CARING FOR THE TOTAL YOU - CHOOSE YOUR 2021 BENEFITS OCT. 19-NOV. 6 2021 OPEN ENROLLMENT GUIDE - MYPETCOBENEFITS BENEFITS ...
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HOURLY PARTNERS CARING FOR THE TOTAL YOU. Choose Your 2021 Benefits Oct. 19—Nov. 6 2021 Open Enrollment Guide
Looking for information
about your benefits?
Check out the enhancements
to our benefits website at
www.mypetcobenefits.com.
Open Enrollment in 3 easy steps
1 REVIEW your choices explained in this Open Enrollment Guide.
• Access additional resources such as plan summaries, FAQs, and videos
on the MyPetcoBenefits website. Go to www.mypetcobenefits.com.
• Get information about the medical and dental plans administered by
Collective Health at http://join.collectivehealth.com/petco or call
844-516-3836 to speak to a Member Advocate.
2 CHOOSE the coverage you want for 2021.
3 ENROLL
online or call the Petco Benefits Service Center.
• Go to www.mypetcobenefits.com and click on the Login Here button
to enroll in your 2021 benefits using Benefitfocus.
• Call the Petco Benefits Service Center at 855-847-6067 to enroll in your
2021 benefits over the phone or get answers to your benefit questions.
Representatives are available Monday-Friday from 8 a.m. to 8 p.m. ET.
Passive enrollment process
For 2021, you will be automatically re-enrolled in the coverage you have today,
except for flexible spending accounts, which must be elected each year.
Take action by November 6, 2020 to enroll in a new plan, make changes to
your current coverage, or enroll in a flexible spending account.
Inside
Caring for the total you 2
2021 Open Enrollment – what you need to know 2
Plans included in Open Enrollment 3
Enroll in your 2021 benefits 4
Dependent eligibility reminder 4
Medical 5
Tax savings accounts 11
Vision 13
Dental 14
2021 medical, dental and vision per pay period rates 15
Life and AD&D insurance 16
Disability insurance 16
Legal assistance plan 17
Voluntary benefits 17
Petco preventive care and Petco insurance 18
Other valuable benefits 19
Important contact information 20
Sign-up for text message alerts!
Sign-up for text message alerts on your smartphone to receive
notifications from Petco about benefit program deadlines and
events. Petco does not charge for text message alerts sent to
you. Check with your wireless carrier for possible charges for
text messages.
To sign up, text BENE9 to 31996. To stop, text STOP to 31996.
1
CARING FOR THE TOTAL YOU.
We believe that serving our partners by investing in their health and wellbeing is non-negotiable.
This means we take care in designing Petco’s Total Rewards with affordable benefits that help
support and protect you, your family, your health, and financial goals.
Here are some of the ways our health benefits are caring for the total you:
• Telemedicine: Quick and convenient video visits with a healthcare provider for non-emergency
medical care at no cost with Collective Health PPO plans. See page 10 for details.
• Behavioral health: Video visits also available with behavioral health professionals at no cost for
anxiety, grief, depression, and more with Collective Health PPO plans. See page 10 for details.
• Preventive care: If you’re covered by a Petco medical plan, certain preventive care is covered at
100% when you use in-network providers. Age and frequency limitations apply.
• Affordable care: Collective Health PPO plans have affordable copays for doctor visits and
prescriptions to save you money.
• Expert Second Opinion Service: If you are enrolled in a Collective Health medical plan, you
have access to a free second opinion service from nationally recognized doctors if you are
contemplating surgery or have questions about a treatment plan for serious health conditions.
2021 Open Enrollment
October 19 – November 6, 2020
Open Enrollment is your annual opportunity
to make changes to your benefits and to add
or drop coverage for eligible family members.
What you need to know for 2021
Petco continues to invest to make our benefits inclusive, diverse, and affordable, and to make it easy for
you and your family to get the care you need. Here are a few things you should know about for 2021:
3 Same plans and coverage options in 2021 that are available today.
3 No increase in health plan contributions in 2021. See page 15 for 2021 medical, vision and dental
plan rates.
3 Decrease in health plan contributions if you cover eligible family members under a Collective
Health medical plan.
2
Plans included in Open Enrollment
You can enroll or make changes to the benefits shown below during Open Enrollment. Outside of
Open Enrollment, you can only make changes to these benefits if you have a qualifying life event
during the year such as a marriage or the birth or adoption of a child.
Go to www.mypetcobenefits.com for more information on qualifying life events.
• Medical • Flexible Spending Account • Accident Insurance
• Dental • Short and Long-term Disability • Hospital Indemnity Insurance
• Vision • Critical Illness Insurance • Legal Assistance Plan
Plans you can enroll in at anytime during the year
Once you become eligible, you can enroll or change these benefits at any time:
• 401(k) Plan • Pet Preventive Care • Commuter Benefits Program
• Health Savings Account • Petco Pet Insurance • Auto & Home Insurance
3
Enroll in your 2021 benefits
Enroll online Call the Petco Benefits
The easiest way to choose your benefits for Service Center
2021 is through the Benefitfocus website. You can also call the Petco
Benefits Service Center to enroll
• Go to mypetcobenefits.com and click on
in your benefits or get answers
Benefits Enrollment at the top of any page
to your benefit questions.
• For new users, follow the onscreen
• Call 855-847-6067 M-F from
instructions to create an account on the
8 a.m. to 8 p.m. ET
Benefitfocus website
Dependent eligibility reminders
You are responsible for making sure your
covered dependents are eligible.
Spouse/domestic
Your eligible dependents are your: partner surcharge
• Legal spouse Petco partners who cover a spouse
or eligible domestic partner on a
• Same-sex domestic partner
Petco medical plan—when he or
she is eligible for medical coverage
• Child under age 26 or disabled, dependent
outside of Petco’s plan (other
child incapable of self-support due to mental or
than coverage through Medicare
physical disability, if the child becomes disabled
or Medicaid)—must pay a $50
prior to reaching age 26 surcharge per pay period.
Your eligible children include: The surcharge is in addition to
normal payroll contributions for
• Natural born child medical coverage. If you are adding
a spouse or domestic partner to
• Stepchild, legally adopted child or child
your coverage, you will be required
for whom you have been appointed legal to state whether your spouse or
guardianship by a court of law domestic partner is eligible for
medical coverage outside of Petco’s
• Child for whom the Plan has received a Qualified
plan when you make your enrollment
Domestic Child Support Order elections.
4
Medical
Here’s what you need to know about our 2021 medical plans.
HSA Plan
Enhanced PPO Plan •P
remiums in-between Enhanced and
• Highest premiums Value PPO plans
• Lowest deductible • High deductible
•C
opays for doctor visits, urgent care and
• You must meet the deductible before
generic drugs
the plan begins to pay for services other
•T
elemedicine doctor visit through Teladoc has than preventive care. After you’ve met
a $0 copay (Collective Health medical plan) the deductible, you’ll pay 20% for most
in-network covered services
•T
elemedicine doctor visits through
Teladoc has a $45 copay before the
deductible is met and a $0 copay after
Value PPO Plan the deductible is met (Collective Health
medical plan)
• Lowest premiums
•P
etco will make quarterly contributions
• Highest deductible
into your HSA up to $250 per plan
•C
opays for doctor visits, urgent care and year for employee only coverage and
generic drugs up to $500 per year for employee +
•T
elemedicine doctor visit through Teladoc has dependent(s)
a $0 copay (Collective Health medical plan)
Note: While the HSA plan may be a good
choice for someone who is a low utilizer of
healthcare and has predictable expenses,
it might not be the right plan for everyone.
Plans available through Kaiser Call the Petco Benefits Service Center at
If you live in a Kaiser Permanente service area in CA, 855-847-6067 for assistance evaluating
CO, DC, GA, MD, OR, VA or WA, you may be able to the medical plans available to make the
elect a Kaiser HMO or HSA medical plan. See page 7 best choice for you.
for more information.
5
2021 medical plans at-a-glance
Collective Health Medical Plans: Review the Collective Health Summary of Benefits & Coverage (SBC) for
the plans below at www.mypetcobenefits.com.
Collective Health Medical Plans
Plan Feature Enhanced PPO Plan Value PPO Plan HSA Plan
Plan Year Deductible
• Employee $1,000 $4,000 $2,000
• Family $2,000 $8,000 $4,0001
Petco Contribution to HSA
• Employee n/a n/a $250 ($62.50 quarterly)
• Family n/a n/a $500 ($125 quarterly)
Plan Year Out-of-Pocket Max
• Employee $6,000 $6,000 $4,000
• Family $12,000 $12,000 $8,0005
In-Network In-Network In-Network
YOU PAY YOU PAY YOU PAY
Preventive Care $03 $03 $03
Telemedicine Virtual Doctor Visit $03 $03 $45 (until plan year deductible is met)
through Teladoc $0 (after plan year deductible is met)
Office Visit
• PCP $25 copay $40 copay 20%2
• Specialist $50 copay $80 copay 20%2
Urgent Care $100 copay $100 copay 20%2
Emergency Room 20%2 30%2 20%2
Diagnostic Testing 20%2 30%2 20%2
Outpatient X-Ray and Lab 20%2 30%2 20%2
Hospitalization
• Inpatient Semi-Private Room 20%2 30%2 20%2
• Inpatient Physician 20%2 30%2 20%2
Outpatient Treatment (PT, OT, ST) 20%2 30%2 20%2
Mental Health/Substance Abuse
• Inpatient 20%2 30%2 20%2
• Outpatient 20%2 30%2 20%2
Pharmacy Retail 30-day supply 30-day supply 30-day supply
• Specified Preventive Drugs4 100% covered3 100% covered3 100% covered3
• Generic $10 copay $10 copay 20%2
• Brand Formulary 20%3 30% 3 20%2
• Brand Non-Formulary 30%3 30% 3 20%2
Pharmacy Mail Service 90-day supply 90-day supply 90-day supply
• Specified Preventive Drugs4 100% covered3 100% covered3 100% covered3
• Generic $20 copay $20 copay 20%2
• Brand Formulary 20%3 30% 3 20%2
• Brand Non-Formulary 30%3 30% 3 20%2
1) The
family deductible must be met before any person receives benefits. 4) As specified in essential drug list.
2) Coinsurance you pay after you meet the plan year deductible unless otherwise noted. 5) T
he family out-of-pocket maximum must be met before
3) Plan year deductible waived. benefits are paid at 100% for any person.
6
2021 medical plans at-a-glance
Kaiser Permanente Medical Plans: If you live in a Kaiser Permanente service area in CA, CO, DC, GA, MD,
OR, VA or WA, you may be able to elect a Kaiser Permanente HMO or HSA medical plan. You must use
Kaiser network providers only except for certain emergency situations. Benefits in RED are for California
residents only. See the Kaiser Summary of Benefits & Coverage (SBC) for your state available on the
www.mypetcobenefits.com for details on Kaiser medical plan benefits.
Kaiser Permanente Medical Plans
Plan Feature Enhanced HMO Plan Value HMO Plan HSA Plan
Plan Year Deductible
• Employee $1,000 $4,000 $2,000
• Family $2,000 $8,000 $4,0001 ($2,8002 CA)
Petco Contribution to HSA
• Employee n/a n/a $250 ($62.50 quarterly)
• Family n/a n/a $500 ($125 quarterly)
Plan Year Out-of-Pocket Max
• Employee $6,000 $6,000 $4,000
• Family $12,000 $12,000 $8,000 6
Kaiser Network Providers Kaiser Network Providers Kaiser Network Providers
YOU PAY YOU PAY YOU PAY
Preventive Care $04 $04 $04
Telemedicine Virtual Doctor Visit $04 $04 20% 3
through Kaiser
Office Visit
• PCP $25 copay $40 copay 20% 3
• Specialist $50 copay $80 copay ($50 copay CA) 20% 3
Urgent Care $100 copay ($25 copay CA) $100 copay ($40 copay CA) 20% 3
Emergency Room 20% 3 30%2 20% 3
Diagnostic Testing 20% 3 30% 3 20% 3
Outpatient X-Ray and Lab 20% 3 30% 3 20% 3
Hospitalization
• Inpatient Semi-Private Room 20% 3 30% 3 20% 3
• Inpatient Physician 20% 3 30% 3 20% 3
Outpatient Treatment (PT, OT, ST) 20% 3 30% 3 20% 3
Mental Health/Substance Abuse
• Inpatient 20% 3 30% 3 20% 3
• Outpatient 20% 3 30% 3 20% 3
Pharmacy Retail 30-day supply 30-day supply 30-day supply
• Specified Preventive Drugs5 100% covered4 100% covered4 100% covered4
• Generic $10 copay $10 copay 20% 3 ($50 max CA)
• Brand Formulary 20%4 ($100 max CA) 30% 4 ($100 max CA) 20% 3 ($100 max CA)
• Brand Non-Formulary 30% 4 (20%, 3 $100 max CA) 30% 4 ($100 max CA) 20% 3 ($100 max CA)
Pharmacy Mail Service 90-day supply 90-day supply 90-day supply
• Specified Preventive Drugs5 100% covered4 100% covered4 100% covered4
• Generic $20 copay $20 copay 20% 3 ($50 max CA)
• Brand Formulary 20%4 ($100 max CA) 30% 4 ($100 max CA) 20% 3 ($100 max CA)
• Brand Non-Formulary 30% 4 (20%, 3 $100 max CA) 30% 4 ($100 max CA) 20% 3 ($100 max CA)
1) The family deductible must be met before any person receives benefits. 4) Plan year deductible waived.
2) In CA, a covered family member needs to meet a $2,800 plan year deductible 5) As specified in essential drug list.
before the plan starts sharing costs for that family member under the HSA Plan. 6) The family out-of-pocket maximum must be met before benefits
3) Coinsurance or copay you pay after you meet the plan year deductible unless are paid at 100% for any person.
otherwise noted.
7
Prescription drugs
All Petco medical plans include prescription drug coverage.
Prescription drugs with a Collective Health medical plan
When you enroll in a medical plan administered by Collective Health, you automatically receive prescription
drug coverage through CVS. The CVS pharmacy network has more than 70,000 pharmacies nationwide.
Specified Preventive Generic Drugs Brand Non-Formulary
Drugs Generic drugs have the Brand name drugs not on
Certain generic preventive lowest costs and are the brand formulary have
medications (like birth control) considered identical the highest copays. When
are covered at no cost and not to their brand name you fill a prescription, you
subject to annual deductibles equivalents by the FDA can ask the pharmacist
provided certain requirements in terms of efficacy and whether a generic or
are met. safety. brand formulary drug
of your medication is
available. If you or your
provider choose a brand
Brand Formulary
non-formulary medication
Drugs on the brand formulary are designated as preferred
when a generic is available,
based on their cost effectiveness and, in some cases, efficacy.
you’ll pay the difference
If you or your provider choose a brand formulary medication
in cost between the
when a generic is available, you’ll pay the difference in cost
between the generic and the brand formulary drug. generic and the brand
nonformulary drug.
Prescription drugs with a Kaiser Permanente medical plan
When you enroll in a Kaiser HMO or HSA medical plan, you automatically
receive prescription drug coverage through Kaiser. Many Kaiser Permanente
facilities have pharmacies in the building. You can refill prescriptions in person, online or by phone.
Refill in person: Take your prescription to a Kaiser pharmacy.
Online: Visit kp.org/rxrefill to order your prescription refills online after you register at kp.org/registernow.
Phone: Call the pharmacy refill phone number highlighted on your prescription label.
8Collective Health
Collective Health is the administrator for Petco’s Enhanced PPO, Value PPO and HSA medical
plans. Collective Health is also the administrator for the Standard Dental and Enhanced Dental
plans. Collective Health utilizes the Blue Shield medical provider network and the Delta Dental
provider network.
Why Collective Health?
Collective Health combines technology and industry expertise to help members better understand
their benefits and navigate through their healthcare needs.
With Collective Health’s unique platform, you will be able to view your medical, pharmacy and
dental claims all in one place (excluding Kaiser plans and the dental HMO). You can work online
to manage your healthcare claims and access tools that help you find care and compare costs for
services and procedures in your geographic area. You can also speak to a Member Advocate by
phone to ask questions about your coverage
and for help submitting claims. Collective
Health makes it simple for you to make the
most effective decisions for your health Contact Collective Health
and your wallet.
http://join.collectivehealth.com/petco
Member Advocates
Collective Health’s Member Advocates can: help@collectivehealth.com
• Help you understand your coverage
• Give you a single place to review your 844-516-3836
claims history Mon-Fri, 4 a.m. to 6 p.m. PT
Sat 7 a.m. to 11 a.m. PT
• Answer your questions
• Connect you to programs that meet your Search for the Collective Health
unique needs including mental health mobile app on the App Store or
support, expert medical advice, and more. Goggle Play
How to find network providers
Access the Collective Health online portal and
go to “Find Care.” If you have questions or need
assistance finding in-network providers, contact
Collective Health by phone or email noted above.
9Teladoc
Teladoc provides you with 24/7 access to a national network of U.S. board certified doctors when
you are enrolled in a Collective Health medical plan.
You can connect with a Teladoc physician from
Your Cost
anywhere—home, work or on the road. Teladoc
for Medical or
doctors diagnose non-emergency medical 2021 Medical Behavioral
problems, recommend treatment, and can even Plan Health Visits
call in certain prescriptions to your pharmacy.
Enhanced PPO Plan $0
Behavioral health visits through Teladoc are Value PPO Plan $0
also available with a psychiatrist, psychologist,
social worker or licensed therapist for anxiety, Subject to deductible;
HSA Plan $0 after deductible
grief, depression and more.
is met
Grand Rounds
Connect with nationally recognized medical doctors from the comfort of your home. If you are
enrolled in a Collective Health medical plan, you can connect with board-certified doctors for an
expert second opinion via phone or video all within a matter of days and at no cost to you!
Get expert advice when you or a covered family member has questions about:
• A new or existing diagnosis • A chronic condition
• Treatment plan • Your medication
• Possible surgery
Petco spine program requirement
If you or a family member is enrolled in a Collective Health medical plan, you must complete
an Expert Opinion with Grand Rounds prior to spine surgery. Failure to get a second opinion
may lead to an additional $500 copay.
10Tax savings accounts
HealthyEquity is the new administrator for Petco’s tax savings accounts
HealthEquity is the new administrator for the health savings account (HSA), flexible spending accounts (FSA), and
commuter benefits program. HealthEquity is an industry leader offering partners enhanced customer service,
claims processing, simple tools, and and online services to get the most from your account(s).
HealthEquity • Live service 24/7/365: Get the same service at 2 a.m. or 2 p.m.
from knowledgeable, US-based HealthEquity Member
https://learn.healthequity.com/petco Service specialists.
•E
asy-to-use online account access: Access claims, pay bills, get
844-341-4934
reimbursements, and more—all from a single, easy-to-use
Available 24/7, online portal.
365 days a year! •H
ealthyEquity educational and informational resources:
Watch videos, user interactive tools including contribution
calculators and access links to other useful websites.
Health savings account (HSA)
If you enroll in the HSA Plan through Collective Health or Kaiser, you have the option to contribute to a
health savings account (HSA). Unlike money in an FSA, the funds in your HSA roll over each year and
continue to build. Your HSA funds are also portable, so if you leave Petco, you can take your account
balance with you.
Transferring your HSA to HealthEquity: If you currently have an HSA with BenefitFocus, you can transfer
your account balance as of 12/31/2020 to HealthEquity at no cost. Refer to the instructions on how to
transfer your HSA balance to HealthEquity on the Open Enrollment page on www.mypetcobenefits.com.
Key things to know about a health savings account
Petco contributes to your In 2021, you can contribute You can use your HSA to pay
HSA up to $250 ($62.50 pre-tax dollars up to $3,350 for eligible medical, dental
per quarter) for employee- for employee only and up and vision expenses.
only coverage and up to to $6,700 if you cover at
$500 ($125 per quarter) least one dependent. If you
if you cover at least one are 55 or older in 2021, you You can adjust your HSA
dependent. can contribute an additional payroll contributions at any
$1,000. time during the year.
You decide when to You can contribute to an HSA if Your HSA earns interest,
spend (or save) your HSA your are enrolled in the HSA Plan and once the balance
dollars. Any unused money and you are not covered by a reaches $2,000, you can
remaining in your account at non-HSA medical plan, Medicare, choose to invest the
the end of the plan year rolls Medicaid, TRICARE, or a amount over $2,000 —
over for you to use to pay healthcare FSA. Also you cannot similar to how the 401(k)
for eligible expenses now or be claimed as a dependent on plan works.
save for the future. another person’s tax return.
11Tax savings accounts (continued)
Healthcare flexible Healthcare Flexible Spending Account
spending account Annual maximum Up to $2,750 in 2021
A healthcare FSA gives you a tax break on contribution
many medical, dental and vision expenses that
are not covered by other plans. By anticipating Eligible expenses Medical, dental and vision care
expenses not paid by your health
your expenses and arranging for deductions to
insurance and on the IRS list of
be made from your paycheck each pay period, approved expenses.
you lower your tax bill. You can set aside up
to $2,750 in 2021 on a pre-tax basis to cover Pairs with Enhanced or Value PPO Plan
eligible medical, dental and vision expenses.
If you don’t use it Up to $550 carry over to
next year and any additional
Limited use flexible funds will be forfeited
spending account Limited Use Flexible Spending Account
If you enroll in the HSA Plan and open a health
savings account, you can open a limited use FSA Annual maximum Up to $2,750 in 2021
to set aside a portion of your earnings on a pre-tax contribution
basis to pay for dental and vision expenses only.
Eligible expenses Dental and vision care expenses
You can set aside up to $2,750 in 2021 on a pre-tax not paid by your health insurance
basis to cover eligible dental and vision expenses or reimbursed through a health
not reimbursed by any other health plan. savings account
Pairs with HSA Plan
Dependent care flexible If you don’t use it Up to $550 carry over to
spending account next year and any additional
funds will be forfeited
A dependent care FSA allows you to pay for
eligible day care or elder care expenses while you
are working. You can set aside up to $5,000 each Dependent Care
plan year on a pre-tax basis to cover the cost of Flexible Spending Account
dependent care expenses.
Annual maximum Up to $5,000 in 2021 per married
The amount you contribute to a dependent care contribution couple filing jointly ($2,500 max
FSA cannot be greater than your income or your for married, filing separately.)
spouse’s income, whichever is less. If your spouse
contributes to a dependent care FSA through his Eligible expenses Dependent care expenses that
or her employer, your combined contributions make it possible for you to work
may not exceed $5,000. If you don’t use it Any funds remaining at the end
of the plan year are forfeited
Commuter benefits program
Set aside pre-tax dollars for transportation and
Commuter Benefits Program
parking. Use the commuter benefits program
administered by HealthEquity to save money on 2021 Transit Maximum $270 per month
commuting expenses.
2021 Parking Maximum $270 per month
12Vision
Standard and Enhanced Vision Plans
The Standard and Enhanced Vision Plans are offered through VSP. Both plans provide discounts on
exams, eyeglasses or contacts, and other vision services.
Your benefits are highest when you visit a VSP provider. If you see a non-VSP provider, you’ll have to
file your own claim forms and you’ll likely pay more out-of-pocket. The benefits shown in the table
apply to in-network services and providers.
2021 Vision Benefits At-a-Glance
VSP Standard Vision VSP Enhanced Vision
Benefit Feature Using VSP Provider Using VSP Provider
Eye Exam (Once each plan year) Covered in full with $10 copay Covered in full with $10 copay
Frames Once every other plan year Once every plan year
Covered up to a $130 Covered up to a $175
retail allowance; plus 20% off retail allowance; plus 20% off
any out-of-pocket costs any out-of-pocket costs
Lenses (Once each plan year)
• Single vision, lined bifocal, lined trifocal Covered in full with $25 copay Covered in full with $10 copay
Lens Options 20% to 25% off retail cost 20% to 25% off retail cost
Scratch resistant coating, ultraviolet coating,
tint, standard polycarbonate, anti-reflective
coating, other add-ons and services
Contact Lenses (Once each plan year in lieu
of frames and lenses)
• Contact lens exam (fitting and evaluation) Covered in full with copay Covered in full with copay
not to exceed $60 not to exceed $60
• Contact lenses Covered up to $130 allowance Covered up to $175 allowance
To find VSP providers in your
area, call VSP at 800-877-7195
or visit vsp.com
13Dental
Standard and Enhanced Dental PPO Plans
Collective Health administers the Standard and Enhanced Dental PPO Plans through Delta Dental. Both
plans give you access to Delta Dental’s network of preferred dentists. If you use a Delta Dental network
dentist, your preventive care is covered at 100% and you’ll pay less out-of-pocket costs for other services
because network dentists provide services at pre-negotiated rates.
To find Delta Dental network dentists, go to http://join.collectivehealth.com/petco and click on
“Find Care.” You can also call Collective Health at 844-516-3836 for assistance.
Delta Dental HMO Plan
The Delta Dental HMO Plan requires you to visit your selected primary care dentist in order to receive
benefits. You must choose a dentist for each covered family member. Preventive services are covered
at no charge. You pay a fixed copay for other dental services. To find a DeltaCare USA dentist, go to
www.deltadentalins.com and click on Find a Dentist.
2021 Dental Benefits At-a-Glance
Collective Health Dental Plans Delta Dental
Benefit Feature Standard Dental PPO Enhanced Dental PPO Delta Dental HMO
Plan Year Deductible $50 per person, $50 per person, None
$150 per family $150 per family
Plan Year Maximum Benefit $1,500 $2,000 No Maximum Benefit
Diagnostic/Preventive Services
• Preventive Care No charge, no deductible No charge, no deductible No charge1,2
• Oral Exams, X-rays No charge, no deductible No charge, no deductible No charge
Basic Services
• Oral Surgery 20% after deductible 20% after deductible $12—$125 copay
• Restorative (fillings) 20% after deductible 20% after deductible $0—$115 copay
• Endodontics (root canals) 20% after deductible 20% after deductible Up to $430 copay
Major Services
• Crowns 50% after deductible 50% after deductible Up to $500 per unit
• Dentures 50% after deductible 50% after deductible $525—$715 copay
Orthodontia
• Adolescent Benefit (to age 19) Not covered 50% after deductible $1,530—$2,505 copay3
up to $1,500 lifetime max
• Adult Benefit Not covered Not covered $1,730—$2,705 copay3
1) $12 copay per tooth for sealants and a $170 copay for space maintainers.
2) $30 copay (child) or $45 copay (Adult) for prophylaxis beyond the limit of 2 per year with no copay.
3) Additional charges for evaluation, treatment plan, banding (placement of braces) and retention.
142021 medical, vision and dental rates
Medical (costs shown are per pay period)
Employee Employee + Employee +
Option Only Spouse/DP1 Child(ren) Family
Enhanced PPO Plan $94.80 $285.51 $190.16 $326.30
Value PPO Plan $39.30 $130.26 $85.67 $175.11
HSA Plan $62.43 $202.30 $137.58 $259.66
Kaiser Enhanced Plan2 $71.01 $217.64 $144.32 $290.96
Kaiser Value Plan2 $34.87 $109.24 $72.06 $146.42
Kaiser HSA Plan2 $47.96 $148.51 $98.24 $198.78
Spouse/Domestic Partner Surcharge: A $50 surcharge is added to your medical rate each pay period if you
cover a spouse or domestic partner on a Petco medical plan when he or she is eligible for medical coverage
through their own employer (other than coverage through Medicare or Medicaid).
Nicotine Surcharge: A $15 surcharge is added to your medical rate each pay period if you and/or your covered
spouse currently uses nicotine and is not currently participating in a tobacco cessation program. The maximum
nicotine surcharge is $30 ($15 for the Petco Partner and $15 for the covered spouse).
Vision (costs shown are per pay period)
Employee Employee + Employee +
Option Only Spouse/DP1 Child(ren) Family
VSP Enhanced Vision $3.66 $7.30 $7.77 $12.43
VSP Standard Vision $2.31 $4.58 $4.88 $7.80
Dental (costs shown are per pay period)
Employee Employee + Employee +
Option Only Spouse/DP1 Child(ren) Family
Enhanced Dental PPO $13.61 $27.23 $29.66 $42.78
Standard Dental PPO $10.21 $20.42 $22.85 $32.09
Delta Dental HMO $6.36 $11.65 $12.71 $16.95
1) D
omestic partner: If you cover a domestic partner under a Petco medical, dental or vision plan, the portion of the premium that applies to
dependent coverage is taxable.
2) You must live in a Kaiser Permanente service area in CA, CO, DC, GA, MD, OR, VA or WA to enroll in a Kaiser Permanente medical plan.
15Life and AD&D insurance
Basic life and accidental death & dismemberment (AD&D)
Petco provides company-paid life and AD&D coverage to all salaried partners. Under most circumstances,
life insurance pays benefits upon your death. AD&D insurance pays benefits if your death is the result of a
covered accident. If you die from an accidental injury, your beneficiary may receive both the life and AD&D
benefit. Basic life and AD&D will decrease to 65% of the original coverage amount at age 65 and 50% of the
original coverage amount at age 70.
Coverage (Company Paid) Coverage Amount
Hourly partners $25,000 paid by Petco
Disability insurance
Disability insurance ensures that you have a financial safety net in place should you become unable to
work. Petco pays for basic short and long-term disability. You pay for buy-up coverage.
Short-term disability insurance
Short-term disability pays a portion of your earnings while you are temporarily disabled. Partners in
California, Hawaii, New Jersey, New York and Rhode Island are also covered under a state disability plan.
Short-term disability benefits from Petco are reduced by payments you receive from state plans.
Coverage (Partner Paid) Waiting Period Coverage Amount Paid By
Voluntary short-term disability 7 days 60% of eligible weekly earnings up to $500 per week You
Long-term disability insurance
Long-term disability provides financial protection in the event you are unable to work for an extended
period of time. Benefits begin after 180 days of disability and continue until you are no longer disabled
or reach age 65 (if you become disabled at age 60 or younger). If you become disabled after age 60,
benefits continue according to a schedule. Refer to the Summary Plan Description for more information.
Coverage (Partner Paid) Waiting Period Coverage Amount Paid By
Voluntary long-term disability1 180 days 60% of eligible monthly earnings up to $2,000 per month You
16Legal assistance plan
Hyatt Legal Plans provides access to a national network of more than 12,000
attorneys. If you prefer, you may use your own attorney and be reimbursed
according to a set fee schedule.
The attorney fees for covered services are fully paid when you use a network
attorney. There are no limits on the number of times you may use the plan,
and there are no dollar limits on your use of a plan attorney for covered
services. Services provided to you, your spouse/domestic partner
and children under the age of 26 include:
• Wills and estate planning • Power of attorney
• Personal bankruptcy • Purchase or sale of home
• Traffic ticket defense • Consumer protection
• Juvenile court proceedings • IRS audit
Voluntary benefits
The voluntary plans offered through Transamerica provide additional financial protection with
premiums paid through the convenience of payroll deduction.
Benefit Plan or Coverage Option
Critical Illness Pays a one-time lump sum benefit amount upon the diagnosis of a covered disease
You pay the cost with or illness such as a heart attack, stroke, cancer, major organ transplant, coronary
after-tax contributions. bypass surgery and more. You can use the money for any purpose.
• Coverage for you: $5,000, $10,000 or $20,000
•C
overage for your spouse or domestic partner: 50% of your coverage amount
• Coverage for your child(ren): 50% of your coverage amount
Accident Pays a specified benefit for specific injuries resulting from a covered accident.
You pay the cost with You can choose from two coverage options. The amount the plan pays depends
after-tax contributions. on the type of injury. Examples include:
• Fractures: $280 to $4,000
• H ospital confinement: $225 per day up to 365 days
• Burns: $300 to $6,000
• Coverage is available for yourself and your eligible family members.
Hospital Indemnity Pays a cash benefit of $150 each day you are confined to a hospital up to
You pay the cost with 31 days maximum. Optional riders include $150 per day cash benefit if you
after-tax contributions. are confined to an intensive care unit up to 30 days and a $1,500 additional
hospital confinement, one day per calendar year. How you use the money is
up to you—groceries, rent bills or whatever you need. Coverage is available for
yourself and your eligible family members.
More information about the voluntary benefits is available on www.mypetcobenefits.com. The cost for
coverage is included on the Benefitfocus enrollment website.
17Petco preventive care (for pets)
The Petco preventive care plan pays you back for routine exams, tests, vaccinations and basic treatments
for your covered pets.
Annual Services Value
Monthly price $20 per pet
(max: 5 pets)*
Benefits total value Up to $600**
Benefits overview Max. reimbursement
Two routine vet checkups $50
Blood test $50
Vaccination or titer testing $50
Microchipping $40
Health certificate $40
Behavioral exam $30
Heartworm or FeLV/FIC test $30
Urine test $25
Deworming $25
Fecal test $20
Additional perks
Unlimited Ask-a-Vet online consultation $150 value
Flea, tick and heartworm care $60
Wellness welcome kit $30
* Applies to dogs and cats only.
** Based on annual average of the aggregate total of all services.
Petco insurance (for pets)
With Petco insurance, you’ll enjoy the peace of mind that your furry family members are protected, and
money won’t be the first concern when your pet is in the exam room. Pet insurance covers unexpected
accidents, illness and costly veterinary bills. You can customize your coverage for a fit that’s right for you.
Have questions?
Contact customer support by phone at 833-898-7387 or send an email to
support.wellness@petco.com.
To enroll, go to mypetcobenefits.com and click on the Benefits Enrollment link at the
top of any page..
18Other valuable benefits
Petco’s Total Rewards program is designed to care for the total you. This means that in addition
to healthcare, life and disability insurance, we care about your financial health and emotional
well-being too. Here are a few plans that add value to the Total Rewards you have access to as
a Petco partner.
Petco 401(k) Plan
The Petco 401(k) Plan helps you build financial security for your future. You become eligible to
participate on the first day of month following 6 months of service during which you worked at
least 500 hours. You must be age 21 to participate.
You can contribute up to $19,500 in 2021 to your 401(k) account1. If you are age 50 or older in
2021, you can contribute up to an additional $6,500 under the catch-up provision.
Petco matches 100% of the first 1% that you contribute plus 50% of the next 5%.
Contact Fidelity to get started at 800-835-5095. The plan number is 49089.
Employee Assistance Program
Petco’s Employee Assistance Program (EAP) is available to all partners and their family
members. The EAP provides access to in-person or telephonic counseling for a variety of issues.
Administered by ComPsych and paid by Petco, the EAP offers up to five 50-minute confidential
counseling sessions per issue per plan year as well as referrals.
Get help with drug or alcohol dependency, emotional problems, stress, relationship issues, legal or
financial concerns and more. Other services include health and wellness articles and resources, and
child and elder care referrals. All Petco partners and family members are eligible and can access EAP
services by calling 877-327-4738 (TDD: 800-697-0353), or by visiting guidanceresources.com. To
register on the website, use EAP4PET for the organization web ID.
This guide provides an overview of some of the benefit plans offered by Petco. It is not intended to be all
inclusive. In the event of any conflict between this guide and the official plan documents and contracts, the
official plan documents and contracts will govern. Petco reserves the right to change or modify its benefit
plans as appropriate without advance notice. This guide does not represent a contract of employment.
19Important benefit contacts
Here is a list of contacts to help you get the most out of your benefits.
Benefit Group Number Telephone Website
Petco Benefits Service Center NA* 855-847-6067 NA*
Petco Benefits Website NA* NA* www.mypetcobenefits.com
Petco Payroll NA* NA* payroll@petco.com
Medical
Collective Health Group #: 844-516-3836 http://join.collectivehealth.com/petco
• Enhanced PPO, Standard PPO & W0070147
HSA Plan
— Telemedicine
Teladoc NA* 800-835-2362 www.teladoc.com
— Expert Second Opinion
Grand Rounds NA* 855-543-5186 www.grandrounds.com/petco
Kaiser Permanente kp.org/thrive
• Enhanced, Standard and HSA Plan
Kaiser Permanente—No CA Group #: 606363 800-464-4000
Kaiser Permanente—So CA Group #: 234494 800-464-4000
Kaiser Permanente—CO Group #: 47076 800-632-9700
Kaiser Permanente—GA Group #: 10463 888-865-5813
Kaiser Permanente—DC, MD, VA Group #:28717 800-777-7902
Kaiser Permanente—OR Group #: 19862 800-813-2000
Kaiser Permanente—WA Group #: 19862 888-901-4636
Prescription Drugs
CVS (Collective Health Plans) Group #: RX1172 844-294-0389 caremark.com
Rx Savings Solutions NA* NA* rxsavingssolutions.com
(Collective Health Plans)
Vision Group #: 800-877-7195 vsp.com
Vision Service Plan (VSP) 30043528
• VSP Standard Vision
• VSP Enhanced Vision
Dental
Collective Health Group #: 20421 844-516-3836 http://join.collectivehealth.com/petco
• Standard Dental Plan
• Enhanced Dental Plan
Delta Dental Group #: 79267 800-422-4234 www.deltadentalins.com
• Delta Dental HMO Plan
Flexible Spending Accounts (FSAs) NA* 844-341-4934 https://learn.healthequity.com/petco
Health Savings Account (HSA) www.healthequity.com
Commuter Benefits Program
HealthEquity
Basic Life and AD&D Insurance Group #: 888-787-2129 https://www.mylincolnportal.com
Liberty Mutual 40-444824 (Company code: PETCO)
Disability Group #: 800-320-7585 https://www.mylincolnportal.com
Lincoln Financial Group 40-444824 (Company code: PETCO)
• Short and Long-term Disability
Voluntary Plans
• Transamerica Critical Illness, Accident, NA* 855-244-8318 mypetcobenefits.com
& Hospital Indemnity
Petco Insurance NA* 833-898-7387 Email: support.wellness@petco.com
Petco Preventive Care NA* 833-898-7387 Email: support.wellness@petco.com
Auto and Home Insurance NA* 800-GET-MET8 metlife.com/mybenefits
MetLife (800-438-6388)
Legal Assistance Plan code: 800-821-6400 legalplans.com
Hyatt Legal Plans 6090656
Employee Assistance Program (EAP) NA* 877-EAP-4PET guidanceresources.com
ComPsych/Guidance Resources (877-327-4738) (To register, use EAP4PET for
organization web ID)
401(k) Plan Plan #: 49089 800-835-5095 401k.com
Fidelity Investments Use your SSN to log in and create
Personal Identification Number (PIN)
* Not applicable
2021
HOURLY PARTNERS
PRE-SORTED
FIRST CLASS
Location Name & Number U.S. POSTAGE
PAID
Street Address
ACTION MAIL
City, State Zip
Sam Sample
1234 Anywhere Street
San Diego, CA 00000
2021 OPEN ENROLLMENT
Choose your benefits
October 19—November 6, 2020
Open Enrollment is your annual opportunity to make
changes to your benefits and to add or drop coverage
for eligible family members.
Passive Enrollment Process
For 2021, you will be automatically re-enrolled in the
coverage you have today, except for flexible spending
accounts, which must be elected each year.
If you would like to enroll in a new plan, need to make
changes to your current coverage, or wish to enroll in
a flexible spending account, be sure to take action by
November 6, 2020.You can also read
