2022 - 2023

EMPLOYEE BENEFITS KIPP DELTA

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H e ath e r M a r ti n 1 (5 0 1 ) 5 4 1 . 4 9 0 0 h e ath e r@jts fs. co m E l i z a b e th B a rg e r 1 (5 0 1 ) 4 0 0 . 1 8 0 1 e l i z a be th @jts fs. co m

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TABLE OF CONTENTS OVERVIEW WHAT YOU NEED TO KNOW........................................... GLOSSARY OF INSURANCE TERMS............................... BENEFITS DENTAL INSURANCE..................................................... VISION INSURANCE...................................................... VOLUNTARY DISABILITY INSURANCE......................... UNIVERSAL LIFE INSURANCE........................................ ACCIDENT INSURANCE.................................................. CANCER INSURANCE..................................................... CRITICAL ILLNESS INSURANCE..................................... MASA.......................................................................... ...... IDENTITY THEFT PROTECTION...................................... *NEW HOSPITAL INDEMNITY INSURANCE................... LEGAL SHIELD PROTECTION......................................... ANNUAL WELLNESS BENEFITS...................................... FLEXIBLE SPENDING ACCOUNT.....................................

4 6-7 8 9 10 11 12-13 14-15 16 17 18 19 20 21 22-23 24-27

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WHAT YOU NEED TO KNOW Ch eck list of what to br in g fo r o p en en ro llm ent fo r eac h d e pe n d e nt th at yo u a re en rol l ing in eligible be n efit s: ☑ ☑ ☑

S o cia l S e cur it y Nu m b er Ad dress Date of Bir t h

Hav in g the se items will exp ed it e t h e co m p let io n o f a l l e n r o l l me n t f o r ms , b en ef icia ry ca rds, e t c.

I f you a re a cur re nt e m p loyee ( n o t a n ew h ire) , p lea se k e e p th e fo l l ow i n g in for mat io n in mind: •

You ca nnot ma k e a n y ch a n ges u n t il t h e a n n u a l “ o pe n e n r o l l me n t pe r i o d ”, w hich a llows e mplo y ees, wh o m a y h a ve p revio u s l y d e c l i n e d to e n r o l l , th e opport unity t o e n ro ll in n ew c o vera ge. (C ert a in re s tr i c ti o n s a n d l i mi tati o n s ma y a pply t o e mplo y ees wh o in it ia lly d ec lin ed c o v e r a g e w h e n th e y f i r s t b eca me e lig ible to en ro ll.) ○

H owe ve r, t he re a re cert a in q u a lify in g even t s th a t a l l o w c u r r e n t e mpl o y e e s to ma k e be ne fit c h a n ges. T h ese in clu d e, b u t ar e n o t l i mi te d to : »

ma rria g e , div o rc e, a d o p t io n o r b irt h o f c h ild , d e a th o f a s po u s e o r o th e r e lig ible depen d en t .

You mig ht see the se b oxes o n cer t a in p a ges. Here’s w h at th e y me a n :

EC

E m p l oyer Co ntr ibutio n - yo ur em pl oyer co ntr ibutes a percentage to your prod uc t prem iu m s

ER

E m p l oyer Pa id - yo ur em pl oyer cover s 100% o f th e cost of your prod uc t

NH

N ew H ire E l igibl e - if yo u a re a n ew h ire fo r th e dis tr i c t, you are eli gi ble for this benef it

DISCLAIMER: This benefit summary is provided for illustrative purposes only and is simply an overview of your benefits. For a detailed explanation for each policy you should review a copy of the actual policy on file with the Human Resources Depar tment or you may specifically request a copy of each polic y from JTS Financial Ser vices, LLC

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WELCOME TO OPEN ENROLLMENT

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GLOSSARY

OF INSURANCE TERMS An n ua l M a x imum - Th e to t a l d o lla r a m o u nt t h at a p la n w i l l pay fo r c a re in cur re d by a n indivi d u a l en ro llee o r fa m ily ( u n d er a f a mi l y pl a n ) i n a s pe c i f i e d b en efit pe r iod. B en efit Yea r - A per iod in wh ich covered exp en ses a re a cc r u e d a n d a re co u nte d toward the a nnua l ma xim u m s, d ed u c t ib les, a n d / o r ou t- o f - po c k e t l i mi ts. B en efit s - I tems or ser vices covered u n d er a n in su ra nce pl a n . B en eficia r y - A person o r ent it y ent it led to receive t he c l a i m a mo u nt a n d o th e r b en efits upo n t he deat h o f t h e b en efa c to r o r o n t h e matu r i t y o f th e po l i c y. B roker - An individual a gent o r a gen c y wh o rep resents th e bu ye r, rath e r th a n th e insura nce co mpany, a n d t r ies to fin d t h e b u yer t h e be s t po l i c y. Th e bro k e r can ma k e specific reco m m en d at io n s a b o u t wh ich p la n s be s t s u i t yo u a n d yo u r f am ily ’s needs. COB R A - A fe de ra l law t h at m ay a llow t h e in su red to te mpo ra r i l y k e e p in surance covera g es a f ter em p loy m ent en d s. Cl aim - A request fo r p ay m ent u n d er a n in su ra n ce p l a n . A c l a i m w i l l l i s t th e s er vices re ndere d, t h e d ate o f ser vice, a n d a n item iz ati o n o f co s t. Coin sura nce - I nsura n ce in wh ic h t h e in su red is req u i re d to pay a f i xe d p erce nt a g e of the co st o f exp en ses a f ter t h e d ed u c t i bl e h a s be e n pa i d. Cop ayment (Copay) - A fixed a m o u nt t h at t h e in su re d i s re qu i re d to pay be fo re receiving t he ser vice. D edu c t ible - An out- of- p o c ket a m o u nt t h at a n in su re d mu s t pay pr i o r to a n in surance pla n paying a c la im . D ependent - A child or o t h er in d ivid u a l fo r wh o m a p a re nt, re l ati ve, o r o th e r p er s o n may cla im a p erso n a l exem p t io n t a x d ed u c t ion . El im inatio n Per iod - A p er io d o f co nt in u o u s d isa b ilit y w h i c h mu s t be s ati s f i e d b efore you a re e ligible to receive b en efit s.

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Ev iden ce of I nsura bilit y ( EO I) - Pa r t o f t h e a p p licat io n p ro ce s s fo r a n i nsuran ce po lic y dur ing w h ich a n a p p lica nt p rovid es h ea l th i n fo r mati o n . Coverage does not be com e effec t ive u nt il a p p rova l o f t h e E O I . Flexibl e Spe nding Account ( F S A) - A t y p e o f a cco u nt t h at prov i d e s th e a cco u nt h ol der w it h spe cific ta x a d va nt a ges o n q u a lified m ed ic a l a n d /o r d e pe n d e nt c are exp enses (ex. M e dica l R eim b u rsem ent, D ep en d ent Ca re, a n d /o r L i mi te d Pur p ose FSA). G uarantee d Issue - A pred eter m in ed b en efit a m o u nt a llowe d by a n i n s u ra n ce p l an w itho ut requir ing Evid en ce o f I n su ra b ilit y ( EO I) . GI a l l ows yo u to e n ro l l re gardl ess of hea lth statu s, a ge, gen d er, o r o t h er fa c to rs th at mi g ht pre d i c t th e us e of h e a lth se r vices. This d o es n o t, h owever, p rec lu d e th e a ppl i c ati o n o f th e p re - existing co ndit io n exc lu sio n s. L im ited Pur po se FSA - A t y p e o f a cco u nt to b e u sed wit h a n H SA . I t i s re s e r ve d fo r th e payment of dent a l a n d visio n exp en ses o n ly. Lo n g-Ter m Ca re - A ra ng e o f ser vices a n d su p p o r t s yo u m ay n e e d to me e t yo u r p er s on al ca re needs in th e event o f a ch ro n ic illn ess o r d i s a bi l i t y. M edical l y N ece ssa r y - A covered h ea lt h ser vice o r t reat me nt th at i s ma n d ato r y to protec t a nd enha nce th e h ea lt h st at u s o f a p at ient, a n d co u l d a d ve r s e l y af fec t th e pat ient ’s condit io n if o m it ted, in a cco rd a n ce w i th a cce pte d s tan dards of medica l prac t ice. Net wor k - The fa cilities, provid ers a n d su p p liers yo u r in s u ra n ce pl a n h a s co ntrac ted wit h to provide h ea lt h c a re ser vices ( i.e. “in - n e t wo r k ” ) . Non -Prefer red Provider - A p rovid er wh o d o es n o t h ave a co ntra c t w i th yo u r i nsuran ce ca r r ie r or pla n to p rovid e ser vices to yo u. Yo u’ l l pay mo re to s e e a n on -prefer red provider. ( i.e. “o u t- o f- n et wo r k ” ) . O ut- of -Pock et M a x imum - Th e m a xim u m a m o u nt o f m o n e y yo u may pay fo r s er vices in a bene fit ye a r. Pre -Existing Condit io n - A m ed ica l co n d it io n t h at is exc lu d e d f ro m cove ra g e by an in sura nce co mpa ny b eca u se t h e co n d it io n wa s b el i e ve d to ex i s t pr i o r to t h e in div idua l o bt a ining a p o lic y fro m t h e in su ra n ce co mpa ny. Prem ium /R ate - The a mo u nt yo u p ay fo r yo u r in su ra n ce p re mi u ms e a c h mo nth . Q ual if ying L ife Event (QLE) - A c h a n ge in yo u r sit u at io n t h at c a n ma k e yo u e l igib l e for a specia l e nro llm ent p er io d, a llowin g yo u to e n ro l l i n a n i n s u ra n ce p l an outside the ye a r ly o p en en ro llm ent p er io d. ( ex. Lo s s o f cove ra g e, g e tti n g m ar r ied or divorced, havin g a b a by / a d o p t in g a ch ild, o r a d e ath i n th e f a mi l y) .

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DENTAL INSURANCE Hav i n g d e nt a l insu ra nce co ntr ibutes to yo ur over a l l wel l -bein g. D ental i nsurance provi d es cove rage fo r preventative, b a s ic, a n d m a j o r s er v ices.

D E N TA L S E R V I C E S P R E V E N TAT I V E S E R V I C E S (N o D educ tible )

10 0%

BASI C SER VICE S (D educ tibl e Applies)

80 %

MA JOR SER VICE S (D educ tibl e Applies)

50 %

• • • • •

O ra l Exa m s Bitewin g X- rays C lea n in gs Flu o r id e Ap p lic at io n ( to a g e 1 9 ) S ea la nt s ( to a ge 16)

• • • • •

S p a ce M a int a in ers ( to a g e 1 4 ) Fillin gs (Am a lga m a n d Co mpo s i te ) R o o t Ca n a ls O ra l S u rger y ( S im p le & Su rgi c a l E x tra c ti o n s ) Em ergen c y Pa lliat ive Tre atme nt

• • • • • •

Crown s I n lays O n lays R elin es, R eb a ses, a n d R e pa i r s Per io d o nt a l S u rger y Per io d o nt a l S c a lin g, R oo t Pl a n n i n g a n d M a inten a n ce

A N N UA L M A X I M U M

$1,500 p er p erso n

DEDUCTIBLE

$50 p er p erso n

COVERAGE TIER

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SEMI-MONTHLY RATES

Employee

$14.75

Employee + Spouse

$29.30

Employee + Child(ren)

$29.71

Family

$46.63

VISION INSURANCE Vi s i o n i n s u ra nce is o f fered to h el p peo pl e s ee by prov idin g a fford able access to hi gh- q uali t y eye care an d e yewea r. An indiv idua l o r fa m il y v is io n in s ura n ce pl a n saves you money on f rames, l e n s e s, co nta c t s, eye ex a m s a n d m o re.

VISION SERVICES E x a m Copay

$10

M ater ials Cop ay

$15

Co ntac t Le ns Fi t t i ng Cop ay

$35

CONTAC TS E l e c tive Al l owa nce

$ 1 5 0 re ta i l a l l owance

Co ntac t Le ns Fi t t i ng ( St a n d a rd )

Cove re d i n fu l l

Co ntac t Le ns Fi t t i ng ( S pe ci a l t y )

$ 5 0 re ta i l a l l owance

LENSES Fra mes

$ 1 3 0 re ta i l a l l owance

S ingle Visi on Al l owa nce

Cove re d i n fu l l af ter co p ay

Bifoc al Allowa nce

Cove re d i n fu l l af ter co p ay

Tr ifocal Al l owa nce

Cove re d i n fu l l af ter co p ay

Lenticu lar Al l owa nce

Cove re d i n fu l l af ter co p ay

Progressive Al l owa nce

Cove re d at L i n e d Tr ifo c al Level

SERVICES

FREQUENCY

COVERAGE TIER

Exam

12 m o nt h s

Fra mes

24 m o nt h s

Le n ses

12 m o nt h s

Co ntac t Lenses

12 m o nt h s

Co ntac t Lens Fitt ing

12 m o nt h s

SEMI-MONTHLY RATES

Employee

$2.87

Employee + Spouse

$5.69

Employee + Child(ren)

$5.57

Family

$8.47 9

VOLUNTARY DISABILITY D i s ab i li t y insu ra nce p rov ides in co m e pro tec tio n in th e event that you mi ss wor k d ue to an acci d e nt o r il l ness.

VOLUNTARY DISABILITY BENEFITS M A X I M U M M O N T H LY BENEFIT

60% o f s a l a r y up to $6,000 per m o nth

MAXIMUM BENEFIT D U R AT I O N

Later o f a ge 65, o r S o c ia l S ec ur it y Nor mal R eti rement Age

O W N O CC U PAT I O N PERIOD

24 m o nth s

S TD BE N E F ITS BE G IN ON : E L I M I N AT I O N P E R I O D

PRE-EXISTING CO N D I T I O N E XC LU S I O N L I M I TAT I O N

WA I V E R O F P R E M I U M

LTD BENEFITS B EGIN O N: 91st d ay

3/12: Any co n ditio n yo u receive m e d i cal treatment for i n the 3 m o nth s pr io r to th e effec tive date wi ll not be covered i n the f i rst 12 m o nth s o f th e po l ic y.

Yo u w il l n o t be required to pay premi ums d ur i ng any ti me of a pproved to ta l o r pa r tia l dis a bil it y

S U R V I V O R I N CO M E BENEFIT

A s ur v ivo r ben efit m ay be pa id to your benef i ci ar y i f you should d i e w h il e receiv in g qua l ify in g dis a bil it y payments

E M P LOY E CO N N E C T

Acces s to a n em pl oyee a s s is ta n ce program for the employee or an im m ediate h o us eh o l d fa m il y m ember who may be exper i enci ng per s o n a l dis a bil it y

BENEFIT L I M I TAT I O N S

10

1s t day fo r a n Acc ident 4th day fo r a n I l l n es s

• • • •

M enta l I l l n es s : 24 m o nth s S ubs ta n ce Abus e: 24 m o nth s S pec ified I l l n es s : 24 m o nth s Fa m il y Ca re E xpen s e - I f yo u have a q uali f i ed d i sabi li t y and in c ur Fa m il y Ca re E xpen s es, you wi ll be rei mbursed for expenses up to $250 fo r a m a xim um o f 1 2 months

UNIVERSAL LIFE Th i s covera g e prov ides per m a n ent l ife in s ura n ce pro tec tio n wi th a premi um that never i ncreases du e to age o r a spec if ied ter m . Life I n s ura n ce is a pro m is e to yo ur f ami ly to help protec t thei r f uture. Th e d e at h b enef it c a n be u sed a ny way yo u o r yo ur fa m il y s ees f i t.

WHY BUY UNIVERSAL LIFE AT WORK? 1. 1. 1.

Por tabilit y - Ta k e your covera ge wit h yo u a n d p ay t h e s a me pre mi u m i f yo u c h a n g e jobs or re t ire. Payrol l de duc tio n - No b ills to watc h fo r. No c h ec ks to ma i l. A d i re c t bi l l o pti o n i s avail able whe n yo u ch a n ge j o b s o r ret ire. On e - on- o ne g uida nce - Yo u’ll get p erso n a lized b en efit a d v i ce a n d a s s i s ta n ce w i th th e applicatio n proce ss.

FEATURES YOU‘LL APPRECIATE • • •

• • • • • • • • •

Accel erated D eath B e n efit fo r Ter m in a l I lln ess in c lu d e d Fam il y Covera g e - Apply fo r yo u r sp o u se, ch ild ren , a n d gra n d c h i l d re n e ve n i f yo u ch oose no t to pa r t icipate. G uaranteed re ne wa ble - Gu a ra nteed covera ge, a s lo n g a s yo u r pre mi u ms a re pa i d. Your pre mium may cha n ge if t h e p rem iu m fo r a ll p o lic i e s i n yo u r c l a s s c h a n g e s. Coverag e up to $500,000 G uaranteed 3% I ntere st R ate Ter m ina l I llness B ene fit No Physica ls or Blo o d Wo r k Cash Va lues Accer l ated D eath B e ne fit D epen de nt Covera g e Ava ila b le Convenie nt Payro ll D e d u c t io n Layof f Provisio n

Employee

Spouse

L i fe Am ount M a x

$500,000

-

G u ar an tee Issue

$150,000

Accel erated D e ath B e ne fit fo r Ter m in a l I llness

75% o r $100,000, wh ich ever is less

$15,000 -

Dependent $25,000 -

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ACCIDENT INSURANCE Acci d e nt insu ra nce hel ps p ay fo r un expec ted h ea l th c a re expen ses d ue to i njur i es that occur ever y day – f ro m t he so ccer f iel d to th e s k i s l o pe a n d th e h ighway in -bet ween. Acci d ent i nsurance p rov i d e s b enef it s du e to covered a cc idents fo r in itia l c a re, in j ur i es, and follow-up care.

BENEFITS

PAYO U T A M O U N T

Emergency Room Treatment

$200

Initial Doctor’s Office Visit

$100

Accident Follow-up Treatment

$100

Burns - Flat amount for: Third-degree 35 or more sq in. Third-degree 9 to 34 sq. in. Second-degree for 36% or more of body

$10,000 $1,500 $750

Dislocations Open reduction Closed reduction

Up to $4,000 Up to $2,000

Fractures Open reduction Closed reduction Chips

Up to $7,500 Up to $3,750 25% of closed reduction amount

Laceration

Up To $800

Tendon/Ligament/Rotator Cuff Repair of more than one Repair of one Exploratory without repair

$1,200 $800 $200

Concussion

$100

Eye Injury

$400

Emergency Dental Benefit Extraction Crown

$50 $150

Appliance

$150

Ground Ambulance Air Ambulance

$200 $1,000

Hospital Admission

$2,000 - once per year/per covered person

Hospital Confinement Hospital Confinement - ICU

$400 per day $600 per day

Surgery Open, abdominal, thoracic Exploratory

$1,250 $125

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BENEFITS

PAYO U T A M O U N T

Blood, Plasma, and Platelets

$300

Loss of Finger, Toe, Hand, Foot, or Sight of an Eye

$750 to $15,000

Health Screening Benefit Routine health screening tests/one per person per year

COVERAGE TIER

$100

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DIDYOU KNOW

SEMI-MONTHLY RATES

Employee

$7.32

Employee + Spouse

$11.29

Employee + Child(ren)

$14.69

Family

$18.67

LESS THAN 5% of disabling accidents and illnesses are work related.

HEALTH SCREENING BENEFIT

We will pay a total of $100 per calendar year per person to undergo one of the covered tests or exams listed below.

• Low dose Mammography • Pap Smear for women over age 18 • Flexible Sigmoidoscopy • Hemocult Stool Sample • Colonoscopy • Chest X-ray

• Prostate Specific Antigen (for prostate cancer) • Stress Test on a Bicycle or Treadmill • Fasting Blood Glucose Test • Blood Test for Triglycerides

The other 95% are not, meaning

WORKERS’ COMPENSATION DOESN’T COVER THEM. (Council for Disability Awareness, Long-Term Disability Claims Review. 2012.)

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CANCER INSURANCE Can ce r i n s u ra nce hel ps tho se dia gn o s ed w ith c a n c er to s ta y fo c used on recovery by allevi ati ng some o f t h e f i n a n­c ia l bu r d en a ssoc ia ted w ith th e c o s t o f c a n c er tr ea tment. Radiation & Chemotherapy

Low Plan

High Plan

Policy Says

Radiation & Chemotherapy

$10,000

$20,000

maximum benefit per 12-month period; pays actual charges

Blood, Plasma, Blood Components, Bone Marrow & Stem Cell Transplant

$10,000

$20,000

maximum benefit per 12-month period; pays actual charges

New or Experimental Treatment

$10,000

$20,000

actual charges,* up to selected amount, for experimental or investigational treatment defined as drugs or chemicals approved by the FDA or surgery or therapy approved by either the NCI or ACS for experimental studies

Wellness & Non-Medical Benefits

Low Plan

High Plan

Policy Pays

Wellness

$100

$100

per calendar year for cancer screening tests

Magnetic Resonance Imaging (MRI) Scans

$100

$100

per calendar year for MRI scan used as diagnostic tool for breast cancer, in addition to Wellness Benefit

Non-Local Transportation

√

√

Actual round-trip charges or private allowance, up to 750 miles at $.40 per mile when required non-local hospital confinement is more than 50 miles from residence for covered person and an adult, immediate family member during confinement

Physical Therapy & Speech Therapy

$50

$50

per treatment; limit one per day

At Home Nursing

$100

$100

per day, up to the number of days of the prior hospital stay when admitted within 14 days of hospital discharge

Hospital Benefits

Low Plan

High Plan

Policy Pays

Hospital Confinement

$100

$100

per day; up to 90 days of covered confinement

Extended Benefits

$200

$200

per day of hospital confinement in lieu of all other benefits (except surgery & anesthesia); begins on day 91 of continuous confinement

Inpatient Drugs & Medicine

$15

$15

per day during hospital confinement

Private Duty Nurse

$100

$100

per day during hospital confinement

Ambulance

$100

$100

for service by a licensed professional ambulance service for transportation to a hospital to which the covered person is admitted

Hospice Care

$100

$100

per day when confined in a hospice center or hospice home care by a hospice team; 100-day lifetime maximum

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Low Plan

High Plan

$1,000 $1,500

$5,000 $7,500

maximum benefit; actual benefit is determined by the surgery schedule in the contract; for multiple procedures in same incision only the highest benefit is paid for multiple procedures in separate incisions will pay highest benefit and then 50% for each lesser procedure

Anesthesia

25%

25%

of covered surgery benefit as scheduled in the certificate

Reconstructive Surgery Breast Cancer (Total Mastectomy) Breast Cancer (Radical Mastectomy) Cancer of the male/female genitalia Cancer of the head, neck or oral cancer

$120 $170 $170 $250

$600 $850 $850 $1,250

Surgery Benefits Surgery

Inpatient Outpatient

Skin Cancer

One Removal Per Additional Removal

$75 $35

$375 $175

Policy Says

for reconstructive surgery within 2 years of the initial cancer removal; excluded skin cancer and malignant melanoma; benefit not payable if paid under any other provision of the policy.

?

DIDYOU KNOW

1.7 MILLION

new cases of cancer are diagnosed annually. (American Cancer Society, 2017)

up to selected amount per diagnosis

SEMI-MONTHLY RATES

LOW PLAN

HIGH PLAN

Employee

$9.24

$17.67

Employee + Child(ren)

$10.69

$19.96

Family

$17.04

$31.81

13%

of all new cancer diagnoses are for

“RARE FORMS” (American Cancer Society, 2017)

WELLNESS BENEFIT

We will pay a total of $100 per calendar year per person to undergo one of the covered tests or exams listed below.

• Mammogram • Pap Smear • Flexible Sigmoidoscopy • Prostate Specific Antigen Test • Hemocult Stool Specimen • Chest X-ray • Bone Marrow Testing • Blood Screening for Cancer

• Ultrasound • CEA test • CA125 test • Biopsy • Thermography • Colonoscopy • Serum Protein Electrophoresis

This is a brief summary of CancerSelect® Plus, Cancer Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. Policy form series CPCAN200 and CCCAN200. Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. EBD LJPBSD 0813

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CRITICAL ILLNESS Cr i t i cal I l l ness insu ra nce pa y s a l um p s um ben efit dir ec tl y to y ou and your covered d epend ents up on d i ag no sis o f a covered c r itic a l il l n es s.

BENEFITS LUMP SUM BENEFIT OPTIONS

Employee: $5,000-$50,000 Spouse: 50% of Employee Benefit Children: 50% of Employee Benefit

BENEFITS FOR 2ND OCCURRENCE

1 Co n s e cu ti ve M o nt h Pays @ 100%

GUARANTEE ISSUE OFFERING (GI)

Employee: $ 3 5 , 0 0 0 Spouse/Child: $ 1 7,500

WELLNESS

$100

COVERED CRITICAL ILLNESSES

Stro k e, H e a r t At t ac k , Hear t Transp lant, M a jo r O rg a n Transp lant, B o ne M ar row Tra n s p l a nt, Su d den Cardiac Ar rest, R e n a l Fa i l u re, Coro nar y Ar ter y B y p ass Su rg e r y (2 5 % ), AL S, M S and C hi ld Cys ti c Fi bro s i s, Cereb ral Palsy, Clef t L i p o r C l e f t Pa l ate, D own Sy ndro m e, Ph e ny l a l a n i n e H ydrox y lase D ef ic ienc y D i s e a s e (PK U ), S p i na B i f ida, Ty p e 1 D i a be te s, Au ti s m Sp ec t r um Diso rder

PORTABLE

Ye s

PRE-EXISTING CONDITION

None

BENEFITS REDUCTIONS

None

16

MEDICAL TRANSPORT SOLUTIONS (MASA) Th e h i gh co st o f em erg ent a n d n o n - em ergent tra n s po r tatio n results i n unexpec ted out of pocket ex p e n s e s. MAS A pro tec ts mem ber s fro m th es e expen s es rel ated to emergenc y ai r transpor tati on an d ground a m b u l a nce c ha rges.

ANY GROUND. ANY AIR. ANYWHERE. BENEFITS Cost

PLATINUM

EMERGENT PLUS

$19.50

$7

Family Included

Yes

Yes

Emergent Ground Transportation

Yes

Yes

(U.S. & Canada)

•

• •

Emergent Air Transportation

Yes

Yes

Repatriation (Worldwide)

Yes

Yes

Non-Emergent Interfacility Transportation (Worldwide)

Yes

Yes

•

Return Transportation (Worldwide)

Yes

No

•

Vehicle Return

Yes

No

(U.S. & Canada)

(Basic Coverage Area)

•

•

Organ Transplant Transportation

Yes

No

Pet Return

Yes

No

Minor Children/Grandchildren Return

Yes

No

Mortal Remains Transportation (Worldwide)

Yes

No

(U.S. & Canada)

(Basic Coverage Area)

(Basic Coverage Area)

•

•

TM

Global Reach Emergent Plus (US 50/ Canada), Platinum (up to worldwide) Leading company in the Industry The only plans that cover at home and away MASA steps in where insurance falls short by helping protect families against uncovered costs MASA also provides many benefits not covered by insurance Any Ground. Any Air. Anywhere TM Simply contact 911 for Emergency Transport Covers any of the 1,500+ Air Ambulances in US with 300 different Provider Companies Covers any of the 21,000 Ground Ambulance Providers in the US US Based Support, Local Reps, Simple Enrollment, Easy Claims, and Online access

17

IDENTITY THEFT PROTECTION 60 million Americans experienced identity fraud in 2018. This has quadrupled since 2017. With Protec tEd, you have the same protec tion as millions of Amer ican wor kers, and the peace of mind from the devastation of identit y thef t.

ProtectEd features Social Media and Cyberbullying Monitoring ProtectEd keeps tabs on social accounts for everyone in the family, watching for account takeover, vulgarity, threats, explicit content, violence, and cyberbullying

ProtectEd also covers: • • • • • • •

Dark Web Monitoring Financial Transactions Credit Monitoring Credit/Debit Cards Activity Monitoring Your IP Address Student Loan Activity An Annual Tri-Bureau Credit Report and Score/ Credit Monitoring • Tax Fraud Refund Advances • Sex Offender Alerts • 24/7 Privacy Advocate Remediation

COVERAGE TIER

18

MONTHLY RATES

Individuals

$9.95

Family

$17.95

HOSPITAL INDEMNITY POLICY You are now off e r e d a h o s p i t a l c o n fin e m e n t in d e m n ity p o licy th r o ugh U S A bl e. Thi s pol i cy hel ps o ffe r y ou f inanc i a l p r o t e c t i o n i n th e e ve n t th a t yo u o r yo u r d e p e n dents are admi tted to the hospi tal . Be nef it s prov id e y o u w i t h a s s i s ta n ce in p a yin g yo u r d e d u ctib le a nd co-payments associ ated w i th inpat i e nt ex pen s e s . • • • • •

M at ernit y B e n e f i t s I n c l u d e d - To a d d a n e wb o r n ch ild , yo u m ust contact your H R w i thi n 30 day s of bir t h No Medic a l Q u e s t i o n s 12/ 12 P re- e x - Wa i v e d f o r existin g p o licy h o ld e r s. G uarant ee d I s s u e P lan pay s h o s p i t a l i z a t i o n be n e fit fo r in ju r ie s o r sickn e ss ( M ini mum 18 hrs. of confi nement at i n pat ient h o s p i t a l f a c i l i t y )

L O W P L A N - B E N E F I T D E TA I L S F i r st Day Hos p i t a l A d m i s s i o n

$ 5 0 0 u p to 1 0 co n finements per year

D ai l y Hos pit a l C o n f i n e m e n t

$ 1 0 0 p e r d a y ( M a x. up to 180 days per confi ne m e n t)

I n t ens iv e Care C o n f i n e m e n t

$ 1 5 0 p e r d a y, u p to 15 days

Gr ound A m bul a n c e ( 3 p e r y e a r )

$80

Ai r Am bulanc e ( 3 p e r y e a r )

$500

We l l nes s (O nce p e r p e r s o n p e r ca le n d a r year)

$ 3 0 p a ya b le o n ce p er cal endar year per covered p e r so n s

H I G H P L A N - B E N E F I T D E TA I L S F i r st Day Hos p i t a l A d m i s s i o n

$ 7 5 0 u p to 1 0 co n finements per year

D ai l y Hos pit a l C o n f i n e m e n t

$ 1 5 0 p e r d a y ( M a x. up to 180 days per confi ne m e n t)

I n t ens iv e Care C o n f i n e m e n t

$ 2 2 5 p e r d a y, u p to 15 days

Gr ound A m bul a n c e ( 3 p e r y e a r )

$120

Ai r Am bulanc e ( 3 p e r y e a r )

$750

We l l nes s (O nce p e r p e r s o n p e r ca le n d a r year)

$ 6 0 p a ya b le o n ce p er cal endar year per covered p e r so n s

NOTE: THIS IS NOT MAJOR MEDICAL INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL INSURANCE. IT DOES NOT QUALIFY AS MINIMUM ESSENTIAL HEALTH COVERAGE UNDER THE FEDERAL AFFORDABLE CARE ACT. * Pl ease consu l t e n r o l l m e n t w eb s it e f o r ra t e s .

19

LEGALSHIELD PROTECTION Wi t h Le g a l S hiel d, yo u c a n have pea ce o f m in d w ith identit y th ef t protec ti on for as li ttle as $20/ mont h .

Everyone deserves legal protection At LegalS hi e l d, we’ve b e e n o ffe r i n g l e g a l pl a n s to o u r m em b er s fo r over 40 year s, creat i ng a wor l d w h e re e ve r yo n e ca n a cce s s legal p ro tec t i o n—and ever yon e c a n a f ford i t. U n ex p e c te d l e g a l q u e s ti o n s ar ise ever y day and wit h LegalSh iel d on your si d e, yo u’ l l h ave a cce s s to a q u alit y law f i r m 24/ 7, fo r covered p e r sona l si t uat io n s.

Why LegalShield ? Fo r as littl e a s $20 a m o nth , Le g a l Sh i e l d gi ve s yo u the ab ilit y to t alk to an at tor n ey o n a ny p e r sona l l e g a l m atte r w i th o u t wo r r y i ng ab o ut high ho ur ly co sts. Th at ’s w hy, und e r th e p ro te c ti o n o f Le g a l Sh i e ld, yo u o r yo ur f am i ly c an l ive you r li ve s wor r y f re e. M e mber shi p i nc l ud e s un l i m i te d s a m e - d ay a cce s s to o ur lo c al net wo r k o f at tor n eys for a ssi st a nce w i th ANY l e g a l i s s u e, n o m at ter how t r ivi al o r t rau matic i t m ay b e. Unlimited sa m e - d ay a cce s s to o u r n e t wo r k o f atto r neys fo r an ent i re year fo r l ess th an t he ave ra ge co s t o f o n e h o u r o f l e g a l re present at io n by no n- net wo r k at tor n eys. Woul d you rath e r p ay $ 3 0 0 a n h o u r, o r $ 2 40 p er year ?

20

SEMI-MONTHLY RATES

EMPLOYEE PLAN

FAMILY PLAN

LegalShield

$15.95

$15.95

ID Shield

$8.95

$18.95

Combo

$24.90

$30.90

ANNUAL WELLNESS BENEFITS B e low i s yo u r a nnu a l wel l nes s in fo r m atio n . Pl ea s e s ee a ben efit counselor for a wellness for m f rom e ach car r i er.

Accident Policy

Cancer Policy Low Plan: $100 Wellness High Plan: $100 Wellness

$100 Health Screening

To File:

By Mail

By Fax

Attn: MAWORKSITE Trustmark Insurance Co. 100 N. Parkway, Ste. 200 Worcester, MA 01605

(508) 471-3208

To File:

Information Needed

Include Bill or Statement as proof of test. Bill/statement should include the following: Information Needed

• • •

Covered Tests

• •

Full Name Name and address of the facility where the test/procedure was performed The specific test/procedure performed

Low dose mammography, pap smear for women over age 18, flexible sigmoidoscopy, hemocult stool sample, colonscopy, prostate specific antigen (for prostate cancer), stress test on a bicycle or treadmill, fasting blood glucose test, blood test for triglycerides, chest x-ray

Covered Tests

• • • •

By Phone

By Fax

(800) 251-7254

(866) 586-6528

Insured‘s name and Social Security Number Covered person‘s name, date of birth, and relationship to insured Name of test/procedure Date of test/procedure Provider‘s name, address, and phone number Bill or statement as proof of test (fax only)

Mammogram, pap smear, flexible sigmoidoscopy, prostate-specific antigen tests, chest X-ray, hemocult stool specimen, ultrasound, CEA, CA125, biopsy, thermography, colonoscopy, serum protein electrophoresis, bone marrow testing, and blood screening for cancer

Critical Illness Policy $100 Health Screening

To File:

By Mail

By Fax

Attn: MAWORKSITE Trustmark Insurance Co. 100 N. Parkway, Ste. 200 Worcester, MA 01605

(508) 471-3208

Include Bill or Statement as proof of test. Bill/statement should include the following: Information Needed

• • •

Full Name Name and address of the facility where the test/procedure was performed The specific test/procedure performed

21

FLEXIBLE SPENDINGACCOUNT Features of an FSA

Why an FSA?

E m p l oyee B e ne fit s

How it Wo r k s

Using a Fl exibl e S pen din g Acco unt (F S A) i s great way to stretch your bene fit do l l a r s. Yo u us e befo re -ta x do l l a rs i n your FSA to rei mburse yo u r s el f fo r el igibl e o ut- o f-po c k et m edical and d epend ent care expenses. That m ea n s yo u c a n en j oy ta x s av in gs a nd i ncreased take -home pay—all w ith th e co nven ien ce o f a prepa id debit card. • R educes yo ur in co m e ta xes (Federa l, s t ate, and FIC A) because set tin g a s ide pre -ta x F S A do l l a r s res ul ts i n a lower taxable salar y. • Usin g pre -ta x do l l a r s to pay fo r el igibl e med i cal and /or d epend ent c a re expen s es tra n s l ates into s av in gs of as much as 30%. • O f fer s im m ediate a cces s to el ec ted h ealthcare FSA f und s vi a an FS A debit c a rd. • M o s t co m m o n expen s es s uc h a s m edic al, d ental, or thod onti c, vi si on, pres c r iptio n dr ug, a n d dayc a re expen s es are eli gi ble for reim bur s em ent w ith s uppo r tin g do c umentati on. • D e c ide h ow m uc h yo u w il l co ntr ibute to thei r FSA each year, up to the m a xim um a l l owed by th eir em pl oye r ’s FSA plan. Thi s elec ti on a mo unt (div ided equa l l y by th e n um be r of payroll per i od s) i s a u to m atic a l l y deduc ted fro m th e pa r tici pant ’s paycheck by your em pl oyer. Fro m a ta x per s pec tive, th e more you elec t to put i nto your FS A , th e m o re yo u s ave! • Yo u c a n c h o o s e to be reim bur s ed fo r eli gi ble med i cal expenses up to the a m o unt o f yo ur a n n ua l el ec tio n by submi tti ng a req uest to Co ns o l idated Adm in S er v ices v ia yo ur onli ne FSA por tal, by emai l/f ax, o r o n yo ur Co n s o l idated Adm in S er v ices FSA phone app. O r you may c ho o s e to us e yo ur co nven ient F S A debi t card to pay for the eli gi ble ex p en s e at th e po int o f purc h a s e, el imi nati ng the need to req uest reim bur s em ent (p er IRS req uirem ent s, note t h at a ddi t i o n a l s u b s t a nt i at i n g do cument at ion may b e req uested by Consolidate d Admi n S e r vi ce s fo r de b i t c a rd pu rc hases).

MAXIMUM CONTRIBUTION AMOUNTS • •

$2, 750 - M edic a l R eim b u rs em ent $5, 000 - D ep end ent Ca re (to a ge 12)

FOR EMPLOYEES/PARTICIPANTS •

• • • • •

22

w w w.conso lidateda d m in .co m (877) 941-5956

Co nven ient Consoli d ated Ad mi n S er vi ces M o bil e Technology (mobi le app and tex t m es s a gin g) M ul tipl e account management tools (web, ph o n e, a nd f ax) Fa s t reim bursements To l l -free Customer Care Center E a s y o n l ine enrollment or re - enrollment Ta x S av in g s Calculator

FLEXIBLE SPENDING ACCOUNT Want to c hec k yo u r hea l thca re a cco unt ba l a n ces a n d s ubm it recei pts f rom any where? There’s an ap p for t h at! Co nso l id ated Adm in S er v ices (C A S ) m o bil e a pp l ets you easi ly and securely access you r h e al th b enef it a cco u nts, s ubm it c l a im s a n d upl o a d receipts at any ti me. You have q ui ck access to co mmo n ta sk s w it h a n ea s y-to -us e des ign th at h el ps m a k e s ense of your health and f i nanci al i n for mat io n.

GET REIMBURSED QUICKLY Let‘s face it - no one really likes visiting the doctor, dentist, pharmacy or other healthcare provider. But sometimes you do and you may forget to use your health benefits card. So, when you pay for a qualified medical expense using your own money, you want to maximize your dollars and be reimbursed from your pre-tax account. File a claim with a receipt or request a distribution from you HAS soon after it happens. Right from your phone. Ight from wherever you are. Get the payment process serrated.

•

VIEW ACCOUNT ACTIVITY AND CHECK BALANCE

•

UPDATE YOUR INFORMATION

•

ENTER AND TRACK EXPENSES

•

MAKE A PAYMENT FROM YOUR ACCOUNT

•

FILE CLAIMS WITH RECEIPT IMAGES

•

SCAN OR VIEW ELIGIBLE EXPENSES, AND MOVE!

TRACK RECEIPTS

CHECK BALANCES

Why is it that the one receipt you needs is always the one you can‘t find? With CAS‘ mobile app, you can record a health expense and capture the receipt the moment the transaction happens. That‘s peace f mind with a touch of a button.

Wondering whether you can pay for an elective procedure or a mounting bill? Do a quick account check to see your current balance. No need to wait for an answer - it‘s right at your fingertips.

23

NOTES

24

NOTES

25

NOTES

26

NOTES

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CUSTOMER SERVICE 1 (501) 227.0194 (phone) 1 (888) 965.4050 (fax) H eat h er M a r t i n 1 (501) 541. 4900 h eat her@ j t s fs. co m E li z a b et h B a rg er 1 (501) 400. 1801 eli z a b et h @ j t s fs. co m 28