Annual Notices for Medtronic Benefit Programs...

Annual Notices for Medtronic Benefit Programs (U.S.)

This booklet of required notices is provided for your information and reference only, including the Annual Fee Disclosure Notice for the Medtronic Savings and Investment Plan (also known as the Medtronic 401(k) Plan). Some of the notices and information may not apply to you. No action is required.

If you have any questions about this information, contact AskHR by calling (800) 987-3565, Monday-Friday 8 a.m. to 8 p.m. Eastern Time or by sending an email to [email protected].

Contents

Annual Fee Disclosure Notice 1

Notice for Plan Year 2018 Automatic Contribution Arrangement and Default Investment 7

Summary Annual Reports 9

Tax Equity and Fiscal Responsibility Act 11

Notice of Privacy Practices 12

Medicare Part D Creditable Coverage Notice 16

Notice of State Premium Assistance Programs 18

Rights for Mothers and Newborn Children 21

Rights for Women Who Undergo a Mastectomy 21

Special Enrollment Rights 21

Notice Regarding Wellness Program 22

Summaries of Benefits and Coverage 24

A WORD ABOUT STATE PREMIUM ASSISTANCE PROGRAMS

If you are eligible for coverage under the Medtronic medical plans but unable to afford it,

you should be aware that some States have premium assistance programs that can

help you pay for coverage. For more information, please review the Notice of State

Premium Assistance Programs on page 18.

Annual Fee Disclosure Notice

Important Information About Your Investment Options, Fees, and Other Expenses for the Medtronic Savings and Investment Plan October 2017

The Medtronic Savings and Investment Plan (also known as the

Medtronic 401(k) Plan) is a great way to build savings for your future.

Through the Medtronic 401(k) Plan you get:

The convenience of automatic savings through payrolldeductions and the opportunity for tax advantages throughbefore-tax and Roth 401(k) contributions

Contributions from Medtronic that match a portion of yoursavings

A flexible, comprehensive investment line-up that ismonitored by the Qualified Plan Committee and includesoptions that are only available to large, institutional investors

Youll want to make sure you are taking full advantage of the

Medtronic 401(k) Plan by choosing a savings rate and investments in

the Plan to meet your long-term retirement needs. Use the tools

available on the Medtronic 401(k) Plan website to explore how your

savings and investment decisions impact your long-term savings

goals.

Review this notice to learn more about fees and expenses, the

Medtronic 401(k) Plans investment options, and where to go for

more information or to take action.

To learn more about the Medtronic 401(k) Plan, please see the

Summary Plan Description available on the Plans website.

1. About Fees and Expenses

As with other investments, many fees and expenses for the

Medtronic 401(k) Plan are paid by investors; in this case, participants

in the Plan. There are several types of fees:

Some fees are asset-based fees. You wont see these feesdirectly because they are charged to Plan investment optionsand reduce your investment earnings. These fees are shownin Section 3 of this notice. Asset-based fees are utilized topay for investment management fees.

You also have individual fees that result in charges due toactivity you have requested. (See the next page to learnmore about individual fees.)

When you decide to invest in any of the funds in theMedtronic 401(k) Plan, there are no upfront sales loads orcharges.

Medtronic generally pays Plan administrative expenses byreducing any discretionary True-Up Contribution by theamount of such expenses, including recordkeeping fees.

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Fees and expenses are important because they can reduce the

growth of your account over the long term. (You can find an example

that illustrates this concept on the Department of Labors website,

http://www.dol.gov/ebsa/publications/401k_employee.html.)

But, fees are still only one of several factors to consider when making

investment decisions. You also should carefully consider other key

factors, including asset class and investment risk, investment

objectives, principal investment strategies, and historical performance

when selecting investment options.

2. Medtronic 401(k) Plans Investment Options

As a participant in the Medtronic 401(k) Plan, youre responsible for

investing your account in one or any combination of the Plans

investment options. Section 3 provides more specific information

about the investment options, which include: Target Retirement

Date Funds and the Core Funds that primarily provide you with

investments that have returns that can change as the market goes up

and down.

Choosing Your Investment Strategy

Ultimately, how you invest should depend on your age, lifestyle,

accumulated wealth, years to retirement, and comfort level around

risk. This notice only provides some information about your

investment choices like fees, expenses, and historical returns. Your

decisions should be based on the full picture, taking into account your

individual situation, not just the information in this notice.

To learn more about the investment funds offered and fees that apply to these funds, visit the Plan website. You can find fund facts, fund performance, and other fund information. You can also receive more information about the funds, including paper copies of the information that is provided online or by calling the Retirement Service Center at (844) 335-9042. Representatives are available from 9 a.m. to 7 p.m., Eastern Time, Monday through Friday.

Some of the information you can find on the website or request copies of includes:

Copies of summary prospectuses or similar documents forfunds that are not federally registered.

Copies of any financial statements or reports, such asstatements of additional information and shareholder reports,and of any other similar materials relating to the Medtronic401(k) Plans funds, to the extent such materials are providedto the Plan.

A statement of the value of a share or unit of each fund aswell as the date of the valuation.

A list of the Plan assets comprising the portfolio of eachfund.

Individual Fees in the Medtronic 401(k) Plan

Professional management account services fees: If you sign

up for Professional Management, you will be charged a fee that is

based on the size of your account:

For the first $100,000 0.40% of assets

For the next $150,000 0.30% of assets

For the next $250,000 0.20% of assets

For assets over $500,000 0.10% of assets

The fee is calculated based on the average amount of assets under

management for the calendar quarter and is debited from your

account at the start of the following quarter.

Loan fees: You will pay a $50 fee whenever you take a loan from

the Medtronic 401(k) Plan. This fee is taken out of your loan

proceeds.

Domestic relations order fees: You will pay a $750 fee when a

domestic relations order is processed on your account. (This

occurs when a court awards a portion of your account to another

person due to a divorce settlement.) The fee is deducted after the

order is qualified and with the split.

Learn more about applicable Plan fees on the Plans website:

retirement.medtronic.com

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Voting Rights for Certain Investments

As a participant in the Medtronic 401(k) Plan, you can direct the

manner in which the Trustee will vote the Medtronic Ordinary

Shares credited to your Medtronic plc Stock Fund account. The

Trustee votes your Ordinary Shares in accordance with the voting

instructions received from you. If you fail to vote your Ordinary

Shares, those not voted shares are voted in proportion to the

Ordinary Shares voted by all voting Plan participants.

To Enroll or Make Changes to Your Investments. You can enroll in the Medtronic 401(k) Plan or make changes to your investments at any time by logging on to the Plans website. Once you have logged on you can:

Enrollsimply go to Savings and Retirement > Enroll Now

Change your current investment mix or your investmentelections for future contributionsgo to Savings andRetirement > Investment > Change Investments andfollow the instructions on the website

To help you create an investment strategy, the Medtronic 401(k) Plan

offers you the option to enroll in Professional Management.

Medtronic has designated Aon Hewitt Financial Advisors, LLC (AFA)

in partnership with Financial Engines (FE), an independent

Registered Investment Advisor, to provide fiduciary investment

advice and managed account services to Plan participants. If you

choose Professional Management, AFA in partnership with Financial

Engines will select and manage your account investments for you.

Fees apply for managed account services; see the Individual Fees

in the Medtronic 401(k) Plan box in Section 1.

If you are unable to log on to the website you may also enroll or

change investment options by calling the Retirement Service Center

at (844) 335-9042. Representatives are available from 9 a.m. to

7 p.m., Eastern Time, Monday through Friday.

3. Investment-Related Information

The following table provides you with information on the investment

options that have a variable rate of return. Youll find three things:

General information about the type of investment option

Fee information including asset-based fees1 (often called theexpense ratio) plus other shareholder-type fees orinvestment restrictions2

Historical performance for the fund and an appropriatebenchmark for the same period of time3

Keep in mind, however, that past performance does not guarantee

how the investment option will perform in the future. Your

investments in these options could lose money. Information about an

options principal risks is available on the Plans website.

For more information about this notice, you may contact the Retirement Service Center at (844) 335-9042 or the Plan administrator:

Plan Administrator 710 Medtronic Parkway LC245

Minneapolis, MN 55432

Federal regulations require plan sponsors to provide this notice. It includes

important information to help you understand your retirement plan and

compare the investment options offered to you. Most or all of the fund

information available in this notice is available to you by other means, and is

provided by third parties. We have not independently verified the third-party

information we are relaying in this notice.

1 Total asset-based fees are investment management company fees for services for

portfolio management, trading of securities and other fund management activities. 2 Shareholder-Type Fees and Investment Restrictions outlines any fees paid directly

from your investment in this option and any restrictions (e.g., equity wash and

purchase block provisions) on trading that might exist for a specific investment option. 3 In general, 1-year, 5-year, and 10-year performance history is shown. If a full history is

not available, a return since inception is provided instead. Any returns that are since

inception are footnoted and the benchmark is adjusted to reflect the same time frame.

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General Information Fee Information Historical Performance

Fund Name/ Benchmark

Asset Class

Total Asset-Based

Fees1

Annual Cost Per $1,000 of

Investment

Shareholder-Type Fees and

Investment Restrictions2

Average Annual Total Return as of 06/30/2017

(Fund and Benchmark)

1 yr. 5 yr. 10 yr. Incept. to date

Target Retirement Date Funds

Target Retirement Income Trust Select

Benchmark: Dow Jones Moderately

Conservative Index

Target Date 0.05% $0.50

There is a 30 day purchase block restriction on

this fund. After moving money out of this fund,

you must wait 30 days before you can move

money back into the fund.

4.62%

4.84%

4.15%

5.56%

N/A

N/A

4.72%

5.54%

Target Retirement 2015 Trust Select

Benchmark: Dow Jones Target 2015 TR Target Date 0.05% $0.50

There is a 30 day purchase block restriction on this fund. After moving money out of this fund, you must wait 30 days before you can move money back into the fund.

7.21%

1.89%

7.43%

4.29%

N/A

N/A

7.58%

4.46%




9.14%

3.98%

8.63%

5.68%

N/A

N/A

8.61%

5.69%




10.64%

6.09%

9.44%

7.10%

N/A

N/A

9.33%

6.96%




12.02%

8.70%

10.23%

8.55%

N/A

N/A

10.01%

8.23%




13.45%

11.05%

10.99%

9.74%

N/A

N/A

10.66%

9.26%




14.88%

12.99%

11.51%

10.65%

N/A

N/A

11.10%

10.04%


Benchmark: Dow Jones Target 2045 TR

Target Date 0.05% $0.50


-15.38%

14.33%

11.62%

11.18%

N/A

N/A

11.20%

10.49%




15.39%

14.92%

11.63%

11.32%

N/A

N/A

11.20%

10.61%




15.36%

14.95%

11.57%

11.32%

N/A

N/A

11.66%

11.28%

4


Asset Class

Total Asset-Based

Fees1


Investment









15.36%

14.95%

12.39%

11.32%

N/A

N/A

11.05%

9.80%

Core Funds

Medtronic plc Stock

Benchmark: S&P 500 TR Stock 0.02% $0.20 N/A

-2.15%

16.04%

18.31%

14.78%

7.11%

7.74%

5.06%

8.34%

Medtronic ESOP

Benchmark: S&P 500 TR Stock 0.02% $0.20 Closed to new investments.

-2.08%

16.04%

18.56%

14.78%

7.31%

7.74%

5.25%

8.34%

Interest Income

Benchmark: BofA Merrill Lynch USD

LIBOR 3 Mth Const Mat TR

GIC/Stable

Value 0.30% $3.00

You can't transfer money directly from this fund

to a competing fund. You must first transfer

money into a different, non-competing fund for

at least 90 calendar days before you can

transfer the money into a competing fund. The

Vanguard Inflation-Protected Securities Fund

Institutional Shares is a competing fund.

1.85%

0.93%

1.84%

0.44%

2.61%

1.03%

2.85%

1.60%

Vanguard Inflation-Protected

Benchmark: Barclays U.S. TIPS TR Bond 0.07% $0.70





-0.94%

-1.04%

-0.03%

-0.02%

3.99%

4.09%

4.04%

4.12%

Vanguard Total Bond Market Index

Benchmark: Barclays US Aggregate

Bond TR

Bond 0.03% $0.30





-0.85%

-0.51%

1.96%

2.02%

N/A

N/A

3.47%3

43.51%

Vanguard Wellington

Benchmark: Dow Jones Moderately

Aggressive Index

Balanced 0.16% $1.60


11.02%

13.02%

10.40%

10.23%

7.28%

5.87%

7.61%

7.19%

Vanguard Institutional Index

Benchmark: S&P 500 TR Large U.S.

Equity 0.02% $0.20


16.03%

16.04%

14.77%

14.78%

7.76%

7.74%

7.13%

7.08%

Vanguard Windsor II

Benchmark: Russell 1000 Value TR Large U.S.

Equity 0.25% $2.50


15.01%

13.76%

12.82%

14.00%

6.14%

6.21%

6.74%

6.88%

Vanguard PRIMECAP

Benchmark: S&P 500 TR Large U.S.

Equity 0.33% $3.30


22.13%

16.04%

18.38%

14.78%

10.25%

7.74%

10.22%

7.32%

5


Asset Class

Total Asset-Based

Fees1


Investment






Vanguard Extended Market Index

Benchmark: Russell MidCap TR

Mid U.S.

Equity 0.05% $0.50


16.72%

13.04%

14.78%

15.00%

N/A

N/A

11.28%3

11.90%

Vanguard International Growth

Benchmark: MSCI EAFE Growth NR USD International 0.33% $3.30





28.18%

12.98%

11.78%

9.34%

4.34%

2.39%

7.47%

5.68%

1 Total asset-based fees are investment management company fees for services for portfolio management, trading of securities and other fund management activities.

2 The Shareholder-Type Fees and Investment Restrictions column outlines any fees paid directly from your investment in this option and any restrictions (e.g., equity wash and purchase

block provisions) on trading that might exist for a specific investment option. 3 In general, 1-year, 5-year, and 10-year performance history is shown. If a full history is not available, a return since inception is provided instead. Any returns that are since inception

are footnoted and the benchmark is adjusted to reflect the same time frame.

4. Terms You Should Know

For definitions related to investments, go to the Plans website at retirement.medtronic.com. You will find definitions in Retirement and Savings

> Your Investment Strategy > Fund Detail

6

Notice for Plan Year 2018 Automatic Contribution

Arrangement and Default Investment

Automatic Contributions This notice advises you of certain rights you have under the Medtronic 401(k) Plan. The Medtronic 401(k) Plan includes an automatic contribution arrangement, which means that if you do not make a contribution election within 60 days of the date you are first eligible to participate in the Medtronic 401(k) Plan, Medtronic will automatically deduct contributions on your behalf of 6% of your earnings by deferring this amount from your pay into the Medtronic 401(k) Plan on a pre-tax basis. This deferral percentage will increase 1% each year on August 1st (rounded to the next business day if necessary), to a maximum of 10%, unless you change the deferral percentage or suspend your contributions.

You can elect to defer any percentage of your eligible pay from 2% to 75% (or you can elect 0% if you do not wish to make deferrals) by logging on to retirement.medtronic.com or by calling the Retirement Service Center at (844) 335-9042. Representatives will be available from 9 a.m. to 7 p.m., Eastern Time, Monday through Friday. Any election you make will become effective as soon as administratively possible after receipt by the Medtronic 401(k) Plan Administrator and will remain in effect unless and until you change it. Please keep in mind that if you are eligible for automatic contributions and you do not wish to defer any of your compensation, or you wish to defer a percentage of your compensation different from (either more or less than) the automatic deferral percentage, you must make a deferral election.

Default Investment You have the right to direct the investment of contributions made to your account under the Medtronic 401(k) Plan into any of the investment choices available through the Medtronic 401(k) Plan. If you do not make an election as to how contributions to your account should be invested, contributions will be invested in the Vanguard

Target Retirement Trust Select Fund with the target date closest to the year when you will

reach age 65 as illustrated in the table on the following page.

All Vanguard Target Retirement Date Select Funds slowly reduce their risk and return characteristics over time to respond to the changing needs of investors as they near retirement age. Vanguard Target Retirement Date Trust Select Funds generally reach the most conservative asset mix by the year identified in the funds name (for example, the Vanguard Target Retirement 2020 Trust Select Fund will reach its most conservative asset mix by 2020). At that time, the respective Vanguard Target Retirement Date Trust Select Fund will be blended into the Vanguard Target Retirement Income Trust Select Fund, which is designed specifically to provide an appropriate blend of income and inflation protection to retired (or near-retired) individuals who are withdrawing money. Because it is designed for retirees, the Vanguard Target Retirement Income Trust Select Fund offers a consistently lower level of risk compared to all of the other Vanguard Target Retirement Date Select Funds. It does, however, maintain a small allocation of stocks and other riskier asset classes to provide the retiree with some inflation protection during their retirement years.

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Investment Name Default for Investors Born Expense ratio*

Vanguard Target Retirement 2060 Trust Select After 1992 0.05%

Vanguard Target Retirement 2055 Trust Select 19881992 0.05%









Vanguard Target Retirement Income Trust Select Before 1943 0.05%

You have the right to change your investment elections at any time to one or more of the other investment choices available under the Medtronic 401(k) Plan without penalty. You can change your investment elections by logging on to retirement.medtronic.com or by calling the Retirement Service Center at (844) 335-9042. For more information about automatic contributions and about the Medtronic 401(k) Plans investment alternatives, please refer to the Medtronic 401(k) Plans Summary Plan Description or contact the Medtronic 401(k) Plan Administrator at (763) 514-4000.

*The cost of running the investment, expressed as a percentage of the investments assets, as of the most recent fact sheet. ForVanguard Target Retirement Trusts, this is an average weighted expense ratio, based on expenses incurred by the Vanguard funds that make up each Target Retirement Trust Select. This data is as of July 31, 2017.

To obtain more information about any fund, including investment objectives, risks, charges, and expenses, call the 401(k) Plan Retirement Service Center at (844) 335-9042 to obtain a prospectus. The prospectus contains this and other important information about the fund. Read and consider the prospectus information carefully before you invest. You can also download Vanguard fund prospectuses at retirement.medtronic.com.

A Vanguard Target Retirement Trust Select is not a mutual fund. It is a collective trust available only to tax-qualified plans and their eligible participants. Investment objectives, risks, charges, expenses, and other important information should be considered carefully before investing. The collective trust mandates are managed by Vanguard Fiduciary Trust Company, a subsidiary of The Vanguard Group, Inc.

Vanguard is a trademark of The Vanguard Group, Inc. All other marks are the exclusive property of their respective owners.

8

Summary Annual Reports

Medtronic Savings and Investment Plan This is a summary of the annual report for the Medtronic Savings and Investment Plan (also known as the Medtronic 401(k) Plan), EIN 41-0793183, Plan No. 005, for period May 1, 2015 through April 30, 2016. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

Benefits under the Plan are provided by insurance contracts and a trust fund. Plan expenses were $450,973,000. These expenses included $2,283,000 in administrative expenses, $448,690,000 in benefits paid to participants and beneficiaries. A total of 52,397 persons were participants in or beneficiaries of the Plan at the end of the plan year, although not all of these persons had yet earned the right to receive benefits.

The value of Plan assets, after subtracting liabilities of the Plan, was $7,890,347,000 as of the end of the plan year, compared to $5,913,638,000 as of the beginning of the plan year. During the plan year the Plan experienced a change in its net assets of $1,976,709,000. This change includes unrealized appreciation or depreciation in the value of Plan assets; that is, the difference between the value of the Plan's assets at the end of the year and the value of the assets at the beginning of the year or the cost of assets acquired during the year. The Plan had total income of $498,795,000, including employer contributions of $195,878,000, employee contributions of $270,334,000, and earnings from investments of $8,783,000, and other income of $23,800,000.

Medtronic, Inc. Group Insurance Plan This is a summary of the annual report of the Medtronic Group Insurance Plan, EIN 41-0793183, Plan No. 540, for the period January 1, 2016 through December 31, 2016. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

Medtronic has committed itself to pay certain health flexible spending account and dental claims incurred under the terms of the Plan.

The Plan has contracts with Aetna Life Insurance Company, Aetna International, Genworth Life Insurance Company, Hartford Life and Accident, Kaiser Foundation Health Plan, Inc., Multinational Life Insurance Company, Prudential Insurance Company of America, Reliance Standard Life Insurance Company, Vision Service Plan Insurance Company and Zurich American Insurance Company to pay health, dental, vision, life insurance, temporary disability, long-term disability, prescription drug, business travel accident, and accidental death and dismemberment claims incurred under the terms of the Plan. The total premiums paid for the plan year ending December 31, 2016 were $40,090,778.

Medtronic Retiree Health Plan This is a summary of the annual report of the Medtronic Retiree Health Plan, EIN 41-0793183, Plan No. 541, for the period January 1, 2016 through December 31, 2016. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

Medtronic has committed itself to pay certain health flexible spending account claims incurred under the Plan.

The Plan had contracts with Delta Dental of Minnesota, Group Health Plan, Inc., Kaiser Foundation Health Plan, Inc., Medica, UCare Minnesota and Vision Service Plan Insurance Company to pay health, dental, vision and prescription drug claims incurred under the terms of the Plan. The total premiums paid for the plan year ending December 31, 2016 were $3,075,179.

9

Because Delta Dental of Minnesota is a so called experience-rated contract, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending December 31, 2016, the premiums paid under such experience-rated contracts were $738,469 and the total of all benefit claims paid under these contracts during the plan year was $510,680.

You have the right to receive a copy of the full annual report, or any part thereof, on request. To obtain a copy of the full annual report, or any part thereof, write or call the Medtronic Benefits Department LC245, 710 Medtronic Parkway, Minneapolis, MN 55432, or by telephone at (763) 514-4000. You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the Plan and accompanying notes, or a statement of income and expenses of the Plan and accompanying notes, or both.

If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report. The items listed below may also be included in that report:

An accountant's report;

Assets held for investment;

Financial information and information on payments to service providers;

Insurance information, including sales commissions paid by insurance carriers; and

Information regarding any common or collective trusts, pooled separate accounts, master trusts or103-12 investment entities in which the Plan participates.

You also have the legally protected right to examine the annual report at the main office of the Plan (Medtronic Benefits, LC245, 710 Medtronic Parkway, Minneapolis, MN 55432) and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.

Note: Beginning Jan. 1, 2018, the Medtronic Retiree Health Plan coverage, including medical, dental, and vision coverage, for post-65 (Medicare eligible) retirees will transition from company-sponsored group coverage to individual health insurance.

10

Tax Equity and Fiscal Responsibility Act

Applicable to participants who are receiving an annuity payment from one of the Medtronic retirement plans.

To make changes to your address, direct deposit or tax withholding elections, including an election to not have Federal withholding apply to your qualified periodic payment, access the Retirement Service Center at retirement.medtronic.com or call the Retirement Service Center at (844) 335-9042.

You have the right to elect not to have federal withholding apply to your qualified periodic payment. Your withholding election will remain in effect until you change it, which you may do at any time. If you elect not to have withholding apply, or if you do not have enough income tax withheld from your pension or periodic amounts, you may incur penalties under the estimated tax rules.

11

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Title II of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law. This Notice describes the health information privacy practices of the Medtronic medical, dental, vision and health flexible spending account plans, to the extent such benefits are subject to HIPAA. These plans are collectively referred to as the Plan in this Notice, unless specified otherwise. Any other benefit plans sponsored by Medtronic are not covered by this Notice.

The HIPAA Privacy Rule protects only certain medical information known as protected health information (PHI). Generally, PHI is individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health plan, or your employer on behalf of a group health plan that relates to:

1. Your past, present, or future physical or mental health or condition;

2. The provision of health care to you; or

3. The past, present or future payment for the provision of health care to you.

This Notice is effective October 31, 2017. If you have any questions about this Notice or about the Plans privacy practices, please contact the Health Plans Privacy Officer at (763) 505-0792.

The Plans duties with respect to your PHI The Plan is required by law to:

Maintain the privacy of your PHI;

Provide you with certain rights with respect to your PHI;

Provide you with a copy of this Notice of our legal duties and privacy practices with respect to yourPHI;

Notify you of a breach of your unsecured PHI; and

Follow the terms of the Notice that is currently in effect.

The Plan reserves the right to change the terms of this Notice and to make new provisions regarding any PHI that the Plan maintains, as allowed or required by law. If the Plan makes any material change to this Notice, it will provide you with a copy of the revised Notice of Privacy Practices electronically or by mail, as required by law. It is important to note that under Title II of HIPAA, these rules apply to the Plan, not Medtronic or its affiliated companies as an employer.

How the Plan may use or disclose your PHI The privacy rules generally allow the use and disclosure of your PHI without your permission for purposes of health care Treatment, Payment Activities, and Health Care Operations. Here are some examples of what that might entail:

Treatment: The Plan may use or disclose your PHI to facilitate medical treatment or services byproviders. This means the Plan may disclose medical information about you to one or more healthcare providers or doctors to assist with providing, coordinating, or managing your health care. Forexample, the Plan may share PHI about you with physicians who are treating you. The Plan mayalso contact you to provide treatment alternatives or other health-related benefits and services thatmay be of interest to you.

Payment: The Plan may use or disclose your PHI to determine your eligibility for Plan benefits, tofacilitate payment for the treatment of services you receive from health care providers, to determine

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benefit responsibility under the Plan, or to coordinate Plan coverage. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan in order to coordinate payment of benefits.

Health Care Operations: The Plan may use and disclose your PHI for other Plan operations wheresuch disclosure is necessary to run the Plan. For example, the Plan may use your medicalinformation in connection with wellness and risk assessment programs, conducting qualityassessment and improvement activities, customer service and appeals. Plan operations alsoinclude vendor evaluations, credentialing, training, accreditation activities, underwriting, premiumrating, arranging for medical review and auditing activities. The Plan will not use genetic informationfor underwriting purposes.

Generally speaking, the amount of PHI used or disclosed will be limited to the minimum necessary for the stated purpose, as required under the HIPAA rules.

How the Plan may share your PHI with Medtronic The Plan or its business associates (those that perform duties on behalf of the Plan) may disclose to Medtronic the following information without your written authorization:

Summary health information for purposes of obtaining bids to provide coverage under the Plan, orfor modifying, amending or terminating the Plan. Summary health information is information thatsummarizes participants claims information, but from which names and other identifyinginformation have been removed.

Information on whether an individual is participating in the Plan, or has enrolled or disenrolled in abenefit option offered by the Plan.

Although the Plan is also allowed to disclose your PHI to Medtronic for plan administration purposes, including Payment and Health Care Operations, at present, Medtronic has determined that it will limit its access to PHI to the enrollment, disenrollment, and summary health information described in this section of the Notice. The following employees of Medtronic may have access to your PHI:

Any employee who is assigned direct responsibility for the administration of the Plan (this categoryincludes, without limitation, employees working in AskHR, HR Operations and Global Rewards);

Any employee who is assigned direct or indirect responsibility for the legal compliance of the Plan;

Any employee who is assigned direct or indirect responsibility for administrative activities in supportof the Plan (this category includes, without limitation, employees working in information technologyservices, accounting, compensation, risk management or human resources);

The Privacy Officer;

The Security Officer; and

Any employee who is assigned to provide administrative or secretarial support to any of theemployees described above.

Medtronic cannot and will not use PHI obtained from the Plan for any employment-related actions. However, other health information received by Medtronic, for example under the Family and Medical Leave Act, American with Disabilities Act, or workers compensation, is not protected under HIPAA.

Other allowable uses or disclosures of your PHI In addition to the disclosures described above, the Plan is allowed to use or disclose your PHI without your written authorization in the following circumstances, subject to certain restrictions:

To professionals hired to assist in administering the Plan, such as vendors, consultants, attorneys,third party administrators, etc., provided such professionals agree, in writing, to protect your PHI tothe same extent that the Plan would protect it

In an emergency situation, certain PHI may be disclosed to family members, close personal friendsor other persons identified as involved in your care or payment of care

To determine workers compensation benefits

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In response to a court or administrative order or in response to a subpoena or discovery request

In response to a request by law enforcement officials in certain situations

For public health actions including, disease prevention, reporting child abuse or neglect, reportingreactions or problems with products, notification of recalls of products, notification regardingexposure to or risk of contracting or spreading a disease

For public health oversight activities, as authorized by law, including audits, investigations,inspections and licensure or disciplinary actions

As necessary to identify a deceased person or determine a cause of death

For certain specialized government functions

As necessary to facilitate organ or tissue donation and transplantation

To facilitate research, as permitted by state law

In emergency situations involving a threat to public safety

When otherwise required by federal, state or local law

The Plan is required to disclose your PHI in the following circumstances:

Upon request by the Secretary of the Department of Health and Human Services during aninvestigation of compliance with HIPAA privacy rules.

Upon your request

Except as described in this Notice, other uses and disclosures will be made only with your written authorization. You may revoke your authorization, in writing, as allowed under the HIPAA rules. However, you cannot revoke your authorization for use or disclosure of information made prior to receipt of your written revocation.

Your individual rights You have the following rights with respect to your PHI:

Right to inspect and copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your health care benefits. To inspect and copy your PHI, you must submit your request in writing to the Plan. If you request a copy of the information, the Plan may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. You may receive your PHI in electronic format if the Plan maintains it in such format. The Plan may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to the Plan. Your requests should be mailed to the Health Plans Privacy Officer at the address provided at the end of this Notice.

Right to amend. If you feel that the PHI the Plan has about you is incorrect or incomplete, you may ask the Plan to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. If you want to exercise this right, your request must be in writing and you must include a statement to support the requested amendment. Your request should be mailed to the Health Plans Privacy Officer at the address provided at the end of this Notice.

The Plan may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, the Plan may deny your request if you ask to amend information that:

Is not part of the medical information kept by or for the Plan;

Was not created by the Plan, unless the person or entity that created the information is no longeravailable to make the amendment;

Is not part of the information that you would be permitted to inspect and copy; or

Is already accurate and complete.

If the Plan denies your request, you have the right to file a statement of disagreement, and any future disclosures of the disputed information will include your statement.

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Right to an accounting of disclosures. You have the right to request an accounting of certain disclosures of your PHI. The accounting will not include disclosures:

Disclosures for purposes of Treatment, Payment, or Health Care Operations;

Disclosures made to you;

Disclosures made pursuant to your authorization;

Disclosures made to friends or family in your presence or because of an emergency;

Disclosures for national security purposes; and

Disclosures incidental to otherwise permissible disclosures.

To request this list or accounting of disclosures, you must submit your request in writing to the Health Plans Privacy Officer at the address provided at the end of this Notice. Your request must state a time period of not longer than six years.

Right to request restrictions. You have the right to ask the Plan to restrict the use and disclosure of your PHI for Treatment, Payment, or Health Care Operations, except for uses or disclosures required by law. You also have the right to ask the Plan to restrict any PHI disclosed to family members, close friends or other persons identified as being involved in your care or payment for your care. If you want to exercise this right, your request to the Plan must be in writing and must specify what information you want to limit; whether you want to limit our use, disclosure, or both; and to whom you want the limits to apply. Your request should be mailed to the Health Plans Privacy Officer at the address provided at the end of this Notice. The Plan is not required to agree to your request. However, if the Plan does agree to the request, it will honor the restriction until you revoke it or you receive notice otherwise.

You have the right to restrict the disclosure of PHI about you to the Plan if the disclosure is for the purpose of carrying out payment or health care operations and you paid for the service in full. You must make the request to the person or entity that provided the care to you. A provider who is covered by HIPAA must agree to such a request.

Right to request confidential communications. You have the right to request that the Plan communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing. Your request must specify how or where you wish to be contacted. The Plan will accommodate all reasonable requests if you clearly provide information that the disclosure of all or part of your protected information could endanger you.

Right to a paper copy of this Notice. You have the right to request a paper copy of this Notice at any time. To obtain a paper copy of the Notice contact AskHR at (800) 987-3565.

Complaints If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights. All complaints must be submitted in writing to the addresses noted below. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office of Civil Rights or with the Plan.

Privacy Officer Contact: The US Department of Health & Human Services:

Medtronic Health Plans Privacy Officer Denise King, VP, Americas Benefits Centers Of Expertise and Total Rewards Operations 710 Medtronic Parkway, LC245 Minneapolis, MN 55432 Phone: (763) 505-0792

Office for Civil Rights 200 Independence Avenue, SW Washington, D.C. 20201 Toll Free: (877) 696-6775

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Medicare Part D Creditable Coverage Notice

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Medtronic and about your options under Medicares 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.

Note: Beginning Jan. 1, 2018, the Medtronic Retiree Health Plan coverage, including medical, dental, and vision coverage, for post-65 (Medicare eligible) retirees will transition from company-sponsored group coverage to individual health insurance.

There are two important things you need to know about your current coverage and Medicares prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can getthis coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like anHMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least astandard level of coverage set by Medicare. Some plans may also offer more coverage for a highermonthly premium.

2. Medtronic provides prescription drug coverage through the Medtronic Medical Plan, the MedtronicRetiree Health Plan, and the Covidien Retiree Health Plan. Medtronic has determined that theprescription drug coverage is, on average for all plan participants, expected to pay out as much asstandard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage.Because this coverage is Creditable Coverage, you can keep this coverage and not pay a higherpremium (a penalty) if you later decide to join a Medicare drug plan.

__________________________________________________________________________

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 15

th through December 7

th.

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 are covered under the Medtronic Medical Plan (or Covidien Retiree Health Plan) and decide to join a Medicare drug plan, your current medical coverage under Medtronics plan will not be affected. As long as you keep the prescription drug coverage you have with Medtronic, you probably do not need to enroll in a Medicare drug plan. Doing so will cost you extra money, and may not provide you with any additional prescription drug benefits.

If you are covered under the Medtronic Retiree Health Plan through BlueCross BlueShield of Minnesota (BCBS), you must be enrolled in the Medtronic sponsored Medicare Part D Plan. If you do decide to join a Medicare drug plan and drop your current Medtronic coverage, be aware that you and your dependents will not be able to get this coverage back. Reminder: Beginning Jan. 1, 2018, the Medtronic Retiree Health Plan coverage, including medical, dental, and vision coverage, for post-65 (Medicare eligible) retirees will transition from company-sponsored group coverage to individual health insurance.

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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 Medtronic and dont 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 November to join.

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. Youll 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 medicare.gov

Call your State Health Insurance Assistance Program (see the inside back cover of your copy of theMedicare & 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 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).

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Notice of State Premium Assistance Programs

If you or your children are eligible for Medicaid or CHIP and youre 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 arent eligible for Medicaid or CHIP, you wont 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 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 arent 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 askebsa.dol.gov or call (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 Aug. 10, 2017. Contact your State for more information on eligibility

ALABAMA Medicaid FLORIDA Medicaid

Website: http://myalhipp.com/ Phone: (855)-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/ Phone: (877) 357-3268

ALASKA Medicaid GEORGIA Medicaid

The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: (866) 251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: http://dch.georgia.gov/medicaid

Click on Health Insurance Premium Payment (HIPP)

Phone: (404) 656-4507

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: (877) 438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone (800) 403-0864

COLORADO Health First Colorado

(Colorados Medicaid Program) & Child Health Plan Plus (CHP+)

IOWA Medicaid

Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: Phone: 1-800-221-3943/ State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711

Website: http://dhs.iowa.gov/ime/members/medicaid-a- to-z/hipp Phone: (888) 346-9562

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http://www.healthcare.gov/http://www.insurekidsnow.gov/http://www.askebsa.dol.gov/

KANSAS Medicaid NEVADA Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512

Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900

KENTUCKY Medicaid NEW HAMPSHIRE Medicaid

Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218

LOUISIANA Medicaid NEW JERSEY Medicaid and CHIP

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

MAINE Medicaid NEW YORK Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711

Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831

MASSACHUSETTS Medicaid and CHIP NORTH CAROLINA Medicaid

Website: http://www.mass.gov/eohhs/gov/departments/ masshealth/ Phone: 1-800-862-4840

Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100

MINNESOTA Medicaid NORTH DAKOTA Medicaid

Website: http://mn.gov/dhs/people-we-serve/seniors/healthcare/health-care-programs/programs-and-services/medicalassistance.jsp Phone: 1-800-657-3739

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

MISSOURI Medicaid OKLAHOMA Medicaid and CHIP

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

MONTANA Medicaid OREGON Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html

Phone: 1-800-699-9075

NEBRASKA Medicaid PENNSYLVANIA Medicaid

Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178

Website: http://www.dhs.pa.gov/provider/medicalassistance/ healthinsurancepremiumpaymenthippprogram/index.htm Phone: 1-800-692-7462

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RHODE ISLAND Medicaid VIRGINIA Medicaid and CHIP

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

Phone: 401-462-5300

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

SOUTH CAROLINA Medicaid WASHINGTON Medicaid

Website: http://www.scdhhs.gov Phone: 1-888-549-0820

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

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

SOUTH DAKOTA - Medicaid WEST VIRGINIA Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

TEXAS Medicaid WISCONSIN Medicaid and CHIP

Website: http://gethipptexas.com/ Phone: 1-800-440-0493

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

UTAH Medicaid and CHIP WYOMING Medicaid

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

Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

VERMONT Medicaid

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

To see if any other states have added a premium assistance program since Aug. 10, 2017, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services dol.gov/agencies/ebsa cms.hhs.gov (866) 444-EBSA (3272) (877) 267-2323, Menu Option 4, Ext. 61565

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http://www.dol.gov/ebsahttp://www.cms.hhs.gov/

Rights for Mothers and Newborn Children

The Medtronic medical plans provide benefits for hospital stays associated with childbirth. Under Federal law, benefits for a hospital stay associated with childbirth for the mother or newborn child must not be less than 48 hours following a vaginal delivery or less than 96 hours following delivery by cesarean section. However, Federal law does not prohibit the mothers or newborns attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, if applicable) after delivery. In any case, the Medtronic medical plans may not, under Federal law, require a provider to obtain authorization for prescribing a hospital stay that does not exceed 48 hours (or 96 hours as applicable). Please note that hospital stays for childbirth are subject to the same annual deductibles and coinsurance provisions that apply to other hospital stays covered under the Medtronic medical plans.

Rights for Women Who Undergo a Mastectomy

The Medtronic medical plans provide benefits for mastectomy-related services. Under Federal law, benefits for mastectomy-related services must cover all stages of reconstruction of the breast on which the mastectomy is performed, surgery to achieve symmetry between the breasts, prostheses, and treatment of physical complications resulting from a mastectomy, including lymphedema. Please note that benefits for mastectomy-related services are subject to the same annual deductibles and coinsurance provisions that apply to other medical and surgical benefits covered under the Medtronic medical plans.

Special Enrollment Rights

The Medtronic medical plans for active employees permit you to enroll when you are first eligible, during the annual open enrollment period, and when you have a special enrollment right. Under Federal law, special enrollment rights allow you to enroll, change your level of coverage or medical benefit option, for yourself and your eligible dependents in the following circumstances:

If you lose other coverage or employer contributions to your other coverage cease and you enroll inthe Plan within 31 days following the loss of other coverage;

If you acquire a spouse or dependent by marriage, adoption, placement for adoption or birth andyou enroll in the Plan within 31 days following the marriage, adoption, placement for adoption orbirth;

You or a dependent lose coverage under Medicaid or a State childrens health insurance programdue to a loss of eligibility and you enroll yourself or your dependent in the Plan within 60 days of theloss of such coverage; or

You or a dependent become eligible for premium assistance with respect to Medicaid or a Statechildrens health insurance program and you enroll yourself or your dependent in the Plan within60 days of such eligibility.

You can enroll on-line by accessing Workday. The change will be effective on the first of the month following the date you initiate the request in Workday or the first of the month following the event date, whichever is later. However, for an increase in the number of your dependents due to birth, adoption or placement for adoption, the change will be effective as of the date of the birth, adoption or placement provided you enroll within 31 days of the event.

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Notice Regarding Wellness Program

Healthier Together is a voluntary wellness program sponsored by Medtronic and available to all employees scheduled to work at least 20 hours per week. 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.

The Healthier Together program allows you to earn incentives in various ways. For example, you may earn incentives by choosing to participate in the Wellness Screening Program. The Wellness Screening Program is a blood draw that consists of 36 lab tests designed to detect disease or illness at the earliest stage. The Wellness Screening Program also includes a blood pressure check and measures your body mass index (BMI). The blood tests can detect various conditions and diseases, including anemia, certain cancers, kidney disease, diabetes, heart disease and stroke, thyroid disease, liver and gallbladder abnormalities, nutritional disorders and gastrointestinal disorders. There are optional tests available free for employees age 50 and over (PSA test for men, and colorectal screening for women and men) as well as additional test options available for a fee.

You may also earn additional incentives by achieving 3 or more goals under the Healthy Measures Program. There are 6 Healthy Measure categories, including blood pressure, BMI, waist measure, glucose, Non-HDL cholesterol and tobacco use.

You are not required to participate in either the Wellness Screening Program or the Healthy Measures Program to earn incentives. You may also earn incentives by participating in a wide variety of well-being activities listed at healthiertogether.medtronic.com. If you earn a specified number of incentives during 2018, you will pay less for Medtronic medical coverage in 2019. If your spouse is covered under the Medtronic Medical Plan, then both you and your spouse must separately earn the specified number of incentives.

If you or your spouse is unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you or your spouse may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting AskHR at [email protected].

The information from the Wellness Screening Program will be used to provide you with information to help you understand your current health and potential risks. You also are encouraged to share your results or concerns with your own doctor.

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Medtronic may use aggregate information it collects to design a program based on identified health risks in the workplace, the Healthier Together Program will never disclose any of your personal information either publicly or to Medtronic, 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. The only individual(s) who will receive your personally identifiable health information are employees who administer the Wellness Screening Program and who may need to reach out to you with additional information. In addition, all medical information obtained through the Healthier Together program will be maintained separate from your personnel records, information stored electronically will

22

mailto:[email protected]

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 AskHR at [email protected].

23

Summaries of Benefits and Coverage

The following pages contain Summaries of Benefits and Coverage (SBC) information for:

BCBS CHP with HSA

BCBS PPO Plan

BCBS Hawaii PPO Plan

HealthPartners PPO Plan (MN only)

Kaiser HMO Plan (CA only)

UHC CHP with HSA

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Medtronic Consumer Health Plan (CHP) with HSA (Health Savings Account) Coverage Period: Beginning on or after 1/1/2018Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: All Coverage Levels | Plan Type: PPO

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visit www.bluecrossmn.com/mdt or

call 1-866-455-8221. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-866-873-5943 to request a copy. Important Questions Answers Why This Matters:

What is the overall deductible?

In-Network Providers $1,400 per employee $2,800 per employee & spouse $2,800 per employee & child(ren) $3,600 per family

Out of Network Providers $2,800 per employee $5,600 per employee & spouse $5,600 per employee & child(ren) $7,200 per family

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay.

This plan has a non-embedded deductible. For single plans, the plan begins paying benefits when the single deductible is met. For family plans, the plan begins paying benefits when the entire family deductible is met. The family deductible can be met by one or a combination of several family members.

Are there services covered before you meet your deductible?

Yes. Well-child care, prenatal care and Network Preventive care services are covered before you meet your deductible.

This plan covers some items and services even if you havent yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific services?

No. You dont have to meet other deductibles for specific services.

What is the out-of-pocket limit for this plan?

In-Network Providers $3,500 per employee $7,000 per employee & spouse $7,000 per employee & child(ren) $9,000 per family

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

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Out of Network Providers $7,000 medical & drug per employee $14,000 medical & drug per employee & spouse $14,000 medical & drug per employee & child(ren) $18,000 medical and drug per family

What is not included in the out-of-pocket limit?

Premiums, balance-billing charges, and health care this plan doesnt cover.

Even though you pay these expenses, they dont count toward the outofpocket limit.

Will you pay less if you use a network provider?

Yes. See www.bluecrossmn.com/mdt or call 1-866-455-8221 for a list of network providers.

This plan uses a provider network. You will pay less if you use a provider in the plans network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the providers charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral.

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Common Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider

If you visit a health care providers office or clinic

Primary care visit to treat an injury or illness 20% coinsurance 40% coinsurance None

Specialist visit 20% coinsurance 40% coinsurance None

Preventive care/screening/ immunization

No charge 40% coinsurance

You may have to pay for services that arent preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for.

If you have a test

Diagnostic test (x-ray, blood work) 20% coinsurance 40% coinsurance None Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance

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If you need drugs to treat your illness or condition. A Retail Pharmacy is any licensed pharmacy that you can physically enter to obtain a prescription drug. A Mail Service Pharmacy dispenses prescription drugs through the U.S. Mail. More information about prescription drug coverage is available at www.bluecrossmn.com/mdt

Preferred generic drugs 20% coinsurance 20% coinsurance In Network Only: No charge for A.) 90-day scripts of certain generic diabetes, high blood pressure and cholesterol medications through Mail-Order or Choice Rx Network B.) Certain prescribed generic contraceptives

Preferred brand drugs 20% coinsurance 20% coinsurance

Non-preferred drugs 20% coinsurance 20% coinsurance

Specialty drugs 20% coinsurance 20% coinsurance None

If you have outpatient surgery Facility fee (e.g., ambulatory surgery center)

20% coinsurance 40% coinsurance None

Physician/surgeon fees 20% coinsurance 40% coinsurance None

If you need immediate medical attention

Emergency room care 20% coinsurance 20% coinsurance

None Emergency medical transportation 20% coinsurance 20% coinsurance

Urgent care 20% coinsurance 40% coinsurance

If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance None

Physician/surgeon fees 20% coinsurance 40% coinsurance NoneIf you need mental health, behavioral health, or substance abuse services

Outpatient services 20% coinsurance 40% coinsurance Services for marriage/couples counseling are not covered. Inpatient services 20% coinsurance 40% coinsurance

If you are pregnant

Office visits Prenatal Care: No charge Postnatal Care: 20% coinsurance

Prenatal Care: 40% coinsurance Postnatal Care: 40% coinsurance

Cost sharing does not apply to certain preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).

Childbirth/delivery professional services 20% coinsurance 40% coinsurance

Childbirth/delivery facility services 20% coinsurance 40% coinsurance

If you need help recovering or Home health care 20% coinsurance 40% coinsurance 40-visit maximum applies for

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have other special health needs all networks.

Rehabilitation services

20% coinsurance for occupational therapy 20% coinsurance for physical therapy 20% coinsurance for speech therapy


40-visit maximum applies for occupational therapy for all networks.

50-visit maximum applies for physical therapy for all networks.

40-visit maximum applies for speech therapy for all networks.

Habilitation services



40-visit maximum applies for occupational therapy for all networks.

50-visit maximum applies for physical therapy for all networks.

40-visit maximum applies for speech therapy for all networks.

Skilled nursing care 20% coinsurance 40% coinsurance 120-day maximum applies for all networks. Durable medical equipment 20% coinsurance 40% coinsurance None

Hospice services 20% coinsurance 40% coinsurance None

If your child needs dental or eye care

Childrens eye exam No charge 40% coinsurance None

Childrens glasses Not covered Not covered No coverage for these services. Childrens dental check-up Not covered Not covered

No coverage for these services.

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Excluded Services & Other Covered Services: Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) Cosmetic Surgery (except as specified in Plan

benefits) Dental Care (except as specified in Plan benefits) Long-Term Care

Private Duty Nursing Weight Loss Programs

Other Covered Services (Limitations may apply to these services. This isnt a complete list. Please see your plan document.) Acupuncture (subject to coverage limitations) Bariatric Surgery Chiropractic Care

Hearing aids (subject to coverage limitations) Infertility treatment (subject to coverage

limitations)

Routine Foot Care Routine eye care (Adult) Fitness Club discount

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Minnesota Department of Commerce, Attention: Consumer Concerns/Market Assurance Division, 85 7th Place East Suite 500, St. Paul, MN 55101-2198, or call 1-800-657-3602; or, Department of Health and Human Services, Center for Consumer Information and Insurance Oversight at 1-877-267-2323, extension 61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through MNsure. For more information about MNsure, visit www.mnsure.org or call 1-855-366-7873.

Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For questions about your rights, this notice, or assistance, you can contact your Claims Administrator by calling toll-free 1-866-873-5943 or the Department of Labors Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. For more information about your rights, this notice, or assistance, contact: Minnesota Commissioner of Commerce by calling (651) 539-1600 or toll-free 1-800-657-3602. If you are covered under a plan offered by the State Health Plan, a city, county, school district, or Service Coop, you may contact the Department of Health and Human Services Health Insurance team at 888-393-2789. Does this plan provide Minimum Essential Coverage? Yes. If you dont have Minimum Essential Coverage for a month, youll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month. Does this plan meet Minimum Value Standards? Yes. If your plan doesnt meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through MNsure. Notice of Nondiscrimination Practices Effective July 18, 2016

Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or gender. Blue Cross does not exclude people or treat them differently because of race, color, national origin, age, disability, or gender.

Blue Cross provides resources to access information in alternative formats and languages: Auxiliary aids and services, such as qualified interpreters and written information available in other formats, are available free of charge to people with disabilities

to assist in communicating with us.

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Language services, such as qualified interpreters and information written in other languages, are available free of charge to people whose primary language is notEnglish.

If you need these services, contact us at 1-800-382-2000 or by using the telephone number on the back of your member identification card. TTY users call 711.

If you believe that Blue Cross has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or gender, you can file a grievance with the Nondiscrimination Civil Rights Coordinator by email at: [email protected] by mail at: Nondiscrimination Civil Rights Coordinator

Blue Cross and Blue Shield of Minnesota and Blue Plus M495 PO Box 64560 Eagan, MN 55164-0560

or by telephone at: 1-800-509-5312Grievance forms are available by contacting us at the contacts listed above, by calling 1-800-382-2000 or by using the telephone number on the back of your member identification card. TTY users call 711. If you need help filing a grievance, assistance is available by contacting us at the numbers listed above.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf by telephone at: 1-800-368-1019 or 1-800-537-7697 (TDD) or by mail at: U.S. Department of Health and Human Services

200 Independence Avenue SW Room 509F, HHH Building Washington, DC 20201

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Language Access Services:

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To see examples of how this plan might cover costs for a sample medical situation, see the next section.

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The plan would be responsible for the other costs of these EXAMPLE covered services.

Peg is Having a Baby (9 months of in-network pre-natal care and a

hospital delivery)

Mias Simple Fracture (in-network emergency room visit and follow up

care)

Managing Joes type 2 Diabetes (a year of routine in-network care of a well-

controlled condition)

The plans overall deductible $1,400 Specialist copayment $0 Hospital (facility) coinsurance 20% Other coinsurance N/A

This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

Total Example Cost $12,800

In this example, Peg would pay: Cost Sharing

Deductibles $1,400 Copayments $0 Coinsurance $2,048

What isnt covered Limits or exclusions $60 The total Peg would pay is $3,508

The plans overall deductible $1,400 Specialist copayment $0 Hospital (facility) coinsurance 20% Other coinsurance N/A

This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)

Total Example Cost $7,400

In this example, Joe would pay: Cost Sharing

Deduc

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