North Penn School District Presented by: Elite Voluntary Benefits, LLC

Transcription

1 North Penn School District Presented by: Elite Voluntary Benefits, LLC Effective Date: 07/01/2012 Coverage(s): Accident Critical Illness Cancer Assurant Employee Benefits 2323 Grand Boulevard Kansas City, MO T F Assurant Employee Benefits is the brand name for insurance products underwritten and issued by Union Security Insurance Company. Coverage may not be available in all states and may be subject to state variations. Certain policy benefits may not be available in all states. Plans contain limitations, exclusions and restrictions. Contact Assurant Employee Benefits for additional information.

2 Welcome to Assurant Employee Benefits Thank you for your interest in our products and services! As one of the largest providers of employee benefits in the United States, we specialize in helping small and mid-size businesses maximize their benefits investment without sacrificing quality. This means small to mid-size businesses enjoy plan customization and flexibility generally reserved for large corporations. Since 1910, we have delivered quality insurance products and services. Today, that full suite of coverages includes: Dental Prepaid/DHMO Dental Life Disability Accident Critical Illness Cancer Gap Vision Headquartered in Kansas City, Mo., Assurant Employee Benefits has offices nationwide and is a part of Assurant, Inc. Traded on the New York Stock Exchange under the symbol AIZ, Assurant is a Fortune 500 company and a member of the S&P 500 Index. Financial Strength Ratings 1 A- (Excellent) by A.M. Best A- (Strong) by Standard & Poor s A3 (Good) by Moody s 1 Financial strength rating is for Union Security Insurance Company November 2010 (A.M. Best) December 2010 (Standard & Poor s) and March 2011 (Moody s). 2

3 Accident Insurance What is Accident insurance? Accident insurance from Assurant Employee Benefits is designed to provide fixed benefits for accidental injuries to those covered by the policy. The likelihood of experiencing an accident is real. In fact, regardless of gender, race or economic status, injuries remain a leading cause of death for Americans of all ages. 1 This accident only policy provides limited benefits and has some specific annual benefit limits. However, it may help cover out-of-pocket expenses associated with an accident. What benefit can Accident insurance provide? It provides fixed payments for the treatment of covered accidental injuries based on a schedule that lists specific amounts for specific accidents or associated expenses. Coverage also includes accidental death & dismemberment benefits. While you need to check this proposal for complete information, accident insurance may help cover payments for hospitalization, emergency room visits, exams, physical therapies, etc. Accident Injuries the facts st 1 Injuries are the leading cause of death for Americans 1-44 years old. 1 1 in 6 U.S. residents annually require medical treatment from an injury. 2 1 in 10 U.S. residents visit a hospital emergency room each year for treatment of a non-fatal injury million Americans visit a physician s office for unintentional injuries every year. 3 1 Centers for Disease Control, Centers for Disease Control, Congressional Testimony, May 1, National Safety Council, Injury Facts This is an accident only insurance policy. It provides limited benefits and has some specific benefit limits. It does not pay benefits for sickness or loss from any other cause and is not a policy of Workers Compensation insurance. Please refer to the issued insurance policy for complete details and all benefit requirements, including all limitations, exclusions and restrictions. We reserve the right to cancel the policy with advance written notice to the policyholder. Insurance policies and certain policy benefits are subject to state variations and availability. Issued insurance contracts determine all plan features and benefits. Contact Assurant Employee Benefits for additional details. 3

4 Accident Insurance Group Name: North Penn School District Presented by: Elite Voluntary Benefits, LLC This proposal is good for a future effective date through 10/01/2012. Plan Detail Plan Level 1: Non-Occupational Group Accident (accidents/injuries that are not job-related) Contributions Accident Benefits provided Family Coverage Options Portability 100% employee paid Provides a fixed benefit for accidental injuries such as fractures and dislocations and related expenses, such as emergency room visits and physical therapy. Daily hospital and ICU benefits are also included as well as an Accidental Death and Dismemberment provision. See Group Accident Insurance Schedule for more detail. Employee, spouse, child. Employee must enroll in order to enroll dependents. Greater of to age 65 or 12 months Underwriting Guidelines Minimum Lives Participation Requirement Pre-existing Conditions Limitation Guarantee Issue Requirements Annual Enrollment Period 5 employee enrolled lives Minimum participation % not required None All amounts Guarantee Issue This plan includes an annual enrollment period, which provides an opportunity for late applicants to join the plan and allows for benefit changes. 4

5 Group Accident Insurance Schedule Initial Accident Hospitalization ICU Initial Accident Hospitalization Accident Hospital Confinement Intensive Care Unit Confinement $1,000; limited to once each benefit year $1,500; limited to once each benefit year. ICU Initial Accident Hospitalization payable instead of Initial Accident Hospitalization, if confined immediately to ICU. $250 per day, not to exceed 365 days $500 per day, limited to 15 days for each accident. This benefit is paid in addition to any Accident Hospital Confinement benefit. Accidental Death Employee $50,000; Spouse $25,000; Child $12,500 Common carrier accident - Triple the amounts above. Either the accidental death or the common carrier accidental death benefit will be paid, but not both. Accidental Dismemberment Accident Emergency Treatment Accident Follow-Up Treatment Ambulance Appliances Blood/Plasma/Platelets Employee up to $50,000; Spouse up to $25,000; Child up to $12,500 $150; limited to once each accident and once in any 24-hour period $25 per day, not to exceed 6 payments $200 Ground ambulance; $1,500 Air ambulance $125 Wheelchairs, leg or back braces, crutches or walkers. Payable for one appliance for any accident. $200; payable once for any accident Burns Third Degree Burns $1,000 to $20,000* Second Degree Burns $400 to $2,000* Skin Grafts If the covered employee or dependent receives one or more skin grafts for a second degree or third degree burn, we will pay 50% of the total burn benefit amount paid. *Fixed benefit amount is determined by the surface area burned. Coma $20,000 Concussion $100 Dislocation Emergency Dental Work Eye Injury Up to $4,000 for open reduction (surgery); Up to $1,000 for closed reduction (repair by manipulation). Limited to 2 dislocations per accident; reduction under general anesthesia. (If reduction is administered without general anesthesia, we will pay 25% of the amount shown for the closed reduction dislocation.) $200 Broken teeth repaired with crowns; $65 - Broken teeth resulting in extractions. Limited to 1 benefit per accident. $300 Surgical repair; $65 Removal of foreign body by a doctor 5

6 Group Accident Insurance Schedule Fractures Lacerations $35 to $500 Lodging Major Diagnostic Exams Paralysis Physical Therapy Prosthesis Rehabilitation Unit Surgical Procedures (must be performed within 90 days of the accident) Transportation Up to $5,000 for open reductions; Up to $2,500 for closed reductions. Limited to 2 fractures per accident. (We will pay 25% of the amount shown for the closed reduction for chip fractures and other fractures not reduced by open or closed reduction.) $100 per day; limited to one benefit per day and 30 days per accident per benefit year $200 per benefit year $50,000 for Quadriplegia; $25,000 for Paraplegia. Payable only once per lifetime. $25 per day, for up to 10 days of treatment $500; limited to one prosthesis per accident $150 per day; limited to 30 days per period of confinement and limited to 60 days per benefit year. $1,250 Open abdominal (including exploratory laparotomy), cranial, hernia, or thoracic surgery $625 Repair of tendons and/or ligaments, torn rotator cuffs, ruptured discs, or torn knee cartilages $300 Arthroscopy without surgical repair, or miscellaneous surgery requiring general anesthesia that is not covered by any other specificsum injury benefit. Miscellaneous surgery limited to one surgery per 24-hour period. $600, limited to 3 round trips per benefit year, for each covered employee and each covered dependent. This benefit is paid upon completion of a round trip transport (excluding transportation by ambulance) to a hospital if the purpose of the trip is to obtain medical care prescribed by an attending doctor for treatment of an injury that is not available within 100 miles of the accident or that is not within 100 miles of the covered employee's or dependent's residence. The benefit will also be paid for commercial travel by bus, train or airplane for a parent or guardian if the medical care is for a covered dependent child and he or she is accompanied by a parent or guardian. 6

7 Proposed Plan Rates Accident Monthly Premiums Plan Employee Spouse Child Level 1 - Non-occupational $14.14 $9.58 $14.07 Child rates are for all children, not per child. Rate Assumptions Rates are valid for a 07/01/2012 effective date and are guaranteed for 24 months. This proposal is valid for groups of less than 2,000 eligible lives and assumes any Accident coverage currently in effect will not be replaced with this offering. 7

8 Group Accident Conditions of Quote (The provisions listed here may not apply to every plan in the Schedule.) Rate Assumptions These rates are based on enrollment and other solicitation assumptions that are subject to change dependent on the enrollment plan approved by the policyholder. The rates quoted are based on the information provided to us at the time of proposal and reflect the risk presented and benefits requested at that time. The rates also reflect coverage only for employees who are actively at work on the effective date. Any change in our risk or any change in the benefits requested may result in a change of premium rates, a change in the plan offered, or a withdrawal of the proposal. Acceptance of the proposed group, plan design and/or rate is subject to evaluation by group underwriting at our Home Office. Upon receipt of all required forms and documentation, the group will be reviewed and, if accepted, acceptance will be communicated via a risk letter. Note: Prior coverage should not be canceled unless and until the risk letter has been received by the policyholder. Eligibility* Eligible employees must be full-time employees of the employer or an associated company, at active work and working in the United States of America**. Temporary or seasonal workers are not eligible. Full-time means working at least 20 hours per week. Employers may limit eligibility to certain classes. **Insured employees are covered for incidental business and personal travel outside of the United States. If a more expansive eligibility is required, please contact your Assurant Employee Benefits representative. Non-standard options are available, subject to Home Office approval. Eligible dependents of covered employees include the employee s lawful spouse and unmarried children from live birth but less than age 19 (less than age 25 if a full-time student). If an eligible dependent is in a hospital or similar facility on the day insurance would otherwise take effect, it will not take effect until the day after she or he leaves the hospital or similar facility. This does not apply to a child born while dependent insurance is in effect. Dependent insurance for a newborn dependent child, including an adopted newborn child, will automatically take effect at birth and will continue for 31 days. For insurance to continue beyond the 31 days, the covered employee must notify us (if dependent child insurance is not already in force) and make the required premium payment within the 31-day period. *State variations can exist. Contact your Assurant Employee Benefits representative for details. General Information For benefits to be payable under this policy, the accident must be due to a sudden, unforeseen, external and unexpected event, which results in an injury and which occurs while a covered employee or dependent is insured under this policy. This plan does not cover sickness, cerebrovascular accident (stroke) or any drug overdose unless the drugs were used as prescribed by a doctor. 8

9 Plan portability allows covered employees to continue their coverage and their dependent coverage until the later of the employee s 65th birthday or 12 months after coverage under the employer s policy ends, subject to certain restrictions. Definitions Hospital means an institution which is primarily engaged in providing, by and under the supervision of doctors, diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled, or sick persons; or rehabilitation services of injured, disabled, or sick persons. It must meet all of the following requirements: maintain clinical records on all patients; have every patient be under the care of a doctor; provide 24 hour nursing service provided by a licensed practical or registered nurse and supervised by a registered professional nurse; be licensed or be approved by the state or local licensing agency; meet other health and safety requirements found necessary by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); and is not primarily a clinic, nursing, rest or convalescent home. Hospital confined or hospital confinement means admission to a hospital as an inpatient for at least 24 consecutive hours by a doctor for an injury. A hospital stay that does not result in charges to the covered employee or dependent is not a hospital confinement under this policy unless there is no charge because the hospital is a United States government facility. Exclusions We will not pay benefits for the covered employee or dependent relating to or resulting from: services or treatment not included in the Schedule; services or treatment for which the covered employee or dependent is not charged, unless there is no charge because the facility is a United States government facility; services or treatment provided by a family member; services or treatment rendered or hospital confinement outside the United States; or dental care except for emergency dental work for broken teeth either repaired by crowns or extracted due to an accident. We will not pay benefits for the covered employee or dependent if the accident or injury results, directly or indirectly, from: service in the armed forces or related auxiliaries such as the National Guard or Army Reserve of any country, combination of countries, or international organization at war, whether declared or not; war or any act of war, whether declared or not; taking part in a riot or insurrection, or an act of riot or insurrection; committing or attempting to commit an assault or felony; incarceration in a penal institution of any kind; intoxication (intoxication means the covered employee s or dependent s blood alcohol level exceeds the legal limit for operating a motor vehicle in the jurisdiction in which the injury occurs); use of any drug, unless used as prescribed by a doctor; intentionally self-inflicted injury, while sane or insane; suicide or attempted suicide, while sane or insane; travel or flight in any kind of aircraft, including any aircraft owned by or for the policyholder or an associated company, except as a fare-paying passenger on a common carrier; participation in any kind of sporting activity for compensation or profit, including coaching or officiating; participation in 9

10 racing, stunting, exhibition work, sport or test driving of a motor vehicle, including but not limited to cars, motorcycles and boats; participation in mountaineering, operating a glider, bungee jumping or skydiving; operating a taxi or any other delivery service for any kind of compensation or profit; any physical or mental sickness or related complications; or treatment or complications of treatment. 10

11 Critical Illness Insurance What is Critical Illness insurance? Critical Illness insurance from Assurant Employee Benefits is designed to pay a fixed benefit at the first diagnosis of a critical illness. The benefit you receive can be used to pay your mortgage or even replace lost income; it does not have to be used to pay for treatment. This critical illness insurance policy provides limited benefits. The benefits provided may help cover out-of-pocket expenses. What benefit can Critical Illness insurance provide? It provides a fixed benefit for the first diagnosis of a critical illness such as heart attacks, stroke, paralysis, etc. It also provides a fixed benefit for the first time you undergo coronary bypass surgery. Check this proposal for complete information of covered illnesses. Critical Illness the facts #1 Heart disease is the number one killer in the United States of both men and women. 1 3rd Stroke is the third leading cause of death in the United States. 2 1 in 3 Men and women have some form of cardiovascular disease. 3 Twice For those suffering a critical illness prior to age 65, the probability of surviving is almost twice that of dying. 3 1 Accessed at on April 22, Accessed at on April 22, Heart Disease & Stroke Statistics 2007 Update, American Heart Association. This critical illness only insurance policy provides limited benefits. This limited policy has some specific benefit limits and is not a medical insurance policy, a Medicare Supplement policy, or a high deductible health plan or a policy of Workers Compensation insurance. Please refer to the issued insurance policy for complete details and all benefit requirements, including all limitations, exclusions, restrictions and reductions. We reserve the right to cancel the policy with advance written notice to the policyholder. Insurance policies and certain policy benefits are subject to state variations and availability. Issued insurance contracts determine all plan features and benefits. Contact Assurant Employee Benefits for additional details. 11

12 Group Critical Illness Only Insurance Group Name: North Penn School District Presented by: Elite Voluntary Benefits, LLC This proposal is good for a future effective date through 10/01/2012. Plan Detail Plan Options Contributions Group Critical Illness 100% employee paid Covered Conditions Category 1 Category 2 Heart attack, heart failure, stroke 100%; coronary bypass surgery 25% Blindness, major organ failure (excluding heart failure), end stage kidney disease, paralysis (excluding paralysis from stroke), coma 100% The percentages shown reflect the applicable percentage of the benefit amount elected. A covered employee or dependent will not receive more than 100% of the schedule amount in any one category unless eligible for the Recurrence Benefit. Additional Occurrence Benefit Recurrence Benefit Wellness Screening Benefit Portability Included. Pays for an illness or procedure in a different category if there are at least 6 consecutive months between the diagnosis or procedure dates. Included for Category 1 and 2 illnesses and procedures. Pays 25% of the previously paid benefit for a subsequent diagnosis of the same critical illness or procedure. (The recurrence diagnosis must occur more than 18 months after the previous diagnosis and must follow a treatment free period of at least 18 months for the same critical illness or procedure.) Applies to employee and spouse coverage. Pays $50 per benefit year for one covered wellness screening test performed while covered under the policy. (See General Information for list of covered tests) Can continue up to the later of age 65 or 12 months 12

13 Group Critical Illness Insurance Schedule Employee Amount Options Spouse Amount Units of $5,000, up to a maximum of $50,000 Units of $2,500, up to the lesser of 50% of the employee's amount or $25,000 Child Amount Live birth but less than 19 (less than age 25 if a full-time student) - $2,500 or $5,000. The dependent child amount cannot exceed 50% of the employee amount. Age Reductions For a covered employee at age 70, amounts are reduced by 50% and are rounded to the next higher $1,000. Dependent amounts cannot exceed 50% of the employee amount. Underwriting Guidelines Minimum Lives Pre-existing Conditions Limitation Annual Enrollment Period 5 employee enrolled lives 3/12; Applies to all amounts (See Limitations for details) This plan includes an annual enrollment period, which provides an opportunity for late applicants to join the plan and allows for benefit changes. Proof of good health must be provided for all late entrants and for those who wish to increase coverage. The pre-existing conditions limitation will still apply. Guarantee Issue Limits Employee Guarantee Issue Spouse Guarantee Issue Child(ren) Guarantee Issue $5, $2, $2, Guarantee Issue amounts apply to timely eligible applicants. A timely applicant is one who applies for coverage within 30 days from the date that all eligibility requirements are met. 13

14 Proposed Plan Rates Issue age rating applies premiums will not increase due to age increases. The employee s age is used to determine both the employee and spouse rates. Rates are tobacco-distinct, based on employee and spouse tobacco use separately. Group Critical Illness Monthly Critical Illness Rates Per $1,000 of Benefit Issue Age Employee Non-Tobacco Employee Tobacco Spouse Non-Tobacco Spouse Tobacco Thru 29 $0.53 $0.71 $0.59 $ Monthly Child Premiums (for all children, not per child) $2,500 $0.15 $5,000 $0.30 Rate Assumptions Rates are valid through a 07/01/2012 date and are guaranteed for 24 months. This proposal is valid for groups of less than 2,000 eligible lives and assumes any Critical Illness coverage currently in effect will not be replaced with this offering. 14

15 Group Critical Illness Conditions of Quote (The provisions listed here may not apply to every plan in the Schedule.) Rate Assumptions These rates are based on enrollment and other solicitation assumptions that are subject to change dependent on the enrollment plan approved by the policyholder. The rates quoted are based on the information provided to us at the time of proposal and reflect the risk presented and benefits requested at that time. The rates also reflect coverage only for employees who are actively at work on the effective date. Any change in our risk or any change in the benefits requested may result in a change of premium rates, a change in the plan offered, or a withdrawal of the proposal. Acceptance of the proposed group, plan design and/or rate is subject to evaluation by group underwriting at our Home Office. Upon receipt of all required forms and documentation, the group will be reviewed and, if accepted, acceptance will be communicated via a risk letter. Note: Prior coverage should not be canceled unless and until the risk letter has been received by the policyholder. Eligibility* Eligible employees must be full-time employees of the employer or an associated company, at active work and working in the United States of America**. Temporary or seasonal workers are not eligible. Full-time means working at least 20 hours per week. Employers may limit eligibility to certain classes. **Insured employees are covered for incidental business and personal travel outside of the United States. If a more expansive eligibility is required, please contact your Assurant Employee Benefits representative. Non-standard options are available, subject to Home Office approval. Eligible dependents of covered employees include the employee s lawful spouse and unmarried children from live birth but less than age 19 (less than age 25 if a full-time student). If an eligible dependent is in a hospital or similar facility on the day insurance would otherwise take effect, it will not take effect until the day after she or he leaves the hospital or similar facility. This does not apply to a child born while dependent insurance is in effect. Dependent insurance for a newborn dependent child, including an adopted newborn child, will automatically take effect at birth and will continue for 31 days. For insurance to continue beyond the 31 days, the covered employee must notify us (if dependent child insurance is not already in force) and make the required premium payment within the 31-day period. *State variations can exist. Contact your Assurant Employee Benefits representative for details. General Information The critical illness must be diagnosed or the procedure undergone while a covered employee or dependent is insured under this policy. Benefits are not payable for any critical illness or procedure if the covered employee or dependent was diagnosed with that critical illness or has undergone that procedure prior to the effective date under this policy. 15

16 Covered employees or dependents will not receive more than 100% of the Schedule Amount in any one category unless they are eligible for the recurrence benefit. The recurrence benefit will only be paid once in each category. This plan is subject to federal COBRA continuation requirements. The Wellness Screening benefit is limited to the following tests: cardiac exercise stress test, fasting blood glucose test, blood test for lipids including total cholesterol, LDL, HDL and triglycerides, breast ultrasound or mammography, 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, pap smear, PSA (blood test for prostate cancer), serum protein electrophoresis, carotid doppler, electrocardiogram, echocardiogram. In order to receive this benefit, documentation from the covered employee s or dependent s doctor must be submitted. Plan portability allows covered employees to continue their coverage and their dependent coverage until the later of the employee s 65 th birthday or 12 months after coverage under the employer s policy ends, subject to certain restrictions. Limitations All benefit amounts are subject to a pre-existing conditions limitation. A pre-existing condition means an injury, sickness, symptom or physical finding, or any related injury, sickness, symptom or physical finding, for which the covered employee or dependent consulted with or received advice from a licensed medical or dental practitioner; or received medical or dental care, treatment or services, including taking drugs, medicine, insulin or similar substances during the 3 months that end on the day before the covered employee or dependent became insured under the policy. We will not pay benefits for any claims resulting directly or indirectly from a pre-existing condition unless the covered employee or dependent is initially diagnosed with a critical illness or undergoes a procedure after 12 consecutive months during which the covered employee or dependent is continuously insured under this plan. Exclusions We will not pay benefits for the covered employee or dependent if the critical illness or procedure is related to or resulting directly or indirectly from: services or treatment not included in the Schedule; services or treatment for which the covered employee or dependent is not charged, unless there is no charge because the facility is a United States government facility; services or treatment provided by a family member; any critical illness that is diagnosed outside the United States; services or treatment rendered outside the United States; services or treatment provided primarily for cosmetic purposes; treatment or complications of treatment not related to a critical illness or procedure; an autologous bone marrow transplant, one in which the covered employee s or dependent s own bone marrow is used; service in the armed forces or related auxiliaries such as the National Guard or Army Reserve of any country, combination of countries, or international organization at war, whether declared or not; war or any act of war, whether declared or not; taking part in a riot or insurrection, or an act of riot or insurrection; committing or attempting to commit an assault or felony; incarceration in a penal institution of any kind; intoxication (intoxication means the covered employee s or dependent s blood alcohol level exceeds the legal limit for operating a motor vehicle in the jurisdiction in which the injury occurs); use of any drugs, unless the drugs were used as prescribed or directed by a doctor; intentionally self-inflicted injury while sane or insane; or suicide or attempted suicide while sane or insane. 16

17 Cancer Insurance What is Cancer insurance? Cancer insurance is designed to provide financial support when those covered under the policy are diagnosed and subsequently treated for cancer. We understand there are costs associated with cancer beyond what is covered by medical insurance. This cancer only policy provides limited benefits and has some specific annual benefit limits. The benefits provided may help cover out-of-pocket expenses. What benefit can Cancer insurance provide? It provides a fixed benefit amount for early detection, incidence and treatment of cancer as well as related expenses. While you need to check this proposal for complete information, cancer insurance may cover occurrences such as screenings, hospital confinement, radiation/chemotherapy, surgery, hospice, etc. Cancer by the numbers $219.2 billion National Institute of Health estimate of overall cost of cancer in in 4 Deaths in the United States resulting from cancer.* 1 in 2 Men in the U.S. have a chance of developing cancer.* 1 in 3 Women in the U.S. have a chance of developing cancer.* * American Cancer Society, Cancer Facts & Figures This is a cancer only insurance policy. It does not pay benefits for loss from any other cause. This policy provides limited benefits and has some specific benefit limits. This is not a medical insurance policy, a Medicare Supplement policy, or a high deductible health plan or a policy of Workers Compensation insurance. Please refer to the issued insurance policy for complete details and all benefit requirements, including all limitations, exclusions and restrictions. We reserve the right to cancel the policy with advance written notice to the policyholder. Insurance policies and certain policy benefits are subject to state variations and availability. Issued insurance contracts determine all plan features and benefits. Contact Assurant Employee Benefits for additional details. 17

18 Group Cancer Only Insurance Group Name: North Penn School District Presented by: Elite Voluntary Benefits, LLC This proposal is good for a future effective date through 10/01/2012. Group Cancer Insurance Plans Level 1* Level 2 *HSA Compliant Benefits: Cancer Screening Second Surgical Opinion Surgery and General Anesthesia Hospital Confinement In-hospital Doctor Visits Radiation and Chemotherapy Blood and plasma Skin Cancer Prosthesis Extended-care Facility Hospice Ambulance Includes ALL of Level 1 benefits PLUS: National Cancer Institute Evaluation/Consultation Medical Imaging First Occurrence Transportation Lodging Bone Marrow (donor and recipient) or Stem Cell Transplant Immunotherapy Anti-nausea Treatment Reconstructive Surgery Outpatient Hospital Surgical Post-hospital Doctor Visits Nursing Services Experimental Treatment Alternative Care Home Health Care 18

19 Plan Details Cancer Benefits provided Employee Options Employer Contributions Family coverage options Portability Annual Enrollment Period Provides a fixed benefit for the early detection, incidence and treatment of cancer as well as related expenses. When Level 2 is also offered by the employer, a greater range of benefits such as reconstructive surgery and immunotherapy are provided. See Group Cancer Schedule for more detail. When both Level 1 and Level 2 are offered, the employee may enroll in either plan. The level chosen determines not only the range of benefits provided, but the amount of benefit payable for each benefit category. Employees and their covered dependents must enroll in the same benefit level. 100% employee paid Employee only, employee and spouse, employee and children, family. Employee must enroll in order to enroll dependents. Greater of to age 65 or 12 months This plan includes an annual enrollment period, which provides an opportunity for late applicants to join the plan and allows for benefit changes. Proof of good health must be provided at annual enrollment for all late entrants and for those who wish to change plan level. The pre-existing conditions limitation and any waiting periods will still apply. Underwriting Guidelines Minimum Lives Participation Requirement Pre-existing Conditions Limitation 5 employee enrolled lives Minimum participation % not required 3/12 19

20 Issue age rating applies premiums will not increase due to age increases. The employee s age is used to determine the rates. Group Cancer Level 1 Monthly Premiums Employee Only Employee + Spouse Issue Age Issue Age Thru 49 $11.85 Thru 49 $ Employee + Child(ren) Employee + Family Issue Age Issue Age Thru 49 $13.01 Thru 49 $ Group Cancer Level 2 Monthly Premiums Employee Only Employee + Spouse Issue Age Issue Age Thru 49 $27.84 Thru 49 $ Employee + Child(ren) Employee + Family Issue Age Issue Age Thru 49 $30.62 Thru 49 $ Rate Assumptions Rates are valid through a 07/01/2012 date and are guaranteed for 24 months. This proposal is valid for groups of less than 2,000 eligible lives and assumes any Cancer coverage currently in effect will not be replaced with this offering. 20

21 Group Cancer Insurance Schedule Level 1 Level 2 Cancer Screening Pays the amount shown for each covered employee or dependent who is tested for internal cancer and charged for undergoing either a colonoscopy, CA 125 test, chest x-ray, flexible sigmoidoscopy, mammogram, pap smear, biopsy, PSA, CT scans or MRI scans, BRCA testing, or Hemocult stool specimen. This benefit is limited to once per benefit year. Second Surgical Opinion Pays the amount shown once per surgical procedure for each covered employee or dependent who is diagnosed by a doctor with internal cancer requiring surgery and the covered employee or dependent obtains a second surgical opinion. This benefit is not payable for the same day the National Cancer Institute Evaluation/Consultation benefit is payable. National Cancer Institute Evaluation/Consultation Pays the amount shown for each covered employee or dependent if the covered employee or dependent obtains an evaluation or consultation at a National Cancer Institute designated cancer center strictly to determine the appropriate course of cancer treatment as a result of receiving a prior diagnosis of internal cancer. This benefit is not payable for the same day the Second Surgical Opinion benefit is payable. This benefit is limited and only payable once per lifetime. Medical Imaging Pays the amount shown if, after an initial diagnosis of internal cancer, a follow-up evaluation is performed using any imaging test as directed by a doctor (except breast mammography and breast ultrasound). Benefits are payable twice per benefit year provided the covered employee or dependent is charged for these procedures and they are performed on an outpatient basis. First Occurrence Pays the amount shown when the covered employee or dependent is diagnosed for the first time as having internal cancer. A 30-day waiting period applies. This benefit is only payable once per lifetime. $50 $75 $200 $200 No benefit $500 No benefit $100 No benefit $5,000 Surgery and General Anesthesia Pays the benefit amount listed in the policy if the treatment of internal cancer requires surgery. A separate benefit amount is paid for surgery and general anesthesia and varies based on the procedure performed. Surgery for skin cancer and reconstruction is not covered under this benefit. The combined surgery and anesthesia maximum benefit for one operation for Level 1 is $2,000; for Level 2 - $7,500. Anesthesia $50 to $1,815 Surgical $150 to $5,500 Anesthesia $50 to $1,815 Surgical $150 to $5,500 21

22 Group Cancer Insurance Schedule Level 1 Level 2 Outpatient Hospital Surgical Pays the amount shown per day when a doctor performs a surgical procedure on a covered employee or dependent diagnosed with internal cancer on an outpatient basis in a hospital or ambulatory surgical center. Benefit is not payable for surgery performed in a doctor s office or if the covered employee or dependent is hospital confined on the same day. Limited to a maximum of 3 days per procedure. Transportation Pays the amount shown for round trip transport (not including ambulance) to a hospital or clinic for the purpose of obtaining internal cancer treatment prescribed by the covered employees or dependent s local attending doctor. The hospital or clinic must be more than 100 miles away from the covered employee s or dependent s residence. The benefit will also be paid for commercial travel by bus, train or airplane for a parent or guardian if the medical care is for a covered dependent child and he or she is accompanied by a parent or guardian. Limited to 3 round trips per benefit year, per covered employee or dependent. Lodging Pays the amount shown per day for hotel lodging during treatment for internal cancer at a hospital or clinic. The hospital or clinic must be more than 100 miles away from the covered employee s or dependent s residence. Limited to 1 benefit per day up to 90 days per benefit year, per covered employee or dependent. No benefit $250 No benefit $500 No benefit $100 Skin Cancer Pays the amount shown based on the procedure performed for diagnosed skin cancer. The benefit amount shown includes the amount payable for anesthesia services. Biopsy only $100 $100 Reconstructive surgery following previous excision of skin $250 $250 cancer Excision of skin cancer without flap or graft $375 $375 Excision of skin cancer with flap or graft $600 $600 Ambulance Pays the amount shown for a licensed professional ambulance to transport the covered employee or dependent to a hospital for inpatient internal cancer treatment. This benefit is limited to 2 one-way trips per period of hospital confinement per covered employee or dependent. $250 Ground $250 Air $2,000 22

23 Group Cancer Insurance Schedule Level 1 Level 2 Bone Marrow or Stem Cell Transplant Pays the amount shown if the covered employee or dependent is charged for a bone marrow transplant or a peripheral stem cell transplant as the result of internal cancer. Payable once per lifetime, per covered employee or dependent. A benefit is paid for either a bone marrow transplant or a stem cell transplant, not both. Prosthesis Pays the amount shown per device if, as a direct result or consequence of treatment of internal cancer, a covered employee or dependent receives an implantable prosthetic device or other non-implantable prosthetic devices, such as voice boxes, hairpieces or removable breast prosthesis. This benefit does not include coverage for a Breast Transverse Rectus Abdominis Myocutaneous (TRAM) flap procedure. Surgically Implanted Lifetime maximum for Level 1 is $4,000; for Level 2 $6,000; Other Devices Lifetime maximum for Level 1 is $400; for Level 2 $600. Bone Marrow No benefit Stem Cell No benefit Surgically Implanted $2,000 Other Devices $200 Bone Marrow $10,000 (Donor $1,500) Stem Cell $2,500 Surgically Implanted $3,000 Other Devices $300 Hospital Confinement Pays the daily amount shown for hospital confinement due to inpatient treatment of the covered employee or dependent for internal cancer. Limited to 90 days per period of hospital confinement. $200 $400 23

24 Group Cancer Insurance Schedule Level 1 Level 2 Radiation and Chemotherapy Pays the amount shown if the covered employee or dependent receives cytotoxic medications or radiation (approved by the FDA or NCI-listed) administered by medical personnel in a hospital, clinic or doctor s office as internal cancer treatment for the purpose of changing or destroying abnormal tissue. These benefits are not payable for the same day the Experimental Treatment benefit is payable. Maximums apply: Oral Cytotoxic Medications are subject to a $450 monthly maximum for Level 1 ($1,500 for Level 2). For Level 1, a $4,000 benefit year maximum applies to each of the other listed treatments ($12,000 for Level 2). This benefit is not payable for treatment planning, therapeutic devices, immunotherapy, laboratory tests, diagnostic x-rays, dosimetry or simulation associated with these procedures. Injected Cytotoxic Medications (weekly) $300 $1,000 Pump Dispensed Cytotoxic Medications (first prescription & per $300 $1,000 refill) Oral Cytotoxic Medications (per prescription) $150 $500 Cytotoxic Medications Administration by Any Other Method $300 $1,000 (weekly) External Radiation Therapy (weekly) $400 $600 Insertion of Interstitial or Intracavity Administration of $450 $750 Radioisotopes or Radium (weekly) Oral or I.V. Radiation (weekly) $400 $600 In-hospital Blood and Plasma Pays the amount shown for each day the covered employee or dependent receives blood and/or plasma due to internal cancer treatment while hospital confined. $50 $50 Outpatient Blood and Plasma Pays the amount shown for each day the covered employee or dependent receives outpatient blood and/or plasma transfusions in a doctor s office, clinic, hospital, or ambulatory surgical center directly related to internal cancer treatment. In-hospital Doctor Visits Pays the daily visit amount shown for each covered employee or dependent visited by a doctor other than the operating surgeon while hospital confined for internal cancer treatment. Limited to a maximum of 75 visits. Anti-nausea Pays the amount shown for each month the covered employee or dependent is charged for drugs prescribed by a doctor to control nausea related to chemotherapy or radiation treatments for internal cancer. $50 $50 $25 $25 No benefit $100 24

25 Group Cancer Insurance Schedule Level 1 Level 2 Immunotherapy Pays the amount shown for each month the covered employee or dependent receives immunotherapy prescribed by a doctor as treatment for internal cancer. Lifetime maximum of $3,500 applies, per covered employee or dependent. We will not pay benefits under this provision for the same treatment under either the Radiation and Chemotherapy Benefit or the Experimental Treatment Benefit. No benefit $450 Reconstructive Surgery Pays the amounts shown for internal cancer related reconstructive surgery listed below. In addition, 30% of the surgery amounts listed is paid for general anesthesia used during these procedures. Breast Symmetry (modification of the non-cancerous breast No benefit $350 performed within 5 years of reconstructing the cancerous breast) Breast Reconstruction No benefit $700 Facial Reconstruction No benefit $700 Breast Transverse Rectus Abdominis Myocutaneous (TRAM) Flap No benefit $2,500 Experimental Treatment Pays the daily amount shown for doctor prescribed experimental treatments intended to destroy or change abnormal tissue. Treatment must be administered by medical personnel in a doctor s office, clinic, or hospital; maximum monthly benefit is $1,050. We will not pay benefits under this provision for laboratory tests, immunotherapy, diagnostic x-rays and therapeutic devices or other procedures related to these treatments. This benefit is not payable for any day the Radiation or Chemotherapy benefit is payable. No benefit $150 Alternative Care Pays the amount shown per visit to an accredited practitioner for each covered employee or dependent upon the diagnosis of internal cancer for Palliative care (acupuncture, massage therapy, bio-feedback and hypnosis), and Lifestyle training (smoking cessation, Yoga, meditation, relaxation techniques, Tai Chi and nutritional counseling). Limited to 20 visits per benefit year under either category, per covered employee or dependent and lifetime maximum of 2 benefit years. There is also a one-time benefit ($150) for Integrative Assessment and Education when performed by an accredited practitioner following the diagnosis of internal cancer. Post-hospital Doctor Visits Pays the amount shown per doctor visit once every 6 months if the covered employee or dependent visits the doctor after being released from the hospital. Benefits payable up to 5 years after the diagnosis of internal cancer for the purpose of ongoing cancer evaluation. No benefit $50 No benefit $50 25

26 Group Cancer Insurance Schedule Level 1 Level 2 Nursing Services Pays the daily amount shown if a doctor prescribes a private nurse for fulltime care in addition to those provided by the hospital while the covered employee or dependent is hospital confined for internal cancer. Limited to 30 days per benefit year per covered employee or dependent. Care must be provided by a licensed registered graduate nurse or vocational nurse, but not by a family member. Home Health Care Pays the amount shown per visit if a doctor prescribes home health care or health support services for a covered employee or dependent after being released from the hospital due to internal cancer. The service must begin within 7 days of the covered employee s or dependent s release from hospital confinement. Limited to a maximum of 10 visits per period of hospital confinement; up to 30 visits per benefit year. This benefit is not payable for any day the Hospice benefit is payable. Caregivers must be licensed or certified. Extended-care Facility Pays the amount shown for each day a covered employee or dependent is confined in an extended-care facility. The extended care confinement must occur within 30 days of a period of hospital confinement for internal cancer and the covered employee or dependent has received a Hospital Confinement benefit. Maximum 90 days per benefit year for each employee or dependent. This benefit is not payable for any day the Hospital Confinement benefit is payable. Hospice Pays the daily amount shown for hospice care for the covered employee or dependent for terminal illness as a result of internal cancer. Maximum of 100 days during the covered employee s or dependent s lifetime. This benefit is not payable for any day the Extended-care Facility benefit, the Home Health Care benefit or the Hospital Confinement benefit is payable. No benefit $125 No benefit $50 $200 $200 $100 $100 26

27 Group Cancer Conditions of Quote (The provisions listed here may not apply to every plan in the Schedule.) Rate Assumptions These rates are based on enrollment and other solicitation assumptions that are subject to change dependent on the enrollment plan approved by the policyholder. The rates quoted are based on the information provided to us at the time of proposal and reflect the risk presented and benefits requested at that time. The rates also reflect coverage only for employees who are actively at work on the effective date. Any change in our risk or any change in the benefits requested may result in a change of premium rates, a change in the plan offered, or a withdrawal of the proposal. Acceptance of the proposed group, plan design and/or rate is subject to evaluation by group underwriting at our Home Office. Upon receipt of all required forms and documentation, the group will be reviewed and, if accepted, acceptance will be communicated via a risk letter. Note: Prior coverage should not be canceled unless and until the risk letter has been received by the policyholder. Eligibility* Eligible employees must be full-time employees of the employer or an associated company, at active work and working in the United States of America**. Temporary or seasonal workers are not eligible. Full-time means working at least 20 hours per week. Employers may limit eligibility to certain classes. **Insured employees are covered for incidental business and personal travel outside of the United States. If a more expansive eligibility is required, please contact your Assurant Employee Benefits representative. Non-standard options are available, subject to Home Office approval. Eligible dependents of covered employees include the employee s lawful spouse and unmarried children from live birth but less than age 19 (less than age 25 if a full-time student). If an eligible dependent is in a hospital or similar facility on the day insurance would otherwise take effect, it will not take effect until the day after she or he leaves the hospital or similar facility. This does not apply to a child born while dependent insurance is in effect. Dependent insurance for a newborn dependent child, including an adopted newborn child, will automatically take effect at birth and will continue for 31 days. For insurance to continue beyond the 31 days, the insured employee must notify us (if dependent child insurance is not already in force) and make the required premium payment within the 31-day period. *State variations can exist. Contact your Assurant Employee Benefits representative for details. General Information This policy pays benefits if a covered employee or dependent is diagnosed with cancer and receives services or treatment for cancer. This is a limited cancer only policy. It does not pay benefits for loss from any other cause. It is not a medical insurance policy, a Medicare Supplement policy or a high deductible health plan. This plan is subject to federal COBRA continuation requirements. 27