The Plan Year begins August 1, 2017 and ends July 31, 2018 TABLE OF CONTENTS. Internet Enrollment ~ On-Line Instructions...Page 2 PRE-TAX BENEFITS

Transcription

1 Cabarrus County Schools is offering all full-time employees a comprehensive Cafeteria Benefits Plan. The Cafeteria Benefits Plan is being arranged by Mark III Brokerage, an employee benefits firm that has worked in the public sector since The Cafeteria Benefits Plan allows you to pay for certain insurance premiums, child care, and unreimbursed medical expenses before taxes are taken out of your paycheck. Paying for these benefits in this method reduces your taxes and increases your take home pay. The Plan Year begins August 1, 2017 and ends July 31, 2018 TABLE OF CONTENTS Internet Enrollment ~ On-Line Instructions...Page 2 PRE-TAX BENEFITS Flexible Benefit Administrators Health Care Spending Account...Page 4 Flexible Benefit Administrators Dependent Care Spending Account...Page 15 Ameritas Dental (Passive PPO)...Page 22 Ameritas Dental (PPO)...Page 26 Community Eye Care Vision...Page 30 Allstate Benefits Cancer...Page 32 Aflac Group Accident...Page 46 Aflac Insurance Company Critical Illness Plan-with Cancer...Page 56 Aflac Insurance Company Value Added Services...Page 68 Aflac Insurance Company Critical Illness Plan-without Cancer...Page 70 AFTER-TAX BENEFITS AUL Short Term Disability...Page 81 AUL Long Term Disability...Page 86 Lincoln Financial Term Life...Page 90 Texas Life Whole Life...Page 98 DIRECT- BILL BENEFIT Liberty Mutual Auto & HomeOwners...Page 101 OTHER PLAN INFORMATION Continuation of Benefits...Page 103 Phone Directory.... Page 105 Investment & Retirement Accounts...Page 106 This booklet highlights the benefits offered through your Employer for the current plan year. This is neither an Insurance Contract nor a Summary Plan Description and only the actual policy provisions will prevail. All information in this booklet including premiums are subject to change. All policy descriptions are for informational purposes only. Page 1

2 Internet Enrollment ~ On-Line Instructions REMINDER: You will need to use Internet Explorer version 6.0 or greater. If you experience difficulty using the website, check your Internet Explorer version. Mac computers should have the latest version of Safari downloaded. If not, you may experience problems. 1. To enter the Annual Enrollment site, log onto: net/markiii 2. To Begin reviewing and electing benefits Enter Case ID: M338 Enter the Online ID which is the last 6 digits of your social security number and the initials of your first and last name. Enter the Password which is enroll17 You must type in the Security code exactly like you read it on the screen Click, Enroll Now 3. On-line Service Legal Agreement. - Please read the agreement Click Agree Clicking Agree will allow you to enter the site. Once you click agree, you will go to the Website Instruction Page The Website Instruction Page contains important information relative to the site. Take a moment to read the information provided. Click, NEXT, to continue. 4. Employee Information You can update and correct info on the Employee Information screens by clicking, Edit Click NEXT to proceed through the screen(s). WARNING: Some options will not be available to you if you do not update your dependent information on the Family Data screen. For example, if you have dental employee only coverage and you want to elect employee and spouse dental coverage, you will not be able to make this selection if you do not add your spouse information in the Family Data section. Please make certain that all dependents that should be covered for benefits are listed on the Family Data screen. Page 2

3 5. Election Summary From the Election Summary screen you can review your benefit selection(s) and print a copy for your records. To print the Election Summary, click on the print confirmation statement icon at the bottom of the page. Once you have printed, click, Log Off. Retain this print out as proof of the benefits that you selected for the plan year. Close your browser when you are finished. NOTE: The enrollment site will recall the last change made each time you log on. You may enter and exit the website and update Ameritas Dental, Community Eye Care, FBA Health & Dependent Flexible spending accounts as often as you wish from May 15, 2017 through May 21, You will not be able to make changes or enroll in these benefits after May 21, If you need to enroll or make changes to any other benefit, you MUST visit with a Mark III Counselor May 15th through May 19th. If you should have any questions, please contact one of the following persons: Rhonda Drought at , via at Rhonda.drought@cabarrus. k12.nc.us Debi McKeown at , via at Debora.mckeown@cabarrus. k12.nc.us Kathy Yount (Mark III Brokerage) at , via at kathy@ markiiieb.com Page 3

4 Flexible Benefit Administrators Health Care Spending Account Plan Year: August 1, July 31, 2018 Healthcare Flexible Spending Account Maximum: $2, Healthcare Flexible Spending Account Minimum: $250 Waiting Period: First day of the month following your hire date Run Off Period: 60 days following the end of the plan year to file for services rendered during the plan year. FLEXIBLE BENEFIT PLAN: THE BETTER YOU PLAN, THE MORE YOU SAVE! It s more than a slogan. The Flexible Benefit Plan is a real solution to issues facing all of us. Simply stated, by taking advantage of tax laws, the Flexible Benefit Plan works with your benefits to save you money. Your insurance programs are designed to help you and your family become financially secure as well as to protect you against the high cost of medical care including catastrophic events. However, almost everyone has a number of necessary, predictable expenses that are not covered by your insurance programs. The Flexible Benefit Plan will help you pay for these predictable expenses. The Flexible Benefit Plan offers a unique way to help pay for some of your health care expenses and dependent care expenses. The key to the Flexible Benefit Plan is that your eligible expenses are paid for with Tax Free Dollars. You will not pay any federal, state or social security taxes on funds placed in the Plan. You will save between, approximately, $27.65 and $37.65 on every $100 you place in the Plan. The amount of your savings will depend on your federal tax bracket. Using the Flexible Benefit Plan can save you a significant amount of money each year, however, it is important that you understand how the Plan works and how you can make the most of the advantages the Flexible Benefit Plan offers. This handbook will help you understand the Flexible Benefit Plan. The handbook covers how the Plan works, describes the categories of the Plan, explains the rules governing the Plan, the reimbursement process and how you can elect to participate in the Flexible Benefit Plan. Prior to electing to participate in the Flexible Benefit Plan, it is important that you read and understand the Rules and Regulations section of this handbook. After you read this material, if you have any questions please feel free to contact Flexible Benefit Administrators, Inc. at or FLEX NOTE: FLEX is authorized by Section 125 of the Internal Revenue Code Page 4

5 HEALTH CARE REIMBURSEMENT ACCOUNT The Health Care Reimbursement Account allows you to pay for your uninsured medical expenses with pre-tax dollars. With this account, you can pay for your out of pocket medical expenses for yourself, your spouse and all of your dependents for medical services that are incurred during your Plan Year. The minimum you may place in your account is $250. The maximum you may place in this account for the Plan Year is $2,600. EXAMPLES OF ELIGIBLE HEALTH CARE EXPENSES: FEES/CO-PAYS/ DEDUCTIBLES: Acupuncture Prescription Eye glasses/ Physician Ambulance hire Contact lenses Psychologist Anesthetist Psychiatrist Erectile dysfunction Chiropractor Hospital medication Dental Fees Laboratory Sterilization Fee Diagnostic Nursing Surgery Eye Exams Obstetrician X-Rays Laser Eye Surgery Wheel Chair OTHER ELIGIBLE EXPENSES: Prescription drugs Diabetic supplies Artificial limbs & breasts Routine Physicals (only if reconstructive) Condoms Birth control pills, patches Dentures (e.g. Norplant) Oxygen Orthopedic shoes/inserts Physical Therapy Incontinence supplies Fertility Treatments Carpal tunnel wrist supports Hearing aids and batteries Vaccinations & Immunizations Reading glasses Elastic hose Medical equipment (medically prescribed) Pedialyte for dehydration Contact lens supplies Therapeutic care for drug Take-home screening kits and alcohol addiction (HIV, colon cancer) At home pregnancy test kits Mileage, parking and tolls ( you may be reimbursed $.17 a mile plus parking and tolls when medical reasons make it necessary to travel) Tuition fees for medical care (if the college furnishes a breakdown of medical charges) Orthodontic expenses (not for cosmetic purposes) ORTHODONTIC TREATMENT IS REIMBURSED ACCORDING TO YOUR PAY- MENT PLAN WITH THE ORTHODONTIST. FOR EXAMPLE: If your payment plan is set up to pay $100 a month for the orthodontic treatment, you can be reimbursed $100 a month for the payments that become due during the Plan Year. The above list is compiled from IRS publication 502. If you are unsure that your expected medical expense will be eligible under tax code regulations, please call Flexible Benefit Administrators at or FLEX before making your election for the Plan Year. IRS publication 502 can be ordered by calling the IRS at * Mileage reimbursement rate is based on IRS regulation and subject to change. FLEX NOTE: You can save between 28% and 38% in taxes on every $100 you place in the Plan. Page 5

6 OVER-THE-COUNTER DRUGS Please be advised that Senate legislation has stated that effective January 1, 2011 participants are required to have a prescription for Over-the-Counter ( OTC ) products to be eligible under their FSA plan. Therefore a prescription or letter of medical necessity is now required for OTC items. OVER -THE-COUNTER EXPENSES Examples of medications and drugs that may be purchased in reasonable quantities with a prescription or letter of medical necessity: Antacids Pain relievers/aspirin Ointments & creams for joint pain First aid creams (Bactine, diaper rash) Allergy & sinus medication Cough & cold medications Laxatives Anti-diarrhea medicine Bug-bite medication OVER-THE-COUNTER EXPENSES THAT ARE NOT ELIGIBLE The following examples are OTC items that are not eligible and will not be reimbursed under any circumstances because the items are considered dietary supplements, toiletries, cosmetic or personal use items: Multi/Daily Vitamins Weight loss products/foods Face cream/moisteners Mouthwash/toothpaste Feminine hygiene products Deodorant Chapstick Suntan lotion Herbal/natural supplements Acne creams/face cleanser Medicated shampoo/soaps Toothbrushes (even if dentist recommends a special one) Eye/facial makeup/preparations Rogaine DUAL PURPOSE DRUGS & ITEMS EXPENSES THAT NEED DOCUMENTATION FROM YOUR PHYSICIAN TO BE ELIGIBLE THROUGH THE HEALTH CARE ACCOUNT The following items are examples of products that are considered as having both a medical purpose and a general health, personal/cosmetic purpose and require a medical practitioner s note stating the name of the patient, the specific medical condition for which the OTC is recommended, the time frame of the treatment and that the treatment is not cosmetic: Weight-loss drugs (to treat obesity) Nasal sprays for snoring Pills for lactose intolerance Fiber supplements (to treat a medical condition for a limited time) OTC Hormone therapy (to treat menopausal symptoms) St. John s Wort (for depression) Page 6

7 EXPENSES FOR IMPROVEMENT OF GENERAL HEALTH are not eligible for reimbursement even if a doctor prescribes the program. However, if the program is prescribed for a specific medical condition (e.g. Obesity, Emphysema), then the expense would be eligible. We must have a letter from your doctor on file for each Plan Year stating specifically what illness or disease is being treated or prevented and the length of time you will be required to use this treatment in order to reimburse for any of these types of expenses. Health Club Dues Weight Loss Programs Wigs Exercise classes Exercise equipment NOTE: For Weight Loss Programs, only the cost of the program is an eligible expense. Any cost for food or food supplements is not an eligible expense. COSMETIC expenses, prescriptions and treatments are not eligible. This applies to any procedure that is directed at improving the patient s appearance and does not meaningfully promote the proper function of the body or prevent or treat an illness or disease. If cosmetic treatment is necessary to correct a deformity or abnormality, a personal injury or a disfiguring disease, it must meet IRS eligibility guidelines outlined in IRS publication 502 and will require a physician s letter of medical necessity. OTHER EXPENSES THAT ARE NOT ELIGIBLE FOR REIMBURSEMENT THROUGH THE HEALTH CARE ACCOUNT ESTIMATES for medical expenses that have not been rendered cannot be reimbursed. Medical services do not have to be paid for, however, the services must have been rendered during the Plan Year, to be eligible for reimbursement. PREMIUM EXPENSES for any insurance policies are not eligible for reimbursement through the Health Care Account. This includes contact lens insurance. EXPENSES PAID BY AN INSURANCE COMPANY are not eligible for reimbursement through the Health Care Account. Only the portion you have to pay out of your pocket for your medical expenses is eligible for reimbursement. CLAIMS SUBMISSION OBTAINING A REIMBURSEMENT FROM YOUR HEALTH CARE ACCOUNT To obtain a reimbursement from your Health Care Account, you must complete a Claim Form. This form is available from your employer's website (see sample claim form at the end of this summary). You must attach a receipt or bill from the service provider which includes all the pertinent information regarding the expense: Date of service Patient s name Amount charged Provider s name Nature of the expense Amount covered by insurance (if applicable) Page 7

8 Cash register receipts, credit card receipts and canceled checks alone are not eligible forms of documentation for medical expenses. These items are not considered third party receipts because they only reflect that payment has been made and do not provide the required information listed above. Prescription documentation must include the name of the prescribed medication. OBTAINING A REIMBURSEMENT FOR OVER-THE-COUNTER ITEMS For the purchase of over-the-counter medications, with a prescription or letter of medical necessity, cash register receipts will be accepted as documentation if the receipt is detailed and indicates the name of the service provider, the date of the purchase, the amount of the purchase and the name of the product purchased. You must also send in a copy of the prescription or letter of medical necessity signed by a physician, along with your claim form. If the receipt does not specifically reflect the name of the product we cannot accept the claim for reimbursement of that item. The name of the patient does not have to be on the receipt, however, the name of the patient must be listed on the claim form. NOTE: In order to be eligible for reimbursement through the Health Care Account, the medical expense must be incurred during the Plan Year. IRS defines incurred as when the medical care is provided (or date of service), not when you are formally billed, charged for, or pay for the care. FOR EXAMPLE: If you go to the doctor on December 26th and your Plan Year begins on January 1st, this expense is not eligible in the new Plan Year. Even if you pay for this expense after January 1st, the date of service was before the Plan Year began and therefore is not eligible. THE HEALTH CARE ACCOUNT IS A PRE-FUNDED ACCOUNT This means that you can submit a claim for medical expenses in excess of your account balance. You will be reimbursed your total eligible expense up to your annual election. The funds that you pre-fund will be recovered as deductions continue to be deposited into your account throughout the Plan Year. FLEX NOTE: The minimum you may place in your Health Care account is $250. The maximum you can place in your Health Care Account is $2,600. Page 8

9 THE BENEFITS CARD The Benefits Card system allows you to pay for eligible pre-tax account expenses electronically at approved service providers and merchants. The Benefits Card provides you with instant access to your pre-funded Health Care Reimbursement Account for many common regular eligible expenses. You may also enjoy the convenience of paying for your childcare expenses (up to your account balance at the time of the swipe ) with the Benefits Card. In order for you to get the most benefit from your Plan, we want to remind you of a few things concerning the Benefits Card. The Benefits Card works just like a debit card, only your bank account consists of the funds you elected to set aside in your pre-tax account(s). The card is not eligible for use at ATMs or other unqualified merchant locations. The card will be denied at the point of sale when a transaction at an ineligible location is attempted. If an eligible provider does not accept MasterCard, you must file a paper claim. When using the card at a self-service merchant terminal, you may select the credit or debit option (with your PIN). How To Receive Your PIN: The most cost effective way to provide a cardholder their PIN is to use the e-pin delivery functionality. e-pin delivery provides a simple and secure way for participants to view their PIN on the FBA WealthCare Portal. The FBA WealthCare Portal Debit Card page provides a View PIN button next to each card number. Upon clicking View PIN, The FBA WealthCare Portal pops-up a new window containing the card s four digit PIN. Detailed information will also be available on our website at Your card will be mailed to your home address via first class mail. Please allow up to two weeks for delivery of your card. If you do not receive your card two weeks after the start of your Plan Year, contact Flexible Benefit Administrators, Inc. so that a replacement card may be ordered. Any eligible expense incurred during that time may be reimbursed by mailing, faxing or ing a claim form and proper documentation to Flexible Benefit Administrators, Inc., following the customary claims filing procedure and cutoff times. When you receive your card, sign the back of the card prior to using it. Your card is activated upon the first swipe of your card. Continue to save all receipts. Flexible Benefit Administrators, Inc. may request them to verify expense eligibility. Page 9

10 Flexible Benefit Administrators, Inc. will notify you by mail or if you incur an expense with the card that is or appears to be ineligible. Upon this notice you must send Flexible Benefit Administrators, Inc. a Transaction Substantiation Form with the corresponding itemized documentation within 40 days of the transaction; you may download and print a Transaction Substantiation Form from our website. If you do not send in those required items, your card will be deactivated until the documentation is received. Your transaction will be denied for any amount greater than your health care reimbursement account annual election or your dependent care reimbursement account posted balance at the time of the swipe. You should notify Flexible Benefit Administrators, Inc. immediately if your card is lost or stolen to deactivate the card. If your employment is terminated, your card will be permanently deactivated. You may monitor your account balance, transaction history or print a statement at any time, night or day on the Benefits Card website: com/fba Additional information regarding the Benefits Card is available on our website: You may also download the Transaction Substantiation Form from our website under Participants; Forms. You may also elect to have an additional Benefits Card for your dependent(s) over the age of 18. Attention: Benefits Card Participant Subject: Benefits Card Use In light of IRS Rulings on Benefits Card use, it is important that you make yourself familiar with the cardholder agreement that accompanies your Benefits Card. Flexible Benefit Administrators, Inc. strongly suggests reviewing this document and making yourself and any dependent cardholders in your household aware of the terms. Please be aware that upon receipt and signing of your Benefits Card, you, as the cardholder and employee participant of the Plan are ultimately responsible for using the card for eligible expenses. This also applies to any dependent that has use of the Benefits Card. By signing the back of the card, the employee/dependent is agreeing to the terms and conditions of this agreement. As in the past, your responsibility as a participant in a tax-free plan, is to use the card for eligible expenses ONLY (such as prescriptions, eyeglasses and medical co-pays, etc.) As with paper claim submission, cosmetic prescriptions and procedures as well as over the counter medications and products are not eligible for reimbursement. Please remember that each time you use your card you are certifying that the expense is eligible. If you have any doubt as to whether an expense is eligible or not you should refer to your employee handbook, IRS Publication 502 or call our office to speak with one of our administrators. It is also your responsibility to acquire all documentation such as receipts, EOBs, etc. for the Plan Year s expenses and to retain the documentation for the entire Plan Year. Page 10

11 If you are aware that you have paid for an expense with the card that is ineligible it is your responsibility to notify Flexible Benefit Administrators, Inc. immediately. You will need to submit a paper claim form with substantiating documentation along with repayment for the amount of the ineligible expense. Flexible Benefit Administrators, Inc. may request documentation to substantiate your Benefits Card transactions to determine eligibility of the expense. In the event that your documentation shows ineligible expenses were paid with your Benefits Card, Flexible Benefit Administrators, Inc. will request that you re-pay the amount of the ineligible expense. If the payment is not received in the allotted time frame your card will be de-activated. Also, Flexible Benefit Administrators, Inc. may offset future claims and notify your employer. IRS rulings allow your employer to withhold this amount from your wages if necessary. The Benefits Card is NOT PAPERLESS, just less paper and is a great convenience for the participants in the Plan, if used properly. PLEASE NOTE: Eligible items purchased at participating Inventory Information Approval System (IIAS) merchants will be automatically approved! When purchasing prescriptions and/or over-the-counter FSA eligible items, the merchant s IIAS will verify the items and automatically approve the transaction with no follow-up request. The benefits card is not accepted at merchants who have not implemented IIAS. Please visit com and select IIAS Merchants List for the most recent list of IIAS merchants. RULES AND REGULATIONS CLAIM FILING DATES All claims received in the office of Flexible Benefit Administrators, Inc. will be processed within one week via direct deposit or check. COMMON ERRORS TO AVOID WHEN FILING CLAIMS The claim form is not signed Canceled checks, cash register receipts or credit card receipts are sent in place of receipts or bills from the provider of service Cash register receipts for OTC item(s) do not indicate the specific name of the product(s) purchased Claim form has not been completed Insufficient postage on envelope Previous balance statements or payment on account receipts submitted in place of actual date of service itemized bills or receipts Your claim form may be returned to you or delayed in processing for improper or insufficient documentation. If you have questions about your claims, you may contact Flexible Benefit Administrators, Inc. at (757) or (800) 437.FLEX, from 8:30 a.m. to 5:00 p.m., Monday through Friday. REIMBURSING THE PROVIDER OF SERVICE All reimbursements will be sent to you directly. After receiving payment from your account, you are responsible for paying your providers. Page 11

12 ELIGIBLE DEPENDENTS An individual is considered to be a dependent if he or she is a qualifying child or qualifying relative of the taxpayer. The following qualifying criteria now apply. To be a dependent child : the individual is a child to the participant, and the individual doesn t turn 27, regardless of any other status by the end of the taxable year. In addition, the following qualifying criteria apply to be a dependent relative : the individual has a specific family type relationship to the taxpayer, the individual is not a qualifying child of any other taxpayer, the individual receives more than half of his or her support from the taxpayer, and the individual s annual gross income is less than the Section 151 limit ($4,050 for 2016); this criteria does not apply to health plans). GRACE PERIOD FOR FILING CLAIMS You have the entire Plan Year plus 60 days to file all claims that were incurred during the Plan Year. All claims must be received in the office of Flexible Benefit Administrators, Inc. by 5:00 p.m. on the 60th day, following the end of your Plan Year. If claims are not received during this time frame for expenses incurred during the Plan Year, your remaining funds will be forfeited. (Remember 60 days does not mean 2 months and received in the office does not mean the day it was postmarked). Please, do not delay; complete your claims early. FORFEITING FUNDS Any money you do not use from a reimbursement account for expenses incurred during a Plan Year will be forfeited. The forfeited funds will be returned to your employer to offset the cost of the program. If you plan carefully, you can avoid being affected by this IRS restriction. CHANGES IN YOUR ELECTION No, generally you cannot change the elections you have made after the beginning of the PLAN YEAR. However, there are certain limited situations when you can change your elections. You are permitted to change elections if you have a change in status and you make an election change that is consistent with the change in status. Currently, Federal law considers the following events to be changes in status : Marriage, divorce, death of a spouse, legal separation or annulment; Change in the number of dependents, including birth, adoption, placement for adoption, or death of a dependent Any of the following events for you, your spouse or dependent: Termination or commencement employment, a strike or lockout, commencement or return from an unpaid leave of absence, a change in worksite, or any other change in employment status that affects eligibility for benefits; One of your dependents satisfies or ceases to satisfy the requirements for coverage due to change in age, student status, or any similar circumstance; and A change in place of residence of you, your spouse, or dependent. This applies ONLY to Dependent Care and ONLY if that change in residence results in a change of dependent care service provider and its cost. In addition, if you are participating in the Dependent Care Reimbursement Account, then there is a change in status if your dependent no longer meets the qualifications to be eligible for dependent care. Page 12

13 You may not change your election under the Dependent Care Reimbursement Account if the cost change is imposed by a dependent care provicer who is your relative. To make a change in your elections, a STATUS CHANGE FORM must be completed within 30 days of the event. Flexible Benefit Administrators, Inc. or your benefits contact person will determine if your requests for an election change meets IRS Regulations. TRANSFERRING FUNDS BETWEEN ACCOUNTS IRS regulations do not allow money to be transferred between reimbursement accounts. If you elect funds to be placed in your Health Care Account, you must submit eligible medical expenses to be reimbursed from these funds. This IRS regulation also applies to the Dependent Care Account. TERMINATION OF EMPLOYMENT If you have funds in your Health Care Account and you submit receipts for expenses incurred prior to your termination, you can be reimbursed for funds remaining in your account up to your annual election. However, if you have money left in your Health Care Account and do not have receipts for expenses incurred prior to your termination, you cannot be reimbursed for the money remaining in your account unless you elect to participate in the federal program, COBRA. If you elect to participate in COBRA, you will need to continue to set aside dollars on an after tax basis to be deposited into your Health Care account. You can receive information concerning this program from the contact person in your company. Your Dependent Care Account functions differently. If you have funds remaining in these accounts, this money will be reimbursed to you if appropriate receipts are submitted. You can receive reimbursement for expenses incurred during the Plan Year if receipts are submitted within the Plan Year and before the end of the 60 days grace period following the Plan Year end. EFFECT ON SOCIAL SECURITY BENEFITS As you are not paying social security tax on the portion of your income that has been placed in the Plan, your social security benefits may be slightly reduced. We suggest putting part of your tax savings into your Employer s Retirement Program or some other savings vehicle. ACCOUNT BALANCES You may call Flexible Benefit Administrators, Inc. at or from 8:30 a.m. to 5:00 p.m., Monday through Friday, to check your account balance. You may also access your personal account information at your convenience via our secure website: Each reimbursement check stub will show your contributions, request for reimbursements, and disbursements. It will also show your annual election and the balance to request by the end of the Plan Year for each account. A reminder letter will be sent two months prior to the end of the Plan Year if you have funds left in your account. Page 13

14 FBA ANNOUNCES ITS ONLINE PHARMACY!! Busy day and don t have time to stop by the drugstore? Do you have unspent money in your FSA? Looking for savings from the comfort of your couch? Here s how! Visit Click on FSAStore.com it s free to use! Shop and purchase items online at discounted pricing! You may use your FBA Benefits Card for eligible FSA items (marked FSA approved)* and not have to submit receipts! Purchase non-eligible FSA items using your own personal payment method. All items are shipped directly to you! Free shipping on purchases over $50.00! Visit our website now to start making your life a little easier! * Please note if you do not have a FBA Benefits Card, you may purchase FSA Approved items out of pocket and submit to FBA for reimbursement. Page 14

15 Flexible Benefit Administrators Dependent Care Spending Account Plan Year: August 1, July 31, 2018 Dependent Care Flexible Spending Account Maximum: $5,000 Dependent Care Flexible Spending Account Minimum: $0 Debit card CAN be used with the Dependent Care account The Dependent Care Reimbursement Account allows you to pay for day care expenses for your dependents with tax-free dollars. ELIGIBLE DEPENDENT A child under 13 who qualifies as a dependent on your Federal Income Taxes Any other dependents, including a disabled spouse, disabled children over age 13 and elderly parents, who depend on you for financial support, qualify as dependents for tax purposes, and are incapable of self care A dependent, as revised under Section 152 of the Code by the Working Families Tax Relief Act of 2005 (WFTRA) ELIGIBLE DEPENDENT CARE EXPENSES For dependent care expenses to be eligible for reimbursement, you must be working during the time your eligible dependents are receiving care. If you are married, your spouse must be: Working at the time the day care services are provided; A full-time student for at least five months during the year; or Mentally or physically disabled and unable to provide care for him or herself EXPENSES FOR KINDERGARTEN are not eligible for reimbursement since they are generally for education, and not for custodial care. In order for an expense to be eligible for reimbursement from the Dependent Care Reimbursement Account, the primary purpose for the care of the qualifying individual must be to assure the individual s well-being and protection. Dependent care must still be primarily for custodial care, not education, in order to qualify as an eligible employment-related expense from the Dependent Care Reimbursement Account. EXAMPLES OF DEPENDENT CARE EXPENSES Babysitters or Nannies that claim the child care as income on their taxes Licensed day care centers Private Preschool Before and after school care Day care for an elderly or disabled dependent EXPENSES THAT WOULD NOT BE ELIGIBLE THROUGH THE DEPENDENT CARE ACCOUNT Kindergarten (kindergarten & above is considered an educational expense) Days you or your spouse are not working including sick leave, vacation days, and maternity leave Page 15

16 Transportation, books, clothing, or entertainment (Note: These expenses will be covered if provided by the nursery school or day care center as part of its preschool care services. If these types of expenses are billed separately, they are not an eligible expense.) Care provider may not be a child of yours under the age of 19 or anyone you claim as a dependent for federal income tax purposes Babysitting for social events OVERNIGHT CAMP: Overnight camp is not an eligible expense, only DAY CAMPS are eligible. Remember that this account is set-up so that you and your spouse are able to go to work and Overnight camp is 24-hour care. ANNUAL MAXIMUM FOR THE DEPENDENT CARE REIMBURSEMENT ACCOUNT Must Not Exceed The Lesser Of: $5,000 for one or more children ($2,500 if you are a married individual filing a separate tax return); Your wages or salary for the Plan Year; or The wages or salary of your spouse If your spouse is either a full time student or is incapable of taking care of himself or herself then he or she is deemed to have monthly earnings of $250 if there is one (1) child or dependent, and $500 if there are two (2) or more children or dependents. USING THE DEPENDENT CARE REIMBURSEMENT ACCOUNT VERSUS FILING FOR A TAX CREDIT ON YOUR TAXES Under current IRS regulations, you may be eligible to receive a tax credit for dependent care costs. You may claim a credit for dependent care, up to $3,000 for one child and $6,000 for two or more children, on your income taxes through the child care tax credit. However, through the Dependent Care Reimbursement Account you may set aside up to $5,000 per year, for one or more children, if you are married and filing a joint tax return or if you are a single parent. If you are married and filing separate tax returns, you may set aside only $2,500. Typically, more money is saved by paying for dependent care through the FSA Dependent Care Reimbursement Account than by taking the dependent care credit on your tax return. This is because the total for federal, state, and FICA savings usually exceeds the dependent care credit. At taxable incomes greater than $14,000, participants will probably benefit more from taking reimbursement from the Flexible Benefit Plan. These assumptions are based on the inclusion of your state income tax. You can also file for the tax credit while participating in the Dependent Reimbursement Care Account. If the amount you have placed through the reimbursement account does not meet the maximum allowed by the IRS, you can claim the difference between your Dependent Care deductions and the IRS maximum allowable expenses for the tax credit. You can claim a tax credit for any additional dependent care expenses incurred over the $5,000 maximum FSA limit up to the $6,000 child care tax credit limit on your taxes. Page 16

17 You cannot claim the tax credit for any dependent care expenses paid from the Dependent Care Reimbursement Account. It is your responsibility to report the Dependent Care amount on your tax form The amount is listed on your W-2 under Dependent Care Benefit for the tax year. If you are not sure about the eligibility of an expense, phone Flexible Benefits Administrators at or FLEX or refer to IRS Publication 503: Dependent Care Expenses. This publication can be ordered by calling the IRS at OBTAINING A REIMBURSEMENT FROM YOUR DEPENDENT CARE REIMBURSEMENT ACCOUNT To obtain a reimbursement from your Dependent Care Reimbursement Account you must complete a Claim Form. This claim form is available from your employer (See sample Claim Form at the end of this summary). You must attach a receipt from the service provider which includes all of the following: Name of dependent receiving care Date(s) care was provided (must match Claim Form) Name of service provider Social Security or Tax I.D. number of the provider Amount of the charge NOTE: Dependent care expenses can only be reimbursed after the care is provided. This means that advance payments of dependent care expenses cannot be made. FOR EXAMPLE: If you pay for a summer day camp for your child in May but the camp is the first week in July, we cannot reimburse you for this expense until July when the service is provided. THE DEPENDENT CARE REIMBURSEMENT ACCOUNT IS NOT A PREFUNDED ACCOUNT This means that you will only be reimbursed up to your account balance at the time you submit your claim. If your claim is for more than your account balance, the unreimbursed portion of your claim will be tracked by Flexible Benefit Administrators. You will be automatically reimbursed as additional deductions are taken and deposited into your account, until your entire claim is paid out. Page 17

18 Ph: FLEX or P.O.Box 8188 Virginia Beach, VA Estimating Your Expenses ESTIMATING YOUR QUALIFYING HEALTH CARE EXPENSES This worksheet will help you determine your annual expenses for each reimbursement account. Good planning and careful estimating is the best way to take full advantage of your Flexible Benefit Plan. Medical deductibles Medical co-payments Prescription drugs Vision Exams, Glasses, Contacts Dental/Orthodontia Routine exams and physicals Over-the-counter expenses TOTAL ESTIMATED MEDICAL EXPENSES FOR THE PLAN YEAR (Min $250) (Max. $2,500) ESTIMATING YOUR DEPENDENT CARE EXPENSES Child day care expenses Pre-School expenses Summer Day Camp expenses Adult day care expenses Other eligible expenses TOTAL ESTIMATED DEPENDENT CARE EXPENSES FOR THE PLAN YEAR (Max. $5,000) Page 18

19 Ph: FLEX or P.O.Box 8188 Virginia Beach, VA How to File Form can be submitted by (1) , (2) fax or (3) mail. To submit by fax, Print Form and fax to: FSA Medical Reimbursement Claim Form To submit by , Print Form and sign. form along with documentation to To submit by mail, Print Form and mail to: Flexible Benefit Administrators, Inc. P.O.Box. 8188, Virginia Beach, VA Account Holder Information Print Form Check box if this is to offset previously submitted ineligible expense(s). Employee Name (Print name) Social Security Number or Employee ID # address (For Notification of Processed Claims, Reimbursement & Account Status) Employer Claims For Out-Of-Pocket Expense INCOMPLETE FIELDS MAY RESULT IN YOUR CLAIM BEING DENIED -Please indicate your qualifying expenses below. DO NOT include expenses reimbursed by any other source. -Attach copies of bills, receipts, Explanation of Benefits (EOBs) or other claim documentation. Documentation below must include dates of service, description of service and the expense amount. Cancelled checks and/or credit card statements/receipts are NOT sufficient proof of your claim. -Be sure to keep your original receipts, bills, etc. for your records $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense $ 0 Person treated and Relationship Type of Eligible Expense Date of Treatment Amount of Expense Note: Orthodontia expenses are reimbursed as designated by the provider. We must Total $ 0 have a copy of your orthodontic contract on file. YOU MUST ATTACH APPROPRIATE PROOF OF SERVICE FOR EACH AMOUNT ABOVE. I request reimbursement from my Health Flexible Spending Account (Health FSA) for the amounts listed above. To the best of my knowledge, my statements are complete and true. I certify these expenses are not covered or reimbursable from any other source, nor will I seek reimbursement for these expenses from any other source and that the expense is not for cosmetic purposes. I understand that I cannot use expenses reimbursed through the Health FSA account as tax deductions when filing income tax returns. I further certify that the expenses submitted on this claim are for myself and/or my qualified tax dependents for health coverage purposes as defined under the Internal Revenue Code 125. I, the participant, further certify that the expense(s) noted above have not been previously paid for by use of my Benefits Card. Employee's Signature: Date Page 19

20 h: FLEX or O.Box 8188 Virginia Beach, VA ww.flex-admin.com To submit by fax, Print Form and fax to: To submit by mail, Print Form and mail to: Flexible Benefit Administrators, Inc. P.O.Box. 8188, Virginia Beach, VA FSA Dependent Care Reimbursement Claim Form How to File orm can be submitted by (1) , (2) fax or (3) mail. To submit by , Print Form and sign. form along with documentation to Print Form Account Holder Information Employee Name (Print name) Social Security Number or Employee ID # address (For Notification of Processed Claims, Reimbursement & Account Status) Employer Claims For Out-Of-Pocket Expense INCOMPLETE FIELDS MAY RESULT IN YOUR CLAIM BEING DENIED The following information is REQUIRED: Name of Provider, Dates of Service and the expense amount; a receipt and bill. NOTE: Cancelled checks and/or credit card statements/receipts are not sufficient proof of your claim. 1 Name of Dependent Service Start Date $ 0 Amount of Expense Name of Provider Service End Date 2 Provider's Social Security Number or Tax ID # Name of Dependent Service Start Date $ 0 Amount of Expense Name of Provider Service End Date Provider's Social Security Number or Tax ID # YOU MUST ATTACH APPROPRIATE PROOF OF SERVICE FOR EACH AMOUNT ABOVE. Total $ As a participant of the Plan, I certify that all expenses for which reimbursement or payment is claimed by submission of this form were incurred during a period while I was covered under my employer's Flexible Spending Plan and that the expenses have not been reimbursed and eimbursement will not be sought from any other source. Any claimed Dependent Care expenses were provided for my dependent under the ge of 13 or for my dependent who is incapable of self care. I fully understand that I am fully responsible for the sufficiency, accuracy, and eracity of all information relating to this claim, and that unless an expense for which payment or reimbursement is claimed is a proper expense under the Plan, I may be liable for payment of all related taxes including federal, state, or local income tax on amounts paid from the Plan which elate to such expense. 0 Employee's Signature: Date Page 20

21 ACCESSING YOUR FLEX ACCOUNT ONLINE Our secure Online Inquiry System allows you to have 24/7 access to your account information, payment information and your available balance. Completing your online account set-up is just a few clicks away! Step 1. Log-on to our website at and click the new user link Step 2. You will be directed to the registration page Step 3. Follow the prompts to create your account. Name Address Employee ID (Your SSN, no spaces/dashes) Employer ID (FBACAB or benefit card number) Step 4. Once completed, please proceed to your account. Once you have completed these steps, you will have 24/7 access to current information regarding your Flexible Spending Account. It s that easy! Problems Logging into your Account? to: flexdivision@flex-admin.com Include your Full Name, SS#, Company Name, & Contact phone number ADMINISTERED BY FLEXIBLE BENEFIT ADMINISTRATORS, INC. 509 VIKING DRIVE, SUITE F P.O. BOX 8188 VIRGINIA BEACH, VA or FLEX (3539) (Monday-Friday 8:30a-5:00p EST) FAX: FlexDivision@flex-admin.com Page 21

22 Ameritas Dental - Passive PPO Effective Date: August 1, 2017 IMPORTANT NOTE- PPO ACCESS: All full time eligible employees will now have access to the Ameritas PPO (Participating Provider Organization) network. As an insured member, you will continue to have the freedom to go to any provider you choose. However; should you visit an Ameritas PPO provider, a negotiated fee schedule is used. This negotiated fee is intended to provide you with potentially reduced out-of-pocket costs. If you choose to visit a doctor outside the panel, you are not penalized and you are still reimbursed at your current claim allowance. To locate a participating provider, go to com and select 'Find A Provider'. Choose the PPO-Nationwide network option. CALENDAR YEAR DEDUCTIBLE $50.00 per individual for Type 2 (Basic) and Type 3 (Major) Procedures (3 times family limit) After the date that 3 members of a family have each satisfied their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year. TYPE 1- PREVENTIVE AND DIAGNOSTIC Type 1 benefits are payable at 100% U&C*. No deductible applies. Evaluations (Two per benefit period) Space Maintainers Cleanings (Two per benefit period) Radiographs (X-rays) Fluoride for Children (Under age 19) Bitewings (Two per benefit period) TYPE 2- BASIC PROCEDURES Type 2 benefits are payable at 80% U&C*. $50.00 deductible applies. Sealants (Under age 17) Anesthesia Limited Exams (Problem Focused) Oral Surgery - Complex Extractions Bridge and Denture Repair Restorative Amalgam and Resin Oral Surgery TYPE 3- MAJOR PROCEDURES Type 3 Benefits are payable at 50% U&C*. $50.00 deductible applies. Endodontics (Root Canal) Restorative - Crowns Periodontics (Gum Disease) Prosthodontics - Fixed Pontics Crowns and Crown Repair Partials and Dentures * Usual & Customary Page 22

23 ORTHODONTIA- FOR ADULTS AND CHILDREN Paid at 50% U&C* with a $1,000 lifetime maximum per person. No deductible applies. ANNUAL MAXIMUM BENEFIT Type 1, Type 2, and Type 3 Procedures: $1,000 per calendar year per person. ANNUAL MAXIMUM CARRYOVER Each insured (employee and/or dependent) will qualify for a dental maximum carryover if they: 1. Visit a dentist between January 1 and December 31 of the plan year. 2. Submit a claim for payment prior to March 1 of the following year. 3. Total benefits paid for the Calendar Year must be less than $500. If you meet all 3 requirements you will have an additional $250 available in the Annual Dental Maximum for the next plan year. In future years if you have benefits paid of less than $500, additional amounts of $250 will be added to the carryover. However, the most you can accumulate in the maximum carryover is $1,000. Therefore, the maximum annual benefit may never exceed $2,000 in any one year. LATE ENTRANT PROVISION There is a 12 month waiting period on all services except for cleanings, exams, and fluoride applications for employees who do not enroll when first eligible for coverage. The waiting period will be waived for employees who enroll when first eligible. ELIGIBLE EMPLOYEES You are eligible for insurance if you are a full-time active employee working at least 30 hours per week. ELIGIBLE DEPENDENTS Provides Coverage On: Your Spouse Children up to age 26 DENTAL EXCLUSIONS (DEFERMENT PERIOD) During the first 36 months following your or your dependent's Dental Coverage Effective Date, the initial placement of dentures, partial dentures, or bridges, if it includes the replacement of teeth all of which are missing prior to the effective date. (For currently covered insureds, Ameritas will use the employees Date of Hire to determine the 36 month period.) This exclusion will not apply if the prosthesis replaces a sound natural tooth which is extracted while the patient is insured under this Dental Coverage and which is replaced within 12 months of the extraction. During the first 36 months of coverage, the replacement of bridges, partial dentures, dentures, inlays or crowns is excluded. * Usual & Customary Page 23

24 EXCEPTIONS to this exclusion will be made if the replacement is made necessary by: a) accidental bodily injury to sound natural teeth (chewing injuries are not considered accidental bodily injuries), or b) the extraction of a sound natural tooth provided the replacement is completed within 12 months of the date of the injury or extraction. PREDETERMINATION OF BENEFITS A treatment plan MAY be filed if a proposed course of treatment will exceed $ With this information, Ameritas can determine the benefits payable under this policy prior to the work actually being done. It will give the insured the amount payable, along with an idea of the out of pocket expense. LIMITATIONS/EXCLUSIONS (This is not a complete List) For any treatment which is for cosmetic purposes. Facings on crowns or pontics behind the 2nd bicuspid are considered cosmetic. Charges incurred prior to the date the individual became insured under this plan, or following the date of termination of coverage. Services which are not recommended by a dentist or which are not required for necessary care and treatment. Expenses incurred to replace lost or stolen appliances. Expenses incurred by an insured because of a sickness for which he /she is eligible for benefits under Worker's Compensation Act or similar laws. COORDINATION OF BENEFITS If you or any of your dependents incur charges which are covered by any other group plan, the benefits of this plan will be coordinated with the benefits of the other plan so that the total benefits received are not greater than the charges incurred. CHANGING ELECTIONS A member may change their election only during an annual election period, except for a change in family status. Examples of such events would be marriage, divorce, birth of a child, death of a spouse or child or termination of employment. Please see your plan administrator for details. ORTHODONTIA LIMITATIONS (This is not a complete list) No benefit is payable for expenses incurred: In connection with a Treatment Program which was begun before the individual became insured for orthodontic benefits. During any quarter of a Treatment Program if the individual was not continuously insured for orthodontic benefits for the entire quarter. After the individual's insurance for orthodontic benefits terminates. CERTIFICATE OF INSURANCE The Certificate of Insurance issued to you describes in detail the benefits and limitations of this plan. The information in this booklet is for general information only. Page 24

25 Ameritas Dental Insureds 12 pay periods Employee Only $34.98 Employee + One $67.76 Employee + Two or More $ Ameritas Dental Insureds 10 pay periods Employee Only $41.97 Employee + One $81.31 Employee + Two or More $ Ameritas Dental Insureds 20 pay periods Employee Only $20.98 Employee + One $40.65 Employee + Two or More $70.73 Ameritas Dental Insureds 24 pay periods Employee Only $17.49 Employee + One $33.88 Employee + Two or More $58.94 For Claims/Customer Service call Ameritas at: Website: This insurance is underwritten by Ameritas Life Insurance Corp. Page 25

26 Ameritas Dental - PPO Effective Date: August 1, 2017 To access the full value of the PPO Plan, you are strongly encouraged to utilize In-Network providers. If you are not planning to utilize an In-Network Provider, do not enroll in the PPO Plan or your Out-of-Network benefits will be significantly reduced. Out-of-Network benefits will be paid based on the maximum allowable charge. CALENDAR YEAR DEDUCTIBLE $50.00 per individual for Type 2 (Basic) and Type 3 (Major) Procedures (3 times family limit) After the date that 3 members of a family have each satisfied their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year. TYPE 1- PREVENTIVE AND DIAGNOSTIC Type 1 benefits are payable at 100% MAC*. No deductible applies. Evaluations (Two per benefit period) Space Maintainers Cleanings (Two per benefit period) Radiographs (X-rays) Fluoride for Children (Under age 19) Bitewings (Two per benefit period) TYPE 2- BASIC PROCEDURES Type 2 benefits are payable at 80% MAC*. $50.00 deductible applies. Sealants (Under age 17) Anesthesia Limited Exams (Problem Focused) Oral Surgery - Complex Extractions Bridge and Denture Repair Restorative Amalgam and Resin Oral Surgery TYPE 3- MAJOR PROCEDURES Type 3 Benefits are payable at 50% MAC*. $50.00 deductible applies. Endodontics (Root Canal) Restorative - Crowns Periodontics (Gum Disease) Prosthodontics - Fixed Pontics Crowns and Crown Repair Partials and Dentures * Maximum Allowable Charge Page 26

27 ORTHODONTIA- FOR ADULTS AND CHILDREN Paid at 50% MAC* with a $1,000 lifetime maximum per person. No deductible applies. ANNUAL MAXIMUM BENEFIT Type 1, Type 2, and Type 3 Procedures: $1,000 per calendar year per person. ANNUAL MAXIMUM CARRYOVER Each insured (employee and/or dependent) will qualify for a dental maximum carryover if they: 1. Visit a dentist between January 1 and December 31 of the plan year. 2. Submit a claim for payment prior to March 1 of the following year. 3. Total benefits paid for the Calendar Year must be less than $500. If you meet all 3 requirements you will have an additional $250 available in the Annual Dental Maximum for the next plan year. In future years if you have benefits paid of less than $500, additional amounts of $250 will be added to the carryover. However, the most you can accumulate in the maximum carryover is $1,000. Therefore, the maximum annual benefit may never exceed $2,000 in any one year. LATE ENTRANT PROVISION There is a 12 month waiting period on all services except for cleanings, exams, and fluoride applications for employees who do not enroll when first eligible for coverage. The waiting period will be waived for employees who enroll when first eligible. ELIGIBLE EMPLOYEES You are eligible for insurance if you are a full-time active employee working at least 30 hours per week. ELIGIBLE DEPENDENTS Provides Coverage On: Your Spouse Children up to age 26 DENTAL EXCLUSIONS (DEFERMENT PERIOD) During the first 36 months following your or your dependent's Dental Coverage Effective Date, the initial placement of dentures, partial dentures, or bridges, if it includes the replacement of teeth all of which are missing prior to the effective date. (For currently covered insureds, Ameritas will use the employees Date of Hire to determine the 36 month period.) This exclusion will not apply if the prosthesis replaces a sound natural tooth which is extracted while the patient is insured under this Dental Coverage and which is replaced within 12 months of the extraction. During the first 36 months of coverage, the replacement of bridges, partial dentures, dentures, inlays or crowns is excluded. * Maximum Allowable Charge Page 27

28 EXCEPTIONS to this exclusion will be made if the replacement is made necessary by: a) accidental bodily injury to sound natural teeth (chewing injuries are not considered accidental bodily injuries), or b) the extraction of a sound natural tooth provided the replacement is completed within 12 months of the date of the injury or extraction. PREDETERMINATION OF BENEFITS A treatment plan MAY be filed if a proposed course of treatment will exceed $ With this information, Ameritas can determine the benefits payable under this policy prior to the work actually being done. It will give the insured the amount payable, along with an idea of the out of pocket expense. LIMITATIONS/EXCLUSIONS (This is not a complete List) For any treatment which is for cosmetic purposes. Facings on crowns or pontics behind the 2nd bicuspid are considered cosmetic. Charges incurred prior to the date the individual became insured under this plan, or following the date of termination of coverage. Services which are not recommended by a dentist or which are not required for necessary care and treatment. Expenses incurred to replace lost or stolen appliances. Expenses incurred by an insured because of a sickness for which he /she is eligible for benefits under Worker's Compensation Act or similar laws. COORDINATION OF BENEFITS If you or any of your dependents incur charges which are covered by any other group plan, the benefits of this plan will be coordinated with the benefits of the other plan so that the total benefits received are not greater than the charges incurred. CHANGING ELECTIONS A member may change their election only during an annual election period, except for a change in family status. Examples of such events would be marriage, divorce, birth of a child, death of a spouse or child or termination of employment. Please see your plan administrator for details. ORTHODONTIA LIMITATIONS (This is not a complete list) No benefit is payable for expenses incurred: In connection with a Treatment Program which was begun before the individual became insured for orthodontic benefits. During any quarter of a Treatment Program if the individual was not continuously insured for orthodontic benefits for the entire quarter. After the individual's insurance for orthodontic benefits terminates. CERTIFICATE OF INSURANCE The Certificate of Insurance issued to you describes in detail the benefits and limitations of this plan. The information in this booklet is for general information only. Page 28

29 Ameritas Dental Insureds 12 pay periods Employee Only $32.52 Employee + One $63.00 Employee + Two or More $ Ameritas Dental Insureds 10 pay periods Employee Only $39.02 Employee + One $75.60 Employee + Two or More $ Ameritas Dental Insureds 20 pay periods Employee Only $19.51 Employee + One $37.80 Employee + Two or More $65.78 Ameritas Dental Insureds 24 pay periods Employee Only $16.26 Employee + One $31.50 Employee + Two or More $54.82 For Claims/Customer Service call Ameritas at: Website: This insurance is underwritten by Ameritas Life Insurance Corp. Page 29

30 Community Eye Care Vision Effective Date: August 1, 2017 Vision Plan Comprehensive Plan Cabarrus County Schools is pleased to provide you with the following summary of the voluntary vision benefit. The plan enables you and your family members to significantly reduce what you spend for routine eye care. The plan covers eye exams, glasses and contact lenses. And because Community Eye Care has a huge network of optometrists (OD), ophthalmologists (MD) and retail optical chains, you have easy access to every type of eye care provider. The Benefit The Community Eye Care vision benefit is simple and easy to use. It includes the following: An eye examination every 12 months ($20 co-pay) An eyewear allowance of $150 (per person) every 12 months (no co-pay) A contact lens fitting, re-fit or evaluation every 12 months ($20 co-pay) The eyewear allowance is completely flexible. It can be applied to frames, eyeglass lenses, contact lenses, special lens options, or any combination. As long as you select eyewear having a retail price that s less than or equal to your allowance, you incur no out-of-pocket expense for the eyewear. If the eyewear you choose is more expensive than $150, you are eligible for attractive discounts on the overage amount from most network providers: 20% for frames and lenses, and 10% for contact lenses. LASIK Discounts Members receive up to a 50%* discount on LASIK from participating providers. o *Relative to national averages Note that maximum coverage for contact lens examinations is $100 for fittings and $80 for annual evaluations. Members are responsible for any charges exceeding these amounts. How to Use Your Benefit 1) Select a provider from the Community Eye Care provider network. 2) Call the provider to make an appointment, and let them know that you have Community Eye Care coverage. 3) See the provider and select your eyewear. 4) Pay the provider your co-pays, plus any discounted amount that exceeds the $150 eyewear allowance. To locate a provider in your area, go to and search by any of the following categories: county doctor s last name practice name zip code Page 30

31 There are no claims to file when you see an in-network provider. Network providers file claims on your behalf. Members who obtain exams and eyewear from a non-network provider still receive their full benefit. The member simply submits a claim form to Community Eye Care and is reimbursed for the full cost of their exam (minus the co-pay) and for the cost of their eyewear, up to the amount of the allowance. Note that a claim form can be printed from the member benefit page of the Community Eye Care website. Alternatively, members can contact Community Eye Care to obtain a form. Community Eye Care Vision Insureds 12 pay periods Employee Only $9.75 Employee + One $18.53 Employee + Family $27.30 Community Eye Care Vision Insureds 10 pay periods Employee Only $11.70 Employee + One $22.24 Employee + Family $32.76 Community Eye Care Vision Insureds 20 pay periods Employee Only $5.85 Employee + One $11.12 Employee + Family $16.38 Community Eye Care Vision Insureds 24 pay periods Employee Only $4.88 Employee + One $9.27 Employee + Family $13.65 Member Services, Provider Services, and Claims Services: ~ FAX: Website: Perimeter Pointe Parkway, Suite 150 Charlotte, NC Page 31

32 Allstate Benefits Group Cancer Effective Date: August 1, 2017 In the United States, about 1,665,540 new cancer cases were expected to be diagnosed in Group Voluntary Cancer If you suddenly become diagnosed with cancer, it can be difficult on your family s financial and emotional stability. Having the right coverage to help when you are sick and undergoing treatment or when you cannot work is important. Our cancer insurance can help provide security when you need it most. Meeting Your Needs: Our cancer coverage can help offer you and your family members financial support during a period of unexpected illness. Benefits will be paid directly to you unless otherwise assigned Coverage can be purchased for you and your entire family No evidence of insurability required at initial enrollment for new hires Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts* Includes coverage for 29 other specified diseases** Portable coverage Benefit Coverage Highlights Group Voluntary Cancer Insurance offers you coverage should you be diagnosed with cancer or 29 specified diseases. It can help you and your family 24 hours a day, seven days a week. Each pre-packaged plan doesn t just cover you; if you choose, it also covers your dependents (which can include spouse, domestic partner and dependent children.) Our valuable coverage can help supplement your traditional medical insurance which may only cover a small portion of the non-medical expenses that can be incurred with such a diagnosis as cancer. You and each covered family member can be sure they will receive: Benefits that can be used to help pay for treatment, hospital stays, transportation, and more! Easy enrollment without required evidence of insurability for qualified employees A cancer diagnosis can mean unforeseen expenses that may be difficult to pay, especially if you aren t working. Hospital stays, medical or surgical treatments, and transportation by air or ground ambulance can add up quickly and be very costly. Our Group Voluntary Cancer Supplemental Insurance can help offset some of the expenses your health insurance may not cover, so you can focus on getting well. *Primary insured only **List of covered diseases on the following page 1. Cancer Facts & Figures, American Cancer Society, 2014 Page 32

33 In the U.S., men have slightly less than a 1 in 2 lifetime risk of developing cancer; for women, the risk is a little more than 1 in 3. 2 Your Benefit Coverage Benefits are paid for cancer and specified disease and can help cover the costs of specific treatments and expenses as they happen. Terms and conditions for each benefit will vary. Specified Diseases Amyotrophic Lateral Sclerosis (Lou Gehrig s Disease),Muscular Dystrophy, Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis (bacterial), Brucellosis, Sickle Cell Anemia, Thalassemia, Rocky Mountain Spotted Fever, Legionnaires Disease (confirmation by culture or sputum), Addison s Disease, Hansen s Disease, Tularemia, Hepatitis (Chronic B or Chronic C with liver failure or Hepatoma), Typhoid Fever, Myasthenia Gravis, Reye s Syndrome, Primary Sclerosing Cholangitis (Walter Payton s Liver Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, and Primary Biliary Cirrhosis. Continuous Hospital Confinement A $100 benefit will be paid for each day of continuous hospital confinement for the treatment of cancer or specified diseases. Government or Charity Hospital A $100 benefit will be paid for each day a covered person is confined to: 1. a hospital operated by or for the U.S. Government (including the Veteran s Administration); or 2. a hospital that does not charge for the services it provides (charity). This benefit is paid in lieu of all other benefits in the policy (except Waiver of Premium Benefit). Surgery** Up to a $3,000 benefit will be paid when a covered surgery (**amount per surgery depends on surgery) is performed on a covered person. This benefit pays the actual charges, up to the amount listed in the Schedule of Surgical Procedures for the specific procedure. Two or more procedures performed at the same time through one incision or entry point are considered one operation; Allstate Benefits pays the amount for the procedure with the greatest benefit. Allstate Benefits pays for a covered surgery performed on an outpatient basis at 150% of the scheduled benefit. This benefit does not pay for surgeries covered by other benefits in the Schedule of Benefits. 2 Cancer Facts & Figures, American Cancer Society, Page 33

34 Second Opinion A $400 benefit will be paid for a second surgical opinion, if physician recommends surgery for covered condition. This second opinion must be rendered prior to surgery or treatment being performed, and obtained from a physician not in practice with the physician rendering the original recommendation. Physical or Speech Therapy A $50 benefit will be paid per day, for physical or speech therapy for restoration of normal body function. Anesthesia 25% of the surgery benefit will be paid for anesthesia. Ambulatory Surgical Center A $500 benefit will be paid for a surgical procedure covered under the Surgery benefit that is performed at an ambulatory surgical center. Radiation/Chemotherapy for Cancer Up to a $10,000 (Low) or $20,000 (High) benefit will be paid per 12 month period for radiation therapy and chemotherapy received by a covered person. This benefit pays the actual cost and is limited to the amount shown per 12 month period beginning with the first day of benefit under this provision. Administration of radiation therapy or chemotherapy other than by medical personnel in a physician s office or hospital, including medications dispensed by a pump, will be limited to the costs of the drugs only, subject to the maximum amount payable per 12 month period. Anti-Nausea Benefit Up to a $200 benefit will be paid per calendar year for the actual cost of antinausea medication prescribed for a covered person by a physician in conjunction with cancer or specified disease treatment. This benefit does not pay for medication administered while the covered person is an inpatient. Inpatient Drugs and Medicine A $25 benefit will be paid per day for drugs and medicine while continuously hospital confined. This benefit does not pay for drugs and/or medicine covered under the Radiation/Chemotherapy Benefit or the Anti-Nausea Benefit. Hematological Drugs Up to a $200 (Low) or $400 (High) benefit will be paid per year for the actual cost of drugs intended to boost cell lines such as white blood cell counts, red blood cell counts and platelets. This benefit is paid only when the Radiation/ Chemotherapy for Cancer benefit is paid. Page 34

35 Medical Imaging Actual cost up to a $500 (Low) or $1,000 (High) benefit will be paid per calendar year if a covered person receives an initial diagnosis or follow-up evaluation based upon one of the following medical imaging exams: CT scan; Magnetic Resonance Imaging (MRI) scan; bone scan; thyroid scan; Multiple Gated Acquisition (MUGA) scan; Positron Emission Tomography (PET) scan; transrectal ultrasound; or abdominal ultrasound. This benefit is limited to 1 payment per calendar year per covered person. Private Duty Nursing Services A $100 benefit will be paid per day while hospital confined, if a covered person requires the full-time services of a private nurse. Full-time means at least 8 hours of attendance during a 24 hour period. These services must be required and authorized by a physician and must be provided by a nurse. New or Experimental Treatment Actual charges up to a $5,000 benefit will be paid per 12 month period, for new or experimental treatment. New or Experimental Treatment is covered for cancer and specified disease when: the treatment is judged necessary by the attending physician; and no other generally accepted treatment produces superior results in the opinion of the attending physician. This benefit is limited to the maximum shown per 12 month period beginning with the first day of treatment under this provision. This benefit does not pay if benefits are payable for treatment covered under any other benefit in the Schedule of Benefits. Blood, Plasma, and Platelets Up to a $10,000 (Low) or $20,000 (High) benefit will be paid per 12 month period for the actual cost of blood, plasma and platelets (including transfusions and administration charges); processing and procurement costs; and cross-matching. Does not pay for blood replaced by donors or immunoglobulins. Physician s Attendance A $50 benefit will be paid for a visit by a physician during hospital confinement. Benefit is limited to one visit by one physician per day of hospital confinement. Admission to the hospital as an inpatient is required. At Home Nursing A $100 benefit will be paid per day for private nursing care and attendance by a nurse at home. At home nursing services must be required and authorized by the attending physician. Benefit is limited to the number of days of the previous continuous hospital confinement. Prosthesis Up to a $2,000 benefit will be paid per amputation, per covered person for the actual charges for prosthetic devices which are prescribed as a direct result of surgery and which require surgical implantation. Page 35

36 Hair Prosthesis A $25 benefit will be paid every 2 years, for a wig or hairpiece if the covered person experiences hair loss. Nonsurgical External Breast Prosthesis Up to a $50 benefit will be paid for the actual cost of the initial, nonsurgical breast prosthesis following a covered mastectomy or partial mastectomy that is paid for under the policy. Ambulance A $100 benefit will be paid per continuous hospital confinement for transportation by a licensed ambulance service or a hospital owned ambulance to or from a hospital in which the covered person is confined. Hospice Care A $100 benefit will be paid for one of the following when a covered person has been diagnosed by a physician as terminally ill as a result of cancer or specified disease, is expected to live 6 months or less and the attending physician has approved services: 1. Freestanding Hospice Care Center A benefit will be paid per day for confinement in a licensed freestanding hospice care center. Benefits payable for hospice centers that are designated areas of hospitals will be paid the same as inpatient hospital confinement; or 2. Hospice Care Team A benefit will be paid per visit, limited to 1 visit per day, for home care services by a hospice care team. Home care services are hospice services provided in the patient s home. Benefit is payable only if: (a) the covered person has been diagnosed as terminally ill; and (b) the attending physician has approved such services. Does not pay for: food services or meals other than dietary counseling; or services related to well-baby care; or services provided by volunteers; or support for the family after the death of the covered person. Extended Care Facility A $100 benefit will be paid for each day a covered person is confined in an extended care facility for the treatment of cancer or specified disease. Confinement must be at the direction of the attending physician and must begin within 14 days after a covered hospital confinement. Benefit is limited to the number of days of the previous continuous hospital confinement. Outpatient Lodging A $50 benefit will be paid for lodging per day when a covered person receives radiation or chemotherapy treatment on an outpatient basis, provided the specific treatment is authorized by the attending physician and cannot be obtained locally. Benefit is the actual cost of a single room in a motel, hotel, or other accommodations acceptable to Allstate Benefits during treatment, up to the maximum $2,000 per 12 months beginning with the first day of benefit under this provision. Outpatient treatment must be received at a treatment facility more than 100 miles from the covered person s home. Page 36

37 Non-Local Transportation $0.40 per mile or actual cost of round trip coach fare on a common carrier benefit will be paid for treatment at a hospital (inpatient or outpatient); or radiation therapy center; or chemotherapy or oncology clinic; or any other specialized freestanding treatment center nearest to the covered person s home, provided the same or similar treatment cannot be obtained locally. Benefit pays up to 700 miles for round trip in personal vehicle. Non-Local means a round trip of more than 70 miles from the covered person s home to the nearest treatment facility. Mileage is measured from the covered person s home to the nearest treatment facility as described above. Does not cover transportation for someone to accompany or visit the person receiving treatment; visits to a physician s office or clinic; or for services other than actual treatment. Family Member Lodging and Transportation Up to a $50 benefit per day will be paid for lodging and $0.40 per mile or the actual cost of round trip coach fare on a common carrier will be paid for one adult member of the covered person s family to be near the covered person, when a covered person is confined in a non-local hospital for specialized treatment. 1. Lodging -This benefit is for a single room in a motel, hotel, or other accommodations acceptable to Allstate Benefits. Benefit is limited to 60 days for each period of continuous hospital confinement. 2. Transportation -Benefit is limited to 700 miles per continuous hospital confinement if traveling in personal vehicle. Mileage is measured from the visiting family member s home to the hospital where the covered person is confined. Does not pay the Family Member Transportation Benefit if the personal vehicle transportation benefit is paid under the Non-Local Transportation Benefit, when the family member lives in the same city or town as the covered person. Waiver of Premium (primary insured only) If, while coverage is in force the insured employee becomes disabled due to cancer first diagnosed after the effective date of coverage and remains disabled for 90 days, Allstate Benefits pays premiums due after such 90 days for as long as the insured employee remains disabled. Bone Marrow or Stem Cell Transplant* A 1. $1,000*, 2. $2,500*, 3. $5,000* benefit will be paid for the following types of bone marrow or stem cell transplants performed on a covered person. 1. A transplant which is other than non-autologous. 2. A transplant which is non-autologous for the treatment of cancer or specified disease, other than Leukemia. 3. A transplant which is non-autologous for the treatment of Leukemia. *This benefit is payable only once per covered person per calendar year. Page 37

38 ADDITIONAL BENEFIT Wellness A $100 benefit will be paid per calendar year per covered person for one of the following wellness tests: Biopsy for skin cancer; Blood test for triglycerides; Bone Marrow Testing; CA15-3 (cancer antigen blood test for breast cancer); CA125 (cancer antigen 125 blood test for ovarian cancer); CEA (carcinoembryonic antigen blood test for colon cancer); Chest X-ray; Colonoscopy; Doppler screening for carotids; Doppler screening for peripheral vascular disease; Echocardiogram; EKG (Electrocardiogram); Flexible sigmoidoscopy; Hemocult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Cervical Cancer Screening; PSA (prostate specific antigen blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening of the abdominal aorta for abdominal aortic aneurysms. This benefit is paid regardless of the result of the test. OPTIONAL BENEFITS Cancer Initial Diagnosis (First Occurrence) A one time benefit of $3,000 will be paid when a covered person is diagnosed for the first time in their life as having cancer other than skin cancer. The first diagnosis must occur after the effective date of coverage for that covered person. Benefit is payable only once per covered person. Intensive Care** (Low and High Options only) A benefit will be paid for each day for the following types of intensive care confinement: A. Hospital Intensive Care Unit Confinement $600* - This benefit is for hospital intensive care unit confinement for any illness or accident. B. Step-Down Hospital Intensive Care Unit Confinement $300*- This benefit is for step-down hospital intensive care unit confinement for any illness or accident. C. Ambulance - Allstate Benefits pays the actual charges for transportation of a covered person by licensed air or surface ambulance service to a hospital for admission to an intensive care unit for a covered confinement. This benefit is not paid if an ambulance benefit is paid under the Ambulance benefit in the policy. *This benefit is limited to 45 days for each period of such confinement. A day is a 24 hour period. If confinement is for only a portion of a day, then a prorata share of the daily benefit is paid. **This benefit is not disease-specific and pays a benefit for a covered confinement in a hospital intensive-care unit for any covered illness or accident from the first day of coverage. Page 38

39 Allstate Benefits Group Cancer Rates - 12 pay Rates per year (Monthly) Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $20.07 Employee + Child(ren) $27.71 Employee + Spouse $30.96 Family $38.57 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $26.06 Employee + Child(ren) $36.81 Employee + Spouse $41.50 Family $52.23 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $31.09 Employee + Child(ren) $43.65 Employee + Spouse $47.51 Family $60.04 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $37.08 Employee + Child(ren) $52.75 Employee + Spouse $58.05 Family $73.70 Page 39

40 Allstate Benefits Group Cancer Rates- 10 pay rates per year Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $24.09 Employee + Child(ren) $33.26 Employee + Spouse $37.16 Family $46.29 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $31.28 Employee + Child(ren) $44.18 Employee + Spouse $49.80 Family $62.68 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $37.31 Employee + Child(ren) $52.38 Employee + Spouse $57.02 Family $72.05 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $44.50 Employee + Child(ren) $63.30 Employee + Spouse $69.66 Family $88.44 Page 40

41 Allstate Benefits Group Cancer Rates - 20 pay rates per year Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $12.05 Employee + Child(ren) $16.63 Employee + Spouse $18.58 Family $23.15 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $15.64 Employee + Child(ren) $22.09 Employee + Spouse $24.90 Family $31.34 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $18.66 Employee + Child(ren) $26.19 Employee + Spouse $28.51 Family $36.03 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $22.25 Employee + Child(ren) $31.65 Employee + Spouse $34.83 Family $44.22 Page 41

42 Allstate Benefits Group Cancer Rates - 24 pay rates per year Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $10.04 Employee + Child(ren) $13.86 Employee + Spouse $15.48 Family $19.29 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $13.03 Employee + Child(ren) $18.41 Employee + Spouse $20.75 Family $26.12 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $15.55 Employee + Child(ren) $21.83 Employee + Spouse $23.76 Family $30.02 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $18.54 Employee + Child(ren) $26.38 Employee + Spouse $29.03 Family $36.85 Page 42

43 Issue Ages- 18 and older while actively at work. Certificates- Certificates under this plan are issued on a guaranteed basis only at the time of the initial enrollment. A completed Evidence of Insurability form is required for late entrants into the group plan. Eligibility- Family members eligible for coverage include: you; your spouse or domestic partner; and children. Portability Privilege- Allstate Benefits will provide portability coverage, subject to these provisions. Such coverage will not be available for you unless: coverage under the policy terminates under the General Provision entitled Termination of Coverage ; and Allstate Benefits receive a written request and payment of the first premiums for the portability coverage not later than 63 days after such termination; and the request is made for that purpose. No portability coverage will be provided to you, if your insurance under the policy terminates due to your failure to make required premium payments. Termination of Coverage- As long as you are insured, your coverage under the policy ends on the earliest of: the date the policy is canceled; or the last day of the period for which you made any required premium payments; or the last day you are in active employment except as provided under the Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence provision; or the date you are no longer in an eligible class; or the date your class is no longer eligible. Allstate Benefits will provide coverage for a payable claim incurred while you are covered under the policy. If your spouse is a covered person, the spouse s coverage ends upon valid decree of divorce or your death. If your domestic partner is a covered person, the domestic partner s coverage ends upon termination of the domestic partnership or your death. If your child is a covered person, the child s coverage ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. Coverage does not terminate on a child who: 1. is incapable of self-sustaining employment by reason of mental or physical incapacity; and 2. became so incapacitated prior to the attainment of the limiting age of eligibility under the coverage; and 3. is chiefly dependent upon you for support and maintenance. Dependent coverage continues as long as the coverage remains in force and the dependent remains in such condition. Proof of the incapacity and dependency of the child must be furnished within 60 days of the child s attainment of the limiting age of eligibility. Thereafter, such proof must be furnished as frequently as may be required, but no more frequently than annually after the child s attainment of the limiting age for eligibility. If Allstate Benefits accepts a premium for coverage extending beyond the date, age, or event specified for termination as to a covered person, such premium will be refunded, coverage will terminate and claims will not be paid. Page 43

44 Pre-Existing Condition - Allstate Benefits does not pay for any benefit due to, or caused by, a pre-existing condition, as defined, during the 12 month period beginning on the date that person became a covered person. This exclusion will not apply to your newborn child, adopted child or foster child under the age of 18 if Allstate Benefits is notified within 31 days of the child s birth or date of placement. A Pre-Existing Condition is a disease or physical condition for which medical advice or treatment was recommended or received from a member of the medical profession within the 12 month period prior to the effective date of coverage. Exclusions and Limitations - Allstate Benefits does not pay for any loss except for losses due directly from cancer or specified disease. Allstate Benefits does not pay for any other conditions or diseases caused or aggravated by cancer or a specified disease. Diagnosis must be submitted to support each claim. For the Surgery, New or Experimental Treatment and Prosthesis Benefits, if specific charges are not obtainable as proof of loss, Allstate Benefits will pay 50% of the applicable maximum for the benefits payable. Treatment must be received in the United States or its territories. Intensive Care Exclusions and Limitations - The Hospital Intensive Care Unit Confinement benefit does not pay for intensive care if a covered person is admitted because of an attempted suicide; or intentional self-inflicted injury; or intoxication or being under the influence of drugs not prescribed or recommended by a physician; or alcoholism or drug addiction. Allstate Benefits does not pay for confinements in any care unit that does not qualify as a hospital intensive care unit. Progressive care units, sub-acute intensive care units, intermediate care units, and private rooms with monitoring, step-down units and any other lesser care treatment units do not qualify as hospital intensive care units. We do not pay for step-down hospital intensive care unit confinement if a covered person is admitted and confined in the following type of units: telemetry or surgical recovery rooms; post-anesthesia care units, progressive care units; intermediate care units; private monitored rooms; observation units located in emergency rooms or outpatient surgery units; beds, wards, or private or semi-private rooms with or without telemetry monitoring equipment; an emergency room; labor or delivery rooms; or other facilities that do not meet the standards for a step-down hospital intensive care unit. We do not pay this benefit for continuous hospital intensive care unit confinements or continuous step-down hospital intensive care unit confinements that occur during a hospitalization that begins before the effective date of coverage. We do not pay for ambulance if paid under the cancer and specified disease ambulance benefit. Coverage Subject to the Policy - The coverage described in the certificate of insurance is subject in every way to the terms of the policy that is issued to the policyholder (your employer). It alone makes up the agreement by which the insurance is provided. The group policy may at any time be amended or discontinued by agreement between Allstate Benefits and the policyholder. Your consent is not required for this. Allstate Benefits is not required to give you prior notice. Page 44

45 The policy is Limited Benefit Cancer and Specified Disease Insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer s Guide available from American Heritage Life Insurance Company. Subject to COBRA continuation of coverage. This coverage does not constitute comprehensive health insurance coverage (often referred to as major medical coverage ) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. This material is valid as long as information remains current, but in no event later than August 1, Group Cancer and Specified Disease benefits provided by policy GVCP3, or state variations thereof. This brochure highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. The policy sets forth, in detail, the rights and obligations of both the policyholder (employer) and the insurance company. For complete details, contact your Allstate Benefits Representative. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company. Details of the insurance, including exclusions, restrictions and other provisions are included in the certificate issued. This information is for use in enrollments which are sitused in North Carolina. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), the underwriting company and a subsidiary of The Allstate Corporation. Allstate Benefits The Workplace Marketer 1776 American Heritage Life Drive, Jacksonville, Florida Customer Care Center: Customer Claims : or allstatebenefits.com Page 45

46 Aflac Accident 7700 (High Plan) Effective Date: August 1, 2017 Plan Features No limit on the number of claims. Supplements and pays regardless of any other insurance programs. Benefits available for Spouse and/or Dependent Children. Provides 24-hour (on and off-job) protection. Benefits for both inpatient and outpatient Treatment of covered accidents. Guaranteed-Issue - No underwriting required to qualify for coverage. Payroll Deduction - Premiums are paid by convenient payroll deduction. Immediate effective date Coverage will be effective the date the employee signs the application. Eligibility Employee works at least 30 hours per week and Have been employed for at least 0 continuous days by the enrollment date Issue Ages Employee ~ Spouse ~ Children ~ under age 26, dependent Portability When coverage is effective and would otherwise terminate under the plan because the employee ends employment with the employer, coverage may be continued. The employee will continue the coverage that is in force on the date employment ends, including dependent coverage then in effect. The employee will be allowed to continue the coverage until the earlier of the date the employee fails to pay the required premium, or the date the group policy is terminated. Coverage may not be continued if the employee fails to pay any required premium, employee attains age 70, or the group policy terminates. Page 46

47 Accident Benefits High Option Complete Fractures (diagnosis & treatment within 90 days) Closed Reduction Open Reduction Hip/Thigh $1,500 $2,250 Vertebrae $1,350 $2,025 Pelvis $1,200 $1,800 Skull (Depressed $1,125 $1,688 Leg $900 $2,400 Forearm/Hand $750 $1,125 Foot/Ankle/Knee Cap $750 $1,125 Shoulder Blade/Collar Bone $600 $900 Lower Jaw (Mandible) $600 $900 Skull (Simple) $525 $788 Upper Arm/Upper Jaw $525 $788 Facial Bones (Except teeth) $450 $675 Vertebral Processes $300 $450 Coccyx/Rib/Finger/Toe $120 $180 A fracture is a break in a bone which can be seen by x-ray. If more than one fracture requiring either open or closed reduction occurs in any one covered accident, we will pay the scheduled benefit for each fracture, not to exceed 150 percent of the scheduled benefit amount with for the bone fractured with the highest dollar value. Benefits for chip fractures are payable at 10 percent of the scheduled amount shown for the affected bone. A chip fracture is a piece of bone which is completely broken off near a joint. Complete Dislocations (diagnosis & treatment within 90 days) Closed Reduction Open Reduction Hip $1,350 $2,025 Knee (not kneecap) $975 $1, Shoulder $750 $1,125 Foot/Ankle $600 $900 Hand $525 $ Lower Jaw $450 $675 Wrist $375 $ Elbow $300 $450 Finger/Toe $120 $180 A dislocation is a completely separated joint. If more than one dislocation requiring either open or closed reduction occurs in any one covered accident, we will pay the scheduled benefit for each dislocation, not to exceed 150 percent of the scheduled benefit amount for the joint dislocated which has the higher dollar value. Benefits for partial dislocations are payable at 25 percent of the scheduled amount shown for the affected joint. A partial dislocation is one in which the joint is not completely separated. If the insured fractures a bone and dislocates a joint in the same accident, we will pay for both. Page 47

48 However, we will pay no more than 150 percent of the scheduled benefit amount for the bone fractured or joint dislocated with the highest dollar value. Benefits are payable for only the first dislocation of a joint. We will not pay benefits for a recurring dislocation of the same joint. Joints dislocated prior to the effective date of coverage will not be covered should they become dislocated while coverage is in force. Paralysis (lasting more than 90 days & diagnosed by a Physician within 90 days) Employee & Spouse Children Quadriplegia $10,000 $7,500 Paraplegia $10,000 $7,500 Paralysis means the permanent loss of movement of two or more limbs. If this benefit is paid and the insured later dies as a result of the same covered accident, we will pay the appropriate Death Benefit, less any amounts paid under the Paralysis Benefit. Lacerations (Treatment & repaired with stitches within 72 hours) 2-5 long $200 For lacerations not requiring stitches and treated by a Physician, we pay $25. For multiple lacerations, we will pay for the largest single laceration requiring stitches. Injuries Requiring Surgery Eye Injuries (treatment and surgery within 90 days) $250 Removal of foreign body from eye (requiring no surgery) $50 Tendons / Ligaments (treatment within 60 days, surgical repair within 90 days Single If the insured fractures a bone or dislocate a joint, and tears, severe, or ruptures a tendon or ligament in the same accident, we will pay one benefit. We will pay the largest of the scheduled benefit amounts for fractures, dislocations, or tendons and ligaments. $600 Ruptured Disc (treatment with 60 days, surgical repair within one year) Up to renewal years $600 Torn Knee Cartilage (treatment within 60 days, surgical repair within one year) Up to renewal years $400 Page 48

49 Burns (treatment within 72 hours)* Second Degree Less than 10% of body surface covered At least 10%, but not more than 25% of body surface covered At least 25%, but not more than 35% of body surface covered More than 35% of body surface covered Third Degree Less than 10% of body surface covered At least 10%, but not more than 25% of body surface covered At least 25%, but not more than 35% of body surface covered More than 35% of body surface covered * First Degree burns are not covered. Benefit $60 $120 $300 $600 $300 $900 $4,200 $6,000 Concussion (A head injury resulting in electroencephalogram abnormally). Coma (lasting 30 days or more) $100 $10,000 (Coma means a state of profound unconsciousness caused by a covered accident. $4,500 Employee or Spouse $2,500 Child Internal Injuries (resulting in open abdominal or thoracic surgery) $450 Exploratory Surgery (without repair) $250 Emergency Dental Work (to sound, natural teeth) Repaired with crown $150 Medical Fees (for each accident) Employee or Spouse $150 Child(ren) $105 If an insured is injured in a covered accident and receives Treatment within one year, we will pay this benefit for up to six Treatments per covered accident for Physician charges, emergency room services and supplies, and x-rays. The total amount payable will not exceed the maximum shown above per accident. Initial Treatment must be received within 60 days from the date of the accident. Accident Follow-Up Treatment $25 We will pay this benefit for up to six Treatments per covered accident, per covered person for follow-up Treatment. The insured must have received initial Treatment within 72 hours of the accident and the follow-up Treatment must begin within 30 days of the covered accident or discharge from the Hospital. Page 49

50 Physical Therapy $75 We will pay this benefit for up to six Treatments (one per day) per covered accident, per covered person for Treatment. The insured must have received initial Treatment within 72 hours of the accident and physical therapy must begin within 30 days of the covered accident or discharge from the Hospital. Treatment must take place within six months after the accident. This benefit is not payable for the same visit that the accident followup Treatment benefit is paid. Air Ambulance $500 Ambulance $150 If an insured requires transportation to a hospital by a professional ambulance service within 90 days after a covered accident, we will pay the amount shown. Transportation (within 90 days) Train or Plane $300 Bus $150 If Hospital Treatment or diagnostic study is recommended by the employee s Physician as a result of a covered accident and is not available in his/her city of residence, we will pay the amount shown above. The distance to the location of the Hospital Treatment or diagnostic study must be more than 50 miles from the employee s residence. Blood / Plasma $100 If the insured receives blood and plasma within 90 days following a covered accident, we will pay the amount shown. Prosthesis $750 If a covered accident requires the use of a prosthetic device, we will pay the amount shown. Hearing aids, wigs, or dental aids, including but not limited to false teeth, are not covered. Appliance $100 If an insured is advised by a Physician to use a medical appliance as an aid in personal locomotion as the result of an injury received in a covered accident, we will pay this benefit for use of a medical appliance due to injuries received in a covered accident. Benefits are payable for crutches, wheelchairs, leg braces, back braces and walkers. Family Lodging Benefit (per night) $100 We will pay this benefit, for each night s lodging in a motel/hotel room for an adult member of the employee s immediate family when an employee is confined to a Hospital for Treatment of an injury due to a covered accident, for up to 30 days. The Hospital and motel/hotel must be more than 100 miles from the employee s residence. The Treatment must be prescribed by the employee s local Physician. Page 50

51 Wellness $60 After 12 months of paid premium and while coverage is in force, we will pay this benefit per covered person to undergo routine examinations or other preventative testing once each 12 month period. Benefits include, and are payable for: Annual physical exams Ultrasounds Blood screenings Mammograms Eye examinations Pap smears Immunizations PSA tests Flexible sigmoidoscopies Hospital Admission Employee or Spouse $1,500 Children $1,000 We will pay this benefit when the employee is admitted to a Hospital and confined as a resident bed patient because of injuries received in a covered accident within six months of the accident. We will pay this benefit once per calendar year per insured person. We will not pay this benefit for confinement to an observation unit, or for emergency room Treatment or outpatient Treatment. Hospital Confinement (per day) Employee or Spouse $200 Children $175 We will provide this benefit on the first day of Hospital confinement for up to 365 days. Hospital confinement must begin within 90 days from the date of the accident. This benefit is payable once per Hospital confinement even if the confinement is caused by more than one accidental injury. Hospital Intensive Care (per day) Employee or Spouse $600 Children $450 Benefit paid up to 30 days per covered accident. Benefits are paid in addition to the Hospital Confinement Benefit. Accidental Death and Dismemberment (within 90 days) Employee Spouse Children Accidental Death $50,000 $25,000 $5,000 Accidental Common Carrier Death $70,000 $35,000 $7,000 Single Dismemberment $6,250 $2,500 $1,250 Double Dismemberment $25,000 $10,000 $5,000 Loss of One or More Fingers or Toes $1,250 $500 $250 Partial Amputation of Finger(s) or $100 $100 $100 Toes(s) (Including at least one joint) Page 51

52 Dismemberment means: 1. Loss of a hand: the hand is cut off at or above the wrist joint; or 2. Loss of a foot: the foot is cut off at or above the ankle; or 3. Loss of sight: at least 80% of the vision in one eye is lost. Such loss of sight must be permanent and irrecoverable or 4. Loss of a finger/toe: the finger or toe is cut off at or above the joint where it is attached to the hand or foot. If you do not qualify for the Dismemberment Benefit but loose at least one joint of a finger or toe, we will pay the Partial Dismemberment shown. If this benefit is paid and you later die as a result of the same covered accident, we will pay the appropriate death benefit, less any amounts paid under this benefit. Accidental Death If you are injured in a covered accident and the injury causes you to die within 90 days after the accident, we will pay the Accidental Death Benefit shown. If the Accidental Death Benefit is paid, we will not pay the Accidental Common Carrier Death Benefit. Accidental Common Carrier Death - If the employee is injured in a covered accident and the injury causes him/her to die within 90 days after the accident, we will pay the Accidental Common Carrier Death Benefit in the amount shown if the injury is the result of traveling as a fare-paying passenger on a common carrier, as defined below. An airline carrier which is licensed by the United States Federal Aviation Administration and operated by a licensed pilot on a regular schedule between established airports; or A railroad train which is licensed and operated for passenger service only; or A boat or ship that is licensed for passenger service and operated on a regular schedule between established ports. If the Accidental Common Carrier Death Benefit is paid, we will not pay the Accidental Death Benefit. Pre-existing Condition Limitation Pre-existing Condition means within the 12-month period prior to the Effective Date of the Certificate and attached Riders, as applicable. We will not pay benefits for any loss or injury which is caused by, contributed to by, or resulting from a pre-existing condition for 12 months after the Effective Date. A claim for benefits for loss starting after 12 months from the Effective Date, will not be reduced or denied on the grounds that it is caused by a pre-existing condition. A certificate may have been issued as a replacement for a certificate previously issued to the employee under the Plan. If so, then the pre-existing condition limitation provision of the employee s certificate applies only to any increase in benefits over the prior certificate. Any remaining period of pre-existing condition limitation of the prior certificate would continue to apply to the prior level of benefits. Page 52

53 Exceptions and Reductions We will not pay benefits for loss caused by pre-existing conditions (except as stated in the previous provision). We will not pay benefits for loss, injury, or death contributed to, caused by, or resulting from: 1. Participating in war or any act of war, declared or not, or participating in the armed forces of or contracting with any country or international authority. We will return the prorated premium for any period not covered when the employee is in such service. 2. Operating, learning to operate, serving as a crew member on, or jumping or falling from any aircraft, including those which are not motor-driven. 3. Participating or attempting to participate in an illegal activity or working at an illegal job. 4. Committing or attempting to commit suicide, while sane or insane. 5. Injuring or attempting to injure himself/herself intentionally. 6. Having any disease or bodily/mental illness or degenerative process. We also will not pay benefits for any related medical/surgical Treatment or diagnostic procedures for such illness. 7. Traveling more than 40 miles outside the territorial limits of the United States, Canada, Mexico, Puerto Rico, The Bahamas, Virgin Islands, Bermuda, and Jamaica except under the Accidental Common Carrier Death Benefit. 8. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. 9. Participating in any organized sport: professional or semi-professional. 10. Being legally intoxicated or being under the influence of any narcotic unless such is taken under the direction of a Physician. 11. Driving any taxi or intrastate or interstate long-distance vehicle for wage, compensation or profit. 12. Mountaineering using ropes and/or other equipment, parachuting or hanggliding. 13. Having cosmetic surgery or other elective procedures that are not medically necessary or having dental Treatment except as a result of covered accident. Page 53

54 Notices This booklet is a brief description of coverage, not a contract. Read your certificate carefully for exact plan language, terms, and conditions. If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AGCM377TA-1-BK IV (12/16) Underwritten by Continental American Insurance Company A proud member of the Aflac family of insurers Page 54

55 Aflac Accident ~ High Plan 12 Pay Periods Individual $18.80 Named Insured/Spouse Only $25.82 One-Parent Family $31.42 Two-Parent Family $ Pay Periods Individual $22.56 Named Insured/Spouse Only $30.98 One-Parent Family $37.70 Two-Parent Family $ Pay Periods Individual $11.28 Named Insured/Spouse Only $15.49 One-Parent Family $18.85 Two-Parent Family $ Pay Periods Individual $9.40 Named Insured/Spouse Only $12.91 One-Parent Family $15.71 Two-Parent Family $19.22 Continental American Insurance Company Columbia, South Carolina Phone ~ Website ~ aflacgroupinsurance.com Page 55

56 Aflac Critical Illness with Cancer ~ Lump Sum Single Payment Policy / First Occurrence Effective Date: August 1, 2017 Plan Features (2800) Benefits are paid directly to you, unless otherwise assigned. Premiums are paid through convenient payroll deduction. Guaranteed-issue coverage available to employee and spouse. Each dependent child is covered at 50% of the primary insured amount at no additional charge. Benefit amounts are available from $5,000 up to $50,000 for employees and up to $25,000 for spouse. An annual Health Screening benefit is included. The plan is portable, which means you can take your coverage with you if you change jobs or retire (with certain stipulations). Includes an Additional Benefits Rider with benefits for the following: o o o o o o Coma Paralysis Severe Burn Loss of Sight Loss of Hearing Loss of Speech Includes a Heart Event Rider Underwriting Guidelines Guaranteed-Issue Guaranteed-issue coverage is offered for All Employees: Up to $30,000 for employees and up to $15,000 for spouses with no participation requirement. For employee amounts over $30,000 and spouse amounts over $15,000: All applicants are required to answer underwriting questions. Employees who would otherwise be declined will be issued the lesser of the amount applied for or the guaranteed-issue limit. Individual Eligibility Issue Ages Employee Spouse Children under age 26 Benefit-eligible employees, working at least 30 hours or more weekly, with at least 0 days of continuous employment by the date of the enrollment are eligible. If an employee is eligible, his spouse is eligible and all children of the insured who are younger than 26 years of age are eligible for coverage. Seasonal and temporary workers are not eligible to participate. Page 56

57 Class I All full-time and part-time benefit-eligible employees are eligible for Class I coverage. That eligibility extends to their spouses and children under age 26. Class II A Class I primary insured is eligible for Class II coverage if he: Was previously insured under Class I; and Is no longer employed by the policyholder. The employee must elect Class II coverage under the Portability Privilege within 31 days after the date for which his Class I eligibility would otherwise terminate. Only dependents covered under Class I coverage are eligible for continued coverage under Class II. Class II insureds cannot continue coverage through the employer s payroll deduction process. They must remit premiums directly to the company. Spouse Coverage Available The employee may elect to purchase spouse coverage. In order to apply for spouse coverage, the employee must also apply. Spouses are eligible for benefit amounts equaling 50% of the employee amount, not to exceed the $25,000 maximum benefit. If the employee does not meet the underwriting requirements necessary to participate in the plan, the spouse can still obtain coverage. The spouse would then become the primary insured and is limited to face amounts up to $25,000. Dependent Children Coverage at No Additional Charge Each eligible dependent child is covered at 50% of the primary insured amount at no additional charge. The payment of benefits for a dependent child does not reduce the face amount of the primary insured. Children-only coverage is not available. Please see the Definitions section for a complete definition of dependent children. Portability When coverage is effective and would otherwise terminate because the employee ends employment with the employer, coverage may be continued. He may exercise the Portability Privilege when there is a change to his coverage class. The employee and any covered dependents will continue the coverage that is in-force on the date employment ends. The continued coverage will be provided under Class II. The premium rate for portability coverage may change for the class of covered persons on portability on any premium due date. Written notice will be given at least 31 days before any change is to take effect. The employee may continue the coverage until the earlier of: The date he fails to pay the required premium; or The date the class of coverage is terminated. Coverage may not be continued: If the employee fails to pay any required premium; or If the company receives notice of Class I plan termination. Terminations An employee s insurance will terminate on the earliest of the following: 1. The date the plan is terminated, for Class I insureds; Page 57

58 2. The 31st day after the premium due date if the required premium has not been paid; 3. The date he ceases to meet the definition of an employee as defined in the plan, for Class I insureds; or 4. The date he is no longer a member of the Class Insurance for dependents will terminate on the earliest of the following: 1. The date the Plan is terminated, for dependents of Class I insureds; 2. The 31st day after the premium due date, if the required premium has not been paid; 3. The date the spouse or dependent child ceases to be a dependent; or 4. The premium due date following the date we receive the employee s written request to terminate coverage for his spouse and/or all dependent children. Termination of the insurance on any insured will not prejudice his rights regarding any claim arising prior to termination. Group Critical Illness Benefits First Occurrence Benefit After the waiting period, an insured may receive up to 100% of the benefit selected upon the first diagnosis of each covered critical illness. Recurrence of a previously diagnosed cancer is payable provided the diagnosis is made when the certificate is inforce, and provided the insured is free of any signs or symptons of that cancer for 12 consecutive months, and has been treatment-free for that cancer for 12 consecutive months. Critical Illnesses Covered Under Plan Percentage of Face Amount Cancer (Internal or Invasive) 100% Heart Attack Major Organ Transplant Renal Failure (End Stage) 100% Stroke 100% Carcinoma in Situ + 100% Coronary Artery Bypass Surgery+ 25% If diagnosis occurs after age 70, benefits are reduced by 50% Additional Occurrence Benefit We will pay benefits for each different Critical Illness in the order the events occur. We will pay benefits for any one Critical Illness once every six months. Therefore, no benefits are payable for each different Critical Illness after the first unless its date of diagnosis is separated from the prior Critical Illness by at least 6 months. Re-occurrence Benefit - We will pay benefits for the re-occurrence any Critical Illness once every twelve months. Therefore, once benefits have been paid for Critical Illness, no additional benefits are payable for that same Critical Illness unless the dates of diagnosis are separated by at least 12 months, or for cancer, 12 months treatment free. Cancer that has spread (metastasized) even though there is a new tumor, will not be considered an additional occurrence unlessou have gone treatment free for 12 months. + Payment of the partial benefit for Carcinoma in Situ will reduced by 25% the benefits for internal Cancer. Payment of the partial benefit for Coronary Artery Bypass Surgery will reduce by 25% the benefit for a Heart Attack. Page 58

59 Health Screening Benefit- $100 After the Waiting Period, an Insured may receive a maximum of $100 for any one covered screening test per calendar year. We will pay this benefit regardless of the results of the test. Payment of this benefit will not reduce the amount payable for the diagnosis of a critical illness. There is no limit to the number of years the Insured can receive the health screening benefit; it will be paid as long as the policy remains inforce. This benefit is payable for the covered employee and spouse. This benefit is not paid for Dependent Children. The covered health screening tests include but are not limited to: Stress test on a bicycle or treadmill Fasting blood glucose test, blood test for triglycerides or serum cholesterol test to determine level of HDL and LDL Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast Cancer) CA 125 (blood test for ovarian Cancer) CEA (blood test for colon Cancer) Chest x-ray Colonoscopy Flexible sigmoidoscopy Hemocult stool analysis Mammography Pap smear PSA (blood test for prostate Cancer) Serum protein electrophoresis (blood test for myeloma) Thermograph Additional Benefits Rider Illnesses Covered Under Plan Percentage of Face Amount Coma 100% Paralysis 100% Severe Burns 100% Loss of Speech 100% Loss of Sight 100% Loss of Hearing 100% If diagnosis occurs after age 70, benefits are reduced by 50% Page 59

60 Heart Event Rider Covered Surgeries and Procedures Percentage of Face Amount Category 1 Coronary Artery Bypass Surgery 100% Mitral valve replacement or repair 100% Aortic valve replacement or repair 100% Surgical Treatment of Abdominal aortic aneurysm 100% Category 2** AngioJet Clot Busting 10% Balloon Angioplasty (or Balloon Valvuloplasty) 10% Laser Angioplasty 10% Atherectomy 10% Stent implantation 10% Cardiac catheterization 10% Automatic Implantable (or Internal) Cardioverter 10% Defibrillator (AICD) Pacemakers 10% If diagnosis occurs after age 70, benefits are reduced by 50% Benefits from the Heart Event Rider and certificate will not exceed 100% of the maximum applicable benefit. When you purchase the Heart Event Rider, the 25% CABS partial benefit in your certificate is increased to 100%. That means the CABS benefit in the Heart Event Rider, combined with the benefit in your certificate, equal 100% of the maximum benefit not 125%. EXCEPTIONS, REDUCTIONS AND TERMS YOU NEED TO KNOW If the coverage outlined in this summary will replace any existing coverage, please be aware that it may be in your best interest to maintain your individual guaranteed renewable policy. If diagnosis occurs after age 70, benefits are reduced by 50% The plan contains a 30 day waiting period. This means that no benefits are payable for anyone who has been diagnosed before your coverage has been in force 30 days from the effective date. If you are first diagnosed during the waiting period, benefits for treatment of that critical illness will apply only to loss starting after 12 months from the effective date or the employee can elect to void the coverage and receive a full refund of premium. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description. Page 60

61 Benefits will not be paid for loss due to: Intentionally self-inflicted injury or action; Suicide or attempted suicide while sane; Illegal activities or participation in an illegal occupation; War, whether declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence; Substance abuse; or Pre-Existing Conditions (except as stated below). No benefits will be paid for loss which occurred prior to the Effective Date. No benefits will be paid for diagnosis made or treatment received outside of the United States. Pre-Existing Condition Limitation and Exceptions Pre-Existing Condition means a sickness or physical condition which, within the 12 month period prior to the Effective Date resulted in the insured receiving medical advice or treatment. We will not pay benefits for any critical illness starting within 12 months of the Effective Date which is caused by, contributed to, or resulting from a Pre-Existing Condition. A claim for benefits for loss starting after 12 months from the Effective Date will not be reduced or denied on the grounds that it is caused by a Pre-Existing Condition. A critical illness will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after the Effective Date. Additional Benefit Rider Exceptions All limitations and exclusions that apply to the Critical Illness plan also apply to the rider. The Waiting Period and Pre-existing condition limitation apply from the date the rider is effective. No benefits will be paid for loss which occurred prior to the effective date of the rider. Benefits are not payable for loss if these conditions result from another Critical Illness. The date of diagnosis of a Specified Critical Illness must be separated from the date of diagnosis of a subsequent different Critical Illness by at least 6 months. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the rider is in force; and the cause of the illness is not excluded by name or specific description. If diagnosis occurs after age 70, benefits are reduced by 50% Page 61

62 Heart Event Rider Exceptions We will pay the indicated percentages of your maximum benefit if you are treated with one of the specified surgical procedures (Category I) or interventional procedures (Category II) shown if the date of treatment is after the waiting period; treatment is incurred while coverage is in force; treatment is recommended by a physician; and is not excluded by name or specific description. This benefit is paid based on your selected benefit amount. The rider contains a 30 day waiting period. This means no benefits are payable for any insured who has been diagnosed before the coverage has been in force 30 days from the effective date. If an insured is first diagnosed during the waiting period, benefits for treatment of that critical illness will apply only to loss commencing after 12 months from the effective date; or, at your option, you may elect to void the coverage from the beginning and receive a full refund of premium. Benefits are not payable under this coverage for loss if these conditions result from another specified critical illness. Unless amended by the Heart Event Rider, certificate definitions, other provisions and terms apply. Benefits provided by the Heart Event Rider amend any benefits shown in the base plan for the same conditions. Benefits for Category II will reduce the benefit amounts payable for Category I benefits. Benefits will be paid only at the highest benefit level. If Category I and Category II procedures are performed at the same time, benefits are only eligible at the 100% (higher) event and will not exceed the initial face amount shown. The insured is only eligible to receive one payment for each benefit category listed. The dates of loss for covered procedures must be separated by at least 12 months for benefits to be payable for multiple covered procedures. Payment of initial, reoccurrence, or additional occurrence benefits are subject to the benefits section of the base certificate. PRE-EXISTING CONDITIONS EXCEPTION Pre-Existing Condition means a sickness or physical condition which, within the 12 month period prior to an insured s effective date, resulted in the insured receiving medical advice or treatment. We will not pay benefits for any surgical procedure occurring within 12 months of an insured s effective date which is caused by, contributed to, or resulting from a pre-existing condition. A claim for benefits for loss starting after 12 months from an insured s effective date will not be reduced or denied on the grounds that it is caused by a pre-existing condition. A critical illness will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after an insured s effective date. Any benefits for coronary artery bypass surgery denied under the coverage due to pre-existing conditions may be paid at the reduced benefit amount under the certificate, subject to the terms of the certificate. Page 62

63 Notices This booklet is a brief description of coverage, not a contract. Read your certificate carefully for exact plan language, terms, and conditions. If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AGCM328C-NC-BK R1 Continental American Insurance Company Columbia, South Carolina Phone ~ Website ~ aflacgroupinsurance.com Underwritten by Continental American Insurance Company A proud member of the Aflac family of insurers Page 63

64 Aflac Critical Illness Plan (with cancer) Employee and Spouse Monthly (12 pay) Rates CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $6.25 $9.00 $11.75 $14.50 $17.25 $20.00 $22.75 $25.50 $28.25 $ $7.95 $12.40 $16.85 $21.30 $25.75 $30.20 $34.65 $39.10 $43.55 $ $12.85 $22.20 $31.55 $40.90 $50.25 $59.60 $68.95 $78.30 $87.65 $ $19.17 $34.83 $50.50 $66.17 $81.83 $97.50 $ $ $ $ $28.50 $53.50 $78.50 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $6.25 $7.63 $9.00 $10.38 $11.75 $13.13 $14.50 $15.88 $ $7.95 $10.18 $12.40 $14.63 $16.85 $19.08 $21.30 $23.53 $ $12.85 $17.53 $22.20 $26.88 $31.55 $36.23 $40.90 $45.58 $ $19.17 $27.00 $34.83 $42.67 $50.50 $58.33 $66.17 $74.00 $ $28.50 $41.00 $53.50 $66.00 $78.50 $91.00 $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $7.85 $12.20 $16.55 $20.90 $25.25 $29.60 $33.95 $38.30 $42.65 $ $10.95 $18.40 $25.85 $33.30 $40.75 $48.20 $55.65 $63.10 $70.55 $ $22.80 $42.10 $61.40 $80.70 $ $ $ $ $ $ $34.40 $65.30 $96.20 $ $ $ $ $ $ $ $52.85 $ $ $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $7.85 $10.03 $12.20 $14.38 $16.55 $18.73 $20.90 $23.08 $ $10.95 $14.68 $18.40 $22.13 $25.85 $29.58 $33.30 $37.03 $ $22.80 $32.45 $42.10 $51.75 $61.40 $71.05 $80.70 $90.35 $ $34.40 $49.85 $65.30 $80.75 $96.20 $ $ $ $ $52.85 $77.53 $ $ $ $ $ $ $ Rates include cancer benefit. Rates include $100 Health Screening Benefit. Page 64

65 Aflac Critical Illness Plan (with cancer) Employee and Spouse Tenthly (10 pay) Rates CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $7.50 $10.80 $14.10 $17.40 $20.70 $24.00 $27.30 $30.60 $33.90 $ $9.54 $14.88 $20.22 $25.56 $30.90 $36.24 $41.58 $46.92 $52.26 $ $15.42 $26.64 $37.86 $49.08 $60.30 $71.52 $82.74 $93.96 $ $ $23.00 $41.80 $60.60 $79.40 $98.20 $ $ $ $ $ $34.20 $64.20 $94.20 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $7.50 $9.15 $10.80 $12.45 $14.10 $15.75 $17.40 $19.05 $ $9.54 $12.21 $14.88 $17.55 $20.22 $22.89 $25.56 $28.23 $ $15.42 $21.03 $26.64 $32.25 $37.86 $43.47 $49.08 $54.69 $ $23.00 $32.40 $41.80 $51.20 $60.60 $70.00 $79.40 $88.80 $ $34.20 $49.20 $64.20 $79.20 $94.20 $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $9.42 $14.64 $19.86 $25.08 $30.30 $35.52 $40.74 $45.96 $51.18 $ $13.14 $22.08 $31.02 $39.96 $48.90 $57.84 $66.78 $75.72 $84.66 $ $27.36 $50.52 $73.68 $96.84 $ $ $ $ $ $ $41.28 $78.36 $ $ $ $ $ $ $ $ $63.42 $ $ $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $9.42 $12.03 $14.64 $17.25 $19.86 $22.47 $25.08 $27.69 $ $13.14 $17.61 $22.08 $26.55 $31.02 $35.49 $39.96 $44.43 $ $27.36 $38.94 $50.52 $62.10 $73.68 $85.26 $96.84 $ $ $41.28 $59.82 $78.36 $96.90 $ $ $ $ $ $63.42 $93.03 $ $ $ $ $ $ $ Rates include cancer benefit. Rates include $100 Health Screening Benefit. Page 65

66 Aflac Critical Illness Plan (with cancer) Employee and Spouse (20 pay) Rates CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.75 $5.40 $7.05 $8.70 $10.35 $12.00 $13.65 $15.30 $16.95 $ $4.77 $7.44 $10.11 $12.78 $15.45 $18.12 $20.79 $23.46 $26.13 $ $7.71 $13.32 $18.93 $24.54 $30.15 $35.76 $41.37 $46.98 $52.59 $ $11.50 $20.90 $30.30 $39.70 $49.10 $58.50 $67.90 $77.30 $86.70 $ $17.10 $32.10 $47.10 $62.10 $77.10 $92.10 $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.75 $4.58 $5.40 $6.23 $7.05 $7.88 $8.70 $9.53 $ $4.77 $6.11 $7.44 $8.78 $10.11 $11.45 $12.78 $14.12 $ $7.71 $10.52 $13.32 $16.13 $18.93 $21.74 $24.54 $27.35 $ $11.50 $16.20 $20.90 $25.60 $30.30 $35.00 $39.70 $44.40 $ $17.10 $24.60 $32.10 $39.60 $47.10 $54.60 $62.10 $69.60 $77.10 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $4.71 $7.32 $9.93 $12.54 $15.15 $17.76 $20.37 $22.98 $25.59 $ $6.57 $11.04 $15.51 $19.98 $24.45 $28.92 $33.39 $37.86 $42.33 $ $13.68 $25.26 $36.84 $48.42 $60.00 $71.58 $83.16 $94.74 $ $ $20.64 $39.18 $57.72 $76.26 $94.80 $ $ $ $ $ $31.71 $61.32 $90.93 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $4.71 $6.02 $7.32 $8.63 $9.93 $11.24 $12.54 $13.85 $ $6.57 $8.81 $11.04 $13.28 $15.51 $17.75 $19.98 $22.22 $ $13.68 $19.47 $25.26 $31.05 $36.84 $42.63 $48.42 $54.21 $ $20.64 $29.91 $39.18 $48.45 $57.72 $66.99 $76.26 $85.53 $ $31.71 $46.52 $61.32 $76.13 $90.93 $ $ $ $ Rates include cancer benefit. Rates include $100 Health Screening Benefit. Page 66

67 Aflac Critical Illness Plan (with cancer) Employee and Spouse Semi-Monthly (24 pay) Rates Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.13 $4.50 $5.88 $7.25 $8.63 $10.00 $11.38 $12.75 $14.13 $ $3.98 $6.20 $8.43 $10.65 $12.88 $15.10 $17.33 $19.55 $21.78 $ $6.43 $11.10 $15.78 $20.45 $25.13 $29.80 $34.48 $39.15 $43.83 $ $9.58 $17.42 $25.25 $33.08 $40.92 $48.75 $56.58 $64.42 $72.25 $ $14.25 $26.75 $39.25 $51.75 $64.25 $76.75 $89.25 $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.13 $3.81 $4.50 $5.19 $5.88 $6.56 $7.25 $7.94 $ $3.98 $5.09 $6.20 $7.31 $8.43 $9.54 $10.65 $11.76 $ $6.43 $8.76 $11.10 $13.44 $15.78 $18.11 $20.45 $22.79 $ $9.58 $13.50 $17.42 $21.33 $25.25 $29.17 $33.08 $37.00 $ $14.25 $20.50 $26.75 $33.00 $39.25 $45.50 $51.75 $58.00 $64.25 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.93 $6.10 $8.28 $10.45 $12.63 $14.80 $16.98 $19.15 $21.33 $ $5.48 $9.20 $12.93 $16.65 $20.38 $24.10 $27.83 $31.55 $35.28 $ $11.40 $21.05 $30.70 $40.35 $50.00 $59.65 $69.30 $78.95 $88.60 $ $17.20 $32.65 $48.10 $63.55 $79.00 $94.45 $ $ $ $ $26.43 $51.10 $75.78 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.93 $5.01 $6.10 $7.19 $8.28 $9.36 $10.45 $11.54 $ $5.48 $7.34 $9.20 $11.06 $12.93 $14.79 $16.65 $18.51 $ $11.40 $16.23 $21.05 $25.88 $30.70 $35.53 $40.35 $45.18 $ $17.20 $24.93 $32.65 $40.38 $48.10 $55.83 $63.55 $71.28 $ $26.43 $38.76 $51.10 $63.44 $75.78 $88.11 $ $ $ Rates include cancer benefit. Rates include $100 Health Screening Benefit. Page 67

68 Aflac Value Added Services Need help with healthcare? Need We ve got help your lifeline. with healthcare? Introducing Health Advocacy, Medical Bill We ve Saver and got Telemedicine your lifeline. services, now part of your Aflac plan. Introducing Health Advocacy, Medical Bill Saver and Telemedicine services, now part of your Aflac plan. We ve enhanced your plan without adding cost. Now, if you have Aflac Group Critical Illness, Group Accident or Group Hospital We ve enhanced your plan without adding ding cost. Indemnity policies, you also have access to three new services that make it easier Now, to access if you have care, Aflac reduce Group out-of-pocket Critical Illness, medical Group expenses Accident and or Group navigate Hospital the healthcare Indemnity system with plans, greater you also ease: have access to three new services that make it easier to access care, reduce out-of-pocket medical expenses and navigate the healthcare system with Get greater answers ease: and expert help with Health Advocacy from Health Advocate. Get Let answers advocates and expert negotiate help your with medical Health Advocacy bills with Medical from Health Bill Saver Advocate. TM, also Let from advocates Health Advocate negotiate your medical bills with Medical Bill Saver TM, also from Connect Health Advocate with health providers via phone, app or online with MeMD. Connect with health providers via phone, app or online with MeMD. These three services are now embedded in your group plan at no extra charge. These Best three of all, services you can are start now using embedded them as in soon your group as your plan Aflac coverage at no extra starts. charge. Best of all, you can start using them as soon as your Aflac coverage starts. Start using Health Advocacy and Medical Bill Saver from Start using Health Advocacy and Medical Bill Saver from Health Health Advocate Advocate and and Telemedicine Telemedicine from from MeMD MeMD when January your 1, coverage begins. Questions? Questions? Call Call SERVICES SERVICES AVAILABLE AVAILABLE STARTING AS SOON JANUARY AS YOUR 1, COVERAGE 2016 STARTS DID YOU KNOW? KNOW? You You can can also also use use Health Health Advocate s Health Health Advocacy and and Medical Bill Bill Saver Saver TM services TM services for your for your spouse, spouse, dependent dependent children, children, parents parents and and parents-in-law, parents-in-law, while while Telemedicine is available for you and your family. Telemedicine is available for you and your family. Page 68

69 Get more without spending more. You have 24/7 access to Personal Health Advocates who start helping from the first call: More than just peace of mind. Find doctors, More dentists, specialists, hospitals and Assist with eldercare issues, Medic Health than Advocacy just peace from Health of mind. Advocate other providers Health Advocacy from Health Advocate Help transfer medical records, lab r You have 24/7 access to Personal Health Advocates who start helping from the first call: Schedule appointments, treatments and tests Work with insurance companies to Find doctors, dentists, specialists, hospitals and Assist with eldercare issues, Medicare and more You Resolve have 24/7 access benefits to Personal issues Health and coordinate Advocates who benefits start helping from the first and call: other providers clarify coverage Help transfer medical records, lab results and X-rays Schedule appointments, treatments and tests Find doctors, dentists, specialists, hospitals and Work Assist with insurance eldercare companies issues, Medicare to obtain and approvals more Resolve benefits issues and coordinate benefits and clarify coverage other providers Help transfer medical records, lab results and X-rays Schedule appointments, More treatments than and just tests More than just cash benefits. cash Work benefits. with insurance companies to obtain approvals Resolve benefits Medical issues Bill and Saver coordinate TM from benefits Health Advocate Medical Bill Saver TM and clarify coverage from Health Advocate Aflac already pays claims quickly. Now, with Medical Bill Saver, Health Advocate professionals also help you negotiate medical bills not covered by health insurance: Aflac already More than pays just claims cash quickly. benefits. Now, with Medical Bill Saver, Health Advocate profes you negotiate Medical medical Bill Saverbills TM from not Health covered Advocate Once by an health agreement insurance: is made, the provider approves Just send in your medical and dental bills of $400 or more They contact the provider to negotiate a discount Just send in your medical and dental bills of $400 Once an agreement is made, the p Negotiations can lead to a reduction in out-of- Statement, summarizing the outcome and Aflac already pays claims quickly. Now, with Medical Bill Saver, Health Advocate professionals also help pocket or more costs payment terms payment terms and conditions you negotiate medical bills not covered by health insurance: They contact the provider to negotiate a discount You get an easy-to-read personal S Just send in your More medical than and just dental care. bills of $400 Once an agreement is made, Negotiations can lead to a reduction in out-of- Statement, the provider summarizing approves the outcom or more Telemedicine from MeMD payment terms and conditions pocket costs payment terms They contact the provider to negotiate a discount You get an easy-to-read personal Savings Result You can quickly connect with board-certified, U.S. licensed health providers online for 24/7/365 access Negotiations can lead to a reduction in out-of- Statement, summarizing the outcome and to medical care fast: pocket costs payment terms More than just care. Create your account at When you have a health issue, log on and request a provider consultation Telemedicine from MeMD More than just care. You can request consultations via webcam, app or phone payment terms and conditions You get an easy-to-read personal Savings Result Get eprescriptions,* referrals and more Use it for a range of health issues, from allergies and colds to medication refills $25.00 per visit! Telemedicine from MeMD Questions? You can quickly Call connect with board-certified, U.S. licensed health providers online for 24/ to medical care fast: You Value Added can Services quickly connect with board-certified, U.S. licensed This offering health may not supersede providers the terms online and conditions for of 24/7/365 any existing contract access the client Value Added Services not available to residents of Idaho. State availability may vary. has with Health Advocate. Health Advocate reserves the right to refuse any client group to medical care fast: Telemedicine through Aflac if the client group cancels a pre-existing contract with Health Advocate prior to Create your account at date of the contract. Get eprescriptions,* referrals and m Due to Arkansas state regulations, insureds physically located in Arkansas at the time of a telemedicine session may only receive consultation services from physicians. Physicians are aflacgroupinsurance.com prohibited Create from When your providing you account diagnoses or have at prescribing drugs to persons located in Arkansas at Continental a health issue, log on and Get request eprescriptions,* American Insurance Company referrals (CAIC), a proud Use and member it more of the Aflac family of insurers, the time of service. for a range of health issues, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is Medical Bill Saver not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. For groups Medical When a Bill Saver provider you has have restrictions a consultation health for negotiations issue, in-network log on deductibles and request and co-insurance sitused Use in California, it for group a range coverage of is underwritten health and issues, by Continental colds from American allergies to Life Insurance medication refills in Arizona, Colorado, District of Columbia, Illinois, Indiana, New Jersey, New York, North Company. For groups sitused in New York, coverage is underwritten by American Family Life Carolina, a provider Ohio, South consultation Dakota, Texas, Utah and Vermont. Assurance and Company colds of to New medication York. Continental American refills Insurance Company Columbia, South *When medically You necessary, can request MeMD providers can consultations submit a prescription electronically via for webcam, Carolina $35.00 per visit! purchase and pick-up at your local pharmacy. You can request consultations via webcam, $35.00 per visit! AGC app R5 or phone IV (3/17) app or phone Questions? Call Call *When medically necessary, MeMD providers can submit a prescription electronically for purchase and pick-up at your local pharmacy. aflacgroupinsurance.com Medical Bill Saver has restrictions for negotiations on in-network deductibles and co-insurance in Arizona, Colorado, District of Columbia, Illinois, Indiana, New Jersey, New York, North Carolina, Ohio, South Dakota, Texas, Utah and Vermont. Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. Continental American Insurance Company Columbia, South Carolina R3 IV (7/16) Page 69

70 Aflac Critical Illness without Cancer Lump Sum Single Payment Policy / First Occurrence Effective Date: August 1, 2017 Plan Features (2800) Benefits are paid directly to you, unless otherwise assigned. Premiums are paid through convenient payroll deduction. Guaranteed-issue coverage available to employee and spouse. Each dependent child is covered at 50% of the primary insured amount at no additional charge. Benefit amounts are available from $5,000 up to $50,000 for employees and up to $25,000 for spouse. An annual Health Screening benefit is included. The plan is portable, which means you can take your coverage with you if you change jobs or Includes an Additional Benefits Rider with benefits for the following: o Coma o Paralysis o Severe Burn o Loss of Sight o Loss of Hearing o Loss of Speech o Includes a Heart Event Rider Underwriting Guidelines Guaranteed-Issue Guaranteed-issue coverage is offered for All Employees: Up to $30,000 for employees and up to $15,000 for spouses with no participation requirement. For employee amounts over $30,000 and spouse amounts over $15,000: All applicants are required to answer underwriting questions. Employees who would otherwise be declined will be issued the lesser of the amount applied for or the guaranteed-issue limit. Individual Eligibility Issue Ages Employee ~ Spouse ~ Children under age 26 Benefit-eligible employees, working at least 30 hours or more weekly, with at least 0 days of continuous employment by the date of the enrollment are eligible. If an employee is eligible, his spouse is eligible and all children of the insured who are younger than 26 years of age are eligible for coverage. Seasonal and temporary workers are not eligible to participate. Page 70

71 Class I All full-time and part-time benefit-eligible employees are eligible for Class I coverage. That eligibility extends to their spouses and children under age 26. Class II A Class I primary insured is eligible for Class II coverage if he: Was previously insured under Class I; and Is no longer employed by the policyholder. The employee must elect Class II coverage under the Portability Privilege within 31 days after the date for which his Class I eligibility would otherwise terminate. Only dependents covered under Class I coverage are eligible for continued coverage under Class II. Class II insureds cannot continue coverage through the employer s payroll deduction process. They must remit premiums directly to the company. Spouse Coverage Available The employee may elect to purchase spouse coverage. In order to apply for spouse coverage, the employee must also apply. Spouses are eligible for benefit amounts equaling 50% of the employee amount, not to exceed the $25,000 maximum benefit. If the employee does not meet the underwriting requirements necessary to participate in the plan, the spouse can still obtain coverage. The spouse would then become the primary insured and is limited to face amounts up to $25,000. Dependent Children Coverage at No Additional Charge Each eligible dependent child is covered at 50% of the primary insured amount at no additional charge. The payment of benefits for a dependent child does not reduce the face amount of the primary insured. Children-only coverage is not available. Please see the Definitions section for a complete definition of dependent children. Portability When coverage is effective and would otherwise terminate because the employee ends employment with the employer, coverage may be continued. He may exercise the Portability Privilege when there is a change to his coverage class. The employee and any covered dependents will continue the coverage that is in-force on the date employment ends. The continued coverage will be provided under Class II. The premium rate for portability coverage may change for the class of covered persons on portability on any premium due date. Written notice will be given at least 31 days before any change is to take effect. The employee may continue the coverage until the earlier of: The date he fails to pay the required premium; or The date the class of coverage is terminated. Coverage may not be continued: If the employee fails to pay any required premium; or If the company receives notice of Class I plan termination. Page 71

72 Terminations An employee s insurance will terminate on the earliest of the following: 1. The date the plan is terminated, for Class I insureds; 2. The 31st day after the premium due date if the required premium has not been paid; 3. The date he ceases to meet the definition of an employee as defined in the plan, for Class I insureds; or 4. The date he is no longer a member of the Class eligible for coverage. Insurance for dependents will terminate on the earliest of the following: 1. The date the Plan is terminated, for dependents of Class I insureds; 2. The 31st day after the premium due date, if the required premium has not been paid; 3. The date the spouse or dependent child ceases to be a dependent; or 4. The premium due date following the date we receive the employee s written request to terminate coverage for his spouse and/or all depen dent children. Termination of the insurance on any insured will not prejudice his rights regarding any claim arising prior to termination. Group Critical Illness Benefits First Occurrence Benefit After the waiting period, an insured may receive up to 100% of the benefit selected upon the first diagnosis of each covered critical illness. Critical Illnesses Covered Under Plan Percentage of Face Amount Heart Attack 100% Major Organ Transplant 100% Renal Failure (End Stage) 100% Stroke 100% Coronary Artery Bypass Surgery+ 25% ~ If diagnosis occurs after age 70, benefits are reduced by 50%. Additional Occurrence Benefit We will pay benefits for each different Critical Illness in the order the events occur. We will pay benefits for any one Critical Illness once every six months. Therefore, no benefits are payable for each different Critical Illness after the first unless its date of diagnosis is separated from the prior Critical Illness by at least 6 months. Re-occurrence Benefit - We will pay benefits for the re-occurrence any Critical Illness once every twelve months. Therefore, once benefits have been paid for Critical Illness, no additional benefits are payable for that same Critical Illness unless the dates of diagnosis are separated by at least 12 months. + Payment of the partial benefit for Coronary Artery Bypass Surgery will reduce by 25% the benefit for a Heart Attack. Page 72

73 Health Screening Benefit- $100 After the Waiting Period, an Insured may receive a maximum of $100 for any one covered screening test per calendar year. We will pay this benefit regardless of the results of the test. Payment of this benefit will not reduce the amount payable for the diagnosis of a critical illness. There is no limit to the number of years the Insured can receive the health screening benefit; it will be paid as long as the policy remains inforce. This benefit is payable for the covered employee and spouse. This benefit is not paid for Dependent Children. The covered health screening tests include but are not limited to: Stress test on a bicycle or treadmill Fasting blood glucose test, blood test for triglycerides or serum choles terol test to determine level of HDL and LDL Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast Cancer) CA 125 (blood test for ovarian Cancer) CEA (blood test for colon Cancer) Chest x-ray Colonoscopy Flexible sigmoidoscopy Hemocult stool analysis Mammography Pap smear PSA (blood test for prostate Cancer) Serum protein electrophoresis (blood test for myeloma) Thermograph Additional Benefits Rider Illnesses Covered Under Plan Percentage of Face Amount Coma 100% Paralysis 100% Severe Burns 100% Loss of Speech 100% Loss of Sight 100% Loss of Hearing 100% ~ If diagnosis occurs after age 70, benefits are reduced by 50%. Page 73

74 Heart Event Rider Covered Surgeries and Procedures Percentage of Face Amount Category 1 Coronary Artery Bypass Surgery 100% Mitral valve replacement or repair 100% Aortic valve replacement or repair 100% Surgical Treatment of Abdominal aortic aneurysm 100% Category 2** AngioJet Clot Busting 10% Balloon Angioplasty (or Balloon Valvuloplasty ) 10% Laser Angioplasty 10% Atherectomy 10% Stent implantation 10% Cardiac catheterization 10% Automatic Implantable (or Internal) Cardioverter 10% Defibrillator (AICD) Pacemakers 10% If diagnosis occurs after age 70, benefits are reduced by 50%. Benefits from the Heart Event Rider and certificate will not exceed 100% of the maximum applicable benefit. When you purchase the Heart Event Rider, the 25% CABS partial benefit in your certificate is increased to 100%. That means the CABS benefit in the Heart Event Rider, combined with the benefit in your certificate, equal 100% of the maximum benefit not 125%. EXCEPTIONS, REDUCTIONS AND TERMS YOU NEED TO KNOW If the coverage outlined in this summary will replace any existing coverage, please be aware that it may be in your best interest to maintain your individual guaranteed renewable policy. If diagnosis occurs after age 70, benefits are reduced by 50%. The plan contains a 30 day waiting period. This means that no benefits are payable for anyone who has been diagnosed before your coverage has been in force 30 days from the effective date. If you are first diagnosed during the waiting period, benefits for treatment of that critical illness will apply only to loss starting after 12 months from the effective date or the employee can elect to void the coverage and receive a full refund of premium. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description. Page 74

75 Benefits will not be paid for loss due to: Intentionally self-inflicted injury or action; Suicide or attempted suicide while sane; Illegal activities or participation in an illegal occupation; War, whether declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence; Substance abuse; or Pre-Existing Conditions (except as stated below). No benefits will be paid for loss which occurred prior to the Effective Date. No benefits will be paid for diagnosis made or treatment received outside of the United States. Pre-Existing Condition Limitation and Exceptions Pre-Existing Condition means a sickness or physical condition which, within the 12-month period prior to the Effective Date resulted in the insured receiving medical advice or treatment. We will not pay benefits for any critical illness starting within 12 months of the Effective Date which is caused by, contributed to, or resulting from a Pre-Existing Condition. A claim for benefits for loss starting after 12 months from the Effective Date will not be reduced or denied on the grounds that it is caused by a Pre-Existing Condition. A critical illness will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after the Effective Date. Additional Benefit Rider Exceptions If diagnosis occurs after age 70, benefits are reduced by 50%. All limitations and exclusions that apply to the Critical Illness plan also apply to the rider. The Waiting Period and Pre-existing condition limitation apply from the date the rider is effective. No benefits will be paid for loss which occurred prior to the effective date of the rider. Benefits are not payable for loss if these conditions result from another Critical Illness. The date of diagnosis of a Specified Critical Illness must be separated from the date of diagnosis of a subsequent different Critical Illness by at least 6 months. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the rider is in force; and the cause of the illness is not excluded by name or specific description. Page 75

76 Notices This booklet is a brief description of coverage, not a contract. Read your certificate carefully for exact plan language, terms, and conditions. If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AGCM328-NC-BK R1 Continental American Insurance Company, Columbia, South Carolina Phone ~ Website ~ aflacgroupinsurance.com Underwritten by Continental American Insurance Company A proud member of the Aflac family of insurers Page 76

77 Aflac Critical Illness Plan (without cancer) Employee and Spouse Monthly (12 pay) Rates Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $5.35 $7.20 $9.05 $10.90 $12.75 $14.60 $16.45 $18.30 $20.15 $ $6.55 $9.60 $12.65 $15.70 $18.75 $21.80 $24.85 $27.90 $30.95 $ $9.70 $15.90 $22.10 $28.30 $34.50 $40.70 $46.90 $53.10 $59.30 $ $13.45 $23.40 $33.35 $43.30 $53.25 $63.20 $73.15 $83.10 $93.05 $ $19.50 $35.50 $51.50 $67.50 $83.50 $99.50 $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $5.35 $6.28 $7.20 $8.13 $9.05 $9.98 $10.90 $11.83 $ $6.55 $8.08 $9.60 $11.13 $12.65 $14.18 $15.70 $17.23 $ $9.70 $12.80 $15.90 $19.00 $22.10 $25.20 $28.30 $31.40 $ $13.45 $18.43 $23.40 $28.38 $33.35 $38.33 $43.30 $48.28 $ $19.50 $27.50 $35.50 $43.50 $51.50 $59.50 $67.50 $75.50 $83.50 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $6.30 $9.10 $11.90 $14.70 $17.50 $20.30 $23.10 $25.90 $28.70 $ $8.35 $13.20 $18.05 $22.90 $27.75 $32.60 $37.45 $42.30 $47.15 $ $15.80 $28.10 $40.40 $52.70 $65.00 $77.30 $89.60 $ $ $ $23.15 $42.80 $62.45 $82.10 $ $ $ $ $ $ $34.10 $64.70 $95.30 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $6.30 $7.70 $9.10 $10.50 $11.90 $13.30 $14.70 $16.10 $ $8.35 $10.78 $13.20 $15.63 $18.05 $20.48 $22.90 $25.33 $ $15.80 $21.95 $28.10 $34.25 $40.40 $46.55 $52.70 $58.85 $ $23.15 $32.98 $42.80 $52.63 $62.45 $72.28 $82.10 $91.93 $ $34.10 $49.40 $64.70 $80.00 $95.30 $ $ $ $ Rates do not include cancer benefit. Rates include $100 Health Screening Benefit. Page 77

78 Aflac Critical Illness Plan (without cancer) Employee and Spouse Tenthly (10 pay) Rates CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $6.42 $8.64 $10.86 $13.08 $15.30 $17.52 $19.74 $21.96 $24.18 $ $7.86 $11.52 $15.18 $18.84 $22.50 $26.16 $29.82 $33.48 $37.14 $ $11.64 $19.08 $26.52 $33.96 $41.40 $48.84 $56.28 $63.72 $71.16 $ $16.14 $28.08 $40.02 $51.96 $63.90 $75.84 $87.78 $99.72 $ $ $23.40 $42.60 $61.80 $81.00 $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $6.42 $7.53 $8.64 $9.75 $10.86 $11.97 $13.08 $14.19 $ $7.86 $9.69 $11.52 $13.35 $15.18 $17.01 $18.84 $20.67 $ $11.64 $15.36 $19.08 $22.80 $26.52 $30.24 $33.96 $37.68 $ $16.14 $22.11 $28.08 $34.05 $40.02 $45.99 $51.96 $57.93 $ $23.40 $33.00 $42.60 $52.20 $61.80 $71.40 $81.00 $90.60 $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $7.56 $10.92 $14.28 $17.64 $21.00 $24.36 $27.72 $31.08 $34.44 $ $10.02 $15.84 $21.66 $27.48 $33.30 $39.12 $44.94 $50.76 $56.58 $ $18.96 $33.72 $48.48 $63.24 $78.00 $92.76 $ $ $ $ $27.78 $51.36 $74.94 $98.52 $ $ $ $ $ $ $40.92 $77.64 $ $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $7.56 $9.24 $10.92 $12.60 $14.28 $15.96 $17.64 $19.32 $ $10.02 $12.93 $15.84 $18.75 $21.66 $24.57 $27.48 $30.39 $ $18.96 $26.34 $33.72 $41.10 $48.48 $55.86 $63.24 $70.62 $ $27.78 $39.57 $51.36 $63.15 $74.94 $86.73 $98.52 $ $ $40.92 $59.28 $77.64 $96.00 $ $ $ $ $ Rates do not include cancer benefit. Rates include $100 Health Screening Benefit. Page 78

79 Aflac Critical Illness Plan (without cancer) Employee and Spouse (20 pay) Rates Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.21 $4.32 $5.43 $6.54 $7.65 $8.76 $9.87 $10.98 $12.09 $ $3.93 $5.76 $7.59 $9.42 $11.25 $13.08 $14.91 $16.74 $18.57 $ $5.82 $9.54 $13.26 $16.98 $20.70 $24.42 $28.14 $31.86 $35.58 $ $8.07 $14.04 $20.01 $25.98 $31.95 $37.92 $43.89 $49.86 $55.83 $ $11.70 $21.30 $30.90 $40.50 $50.10 $59.70 $69.30 $78.90 $88.50 $98.10 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.21 $3.77 $4.32 $4.88 $5.43 $5.99 $6.54 $7.10 $ $3.93 $4.85 $5.76 $6.68 $7.59 $8.51 $9.42 $10.34 $ $5.82 $7.68 $9.54 $11.40 $13.26 $15.12 $16.98 $18.84 $ $8.07 $11.06 $14.04 $17.03 $20.01 $23.00 $25.98 $28.97 $ $11.70 $16.50 $21.30 $26.10 $30.90 $35.70 $40.50 $45.30 $50.10 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.78 $5.46 $7.14 $8.82 $10.50 $12.18 $13.86 $15.54 $17.22 $ $5.01 $7.92 $10.83 $13.74 $16.65 $19.56 $22.47 $25.38 $28.29 $ $9.48 $16.86 $24.24 $31.62 $39.00 $46.38 $53.76 $61.14 $68.52 $ $13.89 $25.68 $37.47 $49.26 $61.05 $72.84 $84.63 $96.42 $ $ $20.46 $38.82 $57.18 $75.54 $93.90 $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.78 $4.62 $5.46 $6.30 $7.14 $7.98 $8.82 $9.66 $ $5.01 $6.47 $7.92 $9.38 $10.83 $12.29 $13.74 $15.20 $ $9.48 $13.17 $16.86 $20.55 $24.24 $27.93 $31.62 $35.31 $ $13.89 $19.79 $25.68 $31.58 $37.47 $43.37 $49.26 $55.16 $ $20.46 $29.64 $38.82 $48.00 $57.18 $66.36 $75.54 $84.72 $93.90 Rates do not include cancer benefit. Rates include $100 Health Screening Benefit. Page 79

80 Aflac Critical Illness Plan (without cancer) Employee and Spouse Semi-Monthly (24 pay) Rates Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $2.68 $3.60 $4.53 $5.45 $6.38 $7.30 $8.23 $9.15 $10.08 $ $3.28 $4.80 $6.33 $7.85 $9.38 $10.90 $12.43 $13.95 $15.48 $ $4.85 $7.95 $11.05 $14.15 $17.25 $20.35 $23.45 $26.55 $29.65 $ $6.73 $11.70 $16.68 $21.65 $26.63 $31.60 $36.58 $41.55 $46.53 $ $9.75 $17.75 $25.75 $33.75 $41.75 $49.75 $57.75 $65.75 $73.75 $81.75 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider NON- TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $2.68 $3.14 $3.60 $4.06 $4.53 $4.99 $5.45 $5.91 $ $3.28 $4.04 $4.80 $5.56 $6.33 $7.09 $7.85 $8.61 $ $4.85 $6.40 $7.95 $9.50 $11.05 $12.60 $14.15 $15.70 $ $6.73 $9.21 $11.70 $14.19 $16.68 $19.16 $21.65 $24.14 $ $9.75 $13.75 $17.75 $21.75 $25.75 $29.75 $33.75 $37.75 $41.75 CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.15 $4.55 $5.95 $7.35 $8.75 $10.15 $11.55 $12.95 $14.35 $ $4.18 $6.60 $9.03 $11.45 $13.88 $16.30 $18.73 $21.15 $23.58 $ $7.90 $14.05 $20.20 $26.35 $32.50 $38.65 $44.80 $50.95 $57.10 $ $11.58 $21.40 $31.23 $41.05 $50.88 $60.70 $70.53 $80.35 $90.18 $ $17.05 $32.35 $47.65 $62.95 $78.25 $93.55 $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series Additional Benefits Rider Heart Event Rider TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.15 $3.85 $4.55 $5.25 $5.95 $6.65 $7.35 $8.05 $ $4.18 $5.39 $6.60 $7.81 $9.03 $10.24 $11.45 $12.66 $ $7.90 $10.98 $14.05 $17.13 $20.20 $23.28 $26.35 $29.43 $ $11.58 $16.49 $21.40 $26.31 $31.23 $36.14 $41.05 $45.96 $ $17.05 $24.70 $32.35 $40.00 $47.65 $55.30 $62.95 $70.60 $78.25 Rates do not include cancer benefit. Rates include $100 Health Screening Benefit. Page 80

81 AUL Short Term Disability Effective Date: August 1, 2017 Why do you need Disability Insurance? Consider this... Statistics show you are much more likely to be injured in an accident than to die from one. A fatal injury occurs every 5 minutes, and a disabling injury occurs every 1.5 seconds. 1 There is a death caused by a motor vehicle crash every 12 minutes; there is a disabling injury every 14 seconds. 1 In the home, there is a fatal injury every 16 minutes and a disabling injury every 4 seconds. 1 While many people survive accidental injuries, many others live with serious illnesses. In the United States, men have a little less than a 1-in-2 lifetime risk of developing cancer; for women the risk is a little more than 1-in-3. The five-year relative survival rate for all cancers combined is 63%. 2 One in five males and females has some form of cardiovascular disease. High blood pressure is the most common form of cardiovascular disease. 3 More than 35 million Americans are now living with chronic lung diseases, such as asthma, emphysema, and chronic bronchitis. 4 Advances in medicine are allowing us to live longer. However, recovery from a serious illness or injury often requires time away from work. In the last 20 years, deaths due to the big three (cancer, heart attack, and stroke) have gone down significantly. But disabilities due to those same three are up dramatically! Things that use to kill now disable. 5 You have life insurance, home insurance, and automobile insurance. But is your income insured? 1 National Safety Council, Injury Facts, 2003 Edition 2 American Cancer Society, Cancer Facts & Figures American Heart Association, Heart Disease and Stroke Statistics 2004 Update 4 American Lung Association, Lung Disease Data National Underwriter, May 2002 Page 81

82 Class Description All Full-Time Eligible Employees working a minimum of 30 hours per week, electing to participate in the Voluntary Short Term Disability Insurance 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. Monthly Benefit You can choose to insure up to 70% of your covered basic monthly earnings to a maximum monthly benefit of $2,000. The minimum benefit is $500. Elimination Period This means a period of time a disabled Employee must be out of work and totally disabled before weekly benefits begin; seven (7) consecutive days for a sickness and zero (0) days for injury. Benefit Duration This is the period of time that benefits will be payable for disability. You can choose a maximum STD benefit duration, if continually disabled, of thirteen (13) weeks. Basis of Coverage 24 hour coverage, on or off the job. Maternity Coverage Benefits will be paid the same as any other qualifying disability, subject to any applicable pre-existing condition exclusion. STD Pre-Existing Condition Exclusion 3/12, If a person receives medical treatment, or service or incurs expenses as a result of an Injury or Sickness within 3 months prior to the Individual Effective Date, then the Group Policy will not cover any Disability which is caused by, contributed to by, or resulting from that Injury or Sickness; and begins during the first 12 months after the Person s Individual Effective Date. This Pre-Existing Condition limitation will be waived for all Persons who were included as part of the final premium billing statement received by AUL/ OneAmerica from the prior carrier and will be Actively at work on the effective date. Recurrent Disability If you resume Active Work for 30 consecutive workdays following a period of Disability for which the Weekly Benefit was paid, any recurrent Disability will be considered a new period of Disability. A new Elimination Period must be completed before the Weekly Benefit is payable. Page 82

83 Exclusions and Limitations This plan will not cover any disability resulting from war, declared or undeclared or any act of war; active participation in a riot; intentionally self-inflicted injuries; commission of an assault or felony; or a pre-existing condition for a specified time period. Portability Once an employee is on the AUL disability plan for 3 consecutive months, once an employee is on the AUL disability plan for 3 consecutive months, you may be eligible to port your coverage for one year at the same rate without evidence of insurability. You have 31 days from your date of termination to apply for portability by calling The Portability Privilege is not available to any Person that retires (when the Person receives payment from any Employer s Retirement Plan as recognition of past services or has concluded his/her working career). Please refer to the Mark III website (address on the cover of this booklet) for a copy of your certificate, a claim form or application to port form. Annual Enrollment Employees who did not elect coverage during their initial enrollment period are eligible to sign up for $500 to $1000 monthly benefit without medical questions, subject to pre-existing exclusion. Employees may increase their coverage up to $500 monthly benefit without medical questions. The maximum benefit cannot exceed 70% of basic monthly earnings and must be in $100 increments. This information is provided as a summary of the product. It is not a part of the insurance contract and does not change or extend AUL s liability under the group policy. If there are any discrepancies between this information and the group policy, the group policy will prevail. Customer Service Website: Disability Claims American United Life Insurance Company c/o Custom Disability Solutions 600 Sable Oaks Drive, Suite 200, South Portland, ME Toll Free~ Fax~ OneAmerica.claims@customdisability.com Page 83

84 AUL Life Short-Term Disability- Benefit Duration (13 weeks) 12 pay periods 10 pay periods Monthly Benefit Monthly Premium Monthly Benefit Tenthly Premium $500 $10.36 $600 $12.43 $700 $14.50 $800 $16.57 $900 $18.64 $1,000 $20.71 $1,100 $22.78 $1,200 $24.85 $1,300 $26.92 $1,400 $28.99 $1,500 $31.07 $1,600 $33.14 $1,700 $35.21 $1,800 $37.28 $1,900 $39.35 $2,000 $41.42 $500 $12.43 $600 $14.91 $700 $17.40 $800 $19.88 $900 $22.37 $1,000 $24.85 $1,100 $27.34 $1,200 $29.82 $1,300 $32.31 $1,400 $34.79 $1,500 $37.28 $1,600 $39.76 $1,700 $42.25 $1,800 $44.73 $1,900 $47.22 $2,000 $49.70 Page 84

85 AUL Life Short-Term Disability- Benefit Duration (13 weeks) 20 pay periods 24 pay periods Monthly Benefit 20 Pay Premium Monthly Benefit Semi- Monthly Premium $500 $6.21 $600 $7.46 $700 $8.70 $800 $9.94 $900 $11.18 $1,000 $12.43 $1,100 $13.67 $1,200 $14.91 $1,300 $16.16 $1,400 $17.40 $1,500 $18.64 $1,600 $19.88 $1,700 $21.13 $1,800 $22.37 $1,900 $23.61 $2,000 $24.85 $500 $5.18 $600 $6.21 $700 $7.25 $800 $8.28 $900 $9.32 $1,000 $10.36 $1,100 $11.39 $1,200 $12.43 $1,300 $13.46 $1,400 $14.50 $1,500 $15.53 $1,600 $16.57 $1,700 $17.60 $1,800 $18.64 $1,900 $19.67 $2,000 $20.71 Page 85

86 AUL Long Term Disability Effective Date: August 1, 2017 LTD Class Description All Full-Time Eligible Employees working a minimum of 30 hours per week, electing to participate in the Voluntary Long-Term Disability. LTD Monthly Benefit You can choose to insure up to 60% of an Employee s covered basic monthly earnings to a maximum monthly benefit of $2,000 in $500 increments. The minimum benefit is $500. LTD Elimination Period This means a period of time a disabled Employee must be out of work and totally disabled before weekly benefits begin; 90 consecutive days for a sickness or injury. LTD Benefit Duration This is the period of time that benefits will be payable for long-term disability. Up to 5 years if disabled prior to age 61, or if disabled after age 61, as outlined below: Age When Total Disability Begins Maximum Period Benefits are Payable Prior to Age 61 5 Years 61 Lesser of SSFRA or 5 Years Years 63 3 Years Years 65 2 Years Months Months Months Age 69 and over 12 Months LTD Total Disability Definition: An Insured is considered Totally Disabled, if, because of an injury or sickness, he cannot perform the material and substantial duties of his Regular Occupation, is not working in any occupation and is under the regular care of physician. After benefits have been paid for 24 months, the definition of disability changes to mean the Insured cannot perform the material and substantial duties of any Gainful Occupation for which he is reasonably fitted for by training, education or experience. Page 86

87 LTD Mental & Nervous / Drug & Alcohol: Benefit payments will be limited to benefit duration or 24 months, whichever is less, cumulative for each of these limitations for treatment received on an outpatient basis. Benefit payments may be extended if the treatment for the disability is received while hospitalized or institutionalized in a facility licensed to provide care and treatment for the disability. Special Conditions Benefits for Disability due to Special Conditions, whether or not benefits were sought because of the condition, will not be payable beyond 24 months. Benefit payments for Special Conditions are cumulative for the lifetime of the contract. Other income Offsets AUL will not reduce your LTD disability benefit with other disability income benefits that you might be receiving from AUL or external sources such as Social Security or other disability or income benefits you may receive, or be eligible to receive. Waiver of Premium AUL will waive the premium payments for your coverage while you are disabled and will continue to be waived during the elimination period and the benefit eligibility period. Pre-Existing Condition Exclusion 3/12, If a person receives medical treatment, or service or incurs expenses as a result of an Injury or Sickness within 3 months prior to the Individual Effective Date, then the Group Policy will not cover any Disability which is caused by, contributed to, or resulting from that Injury or Sickness; and begins during the first 12 months after the Person s Individual Effective Date. Credit for the Satisfaction of the Pre-Existing Condition Exclusion Period This provision applies when a Person moves from an AUL group voluntary disability income insurance plan that provided the Person short term disability coverage similar to his coverage under the Group Policy offered by the Participating Unit. Credit will be given for the satisfaction of the Pre-Existing Condition exclusion period, or portion thereof, already served under the prior AUL group voluntary short term disability income insurance plan of coverage offered by the Participating Unit IF: 1. Coverage under the Group Policy is elected by the Employee during the Initial Enrollment Period; and 2. The Person changes from one AUL short-term disability Plan to another AUL short term disability Plan under this Group Policy during a Scheduled Enrollment Period. The Person s Individual Effective Date of Insurance under the prior AUL group voluntary short-term disability income insurance plan of coverage offered by the Participating Unit will be used when applying the Pre-Existing Condition exclusion or limitation period. The Group Policy Pre-Existing Condition Limitation will not apply to a Person that was not subject to the prior AUL short-term disability plan s Pre-Existing Condition Limitation. Page 87

88 Portability Once an employee is on the AUL disability plan for 3 consecutive months, you may be eligible to port your coverage for one year at the same rate without evidence of insurability. You have 31 days from your date of termination to apply for portability by calling The Portability Privilege is not available to any Person that retires (when the Person receives payment from any Employer s Retirement Plan as recognition of past services or has concluded his/her working career). Please refer to the Mark III website (address on the cover of this booklet) for a copy of your certificate, a claim form or application to port form. Annual Enrollment Enrollees that did not elect coverage during their initial enrollment are eligible to sign up for $500 or $1000 monthly LTD benefit without medical questions. The maximum benefit cannot exceed 60% of basic monthly earnings. Voluntary Long Term Disability Rates Monthly Benefit Amount 12 Pay Periods $500 $6.40 $1,000 $12.80 $1,500 $19.20 $2,000 $25.60 Monthly Benefit Amount 10 Pay Periods $500 $7.68 $1,000 $15.36 $1,500 $23.04 $2,000 $30.72 Monthly Benefit Amount 20 Pay Periods $500 $3.84 $1,000 $7.68 $1,500 $11.52 $2,000 $15.36 Monthly Benefit Amount 24 Pay Periods $500 $3.20 $1,000 $6.40 $1,500 $9.60 $2,000 $12.80 Page 88

89 Exclusions and Limitations This plan will not cover any disability resulting from war, declared or undeclared or any act of war; active participation in a riot; intentionally self-inflicted injuries; commission of an assault or felony; or a pre-existing condition for a specified time period. This information is provided as a Benefit Outline. It is not part of the insurance policy and does not change or extend American United Life Insurance Company s liability under the group Policy. Employers may receive either a group Policy or a Certificate of Insurance containing a detailed description of the insurance coverages under the group Policy. If there are any discrepancies between this information and the group Policy, the Policy will prevail. Customer Service Website: Disability Claims American United Life Insurance Company c/o Custom Disability Solutions 600 Sable Oaks Drive, Suite 200, South Portland, ME Toll Free~ Fax~ OneAmerica.claims@customdisability.com Page 89

90 Lincoln Financial Term Life Effective Date - when approved by Lincoln Financial All Evidence of Insurability are subject to underwriting approval VOLUNTARY EMPLOYEE LIFE INSURANCE This insurance is payable for death from any cause to any person you name as beneficiary. Your Voluntary Life coverage provides important protection for you as well as your family. VOLUNTARY DEPENDENT LIFE INSURANCE Provides coverage on: Your Spouse Child(ren) from 14 days of age to age 19 (to age 25 if unmarried, wholly dependent upon you for maintenance and support and if enrolled as a full-time student in an accredited school or college). Handicapped children can continue to be covered with no age limit. NOTE: It is your responsibility to notify Human Resources when a dependent is ineligible for coverage. Examples of ineligible dependent status are divorce, death, or a child is 19 years of age and not in college. A child can be covered to age 25 if a full-time unmarried, student and dependent upon you for maintenance and support. FEATURES The plan features easy eligibility and simple enrollment procedures AND...there is no need for a medical exam if you sign up during the enrollment period and you meet the eligibility criteria. Furthermore, automatic payroll deductions simplify paperwork. This means less bookkeeping for you and no worries about a lapse in coverage due to missed payments. LOW COST Your cost is lower than for comparable insurance on an individual basis due to the wholesale economies inherent in group insurance. Additionally, the System absorbs the cost of administering the program which is underwritten by Lincoln Financial Group. ELIGIBILITY You will be eligible for this plan if you are a full-time active employee working 30 hours or more per week. ENROLLMENT Enrollment is simple- just fill out the enrollment form provided by your Employer. Make sure you supply all the required information and return the form where you work.that s all. You will be notified as to when coverage starts. BENEFICIARY You have the right to designate the beneficiary of your choice under Employee coverage. Normally you are the beneficiary under Dependent Life unless you specify otherwise. Page 90

91 REDUCTIONS AT AGE 70 & OVER If you remain in active service beyond age 70 your Voluntary Employee Life Insurance will reduce as follows: Attained Age Coverage Will Reduce By 70 35% 75 20% 80 15% With respect to your dependent spouse, there would not be a reduction in coverage based on age; however, the coverage would end when that person reached the age of 70 if no other events have already ceased the coverage such as: your death, retirement, or when that person ceases to be your dependent. TERMINATION OF COVERAGE All insurance under this plan will terminate upon the earlier of retirement, termination of employment, when the plan ceases or when you withdraw from the plan. Nevertheless, if you should die within 31 days thereafter, your life insurance will still be paid to the beneficiary. If any of your covered dependents should die within such 31 day period, the amount of Life Insurance on account of such dependent will be paid to you. CONVERSION You must apply and pay the premium for the converted policy within 31 days of your group life insurance ending. If the policy ends or is changed to reduce or end your life insurance, and if you have been insured for at least 5 years under the policy, you may convert up to the lesser of: $10,000 or the amount of life insurance that ended minus the amount of any group life insurance for which you become eligible within 31 days. PREMIUM PAYMENT Premium payments must continue until: (1) the day the Insured Person is approved for this Extension of Death Benefit; or (2) the day this Policy terminates (whichever is first) AMOUNT CONTINUED (1) will be the amount of Voluntary Life Insurance and any Dependent Life Insurance in effect on the day the Insured Person s Total Disability begins; and (2) will be subject to the reductions and terminations in effect under this Policy on that day. THE ACCLERATED BENEFIT OPTION (ABO) Lincoln Financial Group has included an Accelerated Benefit Option (ABO) as part of your Group Life benefits. Under this option, if you are diagnosed as having a terminal illness, you will be eligible to receive a maximum of $250,000 or 75% (whichever is less) of your insurance coverage. Please refer to your Group Certificate for details. Page 91

92 SUICIDE EXCLUSION The Voluntary Term Life Insurance on any Insured Person will not be payable if the Person dies as a result of suicide within two years of the date his insurance becomes effective with Lincoln Financial, or prior insurer, and or after an election to increase the amount of insurance under the policy. Lincoln Financial Group s liability for that portion of insurance shall be limited to the return of premiums paid for the life insurance without interest. TERMINATION OF COVERAGE All insurance under this plan will terminate upon the earlier of the date you retire or the date your employment terminates. Nevertheless, if you or a covered dependent should die within 31 days thereafter, the life insurance will still be paid to the beneficiary. CLAIMS PROCEDURE Claim forms needed to file for benefits under the group insurance program can be obtained from your Employer who will also be ready to assist in filing claims. The instructions on the claim form should be followed carefully. This will expedite the processing of the claim. Be sure all questions are answered fully. If there is any question about a claim payment, an explanation can be requested from your Employer, who is usually able to provide the necessary information. PLAN SPONSOR Cabarrus County Schools 4425 Old Airport Road Concord, NC Page 92

93 TravelConnectSM services just made travel easier As part of your employee benefits package, your Lincoln Financial Group life insurance coverage includes our TravelConnectSM program, an employee benefit focusing on travel, medical, and safety-related services while traveling. Lincoln Financial has partnered with MEDEX Assistance Corporation, a worldwide leader in travel assistance, to make this valuable benefit available to you and your immediate family. Business or leisure travel they re both covered. The Travel- ConnectSM benefit is provided at no cost to you and includes a wealth of services when traveling just 100 miles or more from home. These services are provided for both business and leisure travel. Whether you simply want the weather forecast for your travel destination or need emergency medical assistance halfway around the world, MEDEX has the professional staff and resources to provide support, 24 hours a day, seven days a week. Feel free to use the services as much or as little as you need. Comprehensive coverage ~ A sampling of the services: Destination info weather, currency, and more Emergency travel arrangements and funds transfer Lost or stolen travel documents assistance Language translation services Emergency medical evacuation and transportation Dependent child transportation if left unattended Medical and dental referrals Assistance with corrective lenses or medical device replacement Treatment monitoring of a medical situation Delivery of medications, vaccines, or blood arranged Updates to family, employer, and/or home physician Repatriation of a deceased traveler Security and political evacuation assistance Page 93

94 Travel assistance services are subject to specific terms, conditions, and limitations. A program description is available at To use TravelConnectSM services, call MEDEX at or and provide them with ID number TravelConnect SM services are provided through MEDEX Assistance Corporation in Towson, MD (in WA and OR underwritten by Arch Insurance Company, a Missouri corporation, NAIC #11150, with executive offices located in New York, NY), both are separate, independent contractors and are not affiliates of Lincoln Financial Group. Each independent company is solely responsible for its own obligations. Coverage is subject to actual policy language and specific terms, conditions, and limitations. A complete program description is available at www. exec-u-care.com. Page 94

95 SCHEDULE OF BENEFITS BASIC EMPLOYEE LIFE INSURANCE All Eligible Employees $5,000 (no cost to you) VOLUNTARY EMPLOYEE LIFE Your choice of the following amounts: $10,000, $20,000, $30,000, $40,000, $50,000, $60,000, $70,000, $80,000 $90,000, $100,000, $150,000, $200,000, $250,000 $50,000 is guarantee issue for a newly hired employee To be eligible for coverage above $50,000 you must furnish medical evidence of insurability satisfactory to Lincoln Financial. If you are an existing employee and you are increasing your current coverage amount or if you are applying for coverage the very first time (did not apply when first hired) you are required to complete an Evidence of Insurability. This applies to your dependents as well. VOLUNTARY DEPENDENT LIFE INSURANCE Spouse- $10,0000, $20,000, $30,000, $40,000, $50,000 on your spouse $10,000 is guarantee issue for a new hire employee who is covering spouse If you elect more than $10,000 on your spouse, you must complete a health statement. Any existing employee who applies for Spouse Term Life coverage for the first time (did not apply when first hired) or increases the current amount will be required to complete an Evidence of Insurability on that spouse. Child(ren)- $5,000, $10,000, $15,000, $20,000, $25,000 on each of your eligible children* (per child; no matter how many children you have) Child 14 days old to 6 months has $250 coverage. Child from birth to 14 days does not have any life coverage. REMINDERS Voluntary Dependent Life Insurance is available only to those eligible Employees who are insured for Voluntary Employee Life Insurance. Any coverage amounts $50,000 and below will be pre-tax Any coverage amounts over $50,000 will be post-tax Page 95

96 12 pay periods Optional Employee Coverage Monthly Deduction Optional Spouse Coverage Monthly Deduction Optional Child Coverage Monthly Deduction $10,000 $1.90 $10,000 $5.60 $5,000 $1.00 $20,000 $3.80 $20,000 $11.20 $10,000 $2.00 $30,000 $5.70 $30,000 $16.80 $15,000 $3.00 $40,000 $7.60 $40,000 $22.40 $20,000 $4.00 $50,000 $9.50 $50,000 $28.00 $25,000 $5.00 $60,000 $11.40 $70,000 $13.30 $80,000 $15.20 $90,000 $17.10 $100,000 $19.00 $150,000 $28.50 $200,000 $38.00 $250,000 $47.50 Optional Employee Coverage Tenthly Deduction Optional Spouse Coverage Tenthly Deduction Optional Child Coverage Tenthly Deduction $10,000 $2.28 $10,000 $6.72 $5,000 $1.20 $20,000 $4.56 $20, $10,000 $2.40 $30,000 $6.84 $30,000 $20.16 $15,000 $3.60 $40,000 $9.12 $40,000 $26.88 $20,000 $4.80 $50,000 $11.40 $50,000 $33.60 $25,000 $6.00 $60,000 $13.68 $70,000 $15.96 $80,000 $18.24 $90,000 $20.52 $100,000 $22.80 $150,000 $34.20 $200,000 $45.60 $250,000 $ pay periods Page 96

97 Optional Employee Coverage 20 Pay Deduction Optional Spouse Coverage 20 Pay Deduction Optional Child Coverage 20 Pay Deduction $10,000 $1.14 $10,000 $3.36 $5,000 $.60 $20,000 $2.28 $20,000 $6.72 $10,000 $1.20 $30,000 $3.42 $30,000 $10.08 $15,000 $1.80 $40,000 $4.56 $40,000 $13.44 $20,000 $2.40 $50,000 $5.70 $50,000 $16.80 $25,000 $3.00 $60,000 $6.84 $70,000 $7.98 $80,000 $9.12 $90,000 $10.26 $100,000 $11.40 $150,000 $17.10 $200,000 $22.80 $250,000 $ pay periods Optional Employee Coverage 24 Pay Deduction Optional Spouse Coverage 24 Pay Deduction Optional Child Coverage 24 Pay Deduction $10,000 $.95 $10,000 $2.80 $5,000 $.50 $20,000 $1.90 $20,000 $5.60 $10,000 $1.00 $30,000 $2.85 $30,000 $8.40 $15,000 $1.50 $40,000 $3.80 $40,000 $11.20 $20,000 $2.00 $50,000 $4.75 $50,000 $14.00 $25,000 $2.50 $60,000 $5.70 $70,000 $6.65 $80,000 $7.60 $90,000 $8.55 $100,000 $9.50 $150,000 $14.25 $200,000 $19.00 $250,000 $ pay periods Page 97

98 Texas Life Whole Life ~ Solutions 121 Common Issue Date: October 1, 2017 (pending underwriting approval) An ideal complement to any group term and optional term life insurance your employer might provide, Texas Life s SOLUTIONS 121 is the life insurance you keep, even when you change jobs or retire as long as you pay the premiums. It will help protect your family, both today and, more importantly, tomorrow. Even better, you won t even have to pay for it after age 65 (or 20 years if you re 46 years of age or older), because it s guaranteed to be paid up. 1 SOLUTIONS is an individual permanent life insurance product specifically designed for employees and their families. These policies provide a guaranteed level premium and death benefit for the life of the policy, and all you have to do to qualify for basic amounts of coverage is be actively at work the day you enroll. You also may apply for coverage on your spouse, children and grandchildren with limited underwriting requirements. 2 As an employee, you are eligible to apply once you have satisfied your employer s eligibility period. Why Voluntary Coverage? Most employees typically depend on group term life insurance. Today more adults than ever have only group life insurance obtained through their employers, but they carry the lowest average amounts of coverage. 3 On the other hand, adults with both individual life and group life policies have the most life insurance protection. 3 Most term policies generally expire before paying a death claim. When do you want a life insurance policy in force? --Answer: When you die. Term is for IF you die, permanent is for WHEN you die. The SOLUTIONS Advantage Individual Protection SOLUTIONS 121 is a permanent life insurance policy that you own; it can never be canceled, as long as you pay the guaranteed level premiums due, even if your health changes. Because you own it, you can take SOLUTIONS 121 with you when you change jobs or retire with no change in the premium. Coverage for Your Family You may also apply for an individual SOLUTIONS 121 policy for your spouse/domestic partner, dependent children ages 15 days- 26 years and grandchildren ages 15 days-18 years, even if you do not apply for coverage. 2 Paid Up Insurance SOLUTIONS 121 has premiums that are guaranteed to remain level until your age 65, or for 20 years if you purchase the policy after age 45. At that time, the policy becomes fully paid up; no further premiums are due, and the death benefit does not reduce. This gives you the peace of mind that comes with life insurance that s paid for as your income changes in retirement. 16M419-C 1119 (exp1118) See the SOLUTIONS brochure for complete details. Policy form WLOTO-NI-11 or ICC11-WLOTO-NI-11 Page 98

99 Convenience of payroll deduction Thanks to your employer, SOLUTIONS 121 premiums are paid through convenient payroll deductions and sent to Texas Life by your employer. Portable, Permanent You may continue the peace of mind SOLUTIONS 121 provides, even when you change jobs or retire. Once your policy is issued, the coverage is yours to keep. If you should change jobs or retire before the policy becomes paid up, you simply pay the monthly premium directly to Texas Life by automatic bank draft or monthly bill (for monthly bill we may add a billing fee not to exceed $2.00). Premiums are guaranteed to remain level to your age 65, or for 20 years if you purchase the policy after age 45. At that time, the policy becomes fully paid up; no further premiums are due. Accelerated Death Benefit due to Terminal Illness For no additional premium, the policy includes an Accelerated Death Benefit Due to Terminal Illness Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92.6% (92% in CA, CT, DC, DE, FL, ND &SD) of the face amount, minus a $150 ($100 in Florida) administrative fee in lieu of the insurance proceeds otherwise payable at death. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply) (Policy Form ICC-ULABR-11 or Form Series ULABR-11) Accelerated Death Benefit for Chronic Illness Included in the policy at the option of the employer, the Accelerated Death Benefit for Chronic Illness rider covers all applicants. If an insured becomes permanently chronically ill, meaning that he/she is unable to perform two of six Activities of Daily Living (such as bathing, continence, or dressing), or is severely cognitively impaired (such as Alzheimer s), he/she may elect to claim an accelerated death benefit in lieu of the Face Amount payable at death. The single sum payment is 92% of the Face Amount less an administrative fee of $150 ($100 in FL). The Accelerated Death Benefit for Chronic Illness Rider premiums are 8% of the base policy premium. Conditions and limitations apply. See the SOLUTIONS 121 Pamphlet for details. (Policy form ULABR-CI-14 or ICC14-ULABR-CI-14.) Waiver of Premium Rider This benefit to age 65 (issue ages 17-59) waives the premium after six months of the insured s total disability and will even refund the prior six months premium. Benefits continue payable until the earlier of the end of the insured s total disability or age 65. Cost is an additional 10% of the basic monthly premium. Self-inflicted or war-related disability is excluded. Notice, proof and waiting period provisions apply. (Policy Form ICC07-ULCL-WP-07 or Form Series ULCL-WP-07). Coverage begins immediately Coverage normally begins when you complete the application and the authorization for your employer to deduct premiums from your paycheck. Two year suicide and contestability provisions apply (one year in ND). 16M419-C 1119 (exp1118) See the SOLUTIONS brochure for complete details. Policy form WLOTO-NI-11 or ICC11-WLOTO-NI-11 Page 99

100 Sample Rates ~ The chart below displays examples of SOLUTIONS 121 rates at varying ages for a $50,000 policy. Rates shown below are for both non-tobacco and tobacco users and include the cost for Waiver of Premium and the Accelerated Death for Chronic Illness benefit. Age Face Amount SOLUTIONS 121 Monthly Premium Non-Tobacco Chronic Illness, & Waiver Monthly Premium Tobacco Chronic Illness, & Waiver Paid-up Age 20 $50,000 $38.11 $ $50,000 $43.42 $ $50,000 $53.45 $ $50,000 $68.20 $ $50,000 $91.80 $ $50,000 $ $ SOLUTIONS REVIEW Permanent and yours to keep when you change jobs or retire Non-participating Whole Life (no dividends) Guaranteed death benefit 1 Guaranteed level premium Guaranteed paid-up insurance at age 65, or for 20 years if the policy is purchased after age 45 If you re actively at work the day you enroll, you can qualify for basic amounts with no more underwriting. Includes Accelerated Death Benefit for Chronic Illness Waiver of Premium Rider included for ages If you desire more coverage, you can qualify by answering just four underwriting questions. Coverage available for spouse, children and grandchildren 2 1 Guarantees are subject to product terms, exclusions and limitations and the insurers claims-paying ability and financial strength. 2 Coverage and spouse/domestic partner eligibility may vary by state. Coverage not available for children and grandchildren in Washington. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships and legally recognized familial relationships. 3 LIMRA; Life Insurance Ownership Focus Maurer, Tim. Term vs Perm (Life Insurance) In 90 Seconds. Forbes. Forbes Magazine, 3 May Web. 08 Nov QUESTIONS? CALL , prompt # 2 16M419-C 1119 (exp1118) See the SOLUTIONS brochure for complete details. Policy form WLOTO- NI-11 or ICC11-WLOTO-NI-11 Page 100

101 Liberty Mutual Auto & Homeowners Facts about Liberty Mutual Auto and Home Insurance Why should I switch? At Your Liberty employer Mutual, chose we Liberty partner Mutual with you because to help we you partner select with the coverage you to help that you best select the fits coverage your situation. that best You fits can your choose situation. from You flexible can choose options from that flexible allow you options to customize that allow you your to customize protection your to protection match your to specific match needs. your specific And as needs. an <employee> And as an of employee <Partner of Cabarrus Organization> County Public Schools you could you receive are eligible exclusive for exclusive savings on savings your auto on your and auto home and insurance. home insurance. 1 You may also qualify for our Multi-Car and Multi-Policy discounts. 12 What are some of the advantages? In addition to exclusive savings, as a Liberty Mutual customer, you ll have access to a wide range of benefits. AUTO HOME Accident Forgiveness 2 For qualified drivers your rate won t increase due to your first accident. 24-Hour Emergency Repair Service Protect your home from more damage. Better Car Replacement 3 Contractor Network Referral Program Get dependable and guaranteed repairs. Roadside Assistance 4 Real help when you need it. Personal Property Replacement Service We ll help you replace damaged items with an exact or near match. Continued Page 101

102 Our Mobile Apps Make Things Even Easier How do Liberty Mutual s rates compare? Pa y r c v rat oy P r a Besides our already competitive rates, as an employee of Cabarrus County Public Updat y cy y a c t rat y t r ce Schools you may qualify for discounted rates on your auto and home insurance. A R r y Repr a v e y r y Sales Representative can explain your options clearly and help ensure you get all the Ca y c y or. discounts you qualify for. How do I know which coverages and deductibles are right for me? W k t e r c t k rec a a y a w way k r you r r rotect G App App Y What are my payment options? y y a y a y automa a r Tr er Y t Hav y a t toma r y a About Us acc We ve been in the business Pa y t y of helping people live safer, more secure lives for more than 100 years. As a leading provider of auto, home, and life insurance, we operate in all 50 states and are among How do I file a claim? the Fortune 100 largest at t way av t v y att y To help meet all your needs, C e e y e ce insurance products, including: How can I learn more? auto condo home renters For more information on your auto and home insurance options or for a free quote, motorcycle watercraft call Ext libertymutual.com/<url> <800-XXX-XXXX>. personal identity fraud liability expense protection coverage (umbrella) Matt Morrison 9115 Harris Corners Parkway - Suite 200 Charlotte, NC Ext Matt.Morrison@LibertyMutual.com Client #: Discounts and savings are available where state laws and regulations allow, and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. 2 Accident Forgiveness coverage is subject to terms and conditions of Liberty Mutual s underwriting guidelines. Not available in CA and may vary by state. 3 Optional coverage. Deductible applies. Applies to a covered total loss. Does not apply to leased vehicles and motorcycles. Not available NC. 4 With purchase of optional Towing & Labor coverage. Applies to mechanical breakdowns and disablements only. Towing related to accidents would be covered under your Collision or Comprehensive coverage. Coverage provided and underwritten by Liberty Mutual Insurance Company and its affiliates, 175 Berkeley Street, Boston, MA Liberty Mutual Insurance AFF /05 MW How do Liberty Mutual s rates compare? r c v rat oy P r a Besides our already competitive rates, as an employee of Cabarrus County Public y a c t rat y t r ce Schools you may qualify for discounted rates on your auto and home insurance. A Repr a v e y r y Sales Representative can explain your options clearly and help ensure you get all the c y or. discounts you qualify for. How do I know which coverages and deductibles are right for me? W k t e r c t k rec a a y a w way k r you r r rotect What are my payment options? Our Mobile Apps Make Things Even Easier Pa y Updat y cy R r y Ca y App G App Y y y a y a y automa a r Tr er Y t Hav y a t toma r y a acc Pa y t y How do I file a claim? at t way av t v y att y C e e y e ce How can I learn more? For more information on your auto and home insurance options or for a free quote, call Ext libertymutual.com/<url> <800-XXX-XXXX>. About Us We ve been in the business of helping people live safer, more secure lives for more than 100 years. As a leading provider of auto, home, and life insurance, we operate in all 50 states and are among the Fortune 100 largest To help meet all your needs, insurance products, including: auto condo home renters motorcycle watercraft personal liability protection (umbrella) identity fraud expense coverage Matt Morrison 9115 Harris Corners Parkway - Suite 200 Charlotte, NC Ext Matt.Morrison@LibertyMutual.com Client #: Discounts and savings are available where state laws and regulations allow, and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. 2 Accident Forgiveness coverage is subject to terms and conditions of Liberty Mutual s underwriting guidelines. Not available in CA and may vary by state. 3 Optional coverage. Deductible applies. Applies to a covered total loss. Does not apply to leased vehicles and motorcycles. Not available NC. 4 With purchase of optional Towing & Labor coverage. Applies to mechanical breakdowns and disablements only. Towing related to accidents would be covered under your Collision or Comprehensive coverage. Coverage provided and underwritten by Liberty Mutual Insurance Company and its affiliates, 175 Berkeley Street, Boston, MA Liberty Mutual Insurance AFF /05 MW Page 102

103 Continuation of Benefits If You Leave Employment AFLAC GROUP CRITICAL ILLNESS & ACCIDENT When you leave employment, you may continue your Group Critical Illness and Accident plans by having the premiums currently being deducted from your paycheck either drafted from your bank account or billed directly to your home. Certain stipulations apply. You may contact Aflac / Continental American Insurance Company toll-free at ALLSTATE BENEFITS CANCER When you leave employment, you may continue your Allstate Benefits Cancer policy by having the premiums currently being deducted from your paycheck either drafted from your bank account or billed directly to your home. You may contact Allstate Benefits toll-free at AMERITAS DENTAL Under the Ameritas dental plan, you and your covered dependents are eligible to continue coverage through COBRA according to the qualifying events. If you and your dependents are enrolled in the dental plan, you will be eligible to continue coverage through COBRA after you leave your employment for a specified period. In addition, while covered under the plan, if you should die, become divorced or legally separated, or become eligible for Medicare, your covered dependents maybe eligible to continue dental coverage through COBRA. Also, while you are covered under the plan, your covered children who no longer qualify as an eligible dependent may continue coverage through COBRA. Examples of an ineligible dependent would be when your child graduates from college, or reaches the age of not being eligible for dependent coverage. You will receive notification with premium and continuation options shortly following your termination of employment. Should you have any questions you may contact your Benefits Department at AUL SHORT & LONG TERM DISABILITY Once you are on the AUL disability plan for 3 months, you can port the coverage for one year at the same cost without evidence of insurability. You have 31 days from your date of termination to apply for portability by calling COMMUNITY EYE CARE For current CEC members who are leaving their employer, CEC is pleased to offer the opportunity to enroll in our Portability Plan Option. By enrolling, you can continue your vision coverage without an increase in rates for as long as you like! Enrolling in the portability plan is easy! Just follow these steps: You will receive a letter in the mail from CEC offering you the opportunity to enroll in the portability plan. To enroll, contact Ruth Fisher at rfisher@cecvision.com or call ext. 232 within 60 days from receipt of the letter. Please include your name, current Page 103

104 mailing address, telephone number and the name of your previous employer. We will then send you a vision packet with the forms needed to complete your enrollment. After we receive your completed forms: Your plan will be activated on the first day of the following month. Since payroll deductions will stop, your payments will be drafted annually from either a credit card or bank account. A new Member ID card will be mailed to you prior to your effective date, enabling you to continue enjoying the exceptional vision benefits that are the hallmark of CEC. If you have any questions about the portability plan, please contact Ruth Fisher at rfisher@cecvision.com or call ext 232. FBA FLEXIBLE BENEFIT HEALTH CARE & DEPENDENT CARE ACCOUNTS If you have a positive balance (payroll deductions are greater than the amount you have received in reimbursement) in your Health Care Spending Account at the time of your termination, you may continue participation in the Plan for the remainder of the Plan year. If you want to remain in the Plan, you can do so by selecting one of the COBRA options. If you prefer to terminate your participation and contribution to the Plan, any balance in your account on the date of termination will be forfeited if expenses were not incurred prior to the date of termination. For more detailed information, please call your Benefits Department at or Flexible Benefit Administrators at LINCOLN FINANCIAL TERM LIFE Conversion: You must apply and pay the premium for the converted policy within 31 days of your group life insurance ending. If the policy ends or is changed to reduce or end your life insurance, and if you have been insured for at least 5 years under the policy, you may convert up to the lesser of: $10,000 or the amount of life insurance that ended minus the amount of any group life insurance for which you become eligible within 31 days. Please contact your Human Resources Department at for more information. LIBERTY MUTUAL AUTO & HOMEOWNERS When you leave employment, you may continue the coverage that you have with Liberty Mutual. The coverage will continue to be drafted from your bank account. If you have questions you may contact Liberty Mutual at TEXAS LIFE WHOLE LIFE When you leave employment, you may continue your Texas Life Whole Life coverage by having the premiums that are currently deducted from your paycheck drafted from your bank account. You may do that by contacting Texas Life at prompt #2. AFLAC TRADITIONAL POLICIES Those policies 3 years and older will be removed from payroll deduction. If you wish to maintain your current Aflac Traditional policy(ies), you may contact Aflac directly at Page 104

105 PHONE DIRECTORY Aflac Accident & Critical Illness Allstate Benefits Cancer Ameritas Dental AUL Short & Long Term Disability Cabarrus County Schools Human Resources Community Eye Care Vision Flexible Benefit Administrators Spending Accounts Investment & Retirement Accounts Liberty Mutual Auto & HomeOwners x Lincoln Financial Term Life Mark III Brokerage, Inc Texas Life Whole Life prompt #2 Page 105

106 Investment & Retirement Accounts 403b, 457b, & 401k What are the Benefits of a 403(b) and Plan? 457(b) plans? Traditional There are many and Roth benefits 403(b) to contributing accounts offer to 403(b) similar and benefits 457(b) comparatively plans. but are very different regarding federal tax treatment. During your career, you may participate in either or both of these 1) account Contributions types. Deposited into Individual Accounts - You own your account and make all decisions concerning the amount of your retirement savings contributions. 1) 2) Contributions Convenience Deposited of Payroll into Contributions Individual Accounts - Your employer - You own sends your each account of your and make all decisions contributions concerning to your the selected amount of provider your retirement company for savings deposit. contributions. 2) 3) Convenience High Annual of Contribution Payroll Contributions Limits - For - Your 2017, employer employees sends can each contribute of your up contributions to to your $18,000 selected to their provider account. company Some for employees deposit. may qualify for other additional amounts. 3) High Information Annual Contribution concerning Limits these - additional For 2017, employees amounts is can provided contribute within up this to Guide. $18,000 to 4) their Flexible 403(b) Contributions account. Some - You employees may change may qualify the amount for other of your additional contribution amounts. during the Information year as allowed concerning by your these employer. additional amounts is provided within this Guide. 4) 5) Flexible Benefits Contributions Paid to Your - You Beneficiary may change at Death the amount - All funds of your in your contribution account are during payable the to year as your allowed beneficiary by your employer. upon your death. 5) Benefits Paid to Your Beneficiary at Death - All funds in your account are payable to your It is important beneficiary to upon note that your these death. accounts are designed for long-term accumulation. You should consult with your financial advisor or tax consultant to determine the potential advantages of a It is important to note that both traditional and Roth 403(b) accounts are designed for long-term traditional 403(b) and/or 457(b) account. accumulation. You should consult with your financial advisor or tax consultant to determine the potential advantages of traditional and Roth 403(b) accounts. How are traditional 403(b) & 457(b) account contributions made? How Contributions are 403(b) made account to a traditional contributions 403(b) made? or 457(b) account are pre-tax reductions from your paycheck. Contributions Therefore, made to your a traditional income tax 403(b) is reduced account for are every pre-tax payroll reductions contribution from your make. paycheck. Any earnings Therefore, on your your income deposits tax is are reduced tax-deferred for every until payroll withdrawn, contribution usually you make. during Any retirement. earnings on All withdrawals your deposits from are tax-deferred traditional 403(b) until withdrawn, or 457(b) usually accounts during are retirement. taxed during All withdrawals the year of from the withdrawal traditional 403(b) at your accounts income tax are rate taxed applicable during the for year that year. of the withdrawal at your income tax rate applicable for that year. If you choose to participate in both a 403(b) and a 457(b) account, you may contribute up to the How maximum are Roth allowable 403(b) limit account for each contributions plan every made? calendar year. You can defer a maximum of Contributions $18,000 to a 403(b) made account to a Roth and 403(b) $18,000 account to a 457(b) are after-tax account deductions for a total of from $36,000 your during paycheck. the Income taxes are not reduced by contributions you make to your account. All qualified calendar year. These amounts could be higher for employees who qualify for additional amounts distributions from Roth 403(b) accounts are tax-free. Any earnings on your deposits are not taxed defined under the plan. as long as they remain in your account for five years from the date that your first Roth contribution was made. Distributions may be taken if you are 59½ (subject to plan document provisions) or at separation from service. Page 106

107 What are the provisions for 403(b) & 457(b) accounts? Qualified retirement plans, such as 403(b), 401(k) and IRAs apply additional taxes on distributions prior to age 55 and separation from service or attainment of age 59½. Provisions for distributions from 457(b) accounts differ from provisions for 403(b) plans. You may elect to take distributions at any time after separation from service, regardless of age, or defer distributions until age 70½. Distributions will be subject to normal income tax during the year in which they are received. The decision to participate in a 403(b) plan and/or a 457(b) plan should reflect your future financial needs. For example, if you plan to retire and begin withdrawals prior to age 55, you may benefit from special 457(b) rules which allow these withdrawals without incurring a 10% tax surcharge applicable to qualified retirement plans such as 403(b) and 401(k). How How are are Roth Roth 403(b) 403(b) contributions & 457(b) contributions made? made? Contributions made to Roth account are after-tax deductions from your paycheck and are Contributions made to a Roth account are after-tax deductions from your paycheck and are subject to limit coordination with traditional accounts. Income taxes are not reduced by subject to limit coordination with traditional accounts. Income taxes are not reduced by contributions you make to your account. All qualified distributions from Roth accounts are contributions you make to your account. All qualified distributions from Roth accounts are tax-free. Any earnings on your deposits are not taxed as long as they remain in your account for tax-free. Any earnings on your deposits are not taxed as long as they remain in your account for five years from the date that your first Roth contribution was made. Roth 403(b) distributions five years from the date that your first Roth contribution was made. Roth 403(b) distributions may be taken if you are 59½ (subject to plan document provisions) or at separation from service, may be taken if you are 59½ (subject to plan document provisions) or at separation from service. while Roth 457(b) distributions may be taken once you have separated from service. NOTE: You should speak with your financial advisor to determine how participation can help Please note, you should speak with your financial advisor to determine how participation can meet future financial goals. help meet future financial goals. You should review and understand the specific provisions of any 457(b) Deferred Compensation Plan. This important information should be supplied by the plan provider prior to establishing an account. Page 107