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Highlights
Booklet
Effective January 1, 2010 Introducing Your Costco
Employee Benefits Program
REAL LIFE BENEFITS FOR THE
REAL WORLD
They say that life is a journey, made up of many events, big and small.
Marriage or divorce... children... a change of jobs... illness or injury...
getting older. These are real life events that happen to real people in
the real world.
Happy or sad, exciting or stressful, each event offers special challenges
— and often that means financial challenges. That’s where the
Costco Employee Benefits Program comes in. It includes plans that can
help you and your family handle many financial issues you may face in
your lives. This Benefits Highlights booklet is just a brief look at the Costco
Employee Benefits Program. It’s designed to be a companion to the
Costco Employee Benefits Program Summary Plan Description
(SPD) — the official document for Costco’s healthcare plans.
The SPD includes detailed information about our Program such as:
• Who’s eligible
• How to enroll
• What the plans cover, what they don’t
• How technical terms are defined
• How to file benefit claims
Your payroll or Benefits Representative will provide you with
the Summary Plan Description when you first become eligible
for coverage. You can also find the SPD, along with any benefit
updates, online at www.costcobenefits.com, the Costco Benefits
Web Site. For example:
• The high cost of medical, dental and other healthcare
• Loss of income if you become disabled
• Your family’s economic well-being if you were to die
• Day in, day out costs of paying for care of your dependents while
you work
• Healthcare expenses you pay out of your own pocket for yourself
and your family
• A time when you may need to pay for help with activities
of daily living
Maybe you’ve just begun your journey with Costco. Or, perhaps you’re
well along the path of your career with us. In either case, you owe it
to yourself to learn more about the benefits available to you as an
eligible employee — and how those benefits can work in your life.
Let this Highlights booklet be your map to the wide world of Costco
employee benefits.
This booklet updates or highlights only certain Program provisions
— it must be read in conjunction with the underlying Summary
Plan Description. This is not a promise of employment or guarantee
to continue employment for any length of time. Costco, through the
Benefits Committee, has the right, at any time, to amend, modify,
revoke or terminate the Plan or any of the benefits discussed in here,
in whole or in part. If there’s a discrepancy between this Highlights
Booklet and official Program documents or contracts, the underlying
Program documents and insurance contracts will determine plan
provisions and benefits payable. Documents and insurance contracts
are available from the Costco Employee Benefits Department. Officers
and employees of Costco at the various warehouse locations and
third parties are not authorized to represent the Plan Administrator or
to speak on behalf of the Program. The Program is not bound to any
oral or written communication that conflicts with official documents
or contracts. Costco Employee Benefits Program Highlights • 2010 1 Your Map to the World of Costco Benefits Page Benefit Information Resources
Have questions about your benefits? This is where to go to get answers..............................................................................................................................3
Eligibility and Enrollment
Once you’re eligible, Costco offers you a whole world of valuable benefits. Here’s what it takes to
become eligible, benefit options available to you, and how to enroll for the benefits of your choice. ................................................................................4
Healthcare Plans
What could be more important to your life than affordable healthcare coverage? As an eligible
employee, you can elect medical coverage for yourself and your family — and that includes lots
of other healthcare benefit plans, at no extra cost to you. Plus, choose a medical plan, and you’re
welcome to enroll for dental coverage.......................................................................................................................................................................................9
Medical Plans: Choice Plus, Choice Plus for Part-Time Employees, Freedom of Choice (HMSA hmo and ppo in Hawaii)................................................... 12
Summary of Medical Plans.................................................................................................................................................................................................... 14
Vision Care Plan............................................................................................................................................................................................................................ 16
Prescription Drug Program................................................................................................................................................................................................... 16
Care Network — “Confidential Assistance and Resources for Everyone!”............................................................................................ 17
Mental Health and Substance Abuse Plan.................................................................................................................................................................. 18
Smoking Cessation Program................................................................................................................................................................................................. 19
Dental Plans: Core Dental and Premium Dental....................................................................................................................................................... 20
What the Plans Don’t Cover................................................................................................................................................................................................... 21
Disability Insurance Plans
If you’re ever unable to work due to disability, that could seriously disrupt your life — and your finances.
These plans can replace a portion of your lost income until you’re ready to get back on your feet. .................................................................................22
Voluntary Short Term Disability Insurance ............................................................................................................................................................. 23
Long Term Disability Insurance.......................................................................................................................................................................................... 23
What the Plans Don’t Cover................................................................................................................................................................................................... 24
Survivor Benefit Insurance Plans
If anything ever happens to you, these plans can help make sure your family can go on with their
lives — just the way you would want them to. .....................................................................................................................................................................25
Basic Life Insurance.................................................................................................................................................................................................................... 26
Supplemental Life Insurance................................................................................................................................................................................................ 26
Basic and Supplemental AD&D Insurance..................................................................................................................................................................... 27
Business Travel Accident Insurance .............................................................................................................................................................................. 29
Reimbursement Accounts
Chances are, out of pocket costs for dependent care or healthcare expenses are a fact of life for
you. These plans offer two simple, convenient and rewarding ways to save money on what you pay..............................................................................30
Dependent Care Assistance Plan (DCAP)......................................................................................................................................................................... 31
Health Care Reimbursement Account (HCRA)............................................................................................................................................................... 32
Long Term Care Insurance Plan
Sometime in your life you may need ongoing help with everyday activities. Long term care is expensive
now — and likely to get even more costly in the years ahead. That’s where this insurance plan comes in.
It includes a Basic Benefit plus several Buy-Up options. .......................................................................................................................................................33 2 Costco Employee Benefits Program Highlights • 2010 Your Benefit
Information Resources Want to Know More? Costco Benefits Web Site, www.costcobenefits.com, for practically
anything you want to know about the Employee Benefits Program
including: .................................................................... www.costcobenefits.com • personalized information about your current coverage,
• benefit news and updates,
• healthcare provider directories, forms and booklets,
• links to Aetna and other plan sites, and
• direct e-mail to Costco Employee Benefits Department
• tools to improve your health
• access your personal health record
Costco Employee Benefits Department for general benefit
information, including questions about your eligibility, enrollment or
changes in your benefit status.
Your location payroll or Benefits Representative for benefit
materials, such as booklets, printed provider directories, and forms.
Insurance booklets for detailed information about Costco’s Disability
Insurance, Survivor Benefits, and Long Term Care Insurance plans.
These plans are insured, which means Costco has signed contracts
with various insurance companies to provide benefits. To obtain
insurance booklets or contracts, contact the Costco Employee Benefits
Department.
Your personal tax advisor to discuss tax issues related to your
benefits. The fact is, many Costco benefit plans offer tax advantages
— and that can be a definite plus for you. The trade-off is, as described
throughout this Highlights booklet, the plans and their benefits are often
subject to strict Internal Revenue Code rules. Your tax advisor can help
you sort out what these rules might mean in your personal situation. Costco Benefits Web Site
Costco Employee Benefits Department
From 7 am to 5 pm Pacific Time.....................................1-800-284-4882
E-mail...................................................................benefits@costco.com
link available at . ....................................... www.costcobenefits.com Informed Health Line
24 Hour/ 7 days a week access to
a registered nurse at Aetna............................................1-800-556-1555 Aetna Healthcare Plans
Medical, vision care, prescription drug..........................1-800-814-3543
Dental...............................................................................1-800-218-1458
Link to Aetna Navigator............................. www.costcobenefits.com Healthcare plans for Hawaii Employees
HMSA PPO and HMO medical........................................1-800-776-4672
Aetna vision and prescription drug.................................1-800-814-3543
Aetna dental.....................................................................1-800-218-1458 Care Network
To talk to a Unicare counselor or get approval of mental health or
substance abuse care benefits.......................................1-877-578-0528
Link to Care Network Web site................ www.costcobenefits.com Smoking Cessation Program
Healthways QuitNet®......................................................1-866-218-7719
Link to QuitNet® site.................................. www.costcobenefits.com Unum Insurance Plans
Disability (STD and LTD), Survivor
(Life and AD&D), Long Term Care...................................1-877-403-9348
Link to Unum web site............................... www.costcobenefits.com The Hartford Insurance
Business Travel Accident................................................1-800-523-2233 Reimbursement Accounts
Aetna, Plan Administrator...............................................1-888-238-6226
Link to Aetna FSA site............................... www.costcobenefits.com Costco Employee Benefits Program Highlights • 2010 3 Your Map to Costco
BENEFITS ELIGIBILITY AND
ENROLLMENT
Now it’s time to start learning about your Costco employee benefits
and how they can work in your life. To get you started on your journey,
here’s some general information about the Program.
Please see your Costco Employee Benefits Program Summary Plan
Description (SPD) for details about any information in this section,
including who’s eligible, when eligibility starts and ends, and how to
complete enrollment.
Plans at a Glance
• If you’re a U.S. Costco employee, you become eligible for
coverage after completing your eligibility waiting period.
• To stay eligible, you must average at least 20 paid hours per
week per Benefit Measurement Period.
• Your eligible family members include your spouse or
domestic partner and dependent children.
• You can make benefit elections when you’re first eligible,
during Annual Open Enrollment, or following certain
changes in your job or family status.
• You may enter elections online at www.costcobenefits or
via the Costco Enrollment Center, 1-800-541-6205.
• If you don’t enter your elections, you’ll automatically get
Default Coverage including employee-only healthcare
coverage.
• You’ll pay your share of the cost of coverage through
bi-weekly payroll deductions.
ELIGIBILITY FOR BENEFITS
The Employee Benefits Program is available to salaried and hourly
Costco employees in the U.S. If this includes you, when you first come
to work you must fulfill a benefit eligibility waiting period. Once you
complete this waiting period, you will become eligible the first of the
month after:
• date of hire (salaried employees and full-time hourly pharmacists
or senior hearing aid specialists)
• 90 days of service (most full-time hourly employees)
• 180 days of service for most benefits, 90 days of service for
Voluntary Short Term Disability Insurance (part-time hourly
employees)
• four weeks of service (Hawaii employees who have worked at
least 20 hours per week) Employees in a college student retention program who accept regular
positions become eligible the date of the change in status, provided
they’ve fulfilled the applicable eligibility waiting period. Employees
who transfer into a U.S. location from another country are eligible the
day of the transfer.
Special eligibility and enrollment rules apply to the Voluntary
Short Term Disability and Long Term Care Insurance Plans. To
find out more, see the descriptions of those plans later in this
Highlights booklet.
Who’s Not Eligible. Examples of individuals who are not eligible
include seasonal or utility employees (except in Hawaii), limited
part-time employees, independent contractors, leased employees,
temporary employees, interns or anyone hired in connection with
training or education.
Maintaining Your Eligibility. If you’re an hourly employee, Costco
adds up all your paid hours (excluding sick leave pay off) during one
Benefit Measurement Period. Then we divide the total number by the
weeks in that period, taking into account such factors as any time spent
on approved leave of absence.
That results in your average number of paid hours per week for that
period, which will be used for the following purposes. The Costco
Employee Benefits Department will notify you if any of these situations
apply to you:
1. To determine your eligibility for benefits. To stay eligible,
you must average at least 20 paid hours per week. If you
average less than that during one Benefit Measurement
Period, you’ll lose eligibility for the following period. Then
you’ll regain eligibility after any Measurement Period during
which you again average 20 hours or more per week.
2. To determine your eligibility for “part-time” versus
“full-time” benefit options. Costco offers full-time
employees the Choice Plus and Freedom of Choice medical
plan options and Core and Premium dental plan options.
Part-time employees are limited to Choice Plus for Part-Time
Employees and Core Dental. However:
• if you’re a full-time employee, to have the full-time options
you must maintain an average of 34 paid hours per week.
• If you average less than that during one Benefit
Measurement Period, you’ll be limited to part-time options
for the following period.
• You’ll regain eligibility for full-time benefit options after any
measurement period in which you again average at least 34
paid hours per week.
Costco’s fiscal year includes two Benefit Measurement
Periods, each made up of 13 biweekly pay periods. These
generally run from:
1. Early September through February
2. Early March through August. 4 Costco Employee Benefits Program Highlights • 2010 Eligibility for Your Family. If you’re eligible for Costco employee
benefits, so are these family members:
1. Your spouse
2. Unmarried dependent children through age 18 (through
age 22 if full-time students at an accredited school). This
includes:
• Your biological and adopted children
• Your step-children who meet the requirements spelled out in
the “Declaration of Plan Eligibility for Step-Children.”
• Children for whom you or your spouse serve as legal
guardian if you meet the requirements spelled out in the
“Declaration of Legal Guardianship.”
Declaration forms are available at www.costcobenefits.com or from
your payroll or Benefits Representative.
3. Your disabled children if they are unable to support
themselves due to physical or mental disability. To be eligible
for coverage past the normal age limits, these children must
meet certain requirements, for example, they must:
• have been disabled and enrolled in a Costco medical plan
before age 19 (age 23, if full-time students) and
• be pre-approved for continued coverage by the plan
administrator. To find out more, be sure to contact Aetna
(HMSA in Hawaii) at least 31 days before your child will
reach the normal age limit.
The first time you enroll your family members, you’ll need to provide
Costco with proof of their relationship to you. When you enroll, the
enrollment system will let you know what’s considered “acceptable
proof.” Examples include state-certified marriage certificates, statecertified birth certificates and, for children age 19 through age 22, proof
of their full-time student status. You will be asked to confirm dependent
eligibility each year during Annual Open Enrollment.
If Costco receives a Qualified Medical Child Support Order
(QMCSO) for your child and we determine that child is otherwise
eligible: • To complete enrollment, you’ll have to sign and submit the
“Declaration of Domestic Partnership” form to the Costco
Employee Benefits Department along with proof of your
relationship.
• The cost of your domestic partner’s and children’s coverage
will be withheld from your paycheck on an after-tax basis. The
“imputed value” of that coverage is included as part of your
taxable income.
Eligibility While on a Leave of Absence. As described in the Costco
Employee Agreement, Costco recognizes a variety of paid and unpaid
leaves. This includes leaves under the Family and Medical Leave Act
(FMLA).
While you’re on an approved leave of absence, your eligibility for benefit
coverage will continue for a period of time based on your service at the
time of leave. For example, if you have one or more years of service,
Costco will continue coverage for you and eligible family members for
up to six months.
If you go on a leave of absence for one of the following
reasons, you may qualify for an extended period of coverage:
• maternity (in some states),
• military service, or
• terminal illness.
To discuss your situation, be sure to call the Costco Employee
Benefits Department, 1-800-284-4882.
When Eligibility Ends. Your coverage will end when you’re no longer
eligible for the Costco Employee Benefits Program. This will happen,
for example:
• The date your employment ends for any reason, including
retirement.
• March 31 or September 30 after any Benefit Measurement Period
during which you averaged less than 20 paid hours per week.
• The date your employee classification changes if you haven’t
completed the eligibility waiting period for the new classification. • We’ll enroll him or her (and you, if you’re not already
enrolled) for healthcare coverage. • The last day of your continued coverage period while on an
approved leave of absence. • Your share of the cost of coverage will be deducted from
your paychecks. • The last day of a leave of absence if you don’t return to work. For a copy of Costco’s QMCSO policies, please contact the Costco
Employee Benefits Department.
Eligibility for Your Domestic Partner. Your domestic partner
is eligible for coverage if your partnership meets the requirements
described in detail in the “Declaration of Domestic Partnership” and
overview. These are available online at www.costcobenefits.com or
from your payroll or Benefits Representative.
• If your domestic partner is eligible for coverage, so are his or her
unmarried dependent children. The enrollment periods for eligible
domestic partners and their children are the same as for any
other eligible family members. • The last date for which you fail to make any required
contributions.
Coverage for your family will end when your eligibility ends or if you
die. Also, eligibility for individual family members will end when they
no longer meet the Program’s eligibility requirements. For example, this
could happen for your spouse if you get divorced, even if your divorce
decree requires you to provide health care, and for your children if they
no longer qualify as dependents for tax purposes. Costco Employee Benefits Program Highlights • 2010 5 YOUR BENEFIT CHOICES
You can pick the available Costco Employee Benefits Program options
you want, enroll eligible family members — even decline coverage
and choose an alternative benefit package. To make elections, you
must enter your choices online at www.costcobenefits.com or via the
Enrollment Center, 1-800-541-6205.
Costs for Your Benefit Choices. You and Costco will share in the
cost of medical and dental coverage — how much you pay will depend
on your plan options and how many family members you enroll. For
example, you’ll pay a share of the cost for each enrolled child, up to a
maximum of four children.
You’ll pay the full cost if you elect Voluntary Short Term Disability,
Supplemental Life, AD&D and — if you have less than 10 years service
— Long Term Care Insurance. If you participate in the Dependent
Care Assistance Plan (DCAP) and Health Care Reimbursement Account
(HCRA), you will make all those contributions, too.
Your share of the costs will be withheld from your bi-weekly paychecks
throughout the year:
• Contributions from each paycheck are used to pay for your coverage
through that pay date. Your Basic Benefit Package. Electing medical plan coverage will
give you the widest range of benefit choices. This includes:
1. Automatic at no extra cost to you:
• Vision Care and Prescription Drug Programs
• Care Network
• Mental Health and Substance Abuse Care Plan (in Hawaii,
available through HMSA)
• Smoking Cessation Program
• Basic Life and AD&D Insurance
• Business Travel Accident Insurance if you’re a salaried
employee
• Long Term Disability Insurance
• Long Term Care Insurance Basic Benefit (if you have 10 or
more years of service)
2. Elective at an additional cost:
• Dental
• Voluntary Short Term Disability Insurance, for hourly
employees in states where this plan is available
• Supplemental Life and AD&D Insurance • Depending on when your coverage begins, contributions for coverage
before that pay date may also be withheld. • Dependent Care Assistance Plan • Your contributions for medical and dental coverage and to the DCAP
and HCRA will be deducted b...
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