table of

contents

3 Eligibility

4 Making changes During the Plan Year

5 Using PlanSource to Enroll

6 Consider Your Choices

7 Medical Plans

12 Dental and Vision Plans

13 Flexible Spending Accounts

14 Transit & Parking Benefits

15 Short- and Long-Term Disability

16 Life Insurance Coverage

17 Modern Health / Travel Assistance / EAP

18 Perks

19 Employee Costs

20 Resources

21 Annual Notification of Benefit Rights

BENEFITS GUIDE 20203

▪Your spouse;

▪Your same-sex or opposite-sex domestic

partner;

▪Your dependent children up to age 26 (regardless of marital status), including a natural child, stepchild, a legally adopted child, a child placed for adoption or a child for whom you or your spouse are the legal guardian;

▪Your unmarried children age 26 or older who are mentally or physically disabled and who rely on you for support and care; and/or

▪Children of a same-sex or opposite-sex domestic partner relationship, up to age 26 (regardless of marital status). (Please note: Your domestic partner must also be enrolled in order to cover his/her child.)

You may cover your same-sex or opposite-sex domestic partner for certain benefits.

If you elect to cover a qualified domestic partner and/or domestic partner’s child(ren), the total dollar value of their premiums paid by Shopify, and by you, towards their coverage will be considered taxable income (known as Imputed Income) and will be included on your W-2 each year.

ELIGIBILITY

If you (and/or your

dependents) have Medicare

or will become eligible for

Medicare in the next 12

months, a Federal law gives

you more choices about

your prescription drug

coverage. Please see page

17 for more details.

Active, regular, full-time employees working a minimum of 30 hours per week are eligible for

the benefits outlined in this booklet on your date of hire. Benefits end on the last day of the

month in which your employment is terminated for medical, dental and vision. Life and disability

benefits terminate on your last day of employment.

You may also enroll eligible dependents in certain benefits.

BENEFITS GUIDE 20204

MAKING CHANGES DURING THE PLAN YEAR

In most cases, you may only make changes to your

benefits during Open Enrollment. However, if you have a

“qualified life event,” you may make changes to certain

benefits, as defined by the plan documents, related to that

event.

▪ Your marriage;

▪ Your divorce or legal separation;

▪ Birth, adoption or placement for adoption of an eligible

child;

▪ Death of your spouse or covered child;

▪ Change in your or your spouse’s work status that affects

benefits eligibility (for example, starting a new job,

leaving a job, changing from part-time to full-time,

starting or returning from an unpaid leave of absence,

etc.)

▪ A significant change in your or your spouse’s health

coverage attributable to your spouse’s employment;

▪ A change in your children’s eligibility for benefits;

▪ Becoming eligible for Medicare or Medicaid during the

year; and/or

▪ Becoming eligible for domestic partner status.

You MUST complete the steps below within 30 CALENDAR DAYS of the qualified life event to make

changes to your benefit elections.

▪ Go online to your PlanSource account to enter your

qualified life event

https://benefits.plansource.com/logon.

▪ Gather supporting documentation of the life event

▪ Send the documentation to the Shopify Talent

Benefit Team.

Your benefits coverage starts on your date of hire.

Mid-year changes are effective the date of the qualifying

event, following submission of all documentation

required, as long as it is received within 30 calendar days

of the event. For most plans, benefits coverage ends on

the last day of the month in which you are eligible. For

specific details, see your Summary Plan Description (SPD).

Under certain circumstances, you and your enrolled

dependents have the right to continue coverage under

the medical, dental and vision plans, as well as the

healthcare flexible spending account, beyond the time

coverage would have ordinarily ended. You may elect

continuation of coverage for yourself and your

dependents if you lose coverage under the plan because

of one of the following qualifying events:

▪ Termination (for reasons other than gross misconduct)

▪ Reduction in employment hours

▪ Retirement

In addition, continuation of coverage may be available to

your eligible dependents if:

▪ You die

▪ You and your spouse divorce or separate

▪ A covered child ceases to be an eligible dependent

To apply for COBRA coverage, you or a dependent must

contact the Shopify Talent Benefit Team WITHIN 60

DAYS of a qualifying life event. You and/or your

dependents must pay the full cost of COBRA coverage.

Under the law, COBRA must be offered to eligible

individuals at group rates. These rates are subject to

change annually.

!

BENEFITS GUIDE 20205

USING PLANSOURCE TO ENROLL

To make the most of your Shopify benefits, you’ll need to make informed choices using the information in this guide.

You’ll also use PlanSource to make your benefits selection. You can access PlanSource online at any time during and after your enrollment period.

If you don’t enroll during the new hire

enrollment period, you will not be

covered. You will not be able to make

changes until the next Open Enrollment

period or until you experience a qualified

life event.

You will, however, be automatically

enrolled in Shopify’s short and long-term

disability, group life and group

accidental death & dismemberment

plans.

ONLINE LOGIN INSTRUCTION

Login to your portal

https://benefits.plansource.com/logon

BENEFITS GUIDE 20206

CONSIDER YOUR CHOICES

MEDICAL PLANS

▪ UHC PPO Plan: this plan lets you choose in-network or out-of-network providers at the time of service. You will incur higher out-of-pocket costs for out-of-network providers. Available to all employees.

▪ UHC HDHP with HSA: the HDHP medical plan is a PPO plan except the deductible must be met before the plan begins to pay for services. The Health Savings Account (HSA) is a bank account to help you pay for covered expenses. To help you meet out of pocket expenses (including the deductible). Shopify contributes $1,000 for and individual HSA; $2,000 for a family HSA. Available to all employees.

▪ UHC EPO Plan: this plan uses an Exclusive Provider Organization is an In-network Only Plan. It works like an HMO. It is available in all states except AK, AL, AR, AZ, HI, LA, MS, MT, NC, NM and OK.

▪ Kaiser HMO Plan: this plan offers a comprehensive, convenient approach, but requires that you seek care within the Kaiser HMO network (Available only to California employees)

SUMMARY OF BENEFITS AND COVERAGE (SBC) AND UNIFORM GLOSSARY

The SBC is an easy-to-understandsummary about a health plan’s benefits so that you can evaluate your choices.

These are posted in the Shopify Vault at:

https://app.strivebenefits.com/shopify

Password: Welcome

IMPORTANT TERMS

Coinsurance: The amount you pay for covered services after you pay the deductible. For example, the UHC plan has coinsurance of 80%/20%. After you meet the deductible, the plan pays 80% of the costs and you pay 20%.

Copay: The amount you pay up-front for your visit.

Covered Services: Those services deemed by your plan to be medically necessary for the care and treatment of an injury or illness.

Deductible: The amount you pay before the plan starts to pay. For example, the UHC PPO plan requires a $250 deductible for an individual using in-network services. This means that you pay the first $250 in medical care you use (please note, the deductible is not applicable to all services, please see plan details.

Formulary: A list that contains the approved medications that are part of your prescription drug plan.

Generic: An FDA-approved drug, composed of virtually the same chemical formula as a brand-name drug.

Out-of-pocket maximum: The most you will pay for covered medical expenses in a year. Once you reach your out-of-pocket maximum, the plan pays 100% of your covered medical expenses for the balance of the year.

BENEFITS GUIDE 20207

MEDICAL PLANS

United Health Care (UHC)

PPO

In Network Out of Network

General Plan Provisions

Plan Year Deductible

(Individual / Family)$250 / $500 $500 / $1,000

Out-of-pocket Maximum

(Individual/Family)$2,250 / $4,500 $4,500 / $9,000

Outpatient Services

Office Visits / Specialist Visit $20 copay 40% coinsurance*

Preventive Care no charge not covered

Diagnostic Lab & X-ray no charge 40% coinsurance*

Complex Imaging (CT/PET/MRI) 20% coinsurance* 40% coinsurance*

Infertility ($15,000 lifetime limit) 20% coinsurance* 40% coinsurance*

Physical Therapy $20 copay 40% coinsurance*

Outpatient Surgery 20% coinsurance* 40% coinsurance*

Inpatient Services

Inpatient Hospital 20% coinsurance* 40% coinsurance*

Emergency Services

ER (waived if admitted) $100 copay (ded waived) $100 copay (ded waived)

Urgent Care $50 copay (ded waived) 40% coinsurance*

Ambulance – (Emergency) 20% coinsurance* 20% coinsurance*

Prescription Drugs

Retail (31 days)

Tier 1/2/3$10/$30/$50 $10/$30/$50

Mail Order – Tier 1/2/3 $20/$60/$100 not covered

UHC PPO Plan

*deductible applies

BENEFITS GUIDE 20208

MEDICAL PLANS

United Health Care (UHC)

PPO

In Network Out of Network

General Plan Provisions

Plan Year Deductible

(Individual / Family)$2,800 / $5,000 $4,700 / $9,400

Out-of-pocket Maximum

(Individual/Family)$4,700 / $9,400 $9,400 / $18,000

Outpatient Services

Office Visits / Specialist Visit 20% coinsurance* 40% coinsurance*

Preventive Care no charge not covered

Diagnostic Lab & X-ray 20% coinsurance* 40% coinsurance*

Complex Imaging (CT/PET/MRI) 20% coinsurance* 40% coinsurance*

Infertility ($15,000 lifetime limit) 20% coinsurance* 40% coinsurance*

Physical Therapy 20% coinsurance* 40% coinsurance*

Outpatient Surgery 20% coinsurance* 40% coinsurance*

Inpatient Services

Inpatient Hospital 20% coinsurance* 40% coinsurance*

Emergency Services

ER (waived if admitted) 20% coinsurance* 20% coinsurance*

Urgent Care 20% coinsurance* 40% coinsurance*

Ambulance – (Emergency) 20% coinsurance* 20% coinsurance*

Prescription Drugs

Retail (31 days)

Tier 1/2/3$10/$30/$50* $10/$30/$50*

Mail Order – Tier 1/2/3 $20/$60/$100* not covered

UHC High Deductible Health Plan (HDHP) with Health Savings Account (HSA)

*deductible applies

BENEFITS GUIDE 20209

MEDICAL PLANS

United Health Care (UHC)

EPO

In Network Out of Network

General Plan Provisions

Plan Year Deductible

(Individual / Family)$250 / $500 N/A

Out-of-pocket Maximum

(Individual/Family)$500 / $1,000 N/A

Outpatient Services

Office Visits / Specialist Visit $15 copay not covered

Preventive Care no charge not covered

Diagnostic Lab & X-ray no charge not covered

Complex Imaging (CT/PET/MRI) no charge not covered

Infertility ($15,000 lifetime limit) no charge* not covered

Physical Therapy $15 copay not covered

Outpatient Surgery no charge* not covered

Inpatient Services

Inpatient Hospital no charge* not covered

Emergency Services

ER (waived if admitted) $250 copay $250 copay

Urgent Care $50 copay not covered

Ambulance – (Emergency) no charge (ded waived) no charge*

Prescription Drugs

Retail (31 days)

Tier 1/2/3$10/$30/$50 not covered

Mail Order – Tier 1/2/3 $20/$60/$100 not covered

UHC Exclusive Provider Organization (EPO) Plan

*deductible applies

BENEFITS GUIDE 202010

MEDICAL PLANS

Kaiser

HMO

In Network

General Plan Provisions

Plan Year Deductible

(Individual / Family)none

Out-of-pocket Maximum

(Individual/Family)$1,500 / $3,000

Outpatient Services

Office Visits / Specialist Visit $30 per visit

Preventive Care no charge

Diagnostic Lab & X-ray $10 per encounter

Complex Imaging (MRE, CT, PET) $50 per procedure

Infertility (diagnosis and treatment)50% coinsurance (diagnosis/treatment of

cause and artificial insemination only. ART not

covered)

Physical Therapy $30 per visit

Outpatient Surgery $100 per procedure

Inpatient Services

Inpatient Hospital $500 per admission

Emergency Services

ER (waived if admitted) $100 per visit

Urgent Care $30 per visit

Ambulance $100 per trip

Prescription Drugs

Retail (30 days) (generic/brand/specialty) $15 / $35 / 30% to $200

Mail Order (100 days)

(generic/brand/specialty)$30 / $70 / not covered

Kaiser HMO Plan (Only Available in California)

BENEFITS GUIDE 202011

MEDICAL

One Medical Network of Physicians

What is One Medical

One Medical is a membership-based primary care practice that makes

getting quality care more affordable, accessible, and enjoyable for all. Both

employees and their dependents have access to One Medical.

With One Medical you will appreciate:

• same-day and next day appointments that start on time

• 24/7 access to virtual care

• they are contracted with UHC (not available under Kaiser)

• curated referrals, navigation support and patient advocacy

• providers who spend time with you and care about well-being and

mental health

• no late appointments in a dingy office

• care anytime, anywhere in the world on your smartphone

• locations where you live, shop, work and click

• onsite labs

• access to 500+ in-network providers in 70+ offices across

9 major cities:

• San Francisco Bay Area

• Seattle Metro

• New York Metro

• Washington Metro

• Los Angeles

• Chicago Metro

• Boston Metro

• San Diego

• Phoenix

Sign up at: onemedical.com/myhealth

Code: SHOPXOM

BENEFITS GUIDE 202012

DENTAL

Shopify offers a competitive

PPO dental plan to help you

maintain your oral health.

A PPO Dental plan provides you

with the option of going to any

dentist you choose; if a Cigna

PPO dentist is used, the out-of-

pocket costs will be lower, due

to contractual savings. There is a

deductible, which is waived for

preventive services, and an

annual maximum benefit.

Benefits are paid based on the

level of service received

(preventive, basic, major or

orthodontia).

To find a provider in Cigna’s

dental network go to

www.mycigna.com.

Dental PlanCigna Dental

In NetworkOut of

Network

Plan Year Deductible

(Individual / Family)$50 / $150

Maximum Benefit $1,500 per person

Preventive Services (no

deductible)0% 0%

Basic Services (after deductible) 20% 20%

Major Services (after

deductible)50% 50%

Orthodontia (no deductible)50%

Adult & Child

Orthodontia Lifetime Maximum $1,500 per person

DENTAL & VISION PLANS

Vision Plan

Guardian Vision

In Network Out of Network

Frequency

(months)12 exam / 12 lenses /12 frames

Examination $10 copay

$10 copay

+ anything over $50

reimbursement

schedule

MaterialsCovered in full,

after $25 copay

You pay anything over

reimbursement

schedule

Frames $150 allowanceYou pay amount that

exceeds $48

Elective Contacts $150 allowanceYou pay amount

that exceeds $120

VISION

Shopify vision plan gives you the

freedom to see any provider. Keep

in mind, however, that you can

save a significant amount if you

choose a network provider — plus

they’ll handle all the paperwork for

you.

To locate a Guardian (VSP)

provider in your area, you can

contact Guardian Vision at

877-814-8970 or you can visit the

VSP website at www.vsp.com.

BENEFITS GUIDE 202013

FLEXIBLE SPENDING ACCOUNT (FSA)

Shopify has two FSA plan options, a Full Health Care FSA and a Limited Purpose FSA. Both plans allows for significant tax savings.

The Full Health Care FSA can be used for on many health care expenses that are not covered by your medical, dental or vision plans.

If you enroll in the UHC High Deductible Health

Plan (HDHP) with HSA, you are not eligible to

enroll in the Full Health Care HSA, however, you

may enroll in the Limited Purpose FSA for out-of-

pocket dental and vision expenses only.

Here’s how the plans work:

1. You determine how much to contribute.

2. Your contributions are then taken out of your pay in equal amounts each pay period before taxes are deducted.

3. You and your tax-qualified dependents incur eligible expenses.

4. You use your FSA Debit Card to pay for healthcare care expenses at participating locations, or file a claim online, via fax or mail for reimbursement.

5. Your reimbursements are paid to you tax-

free.

FSA ADMINISTRATOR –Navia Benefits

The FSA plan administrator,

Navia Benefits, will help you

manage your accounts and

claims processing.

You can access your online

account at:

www.naviabenefits.com, or

download the free MyNavia

mobile app available on both

iPhone and Android.

Annual Contribution

Limits$2,750

Your Eligible Expenses

Should Be Incurred

Between…

Jan 1 –

Dec 31, 2020

Submit Claim By April 30, 2021

Shopify employees are

automatically enrolled with an

annual employer Health Care FSA

contribution of $500 (prorated

based on date of hire). In addition,

employees may contribute the full

annual allowed amount of $2,750

towards their Health FSA.

BENEFITS GUIDE 202014

• The program is a monthly program; log in and

place an order to be fulfilled on a monthly basis.

Orders must be entered no later than the 20th

of the month for the following benefit period.

For example, to receive an order for use in

January, you must place your order by

December 20th. Changes must be made online

before the cut-off date of the 20th of the month

for the following benefit month.

• Pre-tax deductions are allowed up to the limit of

is shown on the table below. You can, however,

order products that total more than this limit

using your personal credit card.

• No retroactive changes may be made.

TRANSIT & PARKING BENEFITS

Commuting to work each day can be expensive.

Navia Benefits can help you save money on your

commuting costs. Through this program, you

simply go online to electronically order transit

passes and fulfill your commuting needs.

Using the Navia Benefits website, you will create an

account and place orders for transit and parking

products. Navia Benefits will send Shopify

information about your selections and instruct us to

make the proper pre-tax deductions from your

paycheck.

ACCESS TO YOUR ACCOUNT /

FIRST TIME LOGIN

1. visit www.naviabenefits.com (If you have not

registered, you will need to complete the

registration process

2. Select the “GoNavia Commuter Orders” link

under the My Tools” section

3. Select your benefit

4. Enter the dollar amount for your order

5. Select the months you would like to have your

order recur

6. Once you’ve confirmed your order and agreed

to the terms and conditions, select “place my

order”

You are finished! You will receive an e-mail

confirmation when your order has been submitted.

$270Bus, Ferry, Streetcar,

Subway and Train

$270

Parking at or near work /

near public transportation

to get to work

BENEFITS GUIDE 202015

SHORT TERM DISABILITY INSURANCE (STD)

Short-Term Disability (STD) insurance paid by Shopify provides you with

a weekly cash benefit to help pay for everyday expenses, such as a

mortgage, utilities, childcare, or groceries, if you are unable to work for a

short time due to a covered disability. Examples of covered disabilities

include back injuries, recovery from surgery, or even maternity leave.

For all employees, you will receive 66.67% of pre-disability earnings up

to a $2,500 weekly maximum. Benefits will begin after a 7-day waiting

period and are payable for up to 26 weeks.

LONG TERM DISABILITY INSURANCE (LTD)

Disability is often called the “forgotten risk,” as few employees think

about how they would survive financially with no earned income. The

impact of a disabling illness or injury, both financially and emotionally, is

devastating.

While health insurance may cover most medical bills, daily living

expenses such as rent or mortgage, car payments, and utilities continue.

Disability insurance provides partial income replacement if you are

unable to work due to a qualifying non-occupational illness or injury.

Benefits are payable after a period of 180 consecutive days of disability.

You will be considered disabled if, during the elimination period and the

next 24 months of disability, you are unable to perform the duties of

your “own occupation” and thereafter, you are unable to perform the

duties of “any occupation.”

Benefit Amount 66.67% of salary 66.67% of salary

Weekly Maximum $2,500 per week $10,000 per month

Elimination Period 7 days 180 days

Maximum Payment Period 26 weeks SSNRA

Tax Treatment for Claims Taxable Taxable

7 DAYS

STD

WAITING

PERIODSTD

BENEFITS

(26 WEEKS)

180 DAYS

LTD

WAITING

PERIOD

LTD

BENEFITS

Age 65

SHORT-TERM & LONG-TERM DISABILITY

Both STD and LTD payments from Lincoln will be offset by any income you

receive from other sources. This includes payments from state disability,

Social Security or any income from Shopify.

BENEFITS GUIDE 202016

LIFE INSURANCE COVERAGE

BASIC TERM LIFE/AD&D INSURANCE

Most of us don’t like to think about the necessity of life

insurance; however, it is important that you take time

now to make sure you have the right coverage for your

personal situation.

Shopify provides basic term life and Accidental Death &

Dismemberment (AD&D) coverage to you at no cost.

NOTE: The cost of any coverage exceeding $50,000 is

considered “imputed income” by the IRS. Imputed

income will be reported on your W-2 form as part of your

taxable income.

Voluntary Life Coverage Options

In addition to the basic coverage, you can purchase

additional life and Accidental Death & Dismemberment

(AD&D) under Shopify group policy through Lincoln

Financial Group. If you elect Voluntary Life/AD&D

Insurance for yourself, you can elect Voluntary

Life/AD&D Insurance for your spouse/domestic partner

and/or child(ren).

EMPLOYEE LIFE AND AD&D

You may purchase increments of $10,000 not to exceed

the lesser of 5 times annual salary or up to $500,000.

Monthly rate is based on amount selected and your age.

SPOUSE / DOMESTIC PARTNER

You may purchase increments of $5,000 not to exceed

$250,000. The monthly rate is based on the amount

selected and your age.

CHILD(REN)

6 months to age 26: May purchase from $1,000 to a

maximum of $10,000

Child coverage is equal to:

$0 if under 14 days

$1,000 if at least 15 days but under age 6 months

Life and Accidental Death and Dismemberment Coverage

Maximum

Benefits

2X of salary

up to $600,000

2X of salary

up to $600,000

Guaranteed

Issue$600,000 $600,000

Benefits

Reduction

65% at age 65

40% at age 70

25% at age 75

15% at age 80

65% at age 65

40% at age 70

25% at age 75

15% at age 80

BENEFITS GUIDE 202017

MODERN HEALTH / TRAVEL ASSISTANCE / EAP

Modern Health can provide you technology and

professional support to help you reduce stress, feel

more engaged, and lead a happy life.

With Modern Health you have access to:

• Sessions with expert coaches or therapists

• Unlimited texting with coaches

• Evidence-based online courses

• Mental well-being assessments

• Meditation library

Areas of support

• Work Performance

• Stress and anxiety

• Healthy lifestyles

• Financial well-being

• Inclusion and belonging

• Life challenges

• Relationships

To register:

1. Download the Modern Health app in the Google

Play Store (Android) or App Store (IOS). After

your download is complete, select “Join Now”

from the welcome page of the mobile app.

2. Use the first and last name you have on file with

your employer

3. Verify using your company e-mail

4. Enter your company email and password of your

choice

5. Select “Register” on the web or “agree & Join on

the mobile app to complete registration

Travel Assistance provides 24/7/365 access to personal

and emergency assistance with travel-related problems

and circumstances.

If you have a medical emergency while you are more

than 100 miles away from home, you don’t have to face it

alone. With one simple phone call, you can be connected

to a staff of medically trained, multilingual professionals,

who can advise you in a medical emergency, 24/7.

Here’s how the plans work:

1. When you travel 100 miles or more from home while

traveling for business or personal reasons for fewer

than 90 consecutive days. (Dependents traveling with

the employee are also eligible.)

2. Countries have their own number to contact for help.

These numbers are on the Travel Assistance

identification card. Always carry your

UnitedHealthcare Global ID card when you travel.

3. Provide UHC Global ID# 323401

4. Or Navigate to www.members.uhcglobal.com to

register online.

EMPLOYEE ASSISTANCE PROGRAM (EAP)

In addition to Modern Health, the Employee Assistance

Program offers confidential assistance at no cost to you

in areas such as financial, legal, stress, family, alcohol,

depression and more.

You, your family members, or anyone living in your

household can use this program. Coverage provides up

to five sessions a year per issue..

More Information

For more information or to get help:

Call: 888-628-4824 24/7

Visit: GuidanceResources.com

(username: LFGSupport password: LFGSupport1)

UHC Members (3 visits per person per year. Covers

mental health, legal, financial and more.)

Call: 1-866-633-2446

Visit: MyUHC.com

BENEFITS GUIDE 202018

PERKS

Lifestyle Spending Account

Shopify employees are automatically enrolled

with an annual employer contribution of $2,500 (prorated based on date of hire).

Funds can be used for things like:

▪ Wellness – Gym memberships, fitness

classes, art & cooking classes, music

subscriptions, horseback riding lessons,

sports/recreation equipment, etc.

▪ Home Services & Products – House

cleaning, pest control, duct cleaning, mold

removal, dry cleaning, mattresses and

pillows, etc.

▪ Everything else – Home Office Furniture,

computer monitor, headphones,

ergonomic equipment, car was, etc.

▪ Startify & Entrepreneurship – Domain

registration & hosting, test/sample, initial

products, design fees, etc.

Navia BenefitsFSA Employer Contribution

Shopify employees are automatically

enrolled with an annual employer

contribution of $500 (prorated based on

date of hire). In addition, employees may

contribute an additional annual amount of

$2,700 towards their Health FSA.

401K

John Hancock

Shopify employees will receive a lump sum

employer contribution of $3,000 to their

401K account at the end of the year

(amount is prorated based on hire date).

Voluntary Pet Insurance

Nationwide

Plan is 100% voluntary, and managed

directly through Nationwide Pet Insurance.

Cost is based on location and animal type.

Payroll deducted monthly.

Family Planning with Cleo

Cleo offers support for from preconception

to birth. Cleo is available to both moms and

dads, and at no cost to all eligible Shopify

employees.

“Shopify is a company that cares deeply about people.

Our perks program is a tangible reflection of that care.

It has been thoughtfully designed to align with us and the culture we’ve created.”

BENEFITS GUIDE 202019

2020 Employee Costs

MedicalEmployee

OnlyEmployee + Spouse

Employee+ Child(ren)

Employee+ Family

UHC PPO PlanEmployee Cost

Employer Cost

$ 0.00

$595.59

$ 91.72

$1,159.02

$ 75.04

$1,056.58

$ 166.77

$1,620.00

UHC HDHP PlanEmployee Cost

Employer Cost

$ 0.00

$442.77

$ 48.71

$ 881.12

$ 39.85

$ 801.41

$ 88.55

$1,239.76

UHC EPO PlanEmployee Cost

Employer Cost

$ 0.00

$588.96

$ 64.79

$1,172.03

$ 53.01

$1,066.01

$ 117.79

$1,649.09

Kaiser HMO PlanEmployee Cost

Employer Cost

$ 0.00

$450.31

$ 54.04

$ 936.63

$ 45.03

$ 855.58

$ 90.06

$1,260.85

Dental and Vision

Employee Only

Employee + Spouse

Employee+ Child(ren)

Employee+ Family

Cigna DentalEmployee Cost

Employer Cost

$ 0.00

$ 47.37

$ 4.88

$ 91.27

$ 6.10

$ 102.31

$ 11.92

$ 154.65

Guardian Vision (VSP)Employee Cost

Employer Cost

$ 0.00

$ 13.20

$ 4.06

$ 18.62

$ 4.26

$ 18.88

$ 10.20

$ 26.80

BENEFITS GUIDE 202020

Shopify Benefit Website Welcome app.strivebenefits.com/shopify

United Healthcare HDHP 916272 866-314-0335 myuhc.com

United Healthcare PPO/EPO 916272 866-633-2446 myuhc.com

Kaiser HMO 717048 NCR

234557 SCR

800-464-4000 kp.org

Cigna Dental 3342369 800-244-6224 mycigna.com

One Medical onemedical.com

Guardian Vision

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you in touch with supportive benefits

professionals trained to help with a wide range of

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BENEFITS GUIDE 202021

2020Annual

notificationsof benefit

rights

BENEFITS GUIDE 202022

2020 Medicare Part D Notice of Creditable Coverage

Important Notice from Shopify About

Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has

information about your current prescription drug coverage with Shopify and about

your options under Medicare’s prescription drug coverage. This information can help

you decide whether or not you want to join a Medicare drug plan. If you are

considering joining, you should compare your current coverage, including which

drugs are covered at what cost, with the coverage and costs of the plans offering

Medicare prescription drug coverage in your area. Information about where you can

get help to make decisions about your prescription drug coverage is at the end of

this notice.

There are two important things you need to know about your current coverage and

Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with

Medicare. You can get this coverage if you join a Medicare Prescription Drug

Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers

prescription drug coverage. All Medicare drug plans provide at least a standard

level of coverage set by Medicare. Some plans may also offer more coverage for

a higher monthly premium.

2. Shopify has determined that the prescription drug coverage offered by United

Healthcare Insurance and Kaiser, is on average for all plan participants, expected

to pay out as much as standard Medicare prescription drug coverage pays and is

therefore considered Creditable Coverage. Because your existing coverage is

Creditable Coverage, you can keep this coverage and not pay a higher premium

(a penalty) if you later decide to join a Medicare drug plan.

ANNUAL NOTIFICATION OF BENEFIT RIGHTS

BENEFITS GUIDE 202023

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and

each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no

fault of your own, you will also be eligible for a two (2) month Special Enrollment

Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A

Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Shopify coverage may be

affected.

If you do decide to join a Medicare drug plan and drop your current Shopify

coverage, be aware that you and your dependents will not be able to get this

coverage back until the plan’s next open enrollment period.

When Will You Pay A Higher Premium (Penalty) To Join A

Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Shopify

and don’t join a Medicare drug plan within 63 continuous days after your current

coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug

plan later.

If you go 63 continuous days or longer without creditable prescription drug

coverage, your monthly premium may go up by at least 1% of the Medicare base

beneficiary premium per month for every month that you did not have that

coverage. For example, if you go nineteen months without creditable coverage, your

premium may consistently be at least 19% higher than the Medicare base beneficiary

premium. You may have to pay this higher premium (a penalty) as long as you have

Medicare prescription drug coverage. In addition, you may have to wait until the

following October to join.

For More Information About This Notice Or Your Current

Prescription Drug Coverage…

Contact the number listed below for further information. NOTE: You’ll get this

notice each year. You will also get it before the next period you can join a Medicare

drug plan, and if this coverage through Shopify changes. You also may request a

copy of this notice at any time.

BENEFITS GUIDE 202024

For More Information About Your Options Under Medicare

Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug

coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in

the mail every year from Medicare. You may also be contacted directly by Medicare

drug plans.

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see the inside back cover of

your copy of the “Medicare & You” handbook for their telephone number) for

personalized help

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare

prescription drug coverage is available. For information about this extra help, visit

Social Security on the web at www.socialsecurity.gov, or call them at 1 -800-772-1213

(TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join

one of the Medicare drug plans, you may be required to provide a copy of

this notice when you join to show whether or not you have maintained

creditable coverage and, therefore, whether or not you are required to

pay a higher premium (a penalty).

For more information, contact the HR Department.

BENEFITS GUIDE 202025

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’re eligible for

health coverage from your employer, your state may have a premium assistance

program that can help pay for coverage, using funds from their Medicaid or CHIP

programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be

eligible for these premium assistance programs but you may be able to buy

individual insurance coverage through the Health Insurance Marketplace. For more

information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a

State listed below, 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,

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, ask your state if it

has a program that might help you pay the premiums for an employer-sponsored

plan.

If you or your dependents are eligible for premium assistance under Medicaid or

CHIP, as well as eligible under your employer plan, your employer must allow you to

enroll in your employer plan if you aren’t 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, contact the Department of Labor at

www.askebsa.dol.gov or call 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 of states is

current as of July 31, 2019. Contact your State for more information on

eligibility –

BENEFITS GUIDE 202026

ALABAMA – Medicaid FLORIDA – Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/

Phone: 1-877-357-3268

ALASKA – Medicaid GEORGIA – Medicaid

The AK Health Insurance Premium Payment Program

Website:

http://myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility:

http://dhss.alaska.gov/dpa/Pages/medicaid/def

ault.aspx

Website: https://medicaid.georgia.gov/health-

insurance-

premium-payment-

program-hipp Phone: 678-

564-1162 ext 2131

ARKANSAS – Medicaid INDIANA – Medicaid

Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website:

http://www.in.gov/fssa/hip/

Phone: 1-877-438-4479

All other Medicaid

Website:

http://www.indianamedicaid.com

Phone 1-800-403-0864

COLORADO – Health First Colorado (Colorado’s Medicaid Program) &

Child Health Plan Plus (CHP+)IOWA – Medicaid

Health First Colorado Website:

https://www.healthfirstcolorado.com/

Health First Colorado Member Contact

Center: 1-800-221-3943/ State Relay 711

CHP+: https://www.colorado.gov/pacific/hcpf/child-

health- plan-plus

CHP+ Customer Service: 1-800-359-1991/ State Relay

711

Website:

http://dhs.iowa.gov/H

awki Phone: 1-800-

257-8563

KANSAS – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://www.kdheks.gov/hcf/

Phone: 1-785-296-3512

Website: https://www.dhhs.nh.gov/oii/hipp.htm

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-

3345, ext 5218

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP

Website: https://chfs.ky.gov

Phone: 1-800-635-2570

Medicaid Website:

http://www.state.nj.us/humanser

vices/ dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

CHIP Website:

http://www.njfamilycare.org/index.html CHIP

Phone: 1-800-701-0710

BENEFITS GUIDE 202027

LOUISIANA – Medicaid NEW YORK – Medicaid

Website:

http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Phone: 1-888-695-2447

Website:

https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-

assistance/index.h

tml Phone: 1-800-

442-6003

TTY: Maine relay 711

Website: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid

Website:

http://www.mass.gov/eohhs/gov/departments/

masshealth/ Phone: 1-800-862-4840

Website:

http://www.nd.gov/dhs/services/medicalserv/m

edicaid/ Phone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP

Website:

https://mn.gov/dhs/people-we-serve/seniors/health-

care/health- care-programs/programs-and-

services/other-insurance.jsp Phone: 1-800-657-3739

Website:

http://www.insureoklahoma.org

Phone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid

Website:

http://www.dss.mo.gov/mhd/participants/pages

/hipp.htm Phone: 573-751-2005

Website:

http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-

es.html Phone: 1-800-699-9075

MONTANA – Medicaid PENNSYLVANIA – Medicaid

Website:

http://dphhs.mt.gov/MontanaHealthcareProgra

ms/HIPP Phone: 1-800-694-3084

Website:

http://www.dhs.pa.gov/provider/medicalassistance/h

ealthinsu

rancepremiumpaymenthippprogram/index.htm

Phone: 1-800-692-7462

NEBRASKA – Medicaid RHODE ISLAND – Medicaid and CHIP

Website: http://www.ACCESSNebraska.ne.gov

Phone: (855) 632-7633

Lincoln: (402) 473-7000

Omaha: (402) 595-1178

Website: http://www.eohhs.ri.gov/

Phone: 855-697-4347, or 401-462-0311 (Direct RIte

Share Line)

BENEFITS GUIDE 202028

NEVADA – Medicaid SOUTH CAROLINA – Medicaid

Medicaid Website: https://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

Website: https://www.hca.wa.gov/

Phone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid

Website: http://gethipptexas.com/

Phone: 1-800-440-0493

Website: http://mywvhipp.com/

Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP

Medicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

Website:

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002

VERMONT– Medicaid WYOMING – Medicaid

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

Website: https://wyequalitycare.acs-inc.com/

Phone: 307-777-7531

VIRGINIA – Medicaid and CHIP

Medicaid Website:

http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since July 31, 2019, or for more

information on special enrollment rights, contact either:

U.S. Department of Labor

Employee Benefits Security Administration

www.dol.gov/agencies/ebsa

1-866-444-EBSA (3272)

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

www.cms.hhs.gov

1-877-267-2323, Menu Option 4, Ext. 61565

BENEFITS GUIDE 202029

Women's Health and Cancer Rights Act (WHCRA)

If you have had or are going to have a mastectomy, you may be entitled to certain

benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For

individuals receiving mastectomy-related benefits, coverage will be provided in a

manner determined in consultation with the attending physician and patient, for:

• Reconstruction of the breast on which the mastectomy has been performed;

• Surgery and reconstruction of the other breast to produce a symmetrical

appearance; and

• Prostheses and physical complications for all stages of a mastectomy, including

Lymphedemas (swelling associated with the removal of lymph nodes).

These benefits may be subject to annual deductibles and coinsurance provisions that

are appropriate and consistent with other benefits under your plan or coverage. If

you would like more information on WHCRA benefits, contact the HR Department.

Notice of HIPAA Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your

spouse) because of other health insurance coverage or group health plan coverage,

you may be able to enroll yourself and your dependents in this plan if you or your

dependents lose eligibility for that other coverage (or if the employer stops

contributing toward your or your dependents’ other coverage). However, you must

request enrollment within 30 days after your or your dependents’ other coverage

ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or

placement for adoption, you may be able to enroll yourself and your dependents.

However, you must request enrollment within 30 days after the marriage, birth,

adoption, or placement for adoption.

To request special enrollment or obtain more information, contact the HR

Department.

Patient Protections Notice

If a qualifying benefit option under a group health plan maintained by the employer

generally requires or allows the designation of a primary care provider, the covered

individual has the right to designate any primary care provider who participates in

the Plan’s network and who is available to accept the covered individual. Until the

covered individual makes this designation, the Plan may designate a primary care

provider for him or her. For children, the covered employee or spouse may

designate a pediatrician as the primary care provider. For information on how to

select a primary care provider, and for a list of the participating primary care

providers, contact the HR Department.

BENEFITS GUIDE 202030

For any qualifying benefit option, covered individuals do not need prior

authorization from the group health plan 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 the Plan’s 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 the HR Department.

ADA Notice Regarding Wellness Program

The company’s wellness program is a voluntary wellness program available to all

employees. The program is administered according to federal rules permitting

employer-sponsored wellness programs that seek to improve employee health or

prevent disease, including the Americans with Disabilities Act of 1990, the Genetic

Information Nondiscrimination Act of 2008, and the Health Insurance Portability

and Accountability Act, as applicable, among others. If you choose to participate in

the wellness program you may be asked to complete a voluntary health risk

assessment or "HRA" that asks a series of questions about your health-related

activities and behaviors and whether you have or had certain medical conditions

(e.g., cancer, diabetes, or heart disease). You may also be asked to complete a

biometric screening, which may include a blood test. If so, you are not required to

complete the HRA or to participate in the blood test or other medical examinations.

However, employees who choose to participate in the wellness program may receive

an incentive. Although you are not required to complete the HRA or participate in

the biometric screening (if any), the program may provide that only employees who

do so will receive the incentive.

Additional incentives of up to 30% of the cost of coverage may be available for

employees who participate in certain health-related activities or achieve certain

health outcomes. If you are unable to participate in any of the health - related

activities or achieve any of the health outcomes required to earn an incentive, you

may be entitled to a reasonable accommodation or an alternative standard. You

may request a reasonable accommodation or an alternative standard by contacting

the HR Department.

The information from your HRA and the results from your biometric screening (if

any) will be used to provide you with information to help you understand your

current health and potential risks, and may also be used to offer you services

through the wellness program. You also are encouraged to share your results or

concerns with your own doctor.

BENEFITS GUIDE 202031

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally

identifiable health information. Although the wellness program and the employer

may use aggregate information it collects to design a program based on identified

health risks in the workplace, the wellness program will never disclose any of your

personal information either publicly or to the employer, except as necessary to

respond to a request from you for a reasonable accommodation needed to

participate in the wellness program, or as expressly permitted by law. Medical

information that personally identifies you that is provided in connection with the

wellness program will not be provided to your supervisors or managers and may

never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise

disclosed except to the extent permitted by law to carry out specific activities

related to the wellness program, and you will not be asked or required to waive the

confidentiality of your health information as a condition of participating in the

wellness program or receiving an incentive. Anyone who receives your information

for purposes of providing you services as part of the wellness program will abide by

the same confidentiality requirements. Only individuals necessary to administer the

program will receive your personally identifiable health information in order to

provide you with services under the wellness program.

In addition, all medical information obtained through the wellness program will be

maintained separate from your personnel records, information stored electronically

will be encrypted, and no information you provide as part of the wellness program

will be used in making any employment decision. Appropriate precautions will be

taken to avoid any data breach, and in the event a data breach occurs involving

information you provide in connection with the wellness program, we will notify you

immediately.

You may not be discriminated against in employment because of the medical

information you provide as part of participating in the wellness program, nor may

you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against

discrimination and retaliation, please contact the HR Department.

The information contained in this document is proprietary and confidential to Shopify.

No part of this document may be reproduced or transmitted in any form or by any means, electronic or

mechanical, including photocopying and recording, for any purposes without the express written

permission of Shopify

This document is subject to change without notice. Shopify does not warrant that the material contained in

this document is error-free. If you find any problems with this document, please report them to Shopify

Human Resources, in writing.

Shopify reserves the right to terminate, suspend, withdraw, or modify the benefits described in this

document, in whole or in part, at any time. No statement in this or any other document, and no oral

representation, should be construed as a waiver of this right.

This is not a legal document. Please refer to the summary plan descriptions for detailed information. This

document is not intended to cover every option detail. Complete details are in the legal documents,

contracts, and administrative policies that govern benefit operation and administration.

If there should ever be any differences between the summaries in this handbook and these legal

documents, contract, policies, the documents contracts and policies will be the final authority.