2023

EMPLOYEE BENEFITS GUIDE

C o l l ate ra l Edu cato rs S er vices is the on ly b e n ef it provider endo rsed by the AEA. Th e s e b e nefits are vetted and ap p roved by a board of yo u r peers.

L a u ra Fe e ba c k P h o n e : ( 2 0 5 ) 734. 8 1 8 8 E mai l: l fe e ba ck@ s e r v in ge d u cato rs.co m

P ho n e: 1 ( 8 6 6 ) 3 2 2 . 2 2 4 4 Fa x: 1 ( 8 6 6 ) 2 4 0 . 0 7 8 8 Em a il: i nfo@ se r v i nge d ucators.co m Busin e s s Ho u rs: M ond ay -Thursd ay, 8: 0 0 - 5 : 0 0 Fr i d ay, 8 : 0 0 - 4 : 0 0

TABLE OF

CONTENTS OVERVIEW WHAT YOU NEED TO KNOW........................................... 4 GLOSSARY OF INSURANCE TERMS.................................6-7 BENEFITS DENTAL INSURANCE.....................................................8 VISION INSURANCE......................................................9 VOLUNTARY TERM LIFE................................................ 10-11 WHOLE LIFE................................................................. 12 CHILD WHOLE LIFE...................................................... 13 VOLUNTARY AD&D........................................................ 14 CRITICAL ILLNESS INSURANCE..................................... 15 CANCER INSURANCE.....................................................16-17 ACCIDENT INSURANCE................................................. 18-19 LONG TERM DISABILITY................................................ 20 FREEDOM ID................................................................ 21

WHAT YOU NEED TO KNOW Employees under cont ract w ho wor k a mi ni mum o f 1 5 h o u r s p er week a r e e ligible to enroll t he mse l v e s and t he i r q ual i fi e d d ep en d en t s i n a p p li ca b le S chool District emp l oy e e b e ne fi t s. Emp l oye e s m u st b e a ct i vely at wo r k to e nroll in benefits . Check list of w h at to b rin g fo r o pe n e n ro l l m e n t fo r ea ch d ep en d en t t h at yo u a re en rolling in eligible b e n ef its : ☑ ☑ ☑

Soc ial Security N umb e r Address Date of B irth

Check list of w h at to b rin g fo r eac h b e n ef ic ia r y t hat yo u a re d es i g n at i n g : ☑ ☑ ☑

Soc ial Security N umb e r Address Date of B irth

Having these items wi l l e x p e d i t e t he c omp l e t i on of a ll en r o llm en t f o r m s , ben efic iary c ards, etc . I f you are a cur rent e m pl oye e (n ot a n e w hire ), pl ea se keep t h e fo l l ow i n g informatio n in mind : •

You cannot mak e any c hang e s unt i l t he annual “o p en en r o llm en t p er i o d ”, which allows em p l oy e e s, w ho may hav e p r e v i ou s ly d ecli n ed t o en r o ll, t h e opportunity to e nrol l i n ne w c ov e r ag e . ( Ce r t ai n r es t r i ct i o n s a n d li m i tat i o n s may apply to em p l oy e e s w ho i ni t i al l y d e c l i ne d c o ver a ge w h en t h ey f i r s t bec ame eligible t o e nr ol l. ) ○

H owe ver, ther e ar e c e r t ai n q ual i fy i ng e v e nt s t h a t a llo w cu r r en t em p lo yees to mak e bene fi t c hang e s. The se i nc l ud e , b u t a r e n o t li m i t ed t o : »

marriage, d i vo r c e, a d o p t i o n o r bi r t h o f c hi l d , d e a th of a s p ou s e or othe r el igibl e dep en d en t .

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.

4

WELCOME TO

OPEN ENROLLMENT 5

GLOSSARY

OF INSURANCE TERMS Annu a l Ma xi mu m - T he total d ol l ar amount t hat a pla n wi ll pa y fo r ca re in cu rred by an indivi d ual e nrol l e e or fami l y ( und e r a fa m i ly p la n ) i n a s p eci f i ed ben efit period. Benef i t Yea r - A perio d i n w hi c h cove re d ex p e nse s are a ccr u ed a n d a re co u n ted towa rd the annual max i mums, d e d uct i b l e s, and /or o u t- o f- p o cket li m i ts . Benef i ts - Items or ser v i ce s cove re d und e r an i nsura n ce p la n . Benef i c i a r y - A person or e nt i t y e nt i t l e d to re ce i ve t h e cla i m a m o u n t a n d ot h er ben efits upon the deat h of t he b e ne factor or on t he m at u r i t y o f t h e p o li c y. Broker - An individual age nt or age nc y w ho re p re se n ts t h e b u yer, rat h er t h a n the i nsurance company, and t r i e s to fi nd t he b uye r t h e b est p o li c y. T h e b ro ker can make spec ific recomme nd at i ons ab out w hi c h p l a n s b est s u i t yo u a n d yo u r fam il y’s needs. COBRA - A federal law t hat may al l ow t he i nsure d to tem p o ra r i ly keep in surance coverages afte r e mp l oy me nt e nd s. Claim - A request for pay me nt und e r an i nsurance p la n . A cla i m w i ll li st t h e ser v ices rendered, th e d ate of se r v i ce , and an i te mi zat i o n o f co st . Coinsu ra n ce - Insura nce i n w hi c h t he i nsure d i s re q u i red to pa y a f i xed p e rcentage of the cost of ex p e nse s afte r t he d e d uct ib le h a s b een pa i d . Copa ymen t (Copa y) - A fi xe d amount t hat t he i nsure d i s req u i red to pa y b efo re receiving the ser vice. De du cti b le - An out-of- p oc ket amount t hat an i nsure d m u st pa y p r i o r to a n in surance plan paying a c l ai m. De pen d en t - A c hild or ot he r i nd i v i d ual for w hom a pa ren t , relat i ve, o r ot h er p e rs on may claim a p e rsonal exe mpt i on tax d e d uct i o n . E lim i n ati on Per i od - A p e r i od of cont i nuous d i sab i l i t y wh i ch m u st b e s at i s f i ed befo re you are eligibl e to re ce i ve b e ne fi ts.

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Evide nce of In sura b i l i ty ( EOI) - Par t of t he ap p l i cat i on p ro ces s fo r a n i nsuran ce polic y during whi c h an ap p l i cant p rov i d e s hea lt h i n fo r m at i o n . C overage does not become e ffe ct i ve unt i l ap p roval of t h e E O I . F lexible Sp en d i n g Accou n t ( FS A) - A t y p e of account t hat p rovi d es t h e a cco u n t h o ld e r with spec ific tax ad vantage s on q ual i fi e d me d i cal a n d /o r d ep en d en t care exp enses (ex. Medica l Re i mb urse me nt , D e p e nd e nt C a re, a n d /o r L i m i ted Pur p o se FSA). G uaranteed Issue - A pre d ete r mi ne d b e ne fi t amount al l owed by a n i n s u ra n ce p la n without requiring Evi d e nce of Insurab i l i t y ( EOI) . GI a llow s yo u to en ro ll rega rd l ess of health statu s, age , ge nd e r, or ot he r factors t h at m i gh t p red i ct t h e u se o f health ser vices. Thi s d oe s not , howe ve r, p re c l ud e t h e a p p li cat i o n o f t h e p re - exi sting condition exc l usi ons. Lim ite d Pur p ose FSA - A t y p e of account to b e use d w i t h a n H S A . I t i s res er ved for the payment of denta l and v i si on ex p e nse s onl y. Lo ng-Ter m Ca re - A range of se r v i ce s and sup p or ts you m a y n eed to m eet yo u r p e rs o n a l care needs in th e e ve nt of a c hroni c i l l ne ss or d i s a b i li t y. Me dically Necessa r y - A cove re d heal t h se r v i ce or t reat m en t t h at i s m a n d ato r y to p rotect and enhance the heal t h stat us of a pat i e nt , an d co u ld a d vers ely a f fe ct th e patient’s condi t i on i f omi tte d , i n accord ance w i t h a ccepted stan d ard s of medical pra ct i ce . N etwork - The facilities, p rov i d e rs and sup p l i e rs your i n s u ra n ce p la n h a s co n tra cted with to provid e heal t h care se r v i ce s ( i .e . “ i n- n et wo r k” ) . N on- P refer red Provi d er - A p rov i d e r w ho d oe s not have a co n t ra ct wi t h yo u r i nsuran ce carrier or plan to p rov i d e se r v i ce s to you. You ’ ll pa y m o re to s ee a n o n - p re ferred provider. ( i .e . “out- of- net wor k” ) . Out-of- Po c ket Ma xi mu m - The max i mum amount of mon e y yo u m a y pa y fo r s er v ices in a benefit year. P re -Existi n g Con d i ti on - A me d i cal cond i t i on t hat i s exc lu d ed f ro m covera ge by an i n surance company b e cause t he cond i t i on was b e li e ved to exi st p r i o r to t he i n d i vidual obtaining a p ol i c y from t he i nsurance com pa n y. P re m ium/Rate - The amo unt you pay for your i nsurance p rem i u m s ea ch m o n t h . Qualifying Li fe Even t (Q L E) - A c hange i n your si t uat i on t h at ca n m a ke yo u e l ig ibl e for a spec ial enro l l me nt p e r i od , al l ow i ng you to en ro ll i n a n i n s u ra n ce p la n o u tside the yearly op e n e nrol l me nt p e r i od . ( ex. Los s o f covera ge, gett i n g m a r r i ed or divorced, havi ng a baby/ad opt i ng a c hi l d , or a d eat h i n t h e fa m i ly) .

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DENTAL INSURANCE B ASE P LAN

EN HA NCED PLA N

ENHA NCED PLUS PLA N

C LA SS A - D I AGN O ST I C / PR EV E N TAT I VE S E RVI C E S • P ro p h yl axi s • Ora l Exa m s • F l o u r i d e TX - C hi l d • X- Ra ys - BW & F M X • S ea l a n ts • Pa l l i at i ve C are • D i a g no st i c C h arts

100%

100%

100%

C LA SS B - BAS I C S E RVI C E S • F i l l i ng s • S i m p l e Ext racti o n s • P ro st h o d o n t i c Re pai rs • S pa ce M ai n tai n e rs EN H A N C E D P LUS O NLY • A nest h es i a • S u rg i ca l Extracti o n s • C o m p l ex O ral S urge r y • E nd o n t i c s • Per i o d o n t i cs

50%

80%

80%

C LA SS C - MA J O R S E RVI C E S • In l a ys , O n l ay s, • B r i d ges & C row n s • P ro st h et i c ( Parti al s & D e n tu res ) EN H A N C E D ON LY • A nest h es i a • S u rg i ca l Extracti o n s • C o m p l ex O ral S urge r y • E nd o n t i c s • Per i o d o n t i cs

Not Covered

50%

50%

C LA SS D - ORT H O DO N T I CS S E RVIC E S (UP TO AG E 1 9 )

Not Covered

Not Covered

50%

M AX I MU MS & DE DU CT I B L E S ( Cu m ul at ive of n et wo rk a n d n o n - n etwork) A N N UAL P ROG RA M DEDU CTI BL E (PER PE RS ON / P E R FAM I LY )

$50 / $150

$50 / $150

$50 / $150

(AP P LIES TO C L ASS B & C )

(AP P L I E S TO C L ASS B & C)

(AP P L I E S TO C L ASS B & C)

$750

$1,250

$1,750

Not Covered

Not Covered

$500/year $1,000/lifetime

N one

No ne

No ne

C LA SS C

N ot Covered

6 Mo nths

6 Mo nths

C LA SS D

N ot Covered

Not Cove re d

12 Mo nths

R EIM BU RSE M E N T I N - N E T WO R K

P P O MAC Sch ed u l e

PPO MAC Sche dule

PPO MAC Sche dule

R EIM BU RSE M E N T N O N - N E T WO R K

P P O MAC Sch ed u l e

PPO MAC Sche dule

90th Pe rce ntile UCR

A N N UAL P ROG RA M M AX I MU M ( P ER P ERS O N) O RTH OD ON T I C M A X I M U M ( P E R P E RSO N ) W AITI N G PER I O DS C LA SS A & CL A SS B

MONTHLY RATES

8

BASE PLAN

ENHANCED PLAN

ENHANCED PLUS PLAN

Employee

$15.91

$29.23

$41.00

Employee + Spouse

$31.35

$57.57

$80.79

Employee + Child(ren)

$29.39

$54.00

$85.11

Family

$48.67

$89.42

$137.45

VISION INSURANCE

V isi o n i n s u ran ce i s o f fe re d to h el p p eop l e s ee by p rovid ing a ffordable acce ss to high-quality e ye ca re a n d e ye wear. An i n di v i du a l or fa mil y vis ion ins u ra nce p l a n s ave s yo u mo ne y on f rame s, le n s es , co n tacts , e ye exam s and m ore.

BE NE FITS

In- Net wor k

O u t- o f N et wo r k

Eye Exam inati on (O p h th a lmo l o g ist)

Cove re d i n Fu ll

U p to $ 3 5

Eye Exam inati on (O ptometrist)

Cove re d i n Fu ll

U p to $ 2 5

C o ntact Lens F itting Stand a rd

Cove re d i n Fu ll

N /A

C o ntact Lens F itting S p e ci a l t y

$ 6 0 Retai l Al l owa n ce

N /A

E le ctive

$ 1 5 0 Retai l Al l owa n ce

U p to $ 1 0 0

Cove re d i n Fu ll

U p to $ 2 0 0

Fra m es

$ 1 5 0 Al l owan ce

U p to $ 7 5

Si n gle Vision

Cove re d i n Fu ll

U p to $ 2 5

B i fo cal

Cove re d i n Fu ll

U p to $ 4 0

Tr i focal

Cove re d i n Fu ll

U p to $ 5 0

Le ntic u lar

Cove re d i n Fu ll

U p to $ 8 0

Standard Progressive

Cove re d i n Fu ll

U p to $ 4 0

Po l ycarbonate fo r De pe nd e n t Chil dre n

Cove re d i n Fu ll

N /A

CO NTACTS

M e d ically Necessar y LE NS E S

FREQUENCY SERVICES

Co-Pays

BASE

ENHANCED

Eye Exam

$10

Exam

1 2 m ont h s

12 mont h s

$20

Fra m e s

2 4 m ont h s

12 mont h s

Materia ls ( frame s & l en ses only)

Contact Le n s e F i tt i ng

1 2 m ont h s

12 mont h s

C o n ta ct Lense Fitting

$20

Lens e s

1 2 m ont h s

12 mont h s

Contact Le n s e s

1 2 m ont h s

12 mont h s

MONTHLY RATES COVERAGE TIER

BASE

ENHANCED

Employee

$7.01

$8.62

Employee + One

$12.62

$15.52

Employee + Family

$19.62

$24.14

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Boston Mutual Group Term Life Open Enrollment August 1, 2022 – July 31, 2023

PROTECT WHAT MATTERS

Guaranteed Issue

For just a few dollars per week, you can enroll in a Term Life insurance plan and have the peace of mind knowing your family is financially secure.

Up to $100,000 (unless application was previously declined or closed)

1.866.322.2244

|

Limited Time Offer During scheduled open enrollments only. Offer valid between 8/1/2022 - 7/31/2023

[email protected]

120 Royall Street, Canton, MA 02021

|

|

servingeducators.com

18135 Burke Street - Suite 120, Omaha, NE 68022 335-5021 12/22

10

VOLUNTARY TERM LIFE

Yo u r need s var y g reatl y upo n a ge, nu m b er of d ep end ents , d ep ende nts age s and yo ur f inancial sit u at i o n. Vo l u n tar y te rm l i fe is d es ig ned to p ro­v id e benefits to yo ur de signate d be ne f iciar y for lo s s o f l i fe .

EMPLOYEE

B E N E FIT AMO U N T

Choice of $ 1 0 , 0 0 0 inc rements up to $ 5 0 0 , 0 0 0 , not to exce e d 5 x e mp l oye e ‘s annual base sal ar y

DEPENDENT

• Bi r t h - 2 6 yea rs : $ 1 0 , 0 0 0

MI N I MU M B EN E FI T A MOUNT

$10,000

$10,000

M A XI MUM B EN E FI T A MOUNT

$500,000

$10,000

Under Age 6 0 : $ 1 0 0 , 0 0 0 Age 60-6 9 : $ 5 0 , 0 0 0 * Age 70+: $ 1 0 , 0 0 0

$10,000

Reduces to 6 5 % of t he or i g inal bene fi t at age 7 0 ; To 50% o f t he or i g i nal b e ne fi t at age 7 5 ; To 25% o f t he or i g i nal b e ne fi t at age 8 0 .

D e p e nd e n t C h i ld ren covera ge te r mi nates u p o n n ot i ce to Boston M u t u a l t h at a ll d e p e nd e n t ch i ld ren a re n o l onge r e li gi b le.

G UARA N T EED I SSU E

B E N E FIT R E DU CT I ON

GUARANTEED ISSUE UP TO $100,000 FOR ALL EMPLOYEE APPLICANTS UNLESS PREVIOUS DECLINED

* Employee’s insurance reduction schedule applies. Please refer to the section: Benefit Reductions

11

WHOLE LIFE

Whole life i ns u ra nce i s m o re than j u st life ins u rance at an affo rd a b l e p r i ce. It co m b i n es th e g uaran te e d prem iu ms , covera ge, a nd va l u es t h at have always be e n so attractive in wh o l e l i fe in s uran ce w i t h th e a d va nta ges of ca s h a ccu mu l at ion at cur re nt inte re st rate s.

Fa m ily covera ge a va i la b l e . You d on’ t have to ap p l y i n ord er to cover yo u r s p o u s e, c h i l d re n , and grandchildre n. G uarante ed p remi um. A s l ong as you pay your p re mi ums , t h e co st o f yo u r li fe i nsuran ce polic y can ne ver go up. G uarante ed ca sh va lue. The cash val ue i l l ust rate d at t he t i m e o f p u rch a s e, wh en yo u rea ch age 65, is guarantee d as l ong as your cove rage stay s i n fo rce.* G uarante ed p or ta b i li ty. Eve n i f your e mp l oy me nt c hanges , yo u ca n keep t h i s coverage and pay us direct l y for t he p re mi ums. G uarante ed a d d i ti on a l p u rch ase . If you b uy a mi ni mum a m o u n t o f covera ge, yo u g uaran te e yourself the right to p urc hase any re mai ni ng p o r t i o n o f t h e gu a ra n tee i s sue lim it at future approve d e nrol l me nts ( sub j e ct to p ro d u ct a n d pa yro ll d ed u ct i o n a va i l a bi l ity).

W h at‘s t h e r i gh t covera ge fo r yo u ? W e kn ow it’s not easy to fi g ure out w hi c h i nsurance fi ts yo u r n eed s . W h o le li fe i nsuran ce provides protect i on and fi nanc i al se c ur i t y t hat ca n en s u re yo u r fa m i ly i s ta ken ca re of when the un ex p e cte d hap p e ns. S peak with a representative to tal k ab out w hat mi g ht wor k fo r yo u a n d yo u r fa m i ly.

ADDITIONAL CATASTROPHIC LOSS RIDER AVAILABLE

12

Late Entrants and any amount above Guaranteed Issue require answering specific medical questions. For more information, please contact Collateral Educators.

CHILD WHOLE LIFE

Wh o l e L i fe Protection Exc l usi ve l y for t he Chi l d re n and Gra n d ch i ld ren o f A la ba m a Ed u cato rs

THE CHILDREN‘S WHOLE LIFE INSURANCE PROGRAM FEATURES • GUARANTEED LE V EL DEATH B EN EF I T • GUARANTEED LE V EL P REM I U M S (VA RY BY I SS U E AG E ) • GUARANTEED CA S H VA LU E GROWTH • CONVENIENT PAY ROL L DEDU CTI ON P REM I U M PAY ME N TS • NO MEDICAL EX AM REQU I RED • PORTABLE • P OLICY LOANS AVA I L A B L E

ISSUE AGE

FACE AMOUNT

MO. PREM.

0

$24,241

$9.75

1

$23,754

$9.75

2

$23,173

$9.75

3

$23,885

$9.75

4

$21,885

$9.75

5

$21,342

$9.75

6

$19,696

$9.75

7

$19,177

$9.75

8

$18,501

$9.75

9

$18,008

$9.75

10

$17,508

$9.75

11

$16,912

$9.75

12

$16,357

$9.75

13

$15,810

$9.75

14

$15,273

$9.75

15

$14,722

$9.75

16

$14,238

$9.75

17

$13,722

$9.75

*CES is a licensed insurance broker and receives compensation for the sales and marketing of insurance products. EBC receives compensation solely for administrative services related to the facilitation of payroll deductions.

13

VOLUNTARY AD&D

Yo u r n eed s var y g reat l y upo n a ge, nu m b er of d ep end ents , d ep ende nts age s and your f inancial sit u at i o n . Vo l u n tar y AD & D i s des igned to p ro­v id e b enefits to you r de signate d be ne f iciar y for loss of l i fe.

ALL FULL-TIME, ACTIVE MEMBERS & RETIREES ENROLLED PRIOR TO RETIREMENT

ALL OTHER RETIREES NOT ENROLLED PRIOR TO RETIREMENT

• B enefit a mounts up to $500,000* • $10,000 m i ni mum b e ne fi t • Available i n i nc re me nts of $10,000

• Be ne f i t a m o u n ts u p to $ 2 5 , 0 0 0 • $ 5 , 0 00 m i n i m u m b en ef i t • Avai l a b le i n i n crem en ts o f $ 5 , 0 0 0

SPO USE B E N E FI T AM O U N T

• B enefit a mounts up to $ 2 5 0 , 0 0 0 (not to exce e d 5 0 % of t he e mp loyee’s b e ne fi t ) • $10,000 m i ni mum b e ne fi t • Available i n i nc re me nts of $5,000

• Be ne f i t a m o u n ts u p to $ 1 2 , 5 0 0 ( n ot to exceed 5 0 % o f t h e em p loyee’s b e ne f i t ) • $ 5 0 0 m i n i m u m b en ef i t • Avai l a b le i n i n crem en ts o f $ 5 0 0

CH I LD B E N E FI T AM O U N T

• B enefit a mounts up to $ 5 0 , 0 0 0 (not to exce e d 1 0 % of t he employee’s b e ne fi t ) • $10,000 m i ni mum b e ne fi t • Available i n i nc re me nts of $5,000

• Be ne f i t a m o u n ts u p to $ 2 , 5 0 0 ( n ot to exceed 1 0 % o f t h e em p loyee’s b e ne f i t ) • $ 5 0 0 m i n i m u m b en ef i t • Avai l a b le i n i n crem en ts o f $ 5 , 0 0 0

EM PLOYEE B E N E FI T AM O U N T

COVE RE D LO SSE S

I NCLU DED BE N E FI TS

• • • • • • •

Loss o f l i fe Loss o f b ot h hand s or b ot h fe et Sight of b ot h e ye s One hand and one foot One hand and si g ht of one e ye One foot and si g ht of one e ye 50% of t he b e ne fi t w i l l b e pai d for t he lo s s o f ; o n e h a n d o r o n e foot , or si g ht of one e ye • Loss o f hand or foot means comp l ete s e vera n ce a b ove t h e wr i st o r above t he ankl e j oi nt . • Loss o f si g ht must b e total and non- recovera b le. • • • •

Seat Be l t Be ne fi t Educat i on Be ne fi t Repatri at i on of Re mai ns Additio nal b e ne fi ts may b e avai l ab l e , p lea s e re vi e w yo u r cer t i f i cate

* Amounts over $250,000 cannot exceed 10 times annual salary.

Monthly Employee, Spouse and Child premium rates per $1,000 of Coverage Selected:

14

Employee

$.08

Employee + Spouse

$.08

Employee + Child(ren)

$.08

CRITICAL

ILLNESS WITH CANCER

T h i s p l a n pay s a l u m p su m benefit d irect l y t o you a nd you r cov e r e d de pe nde nts upon diagno sis of a covere d cri t i cal i l l n e s s.

BENEFIT DETAILS EMPLOYEE

SPOUSE

CHILD

BENEFIT AMOUNT

Choice of $5,000 increments up to $50,000

Choice of $5,000 increments up to $25,000

Choice of $5,000 or $10,000

MINIMUM AMOUNT

$5,000

$5,000

$5,000

MAXIMUM AMOUNT

$50,000

Up to 50% of employee amount

Up to 25% of the primary insured amount

REDUCTIONS

Benefits reduce to 50% at age 70

COVERED SPECIFIC CRITICAL ILLNESS

PERCENT OF BENEFIT AMOUNT

Heart Attack (Myocardial Infarction)

100% of selected benefit amount

Stroke

100% of selected benefit amount

Major Organ Transplant

100% of selected benefit amount

End Stage Renal Disease

100% of selected benefit amount

Severe Burns

100% of selected benefit amount

Coronary Artery Bypass Surgery

30% of selected benefit amount

Alzheimer’s Disease

100% of selected benefit amount

Angioplasty/Stent Insertion

30% of selected benefit amount

Cancer

100% of selected benefit amount

Carcinoma in situ

30% of selected benefit amount

Skin Cancer

$300 one-time (lifetime)

Coma

100% of selected benefit amount

Paralysis

100% of selected benefit amount

ALS (Lou Gehrig’s Disease)

100% of selected benefit amount

Loss of Sight/Speech/Hearing

100% of selected benefit amount

Benign Brain Tumor

100% of selected benefit amount

SEE BROCHURE FOR PLAN DETAILS & INDIVIDUAL RATES HEALTH SCREENING BENEFIT

We will pay a total of $50 per calendar year for a covered person (maximum 2 people per year) to undergo one of the covered tests or exams listed below.

• Stress test on a bicycle or treadmill • Fasting blood glucose test • Blood test for triglycerides • Lipid Panel (total cholesterol count) • Bone marrow testing • CA 15-3 (blood test for breast cancer) • CA 125 (blood test for ovarian cancer) • CEA (blood test for colon cancer) • Chest X-ray • Electrocardiogram (EKG)

• Colonoscopy • Flexible sigmoidoscopy • Hemocult stool analysis • Mammography/Breast Ultrasound • Pap smear (including ThinPrep Pap Test) • PSA (blood test for prostate cancer) • Serum Protein Electrophoresis (blood test for myeloma) • Thermography • Oral Cancer screening using ViziLite OraTest or other similar test • Biopsy for Skin Cancer

15

CANCER INSURANCE

C a n cer i n s uran ce h e l ps t h o se d ia g nos ed wit h ca ncer t o s t a y focuse d on r e cove r y by alle viating some of t h e f i nan ­c i al b urde n as socia t ed wit h t h e cos t of ca ncer t rea tme nt. BENEFITS

PLAN A

PLAN B

PLAN C

Radiation & Chemotherapy

$5,000 per 12 months

$10,000 per 12 months

$20,000 per 12 months

Blood, Plasma, and Platelets

$5,000 per 12 months

$10,000 per 12 months

$20,000 per 12 months

New or Experimental Treatment

$5,000 per 12 months

$10,000 per 12 months

$10,000 per 12 months

Wellness Benefit

$75/year

$100/ year

$100/ year

Non-Local Transportation

Airfare or $0.50.mile

Airfare or $0.50.mile

Airfare or $0.50.mile

Physical Therapy & Speech Therapy

$25/day

$25/day

$25/day

At Home Nursing

$100/day

$100/day

$100/day

Hospital Confinement (up to 70 days of confinement)

$100/day

$100/day

$100/day

Extended Benefits (after 70 days of hospital confinement)

$100/day

$200/day

#200/day

Private Duty Nurse

$100/day

$100/day

$100/day

Ambulance

$100 per confinement

$200 per confinement

$200 per confinement

Hospice Care

$100/day

$100/day

$100/day

CANCER TREATMENT BENEFITS Charges up to the maximum shown each 12 month period beginning with the first day of benefit under this provision for covered treatment techniques used for modification or destruction of cancerous tissue. Charges up to the maximum shown each 12 month period beginning with the first day of benefit under this provision for blood, plasma, and platelets (including transfusions and administration charges); processing and procurement costs; and cross matching. Donor replaced blood is not covered. Charges up to maximum shown for each 12 month period beginning with the first day of treatment under this provision when the attending physician judges such treatment necessary and no other generally accepted treatment produces superior results in the opinion of the attending physician.

WELLNESS & NON-MEDICAL BENEFITS Pays benefit of amount shown each year for each covered person for one of the following cancer screening tests: Bone Marrow Testing; CA15-3 (blood test for breast cancer); CA125 (blood test for ovarian cancer); CEA (blood test for colon cancer); chest x-ray; colonoscopy; flexible sigmoidoscopy; hemocult stool analysis; mammography, including breast ultrasound; Pap smear, including ThinPrep Pap Test; PSA (blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); or biopsy for skin cancer. This benefit is payable only once for each covered person each calendar year. This benefit is paid regardless of the result of the test(s). Up to 700 miles for round trip personal vehicle for round trip personal vehicle transportation for treatment at a hospital (inpatient or outpatient). Does not cover transportation for anyone other than covered person requiring treatment.

HOSPITAL BENEFITS

Charges up to the amount shown each day for confinement in a licensed freestanding hospice care center. Benefits payable for hospice care centers that are designated areas of hospitals will be paid the same as inpatient hospital confinement. Payable only if admission occurs within 14 days after a period of inpatient hospital confinement.

16 16

BENEFITS

PLAN A

PLAN B

PLAN C

$1,500 schedule

$3,000 schedule

$3,000 schedule

150% inpatient

150% inpatient

150% inpatient

Anesthesia

25% of surgical benefit

25% of surgical benefit

25% of surgical benefit

Skin Cancer

Actual charges up to $150

Actual charges up to $300

Actual charges up to $300

$2,000

$2,000

$2,000

SURGERY BENEFITS Surgery Inpatient Outpatient

FIRST OCCURRENCE RIDER Initial Diagnosis Benefit

?

DIDYOU KNOW

1.7 MILLION

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

BENEFIT TYPE

ISSUE AGES 17-64 INDIVIDUAL

FAMILY

Plan A

$13.05

$21.95

Plan B

$21.80

$38.20

Plan C with Additional Benefit Rider

$36.35

$65.66

BENEFIT TYPE

13%

of all new cancer diagnoses are for

“RARE FORMS” (American Cancer Society, 2017)

ISSUE AGES 65-74 INDIVIDUAL

FAMILY

Plan A

$31.05

$52.00

Plan B

$51.80

$90.50

Plan C with Additional Benefit Rider

NA

NA

17

ACCIDENT INSURANCE

A cc i d e n t i n su ran ce h elp s pay fo r unex pected healthcare ex penses due to injurie s t hat occ ur e ve r y d a y – from t he s o cce r fi e l d to th e s ki s lo p e an d the highway in-bet ween. Acc ident insurance p rov id e s be n e fits d ue to cove re d acc i d e nts fo r in itial care, in ju r ies, and follow-up care.

LOSS OR TREATMENT ACCI DE N T TREATMENT Physician Office/ Urgent Care Initial Visit (within 60 days of a covered accident)

$50

Emergency Treatment (within 72 hours)

$200

Emergency Dental (crown/extraction)

$300/$100

Major Diagnostic Imaging (medical imaging /x-rays)

$200 /$500

Lacerations

Up to $1000

Burns (based on severity)

From $1,500 up to $20,000

Eye Injury

$500

Dislocation Closed (with anesthesia) Open (with anesthesia) Closed (without anesthesia)

$200 - $4,000 $400 - $8,000 25% of the closed with anesthesia benefit

Fractures Closed Open Chips

$100 - $5,000 $200 - $10,000 25% of closed benefit

HO SPI TA L CAR E Initial Hospitalization

$2,000

Hospital Confinement (per day up to 365 days)

$500

Hospital ICU (per day up to 15 days)

$1,000

Ambulance (air/ground)

$1,000/$200

Blood, Plasma, Platelets

$200

FO LLOW-UP

18

Physician Follow-Up (per day visit, up to 2 visits)

$100

Physical Therapy (per day visit, up to 10 visits)

$30

Appliance (within 90 days, for locomotion or mobility)

$100

Prosthetic Device (one/ more than one)

$1,000 / $2,000



LOSS OR TREATMENT FO L LOW-U P (CONT.) Lodging (per day, up to 30 days, must be more than 100 miles round trip from residence of the insured)

Transportation (per round trip, up to 3, must travel more than 100 miles round trip for treatment)

$200 $600

S URGE RY Tendon/Ligament/ Rotator Cuff One More than one Exploratory without repair

$1,200 $1,800 $300

Torn Knee Cartilage (surgery w/ repair/ exploratory surgery)

$1,500 $300

Ruptured Disc

$1,000

HEALTH SCREENING BENEFIT RIDER Pays $50 for any one or more of the following health screening tests listed below performed by a Physician more than 30 days after the rider effective date. Benefit is payable once per calendar year per insured person. 1. Biopsy for Skin Cancer 2. Blood test for triglycerides 3. Bone marrow testing 4. CA 125 (blood test for ovarian cancer) 5. CA 15-3 (blood test for breast cancer) 6. CEA (blood test for colon cancer) 7. Chest X-ray 8. Colonoscopy 9. Electrocardiogram (EKG) 10. Fasting blood glucose test 11. Flexible sigmoidoscopy

12. Hemocult stool analysis 13. Lipid Panel (total cholesterol count) 14. Mammography/Breast Ultrasound 15. Oral Cancer screening using ViziLite, OraTest or other similar test 16. Pap smear (including ThinPrep Pap Test) 17. PSA (blood test for prostate cancer) 18. Serum Protein Electrophoresis (blood test for myeloma) 19. Stress test on a bicycle or treadmill 20. Thermography

NOTE: This plan has a Sickness-Hospital Confinement Benefit Rider included that pays $200 per day if

confined as result of a Covered Sickness up to 30 days (see brochure page 6 for more details). SEE BROCHURE FOR PLAN DETAILS

MONTHLY PREMIUMS

GOLD PLAN

Employee

$12.61

Employee + Spouse

$23.31

Employee + Child(ren)

$28.25

Family

$38.96

1919

LONG TERM DISABILITY

Lo n g Te rm Disability insurance p rov i d e s i ncome p rote ct i o n i n t h e e ven t t h at yo u m i s s wo r k d ue to an acc ident or i l l ne ss.

LONG TERM DISABILITY BENEFITS

20

BE N EF IT AMOUNT

Inc re me nts of $ 1 0 0 not to exceed 6 0 % o f s a la r y

M I N I MUM WEEKLY BENEF IT

The mi ni mum b e ne fi t you wo u ld recei ve o n a n a p p roved c l ai m i s t he g reate r of $ 10 0 o r 1 0 % o f yo u r covera ge amo u n t .

MAXI MUM MONTHLY BENEF IT

$ 6, 0 0 0

E LI MI N ATION PER IOD

BENEFITS B E G I N O N : 0 d ay acc i d e nt / 3 rd d a y s i ck n es s 7 t h d ay acc i d e nt / 7 t h d a y s i ck n es s 1 4 t h d ay acc i d e nt / 1 4 t h d a y s i ck n es s 3 0 t h d ay acc i d e nt / 3 0 t h d a y s i ck n es s 6 0 t h d ay acc i d e nt / 6 0 t h d a y s i ck n es s

P R E -E XI STING COND ITION EXCLUSION LIMITATION

Any cond i t i on you re ce i ve m ed i ca l t reat m en t fo r i n t h e 3 mont hs p r i or to t he e ffe ct i ve d ate wi ll n ot b e covered i n t he fi rst 1 2 mon t h s o f t h e p o li c y.

MAXI MUM BENEF IT D URATION

S oc i al S e c ur i t y No r m a l Ret i rem en t A ge

RE DUCTIONS & T E RMINATIONS

Your cove rage w i l l e nd on t h e ea r li est o f t h e fo llowi n g: • The d ate The Po li c y ter m i n ates ; • The d ate The Pol i c y no lo n ger i n s u res Yo u r cla s s ; • The d ate p re mi um pay me n t i s d u e b u t n ot pa i d by Yo u r Emp loyer ; • The l ast d ay of t he p e r i o d fo r w h i ch Yo u m a ke a n y re q ui re d p re mi u m co n t r i b u t i o n ; • The l ast d ay of t he mo n t h o n o r n ext fo llow i n g t he mont h i n w hi c h Your E m p loyer ter m i n ates Yo u r e mp l oym en t ; • The d ate You cease to b e a n A ct i ve E m p loyee i n an e l i g i b l e c l ass for any rea s o n , u n les s covera ge i s exte nd e d und e r t he C o n t i n u at i o n P rovi s i o n s .

FREEDOM ID

Fre e d o m I D I d e nt i t y M a na gem en t Ser v ices prov ides perso n a l ized proactive and resolution ser v ice s to h e l p m a na ge yo u r iden t ity, reso l ve fra ud a n d m in imize damage at e ver y stage of life .

PLAN FEATURES • • • • • • •

Resolves and restores yo u r ide n t it y H elps you if yo ur pe rso n al de vice s are ha c ke d H elps you rep lace lost o r sto l e n pict u re I D’s I n vestigates yo ur cred it re po rts fo r u n u s u al a ct ivit y I n vestigates and resolve pa st is s u e s Provides p remium mo ni to rin g s e r vice s F REE fo r ide n t i t y t h eft v i ct i m s Provides case d o cume ntat io n an d c l aim a s s ista n ce fo r o u t- of- p o cket ex p en s e rei m bu rse me nt

Protect your family for less than $5 /month (for the lifestages plan)

21

NOTES

NOTES

CUSTOMER SERVICE Pho ne: 1 ( 866) 322.2244 Fax: 1 ( 866) 240.0788 E m a il: in fo @s er vin ged u cators.com