2018 Employee Benefits

Transcription

1 2018 Employee Benefits AMG & Affiliates

2 OVERVIEW OF 2018 EMPLOYEE BENEFITS BENEFITS PREMIUM PAYMENTS COVERAGE SUMMARY HEALTH INSURANCE BLUE CROSS BLUE SHIELD Employer & Employee Paid Two plan options for medical benefits. Please see page 4 for medical plan details. DENTAL INSURANCE ALWAYS CARE Employer & Employee Paid Provides benefits for preventive, basic, major, and orthodontic services. VISION INSURANCE ALWAYS CARE Employee Paid Provides benefits for materials, frames, lenses and contacts. LONG TERM DISABILITY CIGNA Employer Paid Provides 60% of pre-disability earnings to a maximum benefit of $5,000 a month depending on hourly rate of pay. SHORT TERM DISABILITY CIGNA Employee Paid Provides 60% of pre-disability earnings up to a maximum benefit of $1,000 a week. BASIC LIFE & AD&D CIGNA Employer Paid AMG will offer 25,000 in life insurance. VOLUNTARY GROUP TERM LIFE CIGNA Employee Paid Each employee can buy up to 5 times annual salary to a maximum of $300,000: Spouse up to $150k; and Child(ren) $10,000. CANCER INSURANCE TRANSAMERICA LIFE INSURANCE COMPANY Employee Paid Benefits help those diagnosed with cancer to stay focused on recovery by alleviating some of the finan cial burden associated with the cost of cancer treatment. ACCIDENT INSURANCE TRANSAMERICA LIFE INSURANCE COMPANY UNIVERSAL LIFE TRANSAMERICA LIFE INSURANCE COMPANY CRITICAL ILLNESS TRANSAMERICA LIFE INSURANCE 2 COMPANY Employee Paid Employee Paid Employee Paid Accident Coverage helps offset deductibles and co-insurance resulting from off-the-job accidents. Benefits for Outpatient Physicians Treatment, hospitalization and surgery are included. Universal Life coverage provides permanent life insurance protection with a premium that never increases due to age or a specified term. Life Insurance is a promise to your family to help protect their future. The death benefit can be used any way you or your family sees fit. This plan pays a lump sum benefit directly to you and your covered dependents upon diagnosis of invasive cancer, heart attack, stroke, organ transplant, kidney failure, among other critical illnesses.

3 WHAT YOU NEED TO KNOW! ELIGIBILITY Full-time employees who work a minimum of 30 hours per week are eligible to enroll themselves and their qualified dependents in applicable AMG employee benefits. For any benefits other than Health, Dental, and vision, employees must be active at work to be eligible for benefits. Dependents must not be (i.e., disabled, in nursing home, hospital, etc...) to be eligible for benefits. ENROLLMENT INSTRUCTIONS 1. REVIEW YOUR BENEFITS - Read this guide thoroughly - it will describe all the plan and benefit options for GETTING READY TO ENROLL - Items to have available when you call to enroll or elect benefits: Social Security numbers and birth dates for yourself and your eligible family members. Last paycheck stub and information about other benefit coverage or insurance you or a family member may have. Beneficiary designation information, so you can properly identify your beneficiaries for your various policies. ENROLL BY YOUR DEADLINE - Representatives from CBA will be available by phone to answer questions and help you complete your enrollment starting Monday, February 5, Friday, February 16, 2018 is the cutoff date to make any changes to your benefit elections. The effective date of any changes made at the open enrollment is March 1, 2018 FOLLOW UP - Be sure to check the Netchex system to verify your enrollment summary and to confirm that your payroll deductions are correct. MAKING CHANGES THROUGHOUT THE YEAR! Once you have made your enrollment choices, you generally cannot make any changes until the next annual Open Enrollment. However, you may make certain changes if you have any qualifying life events that affect your benefits. A qualifying life event could include, but is not limited to: QUESTIONS? CUSTOMER SERVICE Toll Free Direct fax amg-ltac@combined-benefits.com Marriage or divorce; Birth or adoption of a child; Death of a spouse or other eligible dependent; Change in your spouse s or child s employment resulting in gain or loss of eligibility for employee benefits You must notify the AMG HR Department about any qualifying Life Event as soon as possible and before 31 days have passed. If you wait longer than 31 days, you will not be allowed to make any coverage changes until the next annual Open Enrollment, per IRS regulations. DISCLAIMER: This benefit summary is provided for illustrative purposes only and is simply an overview of your benefits. For a detailed explanation of your benefits for each policy, you should review a copy of the actual policy on file with the Human Resources Department or request a copy of each policy from Combined Benefits Administrators. 3

4 Health Insurance BCBS will continue to be our health care provider. Please see the plan options below. The option of the BlueSaver, High Deductible Health Plan (HDHP) is in conjunction with a Health Savings Account (HSA). Please review plan details to be aware of coverage options. Group Care Blue Saver Calendar Year Deductible In-Network / Out-of-Network In-Network / Out-of-Network Individual $2,000 / $4,000 $3,000 / $6,000 Family $6,000 / $12,000 $6,000 / $12,000 Out-of-Pocket calendar year maximum Individual $6,250 / $12,500 $5,000 / $10,000 Family $12,500 / $25,000 $10,000 / $20,000 Per Member Out-of-Pocket Max within a Family $6,850 / $20,000 Coinsurance Office Visit 70% / 50% 80% / 60% Primary Care Physician (PCP) $40 Co-Pay Deductible then Coinsurance Quality Blue Primary Care $25 Co-Pay Deductible then Coinsurance Specialist $55 Copay Deductible then Coinsurance Prescription Deductible Prescription Medication None Integrated with Medical Deductible Generic $15 Retail / $45 Mail Co-Pay Plan pays 80% after deductible Preferred Brand Drugs $40 Retail / $120 Mail Co-Pay Plan pays 60% after deductible Non-Preferred Brand $70 Retail / $210 Mail Copay No Benefit Specialty (Limited to a 30 day supply per fill) Plan pays 90% with a $150 max No Benefit Health Savings Account - HSA This plan is not eligible for HSA This plan is eligible for HSA Health Savings Account (HSA) is available with the BlueSaver Plan. Savings and advantages of an HSA: Tax Savings (Pre-Tax Contributions); Reduces out-of-pocket costs; Portable (may keep your HSA if you leave AMG); Long Term Savings (funds always roll over to the next year). Ask your enrollment advisor or HR contact for a complete summary. Contact Human Resources for enrollment information in the HSA. Contributions may be made pre tax and may not exceed IRS annual max of $3,450 for individual coverage and $6,900 for family coverage. Individuals 55 and older may make additional catch-up contributions up to $1,000 each year until they enroll in Medicare. Bi-Weekly Rates Bi-Weekly Rates Employee $49.68 $39.58 Employee & Spouse $ $ Employee & Children $ $ Family $ $ BCBS PLAN INFORMATION AMG Group Number 78548ERC BCBS Customer Service Website BCBS RX PLAN INFORMATION Rx Bin Rx Group# BSLA PCN# PCN - A4 Pharmacy Help Desk

5 Dental Insurance Having dental insurance contributes to your total well-being. With AlwaysCare, you have comprehensive dental coverage at affordable rates. BENEFITS Preventive Services (No Deductible) 100% Basic Services (Deductible Applies) 80% / 80% (out of network) Major Services (Deductible Applies) 50% / 50% (out of network) Orthodontia (No Deductible) Child Coverage Only (26) 50% Calendar Year Deductible Cleanings Bitewing X-Rays Oral Exams Fluoride Sealants (per tooth) X-rays Space Maintainers Endodontics Periodontics Oral Surgery (simple extractions) General Anesthesia Oral Surgery (complex extractions) Bridges Dentures Crowns Inlays & Onlays $1,000 Lifetime Max $50 Deductible Per Member / $150 Family Waived on Preventive & Orthodontia Services Applies to both in & out of network services Annual Maximum $1,000 Waiting Periods None Carryover Benefit Included Did you know you don t need an ID Card to visit your provider, or for your provider to file a claim? Just tell your dentist you re an AlwaysCare member and they can locate you through the online system or by calling AlwaysCare at You can review your coverage, check your benefits, track your claims, find in-network providers, and print additional ID cards any time at TIER BI-WEEKLY RATES Employee Only $2.65 Employee & Spouse $13.29 Employee & Child(ren) $13.81 Family $

6 Vision Insurance AlwaysCare Vision will continue to be our vision insurance provider and will provide enhanced benefits for materials, frames, lenses and contacts at a reduced cost. VISION CARE SERVICES Vision Exams $10 Materials $25 CO-PAYS BENEFITS In-Network Out-of-Network Exam Covered by Co-Pay Up to $35 Frames* $120 Retail Allowance Up to $50 Lenses (standard) per pair* Single Vision Covered In Full Up to $25 Bifocal Covered In Full Up to $40 Trifocal Covered In Full Up to $50 Progressive $70 Allowance Up to $40 Lenticular $80 Allowance Up to $50 Contact Lenses* Up to $120 Up to $100 Medically Necessary Contact Lenses* Up to $210 Up to $210 *Contact Lenses are in lieu of Eyeglass Lenses and Frames SERVICES FREQUENCY TIER BI-WEEKLY RATES Exam Frames Lenses Contact Lenses 1 per 12 months 1 per 24 months 1 per 12 months 1 per 12 months Employee $2.60 Employee & Spouse $5.20 Employee & Child(ren) $5.50 Family $8.63 Did you know you don t need an ID Card to visit your provider, or for your provider to file a claim? Just tell your eye care professional you re an AlwaysCare member and they can locate you through the online system or by calling AlwaysCare at You can review your coverage, check your benefits, track your claims, find in-network providers, and print additional ID cards any time at 6

7 Group Term Life w/ AD&D Basic Life w/ AD&D Insurance AMG will pay the premium for a $25,000 Life and AD&D Insurance policy to all active, eligible employees. Voluntary Term Life w/ AD&D Insurance You have the option to buy additional coverage to meet your specific needs. Term Life Insurance provides financial protection for you and your family during your working years, when your life insurance needs are typically higher. The affordable group rates allow you to get and your dependents with additional protection for those who depend on you financially. Employee Spouse Children Coverage Amounts $10,000-$300,000 in $5,000 increments Not to exceed 5 times your annual salary $5,000-$150,000 in $5,000 increments Employee must elect coverage for spouse to be eligible. Not to exceed 50% of employee elected amount. $10,000 Child Child: Birth to age 19 to age 26 if student Employee must elect coverage for children to be eligible. Guarantee Issue (For New Hires only) The lesser of $200,000 or 5x annual salary $50,000 $10,000 Benefit Reduction Reduces to 50% of original amount of coverage at age 70 AD&D Benefit (Accidental Death & Dismemberment) AD&D benefit amount equal to the life insurance amount elected. Provides benefits for serious injuries and an additional death benefit if the insured is dismembered or killed by a covered accident. Bi-Weekly Rates Age $25,000 $50,000 $100,000 $150,000 $200,000 Under 35 $0.81 $1.62 $3.23 $4.85 $ $1.15 $2.31 $4.62 $6.92 $ $1.62 $3.23 $6.46 $9.69 $ $2.31 $4.62 $9.23 $13.85 $ $3.35 $6.69 $13.38 $20.08 $ $6.12 $12.23 $24.46 $36.69 $48.92 Children Term Rates Age $10,000 Birth to age 19 (26 if student) $0.92* *Covers all Children $8.31 $16.62 $33.23 $49.85 $ $14.54 $29.08 $58.15 $87.23 $ This information is a brief description of the important features of this plan. It is not a contract. Terms and conditions of life insurance coverage are set forth in Group Policy No. FLX , on Policy Form TL , issued in Delaware to the Trustee of the Group Insurance Trust for Employers in the Services Industry. Terms adn conditions of accident insurance coverage are set forth in Group Policy No. OK on Policy Form No. GA , issued in Louisiana. the group policy is subject to the laws of the jurisdiction in which it is issued. The availability of this offer may change. Please keep this material as a reference. 7

8 Short Term Disability If you miss work due to an injury or illness, disability insurance will help replace a portion of your lost wages. It s not life threatening a broken leg, a hysterectomy, or maybe you re planning on having a baby. You re going to miss work for several weeks, even a month or two. How are you going to pay the bills? You may have a week or two of sick leave or earned time off, but after that what happens? With this coverage you can receive a weekly benefit of 60% of your weekly salary after you have been unable to work for 30 days due to a covered illness or off-the-job injury. BENEFIT AMOUNT WEEKLY MAXIMUM $1,000 ELIMINATION PERIOD MATERNITY BENEFIT PRE-EXISTING CONDITION LIMITATION 60% of Covered Monthly Earnings 30 days Benefit period 6 weeks for natural child birth minus the 30 day elimination period(2 week benefit). Benefit period 8 weeks C Section minus the 30 day elimination period (4 week benefit). You may not be eligible for benefits if you have received treatment for a condition within the past 12 months until you have been covered under this plan for 12 months. BENEFIT PERIOD 9 weeks Annual Salary WEEKLY BENEFIT BI-WEEKLY RATES Annual Salary WEEKLY BENEFIT BI-WEEKLY RATES $25,000 $289 $12.40 $46,000 $531 $22.79 $26,000 $300 $12.88 $47,000 $543 $23.31 $27,000 $312 $13.39 $48,000 $554 $23.78 $28,000 $324 $13.91 $49,000 $566 $24.29 $29,000 $335 $14.38 $50,000 $577 $24.77 $30,000 $347 $14.89 $51,000 $589 $25.28 $31,000 $358 $15.37 $52,000 $600 $25.75 $32,000 $370 $15.88 $53,000 $612 $26.27 $33,000 $381 $16.35 $54,000 $624 $26.78 $34,000 $393 $16.87 $55,000 $635 $27.26 $35,000 $404 $17.34 $56,000 $647 $27.77 $36,000 $416 $17.86 $57,000 $658 $28.24 $37,000 $427 $18.33 $58,000 $670 $28.76 $38,000 $439 $18.84 $59,000 $681 $29.23 $39,000 $450 $19.32 $60,000 $693 $29.75 $40,000 $462 $19.83 $61,000 $704 $30.22 $41,000 $474 $20.35 $62,000 $716 $30.73 $42,000 $485 $20.82 $63,000 $727 $31.21 $43,000 $497 $21.33 $64,000 $739 $31.72 $44,000 $508 $21.80 $65,000 $750 $32.19 $45,000 $520 $22.32 *Additional rates available upon request* 8 This information is a brief description of the important features of this plan. It is not a contract. Terms and conditions of coverage are set forth in Group Policy No. VDT , on Policy Form TL , issued in Louisiana and subject to its laws. The availability of this offer may change. Please keep this material as a reference, and file it with your certificate, should you become insured.

9 Long Term Disability AMG provides a Long Term Disability Insurance policy for all active, eligible employees. When facing a serious disability you can depend on having a check coming in each month to pay the bills. With this coverage you can receive a monthly benefit of 60% of your monthly salary after you have been unable to work for 90 days due to a covered illness or injury that occurred off-the-job. BENEFIT AMOUNT 60% of Covered Monthly Earnings MONTHLY MAXIMUM BENEFIT $5,000 ELIMINATION PERIOD PRE-EXISTING CONDITION LIMITATION 90 days You may not be eligible for benefits if you have received treatment for a condition within the past 3 months until you have been covered under this plan for 12 months. BENEFIT PERIOD To age 65 BENEFIT REDUCTION AGE AT START OF DISABILITY MAXIMUM BENEFIT DURATIONS months months months months months months 69 or older 12 months This coverage is provided to you at no cost, courtesy of AMG. This information is a brief description of the important features of this plan. It is not a contract. Terms and conditions of coverage are set forth in Group Policy No. LK , on Policy Form TL , issued in Louisiana and subject to its laws. The availability of this offer may change. Please keep this material as a reference, and file it with your certificate, should you become insured. 9

10 Accident Insurance Accidents are a part of everyday life, but are you prepared for the added financial burden? If you have an accident you ll want extra cash to cover your increased expenses. Accident insurance helps pay for those unexpected healthcare expenses due to accidents that occur off the job from the soccer field to the ski slope and the highway in-between. These benefits are paid directly to you that you can use for medical bills and other out of pocket expenses - or for any other purpose, including paying your mortgage or other bills. Benefits Accident Follow-up Treatment $50 Payout Amount Accidental death Benefit Employee $40,000 Spouse $40,000 Children $20,000 Accidental Death Benefit Common Carrier Employee $120,000 Spouse $120,000 Children $60,000 Ground Ambulance Air Ambulance $300 $1,500 Appliance $200 Blood, Plasma, and Platelets $400 BURNS - $1,500-$12,000 TIER BI-WEEKLY RATES Employee Only $8.45 Employee & Spouse $13.14 Employee & Child(ren) $11.33 Family $16.41 Catastrophic Accident Benefit Employee $40,000 Spouse $40,000 Children $20,000 Concussion $200 Dislocations Open reduction Closed reduction Initial Doctor s Office Visit $125 EMERGENCY DENTAL BENEFIT Extraction Crown Up to $4,000 Up to $1,350 $80 $300 Emergency Room Treatment $125 Eye Injury $400 FRACTURES Open reduction Closed reduction Chips Health Screening Benefit One per Employee and covered Spouse per year 30 day waiting period from policy s inception Up to $5,000 Up to $1,700 10% of closed reduction benefit $60 Hospital Admission $1, Hospital Confinement ICU Loss of Finger, Toe, Hand, Foot, or Sight of an Eye SURGERY Open, abdominal, thoracic Exploratory Tendon/Ligament/Rotator Cuff Repair of more than one Repair of one Exploratory without repair $250 $750/day $2,000 to $40,000 $1,500 $200 $1,000 $500 $200 This is a brief summary of AccidentAdvance, Accident Insurance. Policy form series CPACC100 and CCACC100. Forms and form numbers may vary, coverage available where approved. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details.

11 Cancer Insurance Chances are someone you know has been diagnosed with cancer. When those medical emergencies occur people are suddenly faced with lengthy medical treatment, drastic lifestyle changes, and uncertain futures. At the same time, most people are also not equipped to handle the mountain of medical bills and associated expenses that their medical insurance may not cover. You can prepare for such an occurence by having a cancer insurance policy that will help cover the costs of you or your families treatment. RADIATION & CHEMOTHERAPY Policy Pays Radiation & Chemotherapy $15,000 maximum benefit per 12-month period; pays actual charges Blood, Plasma, Blood Components, Bone Marrow & Stem Cell Transplant $15,000 maximum benefit per 12-month period; pays actual charges New or Experimental Treatment $15,000 FIRST OCCURRENCE RIDER Initial Diagnosis Benefit $1,000 WELLNESS & NON-MEDICAL BENEFITS maximum benefit per 12-month period; actual charges, up to selected amount, for experimental or investigational treatment defined as drugs or chemicals approved by the FDA or surgery or therapy approved by either the NCI or ACS for experimental studies Policy Pays pays a one-time,lump sum benefit when a covered person is initially diagnosed with cancer (except skin cancer), based on a microscopic examination of fixed tissue or preparations from the hemic system. Clinical diagnosis is accepted under certain conditions. Policy Pays Wellness Benefit $100 per calendar year for cancer screening tests (Customer Service Department ) Magnetic Resonance Imaging (MRI) Scans $100 per calendar year for MRI scan used as diagnostic tool for breast cancer, in addition to Wellness Benefit Non-Local Transportation HOSPITAL BENEFITS Actual round-trip charges or private allowance, up to 750 miles at $.40 per mile when required non-local hospital confinement is more than 50 miles from residence for covered person and an adult, immediate family member during confinement Policy Pays Hospital Confinement $300 per day; up to 90 days of covered confinement Extended Benefits $600 Private Duty Nurse $300 Ambulance $300 per day of hospital confinement in lieu of all other benefits (except surgery & anesthesia); begins on day 91 of continuous confinement per day during hospital confinement; must be authorized by the attending physican; cannot be hospital staff or a family member for service by a licensed professional ambulance service for transportation to a hospital to which the covered person is admitted Hospice Care $300 per day when confined in a hospice center or hospice home care by a hospice team; 100-day lifetime max SURGERY BENEFITS Policy Pays Surgery Inpatient Outpatient $2,000 $3,000 maximum benefit; actual benefit is determined by the surgery schedule in the contract; for multiple procedures in same incision only the highest benefit is paid; for multiple procedures in separate incisions will pay highest benefit and then 50% for each lesser procedure Anesthesia 25% of covered surgery benefit as scheduled in the certificate Reconstructive Surgery $240-$500 for reconstructive surgery within 2 years of the initial cancer removal; excluded skin cancer and malignant melanoma; benefit not payable if paid under any other provision of the policy. Pre-Existing Condition - No benefits are provided during the first 12 months for pre-existing conditions for which a person has been diagnosed, treated, or for which the covered person has incurred expense or has taken medication within 12 months prior to the effective date of such person s coverage. Bi-Weekly Rates Employee Employee & Children Family $12.59 $14.34 $22.89 This is a brief summary of CancerSelect Plus, Cancer Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. Policy form series CPCAN200 and CCCAN200. Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. 11

12 Critical Illness Insurance New CriticalAssistance Advance being offered effective 3/1/2018. Critical Illness Insurance helps offset the financial burden of being diagnosed with a Critical Illness by paying the lump sum benefit directly to you in the amount you choose between $10,000 and $50,000. Even having medical insurance, a person diagnosed with a critical illness can face thousands of dollars in out-of-pocket expenses. Covered Conditions - Pays 100% of benefit chosen unless otherwise indicated below. CATEGORY 1 CATEGORY 2 CATEGORY 3 Heart Attack Major Organ Transplant Surgery Invasive Cancer Stroke End-Stage Renal (Kidney) Failure Carcinoma in Situ (25%) Heart Transplant Surgery Paralysis Not due to stroke all 4 limbs Prostate Cancer with TNM Classification T1 (25%) Coronary Bypass Surgery (25%) Burns (3rd Degree of 50% coverage) Skin Cancer (5%) Angioplasty/Stent (5%) Miscellaneous Diseases Bone Marrow Transplant Alzheimer s Disease (30%) BENEFITS YOU LL APPRECIATE Bi-Weekly Non-Tobacco Rates Bi-Weekly Tobacco Rates Lump-sum benefit Paid directly to you, regardless of any other coverage you have. Permanent coverage- Rates don t increase with age and benefits don t decrease. Health screening benefit- To help you stay well, this benefit pays $75 per covered person per calendar year for one wellness screening. Recurrent Benefit - This benefit provides a lump sum benefit equal to 25% of the Initial benefit for recurrent critical illnesses. Employee 1 Parent Family ISSUE AGES $10, $ $ $ $ $ $ $ $ $ $ $ $32.59 Employee 1 Parent Family ISSUE AGES $10, $ $ $ $ $ $ $ $ $ $ $ $56.64 Portability Option Allows you to continue keep and coverage after termination or retirement at the same rate and plan design. 2 Parent Family $ $ $ $ $ $ Parent Family $ $ $ $ $ $83.69 Pre-Existing Condition - No benefits are provided during the first 12 months for pre-existing conditions for which a person has been diagnosed, treated, or for which the covered person has incurred expense or has taken medication within 12 months prior to the effective date of such person s coverage. 12 This is a brief summary of CriticalAssistance Plus, Critical Illness Insurance. Policy form series CPCI0200 and CCCI200. Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details.

13 Universal Life Insurance Universal Life Insurance goes beyond typical Term Life Insurance. Universal Life provides permanent life insurance protection with a premium that never increases and the benefit never decreases due to age or a specified term. Universal Life insurance offers protection beyond an individual s working years, potentially for your lifetime. Whether your loved ones will need additional funds to pay for basic living expenses, an education, or just your final arrangement, it s valuable help at a difficult time. Employee Spouse Child / Grandchild Child Term Rider ELIGIBLE AGES days to 26 years 15 days to 26 years BENEFIT AMOUNTS ACCELERATED DEATH BENEFIT $10,000*-$500,000 in $5,000 Increments $10,000*-$100,000 in $5,000 Increments *All policies issued are subject to minimum premium limits Accelerates a portion of the coverage amount if a covered person is diagnosed with a covered chronic illness and in the best medical judgement is unable to perform daily activities for at least 90 days. $25,000 $10,000 BI-WEEKLY PREMIUM BASED ON A PURCHASE OF $25,000 ISSUE AGE NON-TOBACCO TOBACCO ISSUE AGE NON-TOBACCO TOBACCO 25 - $ $17.04 $ $ $18.17 $ $ $19.38 $ $ $20.60 $ $ $21.90 $ $ $23.27 $ $ $24.67 $ $8.34 $ $26.23 $ $8.71 $ $27.76 $ $9.06 $ $29.26 $ $9.43 $ $31.46 $ $9.90 $ $33.73 $ $10.46 $ $36.10 $ $10.99 $ $38.54 $ $11.60 $ $41.30 $ $12.29 $ $44.16 $ $13.00 $ $47.32 $ $13.67 $ $50.70 $ $14.45 $ $54.31 $ $15.18 $ $57.01 $ $15.95 $21.64 *Addidtional rates available upon request* CHILD/GRANDCHILD UNIVERSAL LIFE $25,000 POLICY AMOUNT AGE 0-10 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $8.66 Children Term Rates Age $10, days - age 26 $1.15 *Covers all Children This is a brief summary of TransElite Universal Life Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, IA. Policy form series CPGUL300 and CCGUL300. Forms and form numbers may vary. This insurance may not be available in all jurisdictions. Limitations and exclusion apply. Refer to the policy, certificate and riders for complete details. 13

14 EMPLOYEE BENEFITS CLAIMS FILING WELLNESS File Wellness Claims Quick and Easy Transamerica s claim filing process for cancer, critical illness and accident wellness benefits is a snap. Insureds can submit claims for cancer, critical illness and accident wellness benefits by phone or fax. No complicated, state-specific forms to fill out. Once the proper documentation is received, the insured should receive the claim check in 5-10 business days. File a Wellness Claim by Phone Contact the Transamerica Claims Customer Service Department at (800) and press 2. Give the phone representative the following information: + Insured s name/ policy number + Covered person s name, date of birth and relationship to insured + Name of test/ procedure + Date of test/ procedure + Provider s name, address, and phone number File a Wellness Claim by Fax Fax directly to the Claims Department at (866) Document must include: + Insured s name and policy number + Covered person s name, date of birth and relationship to insured + Name of test/ procedure + Provider s billing statement, which includes the test/ procedure and the date it was performed Filing Wellness Claims Online Policyholders can register online at then complete the online form and upload documentation to support claims requests. Following submission, customers may view the claims status, review the submitted claim form and documentation. Once the claim is processed, the Explanation of Benefits (EOB) statement will be available online as well. Claims Assistance CBA Claims Representatives are able to assist you with the claims filing process. CBA can submit wellness claims for Cancer, Accident, and Critical Illness benefits, as well as assist with filing all other claims types. CBA will advocate your claim on your behalf. 14 CBA CUSTOMER SERVICE Direct Toll Free Fax amg-ltac@combined-benefits.com

15 CIGNA OFFERS YOU NUMEROUS WAYS TO MAINTAIN YOUR HEALTH, WELL-BEING AND SENSE OF SECURITY. We value our relationships with our customers and want to provide them with the best opportunities for overall success. Our various programs give you the tools and information that you need to be healthy, secure, and prepared for any life changes. Healthy Rewards Cigna's Healthy Rewards provides discounts of up to 60% on various wellness programs and services, ranging from Weight Management and Nutrition, to Vision and Hearing Care, and Tobacco Cessation. To learn more about these and other Healthy Rewards programs, visit Cigna.com/rewards (password: savings) or call Will Preparation Cigna s Will Preparation Program helps you and your family to plan and protect your financial future by using a simple, online tool. The tool allows you to build state-specific customized wills and other legal documents such as last wills, living wills and power of attorneys. Cigna s Will Center is secure, easy-to-use and available to you and your covered spouse seven days a week, 365 days a year. Visit CignaWillCenter.com to learn more about the Will Preparation Program. Life Assistance SM Program Just when you think you have life figured out, along comes a challenge. But whether those challenges are big or small, Cigna s Life Assistance SM Program is available to help you and your family find solutions to many of life's challenges and restore your peace of mind. For more information about the program call at Cigna Secure Travel Cigna Secure Travel provides special assistance for emergency medical, financial, legal and communication assistance when you travel. This program gives covered individuals access to a travel assistance customer service center from anywhere in the world when traveling at least 100 miles from home. For more information about Secure Travel, call Identity Theft Cigna s Identity Theft Program provides customers with access to personal case managers who give step-by-step assistance and guidance to individuals who have had their identity stolen. This program provides valuable resolution services, including realtime support all over the world, assistance in credit card fraud, and help with emergency travel arrangements. For more information on these and other services in the Identity Theft Program, call Your participation in these valuable programs can mean long-term protection and wellness for you and your family. Offered by: Life Insurance Company of North America or Cigna Life Insurance Company of New York. Cigna and GO YOU are registered service marks, and the Tree of Life logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North America and Cigna Life Insurance Company of New York, and not by Cigna Corporation. All models are used for illustrative purposes only Cigna. Some content provided under license.

16 CUSTOMER SERVICE Direct Toll Free Fax