Your Benefits

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Medical

HSA

FSA

BENEFITS HUB

We have developed this Benefits Hub for you as a one-stop-shop for all of your year-round benefits needs.

Get access to things like plan documents, contact information, plan information, helpful compliance notices & more!

To get started, click a Plan Icon or just continue scrolling.

Remember!

This is not a drill! IF YOU WANT TO HAVE 5B BENEFITS, YOU MUST ENROLL!

Medical Plans

HDHP $1750

Preventive Care:

Free!

Office Visit:

20%, after deductible

Deductible: Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. Services covered before you meet your deductible include In-network preventive care.

$1,750 (I) / $3,500 (F)

HDHP $3500

Preventive Care:

Free!

Office Visit:

10%, after deductible

Deductible:

$3,500 (I) / $7,000 (F)

EPO $800

Preventive Care:

Free!

Office Visit:

$25 copay

Deductible:

$800 (I) / $1,600 (F)

IMPORTANT:

This plan is moving to the Cigna LocalPlus network, an In-Network only plan. You may no longer use out-of-network providers with this plan.

Find a Provider

Contacts

Prescription Drug

Prescription Drug coverage is included with every Cigna plan.

Contacts

Health Savings Account

A health savings account (HSA) is a powerful tool that helps you save on healthcare expenses now and in the future.

An HSA, paired with one of our HDHP plans, is like a normal savings account – the money is yours and never expires. And, your contributions to your HSA are tax deductible!

2021 Limits

Individual Limit:

$3,600

Family Limit:

$7,200

Catch-up Contributions:

$1,000

Plan Eligibility:

HDHP $1750 and $3500 plans only

Contacts

Flexible Spending Accounts

You can elect to have a portion of your paycheck contributed pre-tax to a flexible spending account (FSA) to pay for qualified medical and dependent care expenses.

Health Care FSA Eligibility:
EPO $800 Plan or those who do not elect a medical plan

Dependent Care FSA and Commuter Reimbursement Eligibility:
Anyone can enroll

Health Care FSA

Helps you pay for expenses such as co-payments, dental, and vision.

Annual Contribution Limit:

$2,750

Rollover:

None

Dependent Care FSA

Helps you pay for expenses such as day care, preschool, and elderly care.

Annual Contribution Limit:

$5,000

Rollover:

None

Commuter Reimbursement Account

Can be used to pay for mass transit expenses or parking expenses at work or parking prior to taking mass transit to work

Monthly Contribution Limit:

$265/month

Rollover:

None

Contacts

Dental Plans

We've transitioned away from the Dental PPO Low plan to a Dental HMO plan.

You are still being offered the Dental PPO High plan.

NEW Dental HMO

Network Coverage:

In-Network Only

Deductible:

Basic:

Copay schedule

Major:

Copay schedule

Orthodontic:

None

Dental PPO

Network Coverage:

In- and Out-of-Network Coverage

Deductible:

$50 / $150

Basic:

90% after deductible

Major:

60% after deductible

Orthodontic:

50% no deductible

Find a Provider

Contacts

Vision Plan

Five Below’s Vision Plan is offered through Cigna. It includes benefits to help pay for your annual eye exam, glasses, frames, and contact lenses.

Cigna Vision

Network Coverage:

In- and Out-of-Network Coverage

Exam Copay:

$10

Prescription Glasses:

$30 copay

Frame Allowance:

Up to $130 every 12 months

Contacts:

Up to $130 or 100% for therapeutic

Find a Provider

Contacts

Life & Disability

We provide these benefits at no cost to you. You do not need to re-enroll in these benefits each year in order to receive them. No action required.

The Supplemental Life Plan is 100% Employee-Paid and may cover you, your spouse and/or child(ren).

Included Benefits

✓ Basic Employee Life

✓ Short-Term Disability

✓ Long-Term Disability

✓ Employee-Paid Supplemental Life

401(k) Plan

The Five Below 401(k) plan helps you meet one of life’s most important goals – financial security at retirement.

Fast Facts:

Eligibility:

You are eligible to participate in the plan as of the first of the month following completion of one month of service with the Company.

Contributions:

Contributions from your pay are made on a pretax or after-tax basis up to the IRS annual limit. If you are 50 years of age or older, or if you will reach age 50 by the end of the year, you may make a catch-up contribution in addition to the normal IRS annual limit.

Vesting:

Vesting refers to your right of ownership to the money in your account. You are immediately vested in all contributions and earnings.

Work/Life Benefits

Benefits that go beyond basic and voluntary coverages. These are programs that offer you and your family even more flexibility and added perks on top of what you enroll in above.

Included Benefits:

✓ Voluntary ID Theft

✓ NEW Total Pet Program

Family-Friendly Benefits

Whether you already have a family, or are just starting out, these benefits have family in mind.

Included Benefits:

✓ Cigna's Healthy Pregnancies Program

✓ Cigna's Healthy Babies Program

✓ Ovia Fertility & Pregnancy

Wellness

Get Mental Health support from Cigna or participate in the FREE and confidential Employee Assistance Program through CareBridge.

Compliance

Your hub for compliance information, forms and contacts you may not have found elsewhere.

FIVE BELOW permits INSURERS to offer employees of FIVE BELOW certain voluntary insurance programs. Whether you choose to enroll in any of these programs is completely optional and voluntary. FIVE BELOW does not make a contribution towards the cost of these programs and employees pay the full cost of premiums on an after-tax basis. FIVE BELOW does not sponsor, maintain, endorse, recommend, or promote these voluntary programs. FIVE BELOW'S involvement regarding these voluntary insurance programs is strictly limited to allowing the insurer access to employees to publicize these programs and FIVE BELOW may perform certain ministerial functions such as payroll deduction and forwarding employee premium payments to the insurer. FIVE BELOW does not receive any consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions. Accordingly, these voluntary insurance programs are not subject to ERISA and related regulations. All questions or claims regarding these programs should be directed to the insurer.

In the event of any conflict between the content contained herein and the Summary Plan Description (SPD), the provisions of the Summary Plan Description (SPD) shall prevail.
© Piper Jordan, LLC. All rights reserved.

Health Pro^®

Finding the right care can be confusing and time-consuming. That’s why Five Below has partnered with Alight Solutions to provide you with a personal Health Pro® consultant who is on call to assist you and your family.

Product Highlights

✓ Understand your benefits: Clear up any confusion about your health plan

✓ Schedule appointments: Get care from great providers at times that are most convenient for you

Cigna Telehealth

The Five Below medical plans include access to Cigna’s telehealth services. You can interact with in-network, U.S. board certified physicians 24 hours a day/365 days a year via secure video chat or phone. No need to leave your home or office! And no appointment necessary.

Product Highlights

✓ Care from anywhere: Visit a doctor and get a prescription for common symptoms and illnesses

Tobacco Surcharge

Five Below is committed to keeping our health plan costs affordable for our employees and our company. Because tobacco use is a leading cause of preventable death in the U.S. and a major contributor to avoidable health care expenses, we enforce a tobacco $50/month surcharge for medical plan members who use tobacco^*. That means if both you and your spouse on the medical plan use tobacco, you could pay an extra $100 per month on your medical premium. Want to quit and save on your medical premiums?

*For the purposes of this program, “tobacco” includes pipes, e-cigarettes, cigars, cigarettes, and chewing tobacco.

In-Network Benefits	HDHP $1750	HDHP $3500	EPO $800 This plan is now In-Network Only
Preventive Care	Plan pays 100%	Plan pays 100%	Plan pays 100%
Annual Deductible Individual/Family	Embedded: All family members contribute toward the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied. $1,750 / $3,500	Embedded: $3,500 / $7,000	Embedded: $800 / $1,600
Out-of-Pocket Maximum Individual/Family	$5,250 / $10,500	$6,750 / $13,500	$4,800 / $9,600
Company HSA Contribution	Up to $500 for Individual \| Up to $1,000 for Family	Up to $500 for Individual \| Up to $1,000 for Family	N/A
Primary Care	You pay 20% after deductible	You pay 10% after deductible	$25 copay
Specialist Visit	You pay 20% after deductible	You pay 10% after deductible	$50 copay
X-ray and Lab	You pay 20% after deductible	You pay 10% after deductible	Diagnostic $50 copay Imaging: $250 copay
Inpatient Hospital	You pay 20% after deductible	You pay 10% after deductible	$500 copay after deductible
Outpatient Hospital	You pay 20% after deductible	You pay 10% after deductible	$250 copay after deductible
Urgent Care	You pay 20% after deductible	You pay 10% after deductible	$75 copay
Emergency Room	You pay 20% after deductible	You pay 10% after deductible	$250 copay after deductible, waived if admitted
Retail Prescription (30-day supply) Deductible Generic Preferred Brand Non-preferred Brand Specialty	Pharmacy Deductible is combined with Medical $15 copay after deductible $45 copay after deductible $75 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $10 copay after deductible $40 copay after deductible $70 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $10 copay $40 copay $70 copay $150 copay
Mail Order Prescription (90-day supply) Deductible Generic Formulary/Brand Brand Non-preferred	Pharmacy Deductible is combined with Medical $30 copay after deductible $90 copay after deductible $150 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $20 copay after deductible $80 copay after deductible $140 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $20 copay $80 copay $140 copay $150 copay

Affordable Care Act

The ACA requires all businesses with 100 or more full-time equivalent employees (FTEs) to offer health insurance to their full-time workers (working 130 hours of service in a calendar month) or pay a penalty. In addition, the Company must continue to provide access to quality health insurance at an affordable cost.

After Taxes

Included in your W-2 income or subject to income taxes.

Before Taxes

Not included in your W-2 income or subject to income taxes.

Beneficiary

A person or persons you name – using a form accepted by the plan administrator or insurance carrier – to receive benefits in the event of your death.

Brand-Name Drug

A drug that is patented by the FDA and subject to an exclusivity agreement that allows the company to be the sole manufacturer of the drug for a certain number of years.

Coinsurance

The percentage that you pay of a covered service.

Copay

A fixed dollar amount that you pay for a covered service at the time the service is provided.

Covered Service

The health care services that a plan will cover in part or in full based on plan documents.

Deductible

The amount you pay for covered services in a plan year before the plan begins to pay benefits.

Eligibility Date

The day on which you’re eligible to participate in a Your Benefits plan.

Eligible Expense

Expenses incurred for a covered service.

Evidence of Insurability

A statement of proof of a person’s physical condition, occupation, or other factor affecting his or her acceptance for insurance coverage.

Formulary Drug

A drug that’s considered a “preferred choice” based on its effectiveness and cost.

Generic Drug

A prescription drug that has the same active ingredients as a brand-name drug and is subject to the same FDA standards for quality, strength, and purity as its brand-name counterpart, but typically costs less. Not all brandname drugs have generic equivalents.

Late Enrollee

A Jack in the Box or Qdoba employee or eligible dependent who didn’t enroll in the benefit plan when first eligible to join.

Network Provider

Any licensed doctor, hospital, lab, or other health care provider that has contracted to provide members with comprehensive services at discounted rates.

Non-Formulary Drug

A brand-name drug that isn’t on a plan’s formulary list.

Non-Preferred Drug

A brand-name drug that isn’t on a plan’s preferred list.

Out-of-Pocket Maximum

The maximum amount you pay each plan year for covered services. Once you reach your out-of-pocket maximum, the plan pays 100% for additional covered services.

Out-of-network Provider

Any licensed doctor, hospital, lab, or other health care provider that is not part of a provider network.

Plan Year

October 1 through September 30.

Preferred Drug

A drug that’s considered a “preferred choice” based on its effectiveness and cost.

Primary Care Physician

A doctor within an HMO network whom you’ve selected to coordinate your medical care.

Qualifying Life Event

A life event that may allow you to make certain changes to your health plan coverage. This includes marriage, registration of a domestic partnership, legal separation, or divorce; birth, adoption, legal guardianship, or change in custody for a dependent child (or children); the ineligibility or death of a dependent; a move to an area where your current plan isn’t offered; a change in your or your spouse’s employment; or a significant change in health coverage.

Reasonable & Customary Charges

The maximum amount the plan will pay for a service, based on what providers in that geographic area charge for similar services or supplies.

In-Network Benefits	HDHP $1750	HDHP $3500	EPO $800 This plan is now In-Network Only
Retail Prescription (30-day supply) Deductible Generic Preferred Brand Non-preferred Brand Specialty	Pharmacy Deductible is combined with Medical $15 copay after deductible $45 copay after deductible $75 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $10 copay after deductible $40 copay after deductible $70 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $10 copay $40 copay $70 copay $150 copay
Mail Order Prescription (90-day supply) Deductible Generic Formulary/Brand Brand Non-preferred	Pharmacy Deductible is combined with Medical $30 copay after deductible $90 copay after deductible $150 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $20 copay after deductible $80 copay after deductible $140 copay after deductible $150 copay after deductible	Pharmacy Deductible is combined with Medical $20 copay $80 copay $140 copay $150 copay

In-Network Benefits	Cigna Dental HMO	Cigna Dental High PPO
Annual Deductible	$0	$50 / $150
Calendar Year Maximum	Year 1: $1,000 Year 2: $1,150 Year 3: $1,300 Year 4: $1,450	Year 1: $1,250 Year 2: $1,400 Year 3: $1,550 Year 4: $1,700
Basic Services	Copay	90% after deductible
Major Services	Copay	60% after deductible
Orthodontic Services	N/A	50% no deductible
Orthodontia Lifetime Max	N/A	$1,000

In-Network Benefits	Cigna Vision
Exam Copay	$10 exam
Materials Copay	$20
Glasses Allowances	Single: Covered in full Bifocal: Covered in full Trifocal: Covered in full Lenticular: Covered in full
Contacts	Elective: Up to $130 Therapeutic: Covered in full
Frame Retail Allowance	Up to $130 every 12 months

Health Savings Account

HSAs are savings accounts funded by pre-tax contributions from your paycheck. These accounts earn interest tax free and can be used to help pay for a wide range of medical, prescription, dental and vision expenses.

The money in this account is yours and rolls over from year to year. You can save it or use it for qualified expenses now or anytime in the future. It’s also portable, so if you retire or leave FIVE BELOW, you can take it with you.

Product Highlights

✓ Contributions are pre-tax and are automatically deducted

✓ Funds rollover from year-to-year and are yours to keep

✓ Catch-up contributions are for those aged 55 and older

Flexible Spending Account

An FSA saves you money by reducing your income taxes. You must choose how much to contribute each year, up to the stated limit. Your FSA contributions are automatically deducted from your pay BEFORE any taxes are calculated, and are not reported as income to the IRS. The FSA plan is effective January 1 to December 31 (calendar year).

Existing employees may enroll during Open Enrollment. New Hires must fulfill their eligibility requirements prior to enrolling.

Product Highlights

✓ Contributions are pre-tax and are automatically deducted

✓ Funds do not rollover from year-to-year

Basic Life

The company provides a benefit of 2x base salary up to $500,000, $50,000, or $10,000 - depending on your eligibility class - of Basic Employee Life insurance for all eligible employees.

Highlights & Reminders

✓ You are automatically enrolled

✓ Be sure to have an updated beneficiary form on file

✓ Benefit reduces to 65% at age 65 and 50% at age 70

Short-Term Disability

If you’re suddenly unable to earn a paycheck due to illness or an accident, short term disability insurance through your employer can replace a portion of your income during the initial weeks of your disability.

Product Highlights

✓ You are automatically enrolled

✓ The Disability plans pay 60% of the first $5,000 of Predisability Earnings, reduced by Deductible Income, up to a $3,000 weekly maximum before reduction by Deductible Income

✓ Up to 26 weeks of coverage

✓ Coverage begins on the first day of disability caused by an accidental injury or after 7 days of disability caused by physical disease, pregnancy or mental disorder

Long-Term Disability

Long term disability insurance through your employer can provide a steady stream of income to help cover essential expenses during an extended illness or after a disabling accident.

Product Highlights

✓ You are automatically enrolled

✓ $16,667/month or $10,000/month maximum benefit, depending on eligibility class

✓ 60% of your weekly earnings paid

✓ Coverage begins after 180 days of disability

Supplemental Life Insurance

If you want additional protection for you and your family, you have the option to buy Supplemental Life Insurance as shown below. Note that you must elect Supplemental Life Insurance for yourself in order to purchase coverage for your dependents.

Product Highlights

✓ Employee Life:Increments of $10,000 from $10,000 up to $500,000

✓ Spouse Life: Increments of $5,000 from $5,000 up to $100,000

✓ Child(ren) Life: $1,000, $2,000, $4,000, $5,000 or $10,000 coverage amounts available

✓ Guarantee Issue $150,000, Spouse - $25,000, Child – N/A (EOI not required)

ID Watchdog

Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

Credit Lock

With online and in-app feature, lock your Equifax® credit report2 — and your child’s Equifax credit report — to help provide additional protection against unauthorized access to your credit.

More for Families:

The family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

Dedicated Resolution Specialists:

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

Total Pet Program

Five Below is offering you access to one of the nation's best pet benefits plans. Total Pet Program gives you access to the following:

You get:

✓ PetAssure

✓ PetPlus

✓ PetTag

✓ WhiskerDocs

✓ BarkBox

✓ Rover

401(k) Enrollment & Beneficiary Info

Be Sure to Designate a Beneficiary: You can set up your beneficiary information by going to www.401k.com or by calling a Principal Representative at 800-547-7754. Simply request a Designation of Beneficiary Form to fill out and return to Principal.

Enroll now

Employee Stock Purchase Plan (ESPP)

We offer the chance to build your investment portfolio by purchasing Five Below stock at a discounted rate.

Eligibility:

You are eligible to purchase company stock during the first offering period after six months of employment. Offerings happen twice a year in January and July.

Enrollment:

You may enroll at any point after becoming eligible.

Shopping & Travel Discount from PerkSpot

As a Five Below employee you receive perks and discounts on more than 900 local and national merchants like Apple, Samsung, Sprint, Six Flags, and Disney.

Whether it’s greater discount percentages or benefits like free shipping, this exlusive benefit can help you get more for your money! Plus, PerkSpot includes a newly released

Travel Feature with exclusive discounts up to 60% on hotels in hundreds of destinations worldwide.

Cigna's Healthy Pregancy, Healthy Babies Program

Enrolling in this program is an important first step toward a healthy future for you and your baby. All Cigna Healthy Pregnancies, Healthy Babies services are confidential, and your private information will not be shared with Five Below.

Plan for a Healthy Pregnancy:

When you enroll before becoming pregnant, we can help you be as healthy as possible. You’ll have access to preconception planning tools and resources, including information from the March of Dimes on eating right, maintaining a healthy weight, taking prenatal vitamins, stopping alcohol and tobacco use, and controlling any medical conditions you may have.

Support During Your Pregnancy:

Tell Cigna about your pregnancy so they can meet your needs. You can ask them anything – your coach, who has a nursing background, is there to support you during your whole pregnancy. You’ll even get a pregnancy journal with information, charts, and tools to help you have a happy nine months.

Start Now:

Cigna can help you stay healthy before and during your pregnancy and in the days and weeks following your baby’s birth. Call 800-615-2906 to enroll today. Download the new app by searching for “Cigna Healthy Pregnancies” in the App Store to get support through your entire pregnancy with tips and tools.

Learn more

Ovia

Manage your parenthood journey with Ovia Health! From preconception to returning to work and navigating life as a new parent, Ovia offers three apps to guide you on your journey.

Fertility:

Track your period, symptoms, moods and more! Receive accurate predictions for period and ovulation, connect with an anonymous community of women and read personalized summaries of your health and fertility.

Pregnancy:

Follow your baby's growth by tracking pregnancy, symptoms moods and more. Connect with other moms-to-be for support, check food and medication with safety lookups, and more.

Parenting:

Celebrate memories and milestones by inviting friends and family to follow along, upload photos and videos of precious moments, and track your child's growth and development.

Download apps now

Mental Health Support

Many physical conditions can worsen with stress, substance use, and other behavioral health issues. Cigna’s whole-person approach provides help with life events, dedicated support, lifestyle coaching, and online tools.

Virtual Behavioral Care:

Use your smartphone, tablet, or computer for online video conferencing. And your out-of-pocket cost is the same as a behavioral health outpatient office visit. Visit myCigna.com > Find Care & Costs > Doctor by Type > Behavioral Health Counselor > Virtual Counselor to find a provider.

iPrevail:

On-demand coaching and personalized learning with iPrevail is offered at no cost to you. Learn how to boost your mood and improve mental health with on-demand coaching 24/7. You can work with a peer coach and get access to support communities focused on stress, anxiety, depression, and more. Visit iprevail.com/cigna to sign up and download the free app.

Happify:

Science-based activities and games for stress and worries offered in partnership with Cigna. Happify’s activities and games are designed to help you overcome life’s challenges and can be accessed at any time. Visit happify.com/cigna to sign up and download the free app.

Employee Assistance Program

Our FREE and confidential Employee Assistance Program (EAP) helps you find balance between work and home life. Your EAP benefits cover five sessions of counseling at no cost to you. If you are interested in counseling, you have three choices available: face-to-face counseling, secure video counseling, or scheduled telephone counseling sessions which are available early morning, late in the evening, and on weekends. If you choose to continue to see the counselor beyond the initial sessions, you may be able to use your health insurance benefits for more long-term coverage.

Five Below offers this program to you and your immediate family (spouse or domestic partner, dependent children up to age 26) at no cost to you.

Get Help With:

✓ Marriage and family problems

✓ Job-related issues

✓ Stress, anxiety and depression

✓ And more!

LifeWorks Employee Assistance Program

Get immediate access to specialized professionals in counseling, social work, human services and psychology. You have access to the LifeWorks network of thousands of master’s level counselors and affiliates.

Benefit Features

✓ Get support with financial and legal issues

✓ Receive 5 free appointments included in your Niagara benefits

✓ Enjoy hassle-free scheduling with LifeWork's easy-to-use app

Get started

Your Benefits

Click an icon below to view that benefit.

BENEFITS HUB

Remember!

Medical Plans

HDHP $1750

HDHP $3500

EPO $800

Find a Provider

Prescription Drug

Health Savings Account

2021 Limits

Flexible Spending Accounts

Health Care FSA

Dependent Care FSA

Commuter Reimbursement Account

Dental Plans

NEW Dental HMO

Dental PPO

Find a Provider

Vision Plan

Cigna Vision

Find a Provider

Life & Disability

Included Benefits

401(k) Plan

Fast Facts:

Work/Life Benefits

Included Benefits:

Family-Friendly Benefits

Included Benefits:

Wellness

Compliance

Health Pro®

Product Highlights

Cigna Telehealth

Product Highlights

Tobacco Surcharge

Medical Plan Details:

Health Savings Account

Product Highlights

Flexible Spending Account

Product Highlights

Basic Life

Highlights & Reminders

Short-Term Disability

Product Highlights

Long-Term Disability

Product Highlights

Supplemental Life Insurance

Product Highlights

ID Watchdog

Total Pet Program

You get:

401(k) Enrollment & Beneficiary Info

Employee Stock Purchase Plan (ESPP)

Shopping & Travel Discount from PerkSpot

Cigna's Healthy Pregancy, Healthy Babies Program

Ovia

Mental Health Support

Employee Assistance Program

Get Help With:

LifeWorks Employee Assistance Program

Benefit Features

Health Pro^®