What can I expect from my Aetna medical plans?

RETIREES UNDER 65

GRP_13_100 (5/13)

The Network Option Plan*

What it is This plan lets you choose health care professionals and facilities in or out of network. Your plan, available through RHA, is a Network Option Plan.

How it works You are required to meet an annual deductible each year.

What’s special Key features and benefits to consider when looking at this plan:

• Your preventive care is paid in full.

• No deductible for preventive care if certain in-network providers are used.

• There is an out-of-pocket cap on expenses. (Once you meet the out-of-pocket maximum, the plan pays 100% of the remaining covered expenses for the rest of the year.)

• The Network Option High (HDHP) SA plan is compatible with the requirements of the Health Savings Account (HSA). You can use the HSA to offset higher out-of-pocket expenses of a high-deductible health plan.

A Health Savings Account is a tax-advantaged account that allows money to go in tax free, earn interest tax free and is not taxed when money is withdrawn to pay for qualified expenses.

What you should know Important facts to keep in mind when reviewing this plan:

• If you choose in-network providers, you will pay less out of pocket.

• To find a doctor, hospital or other health care provider in your network, visit DocFind® at www.aetna.com/docfind/custom/rhagroup or call a representative to help you at 1-800-891-6779 TTY/TDD: 711 Monday through Friday, 8 a.m. to 9 p.m. Eastern Time.

• For some benefits, once you meet the deductible, you may share in any remaining expenses.

• Under some plans, you may be required to pay a fixed fee or copay for a covered service. Some plans require you to pay a combination of copays and coinsurance.

• To understand how cost sharing works, please review your plan documents.

• All Network Option Plans available to you use the same provider network.

*The Network Option Plan includes Aetna Open Access® Managed Choice® Network or Aetna Open Choice® Network Option Plan or the Aetna Choice® POS II Plan.

Aexel®: The high performance network

Aexcel®: The high performance network Available through a Network Option Plan, Aexcel offers both inpatient and outpatient specialist services. When you select an Aexcel-designated specialist, you may have a lower copay or coinsurance. Aexcel specialists meet a variety of standards established by leading health organizations, such as the American Heart Association, American College of Obstetricians and Gynecologists and the Centers for Medicare & Medicaid Services.

The Indemnity (Traditional Choice) Plan*

What it is If you are offered a Network Option Plan but live outside the area it serves, you can enroll in the Indemnity Plan.

How it works After you meet the annual deductible, the plan pays a percentage of covered expenses (coinsurance) and you pay the rest.

What’s special Key features and benefits to consider when looking at this plan:

• There is an out-of-pocket cap on expenses. Once you meet the out-of-pocket maximum, the plan pays the remaining covered expenses at 100% for the rest of the year.

• Preventive care is paid in full.

• There is no deductible for preventive care.

What you should know Important facts to keep in mind when reviewing this plan:

• The Indemnity Plan lets you visit any licensed provider when you need care.

*The Traditional Choice Plan is considered an out-of-area or indemnity plan.

Aexcel®: The high performance network Available through a Network Option Plan, Aexcel offers both inpatient and o

Health plan comparison chart Access, affordability, choice

How to get the most from these charts

RETIREES UNDER 65

GRP_13_127 (5/13)

Access, affordability, choice Our retiree health plans are designed to help you stay well. We offer health benefits for retirees that make it easy as well as affordable to get the appropriate care. For most benefits, you will pay applicable fees or copays after you meet your deductible. As part of our commitment to help keep you healthy, preventive care is paid in full. This means you will pay $0 for preventive care services.

In-network preventive services include:

• Routine physical exams/immunizations (one exam every 24 months/pneumonia, flu, hepatitis B)

• Routine gynecological care exams (one routine ob/gyn visit and Pap smear per calendar year)

• Routine mammograms for female members

• Routine prostate-specific antigen (PSA) test and digital rectal exam (DRE) for male members

• Routine eye exam (one exam every 24 months, subject to cost sharing)

• Routine hearing screening (one exam every 24 months, subject to cost sharing)

Please keep in mind this is not a complete listing of benefits. Following your enrollment, you will receive a Booklet Certificate and Summary of Coverage (SOC). It explains the full terms of your plan and how it works. This includes a complete description of benefits, exclusions, limitations and conditions of coverage. You can also visit the Aetna Navigator® member website. Aetna Navigator is a secure website (www.aetnanavigator.com) available to you 24 hours a day, 7 days a week. For more information, contact a representative at 1-866-643-8742 TTY/TDD: 711 Monday through Friday, 8 a.m. – 9 p.m., Eastern Time.

Note: You first need to register on the Aetna Navigator site to get your protected user name and password.

• Go to www.aetnanavigator.com

• Use the First Time User box to register

• Follow the instructions

If you are already registered, then go to www.aetnanavigator.com and log in with your user name and password anytime!

How to get the most from these charts: The Home Depot has partnered with Retiree Health Access® (RHA®) to help you stay healthy. But for that to happen, you need to know your options. The following charts will help you find the plan that’s best for you.

1. Look Review the plan features, including the annual deductible, preventive care services and physician services. Compare what is the same or different about each plan. Be sure to match the health plan you choose to the corresponding prescription drug plan.

2. Consider Think about the type of plan(s) you want to know more about. Include any key features and their related expenses. Jot down any questions you may have.

3. Refer To find out more about your health plan or prescription drug plan, please refer to this guide.

Please refer to your Personal Enrollment Worksheet to see which plans you are eligible to enroll in. Not all of the plans in these charts may be available to you depending on where you live.

Medical Plan Benefits

Preventive Care Services

Routine Eye and Hearing Screening (One exam every 24 months) Physician Services

Primary Doctor Office Visit

Specialist Office Visits†

(Includes outpatient mental health and substance abuse)

X-ray and Lab Services (During office visit)

Emergency Services

Emergency Room (Copay waived if admitted)

Ambulance

Hospital Services

Hospital Admission (Includes mental health and substance abuse)

Outpatient Hospital

Skilled Nursing (Max. 60 days), Home Health (Max. 120 days) and Urgent Care

X-ray and Lab (Outpatient)

Outpatient Therapy and Chiropractic Care

DME/Prosthetics ($10,000 annual max—applies to DME only)

The coinsurance percentage shown applies after you meet the annual deductible.

Annual Deductible

Coinsurance

Out-of-Pocket Maximum (Includes deductible; excludes all copays and penalty amounts)

Specialist Services†

(Other than office visit)

Alternatives to Hospital Care

Other Services

Network Option Value SA† Value Indemnity SA

In-Network

$7,500 Individual§

$15,000 Family§

20%

$10,000 IndividualΩ

$20,000 FamilyΩ

(includes Rx expenses)

$0; deductible waived

20%; deductible waived 20% for designated specialists; 30% for non-designated specialists

20% for designated specialists; 30% for non-designated specialists

20% (deductible waived if primary care office visit)

20%

20%

20%

20%

20%

20%

20%

20%

Out-of-Network∏

$7,500 Individual§

$15,000 Family§

40%

$15,000 IndividualΩ

$30,000 FamilyΩ

(includes Rx expenses)

40%

40%

40%

40%

40%

20%

20%

40%

40%

40%

40%

40%

40%

Retirees not in Network Area $7,500 Individual§

$15,000 Family§

20%

$10,000 IndividualΩ

$20,000 FamilyΩ

(includes Rx expenses)

$0; deductible waived

20%; deductible waived 20%

20%

20% (deductible waived if primary care office visit)

20%

20%

20%

20%

20%

20%

20%

20%

Network Option High (HDHP) SA† High (HDHP) Indemnity SA

In-Network

$1,500 Individual§

$3,000 Family§

20%

$3,600 IndividualΩ

$7,200 FamilyΩ

(includes Rx expenses)

$0; deductible waived

20%

20% for designated specialists; 30% for non-designated specialists

20% for designated specialists; 30% for non-designated specialists

20%

20%

20%

20%

20%

20%

20%

20%

20%

Out-of-Network∏

$1,500 Individual§

$3,000 Family§

40%

$10,000 IndividualΩ

$30,000 FamilyΩ

(includes Rx expenses)

40%

40%

40%

40%

40%

20%

20%

40%

40%

40%

40%

40%

40%

Retirees not in Network Area $1,500 Individual§

$3,000 Family§

20%

$3,600 IndividualΩ

$7,200 FamilyΩ

(includes Rx expenses)

$0; deductible waived

20%

20%

20%

20%

20%

20%

20%

20%

20%

20%

20%

20%

† Check your Personal Enrollment Worksheet to find out whether the Retiree Health Access® plan option(s) available to you feature the Aexcel® network (designated specialists). Aexcel is a physician designation within Aetna’s Performance Network that includes high performance specialists (cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedic surgery, otolaryngology, plastic surgery, urology and vascular surgery).

∏ Member coinsurance and deductible share for non-network plans are based on reasonable and customary fees.

§ Once the family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year. There is no individual deductible to satisfy within the family deductible.

Ω Once the family out-of-pocket maximum is met, all family members will be considered as having met their out-of-pocket maximum for the remainder of the calendar year. There is no individual out-of-pocket maximum to satisfy within the family out-of-pocket maximum.

What can I expect from my Aetna prescription drug plan?

RETIREES UNDER 65

GRP_13_100 (5/13)

Prescription Drug Plan

What it is This plan provides coverage that helps you pay the cost of prescription drugs.

How it works • You can fill prescriptions at more than 60,000 network pharmacy locations.

• You simply pay your cost-sharing amount at the pharmacy. Virtually no paperwork.

What’s special Key features and benefits to consider when looking at this plan:

• You pay a coinsurance or copay subject to a maximum for each prescription with no deductible required.

Aetna Rx Home Delivery® service

You can order up to a 90-day supply of medications you use regularly when you have them delivered to your home or another location of your choice. There is no cost for standard shipping.

Aetna Specialty Pharmacy®

You can get:

• Free, confidential delivery at home or any other location you choose

• Safe, fast delivery

• Refrigerated, insulated packaging of your prescriptions

• 24/7 phone support

• Free, standard supplies for self-injectable medications

• Educational materials

• Medications not normally available through a retail pharmacy

Network Option High (HDHP) SA

High (HDHP) Indemnity SA

$0 after annual medical deductible

25% after annual medical deductible

50% after annual medical deductible

$0 after deductible

25% after deductible

50% after deductible

In-Network

$0 after annual medical deductible

25% after annual medical deductible

50% after annual medical deductible

Not applicable

Not applicable

Not applicable

Out-of-Network

$0 after annual medical deductible

25% after annual medical deductible

50% after annual medical deductible

$0 after deductible

25% after deductible

50% after deductible

Retirees not in Network Area

Network Option Value SA Value Indemnity SA

$20 copay after annual medical deductible¥

$40 copay after annual medical deductible¥

$60 copay after annual medical deductible¥

$40 copay after deductible¥

$80 copay after deductible¥

$120 copay after deductible¥

In-Network

$20 copay after annual medical deductible¥

$40 copay after annual medical deductible¥

$60 copay after annual medical deductible¥

Not applicable

Not applicable

Not applicable

Out-of-Network

$20 copay after annual medical deductible¥

$40 copay after annual medical deductible¥

$60 copay after annual medical deductible¥

$40 copay after deductible¥

$80 copay after deductible¥

$120 copay after deductible¥

Retirees not in Network Area

¥ Deductible waived for certain chronic and preventive medicines.

Retail Pharmacy (30-day supply)

Generic

Preferred Brand

Non-Preferred Brand

Mail-Order Pharmacy (90-day supply)

Generic

Preferred Brand

Non-Preferred Brand

Prescription Drug Plan Benefits

What can I expect from my Aetna dental plan?

RETIREES UNDER 65

GRP_13_100 (5/13)

Aetna Dental® PPO* Plan

We offer affordable coverage on dental cleanings, X-rays, restorative work and more. Choose any dentist in or out of our network.

Participating dentists have agreed to offer services at a special rate, so you will generally pay less out of pocket for your care when you visit a dentist who participates in our network. No referral is needed for covered services.

It's a snap to manage your dental benefits, just visit www.aetna.com to:

• Find a network dentist through our DocFind online directory

• Get estimated average costs for cleanings, X-rays and more

• Check claims and statements

• Request replacement ID cards

*In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).

Dental insurance plans contain exclusions and limitations. Dental PPO plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Policy form numbers in Oklahoma include: GR-9, and/or GR-9N, GR-23, GR-29 and/or GR-29N.

Dental plan benefits All Retirees — Under and over 65

1Only participating dentists have agreed to negotiated rates for Aetna members. Costs may be higher when a member obtains services outside the Aetna network.

2Members who visit a licensed dentist who does not participate in the Aetna network may be subject to balance billing (the difference between the amount covered by the plan and the amount charged by the dentist).

*The deductible applies to: basic and major services.

Aetna Dental® Indemnity For Retirees not in Network Area $100 $200 No coinsurance2

Pay 50%2

Pay 50%2

$1,000

In-Network

Out-of-Network

Annual Deductible* Single Annual Deductible* Family Preventive Services Basic Services Major Services Annual Benefit Maximum

$100 $200 No coinsurance1

Pay 50%1

Pay 50%1

$1,000

$100 $200 No coinsurance2

Pay 50%2

Pay 50%2

$1,000

Plan features

Aetna Dental® PPO Plan

RETIREES UNDER 65

Partial listing of services

Preventive Services Basic Services Major Services

-Oral examinations(a)

-Cleanings, including scaling and polishing(a) adult/child

-Bitewing X-rays(a)

-Full mouth series X-rays(a)

-Space maintainers

-Root canal therapy, with X-rays and cultures

-Anterior teeth/Bicuspid teeth -Amalgam (silver) fillings -Composite fillings (anterior teeth only)

-Stainless steel crowns -Scaling and root planing(a)

-Gingivectomy (b)

-Incision and drainage of abscess (b)

-Uncomplicated extractions -Surgical removal of erupted tooth(b)

-Surgical removal of impacted tooth (soft tissue)(b)

-Root canal therapy, with X-rays and cultures

-Osseous surgery (a)(b)

-Surgical removal of impacted tooth (partial bony/full bony)(b)

-General anesthesia/intravenous sedation (b)

-Inlays -Onlays -Crowns -Full and partial dentures -Denture repairs -Pontics -Crown Lengthening -Crown Build-Ups

(a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate or Evidence of Coverage.

(b) Certain services may be covered under the Medical Plan. Contact Member Services for more details.

– Eligibility rules apply for all plans.

– This material is for informational purposes only.

– Not all services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.

– In the event of a conflict or inconsistency between this material and plan documents, the terms of the plan documents shall govern.

– State mandates may apply. All products may not be available in all states.

These benefit summaries are provided by Aetna Life Insurance Company. Under the Aetna Dental® Preferred Provider Organization (PPO) plans, you may choose at the time of service to visit either a PPO network dentist or any out-of-network licensed dentist. With the PPO plan, savings are possible because the network dentists have agreed to provide care at a negotiated fee. Out-of-network benefits are subject to reasonable and customary charge limits. Under the Indemnity plan, you may choose to visit any licensed dentist and benefits are subject to reasonable and customary charge limits.

Now What?

How to enroll

What will I get after enrolling?

What do I do if I have questions?

What information is available online after I enroll?

GRP_13_100 (5/13)

How to enroll To enroll over the phone, call: 1-866-643-8742 TTY/TDD: 711 To enroll online, go to: www.RHAGroup.net

What will I get after enrolling?

What to expect next When you can expect it

Benefit Confirmation Statement Letter stating we have processed your enrollment. You also get an application to start automatic withdrawal of premium payments from a checking account.

Approximately 1 to 2 weeks after your enrollment is received

Premium payments Payment options include automatic withdrawal or monthly paper statement. If you’ve recently enrolled in Automated Clearing House (ACH), contact the Aetna Retiree Service Center before sending your initial payment.

Premium payments due 1st of each month

Approximately 90 to 120 days from effective date, you can view online at www.aetnanavigator.com or request a print copy by calling the Member Services phone number on your ID card

Booklet Certificate and Summary of Coverage Provides a full explanation of how your plan works.

Member ID card Member ID card to share with providers.

Approximately 1 to 2 weeks prior to your effective date

What do I do if I have questions?

What you need Where to get it

I have questions about my plan, billing, eligibility and/or enrollment information.

Retiree Service Center 1-866-643-8742 TTY/TDD: 711 Monday through Friday 8 a.m. – 9 p.m., Eastern Time www.RHAGroup.net

I need help with claims, using my plan or locating a doctor.

Member Services See your Member ID card for contact information

Aetna Navigator www.aetnanavigator.com

I need to print temporary ID cards, review coverage, search the formulary and/or locate a provider.

I need a 24-hour toll-free nurse hotline. Informed Health Line 1-800-556-1555

I need an easy-to-use online resource that uses interactive tools and pictures to help me learn more about my health.

I need mail-order prescription drug refills and status information.

Aetna InteliHealth www.intelihealth.com

Aetna Rx Home Delivery* See your Member ID card for contact information

*Applicable for Retiree Health Access prescription drug plans.

What information is available online after I enroll? Access Aetna’s secure member website, Aetna Navigator®, to learn about:

• Benefits information so you can better understand your plan

• Claims information, such as claim status and Explanation of Benefits statements

• Cost-of-care tools that provide the estimated average cost of procedures, office visits, tests and more

• A hospital comparison tool

• Self-service features such as requesting a replacement ID card

• Reliable, current health information through links to Aetna InteliHealth®, Aetna’s award-winning health and wellness website

Disclaimers

Disclaimers Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc. and/or Aetna Life Insurance Company.

This material is for informational purposes only. Not all health services are covered. See the Personal Enrollment Worksheet for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians before making a decision. Designations have the risk of error and should not be the sole basis for selecting a doctor. Aetna receives rebates from drug manufacturers that may be taken into account in determining the Aetna Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Pharmacy clinical programs such as precertification, step therapy and quantity limits may apply to your prescription drug coverage. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Both are licensed pharmacy subsidiaries of Aetna, Inc. that operate through mail order. The charges that Aetna negotiates with Aetna Rx Home Delivery and Aetna Specialty Pharmacy may be higher than the cost they pay for drugs and the cost of the mail order pharmacy services they provide. For these purposes, the pharmacies’ cost of purchasing drugs takes into account discounts, credits and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount programs provide access to discounted prices and are not insured benefits.

The Aetna Personal Health Record (“PHR”) should not be used as the sole source of information about the member’s medical history. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

State mandates may apply. Product availability may vary by state.

Retiree Health Access® reserves the right to change or terminate benefit plans at any time. Retiree Health Access® and RHA® are registered trademarks of Health Care Roundtable, LLC, used under license with Health Care Policy Roundtable. All rights reserved.

GRP_13_109 (5/13)