BENEFITS GUIDE 2013–2014

INTRODUCTION Dear fellow employees: Thank you for being a part of the Forever 21 family and for contributing to our success. Your health and well-being is very important to us and, as such, we are committed to providing a comprehensive benefits program that will help you and your family members live a happy and healthy lifestyle. We are pleased to present the 2013-2014 Forever 21 Benefits Guide, to help you navigate your options for the year, and select the best plan for you and your family members. Please review this Benefits Guide carefully and save this as a reference throughout the year. Should you require further assistance, do not hesitate to contact the Human Resources Benefits Department at (213) 741-8897. Sincerely, Alex Ok President

General Disclaimer The material provided in this guide is for general information purposes only. The details of the plans and policies are contained in the official plan and policy documents including some insurance contracts. The plan (and underlying coverage of benefits) can be amended at any time for any reason without prior notice, at Forever 21’s sole and absolute discretion. In the event of any conflict between this guide and the plan document, the actual plan document will govern.

TABLE OF CONTENTS What’s New This Year ��������������������������������������������������������������������������������������������������� 3 Smart Savings ������������������������������������������������������������������������������������������������������������������������ 4 Eligibility��������������������������������������������������������������������������������������������������������������������������������������� 5 Important Notes About Enrollment ���������������������������������������������������������������������� 6 Medical Coverage������������������������������������������������������������������������������������������������������� 7-9 Dental Coverage��������������������������������������������������������������������������������������������������������������� 10 Vision Coverage������������������������������������������������������������������������������������������������������������������ 11 FSA����������������������������������������������������������������������������������������������������������������������������������������������� 12 Commuter Parking and Transit���������������������������������������������������������������������������������13 Term Life Insurance������������������������������������������������������������������������������������������������������������14 Short & Long Term Disability��������������������������������������������������������������������������������������15 Work/Life EAP and Travel Assistance Services������������������������������������������16 Group Accident������������������������������������������������������������������������������������������������������������������ 17 Whole Life������������������������������������������������������������������������������������������������������������������������������� 18 Critical Illness������������������������������������������������������������������������������������������������������������������������� 19 Individual Short Term Disability ���������������������������������������������������������������������������� 20 Wellness Programs������������������������������������������������������������������������������������������������� 21-22 Education������������������������������������������������������������������������������������������������������������������������������� 23 Vitality�����������������������������������������������������������������������������������������������������������������������������������������24 Discount Programs��������������������������������������������������������������������������������������������������������� 25 Contacts��������������������������������������������������������������������������������������������������������������������������������� 26 Notes����������������������������������������������������������������������������������������������������������������������������������������� 27

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WHAT’S NEW THIS YEAR? Below are new developments and changes for the 2013-2014 year that will help you make more effective choices for you and your family. We are excited to share that we have two NEW vendors. • Medical o UnitedHealthcare Low & High PPO o UnitedHealthcare EPO (California only) o Kaiser HMO (Hawaii & California only) • Dental o Aetna - Freedom of Choice Plan • Vision o VSP Core & Premium plans Other Changes This Season •

Exclusive Provider Organization (EPO) We’ve added an EPO which is an Exclusive Provider Organization. This means you can see any doctor within the UnitedHealthcare Network and you don’t need a referral.

• Extended dependent eligibility If you have a dependent child under your Medical, Dental or Vision plan, you can continue his or her coverage up to age 26. • New Employee Benefits Webportal o Access important documents and information regarding your benefit plans. Visit www.MyForever21Benefits.com o Copies of the Summary Plan Descriptions (SPD) and Plan Documents may be obtained from the website above or by requesting a copy at [email protected] • New Group Benefits o Buy-Up Term Life Insurance for employee, spouse and child. Guarantee issue without answering any health questions limits apply. Refer to page 14. o Long Term Disability buy up coverage offering. Please refer to page 15.

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SMART SAVINGS Health care continues to be one of the major costs confronting families each year. By using the following simple strategies, you can significantly reduce your health care costs now and into the future . . . • Copayments for medical services can cost up to $25 per visit. Take advantage of $0 copayments for preventive and well-baby care under all medical plans. • Each visit to an emergency room can cost you up to a $100 copayment. By visiting an urgent care facility instead of an emergency room, your copayment can be significantly reduced. • Smoking is one of the leading causes of many costly health related problems. Take advantage of our smoking cessation programs and also encourage covered family members who smoke to enroll. (UnitedHealthcare and Kaiser Permanente members only.) Both carriers approve CHANTIX. Ask your doctor today for a prescription. • Not all conditions require a doctor’s visit. Call the 24/7 nurse line to talk to a qualified nurse anytime, day or night. o UnitedHealthcare members can call (800) 846-4678. o Kaiser members can call the Nurse Triage Center 24-hour Advice line at (888) 576-6225. • Prescription medication can be expensive and subject to high deductibles. You can save money on prescriptions by opting for the generic prescription. Ask your doctor to prescribe generic drugs when possible. You can save even more when you purchase your prescriptions through mail order. • Employees are required to pay a portion of their earnings for various taxes such as income and social security. Save valuable tax dollars by using a Flexible Savings Account (FSA) to set aside pre-tax earnings to pay for everyday eligible health care expenses for you and your eligible dependents. You may also set aside pre-tax earnings to pay for dependent care expenses. (See page 12 for more details.)

FSA Reminder:

You must re-enroll annually in your FSA plan in order to participate for the next calendar year.

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ELIGIBILITY Employee Eligibility

Dependent Eligibility

• Are a full-time employee, and • Have met the required waiting period (30 days)

• Your legal spouse • Your same-sex registered domestic partner (where mandated by law) • Your child(ren), or the child(ren) of your legal spouse or registered same-sex domestic partner, until age 26

You are eligible to participate in Forever 21’s Benefit Plans if you:

Upon meeting the eligibility requirements, your benefits will become effective the first day of the following month (unless you are hired on the first of the month)

Forever 21 provides valuable benefits for your dependents. Your eligible dependents are:

Eligibility Waiting Period

Who Qualifies

Medical, Dental, Vision, and Voluntary Benefits (Flexible Spending Accounts, Buy-Up Term Life and Long Term Disability, Whole Life Insurance, Individual Short Term Disability, Group Accident and Critical Illness)

30 days

All full-time employees

401(k)

21 years of age; employed for 12 months (with 1,000 hours worked)

All employees (full-time and part-time)

Employer Paid Benefits (Base Plan Term Life Insurance, Short and Long Term Disability, EAP and Travel Assistance)

30 days

All full-time employees

Paid Time Off (PTO)

Upon hire date (available after 60 days of service)

All full-time employees

Paid Holidays: Memorial Day, Fourth of July, Labor Day, Thanksgiving Day, Christmas Day, New Years Day

Upon hire date

All full-time corporate and distribution center employees, store managers, and co-manager 1 positions (CM1)

Paid Bereavement Leave

Upon hire date

All full-time employees

UNPAID Family and Medical Leave (FMLA)

Employed for 12 months (with at least 1,250 hours worked)

All employees (full-time and part-time)

Unpaid Pregnancy Leave (State Specific Laws Apply)

Varies

All employees (full-time and part-time)

Unpaid Personal Leave

30 days

All employees (full-time and part-time)

Educational Discounts

Upon hire date

All employees (full-time and part-time)

Vitality

Upon hire date

All full-time employees

10% Employee Discount

Upon hire date

All employees (full-time and part-time)

Cell Phone Discount through AT&T and Verizon

Upon hire date

All employees (full-time and part-time)

Working Advantage and Dell Product Discounts

Upon hire date

All employees (full-time and part-time)

Benefit

2013-2014 Plan Year

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IMPORTANT NOTES ABOUT ENROLLMENT What if I have questions, comments or concerns? The Human Resource Benefits Department is available to assist you. You can contact the Human Resource Department by phone at (213) 741-8897 or via e-mail at [email protected]

If you experience any of the following life status changes after enrolling...

The following changes can be made within 30 days of the event date…

You get married or form a registered same sex domestic partnership (were mandated by law)

• Add your new spouse or partner and/or stepchildren to your medical, dental or vision plans • Enroll in or increase your contributions to a Heath Care or Dependent Day Care FSA • Apply for Supplemental Life and AD&D insurance for your new spouse or partner If your situation involves a domestic partner, you may want to contact a qualified tax advisor due to the tax treatment of domestic partner benefits

You get divorced, have an annulment, become legally separated or end your domestic partnership

• Remove your former spouse or partner from Forever 21 coverage (required) • Decrease your contributions to a Health Care FSA

You experience the birth or adoption of a child

• • •

Your spouse, domestic partner or child dies

• Remove your dependent from Forever 21’s coverage (required) • Decrease your contributions to a Health Care or Dependent Day Care FSA If you have Supplemental Life and AD&D Insurance coverage for that individual, be sure to file a claim for benefits

Your child reaches the maximum age for coverage or is no longer totally disabled

Remove your child from Forever 21’s coverage (required)

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Add your new child to your plans Enroll in or increase your contributions to a Health Care or Dependent Day Care FSA Apply for Supplemental Life and AD&D insurance for your new child

MEDICAL COVERAGE Medical coverage is one of the most important components of your benefit package and Forever 21 offers a range of medical options to fit your needs and budget.

What’s the difference between an EPO and a PPO? EPO

An Exclusive Provider Organization (EPO) offers comprehensive health services as long as you choose doctors (including specialists), hospitals and pharmacies in the Choice network. If you receive care outside of the UnitedHealthcare network, the plan will not cover the cost. You may visit a specialist or other provider in the network without a referral.

Terms to help you understand your coverage: • Annual Deductible: The amount you must pay each plan year before insurance pays any amount. • Copayment: A payment you must make, usually at the time of service, in addition to what insurance pays. • Coinsurance: The percentage that insurance pays after you have met your deductible. • Out-of-Pocket Maximum: The most you are required to pay in any plan year before insurance pays 100% of eligible expenses.

KAISER

Note that Kaiser Permanente is offered for California employees only. Kaiser operates as a health maintenance organization. You must choose a primary care physician who will manage your healthcare and refer you to specialists and testing as necessary. Most services are covered 100% by your insurance after your copayments.

PPO

In a preferred provider network, or PPO, you can choose to visit any physician of your choice, without a referral. You are responsible for all copays and any coinsurance after your annual deductible up to your annual out-of-pocket maximum. However, costs are higher for services received outside of the preferred network of doctors. Review the following chart for more EPO and PPO differences:

PPO

EPO

Can I go to any doctor I want and receive plan benefits?

Yes, but you pay lower costs if you use doctors and hospitals in the network

No, you may only go to doctors within the UnitedHealthcare network. You may see a specialist without a referral.

Is there a deductible? Will I need to choose a Primary Care Physician? Do I need a referral to see a specialist? Is preventative care (well-child care, check-ups, etc.) covered? Is there a limit to how much I may have to pay in one year? Are prescription drugs covered? Can I use mail order for maintenance drugs? Will I have to pay more if any doctor charges more than the “reasonable and customary” limit?

Yes No

No No

No Yes, covered at 100% (In-Network ONLY)

No Yes, covered at 100% (In-Network ONLY)

Yes, refer to your PPO Plan out-of-pocket maximum Yes Yes, and you will pay less out of pocket

Yes, refer to your EPO Plan out-of-pocket maximum Yes Yes, and you will pay less out of pocket

Only when you use out-of-network providers No

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MEDICAL COVERAGE Forever 21 employees have four different medical options to choose from, depending on where you live: • • • •

UnitedHealthcare Choice Plus PPO Low UnitedHealthcare Choice Plus PPO High UnitedHealthcare Choice EPO (California only) Kaiser Permanente HMO (California only)

EPO/HMO COMPARISON CHART (CALIFORNIA ONLY) Employee Premium Contributions (Per Paycheck) Employee only Employee + spouse Employee + child(ren) Employee + family

UnitedHealthcare Choice EPO Plan

Kaiser Permanente HMO Plan

$41.27 $82.54 $74.25 $123.77

$40.64 $81.29 $73.13 $121.90

Annual Deductible

None

None

Coinsurance

100%

100%

Maximum Out-Of-Pocket

$2,000 per member, $4,000 per family

$1,500 per member, $3,000 per family

Lifetime Benefit Maximum

None

None

Primary Physician and Referred Specialist Office $25 co-pay per visit Visit Outpatient Surgery $150 (ambulatory) $300 (hospital) Hospital Inpatient Services $500 co-pay per admission

$500 co-pay per admission

Emergency Room

$100 co-pay per visit

$100 co-pay per visit

$25 co-pay per visit $150 co-pay per visit

Generic Prescription Drugs

$15 co-pay up to 30 days

$15 co-pay up to 30 days

Brand Name Prescription Drugs

$30 co-pay up to 30 days $150 annual brand deductible

$30 co-pay up to 30 days

*Domestic Partner coverage is offered in only the following states: CA, MA, VT, CT, NJ, NH, WA, DC, HI, ME, MD, NY, OR, WI

Stay Active to Stay Healthy Fitness is for everyone, and best of all, it includes every kind of exercise. As long as you do it regularly, any physical activity can help you look and feel your best. Whether you’re 5 or 65, it’s never too early—or too late—to get started. Just keep these tips in mind: • You don’t have to sweat it. Research shows that getting at least 2 hours and 30 minutes a week of moderate-intensity activity can make a significant difference in your health. You can get the same benefits by working a little harder for a shorter time. • Find the right fit. The key to getting regular exercise is to choose activities that you enjoy and feel comfortable doing, so that you’ll want to keep doing them. • Three’s company. Aerobic exercise, strength training, and flexibility are all key components of total fitness. • Mix it up. Are you already active and looking for a new routine? Or maybe you want to optimize your health and fitness level? Consider cross-training to help you reach your goal.

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MEDICAL COVERAGE PPO COMPARISON CHART (ALL STATES) UnitedHealthcare Choice Plus PPO Low UnitedHealthcare Choice Plus PPO High Employee Premium Contributions (Per Paycheck)

Employee only Employee + spouse Employee + child(ren) Employee + family

$42.35 $84.50 $81.03 $125.40 In Network

Out of Network

$53.09 $106.01 $101.43 $157.20 In Network

Out of Network

Annual Deductible

$1,000 per member, $2,000 for 2 individuals, $3,000 per family

$500 per member, $1,000 for 2 individuals, $1,500 per family

Coinsurance Maximum Out-Of-Pocket

80% $3,000 per member, $6,000 for 2 individuals, $9,000 per family

90% $2,000 per member, $4,000 for 2 individuals, $6,000 per family

Maximum Lifetime Benefit Physician Office Visit

Unlimited Unlimited $25 co-pay per visit 50%

Unlimited Unlimited $15 co-pay per visit 70%

Preventative and Routine Care

$0 copay

Not Covered

$0 copay

Not Covered

Hospital

80%

50%

90%

70%

Emergency Room Copay Generic Prescription Drugs

$100 + 20% per visit $15 co-pay up to $15 co-pay up to 30 days 30 days

10% $10 co-pay up to 30 days

$10 co-pay up to 30 days

Prescription Drugs

50% $6,500 per member, $13,000 for 2 individuals, $19,500 per family

70% $5,000 per member, $10,000 for 2 individuals, $15,000 per family

$30 co-pay Preferred Brand up to 30 days $30 co-pay Preferred Brand up to 30 days $45 Non-Preferred Brand $50 Non-Preferred Brand

*Domestic Partner coverage is offered in only the following states: CA, MA, VT, CT, NJ, NH, WA, DC, HI, ME, MD, NY, OR, WI Required Grandfathered Plans Status Disclosure Forever 21, Inc. believes the medical plans are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your medical plan may not include certain consumer protections of the Affordable Care Act that apply to other plans. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at (213) 741-8897. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at (866) 444-3272 or www.dol.gov/ebsa/ healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

Women’s Health and Cancer Rights Act of 1998 Annual Notice Did you know that in accordance with the “Women’s Health and Cancer Rights Act of 1998”, all group health plans are required to notify each participant of the following benefits. Coverage available under the plan for participants receiving eligible services in connection with a mastectomy and who elect breast reconstruction in connection with such mastectomy will include: • Reconstruction of the breast on which the mastectomy has been performed; • Surgery and reconstruction of the other breast to produce symmetrical appearance; • Prosthesis; and • Treatment of any physical complications, including treatment of lymph edema, the swelling sometimes caused by surgery. Services and supplies will be in a manner determined in consultation with the attending physician and patient. Such coverage may be subject to annual deductibles, coinsurance, and other plan provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan. Please refer to your medical carrier’s Summary Plan Description for a full description for coverage under the plan.

2013-2014 Plan Year

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DENTAL COVERAGE Aetna Dental® Freedom of Choice – More Savings, More Choices With Two Dental Networks You have the freedom to switch dental plans monthlyChoice #1: The Dental Maintenance Organization (DMO®) Plan Key Highlights • Lower out of pocket costs than the PPO • A Primary Care Dentist (PCD) coordinates your care • Get a referral to see a specialist, except for orthodontia • Typically, no cost for preventive care • No deductible or annual benefit maximum • Enhanced Orthodontia • Can switch to the PPO plan each month, if you prefer

Choice #2: The Preferred Provider Organization (PPO) Plan Key Highlights • Generally, higher out of pocket costs than the DMO • Visit any licensed dentist • Use network dentists for discounts to stretch your benefit • Can switch to the DMO plan each month, if you prefer • No referrals

Aetna Dental Freedom of Choice Choose between these two plan options monthly Aetna DMO® Benefit & Covered Services

Aetna PPO®

In-Network Only

In-Network

Non Network

Employee Premium Contributions (Per Paycheck)

Employee only Employee + 1 dependent Employee + 2 or more dependents Diagnostic & Preventative – Exams, cleanings, x-rays, sealants Basic – Fillings, simple tooth extractions, root canals, gum treatment, oral surgery Major – Crowns, inlays, onlays and denture repairs

$5.35 $9.63 $16.02 100%. Exam $5 Copayment

$5.35 $9.63 $16.02 100%

$5.35 $9.63 $16.02 50%

100%

80%

50%

60%

50%

50%

Calendar Year Deductibles

None

$50 per person

$50 per Person

Deductible Exempt on Diagnostic and Preventive Calendar Year Maximum

N/A

Yes

Yes

None

$1,500

$1,500

Orthodontic for Adult and Children 100% after $2,300 Copayment 50% up to $1,500 Lifetime 50% up to $1,500 Lifetime for Adult and Child Maximum for Adult and Child Maximum for Adult and Child Orthodontic Lifetime Maximum 24 months $1,500 $1,500 You can switch between the Aetna DMO and the Aetna PPO monthly, if desired, by calling Aetna at 855-850-9664 by the 15th of the month, for the change to be effective the 1st of the next month. There are three ways to find a participating dentist: 1) Online at www.Aetna.com 2) By phone after you enroll you can call Member Services at the toll-free number on your Aetna ID card 3) Download the Aetna mobile app to your smartphone. To learn more about Aetna Dental’s Freedom of Choice Plan click on www.Aetnafocdental.com *DMO is not offered in the following states: AL, AK, AR, LA, ME, MS, ND, NH, PR, SC

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VISION COVERAGE Value and Savings. VSP is good for your eyes and your wallet. You don’t have to cut coupons or wait for a sale like with retail chains—your savings are built into your VSP plan. Plus, you can use a flexible savings account for any out-of-pocket costs, including copays, at your VSP doctor’s office.

What makes VSP different?

• Personalized Care. Establishing a relationship with your eye doctor is important. They can see differences in your vision and overall eye health. That’s why all VSP’s doctors are private-practice doctors. They stay in their practice year after year, so you don’t have to worry about seeing a new doctor each year. Our doctors take the time to get to know you and your eyes. Through a WellVision Exam®, they will look for vision problems and signs of other health conditions too.

• Doctor Network. Experience the private-practice difference with a VSP doctor. You can get everything you want from a retail chain at a private-practice doctor, including weekend and evening appointments and the same eyewear selection, including designer brands. Plus, you’ll get personalized care from a doctor you can trust and who gets to know you and your eyes. VSP doctors are located nearby and all of them offer eyewear choices you’ll love.

• Everyone Needs an Annual Eye Exam. Think you don’t need an eye exam because you have 20/20 vision or you’ve had laser vision surgery? Think again. Annual eye exams are important to your overall health. During your eye exam, a VSP doctor will look for vision problems and signs of other health conditions like diabetic eye disease, high blood pressure, and high cholesterol. • Satisfaction Guaranteed. You’ll be 100% happy or we’ll make it right. Don’t just take our word for it. In 2008, Synovate, a global market research firm, ranked VSP “Highest in Overall Member Satisfaction” compared to other national vision plans.

How the Vision Plan Works

You have two VSP Vision plans to choose from: Premium and Core. Your Vision plan choice will depend on whether you are also enrolled in a Forever 21 Medical plan and whether you want to pay more from each paycheck for the richer benefits of the Premium Plan. If you enroll in any Medical plan with Forever 21, you will automatically be enrolled in the VSP Core Vision Plan at NO COST to you.

If you enroll in a Medical plan with Forever 21, BUT want the benefits of a richer vision plan, you can elect to pay an additional amount each paycheck for the VSP Premium Plan.

VSP Core Vision If you do not enroll Employee Premium Contributions (Per Paycheck) If you enroll in a in a Medical plan Medical plan* $1.45 No Cost Employee only $2.90 No Cost Employee + spouse $3.10 No Cost Employee + child(ren) $4.96 No Cost Employee + family Benefit Features In-Network Out-of-Network Copayment $10/exam $25/materials Wellvision Exam Every 12 Months Covered after Co-pay $45 Every 24 Months Lenses: Covered after Co-pay $30 Single Vision Covered after Co-pay $50 Lined Bifocal Covered after Co-pay $65 Lined Trifocal $130 $105 Elective Contact Lenses Frames: Every 24 Months $130 $70 Retinal Screenings NA

If you DO NOT enroll in a Medical plan with Forever 21, but still want a vision plan, you can elect to enroll in either the VSP Core Plan or the VSP Premium Plan.

VSP Premium Vision If you do not enroll If you enroll in a in a Medical plan Medical plan $3.18 $1.99 $6.35 $3.97 $6.79 $4.25 $10.86 $6.78 In-Network Out-of-Network $10/exam $25/materials Every 12 Months Covered after Co-pay $45 Every 12 Months Covered after Co-pay $30 Covered after Co-pay $50 Covered after Co-pay $65 $175 $105 Every 12 Months $175 $70 $10 copay

Contact lenses are in lieu of lenses and frame. *There is no employee premium contribution for the VSP Core plan if you are also enrolled in a Forever 21 medical plan.

2013-2014 Plan Year

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FLEXIBLE SPENDING ACCOUNTS (FSA) You have the option of contributing pre-tax dollars to a Health Care Flexible Spending Account and/or a Dependent Care Flexible Spending Account. By setting aside pre-tax dollars from your paycheck, you are reducing your taxable income and can therefore save money by reducing the amount of income tax you owe. You must re-enroll annually in these plans in order to participate for the next calendar year. For detailed information on qualifying FSA expenses, visit www.padmin.com (visitors). FSA operates on a calendar year, January 1, 2013 - December 31, 2014.

IMPORTANT: USE IT OR LOSE IT! Calculate conservatively when making your 2013 FSA elections. IRS regulations require that any money left in your FSA at the end of the plan year be forfeited.

THINGS TO THINK ABOUT • Your FSA elections will remain fixed for the entire plan year. However, if your family status changes, you may be able to increase or decrease your contributions to these accounts. • Funds cannot be transferred between your Health Care and Dependent Care accounts. • Generally the IRS does not consider a Domestic Partner as a qualified relative, so they (and their expenses) may not be claimed under the FSA plans, unless they qualify as dependents on your Federal income tax return.

FSA Reminder:

You must re-enroll annually in your FSA plan in order to participate for the next calendar year.

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Health Care FSA

The Health Care FSA allows you to set aside pre-tax earnings to pay for everyday eligible health care expenses for you and your eligible dependents. You can contribute between $100 and $2,500 each plan year to pay for qualifying out-of-pocket medical, dental, vision, and prescription drug expenses.

Examples of eligible expenses include: • co-payments, coinsurance & deductibles • charges for services or supplies not covered by your medical, dental, or vision plan • charges above the usual, customary and reasonable rates or plan maximums

Examples of ineligible expenses include:

• Cosmetic surgery • Botox • Restylane • No over-the-counter drugs unless prescribed by a physician

Dependent Care FSA

The Dependent Care FSA allows you to set aside pre-tax earnings to pay for a wide range of dependent care services for eligible members of your family. You can contribute between $100 and $5,000 each plan year to reimburse yourself for qualified dependent care expenses.

Examples of eligible expenses include: • senior day care • child day care • in-home dependent care • private preschool program • nursery school • before and after-school programs • sick child care

Eligible dependents include: • a child under age 13 in your custody whom you claim as a dependent on your tax return • a spouse who is incapable of self-care • a dependent who lives with you, such as a child over age 13, parent, sibling, or in-law who is incapable of self-care, and whom you claim as a dependent on your tax return

Examples of ineligible expenses: • school expenses for children in first grade or above • food or clothing provided for your dependent • care provided by your spouse, your child under age 19, or someone you claim as a dependent for tax purposes • overnight camp expenses • transportation expenses to and from the care location • babysitting for social events

COMMUTER PARKING AND TRANSIT Want to save 30% on your monthly parking or transit expenses for work? Enroll in the Parking/Transit Account and use taxfree dollars to pay for your cost of commuting to and from work! Estimate the money you expect to pay for parking or transit and have that dollar amount withheld from your paychecks pre-tax each month.

Here’s An Example Of How The Tax Savings Works

Commuting expenses are inevitable for you because you travel to work almost every day. Let’s assume you spend $100.00 per month for parking at work or commuting to and from work. By enrolling in the Parking/Transit Account, $100 will be withheld from your paychecks over a monthlong period pre-tax, so you never have to pay the state, federal and FICA taxes on your parking of transit expenses! If you fall within the average 30% tax bracket, enrolling in this account will save you approximately $30 every month! That’s an annual savings of $360!

Parking/Transit Account Rules

There are maximum amounts you can elect for this plan. The below amounts are based on the IRS pre-set maximum for the year 2013. • Maximum pre-tax parking contribution: $245 • Maximum pre-tax transit contribution: $245 The Parking/Transit Plan offers flexibility. Unlike the FSA Plan, with the Parking/Transit Account you can change your election amount each month. Please note that any change you make will become effective with the first pay period beginning on or after the following month. So, for example, let’s say you have a vacation and will not be commuting to work. You can change your election amount for that month by notifying your HR department. You will be asked to fill out a new election form for that month.

Claim Submission Methods P&A Benefits Card

If you enroll in this plan you will receive a debit card that can be used to pay for your parking/ transportation expenses to and from work. Employees who enroll in both the FSA and Parking/ Transit Account will receive one debit card for both accounts. If you are currently enrolled in the FSA and enroll in the Parking/Transit Account, your election amount will be automatically added to your current debit card.

• Electronic Claim Upload: Upload claims directly at www.padmin.com. Log into your P&A account - Member Tools - Upload a Claim. When using this method you MUST provide a copy of your receipt in order to process the claim. If you do not have a copy of your receipt please click on the Un-receipt Claim System, which will direct you to our online claim system for parking/transportation expenses that do not have receipts. • Fax: (877) 855-7105* • Mail: 17 Court Street, Suite 500 Buffalo, NY 14202* *Must include a claim form. Claims forms are located here: Log into your P&A Account - Forms - Claim Form.

If your parking garage or mass transportation system does not accept debit cards you can file a claim with P&A Group to receive reimbursement for your expense. Claims can be submitted using one of the three claim submission options.

2013-2014 Plan Year

13

GROUP BENEFITS: BASE TERM LIFE AND VOLUNTARY TERM LIFE (Unum) ‘Who is Eligible?’

Corporate Employees (including Remote Corporate Employees) will receive Life insurance equal to 1 times annual earnings, maximums apply. You must be working a minimum of 30 hours/week to qualify.

Base Plan Term Life Insurance Your Employer is providing 1X annual earnings (maximums apply) at no cost to you.

Buy-Up Term Life Insurance New Offering

Employee: Additional one times or two times your annual earnings to $500,000. You can apply for coverage up to $200,000 without answering any health questions or completing a medical exam. Spouse: You can choose to purchase coverage for your spouse in amounts of $10,000, $25,000, $50,000 or $100,000, not to exceed 100% of employee coverage amount. Benefit amounts up to $100,000 do not require health questions or a medical exam. Child: You can choose to purchase coverage for your child(ren) in amounts of $5,000 or $10,000. The maximum death benefit for a child between the ages of live birth and 6 months is $1,000. Benefits will be paid to the employee. In order to purchase Voluntary Term Life Insurance coverage for your spouse and/or child, you must purchase coverage for yourself. Coverage amounts for life insurance for you and your spouse will reduce to 65% of the original amount when you reach age 70, and will reduce to 50% of the original amount when you reach age 75. Coverage may not be increased after a reduction. Accelerated benefit - If you become terminally ill and are not expected to live more than 12 months, you may request up to 50% of your life insurance amount, to a maximum of $750,000 or the plan maximum, whichever is less, without fees or present value adjustments. A doctor must certify your condition. Upon your death, any remaining benefit will be paid to your designated beneficiaries.

Effective Date of Coverage:

Your coverage will become effective the first day of the month following 30 days of service.

Delayed Effective Date of Coverage:

Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Dependent: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Exception: infants are insured from live birth. “Totally disabled” means that, as a result of an injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; or has a life threatening condition. The policy has exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum Representative for specific provisions and details of availability. Group Term Life Insurance is underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. CE-13068 (8-13)

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GROUP BENEFITS: DISABILITY (Unum) Short Term Disability Insurance

Short Term Disability (STD) insurance is sometimes called income protection. It can replace a portion of your weekly income if you are unable to work for a few weeks or months due to a covered illness or injury — or childbirth. The amount of benefit you receive from the plan may be reduced or offset by income from other sources, such as State Disability Benefits. Forever 21 is providing Short Term Disability (STD) coverage at no cost!

Benefit Amount

• 70% of your weekly earnings • To a maximum benefit of $2,000

Benefit Duration

If you remain disabled, benefits may be continued for up to 12 weeks.

Elimination Period

The Elimination Period is the length of time of continuous disability which must be satisfied before you are eligible to receive benefits. STD benefits would begin after 7 consecutive days of disability, if you are disabled, as described in the policy.

Long Term Disability Insurance

Long Term Disability (LTD) insurance protects a portion of your income. It can pay you a monthly benefit if you can’t work — for an extended period of time — due to a covered injury or illness. Long term disability insurance can pay a benefit as long as you are considered disabled according to your policy. The amount of benefit you receive from the plan may be reduced or offset by income from other sources — such as State Disability Benefits or Social Security Disability Insurance. The length of time you can receive benefits is based on your age when you become disabled. Forever 21 is providing Long Term Disability (LTD) coverage at no cost!

Benefit Amount

• 40% of your monthly predisability earnings • To a maximum benefit of $4,000

Benefit Duration

If you remain disabled, benefits may be continued until you reach retirement age.

Elimination Period

The Elimination Period is the length of time of continuous disability which must be satisfied before you are eligible to receive benefits. LTD benefits would begin after 90 consecutive days of disability, if you are disabled, as described in the policy. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period.

Policy Limitations

Pre-existing Condition Exclusions – If you become disabled within 12 months of your coverage effective date, your condition may be excluded. Mental and Nervous - The maximum pay period for all disabilities due solely to mental disorders is 24 months. Mental disorders payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability. See your policy booklet for complete details on other policy limitations that may apply.

Buy-Up Long Term Disability Insurance You work hard for your paycheck. But it can be hard to budget for life’s unexpected emergencies. That’s why Forever 21 is giving you the option to purchase additional Long Term Disability Insurance. Corporate employees are provided with 40% of their monthly predisability earnings, to a maximum benefit of $4,000. This is already being provided to you at no cost. You may also elect to purchase Buy-Up coverage. This would provide 60% of your pre-disability earnings to a maximum benefit of $10,000. CE-13068 (8-13)

2013-2014 Plan Year

15

GROUP BENEFITS: LIFE EAP AND TAS (Unum)* Work/Life Balance Employee Assistance Program Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your family members twenty four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues such as financing a car or selecting child care, as well as more serious problems such as alcohol or drug addiction,divorce, or relationship problems. Services include: toll-free phone access to master’s-level consultants, up to three face-to-face sessions to help with more serious issues and online resources. There is no additional charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program. However, if you become disabled and are receiving benefits, Unum’s On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources.

Worldwide Emergency Travel Assistance Services Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and dependent children can get immediate assistance anywhere in the world. Emergency travel assistance is available to you when you travel to any foreign country, including neighboring Canada or Mexico. It is also available anywhere in the United States for those traveling more than 100 miles from home. Your spouse and dependent children do not have to be traveling with you to be eligible. However, spouses traveling on business for their employer are not covered by this program. The work-life balance employee assistance program is provided by Ceridian Corporation. Worldwide emergency travel assistance services are provided by Assist America Inc. Services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The service is not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. The policies have exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum representative for specific provisions and details of availability. Group Short Term Disability and Long Term Disability Insurance are underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries CE-13068 (8-13)

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VOLUNTARY BENEFITS: GROUP ACCIDENT (Unum)* Forever 21 is excited to offer a number of voluntary benefits to ensure you and your families have the support and resources when you need them most. Our voluntary benefits are unique in that they are not tied to us as an employer. So, if you ever leave the Forever 21 family, and we hope you don’t, you can take these benefits with you.

Hearing the words “oops” is never a good thing. Maybe your spouse fell off the ladder while cleaning the gutters, or your child tripped and broke a tooth playing outside, or you threw your back out cleaning the garage.

Unexpected accidents always have lousy timing, especially when you are responsible for insurance deductibles and outof-pocket costs. You need a plan that helps you protect your family and your wallet. Voluntary accident insurance from Unum can help with this: • Hospitalization deductibles and copays • Doctor visit copays • Visits to the emergency department • Physical therapy • Transportation and lodging

Features you’ll appreciate

Accident insurance can help cover the extra costs that can occur when you, your spouse or your children suffer a covered injury – like those that can happen during a game of pick-up basketball or when your kids go rollerblading. It also covers on-the-job accidents. • No health questions to answer – You will automatically receive the base plan if you apply. • Lump sum benefit – You will receive a predefined benefit based on the injury or qualifying event. • Family coverage: o Employees who are actively at work are eligible. Spouses age 17 to 64 who are actively at work or not disabled. Dependent children newborn until their 26th birthday. • 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 – before age 65.

Additional coverage options

• Your employer has selected the optional Sickness Hospital Confinement Benefit. If chosen, this benefit could pay you or your spouse a $100 daily benefit if hospitalized due to a covered illness. Children receive 75% of the employee amount.

Other important information

• Premiums are automatically deducted from your paycheck. • Coverage becomes effective on the first day of the month in which payroll deductions begin. • This plan may be portable should you leave the company or retire. The policy has exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum representative for specific provisions and details of availability. THIS IS A LIMITED POLICY. Group accident insurance is underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. CE-13068 (8-13)

*365 day elimination period applies

2013-2014 Plan Year

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VOLUNTARY BENEFITS: WHOLE LIFE (Unum) Why consider interest sensitive whole life? Interest-sensitive whole life insurance can provide an additional source of financial protection for your working years and provide options for your retirement.

Plan Features

• Policy can build cash value based on the current interest rate and is guaranteed to earn the minimum 4%. • Interest-sensitive whole life insurance premiums do not increase as you get older. • The death benefit (the policy’s face value) remains constant and does not decrease as you get older. The death benefit can only be reduced if there is a policy debt. • If you are actively at work* for a minimum of 30 hours per week, you can sign up during Forever 21’s enrollment period and apply for insurance without taking a health exam. However, you will be asked several health questions. • If you choose, you can use the accumulated cash value to buy a smaller “paid-up” policy with no more premiums due, or cash in the policy at any time. • You own the policy and can take it with you if you leave the company or retire. *Eligible employees must be actively at work to apply for coverage. Being “actively at work” means that on the day you apply for coverage, you are working at one of your company’s business locations, or you are working at a location where you are required to represent your company. If you are applying for coverage on a day that is not one of your scheduled workdays, then you will be considered actively at work if you meet this definition as of your last scheduled workday. You are not considered actively at work if your normal duties are limited or altered due to your health, or if you are on a leave of absence. ±Limited life expectancy of 24 months in IL, MA and WA.

Additional features

• Living Benefit Option Rider – automatically included at no extra charge on all policies. You can request up to 100% of the death benefit (to a maximum of $150,000) if you are diagnosed with a medical condition that limits life expectancy to 12 months± or less. Any payout reduces the death benefit. • Accidental Death Benefit Rider – pays an extra benefit equal to the base policy amount (subject to a $150,000 maximum) if the policy holder dies before age 70 as the

result of a covered accident. Payout is doubled if insured dies as a result of a covered accident while a fare-paying passenger via commercial transportation. Death benefit will increase by 25% if death occurs while wearing a seat belt while driving or riding in a non-commercial automobile. • Wavier of premium – an additional benefit included in this policy, if you become disabled prior to age 65 and remain disabled for at least six months, premiums paid during the six month waiting period are refunded and will be waived as long as you remain disabled. Available to employees age 15 to 55.

Family Coverage options

• This insurance is available for your spouse, based on a qualifying health question, even if you don’t apply for your own policy. • Coverage is available for your children, stepchildren, legally adopted children, grandchildren age 14 days through 24 years. Interest-sensitive whole life is available as a standalone policy, or a children’s term rider* can be attached to your policy – or your spouse’s policy – if you are less than 65 years old. *not available in WA Unum offers interest sensitive whole life insurance as a Guarantee Issue, depending on your eligibility. Guarantee Issue means you can enroll without answering any health questions or taking any physical exams. • Existing employees who have purchased this product in previous enrollments: Guarantee Issue – no qualifying health questions • New enrollees: Conditional Guarantee Issue – must first answer qualifying health questions • Modified/Guaranteed Issue: up to 50% of monthly salary not to exceed $5,000 • Simplified Issue: up to 60% of monthly salary not to exceed $5,000

A typical Interest Sensitive Whole Life Benefit Example:

The Situation • A new mother wants to supplement her life coverage with a policy that offers: • Guaranteed premiums • A cash accumulation feature • Is portable • She is also interested in: • Coverage for her husband and son • Needs help finding good coverage at an affordable rate

The Solution • She purchases: • A $25,000 policy for herself • A separate $25,000 policy for her husband; no health exam needed • A term rider for her son; can be converted to an individual policy without a health exam to ensure he always has access to life insurance • Her policy cash value accumulates a minimum of 4% interests and can be used to buy a reduced paid-up policy without any additional premiums

The policy may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum representative for specific provisions and details of availability. Interest Sensitive Whole Life Insurance is underwritten by: Provident Life and Accident Insurance Company, Chattanooga, Tennessee In New York, underwritten by: First Unum Life Insurance Company, New York, New York © 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. CE-13068 (8-13)

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VOLUNTARY BENEFITS: GROUP CRITICAL ILLNESS (Unum) Could your bank account survive a serious illness? Be prepared with group critical illness insurance from Unum. Critical illness insurance can pay a lump sum benefit at the diagnosis of a covered illness. You choose the level of coverage with benefit amounts from $5,000 to $50,000. You can use the money to pay for copays, deductibles, childcare, transportation, lodging or any other expenses that you may have.

What is covered?

The following specified critical illnesses are covered under the base plan: • Heart attack • Blindness • Major organ failure • End-stage renal (kidney) failure • Coronary artery bypass surgery (pays 25% of lump sum benefit) • Benign brain tumor • Stroke (evidence of persistent neurological deficits confirmed at least 30 days after the event) • Coma (resulting from severe injury lasting for 14 consecutive days or more) • Permanent paralysis (complete and permanent loss of the use of two or more limbs for a continuous 90 days as a result of a covered accident) You may also choose to select this benefit for an additional premium for the following specific critical illnesses: • Cancer • Carcinoma in situ1 (pays 25% of the lump sum benefit) Please refer to the policy for complete details about these covered conditions. You can use this coverage more than once. If you receive a full benefit payout for a covered illness, your coverage can be continued for the remaining covered conditions. The diagnosis of a new covered illness must occur at least 90 days after the most recent diagnosis. Each condition is payable once per lifetime. The following is automatically included in your plan:

Wellness benefit

This benefit can pay $75 per calendar year per insured individual if a covered health screening test* is performed, including: • Blood tests • Stress tests • Colonoscopies • Chest X-rays *A full list of covered tests will be provided in your certificate.

CE-13068 (8-13)

Who is eligible?

• All employees who are actively at work • Spouse ages 17 through 64 • Dependent children (newborn until their 26th birthday) All eligible children are automatically covered at 25% of the employee benefit amount at no additional cost. Eligible children are covered for the same conditions as employee and the following specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. Diagnosis must occur after the child’s coverage effective date.

Policy provisions

Waiting period – Diagnosis must occur at least 30 days after the coverage effective date to be eligible for benefits (does not apply to coma, and permanent paralysis or the specific childhood conditions listed above). Pre-existing condition limitation – Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of a pre-existing condition. Please refer to information provided in your certificate or consult with your benefits representative to determine what would be considered a pre-existing condition. Coverage effective date

12 months before effective date

12 months after effective date

pre-existing limitation does not apply

Reduction of benefits – The benefit amount for the employee and spouse reduces by 50% on the first policy anniversary date after the insured individual’s 70th birthday. Premiums will not be reduced. For coverage purchased after age 70, benefit amounts will not be reduced. Being “actively at work” means that on the day you apply for coverage, you are working at one of your company’s business locations, or you are working at a location where you are required to represent your company. If you are applying for coverage on a day that is not one of your scheduled workdays, then you will be considered actively at work if you meet this definition as of your last scheduled workday. You are not considered actively at work if your normal duties are limited or altered due to your health, or if you are on a leave of absence. Carcinoma in situ is defined as cancer that involves only cells in the tissue in which it began and that has not spread to nearby tissues.

1

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form: CI-1 or contact your Unum representative. In CA, insured individuals must be covered by comprehensive health coverage before applying for group critical illness insurance. In CA, occupational HIV is not a covered condition. In CA, $200 mammography benefit is included within the base plan is payable based on a pre-defined schedule – please review the policy for details. THIS INSURANCE PROVIDES LIMITED BENEFITS. Group Critical Illness Insurance is underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

2013-2014 Plan Year

19

VOLUNTARY BENEFITS: INDIVIDUAL SHORT TERM DISABILITY (Unum) Disability insurance can help replace a portion of your salary during a covered disability. Unum individual short term disability insurance replaces a portion of your income if you are unable to work due to a covered injury or sickness. This means you can have some income during a time of need. Common reasons people use this coverage include pregnancy, injuries and digestive problems – such as gall bladder surgery.

Advantages of the plan

• Choose a monthly benefit from $400 to $5,000 for an illness or off-the-job injury. Coverage up to 60% of your gross monthly salary may be offered (max of 40% in CA, HI, NJ, NY and RI) • Affordable coverage. Your premiums are based on your age when you buy the insurance and will not increase as you get older+. • Available to eligible employees 17-69 (64 in CA and NY) who are actively at work. • Premiums are conveniently deducted from your paycheck. • You own the policy. If you leave or retire, you can take your policy with you and pay the same premium. Unum will bill you directly at home. +Premiums can be changed only if we change them on all policies of this kind in force in the state in which the policy is issued.

Policy provisions

Pre-existing condition limitation— If you have a pre-existing condition* within a 12-month1 period before your coverage effective date, benefits will not be paid for a disability period if it begins during the first 12 months2 the policy is enforced. *A pre-existing condition is a condition for which symptoms existed (within 12 months before your coverage effective date) that would cause a person to seek treatment from a physician or for which a person was treated or received medical advice from a physician, or took prescribed medicine. The determination on whether your condition qualifies as pre-existing will be based on the date of disability and not the date you notify Unum.

Pregnancy3— Nine months after coverage becomes effective, pregnancy is considered the same as any other covered illness. The available monthly benefits will be paid upon fulfillment of the elimination period. Benefits will not be paid if the insured individual gives birth within nine months after the coverage becomes effective. However, medical complications of pregnancy may be considered as any other covered sickness, subject to the pre-existing condition limitation. 1 Six-month period applies in ID and NV. 2 Six-month period in TX (for applicants 65+). 3 Nine-month giving-birth exclusion is not applicable in KS, MT and OK. This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. The expected benefit ratio for this policy is 50%. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy.

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This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form: L-21776 (FUL-21776 for NY) (L-21820-CA) and contact your Unum representative. Unum complies with all state civil union and domestic partner laws when applicable. Individual Short Term Disability Insurance is underwritten by: Provident Life and Accident Insurance Company Chattanooga, Tennessee In New York, underwritten by: First Unum Life Insurance Company New York, New York Interest-Sensitive Whole Life and Individual Short Term Disability insurance underwritten by: Provident Life and Accident Insurance Company Chattanooga, Tennessee In New York, by: First Unum Life Insurance Company New York, New York Group Critical Illness and Group Accident insurance underwritten by: Unum Life Insurance Company of America Portland, Maine unum.com ©2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

CE-13068 (8-13)

WELLNESS PROGRAMS (You must be actively enrolled in a UnitedHealthcare Health Plan to participate, with the exception of the Chantix program also available to Kaiser Permanente participants)

Tobacco Cessation Program

UnitedHealthcare’s tobacco cessation program is tailored to your individual smoking habits and needs. You’ll set a “Quit Date” and begin a staged approach to stop smoking. This program features five levels with tips on how to quit, smoking cessation information and access to additional interactive tools to help keep you on track to meet your Quit Date goal. To access this program, log on to www.myuhc.com, click ‘Health&Wellness,’ then ‘Your Personal Health Center’ on the right side of the screen.

Chantix: Helps Make Quitting Count!

Have you been looking for a method to help you quit smoking? Chantix, a new prescription drug, is now covered by both Kaiser Permanente and UnitedHealthcare (HMO & PPO). What’s really great is that both carriers offer a free support program, because it’s always easier with a little extra help. Kaiser Permanente offers: HealthMedia® Breathe (More details can be found at www.kp.org/healthylifestyles) UnitedHealthcare offers: Smoking Cessation Plan (More details can be found at www.myuhc.com)

Baby on the way?

If so, UnitedHealthcare has a program just for you. A healthy pregnancy helps ensure a healthy mom and baby. The Maternity Support Program offers you and your dependents health and educational support from the time you consider starting or expanding your family, through the first few months of your new baby’s life. This free, confidential program is offered to you as part of your regular benefit package. To get the most from the program, it’s best to enroll during the first trimester of your pregnancy. To enroll call 877-201-5328.

Source4Women

Source4Women gives you answers to your health and wellness questions, in plain language. From interactive seminars and presentations to healthy recipes and tips from the experts, we give you information to help you make more informed decisions. You’ll find information about health plan options, terms, and benefits, as well as resources to help you evaluate your options when selecting a plan. And you can access easy-to-use tools that let you take control of your care. Whether you’re preparing for a doctor visit or need help filling prescriptions, you’ll find answers you can trust at Source4Women.com.

Discount Programs

UnitedHealthcare’s discount program helps you and your family save typically 10 to 25 percent on many health and wellness purchases not included in your standard health benefit plan. Use the plan for: • Weight management from Jenny Craig®1, Nutrisystem® and other popular programs • Nutrition counseling • Fitness clubs including Anytime Fitness, Bally Total Fitness, Curves, Gold’s Gym, Jazzercise, MyGym and Snap Fitness • Fitness equipment and apparel • Natural products and foods • Stress reduction and relaxation

With UnitedHealthcare’s Neonatal Resource Services Program, parents can get the education and support they need during this stressful time that may help avoid readmissions and post-discharge complications. UnitedHealthcare’s dedicated team of NICU nurse case managers, social workers and medical directors collaborate in monitoring the clinical care and other services, including psychological, provided to the baby and parents.

2013-2014 Plan Year

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WELLNESS PROGRAMS (You must be actively enrolled in a Kaiser Permanente Health Plan to participate. Available to CA residents only.)

Challenge Yourself To Stay Healthy Kaiser Permanente can provide the resources to help. If you’re feeling good now, health care coverage might be the furthest thing from your mind. Sure, you can just pay for emergency care if you get sick or injured. But can you get the resources to help you stay strong and healthy for the long run? With Kaiser Permanente, you can.

More than just health care

If you’ve got them, use them. Take advantage of the tools you need to help you stay well and keep tackling new challenges. • My Health Manager. E-mail your doctor’s office, order prescription refills, and more at kp.org/myhealthmanager.* • Preferred rates on specialty health services. Get massage therapy, acupuncture, and fitness club memberships for less at kp.org/choosehealthy.† • Farmers’ markets. Check out locations and schedules at kp.org/farmersmarket. • Hear here. Download podcasts of our audio programs at kp.org/listen. • Healthy living classes. Find health-related programs, groups, and classes near you at kp.org/classes. (Some classes may require a fee.) • Preventive care. Dealing with health issues early, before they develop, can save you money. Look up preventive care tips at kp.org/prevention. • We’re here for you. If you don’t feel well, call your doctor during regular office hours or speak to an advice nurse after hours by calling toll free (800) 576-6225. • Things happen. We offer after-hours urgent care and extended hours at many of our locations. And you’re always covered for emergency care, anywhere in the world. For questions or concerns, our Member Service Call Center is available weekdays from 7 a.m. to 7 p.m. and weekends from 7 a.m. to 3 p.m. at (800) 464-4000. (For TTY for the hearing/ speech impaired, call (800) 777-1370.) There’s no need to go without coverage simply because you feel fine today. When you tap into everything we have to offer that’s right for your family, you’ll see that you’ve got more than just a health care plan—you’ve got a plan for good health. * To use these secure features for the first time, go to kp.org/register, then sign on with your user ID and password. † These products and services are provided by entities other than Kaiser Permanente. Some Kaiser Permanente benefit plans include coverage for certain of these discounted services. Plan benefits must be used before those discounted services are available. Check your Evidence of Coverage for details. Kaiser Permanente disclaims any liability for these discounted products and services. Should a problem arise, you may take advantage of the Kaiser Permanente grievance process by calling the Member Service Call Center at (800) 464-4000.

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EDUCATION Art Institutes, Argosy University, Brown Mackie College, South University

Education Management Corporation (EDMC) is one of North America’s largest providers of post-secondary education. They have been providing career-focused education for over 40 years, equipping students with the skills, abilities and experiences employers look for. Our students can earn undergraduate and graduate degrees and specialized non-degree diplomas in a broad range of disciplines including design, media arts, health sciences, psychology and behavioral sciences, culinary, fashion, business, education, legal studies, and information technology. Forever 21 Employees can enjoy: • 10% savings on tuition • Associate’s, bachelor’s, and master’s degree programs, as well as diploma and certificate programs in the areas of design, media arts, fashion, and culinary. • A system of over 45 schools throughout North America. • A collaborative community built on sharing ideas. • Faculty and staff who inspire, mentor, and guide our students. • Professional-grade technology that gives our students the tools to see their vision come to life.

University of Phoenix HOW DO YOU SEE YOUR FUTURE?

If you’ve been wondering how you could get your bachelor’s or master’s—or even your doctoral degree— and still work part time or full time. University of Phoenix is designed especially for the busy working learner, like yourself—with convenient class times and flexible scheduling, allowing you to attend class when most convenient. Forever 21 has teamed up with University of Phoenix to bring you special educational benefits and access to an innovative way to learn. With this opportunity you can pursue your educational goals while staying on top of your professional commitments. You may also be able to turn prior professional development training or certificates into college credit through Prior Learning Assessment. Learn more at phoenix.edu/forever21 or call 866.354.1800.

Contact the Art Institutes to find out more about how you can purse a creative education or visit their website at

Artinstitutes.edu

2013-2014 Plan Year

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VITALITY

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DISCOUNT PROGRAMS WORKING ADVANTAGE

Register for your FREE account today! Follow the five steps below.

Exclusive discounts include: • • • •

Entertainment Theatre and Events Shopping and Gifts Earn Rewards

STEP 2 STEP 3 STEP 4 STEP 5

STEP 1

WORKING ADVANTAGE Go to www.workingadvantage.com/Forever21

NATIONAL AT&T WIRELESS DISCOUNTS

Forever 21 Employees are eligible to receive DISCOUNTS for their New and Existing Personal Wireless Service with AT&T! The discount for Monthly Recurring Service Charges is 18%. This is applied to your primary voice plan of $39.99 or higher, and Wireless Phone Data plans that are $25 and higher (NEW: Forever 21 Employees who purchase the iPhone 3GS or iPhone 4s are eligible to receive discounts of up to 10%!) (Unlimited and Unity Plans are not eligible).

Shop or Register For Your Discount Online: att.com/wireless/FOREVER21

Click the Go To Working Advantage link Select the Register button at the top of the page Select Employees Click Here Enter Member ID# 561188160

To Register: Step 1: Go to the website and type in your zip code and click Continue. Step 2: Look for the “discount registration” link at the top of the page, then click on it and follow the steps! Website is also available for new orders and upgrades. Equipment pricing and promotions found on this website are “exclusive” to this site. No other AT&T Channel will “support” or “match” equipment promotions available on this site!

DELL DISCOUNTS

Phone – For Ordering Only:

Save on the latest Dell products & select electronics and accessories

National Business Ordering (888) 444-4410 Company Sponsorship GSM FAN #2415530

Your membership benefits include:

Retail Store:

• • •

Best price on Dell consumer PCs Free membership to the Dell Advantage loyalty program Discounts on electronics and accessories

Shop Dell using your membership: Dell.com/mpp/forever21 or 1-888-243-9964 Member ID: GS22938926

VERIZON DISCOUNTS

Save 15% on your monthly calling or data plan, phone & accessories!

What you have to do: • • • •

Visit verizonwireless.com/discounts Enter work email address and select “Check for discounts” You will receive an email. Click the “Get Started” button in the email to continue registering Click on the “Register Your Line” link in the “Existing Customers” section under “Enroll”. If you do not have a work email, click on the “I do not have a work email address” link and follow the prompts.

Sponsorship program is available in AT&T retail stores. Equipment pricing will vary compared to the sponsorship website. Please check with your retail sales rep if Premier pricing applies. Bring a paycheck stub or ID badge! To find a store near you visit: www.att.com/storelocator. For assistance, please refer to all inquiries regarding your personal service with AT&T to the Premier site ‘help’ tab, your AT&T retail store, or by calling (800) 331-0500.

Please note the following disclaimers for National AT&T Wireless Discounts: • While AT&T is a valued corporate partner of Forever 21, this should not be interpreted as a sole endorsement for your personal use. You have many choices when you choose a wireless provider, and should you choose AT&T, we have made an employee discount available to you. • The relationship you establish with AT&T is not tied to our corporate partnership with them, except for the discount available. You are financially liable for all payments and guarantees, and Forever 21 has no part in that relationship. • Forever 21 has no part in the escalation or distribution of information regarding cellular use on a personal basis, but is simply forwarding this information to you as a courtesy. Please refer all inquiries regarding your personal service with AT&T to the Premier site, a retail store, or by calling (800) 331-0500.

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CONTACTS Benefit Plans

Contact Information

Core Plans UnitedHealthcare Choice Plus PPO High UnitedHealthcare Choice Plus PPO Low UnitedHealthcare Choice EPO (California only) Policy #755321 (888) 510-9416 (Customer Service)

Medical Plans

www.myuhc.com

Kaiser Permanente HMO (California only) (Southern California Group # 231108 Northern California Group # 603668) (800) 464-4000 (Member Services) www.kp.org

Dental Plans

Aetna (855)-850-9664 www.Aetnanavigator.com

Vision Plan

VSP (800) 877-7195 (Member Services) www.vsp.com

Employer Paid Group Plans Base Plan Term Life, Buy-Up Term Life and Long Term Disability Insurance

Unum, (800) 445-0402, www.unum.com

Short and Long Term Disability

Unum, (877) 851-7637, www.unum.com

EAP

Unum, (800) 854-1446: English, (877) 858-2147: Spanish www.lifebalance.net; user ID and password: lifebalance

Travel Assistance Voluntary Plans

Unum, (800) 872-1414, www.unum.com

Flexible Spending Accounts

P&A (800) 688-2611 www.padmin.com

Whole Life Insurance, Individual Short Term Disability, Group Accident and Critical Illness

Unum (800) 635-5597 www.unum.com

Information and Enrollment Forever 21 Contacts

Phone: (213) 741-8897 Fax: (213) 743-0560 [email protected]

Forever 21 Benefits Portal

www.MyForever21Benefits.com

This Employee Benefits Brochure highlights the main features of your benefit programs and does not include all the rules and details, including limitations and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts and the Summary Plan Description. If there is a conflict between the information in this brochure and the formal language of the Summary Plan Description (SPD), the wording in the Summary Plan Description (SPD) will govern.

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NOTES

2013-2014 Plan Year

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