br />
return to work after one year, unless you are on an<br />
authorized Military Leave of Absence. If you are on an<br />
authorized military leave, your card(s) will remain active<br />
through the end of your leave. If you do not return to<br />
work <strong>at</strong> the end of your authorized military leave, your<br />
card(s) will autom<strong>at</strong>ically be cancelled. A letter will be<br />
mailed to your home address to notify you.<br />
If you have returned to work and your card has been<br />
cancelled due to being on a Leave of Absence for over<br />
one year, it will be your responsibility to contact the<br />
Retirement and Savings Plans Department to have your<br />
card reactiv<strong>at</strong>ed.<br />
When Discount Card <strong>Benefits</strong> End<br />
Your Discount Card benefit ends when your employment<br />
with <strong>Wal</strong>-<strong>Mart</strong> ends. At this time, you must return<br />
your Discount Card (and your spouse’s Discount Card) to<br />
your supervisor (unless you meet the requirements for<br />
the long-term-service discount privilege).<br />
The spouse of a deceased associ<strong>at</strong>e will remain eligible<br />
for the Discount Card for 12 months after the de<strong>at</strong>h of<br />
the associ<strong>at</strong>e.This benefit applies to Long Term Service<br />
Discount Cards.<br />
Long-Term Service Discount Card <strong>Benefits</strong><br />
After You Leave <strong>Wal</strong>-<strong>Mart</strong><br />
You may qualify for a continued Discount Card<br />
privilege after your employment with <strong>Wal</strong>-<strong>Mart</strong> ends,<br />
provided you:<br />
• Are not termin<strong>at</strong>ed for cause (i.e., gross misconduct);<br />
• Do not go to work for a major competitor; and<br />
• Have 15 years or more of continuous service and are<br />
<strong>at</strong> least age 55 or you have a minimum of 20 years of<br />
continuous service <strong>at</strong> any age.<br />
Ask your personnel represent<strong>at</strong>ive for a Long-Term<br />
Service (Retiree) Discount Card applic<strong>at</strong>ion 30 days<br />
before your retirement so th<strong>at</strong> your discount privilege<br />
will not be interrupted. Applic<strong>at</strong>ions are available on<br />
the WIRE, walmartbenefits.com or by calling<br />
the Retirement and Savings Plans Department <strong>at</strong><br />
(479) 273-4664.You may be required to re-enroll from<br />
time to time. If required, an enrollment form will be<br />
mailed to your last known address. It will be your responsibility<br />
to complete the form and return it to the<br />
Retirement and Savings Plans Department. If the enrollment<br />
form is not received, your card will be cancelled.<br />
If your card has been cancelled, contact the Retirement<br />
and Savings Plans Department to obtain an enrollment<br />
form.<br />
If you become divorced or married after you have<br />
received your Long-Term Service card, it is your responsibility<br />
to contact the Retirement and Savings Plans<br />
Department.The Retirement and Savings Plans<br />
Department will assist you in removing the spouse card<br />
or requesting a new spouse card for you.<br />
Any card not used in 18 months will be deactiv<strong>at</strong>ed. It<br />
will be your responsibility to contact the Retirement and<br />
Savings Plans Department to discuss the possibility of<br />
your card being reactiv<strong>at</strong>ed.<br />
230 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Sam’s Club Membership<br />
If you are a Sam’s Club field associ<strong>at</strong>e, you receive a free<br />
membership to Sam’s Club and are eligible to receive a<br />
10 percent discount on fresh fruits and vegetables <strong>at</strong><br />
Sam’s Club with your membership card.You can receive<br />
your Sam’s Club membership card after you receive your<br />
first paycheck from Sam’s Club.<br />
All <strong>Wal</strong>-<strong>Mart</strong> associ<strong>at</strong>es may purchase a membership to<br />
Sam’s Club through payroll deductions.The cost of an<br />
Advantage Membership is $40 (plus tax where applicable)<br />
per year. The cost of an Advantage Plus<br />
Membership is $100 (plus tax where applicable) per year.<br />
If you purchase an Advantage or Advantage Plus membership,<br />
you will receive a personal card and another<br />
card for a spouse or other household member.<br />
Membership cards must be picked up <strong>at</strong> the local Sam’s<br />
Club Membership Desk.<br />
Discounts on Financial Services<br />
The money services <strong>Wal</strong>-<strong>Mart</strong> offers to our customers <strong>at</strong><br />
Every Day Low Prices are also available to associ<strong>at</strong>es <strong>at</strong><br />
further reduced r<strong>at</strong>es. <strong>Benefits</strong> provided through<br />
Financial Services are:<br />
• Cash your <strong>Wal</strong>-<strong>Mart</strong> payroll check for free <strong>at</strong> any register,<br />
seven days a week.<br />
• Receive a 10 percent discount on fees for Money<br />
Orders and Express Bill Payments <strong>at</strong> the Customer<br />
Service Desk.<br />
• Receive a 10 percent discount on Money Transfer<br />
fees. Send money throughout the U.S. and to over<br />
170 countries <strong>at</strong> the Customer Service Desk.<br />
• Receive a 10 percent discount on<br />
Product Care Plan fees.<br />
• When an associ<strong>at</strong>e opens an account with<br />
ShareBuilder on walmartbenefits.com<br />
they receive $25 in their account.<br />
• Receive a 10 percent discount on the Visa Gift Card<br />
fee. (not available in all st<strong>at</strong>es).<br />
• <strong>Associ<strong>at</strong>e</strong>s will receive a 10 percent associ<strong>at</strong>e discount<br />
when purchasing the <strong>Wal</strong>-<strong>Mart</strong> MoneyCard. If<br />
the associ<strong>at</strong>e signs up to have their paycheck direct<br />
deposited onto their card they will get an $8.94<br />
credit to their card. Additionally, if the associ<strong>at</strong>e loads<br />
$750 or more in a month, the monthly fee for the<br />
following month will be waived.<br />
• Receive 10 percent off check printing<br />
services (personal & business checks) through<br />
walmartbenefits.com or by calling the<br />
Check Printing Customer Service Center toll-free<br />
<strong>at</strong> (866) 925-2432.<br />
• Receive 10 percent off credit reports through<br />
walmartbenefits.com.<br />
While the Retirement and Savings Plans Department is<br />
your source for inform<strong>at</strong>ion about the <strong>Wal</strong>-<strong>Mart</strong> Discount<br />
Card, this department does not manage the financial<br />
services discounts. For more inform<strong>at</strong>ion about the discounts<br />
on financial services, visit the Financial Services<br />
website <strong>at</strong> www.walmart.com/financial-services.<br />
Financial Educ<strong>at</strong>ion<br />
Learn more about budgeting, managing credit, credit<br />
reports, and buying a home when you take advantage of<br />
your Financial Educ<strong>at</strong>ion benefit. For more inform<strong>at</strong>ion,<br />
visit walmartbenefits.com.<br />
Your <strong>Associ<strong>at</strong>e</strong> Discounts<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
231
Your Pay Programs<br />
Where Can I Find<br />
Programs th<strong>at</strong> Can Supplement Your Regular Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234<br />
Incentive Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234<br />
Pay for Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234<br />
If You Work on Sunday—Premium Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234<br />
Shift Differential Pay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235<br />
Travel Pay—Hourly <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235<br />
Holiday Bonus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
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Your <strong>Wal</strong>-<strong>Mart</strong> Pay Programs<br />
You may be eligible for several programs th<strong>at</strong> can supplement your regular pay, including<br />
incentive programs, premium pay, and shift differential pay.<br />
Your Pay Program Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
Pay and Incentive<br />
Questions/Compens<strong>at</strong>ion<br />
Most policies and programs may be found<br />
<strong>at</strong> the WIRE<br />
Discuss individual questions with your<br />
facility’s HR manager or, if applicable, a<br />
market HR manager<br />
Wh<strong>at</strong> You Need to Know About Your Pay Programs<br />
• You may be eligible for several programs th<strong>at</strong> can supplement your regular pay, including incentive programs,<br />
premium pay and shift differential pay.<br />
Your Pay Programs<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
233
Programs th<strong>at</strong> Can<br />
Supplement Your Regular Pay<br />
In addition to the pay you receive for a regular day’s<br />
work, there are other programs and benefits th<strong>at</strong> can<br />
supplement your income.<br />
Incentive Programs<br />
Good teamwork helps bring success. To reward you for<br />
contributing to the overall success of the Company or<br />
your facility, you have the opportunity to particip<strong>at</strong>e in<br />
an incentive programs. These programs are different<br />
for each division.<br />
Pay for Performance<br />
<strong>Wal</strong>-<strong>Mart</strong> rewards associ<strong>at</strong>es who meet or exceed the<br />
expect<strong>at</strong>ions for their role. Most annual wage increases<br />
are based upon performance and are given during an<br />
annual evalu<strong>at</strong>ion.<br />
If You Work on Sunday—<br />
Premium Pay<br />
<strong>Wal</strong>-<strong>Mart</strong> Stores Division<br />
If you are an hourly associ<strong>at</strong>e and you were hired:<br />
• On or after September 1, 1991, you will receive<br />
premium pay of an additional $1.00 per hour if you<br />
work on a Sunday.<br />
• Prior to September 1, 1991, you will receive time<br />
and one-half for Sunday hours worked.<br />
In some st<strong>at</strong>es, st<strong>at</strong>e law may override this policy.<br />
Sam’s Club<br />
If you are an hourly associ<strong>at</strong>e and you were hired:<br />
• On or after September 1, 1992, you will receive<br />
premium pay of an additional $1.00 per hour if you<br />
work on a Sunday.<br />
• Prior to September 1, 1992, you will receive time<br />
and one-half for Sunday hours worked.<br />
In some st<strong>at</strong>es, st<strong>at</strong>e law may override this policy.<br />
234 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Field Logistics<br />
If you are an hourly associ<strong>at</strong>e and work on the<br />
defined “weekend schedule,” you will receive a weekend<br />
schedule premium.<br />
Shift Differential Pay<br />
If you are an hourly associ<strong>at</strong>e and you work an<br />
“overnight” shift, you may receive an additional hourly<br />
amount based on the facility where you work.<br />
Travel Pay—<br />
Hourly <strong>Associ<strong>at</strong>e</strong>s<br />
If you are requested to work in a facility other than your<br />
home facility, you will be paid for the additional time<br />
spent traveling to the distant facility.You will also be<br />
reimbursed for all eligible business-rel<strong>at</strong>ed expenses th<strong>at</strong><br />
you incur while you are away from your home facility.<br />
Holiday Bonus<br />
Hourly associ<strong>at</strong>es who meet all of the below<br />
requirements will receive a Holiday Bonus:<br />
• Hired prior to January 1, 2001<br />
• Have <strong>at</strong> least five (5) continuous years of service and<br />
have completed 500 hours of service before the last<br />
complete pay period ends in November of the<br />
current year<br />
• Are employed by <strong>Wal</strong>-<strong>Mart</strong> on the d<strong>at</strong>e the bonus<br />
is distributed.<br />
Eligible associ<strong>at</strong>es receive a holiday bonus each year.<br />
The bonus amount is based on your years of service and<br />
ranges between $20 and $200.<br />
Your Pay Programs<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
235
Your Paid Time-Off<br />
Where Can I Find<br />
Vac<strong>at</strong>ion Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238<br />
Personal Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238<br />
Holiday Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238<br />
Holiday Bonus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238<br />
Sick Time—Full-Time Hourly <strong>Associ<strong>at</strong>e</strong>s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239<br />
Jury Duty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239<br />
Military Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239<br />
Bereavement Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Your Paid Time-Off<br />
Whether you take a trip or relax <strong>at</strong> home, it’s important to take time off from work. Th<strong>at</strong>’s why<br />
<strong>Wal</strong>-<strong>Mart</strong> provides eligible associ<strong>at</strong>es with vac<strong>at</strong>ion pay and six paid holidays. In addition, paid<br />
time off is available to eligible associ<strong>at</strong>es for unplanned absences, such as those for illness, a<br />
de<strong>at</strong>h in the family, or jury duty.<br />
Your Paid Time-Off Resources<br />
Find Wh<strong>at</strong> You Need Online Other Resources<br />
For more inform<strong>at</strong>ion on vac<strong>at</strong>ion<br />
or personal time<br />
Refer to the Vac<strong>at</strong>ion Policy (PD-64)<br />
Refer to the Personal Time Policy (PD-65)<br />
For more inform<strong>at</strong>ion on holidays<br />
and holiday pay<br />
Refer to the Holidays and Holiday Pay Policy<br />
(PD-21)<br />
For more inform<strong>at</strong>ion on sick time<br />
For more inform<strong>at</strong>ion on jury duty<br />
For more inform<strong>at</strong>ion on leaves of<br />
absence, including military leaves<br />
For more inform<strong>at</strong>ion on<br />
bereavement time<br />
Refer to the Illness Protection Pay Policy<br />
(PD-63)<br />
Refer to the Jury Duty Policy (PD-23)<br />
Refer to the Leave of Absence Policy/Military<br />
Leave (PD-24)<br />
Refer to the Bereavement Time Off Policy<br />
(PD-06)<br />
Your Paid Time-Off<br />
Wh<strong>at</strong> You Need to Know About Your Paid-Time Off<br />
• Full-Time associ<strong>at</strong>es and management associ<strong>at</strong>es accumul<strong>at</strong>e vac<strong>at</strong>ion based on the length of service with<br />
the Company.<br />
• Full-Time hourly associ<strong>at</strong>es begin accumul<strong>at</strong>ing sick time after completing six months of employment.<br />
• All eligible associ<strong>at</strong>es receive holiday pay for six holidays each year.<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
237
Vac<strong>at</strong>ion Pay<br />
Full-Time associ<strong>at</strong>es and management associ<strong>at</strong>es accumul<strong>at</strong>e<br />
vac<strong>at</strong>ion based on the length of service with the<br />
Company as follows:<br />
• One average work week after one year of<br />
continuous service<br />
• Two average work weeks after two years of<br />
continuous service<br />
• Three average work weeks after seven years of<br />
continuous service<br />
• Four average work weeks after 15 years of<br />
continuous service<br />
Full-Time hourly associ<strong>at</strong>es can accrue a maximum of<br />
40 hours of vac<strong>at</strong>ion per week.<br />
Vac<strong>at</strong>ion time must be used within one year from the<br />
time it becomes available, where allowed by law.<br />
In order to be classified as Full-Time in the Company’s<br />
payroll system, you must regularly work or have worked<br />
<strong>at</strong> least:<br />
• 34 hours per week; or<br />
• 28 hours per week if continuously Full-Time prior to<br />
January 1, 2002; or<br />
• 20 hours per week if continuously Full-Time prior to<br />
September 1, 1979.<br />
In order to qualify for each classific<strong>at</strong>ion listed above, you<br />
must remain continuously employed as full time. If you<br />
go to Peak-Time st<strong>at</strong>us and then return to Full-Time st<strong>at</strong>us,<br />
you must work <strong>at</strong> least 34 hours per week in order to<br />
be classified as full time.<br />
Personal Time<br />
After one year of employment, eligible associ<strong>at</strong>es can<br />
take advantage of personal time off with pay.The<br />
amount of Personal Time available is equal to two average<br />
workdays per year based on the number of the previous<br />
year’s service hours, up to a maximum of 16 hours.<br />
For more inform<strong>at</strong>ion, see the Personal Time<br />
Policy (PD-65).<br />
Holiday Pay<br />
All eligible associ<strong>at</strong>es receive Holiday Pay for six holidays<br />
each year:<br />
• New Year’s Day<br />
• Memorial Day<br />
• Independence Day<br />
• Labor Day<br />
• Thanksgiving Day<br />
• Christmas Day<br />
For more inform<strong>at</strong>ion, see the Holidays and Holiday Pay<br />
Policy (PD-21).<br />
Holiday Bonus<br />
Eligible associ<strong>at</strong>es receive a holiday bonus each year.<br />
The bonus amount is based on your years of service and<br />
ranges between $20 and $200.<br />
Peak-Time associ<strong>at</strong>es receive one average week of vac<strong>at</strong>ion<br />
after two continuous years of service.<br />
For more inform<strong>at</strong>ion, see the Vac<strong>at</strong>ion Policy (PD-64).<br />
If you are a Logistics associ<strong>at</strong>e, please see your personnel<br />
represent<strong>at</strong>ive for inform<strong>at</strong>ion on vac<strong>at</strong>ion.<br />
238 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Sick Time—<br />
Full-Time Hourly <strong>Associ<strong>at</strong>e</strong>s<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Illness Protection Plan helps protect you and<br />
your family from the financial hardship you may experience<br />
due to lost time <strong>at</strong> work when you are sick or<br />
injured, or when caring for your sick or injured child, or<br />
on an FMLA Leave of Absence and certain Personal<br />
Leaves of Absence. As a Full-Time hourly associ<strong>at</strong>e, once<br />
you have completed six months of employment you can<br />
accumul<strong>at</strong>e an average of one-half work day per month,<br />
or a total of six average work days per year.<br />
For more inform<strong>at</strong>ion, see the Illness Protection Pay<br />
Policy (PD-63).<br />
Jury Duty<br />
When called to serve on jury duty, provide a copy of the<br />
notice to your immedi<strong>at</strong>e supervisor, and active associ<strong>at</strong>es<br />
will be granted time off to serve. During your jury<br />
duty service, you will be paid as if you had worked your<br />
scheduled hours.The compens<strong>at</strong>ion you receive from<br />
the court belongs to you.<br />
For more inform<strong>at</strong>ion, see the Jury Duty Policy (PD-23).<br />
Military Pay<br />
If you need to perform active, full-time U.S. military duty<br />
or fulfill N<strong>at</strong>ional Guard or Reserve oblig<strong>at</strong>ions, you will<br />
be granted Military Leave. If you take a Military Leave to<br />
fulfill your two-week annual training oblig<strong>at</strong>ion, you will<br />
be paid the difference between your regular <strong>Wal</strong>-<strong>Mart</strong><br />
pay and the military pay you receive.<br />
For more inform<strong>at</strong>ion, see the Leave of Absence<br />
Policy/Military Leave Policy (PD-24).<br />
Bereavement Pay<br />
<strong>Wal</strong>-<strong>Mart</strong>’s Bereavement Leave program provides limited<br />
time off due to the de<strong>at</strong>h of an immedi<strong>at</strong>e family member<br />
or someone with whom you reside. Eligible associ<strong>at</strong>es<br />
receive time off with pay for one to three days of<br />
work while on Bereavement Leave. If you need more<br />
than three days of time off due to special circumstances,<br />
you should apply for a Personal Leave of Absence.<br />
For more inform<strong>at</strong>ion, see the Bereavement Time Off<br />
Policy (PD-06).<br />
Your Paid Time-Off<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
239
Glossary of Terms
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Glossary of Terms<br />
Actively-At-Work or Active Work: For Medical, Dental,<br />
RFL Cancer Insurance and Accident Insurance Policy coverage,<br />
Actively-At-Work or Active Work means you have<br />
reported to work for <strong>Wal</strong>-<strong>Mart</strong>.<br />
For Company-Paid Life Insurance, Optional Life<br />
Insurance, Dependent Life Insurance, Accidental De<strong>at</strong>h<br />
and Dismemberment, Business Travel Accident, Short-<br />
Term Disability, Short-Term Disability Plus, Long-Term<br />
Disability, and Truck Driver Long-Term Disability, Actively-<br />
At-Work or Active Work means you are Actively-At-Work<br />
with the Company on a day th<strong>at</strong> is one of your scheduled<br />
work days if you are performing, in the usual way, all<br />
of the regular duties of your job on a Full-Time basis on<br />
th<strong>at</strong> day. You will be deemed to be Actively-At-Work on<br />
a day th<strong>at</strong> is not one of your scheduled work days only if<br />
you were Actively-At-Work on the preceding scheduled<br />
work day.<br />
Annual Deductible: The amount of Covered Expenses<br />
you pay each year before the Plan starts paying a portion<br />
of the Covered Expenses. For the Value Plan, covered<br />
expenses for the Annual Deductible is after you<br />
have exhausted your Health Care Credit amount.<br />
Annual Enrollment or Annual Enrollment Period:<br />
Annual enrollment period for all associ<strong>at</strong>es, usually in<br />
the fall of each year.<br />
<strong>Associ<strong>at</strong>e</strong>s’ Health and Welfare Plan (AHWP or Plan):<br />
The employer-sponsored health and welfare employee<br />
benefit plan sponsored by <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc., and governed<br />
under the Employee Retirement Income Security<br />
Act of 1974, as amended (ERISA).<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan (AMP): The self-insured<br />
medical benefits offered under the AHWP, as<br />
described in this section.<br />
Basic Network: The Network option under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan th<strong>at</strong> has fewer Network<br />
providers than the Choice Network, but th<strong>at</strong> also<br />
generally offers a gre<strong>at</strong>er provider discount than the<br />
Choice Network; and th<strong>at</strong> offers more Network<br />
providers than the Limited Network, but also generally<br />
offers less of a provider discount than the Limited<br />
Network. See The Medical Plan chapter for more details.<br />
Choice Network: The Network option under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan th<strong>at</strong> has most Network<br />
providers (or th<strong>at</strong> generally covers service by Network<br />
and non-Network providers <strong>at</strong> the same percentage),<br />
but th<strong>at</strong> also generally offers less of a provider discount.<br />
See the The Medical Plan chapter for more details.<br />
Coinsurance: The percentage of money you pay toward<br />
Covered Expenses after you have used any applicable<br />
Health Care Credit and after the Annual Deductible has<br />
been met, often expressed as a r<strong>at</strong>io. Example: 20 percent<br />
(associ<strong>at</strong>e)—80 percent (AHWP) if you use Network<br />
providers—depending upon the plan option.<br />
Company: <strong>Wal</strong>-<strong>Mart</strong> Stores, Inc. and its particip<strong>at</strong>ing<br />
subsidiaries.<br />
Copay: A pre-determined dollar amount you pay for<br />
Covered Expenses <strong>at</strong> the time of service. Whether the<br />
Copay applies to your Out-of-Pocket Maximum varies<br />
depending upon the plan you select.<br />
Covered Expenses: Charges for services and<br />
supplies th<strong>at</strong> are:<br />
• Medically Necessary,<br />
• not in excess of UCR/MAC,<br />
• not excluded under the Plan, and<br />
• not otherwise in excess of Plan limits.<br />
Custodial Care: Services th<strong>at</strong> are given merely as<br />
“care” in a facility or home to maintain a person’s<br />
present st<strong>at</strong>e of health, which cannot reasonably<br />
be expected to significantly improve.<br />
Glossary of Terms<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
241
Eligible Dependents: Those who can be claimed on<br />
the tax return filed by your household as dependents<br />
(without regard to the dependent’s income) and are<br />
limited to:<br />
• Your legal spouse of the opposite gender, so long as<br />
you are not legally separ<strong>at</strong>ed;<br />
• Your unmarried dependent children under age 19; or<br />
• Your unmarried dependent children from age 19 to<br />
their 23rd birthday if they are full-time students <strong>at</strong> an<br />
accredited school.<br />
To be eligible, your dependent children must be one of<br />
the following:<br />
• N<strong>at</strong>ural children;<br />
• Adopted children or children placed with you<br />
for adoption;<br />
• Stepchildren who live with you in a parent-child rel<strong>at</strong>ionship<br />
who either live with you <strong>at</strong> least 50 percent<br />
of the year, or who are full-time students age 19 to<br />
their 23rd birthday; or<br />
• Grandchildren, nieces, nephews, and siblings, if you<br />
have legal custody or guardianship.<br />
If a court order requires you to provide Medical<br />
and/or Dental coverage for Eligible Dependent children,<br />
the Plan does not require th<strong>at</strong> these children are<br />
able to be claimed as dependents on the tax return<br />
filed by your household. However, the children must<br />
otherwise meet the Plan’s eligibility requirements for<br />
dependent children.<br />
If Your Child Is Incapable of Self-Support<br />
If your child is not able to <strong>at</strong>tend school full-time or to be<br />
gainfully employed, coverage may be continued beyond<br />
his or her 19th birthday if:<br />
• The child is physically or mentally incapable of selfsupport<br />
and is covered as an Eligible Dependent<br />
under a <strong>Wal</strong>-<strong>Mart</strong>-sponsored Medical or Dental Plan<br />
and/or Dependent Life Insurance as of his or her<br />
19th birthday, and<br />
• The child’s doctor provides written medical evidence<br />
of disability.<br />
Your dependent is not eligible under your coverage if he<br />
or she is:<br />
• Covered by the Plan as an associ<strong>at</strong>e of <strong>Wal</strong>-<strong>Mart</strong>; th<strong>at</strong><br />
is, an associ<strong>at</strong>e may be either a covered associ<strong>at</strong>e or<br />
a covered dependent, but not both <strong>at</strong> the same time.<br />
(This st<strong>at</strong>ement does not apply to Optional and<br />
Dependent Life and AD&D Insurance coverage.)<br />
• Covered by the Plan as a dependent of<br />
another associ<strong>at</strong>e of <strong>Wal</strong>-<strong>Mart</strong>. (This st<strong>at</strong>ement<br />
does not apply to Optional and Dependent Life<br />
Insurance and AD&D coverage.)<br />
• Residing outside the United St<strong>at</strong>es, except those<br />
dependents <strong>at</strong>tending college full-time outside of<br />
the United St<strong>at</strong>es. (This st<strong>at</strong>ement does not apply to<br />
Dependent Life Insurance or coverage under a policy<br />
specifically covering exp<strong>at</strong>ri<strong>at</strong>es or third country<br />
n<strong>at</strong>ionals who are employed by the Company.)<br />
• An illegal immigrant<br />
Experimental and/or Investig<strong>at</strong>ional:<br />
Medical services th<strong>at</strong> are defined as Experimental<br />
and/or Investig<strong>at</strong>ional according to protocols<br />
established by your Third Party Administr<strong>at</strong>or.<br />
Full-Time: You are classified as Full-Time in the<br />
Company’s payroll system. In order to be classified as<br />
Full-Time in the Company’s payroll system, an associ<strong>at</strong>e<br />
must regularly work <strong>at</strong> least 34 hours per week (or 28<br />
hours per week if classified as Full-Time or management<br />
prior to January 1, 2002, or 20 hours per week if classified<br />
as Full-Time or management prior to September 1,<br />
1979). When an associ<strong>at</strong>e transitions from Full-Time to<br />
Peak-Time after January 1, 2002, the 28-hour eligibility<br />
guideline listed above no longer applies. In the event<br />
the associ<strong>at</strong>e transitions back to Full-Time, the associ<strong>at</strong>e<br />
will be required to work <strong>at</strong> least 34 hours per week. Full-<br />
Time hourly Field Logistics <strong>Associ<strong>at</strong>e</strong>s and Full-Time<br />
hourly pharmacists who are classified as Full-Time in the<br />
Company’s payroll system are exempt from the 34-<br />
hours-per-week rule.)<br />
Full-Time Truck Driver: Classified as a Full-Time Truck<br />
Driver in the Company’s payroll system.<br />
242 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Generic Drug: Generic versions work like the brand<br />
name drug in dosage, strength, performance and use,<br />
and must meet the same quality and safety standards.<br />
All generic drugs must be reviewed by the FDA. For<br />
more inform<strong>at</strong>ion visit walmartbenefits.com (see also<br />
Preferred Brand Name Drug, and Non-Preferred<br />
Brand Name Drug).<br />
Health Care Credit: The amount of Covered Expenses<br />
the Plan will pay under the Value Plan before you must<br />
start paying your Annual Deductible.<br />
Hospital: An institution where sick or injured individuals<br />
are given medical or surgical care. The Hospital must<br />
be a licensed and legally oper<strong>at</strong>ed acute care general<br />
facility th<strong>at</strong> provides:<br />
• Twenty-four hour room and board and nursing services<br />
for all p<strong>at</strong>ients with a staff of one or more doctors<br />
available <strong>at</strong> all times, and<br />
• On-premise facilities for diagnosis, therapy, and<br />
major surgery.<br />
A Hospital is an institution th<strong>at</strong> is not primarily a nursing<br />
home, rest home, convalescent home, institution for<br />
tre<strong>at</strong>ing substance abuse, or Custodial Care institution.<br />
Initial Enrollment Period: The first time you are eligible<br />
to enroll. Initial Enrollment Periods may vary by job st<strong>at</strong>us.<br />
See the chart in the Enrollment and Eligibility chapter.<br />
Leave of Absence: Provides associ<strong>at</strong>es with needed<br />
time away from work while maintaining eligibility for<br />
benefits and continuity of employment. To accommod<strong>at</strong>e<br />
situ<strong>at</strong>ions th<strong>at</strong> necessit<strong>at</strong>e absence from work, the<br />
Company provides three types of leave:<br />
• FMLA<br />
• Personal<br />
• Military<br />
The decision to grant a request for leave shall be<br />
based on the n<strong>at</strong>ure of the request, the effect on work<br />
requirements, and consistency with the policy guidelines<br />
and procedures.<br />
Limited Network: The Network option under the<br />
<strong>Associ<strong>at</strong>e</strong>s’ Medical Plan th<strong>at</strong> has the fewest Network<br />
providers, but th<strong>at</strong> generally offers the gre<strong>at</strong>est provider<br />
discount (not available in all geographic regions). See<br />
The Medical Plan chapter for more details.<br />
Maximum Allowable Charge (MAC): The amount of a<br />
provider’s charge (whether Network or non-Network)<br />
paid to providers in a given geographic area as determined<br />
by the Third Party Administr<strong>at</strong>or.<br />
Medically Necessary: Procedures, supplies, equipment,<br />
or services th<strong>at</strong> are determined by the Plan to be:<br />
• Appropri<strong>at</strong>e for the symptoms, diagnosis, or tre<strong>at</strong>ment<br />
of a medical condition,<br />
• Provided for the diagnosis or direct care and tre<strong>at</strong>ment<br />
of the medical condition,<br />
• Within the standards of good medical practice within<br />
the organized medical community,<br />
• Not primarily for the convenience of the p<strong>at</strong>ient or<br />
the p<strong>at</strong>ient’s doctor or other provider, and<br />
Glossary of Terms<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
243
• The most appropri<strong>at</strong>e procedure, supply, equipment,<br />
or service which can be safely provided, and<br />
—There must be valid scientific evidence demonstr<strong>at</strong>ing<br />
th<strong>at</strong> the expected health benefits from the procedure,<br />
supply, equipment, or service are clinically<br />
significant and produce a gre<strong>at</strong>er likelihood of benefit,<br />
without a disproportion<strong>at</strong>ely gre<strong>at</strong>er risk of<br />
harm or complic<strong>at</strong>ions for the p<strong>at</strong>ient with the particular<br />
medical condition being tre<strong>at</strong>ed than other<br />
possible altern<strong>at</strong>ives;<br />
—Generally accepted forms of tre<strong>at</strong>ment th<strong>at</strong> are less<br />
invasive have been tried and found to be ineffective<br />
or are otherwise unsuitable; and<br />
—For Hospital stays, acute care as an inp<strong>at</strong>ient is necessary<br />
due to the kind of services the p<strong>at</strong>ient is<br />
receiving or the severity of the medical condition,<br />
and safe and adequ<strong>at</strong>e care cannot be received as<br />
an outp<strong>at</strong>ient or in a less intensive medical setting.<br />
Network: Health care providers th<strong>at</strong> have a written<br />
agreement to provide services <strong>at</strong> discounted r<strong>at</strong>es.<br />
Network Hospital: A Hospital th<strong>at</strong> has a written agreement<br />
to provide services <strong>at</strong> a discounted r<strong>at</strong>e.<br />
Non-Preferred Brand Name Drug: A drug th<strong>at</strong> is not<br />
on a Preferred Brand Name Drug list or a generic drug.<br />
For more inform<strong>at</strong>ion visit walmartbenefits.com (see<br />
also Preferred Brand Name Drug, and Generic Drug).<br />
Out-of-Pocket Maximum: The maximum amount<br />
of money you pay before the Plan begins paying 100<br />
percent of Covered Expenses for the remainder of the<br />
calendar year.<br />
• Deductibles, Copays, and the money you pay<br />
for Network services apply to your Out-of-<br />
Pocket Maximum.<br />
• Amounts you pay above UCR/MAC, the money you<br />
pay for non-Network services, and charges for services<br />
not normally covered under the Plan do not apply<br />
to your Out-of-Pocket Maximum and vary depending<br />
upon the AMP option you select.<br />
Part-Time Truck Driver: Classified as a Part-Time Truck<br />
Driver in the Company’s payroll system.<br />
Per-Event Deductible: An additional deductible for<br />
certain medical services.<br />
Preferred Brand Name Drug: Drugs th<strong>at</strong> are on<br />
the AHWP’s preferred drug list. This list can be found<br />
<strong>at</strong> walmartbenefits.com. For more inform<strong>at</strong>ion<br />
walmartbenefits.com (see also Non-Preferred Brand<br />
Name Drug, and Generic Drug).<br />
Proof of Good Health: Includes completing a<br />
questionnaire regarding your medical history and<br />
possibly having a medical exam. The Proof of Good<br />
Health questionnaire is made available when you enroll.<br />
Specialty Drug: Specialty drugs are those pharmaceuticals<br />
th<strong>at</strong> target and tre<strong>at</strong> specific chronic or genetic conditions.<br />
Specialty drugs include biopharmaceuticals (bioengineered<br />
proteins), blood-derived products, and complex<br />
molecules.They are available in oral, injectable, or<br />
infused forms.The list of Eligible Specialty Drugs is<br />
available <strong>at</strong> walmartbenefits.com.<br />
St<strong>at</strong>us <strong>Change</strong> Event: A St<strong>at</strong>us <strong>Change</strong> Event<br />
is an event th<strong>at</strong> allows you to make changes to<br />
your coverage outside of the Initial Enrollment<br />
Period or Open Enrollment Period and is in accordance<br />
with federal law. These events are listed in<br />
the Eligibility and Enrollment chapter.<br />
Temporary: You are classified as Temporary in the<br />
Company’s payroll system.<br />
Third Party Administr<strong>at</strong>or (TPA): A third party th<strong>at</strong><br />
makes claims determin<strong>at</strong>ions under the AHWP. Third<br />
Party Administr<strong>at</strong>ors process your claims with respect<br />
to the AHWP’s self-funded medical benefits. Third<br />
Party Administr<strong>at</strong>ors do not insure any benefits under<br />
the AHWP.<br />
Peak-Time: Classified as Peak-Time in the Company’s<br />
payroll system.<br />
244 For more inform<strong>at</strong>ion, log on to walmartbenefits.com, 24/7 or
<strong>2008</strong> <strong>Wal</strong>-<strong>Mart</strong> <strong>Associ<strong>at</strong>e</strong> <strong>Benefits</strong> <strong>Book</strong><br />
Total Disability or Totally Disabled for Short-Term<br />
Disability or Short-Term Disability Plus:<br />
• You are unable to perform the essential duties of Your<br />
Occup<strong>at</strong>ion according to the medical evidence provided<br />
by a qualified doctor other than you or a family<br />
member (failure to meet requirements necessary to<br />
maintain a license to perform the duties of Your<br />
Occup<strong>at</strong>ion does not mean you are Totally Disabled);<br />
• You are under the continuous care of a qualified doctor;<br />
and<br />
• The disability is due to injury, sickness, or pregnancy.<br />
Total Disability or Totally Disabled for Full-Time and<br />
Management Long-Term Disability:<br />
• You are unable to perform the essential duties of<br />
Your Occup<strong>at</strong>ion (or any occup<strong>at</strong>ion after 12<br />
months of benefit payments) according to the medical<br />
evidence provided by a qualified doctor other<br />
than you or a family member (failure to meet<br />
requirements necessary to maintain a license to perform<br />
the duties of Your Occup<strong>at</strong>ion does not mean<br />
you are Totally Disabled);<br />
• You are under the continuous care of a qualified<br />
doctor; and<br />
• The disability is due to accidental bodily injury,<br />
sickness, substance abuse or pregnancy.<br />
Total Disability or Totally Disabled for Truck Driver<br />
Long-Term Disability:<br />
• During your waiting period and for the next 12<br />
months, you are unable to perform the essential<br />
duties of Your Occup<strong>at</strong>ion according to medical evidence<br />
provided by a qualified doctor other than you<br />
or a family member, and as a result you are earning<br />
less than 50 percent of your average monthly wage,<br />
unless engaged in a program of rehabilit<strong>at</strong>ive<br />
employment approved by The Hartford. Failure to<br />
meet the requirements necessary to maintain a<br />
license to perform the duties of Your Occup<strong>at</strong>ion<br />
does not mean you are Totally Disabled.<br />
• After 12 months, you are unable to perform the<br />
essential duties of any occup<strong>at</strong>ion.<br />
• The disability must be due to accidental bodily<br />
injury, sickness, substance abuse, or pregnancy.<br />
Usual, Customary, and Reasonable (UCR)<br />
(as determined by the Third Party Administr<strong>at</strong>or):<br />
Usual—The fee regularly charged for a given service<br />
or supply by medical providers;<br />
Customary—A fee th<strong>at</strong> is within the accepted range<br />
of usual fees charged by other providers of similar<br />
training and experience for services within the same<br />
specific and limited geographical area; and<br />
Reasonable—A fee th<strong>at</strong> meets the two criteria<br />
above and is justifiable, considering the special circumstances<br />
of a particular case in question.<br />
Your Occup<strong>at</strong>ion (for Total Disability)<br />
Includes similar job positions with the Company with<br />
a r<strong>at</strong>e of pay 50 percent or gre<strong>at</strong>er of your indexed<br />
pre-disability earnings.<br />
Glossary of Terms<br />
Visit Ask Betty from the WIRE <strong>at</strong> work or call the <strong>Benefits</strong> Department <strong>at</strong> (800) 421-1362<br />
245
Help and<br />
Inform<strong>at</strong>ion<br />
If you have questions about<br />
Call or go here<br />
• When you’re eligible for benefits<br />
• How and when to enroll<br />
Medical claims<br />
<strong>Wal</strong>-<strong>Mart</strong> <strong>Benefits</strong> Customer Service<br />
• (800) 421-1362<br />
• TDD (800) 335-4225<br />
• Call 24 hours a day, 7 days a week(except<br />
Thanksgiving and Christmas)<br />
• Visit walmartbenefits.com <strong>at</strong> home or email<br />
Ask Betty on the WIRE <strong>at</strong> work<br />
• Call the phone number on your medical ID card<br />
• walmartbenefits.com <strong>at</strong> home<br />
• the WIRE <strong>at</strong> work<br />
Finding network providers<br />
Pharmacy benefits<br />
Health savings account<br />
Dental claims<br />
• Short-Term Disability<br />
• Short-Term Disability Plus<br />
• Long-Term Disability<br />
• Truck Driver Long-Term Disability<br />
• Accident Insurance Policy<br />
• Cancer Insurance Policy<br />
Ask Mayo Clinic<br />
Resources for Living<br />
<strong>Wal</strong>-<strong>Mart</strong> Profit Sharing and 401(k) Plan<br />
<strong>Associ<strong>at</strong>e</strong> Stock Purchase Plan<br />
• walmartbenefits.com <strong>at</strong> home<br />
• the WIRE <strong>at</strong> work<br />
WMS/NextRx<br />
• (877) 850-0185<br />
Mellon Bank<br />
• (800) 358-3494<br />
U.S. Bank<br />
• (800) 358-3494<br />
Delta Dental<br />
• (800) 462-5410<br />
The Hartford<br />
• (800) 492-5678<br />
Aflac<br />
• (888) 792-2352<br />
• (800) 418-0758<br />
• Call 24 hours a day, 7 days a week<br />
• (800) 825-3555<br />
• Call 24 hours a day, 7 days a week<br />
Merrill Lynch<br />
• (888) 968-4015<br />
Computershare<br />
• (800) 438-6278
On White