Quick Chek Medical-HSA Users Guide

Quick Chek Plan Your Medical and Health Savings Account User’s Guide

Quick Chek is committed to being “A Great Place to Work” and to building on our culture of health and wellness. We want you, our team members, and your spouse, if covered by a Quick Chek medical plan, to have the information you need to make healthy lifestyle choices. This guide provides you with the information you need to make the best use of your Quick Chek medical plan to stay healthy and to save money. This User’s Guide is intended to help you have a better understanding of how your medical plan works on a day-to-day basis and what you need to do to ensure you use the plan well. You should also keep this as a reference guide for when you have questions in the future. If you have any questions about the information in this guide, you can contact your Leader Advocate. Your Leader Advocate is your Store Leader or Department Leader. If you need additional assistance, you can contact the benefits team: Linda Solt at (908) 534-7263, Nancy St. Miklosy at (908) 534-7274, or Nancy Rumpf at (908) 534-7159.What’s InsideOverview of the Quick Chek Plan . . . . . . . . 1Quick Chek Plan Features . . . . . . . . . . . . . . 2Enrolling in the Quick Chek Plan . . . . . . . . 4How to Use the Quick Chek Plan . . . . . . . . 7Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Overview of the Quick Chek PlanThe Quick Chek Plan, either the Healthy Choice or Standard, are considered High Deductible Health Plans (HDHP).The HDHP has two components that work together; the medical plan portion and a Health Savings Account (HSA). Medical Plan — Quality Network and Features The Quick Chek Plan has many of the same features as a more traditional medical plan. I A quality network of doctors and hospitals through Aetna. I Flexibility to receive in- or out-of-network coverage, with higher benefits for in-network coverage. I After you meet the annual deductible, you and the Quick Chek Plan share in the cost of coverage with coinsurance. I An out-of-pocket maximum to protect you from the expense of catastrophic illness or injury. + Health Savings Account (HSA) I When you contribute to the HSA, Quick Chek will also contribute to your HSA — $500 if you cover only yourself, and $1,000 if you cover any dependents — to help you pay for health care expenses throughout the year. I Funds you don’t use this year will roll over and be available in future years, so you can decide when you want to take advantage of Quick Chek’s HSA contribution. = Quick Chek Plan When you add the two components together you get: I A medical plan that offers comprehensive benefits with flexible coverage and a Health Savings Account. I The Quick Chek Plan with HSA helps you stay healthy by covering 100% of the costs of in-network preventive care services and encourages you to spend your health care dollars wisely.The Quick Chek Plan has a higher deductible than other medical plans that you must meet before the plan starts payingbenefits. But with the HSA, you have an opportunity to save money on a pre-tax basis that you can use to pay for youreligible medical expenses. Also, when you contribute to the HSA, Quick Chek also contributes to your account. 1

Quick Chek Plan FeaturesFeature How it WorksDeductibles • A deductible is the amount you pay for medical services and prescriptions before the Quick Chek PlanCoinsurance will begin to pay a share of the costs. • The in-network deductible for single coverage is $1,500 and $3,000 for family coverage. The deductibles are higher for out-of-network coverage. • You can use the funds in your HSA to help pay the deductible. • The deductible does not apply to certain preventive care services or preventive care prescription medications. • Coinsurance is the percentage of the cost for care that you pay and the Quick Chek Plan pays. • After you meet the in-network deductible, the Quick Chek Plan will pay 80% of the Aetna negotiated rate and you will pay 20% of this discounted rate. • The coinsurance amounts are different for out-of-network care. The Quick Chek Plan will pay 60% of what Aetna considers reasonable and customary and you are responsible for 40% of this amount. • You can use the funds in your HSA to help pay your portion of the coinsurance. • The out-of-pocket maximum is designed to protect you from the high cost of medical expenses. Once you reach the out-of-pocket maximum, the Quick Chek Plan will cover 100% of your costs.Out-of-Pocket • The in-network out-of-pocket maximum for single coverage is $2,500 and family coverage is $5,000.Maximum The individual out-of-pocket maximum only applies if you are enrolled in the single option. • The IRS defines “family” coverage as any coverage that includes one or more family members. • All expenses for covered services paid by you or any family member are totaled to the out-of-pocket maximum. • All family members have a share in the cost until the out-of-pocket maximum is met, then the Plan will provide 100% coverage for the family. Note: Out-of-network care is subject to what Aetna considers reasonable and customary.Health • This is the medical savings component of the Quick Chek Plan. It is a federally qualified Health SavingsSavings Account (HSA), which is a bank account regulated by the IRS.Account • The IRS requires that an HSA must be combined with a high deductible health plan, like the Quick Chek Plan. Federal regulations also designate maximum annual contribution limits. Contributions to an HSA can be made by Quick Chek and by team members. You can use the funds in this account to help pay for the deductible and coinsurance, however, you are not required to do so. • To be eligible for Quick Chek contributions, you must first elect to make your own contributions to the HSA. When you contribute, Quick Chek will also contribute up to $500 for single coverage and up to $1,000 for family coverage. • The contributions you make are deducted from your paycheck on a pre-tax basis which may lower your taxable income. Any interest earned on these funds is tax-free too. And, when you withdraw the funds, you do not pay any taxes either. • You can use funds from the HSA to pay for eligible health care expenses. This includes the deductible and coinsurance. • See page 5 for more information and how to get started. 2

To see how the Quick Chek Plan works, think of your health care costs like a two-story house:You pay deductibles and coinsurances Out-of-Pocketuntil you hit the out-of-pocket maximum Limitfor the year. Then, the Quick Chek Planpays 100% for covered medical expenses.You pay nothing.Once you meet the annual deductible, Coinsurance Health Savingsyou share in the cost of services by Deductiblepaying coinsurance. You can use money Account (HSA)from your HSA to pay these amounts. A tax-advantaged savingsYou pay the full cost of covered services account that you can use toup to the deductible. You can use money meet your deductible, payin your HSA to satisfy the deductible. coinsurance, and reach your out-of-pocket maximum. Or, you can save it for future health expenses.The Quick Chek Plan provides preventive Preventive Carecare, such as annual physicals and (100%)screenings, at no cost to you when youuse a provider in the network. I You are protected, by both foundation and roof, from the cost of routine preventive care you need to stay well, and the high cost of care if you have a serious illness or injury. I In between is the care you need for illnesses or injuries. Both you and Quick Chek share in the cost of this care through the deductible and coinsurance: – On the “first floor” is the deductible, the first out-of-pocket expenses to pay. Quick Chek’s and your contributions to your HSA can help offset the cost of this deductible. – On the “second floor” is coinsurance based on the negotiated discounted cost (recognized charge). If you use in-network providers, the plan pays 80% of eligible charges after you meet the deductible, and you pay the other 20% — up to the out-of-pocket maximum. I Once your deductible and coinsurance reach the out-of-pocket maximum, the Quick Chek Plan pays 100% of any additional eligible expenses (medical and prescription drug) for the year. (Note: Out-of-network care is subject to what the plan Aetna considers reasonable and customary.)Under the Quick Chek Plan, all eligible charges for non-preventive care — including prescription drugs and office visits —are subject to the deductible. 3

Enrolling in the Quick Chek PlanWhen you become eligible for medical benefits, you can enroll in the Quick Chek Plan. As a new hire in your first year, youare eligible for the Quick Chek “Healthy Choice” Plan without having to meet the qualifiers. In future plan years, you willneed to meet the qualifiers to be eligible for the Healthy Choice Plan. Speak to your Leader Advocate about the qualifiersin place today. You will receive a Qualifier Toolkit with more information when you are required to complete them. If youchoose not to meet the qualifiers, you will be eligible for the Quick Chek “Standard” Plan. Both the Healthy Choice andStandard Plans provide the same level of benefits; however, the weekly premiums you pay for coverage are higher under theStandard Plan than the Healthy Choice Plan.The Health Savings AccountWhen you enroll in the Quick Chek Plan, you are also eligible to contribute to the Health Savings Account (HSA). Whenyou choose to contribute to the HSA, Quick Chek will also contribute. Quick Chek’s contribution will be pro-rated in the firstyear you enroll, based on when the first contribution is deducted from your paycheck. In future years you will receive thefull amount. Maximum Team Quick Chek Member Contribution Contribution*Team Member Only $2,550 $500Team Member + One or More $5,150 $1,000Family Members*Pro-rated in the first yearExample in first yearYou have team member only coverage and begin contributing to the HSA with 32 weeks left in the plan year. Quick Chekwill contribute $9.62 per week based on a total of $500. In the first year, you would receive a contribution from Quick Chekequal to $307.84 ($9.62 x 32).To receive the Quick Chek contribution, you can contribute as little as $1.00 per week; $52 a year. 4

How to Get StartedOnce enrolled in the Quick Chek Plan and you decided to contribute to the HSA, there are other important steps that youneed to complete. This chart shows the process you need to follow to begin HSA contributions.You enroll in the Quick Chek Plan with Health Savings Account. Your information is sent to Aetna (who administers the medical plan) and JP Morgan Chase (JPMC) (who maintains your HSA). JPMC runs your information through a data verification process.They need to confirm that your name, social security number, date of birth,and address all match. The government requires that this process be done.If your data is confirmed... If your data doesn’t pass all four checks, you will receive If you respond and a letter from JPMC asking you your data is confirmed... to correct your information. You must respond to this letter to get your HSA started! You get your HSA debit card! If you don’t respond to their letter, JPMC will send you two more letters You must activate it by calling thenumber on the card. It’s just like a real reminding you to respond. credit or debit card — you need to If you do not respond to the letters, confirm that you received it you will not be able to contribute before it will start to work. to the HSA and receive the Quick Chek contribution. After you activate the card, you must call Linda Solt at(908) 534-7263 to choose how much to contribute to your HSA each paycheck, and to choose a beneficiary for your account. Now you will begin making deposits on a weekly basis, and you are ready to start using your HSA. 5

How the HSA WorksOnce you are ready to contribute to the HSA, you need to know how it works. Here is an overview.1 Your HSA is set up as an interest-bearing account in your name — you own it.2 You can use your HSA as your personal health care savings account. You even receive a debit card to access the money for eligible expenses. If you choose to make contributions to the HSA, Quick Chek will contribute up to $500 for team member only3 coverage and up to $1,000 for all other coverage levels. Contributions are made on a weekly basis and are available for use only after they have been deposited into your account.4 Your contributions are deducted from your paycheck on a pre-tax basis, therefore lowering your taxable income. You decide how much to save from your paycheck. Consider contributing enough so that your money, combined with Quick Chek’s, will cover your deductible.5 Using pre-tax dollars to meet the deductible means savings for you. Note that any HSA contributions you make through payroll deductions would be in addition to your medical plan premiums you pay for the Quick Chek Plan. You can use your HSA to pay for eligible medical expenses such as deductibles, coinsurance, as well as items6 that are not covered by the medical plan (vision care, dental and orthodontic services, cough medicine, durable medical equipment, etc.). Any money you don’t use will roll over from year-to-year, accumulating a balance over time that can be used7 to offset your out-of-pocket health care expenses — or even to pay for medical expenses after you retire or leave the Company (such as long-term care premiums, Medicare premiums, Medicare copays, and COBRA premiums).8 If you leave Quick Chek, you can take the money with you. However, you may only contribute to the HSA while you’re enrolled in the Quick Chek Plan.Tax Advantages of the HSA Remember, any funds left over at the end ofThere are many tax advantages to using an HSA to pay for eligible health care expenses. the year will be carried from year-to-year for I The money you contribute to your HSA reduces your taxable income because you to use for future the deductions are taken from your paycheck on a pre-tax basis. health care expenses. I When you withdraw the money from your HSA it is tax-free, as long as you use Your HSA is portable the funds for eligible health care expenses. and can be taken with you if you leave Quick I Any interest earned on your HSA account is also tax-free. Once your account Chek. balance totals $2,000, a variety of investment options are available through JP Morgan Chase.6

How to Use the Quick Chek PlanHere is an example of how the Quick Chek Plan works when you receive care and how the plan incorporates the use of the HSA feature.Meet MikeMike is a full-time Quick Chek team member. When he became eligible for benefits,he enrolled in the Quick Chek “Healthy Choice” Plan. As he is a new hire, he is eligiblefor the Healthy Choice Plan without meeting the qualifiers. In future years, he will haveto meet the qualifiers to be eligible for the lower cost option.Is it worth it?Taking the time to qualify for the “Healthy Choice” Plan can save you moneyeach year. Here is a look at the weekly premiums for both the Healthy Choiceand Standard Plans for team member coverage only.“Healthy Choice” Plan “Standard” Plan Team member only: Team member only: $9 per week $20 per weekBy going with the “Healthy Choice” Plan, Mike saves $572 ($20 - $9 = $11 x 52 weeks) in premiums for the year!Using the HSAMike decides to contribute to the HSA so he can put tax-free money into his account, and then use that money to help payfor his medical costs throughout the year. Mike has set up his account with JP Morgan Chase and has activated his debit card.Now he has to call Linda Solt to set up his contributions, but he first must decide how much to contribute.How much should he contribute?Each year, he is responsible for bills up to his deductible (though he may not reach the deductible if he’s healthy that year).After he reaches the deductible, the Quick Chek Plan shares in the cost.Mike needs to save $1,000 in his HSA to Annual deductible for team member only coverage:cover the $1,500 in-network deductible $1,500 in-network/$2,000 out-of-networkfor the year. Quick Chek contributes the rest. $1,500 in-network deductible $500 from Quick ChekSo, if Mike needs $1,000 this year to cover the rest of his deductible, that means he needs to contribute $19.23 per paycheck. 7

Super saver scenario: If Mike really wants to make sure that he only uses pre-tax money to pay for any expenses he has this year, he needs to save enough to cover the out-of-pocket maximum (the total amount he could ever be responsible for in one year). The in-network, out-of-pocket maximum for Mike is $2,500. Since Quick Chek contributes $500 to his HSA, he’ll need to save $2,000 for the year. Spread evenly over each paycheck, he would need to contribute $38.46 per paycheck.Yours to KeepThe HSA is yours to keep...even if you leave Quick Chek or don’tenroll in the Quick Chek Plan the following year. And since youraccount rolls over from year-to-year, you keep the balance that’sleft in your account as well. If you set aside more than youspend in a year, you can save it for future health care expenses.You will never lose the money.Now that Mike had decided how much to contribute to theHSA, let’s see how the plan works in different situations,assuming Mike uses in-network providers.Preventive Care VisitThe Quick Chek Plan covers in-network preventive care at 100% with no deductible.When Mike visits the doctor he will need to: I Show his insurance card, but not pay anything I Aetna will work with the doctor’s office for payment for the office visit I The visit is covered at 100% with no deductible, so Mike will not have to use his HSAIf Mike goes out of network…he will have to pay the full cost of the preventive care up front, then file a claim withAetna to ensure the amount is counted toward his deductible and out-of-pocket maximum. If Mike has already met hisdeductible and pays an out-of-network provider cost up front, he may be eligible for reimbursement at the out-of-networklevel from Aetna after he files a claim for reimbursement. 8

Doctor Office VisitFor non-preventive care in-network office visits, the Quick Chek Plan covers 80% of the Aetna contracted rate after thedeductible is met and you are responsible for 20% of this discounted rate plus the deductible.When Mike visits the doctor he will need to:I Show his insurance card, but not pay anything at that time. Use an in-network provider and save money. When you use anI The doctor’s office will submit the claim to Aetna for payment. in-network provider, as an Aetna member, your cost at the doctorI If Mike has not met the deductible, he will be responsible for has been negotiated and is lower 100% of the fees and will be billed directly by his doctor. than if you use an out-of-network provider.I If Mike has met the deductible, Aetna will pay the doctor 80% and Mike will be responsible for the remaining 20%.I Mike can use the funds in his HSA to pay these expenses. If the doctor’s office accepts credit card payments, he can use his debit card. Otherwise, he can pay out-of-pocket and then submit a claim for reimbursement from his HSA.If Mike goes out of network…he will have to pay the full cost of the care up front, then file a claim with Aetna toensure the amount is counted toward his deductible and out-of-pocket maximum. If Mike has already met his deductible andpays an out-of-network provider cost up front, he may be eligible for reimbursement at the out-of-network level from Aetnaafter he submits a claim form for reimbursement. Why does out-of-network care cost more? Doctors who are part of Aetna’s network have agreed to charge lower fees to members of an Aetna health plan. When you get care outside the Aetna network, you miss out on the negotiated discounted fees.If you’ve met your deductible, you are responsible for 40% of the cost, instead of20% of the cost in-network, through your out-of-network coinsurance. Also, inaddition to the 40% of the cost, you need to pay for any charges that are abovewhat Aetna considers reasonable and customary. 9

Filling a PrescriptionPreventive medications are covered at 80% without having Remember, the Quick Chek Plan providesto meet a deductible. 100% coverage after you reach the out-of-pocket maximum; $2,500 teamFor non-preventive prescriptions, you are responsible for member only/$5,000 family coverage,100% of the cost of the medication, until the deductible in-network.is met. After you meet the deductible, you are responsiblefor 20% of the cost and the Quick Chek Plan will pay 80%.When Mike fills a prescription at the pharmacy:I If the medication is considered preventive, Mike can use his HSA debit card to pay his 20% of the cost.I If the prescription is not preventive and if he has not met the deductible, Mike can use his HSA debit card to pay 100% of the cost.I If the prescription is not preventive and he has met the deductible, Mike can use his HSA debit card to pay 20% of the cost.Remember, using a generic version of a prescription will savemoney, whether you’ve reached the deductible or not. 10

The Life of a ClaimThe Quick Chek Plan does not have copays. Instead, you pay the full cost (either with your money or with your HSA), untilyou meet the annual deductible. After you meet the deductible, the Quick Chek Plan begins to pay its share of the cost.How do you know what and when to pay?Here is what happens when you see a doctor or any other provider:Feature How it WorksThe claim Your in-network provider files a claim for you. An out-of-network provider will give you amust be filed receipt so you can submit the claim to Aetna yourself. You can find claim forms on Aetna’swith Aetna website. Important: Be sure you submit claims for every service you receive so Aetna can apply the amount to your deductible and out-of-pocket maximum and pay the insuranceTrack the portion appropriately.claim online Once a claim is submitted, you can track if it’s been paid and how much you owe atReceive a bill www.aetna.com. Keep in mind that doctor’s offices have their own timeline for processingfor your share claims, so if you don’t see a claim, chances are the doctor’s office hasn’t yet filed it. You canof the Aetna always call Aetna or your doctor to get more information.negotiated rate After the claim has been processed by Aetna, your doctor’s office will send you a bill for the amount you owe. At the pharmacy, you will pay any owed amounts for your prescriptions at the time of purchase.Double-check Aetna will send you an Explanation of Benefits statement showing your claim activity, howyour claims much the Quick Chek Plan has paid (if anything), how much you owe, and how much of your deductible you have met so far. This will help keep you informed about the cost.When you use an in-network doctor, hospital or lab, you won’t pay at the time you receive care and the provider willsubmit the claim for reimbursement. Your claim must be submitted to Aetna to receive the proper network discountsand to make sure the costs are counted toward your deductible (and your out-of-pocket maximum). 11

Next StepsOnce you’ve enrolled in the Quick Chek Plan, be sure to follow these steps ifyou want to contribute to the HSA.Step 1: Respond to any inquires you receive from JP Morgan Chase.Step 2: Once you receive your debit card, activate it.Step 3: After your card is activated, call Linda Solt at 908-534-7263 to receive your HSA enrollment package. If you do not contact Linda, you will not be able to contribute to your HSA.Step 4: Return your completed forms to Linda Solt. If your forms are not returned, contributions will not be made to your HSA account.Step 5: Begin using your HSA for eligible health care expenses. 12

QuestionsIf you have any questions about the information in this guide,you can contact your Leader Advocate. If you still have questionsabout getting started in the Quick Chek Plan or the HSA, thebenefits team is available. You can contact Linda Solt at(908) 534-7263, Nancy St. Miklosy at (908) 534-7274, orNancy Rumpf at (908) 534-7159.

Old Highway 28Whitehouse Station, NJ 08889-0600 June 2011