STATION CASINOS LLC TEAM MEMBER BENEFIT PLAN MEDICAL, DENTAL, VISION AND OTHER BENEFITS SUMMARY PLAN DESCRIPTION STATION CASINOS LLC EMPLOYEE BENEFIT PLAN Medical, Dental, Vision and Other Benefits Summary Plan Description January 1, 2015 It is intended that this Summary Plan Description along with the Evidence of Coverage or Certificate of Coverage (“certificate booklet”) will serve to describe your health, prescription, dental, vision, and other benefits under the Employee Benefit Plan (the Plan). The Plan shall conform to the requirements found in the Employee Retirement Income Security Act of 1974 (ERISA), as amended from time to time, as the act applies to employee welfare benefit plans. If any portion of The Plan, now or in the future, conflicts with ERISA or Federal regulations, ERISA or such Federal regulations will govern. If any provision in this SPD conflicts with an Evidence of Coverage or Certificate of Coverage, the applicable certificate booklet will govern. Este folleto contiene un resumen del plan en inglés. Si usted tiene dificultad entendiendo este resumen, una versión en español está disponible. Usted puede obtener ayuda adicional comunicándose con la oficina de Recursos Humanos de su propiedad. TABLE OF CONTENTS INTRODUCTION .............................................................................................................1 ELIGIBILITY REQUIREMENTS ....................................................................................2 HEALTH BENEFITS ...................................................................................................... 11 DENTAL BENEFITS ..................................................................................................... 14 OTHER BENEFITS .......................................................................................................22 CAFETERIA PLAN ......................................................................................................22 CONTINUATION OF BENEFITS (COBRA) .............................................................23 HIPAA PRIVACY RULE .............................................................................................. 26 ANNUAL FEDERAL NOTICES ................................................................................. 29 ERISA RIGHTS ............................................................................................................37 IMPORTANT INFORMATION ................................................................................... 39 DEFINITIONS .............................................................................................................. 45 INTRODUCTION ELIGIBILITY REQUIREMENTS This Summary Plan Description (SPD) is a summary of some of the principal features of the Health Maintenance Organization (HMO) option(s) and Preferred Provider Organization (PPO) option(s) A. TEAM MEMBER ELIGIBILITY REQUIREMENTS available to you as part of your medical and prescription benefits. It also provides a description of your dental, vision, and other benefits under the Employee Benefit Plan (The Plan). NOTE: For the purposes of Section 1 “Eligibility, Enrollment and Effective Date,” in the applicable certificate Throughout this document, any references to the terms “he,” “him,” or “his” shall also mean “she,” booklet or any other materials, the following Eligibility Requirements shall apply for determining “her,” or “hers,” or vice versa. eligibility for coverage under The Plan for benefits under the Medical, Dental, Vision, Life Insurance, and Disability Options. Plan Documents 1. Team Members classified as Full-time (i.e. those Team Members expected as of date of hire to This document, together with the Benefit Schedule, Prescription Drug Benefit Rider, applicable work an average of 30 hours or more per week) are eligible to participate in The Plan on the 1st certificate booklets, endorsements and any other documents distributed by Health Plan of Nevada day of the month following 60 calendar days of regular full-time employment. (HPN) or Sierra Health and Life, a United Healthcare Company (SHL), Davis Vision, or any third party administrator or insurer, as applicable, constitutes the SPD of the Plan. This SPD is meant 2. Full-time regular front of the house Team Members, who work in a specialty restaurant that is to summarize the Plan in easy to understand language. However, in the event of uncertainty or an open for dinner service only and who are expected to work an average of 25 hours per week inconsistency between this SPD and the Evidence of Coverage (EOC) or Certificate of Coverage shall be classified as “Full-Time” and shall be eligible to participate in The Plan on the 1st day of (COC), or insurance certificate, as applicable, the EOC, COC, or insurance certificate will control. the month following 60 calendar days of active continuous employment. Eligibility 3. Team Members whose employment status changes from temporary, part-time, or on-call to Full- Time, who have been employed with The Employer, or a Joint Venture, for at least 60 calendar To be eligible to participate in the Plan, you and your dependents must meet the eligibility days in active continuous employment in temporary, part-time, on-call capacity, are eligible to requirements set forth in the section of this SPD entitled “Eligibility Requirements” and any participate in The Plan on the 1st day of the month following the effective date of the change in additional requirements outlined in the EOC/COC. job status. The Employer intends to maintain the Plan indefinitely. However, it reserves the right to terminate, 4. On-going variable status Team Members (temporary, part-time or on-call) are eligible to suspend, discontinue or amend the Plan at any time and for any reason. Changes in the Plan may participate in the medical portion of The Plan if they work an average of 30 or more hours per occur in any or all parts of the Plan including benefit coverage, Deductibles, Maximums, Co-pays, week in a Standard Measurement Period. For purposes of group medical coverage as required Exclusions, Limitations, Definitions, Eligibility and the like. under the Affordable Care Act, Station Casinos has adopted a Standard Measurement Period If the Plan is terminated, amended, or benefits are eliminated, the rights of Covered Persons are of 6 months for measuring the number of hours that a Team Member has worked. If a Team limited to covered charges Incurred before termination, amendment or elimination. Member works an average of 30 hours per week during a Standard Measurement Period, he or she will be eligible for medical group (but not other benefits coverage otherwise available to We urge you to read this SPD carefully. If you have any questions concerning the Plan, please Full-Time Team Members only) during a Stability Period. For 2015, the Standard Measurement contact your property’s Human Resources Department or applicable carrier/administrator. Periods are (1) April 14, 2014 to October 13, 2014 for medical coverage under the Plan effective for the Stability Period from January 1, 2015 through June 30, 2015, and (2) October 14, 2014 to April 13, 2015 for medical coverage under the Plan effective for the Stability Period from July 1, 2015 to December 31, 2015. 5. Newly hired variable status Team Members (temporary, part-time or on-call) will also be measured using an Individual Measurement Period starting with their first pay period worked through the 6 month anniversary of such pay period. Newly hired Team Members in variable status are also measured under the Standard Measurement Period(s) that begin after the Team Member’s date of hire. 6. Full-Time Team Members who transfer from Full-Time to a variable status (temporary, part- time or on-call) will be eligible to continue their medical coverage under the Plan during the applicable Stability Period and may continue such coverage if during the applicable Standard or Initial Measurement, the Team Member worked an average of 30 hours or more per week. A Team Member’s change from Full-Time to variable status (i.e. a reduction in hours) does not constitute a Qualifying Life Event, however a Team Member who experiences such a change may change medical plans or may obtain coverage through the Nevada Exchange. 7. A Team Member must be actively at work on his scheduled Effective Date of Coverage (see Section C) to begin coverage. Refer to the “Actively at Work” definition. 1 2 Part Time, On Call and Temporary Team Members Mental or Physical Impairments Part-time, on-call and temporary Team Members are not eligible to participate in the dental, vision An unmarried tax-dependent Child who is incapable of self-sustaining employment by reason of and other non-medical benefits of the Plan. Such Team Members are eligible to participate in the mental or physical impairment upon attaining an age limit under the Plan may be considered as an medical portion of the Plan as set forth above. eligible Dependent while remaining incapacitated and continuously covered under the Plan. To continue a Child’s coverage under this provision, proof of incapacity must be submitted within 60 Transferring Properties days of the Child’s attainment of the age limit. Proof of continuing incapacity may be required periodically by the Claims Administrator. Covered benefits may change in transferring from one property It is the responsibility Dependent Coverage to another. For this reason, it is important to contact the property of the Team Member Human Resources department at the new property within