Table Of ContentYOUR 2015
BENEFITS
SUMMARY
for Puerto Rico Part-time Hourly Associates
WHAT’S INSIDE
1 Life Events
11 Eligibility and Enrollment
23 Benefits for Same-sex Domestic Partners
30 The Medical Plan
39 The Critical Illness Protection Plan
49 Dental
IMPORTANT NOTICE
62 Vision
74 Term Life Insurance This 2015 Benefits Summary contains an important notice
about your prescription drug coverage and Medicare.
79 FutureBuilder
111 Employee Stock Purchase Plan You will find this notice in the Medicare Part D
chapter in the back of this book.
123 Work/Life Benefits
126 Time-Off Benefits
127 Leaves of Absence
128 COBRA Coverage
¿No habla o lee inglés?
137 Claims and Appeals
Por favor llame al Benefits Choice Center (Centro de
147 Plan Administration Opción de Beneficios) al 1-800-555-4954 y diga “Estados
153 Medicare Part D Notice Unidos” para hablar con un representante en español.
155 HIPAA Notice
160 Benefits Contact List
161 Payroll Deductions for 2015
The Company benefit plans also provide benefits to the following groups of associates
of Home Depot U.S.A., Inc. and its affiliates in the U.S., who receive different versions
of the Benefits Summary: part-time hourly associates and certain associates of THD
At-Home Services who are paid 100% by commission. The Company benefit plans also
provide benefits to full-time hourly, part-time hourly and salaried associates in the
Company’s affiliates in Guam, Puerto Rico and the U.S. Virgin Islands, who receive
different versions of the 2015 Benefits Summary.
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LIFE EVENTS QUICK FACTS AND QUICK LINKS
A Quick Look at Life Events/Qualified Status Changes
IF YOU EXPERIENCE ONE OF THE LIFE EVENTS/ TO CHANGE YOUR BENEFITS DUE TO A
QUALIFIED STATUS CHANGES BELOW: LIFE EVENT/QUALIFIED STATUS CHANGE:
You have 30 days from the date of the From www.livetheorangelife.com, go to Your Benefits Resources
event to make your benefit changes.* (http://resources.hewitt.com/homedepot) or call the Benefits Choice
Center at 1-800-555-4954
* If you experience a qualified status change, your requested change in benefits must be consistent with, and correspond to, the qualified status change.
Quick Links to Life Events/Qualified Status Changes
• Marriage
• Divorce
• Judgement, Order or Decree, including a Qualified Medical Child Support Order (QMCSO)
• Birth
• Adoption, Placement or Termination of Adoption
• Death
• Gain or Loss of Coverage Due to Moving
• Gain or Loss of Other Coverage
• Change of Employment Status
• Military Leave
• Leaves of Absence
For qualified status changes for domestic partners, click here.
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LIFE EVENTS QUICK FACTS AND QUICK LINKS
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LIFE EVENTS
Puerto Rico Part-Time Hourly Associates
CHAPTER CONTENTS
3 Life Events 6 Death of…
4 Marriage 6 Gain or Loss of Coverage Due to Moving
4 Divorce 7 Gain or Loss of Other Coverage
5 Judgement, Order or Decree, including a Qualified 9 Change of Employment Status
Medical Child Support Order (QMCSO) 9 Military Leave
5 Birth 10 Leaves of Absence
6 Adoption, Placement or Termination of Adoption
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Get the Most Value from Your Plan
What do you need? Find it here...
Notify the Benefits Choice Center that you have had Call the Benefits Choice Center at 1-800-555-4954 and speak with a representative
a qualified status change
Make changes in your benefits after qualified status change Go to Your Benefits Resources at http://resources.hewitt.com/homedepot; or call the Benefits Choice
Center at 1-800-555-4954
Life Events charts to help guide you through the benefit cover- For purposes of this Life Events chapter, your
ages you may need to change following a particular spouse means your spouse as defined in the
When your life changes, chances are your benefits
life event. Absent a qualified status change or rolling Eligibility and Enrollment chapter, and references
will need to change too. As you learn more about
12-month election for life insurance, no mid-year to your child or children only include your own chil-
when you are able to change your benefit elections
election changes can be made with the exception dren, and do not include the child(ren) of your same-
during the year, you’ll find out that marriage, divorce,
of the Critical Illness Protection Plan that can be sex domestic partner. In addition, references to your
birth or adoption, or your spouse’s employment
dropped at any time. dependents do not include your same-sex domestic
change are events that may allow you to make certain
partner or his or her child(ren) regardless of whether
changes in your benefits. You’ll also find out that you Remember that all election changes made as a
they are considered your dependents under other
have 30 days from the date of the event to contact result of a life event must be made within 30 days
chapters in this summary.
the Benefits Choice Center or to visit Your Benefits after the date of the event unless noted otherwise.
ResourcesTM and make your changes. For information on benefits for your same-sex domes-
If you experience a qualified status change, your
tic partner, see the Benefits for Same-sex
Although you are generally not permitted to make requested change in benefits must be consistent
Domestic Partners chapter.
election changes during the year for benefits paid with, and correspond to, the qualified status change.
through a cafeteria plan on a before-tax basis, the IRS For example, if you are divorced and had been Note: the Plan Administrator may also permit any
does allow election changes to be made during the covered under your spouse’s dental plan, it other changes provided for under the Plan document
year on account of and consistent with certain life would be consistent to elect coverage under the or IRS regulations in addition to those listed in these
events (also referred to in this document as qualified Company’s Dental Plan. However, if you did not charts.
status changes). This section outlines the life events lose coverage as a result of the divorce, it would
which may permit you to make election changes to the not be consistent for you to elect dental coverage.
benefits provided to you by the Company. Use the
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You can change your benefits as follows:
If you have
the following You will be asked You must notify the Benefits Medical, Critical Illness
change in to provide the Benefits Choice Center within 30 days Protection Plan, Dental, Term Life Insurance, Legal
status… Choice Center with… after… Vision2,4 Services Plan1
Marriage3
You wish to add Documentation verifying the Date of marriage Can add coverage for spouse Can add coverage for self, spouse
spouse and/or chil- dependency or status change. and/or children and change option4 and/or children
dren
You wish to drop cov- Documentation verifying the Date of marriage or date new coverage Can drop coverage for self and/or Can drop coverage for self, spouse
erage dependency or status change. gained, whichever is later children, if covered under spouse’s and/or children
employer’s plan
Divorce
You wish to drop your Documentation verifying the Date of decree Can drop coverage for Can add or drop coverage for self
dependents’ dependency or status change. children with proof of and/or children
coverage under coverage under other
the plan parent’s plan
You must drop Documentation verifying the Must drop coverage for spouse and
coverage for spouse dependency or status change. any stepchildren who cease to be your
and any stepchildren dependents
who cease to be your
dependents
You wish to add Documentation verifying the Can add or change coverage option Can add coverage for self and/or chil-
self and/or your dependency or status change. for self and/or children if you or at dren
eligible children least one child has lost coverage
under the plan under spouse’s plan4
1 Must be actively at work for coverage to take effect.
2 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents.
3 Marriage includes a marriage to a same-sex spouse as defined in the Eligibility and Enrollment chapter.
4 Medical coverage is available to associates only. Dependents of associates are eligible for dental, vision and critical illness protection plan coverage—dependents cannot be enrolled in the Company medical plan.
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You can change your benefits as follows:
If you have
the following You will be asked You must notify the Benefits Medical, Critical Illness
change in to provide the Benefits Choice Center within 30 days Protection Plan, Dental, Term Life Insurance, Legal
status… Choice Center with… after… Vision3, 4 Services Plan1
Judgement, Order or Decree, including a Qualified Medical Child Support Order (QMCSO)2
Requires Approved court order, judgement Issuance of a court order Coverage is automatically added for No change permitted
coverage for or decree requiring coverage child(ren) and
your child Coverage will start as soon as self, if not enrolled, as
under this plan order is approved specified by the judgement, order or
decree4
Requires Approved order requiring cover- Date other employer plan accepts the Drop coverage for child(ren) covered
coverage of age order by the order
your child under
spouse’s plan
Birth
You wish to add self, Documentation verifying the Date of birth Can add coverage for Can add or increase
spouse dependency or status change. new child, self, other coverage for self, spouse
and/or new child children and spouse and/or change and/or children
coverage option4
You wish to drop Documentation verifying the Can drop coverage for No change permitted
coverage for self, dependency or status change. self, spouse and/or
spouse or other dependents if you gain
children and cover coverage under spouse’s
under spouse’s plan plan following birth
1 Must be actively at work for coverage to take effect.
2 A QMCSO may require coverage for your child, but not for your spouse or former spouse.
3 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents.
4 Medical coverage is available to associates only. Dependents of associates are eligible for dental, vision and critical illness protection plan coverage—dependents cannot be enrolled in the Company medical plan.
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You can change your benefits as follows:
You will be asked to You must notify the Benefits
If you have the following provide the Benefits Choice Center within 30 Medical, Critical Illness Term Life Insurance,
change in status… Choice Center with… days after… Protection Plan, Dental, Vision2,3 Legal Services Plan1
Adoption, Placement or Termination of Adoption
You wish to add self, spouse Documentation verifying the Date of adoption or placement Can add self, spouse and/or child(ren) Can add coverage for self,
and/or new child dependency or status and change coverage option3 spouse and/or child
change.
You wish to drop coverage and Can drop coverage for self, spouse No change permitted
cover child under spouse’s plan and/or other dependents if become cov-
ered under spouse’s plan
You wish to drop coverage due Must drop coverage for child who ceases Drop affected child only
to termination of adoption to be an eligible dependent
proceedings
Death of…
Your dependent covered under a Documentation verifying the Date of death Must drop coverage for dependent who Must drop coverage for
Home Depot plan dependency or status died dependent who died, can drop
change. or decrease your coverage
Your spouse and you and/or your Date coverage ends with other Can add coverage for self and/or children Can add coverage for self and
children lose coverage under employer or change coverage option if you or any children
your spouse’s plan child lost coverage under spouse’s plan3
Gain or Loss of Coverage Due to Moving
You have a work site transfer or Address must be updated in Your move to a new ZIP code Can change plan option No change permitted
ZIP Code change resulting in a payroll system
change to eligibility for coverage
under your plan
You have a work site transfer Address must be updated in Your move to a new ZIP code No change permitted No change permitted
or ZIP Code change resulting payroll system
in no change to your plan
eligibility
1 Must be actively at work for coverage to take effect.
2 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents.
3 Medical coverage is available to associates only. Dependents of associates are eligible for dental, vision and critical illness protection plan coverage—dependents cannot be enrolled in the Company medical plan.
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You can change your benefits as follows:
You will be asked to You must notify the Medical, Critical Illness
If you have the following change provide the Benefits Benefits Choice Center Protection Plan, Dental, Vision4, Term Life Insurance,
in status… Choice Center with… within 30 days after… 5 Legal Services Plan1
Gain or Loss of Other Coverage2
Gain of coverage due to spouse’s Documentation verifying the Effective date of Can drop or decrease coverage Can drop coverage
employer’s period of coverage dependency or status coverage gained for self, spouse and/or children if for self, spouse and/or children
differing from Home Depot’s period of change. become covered under spouse’s plan
coverage
Loss of coverage due to spouse’s Documentation verifying the Effective date of Can add or increase coverage Can add coverage
employer’s period of coverage differing dependency or status coverage lost for self, spouse and/or children for self, spouse and/or children
from Home Depot’s period of coverage change. if coverage is lost under the spouse’s
plan5
Gain coverage due to change in Documentation verifying the Date coverage begins with other Can drop or decrease coverage Can drop coverage
spouse’s or dependent’s employment dependency or status employer for self, spouse and/or children if cov- for self, spouse and/or children
change. ered under newly available plan
Loss of coverage due to child’s Documentation verifying the Effective date of You must drop coverage for dependent Can drop coverage
loss of eligibility under the Home dependency or status coverage lost child for self, spouse and/or children
Depot plans change. You must drop coverage for
child who lost eligibility
You, your child or dependent lose cov- Documentation verifying the Effective date of Can add coverage and/or change Not applicable
erage under another health plan dependency or status coverage lost coverage for you, your spouse or
because it no longer offers benefits to change. your children5
similarly situated individuals
Loss of coverage due to you, your Documentation verifying the Date coverage ends Can add or increase coverage Not applicable
spouse’s or your dependency or status for self, spouse and/or children
dependent’s loss of eligibility under change. or change coverage option if you add
another health plan3 affected dependent5
Loss of coverage due to action of Documentation verifying the Date other coverage Can add or increase coverage for self, Not applicable
other employer by termination of all dependency or status involuntarily ends spouse and/or children or change cov-
plans of the same type change. erage option if each had been covered
or by ceasing all employer under the spouse’s plan5
contributions of coverage that
is not COBRA coverage
1 Must be actively at work for coverage to take effect.
2 You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage.
3 Loss of eligibility does not include loss of coverage due to failure to pay premiums on a timely basis or termination for cause (such as making fraudulent claims).
4 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents.
5 Medical coverage is available to associates only. Dependents of associates are eligible for dental, vision and critical illness protection plan coverage—dependents cannot be enrolled in the Company medical plan.
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You can change your benefits as follows:
You must notify the
You will be asked to Benefits Choice Center
If you have the following provide the Benefits within 30 Medical, Critical Illness Protection Term Life Insurance,
change in status… Choice Center with… days after… Plan, Dental, Vision4, 5 Legal Services Plan1
Gain or Loss of Other Coverage2 (continued)
Loss of coverage due to Documentation verifying Date COBRA coverage ends Can add coverage for self, spouse and/or No change permitted
the exhaustion of COBRA the dependency or status with other employer children or change coverage option if cov-
coverage3 change. ered under the spouse’s plan3, 5
Spouse’s employer eliminates or Documentation verifying Effective date of change If option is eliminated, can add coverage for
adds a benefit option the dependency or status self, spouse and/or children
change. If option is added, can drop coverage for self,
spouse and/or children if covered under new
option5
You, your spouse or your dependent Documentation Date when coverage ends Can add or increase coverage for self, No change permitted
lose coverage under Medicare and verifying the spouse and/or children who lost coverage
you wish to add coverage dependency or status under Medicare or Medicaid
change. (medical only)2,5
You or your spouse gain Documentation verifying Date when Medicare Can drop or decrease coverage for self, No change permitted
coverage by Medicare and the dependency or status or Medicaid coverage begins spouse and/or children covered by Medicare
you wish to drop coverage change. or Medicaid (medical only)
Gain eligibility under Medicaid or Documentation verifying the You must notify the BCC with- Can drop or decrease coverage for self, Not applicable
CHIP dependency in 60 days after the date you spouse and/or children covered by Medicaid
or status change. become eligible for Medicaid or CHIP (medical only)
or CHIP
Lose coverage under Medicaid or Documentation verifying the You must notify the BCC with- Can add or increase coverage for self,
CHIP dependency in 60 days after the date spouse and/or children who lost coverage
or status change. when Medicaid or CHIP cov- under Medicaid or CHIP (medical only)5
erage ends
1 Must be actively at work for coverage to take effect.
2 You must notify the Benefits Choice Center after the loss of coverage has occurred but before the 30 days have passed since that loss of coverage.
3 Exhaustion of COBRA means an individual’s COBRA continuation coverage ceases for any reason other than failure to pay premiums on a timely basis, the individual voluntarily drops COBRA coverage or for
cause (such as making an intentional misrepresentation of a material fact in connection with the Plan).
4 Coverage in the Critical Illness Protection Plan can be dropped at any time for self and/or dependents.
5 Medical coverage is available to associates only. Dependents of associates are eligible for dental, vision and critical illness protection plan coverage—dependents cannot be enrolled in the Company medical plan.
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