Page 54 - 2022 AEO Benefit Guide

NOTICES

AEO REQUIRED BENEFIT FORMS, FLYERS

AND NOTICES

These notices, policies, plan documents, and much more can be found on the Benefitfocus
Communications portal, which can be easily accessed in the AEO Benefitfocus portal.

REQUIRED NOTICES

Plan Wrap Document: Notice of Privacy Practices (full version)

Plan Wrap Document: COBRA Notice (full version)
Medicaid and CHIP Notice

Women’s Health & Cancer Rights Act (WHCRA) of 1998

REQUIRED POLICY AND PLAN DOCUMENTS

Summary of Benefits & Coverage (SBC) — English & Spanish

Summary Plan Descriptions

Summary Annual Report
Schedule of Benefits & Plan Documents

Plan Wrap Document

BENEFIT VIDEOS, FORMS AND FLYERS

AEO “Count Me In!” (or see form on page 55)
“Foundation” and “Helping Hands” Charitable Payroll Deduction Form
AEO Benefit overview videos, Single-Sign-On (SSO) to directly connect
you to your benefits, plan grids, and more!
Claim Forms and Additional Benefit Plan Information

NOTICE OF PRIVACY PRACTICES

The American Eagle Outfitters, Inc. Benefit Plan and its health insurance carriers
maintain private health information about you for health plan purposes. This notice
states the manner in which the Plan may use and disclose medical information, as
well as your rights regarding use and disclosure.

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52 AMERICAN EAGLE OUTFITTERS, INC.