Page 14 - 2022 AEO FT HO Book CAN ENG
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                                          Please see the Benefits at a Glance chart for specifics on plan options, coverage basics,
                                          province-specific default coverage, and plan costs.
                                          Eligible Dependents

                                          Children are covered up to age 21, or up to their 26th birthday if they are in post-
                                          secondary  school. Over-age dependents must re-certify every summer, or the
                                          benefits will be terminated on August 31.

                                          Default Coverage
                                          In Quebec: Associates will receive the CORE PLAN if you do not enrol during
                                          open enrolment. In all other Provinces: Associates will receive OPT-OUT / HCSA-
                                          ONLY PLAN if you do not enroll during open enrolment. Termination age for dental
                                          coverage is the earliest of age 70 or retirement.

                                          OPT-OUT /
                       DENTAL            HCSA ONLY                CORE                         PREMIUM
               Deductible                                          None                          None
               Dental Fee Guide                           Current province of treatment  Current province of treatment
                                          Coverage *
               Recall Examination Frequency                  Once every 9 months            Once every 6 months
               COVERED EXPENSES
               Basic / Preventative                                75%                           100%
               Endodontic / Periodontic                         No Coverage *                    100%
               Dentures / Bridges / Crowns                      No Coverage *                     60%
                                          Coverage *
               Maximum                                           $750 / year          $2,000 / year (excluding orthodontic)
               Orthodontic                                      No Coverage *           50% (maximum $2,000 / lifetime)
                                          OPT-OUT /
                        COST             HCSA ONLY                CORE                         PREMIUM

                        Single            $0 / per pay           $0 / per pay                 $6.77 / per pay
                       Single +1          $0 / per pay           $0 / per pay                 $11.97 / per pay
                Family (Single + more than 1)  $0 / per pay      $0 / per pay                 $17.02 / per pay
              * Expense eligible for reimbursement through HCSA

                    HEALTH CARE           OPT-OUT /
                  SPENDING ACCOUT        HCSA ONLY                CORE                         PREMIUM
                        Amount            $750 / year            $500 / year                   $250 / year

                                          Health Care Spending Account

                                          The HCSA allows you to get reimbursement for your out-of-pocket expenses. When your
                                          coverage starts, you get all of your HCSA money for the year in one deposit.

                                          You can use this money to help pay for:
                                            •  If your plan doesn’t cover the entire amount of your claim, you can submit a
                                              claim to your HCSA to get the rest back.
                                            •  If you’ve opted out of regular health and dental coverage or reached your yearly
                                              limit, you can submit remaining expenses to your HCSA.

          12                                                               AMERICAN EAGLE OUTFITTERS, INC.

        2022 AEO FT HO Book CAN ENG 3.indd   12                                                                2/13/22   9:10 AM
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