2023 BENEFITS GUIDE RICHARDS R-V

CONTACT INFORMATION Phone: 1 ( 417) 893. 8437 Em ai l : i nf o@hpm g- l l c. com

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TABLE OF

CONTENTS OVERVIEW WHAT YOU NEED TO KNOW............................................ 4 GLOSSARY OF INSURANCE TERMS................................ 6-7 BENEFITS HEALTH INSURANCE....................................................... HEALTH INSURANCE RATES........................................... DENTAL INSURANCE....................................................... VISION INSURANCE........................................................ BASIC GROUP TERM LIFE INSURANCE.......................... VOLUNTARY GROUP TERM LIFE INSURANCE............... UNIVERSAL LIFE INSURANCE.......................................... HOSPITAL INDEMNITY INSURANCE................................ CRITICAL ILLNESS.............................................................

8-10 11-12 13 14 15 16 17 18 19

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WHAT YOU NEED TO KNOW Employe es under co nt ra c t wh o wo r k a m in im u m o f 3 0 h o u r s pe r w e e k , un less a bus dr ive r, a re eligib le t o en ro ll t h em selv e s a n d th e i r qu a l i f i e d depe ndents in a pp lic a b le R ich a rd s S c h o o l D ist r ic t e mpl o y e e be n e f i ts . Employe es must be a c t ively at wo r k to en ro ll in b e n e f i ts. Ch eck l ist of what to br in g fo r o p en en ro llm ent fo r ea c h d e pe n d e nt th at yo u a re en rol l ing in eligible be n efit s: 1. 2. 3.

S o cia l S e cur it y Num 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 ll 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 are 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 m at io n in mind: •

You ca nnot ma k e an y c h 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 mpl o y ees wh o m a y h a ve p revio u sly d e c l i n e d to e n r o l l th e opport unity t o e nro 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 m ay a pply t o e mpl o y ees wh o in it ia lly d eclin 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.) ○

Howe ve r, t he re are c ert a in q u a lify in g even t s t h at 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 c lu d e, b u t a re n o t l i mi te d to : »

ma rria g e , divorc e, a d o p t io n o r b irt h o f ch ild , d e a th o f a s po u s e o r ot he r e lig ible d ep en 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 Department or you may specifically request a copy of each policy from Educational Benefits.

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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 lan 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 ic h 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 - items 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 - a n 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 - insura 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 red i s re qu i re d to pay be fo re receiving t he ser vice. D edu c t ible - a n 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 pa 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) - p a 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 S A . 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 - t he 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 - t h 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 ic a 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 s urance co mpa ny be c a u se t h e co n d it io n wa s b elieve d to ex i s t pr i o r to th e i ndiv idua l obt a ining a polic y fro m t h e in su ra n ce co m p a ny. Prem ium /R ate - the a mo u nt yo u p ay fo r yo u r in su ra n ce pre mi u ms e a c h mo nth . Q ual if ying L ife Event (QLE) - a ch 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 of 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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HEALTH INSURANCE H e alt h i n su ra nce cover s yo u a n d yo ur fa m il y fo r yo ur ba s ic h ealth need s af ter you’ve met your cove rag e d ed u c tibl e ( so m e ben efits in c l ude co pay a f ter deduc t i ble). Coverage i nclud es vi si ts w i t h a p r i m a r y c a re p hysic i a n , s pec ia l t y phys ic ia n s, in patient/outpati ent hospi tal care.

PPO PLAN Valenz Mercy

Valenz Mercy

Individual Deductible

$1,500

$2,500

Family Deductible

$3,000

$5,000

Individual Out-of-Pocket Maximum

$4,500

$4,500

Family Out-of-Pocket Maximum

$9,000

$9,000

Coinsurance

70%

80%

Lifetime Maximum

Unlimited

Unlimited

OV Primary

$10 Copay

$10 Copay

OV Specialist

$40 Copay

$35 Copay

Preventive Care

$0 Copay

$0 Copay

Outpatient Lab Services

$0 Copay

$0 Copay

Outpatient RAD*

30% AD*

20% AD*

Urgent Care***

$50 Copay

$50 Copay

Emergency Room (waived if AD*)

$200 Copay + 30%

$100 Copay

Inpatient Hospital Care

30% AD*

20% AD*

Chiropractic

$40 Copay

$35 Copay

Physical Therapy Hospital/Outpatient Setting

$40 Copay

$35 Copay

Inpatient Injectables

30% AD*

20% AD*

Outpatient Injectables

$0 through SMBC Program

$0 through SMBC Program

Generic

$5 Copay

$5 Copay

Preferred Brand

$35 Copay

$35 Copay

Non-Preferred Brand

$75 Copay

$60 Copay

Specialty Drugs

$0 through SMBC Program

$0 through SMBC Program

COVERED SERVICES

PRESCRIPTIONS

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HEALTH INSURANCE H e al t h i n su ra nce cover s yo u a n d yo ur fa m il y fo r yo ur ba s ic h ea lth need s af ter you’ve met your cove rag e d ed u c tibl e ( so m e ben efits in c l ude co pay a f ter deduc t i ble). Coverage i nclud es vi si ts wi t h a p r i m a r y c a re p hysic ian , s pec ia l t y phys ic ia n s, in patient/outpati ent hospi tal care.

HSA PLAN Valenz Mercy Individual Deductible

$5,000

Family Deductible

$10,000

Individual Out-of-Pocket Maximum

$6,350

Family Out-of-Pocket Maximum

$12,700

Coinsurance

0%

Lifetime Maximum

Unlimited

COVERED SERVICES OV Primary

$20 AD*

OV Specialist

$40 AD*

Preventive Care

$0 Copay

Outpatient Lab Services

$0 AD*

Outpatient RAD*

$0 AD*

Urgent Care***

$50 AD*

Emergency Room (waived if AD*)

$150 AD*

Inpatient Hospital Care

$0 AD*

Chiropractic

$0 AD*

Physical Therapy Hospital/Outpatient Setting

$0 AD*

Inpatient Injectables

$0 AD*

Outpatient Injectables

$0 through SMBC Program

PRESCRIPTIONS Generic

$10 AD*

Preferred Brand

$30 AD*

Non-Preferred Brand

$60 AD*

Specialty Drugs

$0 through SMBC Program

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HEALTH INSURANCE H e al t h i n su ra nce cover s yo u a n d yo ur fa m il y fo r yo ur ba s ic h ealth need s af ter you’ve met your cove rag e dedu c t ib l e ( so m e ben efits in c l ude co pay a f ter deduc ti ble). Coverage i nclud es vi si ts wi t h a p r i m a r y c a re p hysic i a n , s pec ia l t y phys ic ia n s, in patient/outpati ent hospi tal care.

PPO PLAN Cox Directed Individual Deductible

$2,000

Family Deductible

$4,000

Individual Out-of-Pocket Maximum

$4,500

Family Out-of-Pocket Maximum

$9,000

Coinsurance

70%

Lifetime Maximum

Unlimited

COVERED SERVICES OV Primary

$25 Copay

OV Specialist

$50 Copay

Preventive Care

$0 Copay

Outpatient Lab Services

$0 Copay

Outpatient RAD*

30% AD*

Urgent Care***

$50 Copay

Emergency Room (waived if AD*)

$200 Copay

Inpatient Hospital Care

30% AD*

Chiropractic

$50 Copay

Physical Therapy Hospital/Outpatient Setting

$50 Copay

Inpatient Injectables

30% AD*

Outpatient Injectables

$0 through SMBC Program

PRESCRIPTIONS

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Generic

$15 Copay

Preferred Brand

$35 Copay

Non-Preferred Brand

$75 Copay

Specialty Drugs

$0 through SMBC Program

HEALTH INSURANCE RATES $1,500 VALENZ MERCY PPO PLAN COVERAGE TIER

MONTHLY RATES EE Cost

ER Cost

Total Cost

Employee

$10.00

$544.00

$554.00

Employee + Spouse

$550.00

$544.00

$1,094.00

$432.00

$544.00

$976.00

$1,002.00

$544.00

$1,546.00

Employee + Child(ren) Family

$2,500 VALENZ MERCY PPO PLAN COVERAGE TIER

MONTHLY RATES EE Cost

ER Cost

Total Cost

$0.00

$544.00

$544.00

Employee + Spouse

$530.00

$544.00

$1,074.00

Employee + Child(ren)

$413.00

$544.00

$957.00

Family

$973.00

$544.00

$1,517.00

Employee

$5,000 VALENZ MERCY HSA PLAN COVERAGE TIER

MONTHLY RATES EE Cost

ER Cost

Total Cost

$0.00

$544.00

$454.00

Employee + Spouse

$353.00

$544.00

$897.00

Employee + Child(ren)

$256.00

$544.00

$800.00

Family

$723.00

$544.00

$1,267.00

Employee

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HEALTH INSURANCE RATES $2,000 COX DIRECTED PPO PLAN COVERAGE TIER

EE Cost

ER Cost

Total Cost

Employee

$24.00

$544.00

$568.00

Employee + Spouse

$579.00

$544.00

$1,123.00

Employee + Child(ren)

$457.00

$544.00

$1,001.00

$1,042.00

$544.00

$1,586.00

Family

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MONTHLY RATES

DENTAL INSURANCE H av i n g d enta 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 p reventative, 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%

BASIC SERVICES (DEDUCTIBLE APPLIES)

10 0%

MAJOR SERVICES (DEDUCTIBLE APPLIES)

80 %

CHILD ORTHODONTIA RIDER (DEDUCTIBLE APPLIES)

• • • • •

R o u t in e Per io d ic Exa ms X- rays Flu o r id e Treat m ent C lea n in g S ea la nt s

• • • • •

Fillin gs R o o t Pla n in g & S c a lin g S im p le Ex t ra c t io n s No n - su rgic a l Per io d o nti c s O ra l S u rger y

• • • • • • • •

I n lays O n lays Crown s Br id ges D ent u res S u rgic a l Per io d o nt ics I m p la nt s R o o t Ca n a l

$1,500 Lifet im e M a xim u m

50 % A N N UA L M A X I M U M

I n Net wo r k : $1,250 p er p e r s o n O u t- o f- Net wo r k : $1,250 p e r pe r s o n

DEDUCTIBLE

I n Net wo r k : $25 p er p erso n / N o Fa mi l y M a x i mu m O u t- o f- Net wo r k : $25 p er pe r s o n / N o Fa mi l y M a x i mu m

COVERAGE TIER

MONTHLY RATES

Employee

$33.99

Employee + Spouse

$67.24

Employee + Child(ren)

$84.58

Family

$126.73 13

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 Exam Copay

$10

M ater ials Cop ay

$10

CONTAC TS El ec tive Al l owa nce

$ 1 5 0 a l l owa n ce

Co ntac t Le ns Eva l uat i on , Fi tti n g, & Follow-U p Ca re Cop ay

$60 maximum

LENSES Sin gle Vis i on Al l owa nce

Cove re d i n fu l l af ter $10 Co p ay

B ifocal All owa nce

Cove re d i n fu l l af ter $10 Co p ay

Tr ifocal Al l owa nce

Cove re d i n fu l l af ter $10 Co p ay

Lentic ular

Cove re d i n fu l l af ter $10 Co p ay

SERVICES

FREQUENCY

COVERAGE TIER

E x am

12 m o nt h s

Employee

$5.77

Fra mes

24 m o nt h s

Employee + Spouse

$11.53

S p ec tacl e Lenses

12 m o nt h s

Employee + Child(ren)

$12.87

Co ntac t Lens Eval uation , Fit t ing & Fo ll ow-Up Ca re

12 m o nt h s

Family

$19.56

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MONTHLY RATES

BASIC GROUP TERM LIFE INSURANCE Yo u r n e e d s va r y greatl y u po n a ge, n um ber o f depen dents, depend ents’ ages and your f i nanci al s i t u at i on . Ter m L ife is designed to pro­v ide ben efits to yo ur des ignated benef i ci ar y for loss of life. A D & D insu ra nce cover s yo u a n d yo ur ben efic ia r ies in th e event of an acci d ental loss of li fe. R i ch ard s p ays $ 2 0 , 0 0 0 towa rd s a l l el igibl e em pl oyee‘s gro up ter m li fe i nsurance.

EMPLOYER PAID

GROUP TERM LIFE EMPLOYEE BENEFIT

Amount

$20,000

AD&D Benefit

$20,000

EMPLOYEE PAID

Amount

Premium Cost

BASIC DEPENDENT LIFE

SPOUSE: $2,500 CHILD: $1,000

$1.07

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VOLUNTARY GROUP TERM LIFE INSURANCE

You r n e e d s va r y greatl y u po n a ge, n um ber o f depen dents, depe nd ents’ ages and your f i nanci al si t u at i on . Ter m L ife is design ed to pro­v ide ben efits to yo ur des i gnated benef i ci ar y for loss of li fe. AD & D i n su ra nce cover s yo u a n d yo ur ben efic ia r ies in th e event of an acci d ental loss of li fe.

EMPLOYEE

SPOUSE

DEPENDENT

Minimum Amount

$10,000

$5,000

$2,000

Maximum Amount

$500,000

$250,000

$10,000

$500,000 in increments of $10,000, not to exceed 5x annual earnings

$250,000 in increments of $5,000, not to exceed 100% of employee amount

Child(ren): Birth through 26: $10,000 in increments of $2,000

$200,000

$50,000 : Through Age 69 $0.00: Age 70+

Amount

Guaranteed Issue Group Term Life Benefit Reduction Benefit Features

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-

Benefits reduce to 65% upon the person‘s attainment of age 65-69, and 50% at age 70+ (Spouse Reduction Based on Employee Age)

-

Portability Conversion Privilege Waiver of Premium

-

-

UNIVERSAL LIFE INSURANCE Th e U n i ver sa l L ife po l ic y prov ides per m a n ent l ife in s ura n ce pro tec ti on wi th a premi um that never i n cre as e s d u e to a g e o r a spec ified ter m . Life I n s ura n ce is a pro mi se to your f ami ly to help protec t t h e i r f u t u re. The d eat h ben efit c a n be us ed a ny way yo u o r yo ur f ami ly sees f i t. GUARANTEED ISSUE* (new hires only)

EMPLOYEE - $150,000

SPOUSE - $25,000

CHILD - $25,000

CHILD TERM RIDER - $10,000

ELIGIBILITY To be eligible for insurance, an employee must satisfy all of the following requirements: - be age 16 through 80. - be on active service, performing in the usual manner all of the regular duties of his or her occupation at one of the places of business where he or she normally works or at some location directed by the employer; and - be continuously employed for the amount of time and working the minimum number of hours per week as you require to be eligible for benefits. These requirements will be defined on the Life and Health Group Application and Agreement. To be eligible for insurance, a spouse (or equivalent as defined by state law or otherwise agreed upon between you and us) must satisfy all of the following requirements: - must be age 16 through 65. - must be legally married to the employee as determined by the laws of the state in which the employee resides or meet the eligibility requirements required by the group to be benefit eligible. - must not be disabled. - must not be eligible as an employee under the group policy. To be eligible for universal life insurance, a child must satisfy all of the following requirements: - must be under the age of 26. - must be an employee‘s natural child, stepchild, grandchild, legally adopted child or child for whom adoption proceedings have begun, or a child for whom the employee has been appointed legal guardian. - must not be disabled. - must not be eligible as an employee under the group policy. To be eligible for insurance under this rider, a child must satisfy all of the following requirements: - must be 15 days through age 25. - must be an employee‘s natural child or stepchild, legally adopted child or child for whom adoption proceedings have begun, or a child for whom the employee has been appointed legal guardian. - must not be eligible as an employee under the group policy.

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HOSPITAL INDEMNITY INSURANCE Th e h os p i t a l ind em nit y po l ic y h el ps o ffer yo u fin a n c ia l pro tec tion i n the event that you or your d e p e n d e nts a re a d m itted to th e h o s pita l. B en efits prov ide yo u wi th assi stance i n payi ng your d e d u c t i b l e a nd co - pay m ents a s s o c iated w ith in patient expen s es.

BENEFITS

STANDARD

HIGH

Hospital Room & Board Benefits (180 Daily Benefits per Coverage Year)

$100

$200

Hospital Critical Care Unit Benefits Critical Care Unit Benefits per Day (30 Daily Benefits per Coverage Year)

$200

$400

Hospital Admission Benefit (Three Daily Benefit per Coverage Year)

$1,000

$1,500

Hospital Critical Care Admission Benefit (One Daily Benefit per Coverage Year)

$1,000

$1,500

Nursery Admission Benefit (One Daily Benefit per Coverage Year)

$200

$500

Nursery Confinement Benefit (Ten Daily Benefit per Coverage Year)

$50

$100

Included

Included

Non-Insurance Services On-Call Travel Assistance

STANDARD MONTHLY PREMIUM

HIGH MONTHLY PREMIUM

Employee

$18.88

$38.38

Employee + Spouse

$33.82

$68.54

Employee + Child(ren)

$26.33

$53.42

Family

$40.75

$82.45

COVERAGE TIER

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.

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

BENEFIT DESCRIPTION

BENEFIT

Heart Category Heart Attack Stroke Aneurysm

Percent of Principal Sum 100% 100% 100%

Organ Category Major Organ Failure

Percept of Principal Sum 100%

Quality of Life Category ALS/Lou Gehrig’s Disease Advanced Alzheimer’s Disease Advanced MS Advanced Parkinson’s Disease Loss of Sight Loss of Hearing Loss of Speech

Percent of Principal Sum 50% 50% 50% 50% 100% 100% 100%

Lifetime Category Maximum (Category Recurrence)

100% of Insurance Amount

Diagnosis Child Cerebral Palsy Cleft Lip or Palate Cystic Fibrosis Downs’ Syndrome Muscular Dystrophy Spina Bifida Type 1 Diabetes

100%

Subsequent Occurrence Benefit

100% of benefit if diagnosed 6 months or later

Benefit Waiting Period

None

Pre-existing Period

6/6

Benefit Reduction

None

Guarantee Issue Employee Spouse Child

$30,000 $30,000 $15,000

Maximum Principal Sum Employee Spouse Child Spouse and Child Principal Sum cannot exceed Employee Principal Sum

$30,000 $3,000 $15,000

Employee Coverage

Choose from a benefit of $5,000 to a maximum of $30,000 in $5,000 increments

Spouse Coverage

Choose from a benefit of $5,000 to a maximum of $30,000 in $5,000 increments, not to exceed 100% of approved employee amount

Dependent Coverage

50% of approved employee amount up to a maximum of $15,000

Cancer Benefit

100%

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CONTACT INFORMATION Ph o n e : 1 (4 1 7 ) 8 9 3 .8 4 3 7 Em a il: in fo @ h p m g -llc .c om

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