Limited Benefit Health Plan for Part-time Employees - My Lowe's Life

Limited Benefit Health Plan for Part-time Employees• Insured Percentage for Medical ExpensesPhysician office visits – 100% of Reasonable andCustomary expenses; andAll other covered medical expenses utilizing PPOproviders, or insureds residing outside the ServicingArea – 80% of Reasonable and Customary expenses;orAll other covered medical utilizing Non-PPOproviders – 70% of Reasonable and Customaryexpenses.You and your covered dependents must pay the followingdeductible and co-payment amounts before any amount will bepaid from the Part-time Medical Plan Option.• Deductible Per Coverage Year (does not apply to doctor’soffice visits)Per insured person $300Per family $600• Co-payment Per Doctor’s Office Visit (not subject todeductible)Office co-payment (PPO/OutsideService Area)$20Office co-payment (Non-PPO) $30• Maternity CareWhen the mother’s pregnancy is covered under the GroupPolicy, charges for inpatient care of the mother and newbornchild will be covered subject to deductible hospital and medicalplan limits for a minimum of 48 hours after vaginal deliveryand for a minimum of 96 hours after delivery by caesareansection. If discharged earlier, charges for outpatient postdeliverycare will also be covered. This post-delivery care mustbe received within 72 hours of such early delivery. Thedependent child is covered from date of birth, provided younotify AWD and pay the additional premium, if any, within 31days of the date of birth.Covered Medical ExpensesCovered Medical Expenses are only the charges and feesincurred by you or your covered dependents for those servicesand supplies listed below. They are subject to the exclusionsand other limits that may apply to this section. Such chargesand fees are limited to what is Reasonable and Customarywithin the area in which the services and supplies are furnished.Such services and supplies must be performed by, prescribed inwriting by, or under the supervision of an attending Physician.They must be Medically Necessary for the care and treatmentof you or your covered dependents due to a Sickness or anInjury.• Ambulance Services: This is for local transportation byprofessional ambulance service to/from a Hospital. Localmeans to/from the nearest Hospital with appropriate staffand equipment prepared to care for or treat the patient’scondition—in no case more than 100 miles away.• Birthing Center Services: These are services received insuch a center for prenatal care, delivery of a child orchildren, and postpartum care during the first 24 hoursafter giving birth.• Diagnostic Services: These are for X-ray exams andlaboratory tests to find the cause of Sickness or the extentof an Injury.• Home Health Services: These are for services andsupplies provided in the home of a covered individual.They must be in lieu of Inpatient care that otherwise wouldbe required. Such services must be therapeutic in natureand must be supervised by the Physician who prescribesthem. The maximum benefit payable for such services is$1,000 in a Coverage Year.• Hospice Services: These include treatment provided inaccordance with a Hospice Care Program and Room andBoard and other services of a Hospice Facility duringInpatient confinement of a covered individual in such aFacility. Such confinement must be needed for the controlof acute symptoms, crisis management, or to providerespite for the patient’s family. Charges for suchconfinement that exceed $200 per day or for more than 30days (five days in any period of three months for respitecare) will not be a Covered Medical Expense.• Hospital Services: These include Room and Board andother services and supplies provided by a Hospital. Roomand Board charges that exceed the daily maximum shownfor them in the Schedule of Insurance will not be coveredmedical expenses. The maximum benefit payable forservices and supplies, other than Room and Board, is alsoshown in the Schedule of Insurance.3

• Medical Equipment and Supplies: These include onlythe items that are specifically listed below, but only if they:are determined by AWD to be Medically Necessaryfor the treatment of a condition covered under theGroup Policy; andwill not, in whole or in part, serve as a comfort orconvenience item for the covered individual.Supplies and services to repair medical equipmentmay be a Covered Medical Expense only if thecovered individual owns the equipment or ispurchasing the equipment. The Covered MedicalExpense for medical equipment is based on the mostcost-effective medical equipment that meets thecovered individual’s needs, as determined by AWD.At AWD’s option, the cost of either renting orpurchasing will be covered. If the cost of renting ismore than its purchase price, only the cost of thepurchase is considered a Covered Medical Expense.With respect to durable medical equipment that ispurchased, only the initial purchase will be a CoveredMedical Expense. The only equipment and suppliesthat are covered are as follows:• Anesthetics, surgical dressings, blood, and bloodplasma.• Casts, splints, and braces.• Durable medical equipment, that includes onlycanes, crutches, walkers, standard manual orelectric wheelchairs, and standard hospital beds.• Hemodialysis for renal disease, including therequired equipment, and medical supplies, whenprescribed by a Physician and provided athemodialysis clinics and home training centersthat are approved by the Joint Commission on theAccreditation of Healthcare Organizations.• Oxygen, including the use of equipment for itsadministration, when the Medical Necessity for24-hour usage is certified by a Physician.• Prescription Drugs, dispensed by a licensedpharmacist for which the law requires aPhysician’s written prescription. In addition,Covered Medical Expenses will include insulinand the needles and syringes required for itsadministration, if the covered individual has aPhysician’s authorization for such supplies onrecord with the pharmacist.• Nursing Services: These are for private duty nursing careby a licensed nurse (R.N. or L.P.N.). They must entailactive medical treatment. They must be provided as HomeHealth Services.• Physician Services: These are for performing Surgery orother medical care and treatment. Each service must bewithin the scope of the Physician’s license to practice.• Radiation Therapy Services: These includechemotherapy, X-rays, radium, and radioactive isotopetherapy for the treatment of benign or malignantconditions.• Surgical Services: These are in connection with Surgeryperformed by a Physician in a surgical facility. Suchfacility must be duly licensed as such.• Therapeutic Services: These are services of a licensedspeech therapist to aid in the restoration of speech loss,resulting from injury, stroke, or surgical procedure; orservices provided by a physiotherapist, occupationaltherapist, respiratory therapist, or inhalation therapist to aidin the restoration of normal physical function that thecovered individual once had, but later lost, provided anysuch loss of speech or physical function occurred whilecoverage under the Part-time Medical Plan Option was inforce.A charge or fee is considered to be incurred on the date acovered individual receives the service or supply for which thecharge is made.Special ProvisionsMental IllnessBenefits are provided under the Part-time Medical Plan Optionfor care and treatment of mental illness and functional nervousdisorders, including alcoholism and drug abuse, except thatsuch benefits shall be limited as follows:• Hospital inpatient care is limited to 30 days in any oneCoverage Year; and• Outpatient care is limited to 40 visits in any one CoverageYear.4

ContraceptivesBenefits are payable under the Part-time Medical Plan Optionfor Reasonable and Customary charges you or your covereddependents incur for outpatient contraceptive services. Benefitswill be based on the Insured Percent and any Deductible or Copaymentthat would be applied to expenses for the treatment ofSickness. This includes oral contraceptives and devices thatmay be dispensed only by prescription. However, RU-486,Preven, or equivalent drugs are not included.Screening for CancerBenefits are payable under the Part-time Medical Plan Optionfor Reasonable and Customary charges you or your covereddependents incur for low dose screening mammography, papsmear, prostate specific antigen tests or colorectal cancerscreening. Benefits will be based on the Insured Percent andany Deductible or Co-payment that would be applied toexpenses for the treatment of Sickness.Anesthesia and Hospitalization for DentalProceduresCharges for general anesthesia and facility charges for care in aHospital or ambulatory surgical center are covered if thepatient: (a) is a child under 9 years of age; or (b) has a seriousmental or physical condition; or (c) has significant behavioralproblems; and (d) the provider certifies that, because of thepatient’s age, condition or problem, hospitalization or generalanesthesia is required in order to safely and effectively performthe procedure. Benefits will be based on the Insured Percentand any Deductible or Co-payment that would be applied toexpenses for the treatment of Sickness.Expenses Not CoveredNo benefits will be paid under any section of the Group Policythat provides a type of Health Expense Insurance for anyexpense incurred by a covered individual:• On account of or in connection with:An examination not required for care or treatment of aSickness or Injury, immunizations or other preventivemeasures, except as may be provided in the provisionfor Maternity Care, or under any Special Provisions;Limited Benefit Health Plan for Part-time EmployeesCare of any person AWD determines to be custodial orfor maintenance purposes, except as may be providedunder the provision for Maternity Care, or under anySpecial Provisions;Injury arising out of or in the course of doing any jobor work for which the covered individual is reasonablyqualified by education or training, or Sickness coveredby any Workers’ Compensation Law or Act;War or any act of war, whether declared or not, thatoccurs while the person is insured;Injury sustained while participating in a riot or in theact of committing an assault or felony;Care or treatment of the teeth, their roots, or rootsockets or gums, except:• Prompt (within 12 months in the case of an adult)repair of sound natural teeth or other body tissuerequired as a result of an Injury; or• Care or treatment of congenital defects in a childwho becomes insured at birth;Eye exams, eyeglasses or lenses, or Surgery for thecorrection of errors of refraction in the eye, except thefirst exam and lens that may be required after cataractSurgery;Hearing aids and their fitting, or hearing exams;Cosmetic Surgery, regardless of any psychological oremotional benefits to be gained by it, unless it isrequired to correct a severe birth defect or the severescar of an acute Sickness or Injury suffered whileinsured;The removal of corns, calluses, or toenails, unless thenail roots must be removed too, or the purchase ofshoes;Acupuncture (this does not apply if used as a form ofanesthesia for which a benefit may be paid);Any type of education or job training of any kind;Therapies that are not otherwise covered, including,but not limited to: primal, educational, megavitamin,bioenergetic, and carbon dioxide therapies, rolfing andpsychodrama;5

Counseling services that are not otherwise covered,including, but not limited to: marriage, family, child,career, social adjustment, pastoral, and financialcounseling;A pregnancy of a Dependent Child and the child’sbirth that may result, or any induced abortion unlessthe mother’s life or health would be endangered if shecarried the fetus to term (this exclusion does not applywhere there are Complications of Pregnancy);For which there is no legal obligation for the coveredindividual to pay, or for which no charge would bemade if insurance did not exist, unless such charge isregularly and customarily made in a similar amount bythe provider of such to other non-indigent patients, orunless, in either case, AWD is required by law to payto the Government of the United States;Rendered and charged for by a resident intern orPhysician;Mental illness, nervous disorders, alcoholism, or drugabuse, except as may be covered under any SpecialProvisions;Drugs or medicines that may be obtained lawfullywithout a Physician’s prescription (this does not applyto insulin);Sexual dysfunction or identity, sex change, orprocedures to cause a person to be pregnant or aid insuch causes;Treatment or tests for infertility (unless brought on bySickness or Injury while insured) or genetic testing;Measures to control food intake for purposes of weightcontrol;Programs to train and teach people to cope with ormanage pain or to retrain for a job;Biofeedback and other forms of training for the care ofone’s self and related testing; orA Preexisting Condition, except as provided under thespecial provisions.That AWD determines to be not necessary fordiagnosis, care, or treatment of the Sickness or Injuryinvolved (this applies even if prescribed by aPhysician);That could have been done for himself/herself or amember of his/her family; or provided or charged forby one of your relatives.• When the provider charges a fee for a service he/she doesnot actively perform (examples of this include, but are notlimited to, case management fees and the professionalcomponent of automated laboratory procedures); or• That exceed the Reasonable and Customary charges withinthe area for the services and supplies furnished.Preexisting ConditionA Preexisting Condition is a Sickness or Injury for whichmedical advice, diagnosis, care, or treatment was recommendedor received within the six-month period prior to the person’senrollment date. See the definition of “Preexisting Condition”below for more information.The terms “education” or “training” as used within the aboveExclusions, do not include diabetes outpatient self-managementtraining and educational services used to treat diabetes, whensuch training and services are: (a) certified as necessary by theattending Physician; and (b) provided by the Physician or by ahealthcare professional designated by the Physician.• For care, treatment, services and supplies:That are not Medically Necessary;No benefits will be payable under the Part-time Medical PlanOption for a Preexisting Condition for the following period oftime after the insured’s enrollment date: (1) 18 months for alate enrollee; or (2) 12 months if not a late enrollee. Thisexclusion will not apply to an employee’s newborn child, fosterchild, or adopted child under the age of 18 years, if the childhas not had a Significant Break in Coverage since his/her dateof birth or placement. If the insured was covered by CreditableCoverage and did not have a Significant Break in Coverage,they will receive credit for that period of Creditable Coverage.To obtain this credit, proof of the previous coverage that issatisfactory to AWD must be provided.6

Coordination of BenefitsIf you are covered by another plan, your benefits under thisPart-time Medical Plan Option will be coordinated with thoseof any other plan so that no more than 100% of the AllowableExpenses will be reimbursed under all plans combined.Mothers’ and Newborns’ HealthProtection ActUnder federal law, group health plans and health insuranceissuers offering group health insurance coverage generally maynot restrict benefits for any hospital length of stay in connectionwith childbirth for mother or newborn child to less than 48hours following a vaginal delivery, or less than 96 hoursfollowing a delivery by cesarean section. However, the plan orissuer may pay for a shorter stay if the attending provider (e.g.,your physician, nurse, midwife, or physician’s assistant), afterconsultation with the mother, discharges the mother or newbornearlier.Also, under federal law, plans and issuers may not set the levelof benefits or out-of-pocket costs so that any later portion of the48-hour (or 96-hour) stay is treated in a manner less favorableto the mother or newborn than any earlier portion of the stay.In addition, a plan or issuer may not, under federal law, requirethat a physician or other healthcare provider obtainauthorization for prescribing a length of stay of up to 48 hours(or 96 hours). However, to use certain providers or facilities, orto reduce your out-of-pocket costs, you may be required toobtain precertification. For information on precertification,contact AWD at 1-800-937-7039 or the Lowe’s Group BenefitsDepartment at 1-800-400-4104.Women’s Health and CancerRights ActThe Part-time Medical Plan Option complies with the Women’sHealth and Cancer Rights Act of 1998, providing benefits formastectomy-related services including Reconstructive BreastSurgery, prosthesis, and complications resulting from amastectomy.Limited Benefit Health Plan for Part-time EmployeesImportant Notice from Lowe’sCompanies, Inc. About YourPrescription Drug Coverage andMedicarePlease read this notice carefully and keep it where you can findit. This notice has information about your current prescriptiondrug coverage available for people with Medicare. It alsoexplains the options you have under Medicare prescription drugcoverage, and can help you decide whether or not you want toenroll. At the end of this notice is information about where youcan get help to make decisions about your prescription drugcoverage.1. Medicare prescription drug coverage became available toeveryone with Medicare through Medicare prescription drugplans and Medicare Advantage Plans that offer prescriptiondrug coverage in 2006. All Medicare prescription drug plansprovide at least a standard level of coverage set byMedicare. Some plans may also offer more coverage for ahigher monthly premium.2. Lowe’s Companies, Inc. has determined that theprescription drug coverage offered in the Part-time MedicalPlan is, on average for all plan participants, NOT expectedto pay out as much as the standard Medicare prescriptiondrug coverage will pay and is considered Non-CreditableCoverage. This is important, because for most peopleenrolled in the Part-time Medical Plan, enrolling inMedicare prescription drug coverage means you will getmore assistance with drug costs than if you had prescriptiondrug coverage exclusively through the Part-time MedicalPlan.3. You have decisions to make about Medicare prescriptiondrug coverage that may affect how much you pay for thatcoverage, depending on if and when you enroll. Read thisnotice carefully—it explains your options.Consider enrolling in Medicare prescription drug coverage.Because the coverage you have with the Part-time Medical Planis on average for all plan participants, NOT expected to pay outas much as the standard Medicare prescription drug coveragewill pay, consider enrolling in a Medicare prescription drugplan. Individual’s can enroll in a Medicare prescription drugplan when they first become eligible for Medicare and eachyear from November 15 th through December 31 st . Beneficiary’sleaving employer/union coverage may be eligible for a Special7

Enrollment Period to sign up for a Medicare prescription drugplan.This may mean that you will have to wait to enroll in Medicareprescription drug coverage and that you may pay a higherpremium (a penalty) if you join later and you will pay thathigher premium as long as you have Medicare prescription drugcoverage.If you go 63 days or longer without prescription drug coveragethat is at least as good as Medicare’s prescription drugcoverage, your premium will go up at least 1% per month forevery month after May 15, 2006, that you did not have thatcoverage. You will have to pay this higher premium as long asyou have Medicare prescription drug coverage. For example, ifyou go nineteen months without coverage, your premium willalways be at least 19% higher than what many other peoplepay.The coverage you currently have pays for other health expensesand may also provide for prescription drug coverage (checkyour Group Certificate/Booklet for verification). Please beaware that you will still be eligible to receive all of your currenthealth and prescription drug benefits if you choose to enroll in aMedicare prescription drug plan.You need to make a decision.When you make your decision, you should also compare yourcurrent coverage, including which drugs are covered, with thecoverage and cost of the plans offering Medicare prescriptiondrug coverage in your area.For more information about this notice or your currentprescription drug coverage…Contact the Customer Care Center at American Heritage LifeInsurance Company, 1-(800)-348-4489.NOTE:You will receive this notice annually and at other timesin the future such as before the next period you can enroll inMedicare prescription drug coverage, and if this coveragethrough Lowe’s Companies, Inc. changes. You also mayrequest a copy.For more information about your options under Medicareprescription drug coverage…More detailed information about Medicare plans that offerprescription drug coverage is in the “Medicare & You”handbook from Medicare. You’ll get a copy of the handbook inthe mail every year from Medicare. You may also be contacteddirectly by Medicare-approved prescription drug plans. Formore information about Medicare prescription drug plans:• Visit www.medicare.gov• Call your State Health Insurance Assistance Program (seeyour copy of the Medicare & You handbook for theirtelephone number) for personalized help• Call 1-800-MEDICARE (1-800-633-4227). TTY usersshould call 1-877-486-2048.For people with limited income and resources, extra helppaying for Medicare prescription drug coverage isavailable. Information about this extra help is available fromthe Social Security Administration (SSA) online atwww.socialsecurity.gov, or you call them at 1-800-772-1213(TTY 1-800-325-0778).Filing ClaimsYou should submit your claim for Part-time Medical PlanOption benefits to AWD. Contact the Customer Service Centerof AWD at 1-800-937-7039 to obtain the necessary claimforms.When the claim form has been processed by AWD, you will benotified of the benefits paid. If any benefits have been denied,you will receive a written explanation.DefinitionsAccident: A sudden, unforeseeable event that causes injury toone or more covered individuals.Allowable Expenses: Charges that are Reasonable andCustomary for services and supplies that are MedicallyNecessary.Birthing Center: A freestanding facility that:• Is licensed as a Birthing Center in which obstetricalprocedures may be performed;• Is directed by an obstetrician;• Has a Physician present at all births;• Has on staff, available at all times, one or more Physicianswho practice obstetrics in an area Hospital;8

Limited Benefit Health Plan for Part-time Employees• Provides room and board and around-the-clock skillednursing services directed by an R.N. or certified nursemidwife;• Keeps a medical record on each mother and child;• Is equipped and staffed to handle medical emergencies tosustain life in the event of complications or a child bornwith an abnormality that threatens life or functionalimpairment; and• Has a written agreement with at least one Hospital in thearea for emergency transfer of a mother or child.Complications of Pregnancy: A condition that:• Requires Hospital confinement as an Inpatient duringwhich the pregnancy is not terminated; and• May be caused or aggravated by the pregnancy, but• Is a condition that could also be suffered by persons whoare not pregnant; and• Missed abortion, nonelective caesarean section, ectopicpregnancy, and the unplanned end of a pregnancy fromwhich it is not possible to bring forth a newborn that cansurvive.Co-payment: The amount of medical expenses incurred by acovered individual for each Physician office visit, beforebenefits are payable.Cosmetic Surgery: Surgery performed to change appearance.It does not mean surgery that is Medically Necessary to correctdisorders of normal function.Coverage Year: A consecutive 12-month period during whichan employee’s coverage under the Part-time Medical PlanOption is in force. The first Coverage Year begins on theeffective date of the employee’s coverage under the grouppolicy and ends after 12 consecutive months of coverage.Dependents added later will have the same coverage year as theemployee.Creditable Coverage: Coverage of a person under any of thefollowing:• A self-funded employer group health plan under theEmployee Retirement Security Act of 1974;• Group or individual Health Insurance Coverage;• Medicare (Part A or Part B);• Title XIX of the Social Security Act, other than coverageconsisting solely of benefits under section 1928;• Chapter 55 of Title 10, United States Code;• A medical care program of the Indian Health Service or ofa tribal organization;• A state health benefits risk pool;• A health plan offered under chapter 89 of Title 5, UnitedStates Code;• A public health plan (as defined in federal regulations);• A health benefit plan under section 5(e) of the Peace CorpsAct (22 U.S.C. 2504(e)).• Title XXI of the Social Security Act (State Children’sHealth Insurance Program (SCHIP)); or• Short term, limited duration, health insurance coverage.Health Expense Insurance: Includes all insurance under theGroup Policy that pays benefits to defray, at least in part, losscaused by the expense of healthcare. Healthcare is the care andtreatment of a covered individual for Sickness or Injury.Health Insurance Coverage: Benefits consisting of medicalcare (provided directly, through insurance or reimbursement, orotherwise) under any hospital or medical service policy orcertificate, hospital or medical service plan contract, or healthmaintenance organization contract offered by a health insuranceissuer.Hospice: An agency that provides hospice care 24 hours a day,seven days a week for the Terminally Ill. It operates inaccordance with law and is licensed as may be required by thejurisdiction in which it is located. It is under the direction of aPhysician and has on its staff at least one Physician, one R.N.,one licensed or certified social worker, and one pastoral orother counselor. Services provided or arranged for by such staffinclude medical and skilled nursing care, medical and/or othersocial services, psychological and dietary counseling,bereavement counseling for the immediate family, physical oroccupational therapy, home health aid services, and Inpatientcare in a Hospice Facility. It assesses each patient’s medicaland social needs and develops a Hospice Care Program to meetthose needs. A medical record is maintained on each patient. Itsadministrator is employed full-time.Hospice Care Program: A plan set forth in writing. It providescare and treatment for a person who is terminally ill. It is underthe direction of an attending Physician who, along withappropriate staff of a Hospice, reviews it from time to time. It is9

designed to give palliative and supportive care to the patientand supportive care to his/her family. It includes an assessmentof the patient’s medical and social needs and describes the careto be given to meet those needs. For purposes of benefits underthe group policy the program ends on the date of the patient’sdeath.Hospice Facility: A facility, or a distinct part of one, thatchiefly provides Inpatient care for the Terminally Ill. It makes acharge for such care and meets all licensing or certificationstandards required by the jurisdiction in which it is located. It isowned by or has working agreements with a Hospice. It has anongoing quality assurance program that includes reviews byphysicians who neither own nor direct it or the hospice. It is runby a staff of Physicians at least one of whom is on call at alltimes. It provides 24-hour a day nursing services supervised bya R.N.Hospital: An institution that operates as such and is licensed bylaw to do so, and that:• Provides continuous room and board and nursing servicesfor its patients;• Has a staff including one or more Physicians available atall times;• Is equipped with organized facilities on its own premisesor under its control for diagnosis, therapy, and both majorand minor surgery; and• Is not primarily a clinic or nursing, rest, or convalescenthome or facility, but• The requirement for surgical facilities does not apply in thecase of care and treatment for mental illness, nervousdisorders, alcoholism, or drug abuse. In such case theHospital must be licensed by the state or be accredited bythe Joint Commission on the Accreditation of Hospitals togive such care and treatment for such condition.Injury: An injury to the body that is sustained by Accident.Inpatient: A person who is a resident patient using and beingcharged for the Room and Board facilities of a Hospital orHospice Facility.Medically Necessary or Medical Necessity: Services andsupplies that are covered medical expenses and are:• Provided for the diagnosis, treatment, cure, or relief of ahealth condition, illness, injury, or disease;• Necessary for and appropriate to the diagnosis, treatment,cure, or relief of a health condition, illness, injury, disease,or its symptoms;• Within generally accepted standards of medical care in thecommunity; and• Not solely for the convenience of the covered individual,his/her family, or the provider of the services.Non-Participating Provider or Non-PPO Provider: APhysician or other health care provider who has not made anagreement with the Third-Party Network and who is not aPreferred Provider.Outpatient: Care or treatment for Sickness or Injury receivedwhile the covered individual is not an Inpatient.Physician: A Doctor of Medicine (M.D.) or Doctor ofOsteopathy (D.O.). He/she must be licensed to practice as such.The term also means any of the following, who are dulylicensed or certified, and provide a covered service, supply, orcertification of disability within the scope of practice of theirrespective license: optometrist, podiatrist, dentist, chiropractor,clinical social worker, substance abuse professional,psychologist, pharmacist, fee-based practicing pastoralcounselor, professional counselor, physician assistant, oradvanced practice R.N. The license or required certificationmust be valid at the time.Preexisting Condition: Any Sickness or Injury, other than:pregnancy, for which medical advice, diagnosis, care, ortreatment was recommended or received within the six-monthperiod right before a covered individual’s enrollment date.Genetic information is not considered a Preexisting Conditionunless there is a diagnosis of the condition to which the geneticinformation relates. A condition that was first diagnosed whilethe person was covered under previous health coverage, and forwhich benefits were payable under that coverage, is also notconsidered a Preexisting Condition, provided there has been noSignificant Break in Coverage. The medical advice, diagnosis,care, or treatment must have been recommended by, or receivedfrom, an individual licensed or similarly authorized to providesuch services under State law and operating within the scope ofpractice authorized by State law.Preferred Provider: A provider of services, which are coveredby the Group Policy, who has an agreement with the Third-Party Network. Such Third-Party Network will furnish lists ofsuch providers to Insured Persons.• Not for experimental, investigational, or cosmeticpurposes;10

Limited Benefit Health Plan for Part-time Employees• Reasonable and Customary: Applies to fees and chargesfor services and supplies. For services rendered by aPreferred Provider, Reasonable and Customary means thecharge contractually negotiated by the network and agreedto between the network and that provider for the particularservice or supply. The Insured Person is not responsible forthe difference between the billed amount and theReasonable and Customary amount when services arerendered by a Preferred Provider.• For services rendered by a Non-PPO Provider, the termmeans the lesser of: (a) the provider’s usual charge for theservice or supply; or (b) the prevailing charge for acomparable service or supply rendered by a similarlytrained and experienced provider, based on available datafor the area in which it is furnished. The Insured Person isresponsible for the billed amount in excess of theReasonable and Customary amount when services arerendered by a Non-PPO Provider.Reconstructive Breast Surgery: Surgery performed as a resultof a mastectomy to reestablish symmetry between the twobreasts, and includes reconstruction of the mastectomy site,creation of a new breast mound, and creation of a newnipple/areolar complex. Reconstructive Breast Surgery alsoincludes augmentation mammoplasty, reduction mammoplasty,and mastopexy of the non-diseased breast.Room and Board: The services of a Hospital or Hospice thatare charged for by the day or week based on theaccommodations furnished. They include bed, room, meals, andgeneral nursing services.Service Area: The geographic area where Preferred Providersare located. The listing of Preferred Providers, that will begiven to each Insured Employee, describes this geographicarea.Sickness: Sickness or disease. It also means pregnancy,childbirth, and medical conditions that are related to these. Asto a child born while the mother is insured, it further includes:• Infancy, while, as a newborn, the child is confined as anInpatient in a Hospital; and• Medically diagnosed birth defects and abnormalities.Significant Break in Coverage: A period of 63 consecutivedays during which the person does not have any CreditableCoverage, except that neither a waiting period nor an affiliationperiod is taken into account in determining a Significant Breakin Coverage.Surgery: Manual procedures that:• Involve cutting of body tissue;• Debridement or permanent joining of body tissue for repairwounds;• Treatment of fractured bones or dislocated joints; and• Endoscopic procedures.Surgery also includes:• Other manual procedures when used in lieu of cutting forpurposes of removal, destruction, or repair of body tissue;and• Reconstructive Breast Surgery due to a mastectomy.Terminally Ill: Those with a medical prognosis of 12 monthsto live.Third-Party Network: A network of hospitals, physicians andother health care providers who have an agreement with acompany other than American Heritage Life InsuranceCompany to deliver health care services to persons insuredunder the Group Policy at a lower cost.Outline of Group VoluntaryTerm Life Insurance OptionBenefitsThis program provides Group Voluntary Term Life Insurancefor you, your spouse or domestic partner, your dependentchild(ren), or your domestic partner’s dependent child(ren). Itallows you to select the amount of coverage that meets yourneeds.You must make an active enrollment election to be covered,and you are not automatically enrolled in the Group VoluntaryTerm Life Insurance Option.Life Insurance BenefitIf you elect this option, you will be provided with $20,000 ofcoverage. In addition, you may also elect to cover your spouseor domestic partner in the amount of $10,000 and yourdependent child(ren) or your domestic partner’s dependentchild(ren) over the age of 6 months, also in the amount of$10,000. You may not elect coverage for your dependentsunless you first elect it.11

Benefit CostThe employee pays 100% of the cost, which is in addition tothe cost of the Part-time Medical Plan Option.Rules Regarding Deferral ofEffective DateIf you are not Actively at Work on the date your Life Insurancewould have become effective, it will not become effective untilthe first day you are Actively at Work. If a dependent isconfined as an inpatient on the date their insurance would havebecome effective, such Insurance will become effective the dayfollowing discharge from the facility.Eligibility for Coverage ofDependent ChildrenA child born to, or adopted by, you or your spouse or domesticpartner while you have Dependent child coverage will beeligible for coverage the date the child is acquired if a writtenrequest is made to the insurance company within 31 days ofbecoming eligible.Benefit for Dependent Children• Children under 15 days old have no coverage;• Children 15 days but less than 6 months have $2,000 ofcoverage; and• Children 6 months to the age limit have $10,000 ofcoverage.Late EnrollmentIf you do not enroll within 31 days from the start of your initialemployment period, you may enroll later only during theannual re-enrollment period and you must submit Evidence ofInsurability with your enrollment form. Your late enrollmentwill not become effective until approved by AWD. Employeesshould contact the Customer Service Center of AWD at1-800-937-7039 if they want to enroll as a late applicant.Family Status ChangeChanges in an employee’s Group Voluntary Term LifeInsurance are permitted if application is made within 31 daysafter a family status change. Evidence of Insurability will berequired for applications submitted more than 31 days after thefamily status change and may only be submitted during the nextre-enrollment period. A change in family status is defined asbirth, death, marriage, divorce or adoption. Employees shouldcontact the Customer Service Center of AWD at1-800-937-7039 if they have a family change of status.Termination of CoverageCoverage is terminated if the employee ceases to pay apremium after the 31 day grace period; or at termination ofemployment of the employee. Spouse or domestic partnercoverage terminates upon the termination of the employee orthe end of the period for which dependent premiums are paid.Reduction in amounts of coverage for employees and spousesor domestic partners apply at age 70 and over as shown under“Benefit Reduction Schedule” on page 13. Dependent childcoverage terminates at termination of employee or as aneligible dependent (see Plan Administration, for moreinformation regarding Eligible Dependents), whichever occursfirst. Termination of coverage also occurs if the Group Policy isterminated.ExclusionThis policy does not pay the death benefit if the insuredemployee, spouse or domestic partner commits suicide withinthe one year period after the effective date of that person’s lifeinsurance under the group policy.Continuation of Coverage(Portability)You have the option, if you leave Lowe’s employment, tocontinue coverage at group rates up to age 70, so long as thegroup policy remains in force. You must apply under thisoption for the portability policy within 31 days after yourcoverage ends. Contact AWD at 1-800-937-7039 forcontinuation of coverage information.12

ConversionYou have the option, if you leave Lowe’s employment, toconvert to an individual permanent life insurance policywithout Evidence of Insurability. Your insured spouse ordomestic partner and dependent children have the option toconvert at the same time you do. They also may convert if theyare no longer eligible for insurance under the group policy. Anexample of this would be when a dependent child reaches theage limit. You must apply under this option for the individualpolicy within 31 days after your coverage ends. Proof of goodhealth is not required. Contact AWD at 1-800-937-7039 forconversion information.Accelerated Death BenefitIf you or your insured spouse or domestic partner are diagnosedwith a terminal illness (defined as less than 12 months to live),this benefit pays a portion of the total face amount (up to thelesser of 50% or $10,000). The remaining life insurance benefitis paid upon the death of the insured.Limited Benefit Health Plan for Part-time EmployeesAfter you complete the form, retain a copy for yourself andsubmit the original to Allstate, PO Box 15049, Wilmington, NC28408. The effective date of change is the date the request issigned. Any payment made by AWD before receipt of notice ofsuch change will fully discharge Lowe’s and AWD’s obligationfor such payment.If you name more than one beneficiary, each will share equallyunless you indicate otherwise on the form.If a beneficiary dies before you, his or her share will be paidequally to your surviving beneficiaries, unless you stateotherwise. If you do not name a beneficiary, or if no namedbeneficiary survives you or is disqualified, your death benefitswill be paid to one or more of your family members in thefollowing order:• Your legal spouse or domestic partner;• Your children;• Your mother or father; or• Your siblings.Benefit Reduction ScheduleReductions in group insurance amounts will apply at olderages, according to the following schedule:Insured Age70 but less than age 75 65%75 but less than age 80 50%80 and over 35%Waiver of PremiumPercent of OriginalCoverage PayableIf you become disabled prior to age 60 and the disability lastsfor 6 months or longer, you will not be required to paypremiums for as long as the disability lasts or until you reachage 65, whichever occurs first, provided the group policyremains in force. Employees should contact AWD at1-800-937-7039 to determine if the Waiver of Premium applies.Beneficiary DesignationYou may name anyone as your beneficiary by listing theirname or names on the Part-time Benefits Enrollment Form.If none of your family members survive you, your deathbenefits will be paid to your estate.You can change your beneficiary designation by contacting theCustomer Service Center of AWD at 1-800-937-7039.Filing ClaimsYou or your beneficiary should contact the Customer ServiceCenter of AWD 1-800-937-7039 to obtain the necessary claimforms.Written notice of death of a covered person must be sent toAWD at which time they will advise the forms needed tocertify “proof of death.” These forms include, but are notlimited to, a certified copy of the death certificate andStatement of Claim signed by the designated beneficiary.Any cost incurred as the result of obtaining these items will bethe claimant’s responsibility.When the claim form has been processed by AWD, you or yourbeneficiary will be notified of the benefits paid. If any benefitshave been denied, you or your beneficiary will receive a writtenexplanation.13

Outline of Group VoluntaryShort Term Disability OptionBenefitsThis option provides that, while you are totally disabled, youwill receive your monthly benefit amount after the eliminationperiod has been satisfied. Benefits continue while you aredisabled up to the benefit period listed on your Certificate ofInsurance.You are totally disabled when, because of sickness or off-thejobinjury, you can not perform the material and substantialduties of your regular occupation and you are not working inany occupation.For any disability period, you may collect a partial disabilitybenefit or a total disability benefit, but not both. If you aredisabled from the same or related cause within 14 days ofrecovery, it is considered to be the same disability; you will notbe required to satisfy a new elimination period.You must be enrolled in the Part-time Medical Option to enrollin the Group Voluntary Short Term Disability Option. But youmust make an active enrollment election to enroll in the GroupVoluntary Short Term Disability Option, even if you arealready enrolled in the Part-time Medical Plan Option. Thismeans you are not automatically enrolled in the GroupVoluntary Short Term Disability Option.The BenefitThe maximum benefit is $650 per month, prorated to a dailyamount of $21.66, less other income benefits.You will begin receiving Short Term disability benefits afteryou have satisfied the Elimination Period, which is seven (7)days. The elimination period is the consecutive days of totaldisability that must pass before benefits start; this period cannot be met if you’re only partially disabled.Group Voluntary Short Term Disability benefits are payable upto 3 months.Preexisting ConditionGroup Voluntary Short Term Disability benefits will not bepaid for a disability that begins within 12 months of youreffective date of coverage, if caused by a preexisting condition.A preexisting condition is any condition for which you receivedmedical treatment, consultation, care, or services includingdiagnostic measures, or for which you’ve taken prescribeddrugs or medicines in the 12 months just prior to your effectivedate of coverage.Pregnancy is covered as any other illness and may beconsidered a preexisting condition.Late EnrollmentIf you do not enroll within 31 days after your eligibility date,you may later enroll only during the reenrollment period andyou must submit evidence of insurability. To do this you mustcomplete an Evidence of Insurability form, answering healthquestions. AWD may ask you to submit a doctor’s statement,provided at your expense. No coverage will become effectiveuntil AWD approves this evidence of insurability, and AWDwill have the right to deny the coverage, based on your healthhistory.Other Income OptionsMonthly benefits are reduced by the deductible sources ofincome listed in your certificate, including, but not limited to:• Worker’s Compensation;• State compulsory disability income benefits;• Other group insurance plans;• Automobile liability insurance;• Payments from certain retirement plans; and• Any other benefit offset as listed on your certificate ofcoverage.Benefit CostThe employee pays 100% of the cost, which is in addition tothe cost of the Part-time Medical Plan Option.14

Exclusions and LimitationsBenefits are not paid for a disability caused by, or resultingfrom (directly or indirectly) your:• Loss of professional license, occupational license, orcertification; or• Participation in a felony; or Intentionally self-inflictedinjuries; or• Active participation in a riot; or• Commission of a crime for which you have been convictedunder state or federal law; or• Preexisting condition; or• Occupational sickness or injury.Disabilities due to war, declared or undeclared, or any act ofwar will not be covered. AWD will not pay a benefit for anyperiod of disability in which you are incarcerated.When Benefits EndThe monthly benefit amount will end on the earliest of thefollowing:• The day you fail to provide proof of continued disability;• The date you are no longer under the regular care of aPhysician, refuse to be examined, refuse to seekappropriate available treatment, or fail to provideinformation or documents needed to determine whetherbenefits are payable;• The date you refuse a full-time or part-time job withLowe’s where work modifications or accommodationshave been made to allow you to perform the duties of yourjob;• The end of the maximum benefit period;• The date you are no longer disabled; or• The date you die.Limited Benefit Health Plan for Part-time EmployeesFiling ClaimsYou should submit your claim for Group Voluntary Short TermDisability benefits as soon as you think your absence fromwork may extend beyond 7 days. You may also submit claimstwo weeks in advance of a planned disability absence such aschildbirth or prescheduled surgery. You should also notify yourHR Manager that you will be missing from work, and ask for aMissed Premium Deductions Form (see Plan Administration,for more information).Contact the Customer Service Center of AWD at1-800-937-7039 to obtain the necessary claim forms.When the claim form has been processed by AWD, you will benotified of the benefits payable. If any benefits have beendenied, you will receive a written explanation.15