bj's 2013 benefit enrollment guide

2014 Benefits

Enrollment Guide

BENEFITS FOR YOU AND YOUR FAMILY

If you have any questions related to your benefits during the Annual Benefits Enrollment period, please call the BJ’s Benefits Service Center at 774-512-7700.

BENEFIT ENROLLMENT DATES: OCTOBER 21 - NOVEMBER 8, 2013

Salaried Guide

IMPORTANT: Benefits Educators from Enrollment Advisors will be available onsite at every location during Annual Benefits Enrollment to meet one-on-one with each eligible Team Member. These knowledgeable, trained Benefits Educators will answer questions about the benefit programs and assist you with completing the enrollment process. At the end of the session, Team Members will receive a confirmation page with a summary of your elected benefits.

BJ’s is pleased to share the 2014 Benefit Programs, which were

designed to provide you more choice in plans while managing the cost of

health care. A Health Reimbursement Account and two Flexible Spending

Accounts have been added to help fund your Health Care and Dependent

Care needs. Please read the information provided in this guide carefully.

BENEFITS FOR YOU AND YOUR FAMILY PLEASE BE SURE TO REVIEW

REQUIRED FEDERAL ANNUAL NOTICES:

P Medicare Part D

P Health Insurance Portability and

Accountability Act (HIPAA)

P Children’s Health Insurance Program

Reauthorization Act (CHIPRA)

P Women’s Health and Cancer Rights Act

(WHCRA)

Available on the Online Enrollment website :

https://mybjsbenefits.hrintouch.com after

you meet with a Benefits Educator.

P Online Enrollment

P Benefits Educators

P Three Medical plans through Cigna

P Health Reimbursement Account

P BJ’s Optical Vision Discount

P Flexible Spending Accounts

P Health Care

P Dependent Care

P Voluntary Accident Insurance and

Permanent Life Insurance

P Two Dental plans through Delta Dental

P Basic Life, Supplemental Life, Accidental Death

and Dismemberment Insurance

P Short-Term Disability Insurance

P Long-Term Disability Insurance

HOW DO I KNOW WHO IS AN ELIGIBLE DEPENDENT? • Your legally married spouse, including same-sex spouse if married in a state that recognizes same-sex marriages

• Your natural, step, legally adopted or eligible foster children until their 26th birthday, regardless of marital status or federal

tax dependency

• Your disabled children after their 26th birthday, provided proof of disability is established before their 26th birthday

• Your children recognized under a Qualified Medical Child Support Order (QMCSO)

IN THIS GUIDE YOU WILL FIND INFORMATION ON THE FOLLOWING:

NEW!

HOW TO ENROLL THIS YEAR: 1. All Team Members will meet with a Benefits Educator from

Enrollment Advisors

2. The Benefits Educator will walk you through all your 2014 benefit

options on the Enrollment Site

3. You can make your benefit elections with the Benefit Educator

and leave with your 2014 confirmation statement in hand

4. The Benefits Educator will give you a card with your username

and password if you need to make any changes on the online

enrollment site after your meeting

Annual Deductible

BJ’s Maximum HRA Funding (based on meeting wellness criteria)

Upfront HRA Deductible

Annual Out-of-Pocket maximum (incl. ded.)

Hospital Inpatient

Outpatient Surgery - Facility

Outpatient Surgery - Office

Emergency Room

Preventive Care Services (incl. routine labs, tests, x-rays)

Primary Care Office Visit

Specialist Office Visit

Diagnostic Labs, Tests

Prescription Co-pays

Cigna MediCal Plan CoMParison Chart for 2014

PreMier Plan Value Plan BasiC Plan

in-network in-network in-networkout-of-network out-of-network out-of-network

$750 Individual$1,500 Family

$1,500 Individual $3,000 Family

$250 Ind / $500 Family TM pays first / HRA second

$500 Individual$1,000 Family

$1,250 Individual$2,500 Family



10% after deductible




$25 PCP / $40 Specialist

co-pay



Covered 100% 30% after deductible

$25 co-pay 30% after deductible




Retail - $10/$30/$60

Not coveredMail -

$20/$60/$120












$25 PCP / $40 Specialist

co-pay








Retail - $10/$30/$60

Not coveredMail -

$20/$60/$120






















Retail - $10/$30/$60

Not coveredMail -

$20/$60/$120

MEDICAL INSURANCE - CIGNA For 2014, BJ’s is offering three medical plan options. Although all three plans are Preferred Provider

Organization (PPO) plans, each has different features. Please be sure to review each plan carefully

so you can choose the best plan for you and your family.

THE CHART BELOW IS AN OUTLINE OF EACH PLAN.

DEDUCTIBLE: The amount you pay for certain health care services before your health plan begins to pay. Under the three new Cigna plans, the deductible is broken out into two parts: – Total Medical Deductible – Total amount of expenses that must be paid by you including HRA funds (if available) before plan co-insurance begins. – Upfront HRA Deductible: Amount you or your covered dependents must pay before HRA funds can be used

For example, if you have a Total Medical Deductible of $750 and have earned $250 in HRA funds, you will be responsible for the first $500 (Upfront HRA Deductible) of expenses before Cigna begins to pay. Once the full $750 is met, you will pay co-insurance up to the Out-of-Pocket Maximum.

CO-INSURANCE: The portion of the cost of a covered health care service you or your covered dependents pay after the Total Medical Deductible is met. For example, if your plan has 10% co-insurance, you would be responsible for $10 of a $100 service and Cigna would pay the remaining $90.

BJ’s will continue to offer a lower medical rate to Team Members who do not use tobacco. Team Members who currently use tobacco and would like to take advantage of the lower rate can join Cigna’s Quit Today

Program by November 8 and select non-tobacco rates! Just call 1-855-561-3805.

TERMS TO KNOW WHEN CHOOSING YOUR BENEFITS:

WELLNESS AND

PREVENTIVE VISITS ARE

COVERED AT 100% WITH

ALL PLANS!

PLEASE SEE THE WEEKLY RATE SHEET INCLUDED SEPARATELY IN THIS ENVELOPE

Total Medical Deductible

Annual Out-of-PocketMaximum (incl. ded.)

HEALTH REIMBURSEMENT ACCOUNT (HRA)BJ’s is committed to helping you maintain a healthy lifestyle and has Wellness Programs to help you do just that. In 2014, you can earn

HRA funds to help reduce your deductible and/or co-insurance payments by participating in certain Wellness Initiatives.

DENTAL INSURANCE - DELTA DENTALBJ’s is offering two dental plan options in 2014. The chart below is an outline of the plan.

• Complete the 2014 Cigna Personal Health Assessment –Earn $150

• Get Your Annual Physical Exam–Earn $100-Physicalsbe

tween

7/1/13and12/

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HOW CAN I EARN FUNDS FOR MY HRA?

Please note the Low Plan will not cover:

• Major Restorative (dentures, crowns and implants)

• Orthodontia coverage

The Calendar Year Maximum Benefit of

$1,500 under the High Plan is separate from

the Lifetime Maximum for Orthodontia.

WHAT IS A HRA FUND?The HRA Fund is a BJ’s-funded account that allows you to

earn money when you and your eligible spouse (or dependent

over age 18) complete certain Wellness Initiatives. You can

earn up to $250 (individual) and $500 (family) each year to

lower your Total Medical Deductible.

You and your spouse (or dependent(s)

over age 18) can each earn $250 when

Wellness Initiatives are completed up

to a family maximum of $500.

These funds and

accounts will be

managed at

www.mycigna.com

(Individual / Family)

(Braces)


100% Covered 100% Covered

80% after deductible 80% after deductible


Salaried Guide

FLEXIBLE SPENDING ACCOUNTS (FSA) – WAGEWORKSBJ’s will be offering Flexible Spending Accounts (FSA) for health care and dependent care through WageWorks in

2014. The FSA plan allows you to set aside (through payroll dedutions) pre-tax dollars to cover qualified

expenses you would normally pay out of your pocket with after-tax dollars. Once an annual

election is made, the participant is unable to opt out or decrease the election amount.

In the case of a qualifying life event, such as the birth of a child, participants may

increase the amount they direct into the accounts.

MAXIMUM ANNUAL ELECTION EXAMPLES OF QUALIFIED EXPENSES

Health Care FSA* $2,500 per Team MemberDeductible (medical and dental), co-payments

(medical and dental), co-insurance, eyeglasses, frames and lenses.

Dependent Care FSA** $5,000 per householdDaycare fees, before-school and after-school care and

day camp for children to age 13. Home care expenses for elder dependents.

*TotalelectedfundsareavailableinJanuaryforparticipanttouse.**Reimbursementcanbemadeonlyfromaccumulatedfundsandafterqualifiedservicehasbeenprovided.

WHAT IS AN FSA?

Accounts that allow you to set aside pre-tax dollars

through payroll deductions for eligible health care

and dependent care expenses.

For a complete list of qualified expenses go to www.WageWorks.com

THE IRS SAYS: “USE IT OR LOSE IT!”Any unused funds in the FSA accounts at the end of the year are forfeited.

You are unable to carry unused funds over to the following year. Choose the amount carefully!

HEALTH CAREElect a pre-tax Health Flexible Spending Account (FSA) to pay for the

cost of medical, dental and vision expenses not covered by your medical

or dental plans.

You may elect up to $2,500 in 2014 for your Health FSA. You will receive a

WageWorks debit card to use at the pharmacy, doctor’s office, or hospital.

Simply swipe your card to pay for your expenses.

You have access to your total annual election amount on January 1, 2014.

• Health Care FSA: Use this for eligible health care expenses

for you and your qualified dependents. It can be used for medical

deductibles, co-insurance and co-pays. This can also be used

for dental deductibles and co-insurance.

DEPENDENT CAREYou may elect up to $5,000 in 2014 for your

Dependent Care FSA. $5,000 is the total allowed per

household.

• Dependent Care FSA: Use this for eligible day

care expenses for your qualified dependents

to age 13, or qualified elder care. This

includes day care, before and after school

programs and day camp.

VISION DISCOUNT PROGRAM – BJ’S OPTICALBJ’s is very excited to offer an exclusive optical discount for Team Members and their families and friends. Team Members enrolled in

Cigna can receive their annual eye exam covered at 100% at their eye doctor’s office. Bring your prescription to BJ’s Optical and take

advantage of the following discounts:

• 50% off complete pair of eyeglasses PLUS:

- Additional $10 off for Inner Circle Members

- Additional $20 off for Rewards Members

• $15 off annual supply of Contact Lenses

DISABILITY INSURANCE – LIBERTY MUTUALSHORT-TERM DISABILITY INSURANCE BJ’s provides Short-Term Disability (STD) at no cost to eligible Team Members. Because of this,

these benefits are taxable to you as wages when paid.

• The STD benefit is 100% of your basic weekly earnings* for the

first four weeks of an approved disability (after a seven calendar day elimination

period) then,

• 60% of your basic weekly earnings for the remainder of your approved disability

to a maximum combined 26 weeks.

Team Members must use any accrued sick time during the first seven calendar days of disability, known as the “elimination period.” Sick

time will be charged based on your normal schedule during the seven calendar-day period.

LONG-TERM DISABILITY INSURANCEEligible Team Members may elect Long-Term Disability (LTD) insurance to supplement their income in the event they remain disabled

longer than 26 weeks. The LTD benefit will be offset by any other disability income you may be eligible for (Social Security, Workers’

Compensation, State-Provided Disability, etc.) and will be based on the following:

• 60% of your basic monthly earnings

• $20,000 maximum monthly benefit (tax-free)

The cost for this benefit is paid entirely by you. The premium associated

with this benefit will be withheld on an after-tax basis allowing any benefit

payments to be tax-free. Benefits are paid on a monthly basis.

Complete these steps to determine your weekly cost:

Step 1: Take your annual salary up to a maximum

of $400,000; divide by 52 to get your weekly pay __________

Step 2: Divide your weekly pay from above by 100 __________

Step 3: Multiply the number in step 2 by .47 __________

= your weekly contributions

*Earningsdonotincludeovertime,bonusorcommissions,butdoincludecarallowances.

If you elect a Health Care FSA through

WageWorks you can use your Health Care FSA

debit card to pay for any remaining unreimbursed

qualified expenses such as glasses. Enclosed are five coupons for you, your family, and friends.

PLEASE NOTE:If you are a Team Member working

in New York, New Jersey, or

Rhode Island, state plan benefits

will apply. The taxability of these

benefits vary by state.

BUSINESS TRAVEL ACCIDENT INSURANCE

All Team Members are covered on their date of hire against

accidental injury or death while travelling on officially

authorized Company business. This means travel on

assignment by or at the direction of BJ’s. Business travel

begins when you leave your residence or place of regular

employment for a business trip and continues until your return

to your residence or place of regular employment.

LIFE INSURANCE - INGBJ’s makes available a number of Life Insurance plans. Rates can be found on the enclosed Weekly Rate Sheet.

BASIC LIFE INSURANCEBJ’s provides, at no cost to eligible Team Members, Basic Life Insurance in the amount of one times your basic annual earnings up to a

maximum of $100,000. This benefit is payable to your designated beneficiary(ies) in the event of your death.

SUPPLEMENTAL LIFE INSURANCEYou may also purchase Supplemental Life Insurance coverage in amounts up to five times your basic annual earnings to a maximum of

$400,000 (cannot exceed $500,000 combined with Basic Life Insurance coverage).

ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)You may purchase AD&D coverage in increments of $10,000 up to a maximum of 10 times your basic annual earnings, to a maximum

of $250,000 for yourself and/or your family. AD&D pays an additional amount of Life Insurance if an accident occurs resulting in

dismemberment or death.

AD&D CoversTeam Member or Team Member and Family

Coverage amounts and pay period deductions vary based on Team Member’s election

SPOUSE / DEPENDENT LIFE AND AD&DYou may elect to purchase Supplemental Life Insurance for your spouse and/or dependents.

Spouse / Dependent Life Insurance Covers Insurance Amount

Spouse $4,000

Child(ren) six months to age 26 $2,000 per Child

Child(ren) 14 days to six months $500 per Child

Age Reductions

Age Reductions will apply to the Team Member’s Basic Life and Supplemental Life amounts. There are no age reductions on Dependent Life

or AD&D. Reductions start at age 65 and continue according to the schedule below:

• At age 65 the benefit amount reduces to 65% of the original amount



Increasing CoverageDuring annual Benefits Enrollment, if you are currently enrolled in Supplemental Life Insurance, you may choose to increase this coverage by one times your base annual salary up to the guaranteed issue amount (lesser of three times your annual earnings or $400,000) without showing Evidence of Insurability (EOI). If you did not enroll in Supplemental Life or Dependent Life Insurance when you were first eligible, or would like increase coverage more than one times base annual salary, you will be asked to complete an EOI form. You must complete an EOI Form for yourself, if you are: • Enrolling for the first time during Benefits Enrollment • Requesting an increase in coverage of two or more increments (example: two to four times salary) • Electing coverage four or five times your annual earnings

Submitting Evidence of Insurability (EOI) • ING will mail the EOI form to your home, if you are required to complete one • Mail the completed EOI form to ING for approval

Spouse/Dependent Life Insurance: • If you are enrolling your spouse or child(ren) in Life Insurance for the first time during Benefits Enrollment, you must complete an Evidence of Insurability form for your dependent(s)

NOTE : Coverage will not be effective for any additional Supplemental or Spouse/Dependent Life Insurance until ING makes the final approval for the coverage.BUSINESS TRAVEL ACCIDENT INSURANCE

All Team Members are covered on their date of hire against

accidental injury or death while travelling on officially

authorized Company business. This means travel on

assignment by or at the direction of BJ’s. Business travel

begins when you leave your residence or place of regular

employment for a business trip and continues until your return

to your residence or place of regular employment.

BENEFIT ENROLLMENT DATES: OCTOBER 21 - NOVEMBER 8, 2013 Salaried Guide

VOLUNTARY BENEFITS - UNUMPERMANENT LIFE INSURANCE (WHOLE LIFE)Unum’s Permanent Life Insurance is designed to pay a death benefit to your

beneficiary(ies), but it also has a cash value you can use while you are living.

This benefit offers an affordable, guaranteed premium that won’t increase due

to age. Unlike Term Life Insurance, this coverage can continue after you leave BJ’s.

Advantages of the Plan

• Coverage is available to eligible Team Members age 16 to 80 who are

actively at work.* Leave of Absence (LOA) Team Members may contact the BJ’s Benefits Service Center upon returning to work

to enroll in Voluntary Benefits.

• You can buy coverage for your spouse and dependent children.

• The policy accumulates cash value at a guaranteed rate of 4.5%. ** Once your cash value builds to a certain level, you can

borrow from the cash value or use it to buy a smaller “paid-up” policy with no more premiums due.

• You get affordable rates when you buy this policy through your employer, and it is paid for through convenient payroll deduction.

• Coverage becomes effective on the first day of the month in which payroll deductions begin.

Below is an example of what a Team Member can purchase for $5.00 a week. The coverage premium is paid up at age 120 and Cash

Value at age 65. The rate is based on a Non-Tobacco user. The Team Member can also purchase Life Insurance for their spouse at the

same dollar amount.

Team Member / Spouse

ISSUE AGE FACE AMOUNT CASH VALUE

20 $34,993 $14,236

30 $24,322 $9,157

40 $15,125 $4,909

50 $8,589 $2,010

60 $4,348 $853

Below is an example of what a Team Member can purchase for their dependent

child(ren), for $3.00 a week.

Child(ren)

ISSUE AGE FACE AMOUNT CASH VALUE

3 $29,828 $12,347

6 $28,312 $11,626

9 $26,174 $10,647

15 $21,727 $8,631

20 $18,594 $7,209

*Eligible Team Members must be actively at work to apply for coverage. Being actively at work means on the day the Team Member applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the Team Member will be considered actively at work as of his/her last scheduled workday. Team Members are not considered actively at work if they are on a leave of absence.

**The policy accumulates cash value based on a non-forfeiture interest rate of 4.5% and the 2001 CSO mortality table. The cash value is guaranteed and will be equal to the values shown in the policy.

Team Members must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Spouses and dependents must live in the U.S. to receive coverage.

Effective January 1, 2014, BJ’s will no longer

manage payroll deductions for Aflac insurance

policies. You have the option to maintain your

Aflac policy (ies) by paying your premium

directly to Aflac. In November, Aflac will send

you information on how you can continue your

policies with them on a direct bill basis.

Terms to Know

Face Amount/Coverage Premium:

The value of the policy paid to the

beneficiary upon the death of the

policyholder.

Cash Value: The amount the policy

holder will get at age 65 if they decide

to cash out the insurance policy.

GROUP ACCIDENT INSURANCEUnum’s Group Accident Insurance will pay lump-sum benefits based on the injury and the treatment you need, including emergency-

room care and related surgery. This benefit can help offset the out-of-pocket expenses that your medical insurance does not pay,

including deductibles and co-pays.

How the Plan Works

• Coverage is available to all eligible Team Members who are actively at work.*

• You can buy coverage for your spouse and dependent children.

• No health questions to answer. If you apply, you automatically receive the base plan.

• This plan includes convenient payroll deduction, so you don’t have to remember to write a check for your premiums.

• Coverage is portable. You may take the coverage with you if you leave the company or retire without having to answer new

health questions. Unum will bill you directly.

• Coverage becomes effective on the first day of the month in which payroll deductions begin.

• Benefits are paid for accidents that occur on and off the job.

• A Catastrophic Benefit is included with this plan. This pays an additional sum if a covered individual has a serious injury — such

as loss of sight, hearing or a limb. Benefit amounts reduce after age 65.

Listed below are a few examples of what the Accident Insurance will pay if you need Emergency Room Services, Hospital Services, or a

CT Scan.

SERVICE BENEFIT AMOUNT

Emergency room $150

Hospital admission $1,500

Hospital confinement (ICU per day) $400

Laceration with stitches $300

CT scan $200

Physician follow-up visit (one per accident) $75

Physical therapy visit $25

Total policy benefit paid $2,650

The base policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department.

IMPORTANT NOTICE: THE BASE POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.

*Eligible Team Members must be actively at work to apply for coverage. Being actively at work means on the day the Team Member applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the Team Member will be considered actively at work as of his/her last scheduled workday. Team Members are not considered actively at work if they are on a leave of absence.

Team Members must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Spouses and dependents must live in the U.S. to receive coverage.

What Is Covered?Some of the covered injuries include:

•broken bones

•burns

•torn ligaments

•cuts repaired by stitches

•coma due to a covered injury

•eye injuries

•ruptured discs

•concussion

Look for your full benefits

list on the website at

www.unum.com

401(K) RETIREMENT PLAN - FIDELITYTeam Members, when eligible, may participate in the BJ’s 401(k) Retirement Plan offered through

Fidelity Investments. You may elect to defer from 1% to 50% of your weekly pay (subject to IRS annual

maximum) on a pre-tax basis.

By increasing your 401(k) contributions, you benefit in a number of ways:

1. Lower your taxable income

2. Maximize the company match

3. Reach your retirement goals faster

EMPLOYEE ASSISTANCE PROGRAM (EAP) - VALUE OPTIONSThe Company-paid Employee Assistance Program (EAP) is available to all Team Members at no cost and is administered by Value

Options. It offers assistance with a variety of topics, including:

• Work/life balance

• Healthy living

• Financial stability

Call 1-888-257-2577 and talk to a trained

counselor 24/7. You can also schedule a

confidential appointment by phone.

The EAP pays for up to three telephone counseling sessions annually for each issue and for each covered member of your family.

Visit www.achievesolutions.net/bjs and gain access to valuable information on work/life topics, news, services and many other resources to enhance your overall well-being.

Team Members are eligible for company match after one

year of employment. BJ’s contributes $1 for every $1 you

contribute up to the first 1% of your contribution. BJ’s

also contributes $0.50 for every $1 you contribute on the

next 4% of your contribution. Saving 5% of your pay will

maximize BJ’s matching contributions.

WHO IS ELIGIBLE? • Must work 500 hours in first 6 months of employment

OR

• Must work 1,000 hours in rolling year of

employment (based on original hire date)

AND

• Must be 21 years of age to begin participating

Watch for Wellness activities again this year; the

Wellness Ambassador will be your contact for

these exciting events!


Salaried Guide

BENEFIT CARRIER PHONE NUMBER WEBSITE

Medical Insurance Cigna 1 (855) 561-3805 www.mycigna.com

Dental Insurance Delta Dental 1 (800) 872-0500 www.deltadentalma.org

Flexible Spending Accounts WageWorks 1 (877) 924-3967 www.wageworks.com

Life Insurance and AD&D Insurance

ING 1 (877) 886-5050 www.ingservicecenter.com

Short Term Disability Insurance Long Term Disability Insurance

Liberty Mutual 1 (888) 398-8924 www.libertymutual.com

Permanent / Whole Life Insurance, Group Accident Insurance

Unum 1 (866) 679-3054 www.unum.com

401(k) Retirement Plan Fidelity1 (800) 835-5095 English1 (800) 587-5282 Spanish

www.401k.com

Theinformationinthisguideshouldinnowaybeconstruedasapromiseorguaranteeofemploymentorbenefitcoverage.Pricing,underwriting,planspecificsandallotherproductfeaturesaresolelythatoftheInsuranceCompanyandnotEnrollmentAdvisors,Inc.Ifthereisaconflictbetweentheinformationinthisguideandtheactualplandocumentorpolicies,thedocumentsorpolicieswillalwaysgovern.Completedetailsaboutthebenefitscanbeobtainedbyreviewingcurrentplandescriptions,contracts,certificates,policiesandplandocumentsavailablefromtheBenefitsDepartment.

Important Telephone Numbers & Websites

25 Research D

riveW

estborough, MA

015812014 Annual Benefits Enrollment

bj's 2013 benefit enrollment guide

Documents

elected benefits

enrollment advisors

trained benefits educators

benefit enrollment dates

enrollment process

benefit educator

online enrollment site

bjs benefits service