Health and Welfare Benefit Highlights Booklet

2017

California Retail Food Source (FSH)

2017 New Hire Summary Understanding your initial benefits at Raley’s

Non-union, hourly, retail, store team members in CA

Benefit Question Answer When will I become eligible for health benefits?

As a new hire or rehire, you and your dependents are eligible for coverage on the first of the month following four (4) consecutive months with at least

96 eligible hours in the third and fourth months. Spousal coverage is not offered

What are my health plan options?

Blue Shield

Core level:

Deductible: $2,000 individual/$4,000 family deductible

Out of Pocket Maximum: $6,000 individual/ $12,000 family

Coinsurance:35% coinsurance on office visits.

Buy-up level:

Deductible: $500 individual/$1,000 family deductible

Out of Pocket Maximum: $4,000 individual/ $8,000 family

Coinsurance:20% coinsurance on office visits.

Prescriptions are $8 generic, 20% coinsurance $30/$45 (min-max)

brand formulary, 50% coinsurance $50/$100 (min-max)

brand non-formulary, 30% coinsurance $200 maximum on

Specialty.

Kaiser HMO/Vision:

Core level:

Deductible: $2,000 individual/$4,000 family deductible

Out of Pocket Maximum: $6,000 individual/ $12,000 family

Coinsurance:35% coinsurance on office visits.

Buy-up level

Deductible: $500 individual/$1,000 family deductible

Out of Pocket Maximum: $4,300 individual/ $8,600 family

Coinsurance:20% /$35 most office visits (after deductible)

Prescriptions are $10 Generic, $35 Brand Formulary, $200 Specialty

Dental: Delta Dental DPPO or Delta Care DMO

Vision: Vision Service Plan

Who are my eligible dependents?

Eligible dependents include your child(ren) to age 26.

How much does coverage cost?

In 2017, the cost for a family selecting Core Blue Shield, Delta Dental

DPPO and VSP is $91.00 per month, or $22.75 per week.

What are my retirement benefits?

You are eligible to contribute to the 401(k) on the first of the month following

two complete months of service, as long as you are over age 18. You will

receive information at your home in advance of your eligibility. Your 401(k)

contributions are matched at a rate of 50% of the first 3% of your

contributions.

You are also eligible to receive a Personal Retirement Account Plan benefit

for any years in which you work at least 1,000 hours. This benefit is entirely

paid by the company.

This is intended to be a brief summary of the in network benefit options available to new team members – for a full description of benefit options, please refer to the Summary Plan Description, available on ePower. If any differences exist between this summary and the Plan Document, the Plan Document will prevail

2017 Benefits Calendar As a new hire or rehire, you and your dependents are eligible for coverage on the first of the month following four (4) consecutive months with at least 96 eligible hours in the third and fourth months. You would then be eligible for our Core or Buy-up plans.

So, if you are hired on January 3, and work at least 96 eligible hours in March and April, you will become eligible for benefits as of May 1. You will then have 31 days from your Initial Benefits letter notification to submit your enrollment elections. If you were hired on or before the 15th of the month, that month will count as your first month of employment for purposes of benefits eligibility.

Table of Contents

ELIGIBILITY AND ENROLLMENT .................................................................................. 1

MEDICAL PLAN HIGHLIGHTS ....................................................................................... 5

DENTAL PLAN HIGHLIGHTS ......................................................................................... 9

VISION SERVICE PLAN (VSP) .................................................................................... 11

SPECIAL BENEFITS PLAN HIGHLIGHTS ................................................................... 12

FLEXIBLE SPENDING ACCOUNT (FSA) HIGHLIGHTS .............................................. 13

401 K RETIREMENT PLAN HIGHLIGHTS ................................................................... 16

RALEY’S PERSONAL RETIREMENT ACCOUNT PLAN .............................................. 17

RALEY’S PENSION PLAN ............................................................................................ 18

IMPORTANT NOTICES ................................................................................................ 19

This booklet only summarizes highlights of the Health and Welfare Benefit Plans.

If there are any discrepancies between this and the actual Plan Document, the Plan Document

will govern

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ELIGIBILITY AND ENROLLMENT

When am I eligible to enroll?

As a new hire or rehire, you and your dependents are eligible for coverage on the first of the month following four (4) consecutive months with at least 96 eligible hours in the third and fourth months. You would then be eligible for our Core or Buy-up plan. Spousal coverage is not offered to team members with hire dates of January 1, 2012 or later. . Eligible dependents include: • Your dependent children up to age 26 (must provide copy of birth certificate(s) or adoption paperwork). You may enroll adult children (under the age of 26) as long as they are not eligible for coverage through their employer;

So, if you are hired on January 3, and work at least 96 eligible hours in March and April, you are eligible as of May 1. You then have until May 31 to submit your enrollment information. If you were hired on or before the 15th of the month, that month will count as your first month of employment for purposes of benefits eligibility.

Transferring to or from the Union

If you are transferring from a union to a non-union position, you may be eligible on the first day

of the month following your transfer date.

Note to newly eligible employees: If you do not enroll in company-sponsored benefits

within 31 days of becoming eligible, you will not be eligible to enroll in benefits until the

next annual Open Enrollment period.

Once enrolled, you will remain eligible for coverage as long as you continue to work 96 eligible

hours every month. You may track your eligible hours each month by using the Benefit Eligibility

Calendar on page 3 or on The Pantry (Raleysway.com).

Note: Raley’s includes an administrative month to the process of determining monthly benefits eligibility. This ensures our team members have advance notice of a pending benefits suspension and will allow you time to plan and/or work with your manager to have eligible sick leave or vacation hours applied to the prior month. For example, your hours worked in March are used to determine your benefits eligibility for May.

Benefits Stabilization Requirements

Team members who work an average of 130 hours per month during a measurement period (listed below) will have continuing benefits regardless of hours worked during the following stabilization period, as long as they remain eligible (employed in a benefits eligible position).

Measure May – October, Stabilization January - June Measure November – April, Stabilization July - December

Eligible hours include straight time and overtime hours worked, hours credited for paid holidays,

vacation, jury duty, bereavement and sick pay.

Please Note: If you and your spouse are both employed by Raley’s and are eligible for

Raley’s administered benefits, only one employee may carry benefits for the family. No

team member, spouse, or dependent may be covered under two separate Raley’s plans.

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What is Coordination of Benefits?

COORDINATION OF BENEFITS — SPOUSAL PROVISION

Effective for team members hired before January 1, 2012, the Raley’s Health and Welfare Plan

contains a “Coordination of Benefits - Spousal Provision.” This provision states that if your

spouse is working and is eligible for health and welfare benefits from their employer, your

spouse must enroll in the best available plan offered by that employer. If your spouse does not

enroll in the best available coverage, you will be required to pay a Spousal Surcharge of $40 per

week, through payroll deduction, to provide coverage for your working spouse.

If you are enrolling your spouse in a Company-provided health plan, you will be required to

complete a Spousal Coordination of Benefits Questionnaire. This questionnaire must be

completed in order to enroll your spouse as a dependent. Failure to provide the requested

information will result in your spouse not being enrolled during the current Plan Year.

When can I make changes to my benefits?

OPEN ENROLLMENT

Each Fall during our annual Open Enrollment, you will have an opportunity to make changes to

your benefits such as changing your health plans for yourself and your dependents, as well as

adding or dropping dependents. These changes will become effective on January 1 of the

following year.

CHANGE IN FAMILY STATUS

If you have a change in family status during the year, e.g., marriage, birth or adoption of a child

or divorce, you must notify the Employee Benefits Department within 31 days of the event by

submitting a Family Change in Status/Beneficiary Form with all necessary documentation.

For a more complete discussion on family status changes, please see your Summary Plan

Description.

SPECIAL ENROLLMENT RIGHTS

If you are declining enrollment for yourself and your dependents (including your spouse)

because of other health insurance coverage, you may in the future be able to enroll yourself or

your dependents in the Raley’s plan provided that you request enrollment within 31 days after

your other coverage ends.

Do I have to contribute toward my benefits?

EMPLOYEE CONTRIBUTIONS

Raley’s carefully evaluates the costs associated with offering competitive health care benefits.

In doing so, an employee share in premium contributions may be necessary. The following chart

shows your share of premium costs based on the plan and coverage level you choose. Weekly

contributions will be deducted from the first four paychecks of each month.

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MEDICAL PLAN HIGHLIGHTS

What are some of the features of the PPO Medical Plan?

BLUE SHIELD PREFERRED PROVIDER ORGANIZATION (PPO) MEDICAL

PLAN

Annual Deductible

The PPO Medical Plan contains an annual deductible, which is the amount of money a covered

person (or covered family members) must pay toward eligible medical expenses before the Plan

begins to pay.

Your Preferred Provider Option

Preferred Providers are health care professionals who discount their fees in exchange for you

using their services. If you use a Preferred Provider, the Company pays a greater percentage of

the bill.

The Company has contracted with Blue Shield of California as your Preferred Provider

Organization. A directory of preferred physicians and hospitals in your area is available from

Blue Shield.

Pre-Hospitalization/Surgical Review

Before being admitted to a hospital or undergoing non-emergency surgery, you must notify

BlueShield for a pre-service review by calling (800)343-1691.

Prescription Drug Plan

The Raley’s Prescription Drug Plan is available to all employees and dependents covered by

the Blue Shield PPO Medical Plan. By presenting your medical card, you may purchase your

prescriptions at any Company-owned pharmacy and pay a fixed co-payment. If you choose to

purchase your prescriptions from a non-company owned pharmacy, there will be a 20% Co-

insurance in addition to the applicable co-payments. To view Blue Shield’s prescription

formulary, please visit Blue Shield’s website at blueshieldca.com.

Telemedicine option

Telemedicine, through Teladoc, provide our team members electing Blue Shield with an opportunity to speak with a doctor over the phone or online (24/7) who can diagnose, treat and order prescriptions as needed. This option may be appropriate for those times when you need to speak with a doctor quickly but may not need the Emergency Room or Urgent Care. Teladoc’s doctors are U.S. board-certified family practitioners, PCPs, pediatricians and internists. With a low $5 co-pay, this is a great way to save money and get the medical attention you or your family members need. To get started go to Teladoc.com or call 1-800-Teladoc for more information and to schedule an appointment. With an average call back time of less than 20 minutes, you could be on the mend in no time!

Benefit Enhancement

Beginning 1/1/2017, Raley’s will provide coverage for infertility treatments. More information on this new benefit is available at blueshieldca.com.

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PPO BLUE SHIELD MEDICAL/ PRESCRIPTION PLAN OPTION CHART

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What are some of the features of the Kaiser Permanente Plan?

KAISER PERMANENTE HMO PLAN

The Company also offers health care to California employees through Kaiser Permanente. As a

member of Kaiser, you obtain health care services from doctors and hospitals associated with

Kaiser. Kaiser offers medical, prescription, and vision services. Before enrolling, check to be

sure that you work or live within the Northern California service area by calling Kaiser at (800)

464-4000 or go on-line to kp.org

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If my dependents or I lose coverage, am I still protected?

Continuation Coverage

If your coverage ends because you either terminate employment or become ineligible, you and your

dependents may be able to continue coverage for 18 months (up to 36 months in certain

circumstances) at your or their own expense. Under COBRA (Consolidated Omnibus Budget

Reconciliation Act), health care coverage remains the same; however, you or your eligible family

members must pay the full cost of premiums, plus a 2% administrative fee.

What if I have a question about a claim or my benefits?

Contact Information

If you have any questions regarding the processing of a claim or for more information on covered -

services, you are encouraged to contact:

Blue Shield Plan PPO (800) 358-9556

blueshieldca.com

Kaiser Permanente Plan HMO (800) 464-4000

kp.org

Also, you may contact the Employee Benefits Department by emailing benefits@raleys.com or

call toll-free at (888) 332-4894.

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DENTAL PLAN HIGHLIGHTS

What are some of the features of the Delta Dental Plan?

DELTA DENTAL DPPO PLAN

The Delta Dental Plan provides preventative care, basic, major dental services and orthodontia.

You pay no annual deductible for the Delta Dental Plan. Delta Dental will pay their percentage

of services up to a maximum amount per calendar year per covered individual.

How do I choose a dentist?

Choosing Your Dentist

You may go to any dentist for treatment, but it is to your advantage to choose a Delta Dental

PPO dentist. PPO dentists are Delta Dental dentists who have agreed to charge PPO enrollees

reduced fees. Selecting dentists in the PPO network will guarantee that you are paying the

lowest out-of-pocket costs. If you choose a dentist who is not in the PPO network, your next

best choice is a Delta Dental Premier dentist.

Non-Delta Dental dentists do not participate in any Delta Dental network. So, your costs will be

higher since you are responsible for any amounts above Delta Dental's allowed amounts. To

find a Delta Dental PPO or Delta Dental Premier dentist, you may call (800) 765-6003 or log

onto Delta Dental’s website at www.deltadentalins.com.

What are some of the features of DeltaCare USA?

DELTACARE USA DHMO PLAN

For California residents only, the Company also offers dental coverage through DeltaCare USA.

The DeltaCare USA Plan provides preventative care, basic and major dental services and

orthodontia. You pay no annual deductible for the DeltaCare USA and you pay a flat-dollar

amount for services.

Choosing Your Dentist

When you enroll in DeltaCare, you select a participating dental office by logging onto

www.deltadentlins.com, or you may call (800) 422-4234. The dental office you select will be the

center for all your dental needs, and all services must be provided by a DeltaCare participating

dentist.

Covered Benefits, Limitations, and Exclusions

Detailed information about covered benefits, limitations, and exclusions for Delta Dental or

DeltaCare USA is contained in your Summary Plan Description. To obtain a copy you may log

onto E-Power via raleysway.com or contact the Employee Benefits Department.

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DENTAL PLAN OPTION CHART

What if I have a question about a claim or about my benefits?

Contact Information

If you have questions regarding the processing of a claim or for more complete information

about your dental benefits, you are encouraged to call:

Delta Dental Plan (800) 765-6003

deltadentalca.org

DeltaCare USA (800) 422-4234

deltadentalca.org/DeltaCareUSA

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Vision

What are some of the features of Vision Service Plan?

VISION SERVICE PLAN (VSP)

Your Vision Service Plan – Core level covers one exam and one pair of standard lenses or

contact lenses in any 24 consecutive months. Frames are covered once in any 24 consecutive

months.

Your Vision Service Plan - Core and Buy-up level covers one exam and one pair of standard

lenses or contact lenses in any 12 consecutive months. Frames are covered once in any 24

consecutive months.

VSP has an extensive network of doctors who agree to provide professional eye care and

materials at a lower cost. To obtain vision care, simply contact your VSP Select doctor to make

an appointment. If you need help locating a VSP Select doctor, call VSP at (800) 877-7195 or

visit their website at vsp.com.

2017 Vision Enhancement: Suncare

Use your VSP benefit to obtain prescription or non-prescription sunglasses as part of

your allowance for frames and lenses.

What if I don’t use a VSP Select doctor?

Choosing a Non-member Doctor

If you decide to obtain covered service or materials from doctors who are not VSP Select

providers, you must pay the provider in full and submit an itemized receipt to VSP at P.O. Box

997100, Sacramento, CA 95899-7100. VSP will reimburse you up to the amounts allowed under

your Plan’s non-member provider schedule.

Where may I get forms and other information?

Contact Information

To request a benefit form, verify benefit eligibility or inquire about a claim or benefits, please call

the VSP Customer Service Department at (800) 877-7195 or visit their website at vsp.com.

Up to $145/12 months

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SPECIAL BENEFITS

GROUP TERM LIFE AND, ACCIDENTAL DEATH AND

DISMEMBERMENT (AD&D) INSURANCE BENEFITS

What is the coverage for Life Insurance?

All eligible hourly employees are covered for Group Term Life Insurance up to the following

amounts:

A B

$10,000 $40,000

A - Provided to team members who have met their Initial Benefits requirements and continue to

work over 64 hours each month.

B - Provided to team members at Open Enrollment following 2 years of Continuous Service and

who continue to work 64 hours each month.

At age 70, benefits are reduced by 50%.

Coverage terminates when you terminate employment with the Company or become ineligible.

You may be eligible to buy portable Group Life insurance upon your termination of employment.

If your death is a result of an accident or other loss, your AD&D coverage provides an additional

benefit.

For more information, please contact Principal Financial Group (800)986-3343

Are my dependents covered?

Dependent Life Insurance

Spouses are covered for $2,000. At age 70, benefits are reduced by 50%. Children, birth to

age 26, are covered for $1,000

*In order for step-children to be covered under Dependent Life, they must have their primary

residence with the employee.

Does the Company provide any counseling or referral services?

EMPLOYEE ASSISTANCE PROGRAM (EAP)

Employees participating in the Raley's Health and Welfare Plan are entitled to EAP services.

This important benefit provides work-life needs, legal, financial, substance abuse, short-term

counseling and referral services to help employees and their family members.

Where can I get more information about the EAP?

Questions

If you want to learn more about the support, resources and information available to you through

the EAP program, you are encouraged to contact:

ComPsych (866) 379-0893 guidanceresources.com Company ID:ZH3636D

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FLEXIBLE SPENDING ACCOUNT (FSA) HIGHLIGHTS

WHAT IS A FLEXIBLE SPENDING ACCOUNT?

An FSA works like a personal expense account. You set aside a portion of your salary before

taxes, and you decide how much you want to contribute, up to the maximum. Contributions are

used to pay certain expenses such as dependent care, medical expenses, and transportation

expenses.

Who is eligible to join?

Eligibility

You may elect to participate in the Dependent Care, Medical Care, or Transportation FSA when

you first become eligible for the Company-provided health plan. You may also elect to

participate in the Dependent Care or Medical Care FSA during each annual benefits Open

Enrollment period. You may enter the Dependent Care or Medical Care FSA plans mid-year as

a result of a qualifying event such as the birth or adoption of a child. You may enroll or change

your Transportation benefit at any time. Each change to your Transportation benefit will be

effective the first of the following month.

To participate in the Dependent Care Plan, your dependents must be:

• Your child under the age of 13 who resides with you and needs care when you are at work;

or

• Your disabled dependent (a child over the age of 13, spouse, parent, or certain other

dependent relative) who:

• Is physically or mentally unable to care for himself or herself; and

• Spends at least eight (8) hours each day in your household.

You must also claim your dependent(s) as an exemption on your Federal Income Tax Return.

How much can I contribute to the Plan?

Your Contributions

Dependent Care: You can set aside up to $5,000* for a Dependent Care (or $2,500 if you are

married and file a separate income tax return) each year in the Dependent Care FSA.

Medical Care: You may set aside a minimum of $250 up to a maximum of $2,550 each year to

pay for eligible health care expenses that you incur.

Transportation: You may set aside up to $130 per month for mass transit and $250 per month

for parking.

What is meant by eligible expenses?

Eligible Dependent Care Expenses

The Dependent Care FSA is designed to reimburse you for household and dependent care

expenses that are necessary to allow you or your spouse to work. According to the IRS, eligible

expenses include the following:

• Care provided for your dependent children under the age of 13;

• Care provided inside your home, at a sitter’s residence or at a licensed care facility;

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• Pre-schooling costs for children if the school is part of dependent care arrangements;

• Household services that include care for eligible dependents;

• Nurse or caregiver expenses for disabled dependents.

• Day Camps (overnight camps not allowed)

Note: Expenses for residential nursing home care are not eligible for reimbursement under IRS

regulations.

Eligible Health-Related Expenses

A medical expense is a health-related expense for you and/or eligible family members that is not

paid or reimbursed by an insurance plan. This includes office visits, prescription co-payments,

deductibles and coinsurance. Corrective eye surgery (Lasik), orthodontic treatment, chiropractic

care, insulin and over-the-counter drugs with a prescription or a Letter of Medical Necessity are

just a few other expenses that can be paid using your FSA.

For a complete list of items and medical expenses that can be reimbursed by the Health Care

FSA, please visit the Employee Benefits Department page located on The Pantry.

Eligible Transportation Expenses

Common expenses include transportation through train, bus, subway, and ferry. Expenses must

be incurred by the employee – dependents are not eligible to incur expenses under this plan.

What are the IRS rules for the Plan?

IRS Rules for Using Pre-Tax Dollars

Federal tax laws make this kind of Flexible Spending Account possible, with the following

restrictions:

• You may be reimbursed only for eligible expenses;

• You may contribute only a pre-designated amount per year (or per month in the case of the

Transportation benefit); and

• You have until March 15 of the following year to incur expenses and until March 31 of the

following year to submit expenses. You will not be refunded any money remaining in your

account at the end of this period.

How do I save through the Plan?

Saving through the Plan

When you enroll in the Plan, you will need to estimate as closely as possible what your health

care or dependent care expenses will be during the year. Your funds are set aside with weekly

payroll deductions that you may use for reimbursement of eligible health care and/or dependent

care expenses that you have incurred.

If you elect the Transportation benefit, you may change your election at any time, effective the

first of the following month.

How am I reimbursed for my expenses?

Expense Reimbursement

When you submit your eligible health care expense to our third party administrator, Discovery

Benefits, you will be reimbursed for these expenses up to the amount of your annual election.

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Your eligible dependent care expense will be reimbursed up to the amount you have in your

account, based on annual payroll deductions to date.

The funds you contribute during a year are used only for that year’s expenses. Each year you must enroll in a new account, which you can do by completing the health care and/or dependent care section on your Open Enrollment Form. You cannot carry over your account balances from one year to the next. Any money you have left in your account on March 31 will be forfeited as required by the IRS.

Discovery Benefits Contact Information and Claims Reimbursement

Discovery Benefits Contact Information

Website www.discoverybenefits.com

Participant Services – Hours of Operations

7:00 a.m. to 7:00 p.m. CT (M-F)

Participant Services Toll-Free Phone Number

866-451-3399

Mailing Address Discovery Benefits PO Box 2926 Fargo, ND 58108

Participant Services Toll-Free Fax Number

866-451-3245

Participant Services Email Address customerservice@discoverybenefits.com

Filing Claims with Discovery Benefits You will be able to file claims in the following ways: 1. Debit Card (if applicable) 2. Submit your claims online via Discovery’s website 3. Online mobile application 4. Fax your paper form and copies of receipts (or mail in the receipts) Note: Most claims will require substantiation. It is important to submit a copy of your receipt to Discovery Benefits to ensure your reimbursement is processed without delay.

How will I know how much money I’ve saved and spent?

Keeping Track of Your Account

To obtain account information (balance, claims status, printable forms, etc.), you will be able to log on to the Discovery Benefits website. You will receive a welcome letter, via email if provided. This welcome letter will include instructions on how to access your online account; or you can call Participant Services at the number listed above for this information.

How do I enroll or change my deduction for the Plan?

Enrolling or Changing Deductions in the FSA Plans

You may enroll or change your deduction in the Medical or Dependent Care FSA Plan when you

are newly employed by the Company, when your family status changes, or during Open

Enrollment. Therefore, you must plan your deduction carefully. If you have a change in family

status, you must notify the Employee Benefits Department within 31 days of the occurrence

causing the change. The change in your account must be consistent with your change in family

status event as determined by the Employee Benefits Department.

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401(K) RETIREMENT PLAN

HIGHLIGHTS

Who is eligible to participate?

Eligibility

If you are at least 18 years old, you can sign up the first of the month following completion of

two (2) full calendar months of continuous employment.

What are the advantages to participating in a 401(k)?

Savings with Before-Tax Dollars

Instead of trying to save with the money you have left after you pay income taxes; the 401(k)

lets you set aside a specific percent of each paycheck before taxes. Because your taxes are

then based on a lower amount, you pay less.

Company Match

Raley’s will contribute to your 401(k) in the form of a company match. Your company match is

2017 is equal to 50% of the first 3% of your contributions – or a maximum of 1.5% of your

eligible compensation.

How much can I contribute to the 401(k)?

Contributing to the Plan

You can contribute from 1% to 75% of your compensation to the 401(k). If you are a highly

compensated employee as defined by the Internal Revenue Code, certain limits may apply.

How do I get more information?

Enrollment Kit

An enrollment kit will be mailed to your home prior to your eligibility date. This kit will contain

important information about your investment options, vesting schedule (if applicable), assigning a

beneficiary(s), and loan and withdrawal options. To enroll, simply fill out the Enrollment/Election

card which will be included in your enrollment kit or enroll at www.principal.com.

You have easy access to information about your 401(k) simply by calling Principal or visiting

their website.

Principal Financial Group (800) 547-7754 (ID#709995) principal.com

Summary Plan Description

This brochure highlights only a few of the 401(k) Retirement Savings Plan’s features. We

recommend that you read the Summary Plan Description for more complete information about

your 401(k) Retirement Savings Plan. You may obtain a copy by going on-line to E-Power, or by

contacting the Employee Benefits Department at (888) 332-4894. Or write:

Raley’s

Employee Benefits Department

P.O. Box 15618

Sacramento, CA 95852

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R A LEY ’ S PER SON A L R ET IR EM ENT

A C C OUNT PLA N

Who is eligible to participate?

Eligibility

To participate in the Raley’s Personal Retirement Account Plan, you must be:

• Hired on or after January 1, 2006 (January 1, 2007 for Nob Hill and Food Source Assistant

Store Team Leaders) or transferred from a union position, or a position other than a non-

union hourly, retail position, to a non-union, hourly retail position after February 15, 2006.

• Rehired into a non-union hourly, salaried exempt, hourly non-union pharmacist or a retail

hourly assistant store director position on or after February 15, 2006.

When do I become fully vested?

Vesting

Participants become fully vested in their accrued benefit after 3 Years of Service (1,000 hours of

service in a calendar year)

How is my benefit calculated?

Contributions

You must work at least 1,000 hours during a plan year to receive a contribution. The Company

will contribute a percentage of your eligible compensation each plan year based on your years

of service with the company; 1-4 Years = 2%, 5-9 Years = 3%, 10-14 Years = 4%, 15-19 Years

= 5%, 20+ Years = 6%.

Contributions to your account will be invested in a target date fund based upon your age.

When I leave the Company, can I get my account balance?

Distributions

After you terminate employment with Raley’s, your vested account balance is available to you.

You may elect to take a distribution:

In a lump sum cash distribution (taxes and penalties may apply), or

Roll the account balance over to another qualified plan or an IRA, or

Leave your account balance in the plan if it is greater than $1,000 until you reach age 70 ½;

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RALEY’S PENSION PLAN

Who is eligible to participate?

Eligibility

To participate in the Raley’s Pension Plan, you must be:

• Hired before January 1, 2006 (January 1, 2007 for Nob Hill and Food Source Assistant Store

Team Leaders) or transferred from a union position, or a position other than a non-union

hourly, retail position, to a non-union, hourly retail position before February 15, 2006.

• Rehired into a non-union hourly, salaried exempt, hourly non-union pharmacist or a retail

hourly assistant store director position before February 15, 2006.

When do I become fully vested?

Vesting

Participants become fully vested in their accrued benefit after 5 Years of Service (1,000 hours of

service in a calendar year)

How is my benefit calculated?

Benefit Determination

Effective January 1, 2006, your annual benefit at Normal Retirement will be based on the

following formula:

$480 for each Year of Credited Service up to 10; plus $636 for each Year of Credited Service in

excess of 10.

You will be notified in writing of any change to this formula.

When I leave the Company, can I get my account balance?

Distributions

After you terminate employment with Raley’s, the value of your vested benefit is available to you

in the form of a lump sum. You may elect to take a distribution:

In a lump sum cash distribution (taxes and penalties may apply), or

Roll the account balance over to another qualified plan or an IRA, or

Elect a lump sum or monthly annuity on a future date.

How do I get more information on the Raley’s Personal Retirement Account Plan or

Raley’s Pension Plan?

Summary Plan Description

This brochure highlights only a few of the benefits of Raley’s Retirement Plans. We recommend

that you read the Summary Plan Description for more complete information on the Plan benefits

available to you. You may obtain a copy by going on-line to E-Power, or by contacting the

Employee Benefits Department at (888) 332-4894. Or write Raley’s, Employee Benefits

Department, P.O. Box 15618, Sacramento, CA 95852

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IMPORTANT NOTICES

The Latest on Health Care Reform

and What It Means to You

As you know, the health care reform law also known as the

Affordable Care Act (ACA), was enacted to ensure most

Americans have access to health coverage they can afford.

Most large employers, including Raley’s, are required to offer

minimum essential health coverage that provides minimum

value and is affordable to full-time employees (defined by the

government as working on average at least 30 hours each

week) or else pay a potential penalty. This is called the

employer mandate. In addition, most individuals must maintain

minimum essential health coverage for themselves or else pay a

penalty. This is called the individual mandate.

Earlier this year the Internal Revenue Service (IRS) issued

guidance on new ACA reporting requirements under Internal

Revenue Code (Code) sections 6055 and 6056. Generally, the

forms that will be used by large employers are the Form 1094-C

(transmittal of information to the IRS regarding self-insured

group health plan) and Form 1095-C (statement to employees

regarding health coverage under a self-insured group health

plan).

The Code requires applicable large employers, such as

Raley’s, to report information to the IRS highlighting the

following:

Section 6055: Each person who enrolled in

minimum essential health care coverage (for

example, full-time and part-time employees,

COBRA qualified beneficiaries, individuals on

short-term disability, long-term disability, leave of

absence, severance, pre-65 retirees, etc.) offered

under the Company’s self-insured group health

plan. This information is reflected in Part III of

Form 1095-C and helps the IRS enforce the

ACA’s individual mandate.

Section 6056: Each full-time employee (who

averages at least 30 hours each week) and the

details on his or her offer of coverage (even if no

offer of coverage is actually made). This

information is reflected in Part II of Form 1095-C

ACA Reporting

Raley’s will send Form 1095-C to employees by January 31, 2016 and

Form 1094-C to the IRS by March 31, 2016

IRS Code Sections

6055/6056

Forms 1094-C & 1095-C

Code Sections

6055 and 6056

require

employers to

provide a new

information

return to

the IRS

and a

statement

to employees

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and will help the IRS enforce the employer

mandate.

As a result of this reporting requirement, you will receive a Form 1095-C in January 2016.

What You Can Expect …

By January 31, 2016, you will receive a Form 1095-C from Raley’s. The form provides confirmation of the health care coverage you were enrolled in (6055) and/or offered (6056) through Raley’s.

There is no action required of you. If you purchased health insurance coverage through the Health Insurance Marketplace and wish to claim the premium tax credit, this information will assist you in determining whether you are eligible. You may receive multiple Forms 1095-C if you had multiple employers during the year that were applicable large employers (for example, you left employment with one applicable large employer and began a new position of employment with another applicable large employer). In that situation, each Form 1095-C would have information only about the health insurance coverage offered to you by the employer identified on the form.

Visit http://www.irs.gov/uac/About-Form-1095-C for more information about Form 1095-C.

Patient Protection

HMO Kaiser Permanente generally requires the designation of a primary care provider. You

have the right to designate any primary care provider who participates in our network and who is

available to accept you or your family members. Until you make this designation, Kaiser

designates one for you. For information on how to select a primary care provider, and for a list

of the participating primary care providers, contact Kaiser at (800) 464-4000 or go on-line to

kaiserpermanente.org. For children, you may designate a pediatrician as the primary care

provider. You do not need prior authorization from Kaiser or from any other person (including a

primary care provider) in order to obtain access to obstetrical or gynecological care from a

health care professional in our network who specializes in obstetrics or gynecology. The health

care professional, however, may be required to comply with certain procedures, including

obtaining prior authorization for certain services, following a pre-approved treatment plan, or

procedures for making referrals. For a list of participating health care professionals who

specialize in obstetrics or gynecology, contact Kaiser at (800) 464-4000 or go on-line to

kaiserpermanente.org.

New Health Insurance Marketplace Coverage Options When key parts of the health care reform law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, a notice providing some basic information about the new Marketplace and employment-based health coverage offered by your employer was mailed to you in September 2013. A copy of this notice can be found on ePower. Privacy Notice A federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires that health plans protect the confidentiality of your private health information. A complete description of your rights under HIPAA can be found in the Plan’s privacy notice, revised in September 2013, which is available from the Employee Benefits Department or on our internal websites (The Pantry, or ePower). This Plan maintains a privacy notice, which provides a complete description of your rights under HIPAA’s privacy rules. For a copy of the notice, please contact the Employee Benefits

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Department toll-free at (888) 332-4894. If you have questions about the privacy of your health information or you wish to file a complaint, please contact the Privacy Office toll-free at (866) 708-5653. Newborns’ and Mothers’ Health Protection Act Under federal law, group health plans and health insurance issuers generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a caesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, under federal law, plans and issuers may not require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP). If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for state premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can contact your state Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think

you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list is current as of July 31, 2013. You should contact your state Medicaid office for further information on eligibility. Nevada Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900

Oregon Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075

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Important Notice about your Rights under Your Group Health Plan

Women’s Health and Cancer Rights Act of 1998

Initial Notice

On October 21, 1998, the Federal government enacted the Women’s Health and Cancer Rights

Act. This law requires that all group health plans that provide coverage for mastectomies also

provide coverage for breast reconstruction surgery in connection with that mastectomy. This

notice is intended to provide all new participants and beneficiaries with notice of their rights

under the Women’s Health and Cancer Rights Act.

All participants and beneficiaries, who receive benefits under the Raley’s Health and Welfare

Plan (“the Plan”) with respect to a mastectomy, and elect breast reconstruction surgery in

connection with that mastectomy, are entitled to coverage for the reconstruction in a manner

determined in consultation with the attending physician and the patient. Such coverage

includes:

1. Reconstruction of the breast on which the mastectomy was performed.

2. Surgery and reconstruction of the other breast to produce a symmetrical appearance.

3. Prostheses and treatment of physical complications at all stages of the mastectomy,

including lymphedemas.

This coverage will be provided for treatment as determined by the attending physician in

consultation with the patient, and will be provided in a manner consistent with that applicable to

other benefits (e.g., same annual deductibles, flat dollar co-payments, and percentage co-

payment provisions that apply for other benefits).

For more information regarding the deductible, flat dollar co-payments and percentage co-

payment limitations for this coverage, please see your Summary Plan Description. For Kaiser

members, additional information may also be found in the Evidence of Coverage booklet

(“EOC”) provided by your carrier.

If you have any questions about the Plan’s coverage of mastectomies and reconstructive

surgery, please call the Member Services phone number on the back of your ID card. You may

also call the Employee Benefits Department toll-free at (888) 332-4894.

Understanding Coordination of Benefits

Coordination of benefits establishes the priority or sequence in which medical benefit claims are

paid. The benefit plan of a person’s employer is the primary insurance and is required to pay

first on medical claims.

Benefit claims for employed spouses will be paid after the maximum benefits are paid by the

working spouse’s medical insurance.

Benefit Eligibility of Registered Domestic Partners

Raley’s employees who have registered domestic partners may cover those partners under the Kaiser Permanente HMO plan (employees must live or work in a Kaiser Service area) and the dependent life insurance plan. This option is based on changes in California law through Assembly Bills 205 and 2208. The purpose of this notice is to tell you about this coverage and what you need to do to enroll, if you are eligible.

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Benefit Plan Coverage for Registered Domestic Partners

If you can provide valid documentation from the state in which you have a registered domestic

partnership, you may be able to enroll your domestic partner for coverage under the Kaiser

Permanente HMO plan (but not in any of the other health plan options) and the Raley’s

Dependent Life Insurance plan if the following criteria is met:

• You are each eighteen (18) years of age or older in a committed same-sex relationship or

• You are in a committed opposite-sex relationship (but are not married) and either you or your

domestic partner is age 62 or older.

In addition, your registered domestic partner’s children will be treated as if they were your

children, for purposes of the Kaiser HMO plan option and the Dependent Life Insurance plan,

as long as they satisfy the definition of a dependent under the Raley’s Health & Welfare Plan.

If you enroll your domestic partner and his or her eligible children, please use the Dependent

Data section of your benefits enrollment form to add the name of your domestic partner and his

or her eligible children to the available coverage. You will also need to complete the Spousal

Coordination of Benefits section. Additionally, in order to process your request, you must

provide the Employee Benefits Department with valid documentation of your registered

domestic partnership and provide copies of birth certificates for any eligible children of your

domestic partner.

If your domestic partnership, you must notify the Company within 31 days of the change in status by completing a Change in Family Status/Beneficiary Form. Keep in mind that upon termination of group health coverage, domestic partners do not have rights to continue health coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Tax Treatment of Domestic Partners

In some cases, your registered domestic partner and his or her children may qualify as your

dependents for federal income tax purposes. If applicable, please contact the Employee

Benefits Department regarding the required documentation prior to completing your benefits

enrollment form. If your registered domestic partner and his or her children do not qualify as

your dependents for federal income tax purposes, any contributions you make for their benefit

plan coverage must be made on an after-tax basis. Furthermore, any portion of the cost of

coverage paid by Raley’s will be taxable income to you for federal income tax purposes.

However, these amounts are nontaxable for California income tax purposes.

Eligibility for Dependent Care FSA and Health Care FSA

Based on IRS guidelines, if your domestic partner and his or her children do not qualify as your

dependent for federal income tax purposes, you cannot use a Flexible Spending Account to

receive reimbursement for their dependent care or health care expenses.

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Employee Benefits Department

P. O. Box 15618

Sacramento, CA 95852