2018 Benefit Guide LGBS by Higginbotham Public Sector

LGBS

BENEFIT GUIDE EFFECTIVE: 07/01/2018 - 6/31/2019 WWW.MYBENEFITSHUB.COM/LGBS

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 4. Eligibility Requirements AUL a OneAmerica company Life and AD&D Voya Hospital Indemnity AUL OneAmerica company Disability Voya Accident Voya Critical Illness 5 Star FPP TI with Quality of Life Rider

3 4-5 6-9 6 7 8-11 12-13 14-17 18-21 22-23 24-27

FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 8 YOUR BENEFITS

Benefit Contact Information BENEFIT ADMINISTRATORS

HOSPITAL INDEMNITY

CRITICAL ILLNESS

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/lgbs

VOYA (800) 955-7736 www.voya.com

LGBS ADMINISTRATOR

DISABILITY

VOLUNTARY LIFE

Diane Shofield (512) 447-6675 diane.shofield@lgbs.com

AUL a OneAmerica company (800) 553-5318 Claims: (855) 517-6365 www.oneamerica.com

AUL a OneAmerica company (800) 583-6908 www.oneamerica.com

BASIC LIFE

ACCIDENT

INDIVIDUAL LIFE

AUL a OneAmerica (800) 553-5318 www.oneamerica.com

VOYA (800) 955-7736 www.voya.com

5 Star Life Insurance Company (800) 776-2322 www.5starlifeinsurance.com

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS LGBS” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information



Online Support



Interactive Tools



And more. PLAY VIDEO

Text “FBS LGBS” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/lgbs

CLICK LOGIN

ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:

Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

ONLIINE SUPPORT

If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

Annual Benefit Enrollment

SUMMARY PAGES

7/1/18 PLAN YEAR Great News, there are no plan changes or increase to premiums for the 7/1/2018 plan year! Enrollment for the 7/1/2018 plan year is “passive”, which means you only need to login if you wish to add or make changes to your benefit elections. If you do not login to make changes, all current supplemental benefit plans for eligible employees will continue for the new plan year.

ONEAMERICA DISABILITY If you are enrolled in the short term or long term disability plan and you have a salary increase between now and June 30th your disability premiums could be adjusted for the new plan year effective 7/1/2018, based on a new salary.

ONEAMERICA VOLUNTARY LIFE Premiums are age-banded and will change if you have entered a new age bracket (age ending in a 5 or 0).

DON’T FORGET ENROLLMENT FOR THE 7/1/2018 PLAN YEAR IS “PASSIVE”, WHICH MEANS YOU ONLY NEED TO LOGIN IF YOU WISH TO ADD OR MAKE CHANGES TO YOUR BENEFIT ELECTIONS.

SUMMARY PAGES

following 20 days and non exempt employees are eligible for

Employee Eligibility Requirements

benefits first of month following 60 days.

for all supplemental benefits.

Dependent Eligibility Requirements

Eligible employees must be actively at work on the plan effective

Dependent Eligibility: You can cover eligible dependent

date for new benefits to be effective, meaning you are physically

children under a benefit that offers dependent coverage,

capable of performing the functions of your job on the first day

provided you participate in the same benefit, through the

of work concurrent with the plan effective date. For example, if

maximum age listed below. Dependents cannot be double

your 2018 benefits become effective on July 1, 2018, you must

covered by married spouses within the LGBS or as both

be actively-at-work on July 1, 2018 to be eligible for your new

employees and dependents.

Employees must work 20 regularly scheduled hours each week

benefits. Exempt employees are eligible for benefits first month

PLAN

CARRIER

MAXIMUM AGE

Accident

VOYA

Up to 26

Hospital Indemnity

VOYA

Up to 26

Critical Illness

VOYA

Up to 26

Voluntary Life

AUL a OneAmerica company

Up to 26

Individual Life

5 Star

Up to 23

If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physicianâ&#x20AC;&#x2122;s statement confirming your dependentâ&#x20AC;&#x2122;s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 7

AUL A ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Life and AD&D

PLAY VIDEO

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the LGBS Benefits Website: www.mybenefitshub.com/lgbs

Life and AD&D Group Term Life including matching AD&D Coverage    

Life and AD&D insurance coverage amount of $15,000 at no cost to you Waiver of premium benefit Accelerated life benefit Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns

AUL's Group Voluntary Term Life Insurance Terms and Definitions Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 30 hours per week.

Flexible Choices:

Guaranteed Increase in Benefit: If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You may be able to increase your benefit amount by $10,000 every year until you reach your maximum amount, without providing Evidence of Insurability. If Evidence of Insurability is applied for and denied, please be aware Guaranteed Increase in Benefits will not be made available to you in the future.

Life Event Benefit: You may be able to add coverage or increase your benefit amount if you apply within 31 days from the date of a life event. Examples of a life event include marriage, the birth of a child, or adoption.

Continuation of Coverage Options: Portability Should your coverage terminate for any reason, you may be eligible to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.

Since everyone's needs are different, this plan offers flexibility for OR you to choose a benefit amount that fits your needs and budget. Conversion Should your life insurance coverage, or a portion of it, cease for Accidental Death & Dismemberment (AD&D) If approved for this benefit, additional life insurance benefits may any reason, you may be eligible to convert your Group Term Coverage to Individual Coverage without providing Evidence of be payable in the event of an accident which results in death or Insurability. You must apply within 31 days from the last day you dismemberment as defined in the contract. AD&D coverage is are eligible. not included for dependents. Accelerated Life Benefit: Guaranteed Issue Amounts: If diagnosed with a terminal illness and have less than 12 months This is the most coverage you can purchase without having to to live, you may apply to receive 25%, 50% or 75% of your life answer any health questions. If you decline insurance coverage insurance benefit to use for whatever you choose. now and decide to enroll later, you will need to provide Evidence Waiver of Premium: of Insurability. If approved, this benefit waives your and your dependents' insurance premium in case you become totally disabled and are Employee Guaranteed Issue Amount $250,000 unable to collect a paycheck. Spouse Guaranteed Issue Amount $50,000 Reductions: Child Guaranteed Issue Amount $10,000 Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule.

Timely Enrollment: Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.

Evidence of Insurability: If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you and / or your dependents will be approved or declined for insurance coverage by AUL. 9

Age:

Reduces To:

65%

40%

25%

15%

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Life and AD&D Monthly Payroll Deduction Illustration About your benefit options:    

You may select a minimum benefit of $10,000 up to a maximum amount of $1,000,000, in increments of $10,000, not to exceed 5 times your annual base salary only, rounded to the next higher $10,000. AD&D coverage is not included for dependents. Amounts requested above $250,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Employee must select coverage to select any Dependent coverage. Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 06/01) Life & AD&D

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.50

$.70

$.90

$1.50

$2.60

$4.10

$7.30

$12.90

$20.40

$29.90

$20,000

$1.00

$1.40

$1.80

$3.00

$5.20

$8.20

$14.60

$25.80

$40.80

$59.80

$30,000

$1.50

$2.10

$2.70

$4.50

$7.80

$12.30

$21.90

$38.70

$61.20

$89.70

$40,000

$2.00

$2.80

$3.60

$6.00

$10.40

$16.40

$29.20

$51.60

$81.60 $119.60 $119.60

$50,000

$2.50

$3.50

$4.50

$7.50

$13.00

$20.50

$36.50

$64.50 $102.00 $149.50 $149.50

$90,000

$4.50

$6.30

$8.10

$13.50 $23.40

$36.90

$65.70 $116.10 $183.60 $269.10 $269.10

$100,000

$5.00

$7.00

$9.00

$15.00 $26.00

$41.00

$73.00 $129.00 $204.00 $299.00 $299.00

$150,000

$7.50

$10.50 $13.50 $22.50 $39.00

$61.50 $109.50 $193.50 $306.00 $448.50 $448.50

$200,000

$10.00 $10.00 $10.00 $14.00 $18.00 $30.00 $52.00

$82.00 $146.00 $258.00 $408.00 $598.00 $598.00

$250,000

$12.50 $12.50 $12.50 $17.50 $22.50 $37.50 $65.00 $102.50 $182.50 $322.50 $510.00 $747.50 $747.50

SPOUSE ONLY OPTIONS (based on Employee's Age as of 06/01 Life Options

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.30

$.50

$.70

$1.30

$2.40

$3.90

$7.10

$12.70

$20.20

$29.70

$20,000

$.60

$1.00

$1.40

$2.60

$4.80

$7.80

$14.20

$25.40

$40.40

$59.40

$30,000

$.90

$1.50

$2.10

$3.90

$7.20

$11.70

$21.30

$38.10

$60.60

$89.10

$40,000

$1.20

$2.00

$2.80

$5.20

$9.60

$15.60

$28.40

$50.80

$80.80 $118.80 $118.80

$50,000

$1.50

$2.50

$3.50

$6.50

$12.00

$19.50

$35.50

$63.50 $101.00 $148.50 $148.50

Life and AD&D CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children) Child(ren) 6 months to age 26 Option 1:

$10,000

Child(ren) live birth to 6 months $1,000

Monthly Payroll Deduction Life Amount $1.70

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance CompanyÂŽ (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.

VOYA YOUR BENEFITS PACKAGE

Hospital Indemnity

PLAY VIDEO

About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,000.

$8,800

9,600

10,400

2003

2008

2012

Hospital Indemnity What Hospital Confinement Indemnity Insurance benefits are available?

Exclusions and Limitations

Exclusions in the Certificate, Initial Confinement Benefit, Spouse Hospital Confinement Indemnity Insurance and Child Hospital The following list includes the benefits provided by Hospital Confinement Indemnity Insurance are listed below. (These may Confinement Indemnity Insurance. The benefit amounts paid vary by state.) Benefits are not payable for any loss caused in depend on the type of facility and number of days of confinement. For a list of standard exclusions and limitations, go whole or directly by any of the following*: to the end of this document. For a complete description of your  Participation or attempt to participate in a felony or illegal activity. available benefits, along with applicable provisions, conditions  Operation of a motorized vehicle while intoxicated. on benefit determination, exclusions and limitations, see your  Suicide, attempted suicide or any intentionally self-inflicted certificate of insurance and any riders. injury, while sane or insane. You employer offers you the opportunity to purchase a daily  War or any act of war, whether declared or undeclared, benefit amount of $100 or $300. The benefit amount is other than acts of terrorism. determined by the type of facility in which you are confined:  Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon  Hospital—The benefit is 1x the daily benefit amount ($100 written notice of such service, any premium which has been or $300), up to 30 days per confinement. accepted for any period not covered as a result of this  Critical care unit (CCU)—The benefit is 2x the daily benefit exclusion. amount ($200 or $600), up to 15 days per confinement.  Alcoholism, drug abuse, or misuse of alcohol or taking of  Rehabilitation facility—The benefit is one-half of the daily drugs, other than under the direction of a doctor. benefit amount ($50 or $150), up to 30 days per  Elective surgery, except when required for appropriate care confinement. as a result of the covered person’s injury or sickness.**  Riding in or driving any motor-driven vehicle in a race, stunt How much does Hospital Confinement show or speed test. Indemnity Insurance cost?  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any All employees pay the same rate, no matter their age. See the aircraft or hot air balloon, including those which are not chart below for the premium amounts. motor-driven. Flying as a fare-paying passenger is not Rates shown are guaranteed until July 1, 2019. excluded. Low Option:  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar Tier Daily Benefit Monthly Rate activities. Employee $100 14.88  Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any EE +Spouse $100 29.13 type of compensation or remuneration is received. EE + Children $100 22.83 EE + Family

$100

37.08

Tier

Daily Benefit

Monthly Rate

Employee

$300

42.13

EE +Spouse

$300

82.39

EE + Children

$300

63.48

EE + Family

$300

103.74

High Option:

*See the certificate of insurance and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations. 13

AUL A ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Disability

PLAY VIDEO

About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.

34.6 months is the duration of the average disability claim.

Long Term Disability Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 30 hours per week.

Flexible Choices: Since everyone's needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget.

Portability: Should your coverage terminate, you may be eligible to take this disability insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.

Waiver of Premium:

offered up to a maximum of 12 months. Return to Work is applicable to option 1.

Integration: The method by which your benefit may be reduced by Other Income Benefits. Integration is applicable to option 1.

Pre-Existing Condition Limitations: The pre-existing period is 3/12. Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage. A pre-existing condition is any condition for which a person would have received medical treatment or consultation, taken or were prescribed drugs or medicine, or received care or services, including diagnostic measures, within a time-frame specified in the contract. You must also be treatment-free for a time-frame specified in some contracts following your individual effective date of coverage.

If approved, this benefit waives your Disability insurance premium in case you become disabled and are unable to collect a paycheck.

About Your Benefits:

Elimination Period:



This is a period of consecutive days of disability before benefits may become payable under the contract.

Long Term Disability (LTD) benefits are illustrated and paid on a monthly basis. Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.

Total Disability:

Option 1 WDL

You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Benefit Percentage

60%

Maximum Monthly Benefit

$10,000

Partial Disability:

Elimination Period

90/90

You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full-time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation, on a full or part- time basis, and are earning less than 50% of your pre-disability earnings due to the same injury or sickness. Partial Disability is applicable to option 1.

Maximum Benefit Duration

SSFRA

Pre-Existing Condition Period

3/12

Residual: The elimination period can be satisfied by total disability, partial disability, or a combination of both. Residual is applicable to option 1.

To Determine Your Estimated Monthly Benefit 

Enter your Monthly Salary:



Multiply Step 1 by 60%: . If this number is less than $10,000, this is your estimated Monthly Benefit. If this number is $10,000 or greater, your estimated Monthly Benefit is $10,000.

Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is 15

Short Term Disability Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 30 hours per week.

Flexible Choices: Since everyone's needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget.

Waiver of Premium:

offered up to a maximum of 12 months. Return to Work is applicable to option 1.

Integration: The method by which your benefit may be reduced by Other Income Benefits. Integration is applicable to option 1.

If approved, this benefit waives your Disability insurance premium in case you become disabled and are unable to collect a paycheck.

About Your Benefits:

Elimination Period:



This is a period of consecutive days of disability before benefits may become payable under the contract.



Total Disability: You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Short Term Disability (STD) benefits are illustrated and paid on a weekly basis. Amounts not requested timely will require Evidence of Insurability. Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits. Option 1 WDS

Partial Disability: You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full-time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation, on a full or part- time basis, and are earning less than 80% of your pre-disability earnings due to the same injury or sickness. Partial Disability is applicable to option 1.

Benefit Percentage

60%

Maximum Weekly Benefit

$1,500

Elimination Period

14/14

Maximum Benefit Duration

11 weeks

Pre-Existing Condition Period

3/12

Residual:

To Determine Your Estimated Weekly Benefit

The elimination period can be satisfied by total disability, partial disability, or a combination of both. Residual is applicable to option 1.



Enter your Weekly Salary:



Multiply Step 1 by 60%: . If this number is less than $1,500, this is your estimated Weekly Benefit. If this number is $1,500 or greater, your estimated Weekly Benefit is $1,500.

Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is

Disability Rates Long Term Disability MONTHLY PREMIUM RATES PER $100 OF COVERED MONTHLY EARNINGS (based on Employee's age as of 07/01)

Short Term Disability MONTHLY PREMIUM RATES PER $10 OF COVERED WEEKLY EARNINGS (based on Employee's age as of 07/01)

Age Brackets

Opt 1 WDL

Age Brackets

Opt 1 WDL

0 - 19

$.135

0 - 19

$.770

20 - 24

$.135

20 - 24

$.770

25 - 29

$.135

25 - 29

$.770

30 - 34

$.194

30 - 34

$.770

35 - 39

$.303

35 - 39

$.590

40 - 44

$.438

40 - 44

$.500

45 - 49

$.565

45 - 49

$.540

50 - 54

$.793

50 - 54

$.650

55 - 59

$1.088

55 - 59

$.800

60 - 64

$1.400

60 - 64

$.930

65 - 69

$1.484

65 - 69

$1.000

70 - 74

$1.855

70 - 74

$1.000

75+

$1.855

75+

$1.000

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance CompanyÂ® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.

VOYA YOUR BENEFITS PACKAGE

Accident

PLAY VIDEO

About this Benefit

2/3

Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or

usually live paycheck to paycheck.

Accident What accident benefits are available? The following list includes the benefits provided by Accident Insurance. The benefit amounts paid depend on the type of injury and care received. You may be required to seek care for your injury within a set amount of time. You must be insured under the policy for 30 days before benefits are payable. Note

EVENT

that there may be some variation by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.

BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic

Surgery exploratory or without repair

Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365

Critical care unit confinement per day, up to 15 days

Rehabilitation facility confinement per day for 90 days

Coma Duration of 14 or more days

Transportation per trip, up to 3 per accident

Lodging Per day, up to 30 days

Family care per child, up to 45 days

$2,500 $250 $400 $1,400 $300 $600 $175 $7,000 $400 $150 $30

Follow-up care Medical equipment duration of 14 or more days

Physical therapy duration of 14 or more days

Prosthetic device (one) Prosthetic device (two or more) duration of 14 or more days

$250 $50 $1,200 $2,400

Common injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of thebody

Burns 3rd degree, 35 or more square inches of the body

Skin Grafts Emergency dental work while hospital confined

Eye Injury removal of foreign object

Eye Injury surgery

Torn Knee Cartilage surgery with no repair or if cartilage is shaved

Torn Knee Cartilage surgical repair

Laceration1 treated no sutures 19

$1,250 $2,500 $18,000 25% of burn benefit $250 crown, $125 extraction $75 $300 $150 $750 $60 19

Accident EVENT Laceration1

$120

sutures up to 2”

Laceration1

$480

sutures 2” – 6”

Laceration1

$960

sutures over 6”

Ruptured Disk

$600

surgical repair

Tendon/Ligament/Rotator Cuff One, surgical repair

Tendon/Ligament/Rotator Cuff Two or more, surgical repair

Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair

Paralysis quadriplegia

Dislocations Hip joint Knee Ankle or foot bone(s) Other than toes

$2,500/$5,000 $1,500/$3,000 $1,200/$2,400

25% of the closed reduction amount

Partial dislocations

Fractures Hip Leg Ankle Kneecap Foot Excluding toes, heel

Upper arm Forearm, Hand, Wrist Finger, Toe Vertebral body Vertebral processes Pelvis

Closed/open reduction2

$500/$1,000 $500/$1,000

Lower jaw Collarbone

Except fingers

$15,000

$500/$1,000

Other than fingers

Nose Upper jaw Lower jaw Collarbone Rib or ribs

$200

$500/$1,000 $500/$1,000 $500/$1,000 $150/$300

Shoulder Elbow Wrist Finger/toe Hand bone(s)

Except nose

$900

$7500

Paralysis paraplegia

Coccyx Bones of face

$600

$250

Concussion

Except coccyx

BENEFIT

Closed/open reduction3 $2,500/$5,000 $1,250/$2,500 $500/$1,000 $500/$1,000 $500/$1,000 $550/$1,100 $500/$1,000 $100/$200 $1,200/$2,400 $500/$1,000 $1,200/$2,400 $350/$700 $550/$1,100 $150/$300 $550/$1,100 $500/$1,000 $500/$1,000 $450/$900

Accident EVENT

Exclusions and Limitations

BENEFIT

Skull – simple

$1,500/$3,000

Except bones of face

Skull – depressed

$5,000/$10,000

Except bones of face

Sternum Shoulder blade

$500/$1,000 $500/$1,000

Chip fractures

25% of the closed reduction amount

Emergency care benefits Ground ambulance Air ambulance

$200 $1000 $300 $80 $80

Emergency room treatment Initial doctor visit Follow-up doctor visit 1 Laceration

benefits are a total of all lacerations per accident. Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint. 3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical. 2 Closed

Catastrophic Accident Rider (in $s) Employee* Spouse* Children Home Modification Benefit Vehicle Modification Benefit

120,000 60,000 30,000 5,000 5,000

*Benefit reduces to 50% at age 65, and to 25% of the original benefit amount at age 70.

How much does Accident Insurance cost? All employees pay the same rate, no matter their age. See the chart below for the premium amounts.

Monthly Rates Employee $16.38

Employee and Employee and Spouse Children $23.40

$31.20

Rates shown are guaranteed until July 1, 2019.

Family $38.22

Exclusions in the Certificate, Spouse Accident Insurance, Children’s Accident Insurance and AD&D Benefit are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*:  Participation or attempt to participate in a felony or illegal activity.  An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.  Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.  Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Any sickness or declining process caused by a sickness. *See the certificate of insurance and riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.

Exclusions and limitations in the Catastrophic Accident Benefit are the same as in the Certificate, plus :  The catastrophic accident benefit is not payable if the covered person is in a coma at the end of the catastrophic accident elimination period.  The catastrophic accident benefit reduces to 50% at age 65 and to 25% of the initial benefit amount at age 70.

VOYA

Critical Illness

YOUR BENEFITS PACKAGE

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About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.

$16,500 Is the aggregate cost of a hospital stay for a heart attack.

Critical Illness What is Critical Illness Insurance? Critical Illness Insurance pays a lump-sum benefit if you are diagnosed after your effective date of coverage with a covered illness or condition listed below. Please review certificates of coverage for any limitations that may apply. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

For what critical illnesses and conditions are benefits available? Critical illness insurance provides a benefit for the following illnesses and conditions. Benefits are paid at 100% of the Maximum Critical Illness Benefit unless otherwise stated. For a complete description of your benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders. BASE MODEL  Heart attack  Stroke  Coronary artery bypass (25%)  Coma  Major organ failure  Permanent paralysis  End stage renal (kidney) failure CANCER MODEL  Cancer  Skin cancer (10%)  Carcinoma in situ (25%)

How much does Critical Illness Insurance cost? See chart for the premium amounts. Rate shown are guaranteed until July 1, 2019. Benefits reduce 50% for the employee and/or covered spouse on the policy anniversary following the 70th birthday, however, premiums do not reduce as a result of this benefit change .

Exclusions and Limitations Benefits are not payable for any critical illness caused in whole or directly by any of the following*:  Participation or attempt to participate in a felony or illegal activity.  Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, 23 other than under the direction of a doctor.

*See the certificate of insurance and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.

Employee Coverage Monthly Rates Includes Wellness Benefit Rider NON- TOBACCO USER Issue Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 Under 30 $2.25 $4.50 $6.75 $9.00 $11.25 $13.50 30-39 $3.30 $6.60 $9.90 $13.20 $16.50 $19.80 40-49

$6.35

$12.70

$19.05

$25.40

$31.75

$38.10

50-59

$11.05 $22.10

$33.15

$44.20

$55.25

$66.30

60-64

$15.45 $30.90

$46.35

$61.80

$77.25

$92.70

65-69

$20.05 $40.10

$60.15

$80.20 $100.25 $120.30

70+

$29.25 $58.50

$87.75 $117.00 $146.25 $175.50

TOBACCO USER Issue Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 Under 30 $3.00 $6.00 $9.00 $12.00 $15.00 $18.00 30-39 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 40-49

$9.95

$19.90

$29.85

$39.80

$49.75

50-59

$17.90 $35.80

$53.70

$71.60

$89.50 $107.40

60-64

$25.85 $51.70

$77.55 $103.40 $129.25 $155.10

65-69

$30.60 $61.20

$91.80 $122.40 $153.00 $183.60

70+

$59.70

$44.50 $89.00 $133.50 $178.00 $222.50 $267.00

Spouse Coverage* Monthly Rate

Issue Age Under 30 30-39 40-49 50-59 60-64 65-69 Issue Age Under 30 30-39 40-49 50-59 60-64 65-69

Includes Wellness Benefit Rider NON-TOBACCO USER $5,000 $10,000 $2.70 $5.40 $3.80 $7.60 $7.50 $15.00 $13.45 $26.90 $18.72 $37.43 $25.40 $50.80 TOBACCO USER $5,000 $10,000 $3.65 $7.30 $5.65 $11.30 $11.70 $23.40 $21.80 $43.60 $31.40 $62.80 $39.20 $78.40

$15,000 $8.10 $11.40 $22.50 $40.35 $56.15 $76.20 $15,000 $10.95 $16.95 $35.10 $65.40 $94.20 $117.60

Children Coverage Monthly Rates Includes Wellness Benefit Rider Coverage Amount $1,000 $2,500 $5,000 $10,000

Rate $0.87 $2.18 $4.35 $8.70 23

5 STAR

Individual Life

YOUR BENEFITS PACKAGE

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About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

Experts recommend at least

x 10 your gross annual income in coverage when purchasing life insurance.

Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don’t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That’s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss.

Affordability - With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness - This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability - You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

DID YOU KNOW? Protecting your financial well being is easier than you think. It’s like trading in a daily latte for peace of mind.

$4.30 per day to start your morning with a $1.75

gourmet coffee OR per day to enrich your employee benefits package

It’s less expensive than you think.

Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages newborn through 23). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or  Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Convenience - Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On - Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions. 25

* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge, Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.

Term Life with Terminal Illness and Quality of Life Rider Monthly Rates with Quality of Life Rider Defined Benefit Age on App. Date

$10,000

Employee Coverage Amounts $25,000 $50,000 $75,000

$100,000

18-25

$7.56

$12.40

$20.46

$28.52

$36.58

$7.58

$12.46

$20.58

$28.71

$36.83

$7.65

$12.63

$20.92

$29.21

$37.50

$7.74

$12.85

$21.38

$29.90

$38.42

$7.88

$13.21

$22.08

$30.96

$39.83

$8.07

$13.67

$23.00

$32.33

$41.67

$8.27

$14.17

$24.00

$33.83

$43.67

$8.49

$14.73

$25.13

$35.52

$45.92

$8.73

$15.31

$26.29

$37.27

$48.25

$9.00

$16.00

$27.67

$39.33

$51.00

$9.30

$16.75

$29.17

$41.58

$54.00

$9.64

$17.60

$30.88

$44.15

$57.42

$10.02

$18.54

$32.75

$46.96

$61.17

$10.41

$19.52

$34.71

$49.90

$65.08

$10.84

$20.60

$36.88

$53.15

$69.42

$11.31

$21.77

$39.21

$56.65

$74.08

$11.83

$23.08

$41.83

$60.58

$79.33

$12.41

$24.52

$44.71

$64.90

$85.08

$13.00

$26.00

$47.67

$69.33

$91.00

$13.63

$27.56

$50.79

$74.02

$97.25

$14.28

$29.19

$54.04

$78.90

$103.75

$14.97

$30.92

$57.50

$84.08

$110.67

$15.69

$32.73

$61.13

$89.52

$117.92

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: full term new born to 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage

Term Life with Terminal Illness and Quality of Life Rider Monthly Rates with Quality of Life Rider Defined Benefit (cntd.) Age on App. Date

$10,000

Employee Coverage Amounts $25,000 $50,000 $75,000

$100,000

$16.43

$34.56

$64.79

$95.02

$125.25

$17.22

$36.54

$68.75

$100.96

$133.17

$18.08

$38.69

$73.04

$107.40

$141.75

$19.04

$41.10

$77.88

$114.65

$151.42

$20.16

$43.90

$83.46

$123.02

$162.58

$21.40

$47.00

$89.67

$132.33

$175.00

$22.79

$50.48

$96.63

$142.77

$188.92

$24.27

$54.17

$104.00

$153.83

$203.67

$25.93

$58.33

$112.33

$166.33

$220.33

$27.66

$62.65

$120.96

$179.27

$237.58

$29.42

$67.04

$129.75

$192.46

$255.17

$31.23

$71.56

$138.79

$206.02

$273.25

$33.12

$76.29

$148.25

$220.21

$292.17

$35.08

$81.19

$158.04

$234.90

$311.75

$37.13

$86.31

$168.29

$250.27

$332.25

$39.31

$91.77

$179.21

$266.65

$354.08

$41.68

$97.71

$191.08

$284.46

$377.83

$44.33

$104.33

$204.33

$304.33

$404.33

66*

$44.93

$105.81

$207.29

$308.77

$410.25

67*

$48.25

$114.13

$223.92

$333.71

$443.50

68*

$52.03

$123.58

$242.83

$362.08

$481.33

69*

$56.33

$134.31

$264.29

$394.27

$524.25

70*

$61.17

$146.42

$288.50

$430.58

$572.67