YOUR BENEFIT OPTIONS SHORT-TERM DISABILITY LONG-TERM DISABILITY DENTAL TERM LIFE VISION VOLUNTARY

Transcription

1 YOUR OPTIONS SHORT-TERM DISABILITY LONG-TERM DISABILITY DENTAL TERM LIFE VISION VOLUNTARY

2 Rapid Pay Income Replacement SM (Short-term Disability) S AT A GLANCE GROUP SIZE PARTICIPATION WAITING PERIODS DURATION PERCENTAGE ISSUE STANDARD S 2-9 with other coverage 10+ for stand-alone 2-50 Lives: must work a minimum of 30 hours per week 51+ Lives: must work a minimum of 80 hours per month Non-contributory plans: 100% Contributory plans: 2-9 Lives: 100% 10+ Lives: 75% Accident 1, 8, 15, or 30 Days Sickness 8, 15, or 30 Days 13, 26 Weeks 52 Weeks (only available for 25+ Lives with 15- or 30-day waiting period) 50% or 60%, 66 2 /3% or 70% 50%, 60%, 66 2 /3%, or 70% $1000* Lives: $2,000* 25+ Lives: $2,500* $ Lives: $2, Lives: $2,500 Survivor Benefit Maternity Pre-ex Waived 1-year rate guarantee 2-year rate guarantee * Evidence of insurability is required for any amount over guarantee issue. RAPID PAY CLAIM PROCESS With Rapid Pay, benefit payments are triggered by input from your clients and their employees. Even when information from the physician takes weeks to receive, the claimant receives a decision on their claim in as little as 2 days after EPIC is notified. OPTIONAL S PARTIAL DISABILITY Provides a financial incentive for an employee to return to work part-time. FIRST DAY HOSPITAL If an employee is hospitalized on the date of disability, the waiting period will be waived and benefit payments will begin immediately. W-2 PROCESSING EPIC provides three optional FICA services to simplify the administration of disability policies and help your client comply with government reporting requirements. Standard reporting W-2 service W-2 and employer FICA service INTEGRATION WITH OTHER INCOME S Benefits will be reduced by other income sources your client receives or is eligible to receive. The Short-term disability department has been very helpful to our employees. Great customer care. MIDWEST SCHOOL DISTRICT RAPID PAY INCOME REPLACEMENT SM (SHORT-TERM DISABILITY)

3 Long-term Disability S AT A GLANCE FUNDING: WHO PAYS THE PREMIUM? GROUP SIZE PERCENT PARTICIPATION DURATION ELIMINATION PERIOD ISSUE AMOUNTS FEATURES INCLUDED Employer pays 100%, or Employer and employee share cost Groups of 2-9 with other coverage Groups of 10+ on a stand-alone basis $100 per month $6,000 per month $10,000 per month 60% 40%, 50%, 60%, or 66 2 /3% 2-24 Lives: must work a minimum of 30 hours per week 25+ Lives: must work a minimum of 80 hours per month Non-contributory plans: 100% Contributory plans: 2-5 Lives: 100% 6-9 Lives: 1 employee may waive 10+ Lives: 75% 5 years or maximum benefit duration to retirement 2 years, 5 years, or maximum benefit duration to retirement 90 or 180 days 90, 120, 150, 180, 270, or 365 days 2-3 Lives: Requires evidence of insurability 4-9 Lives: $3,000 $10,000 Survivor Benefit Residual Disability Assistance Program Initial 2-year rate guarantee INTEGRATION WITH OTHER INCOME S FAMILY INTEGRATION The long-term disability (LTD) benefit is reduced by the amount of benefits the employee and his/her family receives from other qualified sources as the result of the disability. PRIMARY INTEGRATION Available to groups of 10+ employees, the LTD benefit for this option is reduced solely by the amount of benefits the disabled employee receives from Social Security and other sources, without taking the family s benefits into account. OTHER S THAT WILL REDUCE PAYMENTS: Primary and family Social Security benefits. Workers compensation and similar benefits. Disability benefits from any other group insurance plan or any compulsory benefit law. Benefits from your client s retirement plan. S THAT WILL NOT REDUCE PAYMENTS: No-fault automobile insurance benefits. Individual disability income policies. The portion of retirement benefit attributable to employee contributions. Retirement benefits from another client. Military disability benefits. Our Sales Rep is very helpful. She makes my job easier with minimal paperwork for group administration. PRINTER REPAIR SERVICE LONG-TERM DISABILITY

4 Dental PREVENTIVE SERVICES Routine oral exams Cleaning and polishing Topical fluoride treatment for dependents X-rays Emergency care to relieve pain Sealants for dependents BASIC SERVICES Lab tests and diagnostic exams Oral surgery Anesthesia Routine/surgical extractions Therapeutic injections Restorations Alveolectomy Stainless steel crowns S AT A GLANCE TRADITIONAL PLAN BASE PLAN BUY-UP PLAN Plan Designs Traditional Dental Plan You can offer your employees the Base Plan as a stand-alone product, or with the optional Buy-up Plan Funding Who pays the premium? Benefit Designs Available Calendar-year Deductible Options Basic and Major COINSURANCE Employer must pay at least 50% of the premium Preventive, Basic, Major, and Orthodontia Services Employer must pay at least 50% of the premium Preventive and Basic Services pays 100% of the premium Major and Orthodontia Services $25, $50, $75, $100 $25, $50, $75, $100 Same as Base deductible Preventive Services 100%, 80% 100%, 80% N/A Basic Services 80% (Group Size 10+)* 50% (Group Size 2+)* 80%, 50% N/A Major Services 50% N/A 50% Orthodontia Services 50% (Group Size 10+)* N/A 50% Endodontics & Periodontics Services (Group Size 2+)* Major (Group Size 10+)* Basic N/A Covered in Major Services Space maintainers for dependents Denture and bridge repair MAJOR SERVICES Inlays, onlays Crowns, other than stainless steel Periodontics Endodontics Prosthetics, including bridges and dentures ORTHODONTIA SERVICES Orthodontic services Calendar-year Maximum Options Preventive, Basic, and Major Services Orthodontia Lifetime Maximum WAITING PERIODS $1,000 (Group Size 2-9) $1,000 $1,500 (Group Size 10+)* $2,000 $1,000 $1,500 (Group Size 10+)* $2,000 $500 (Group Size 2-9) $500 $750 (Group Size 10+)* $1,000 2 Times the Base maximum for Base and Buy-up combined N/A $1,000 $1,500 (Group Size 10+)* $2,000 Type I - Preventive 0 Months 0 Months N/A Type II - Basic 0 Months 3 Months N/A Type III - Major 12 Months N/A 12 Months Type IV - Orthodontia 24 Months N/A 24 Months These waiting periods apply to new groups without prior coverage. Minimum Group Size Stand-alone 10 Lives 10 Lives With other EPIC coverage 2 Lives 10 Lives * Group Size + Groups with that size or greater, of eligible employees, have the option to choose the indicated benefit. Eligible employees who elect to waive coverage are included in the Group Size. Example: 100+ groups would have all choices indicated Minimum Participation Eligibility Non-contributory plans: 100% of total eligible employees regardless of spouse s coverage Contributory plans: 2 to 9 Lives - 100% of eligible employees 10+ Lives - 75% of eligible employees 2-24 Lives: must work a minimum of 30 hours per week 25+ Lives: must work a minimum of 80 hours per month Eligible Lives, greater of 10 Lives or 50% Eligible Lives, greater of 10 Lives or 40% Eligible Lives, 35% of Eligible employees Eligible lives, 25% of Eligible employees 500+ Eligible Lives, 20% of Eligible employees Lives: must work a minimum of 30 hours per week 25+ Lives: must work a minimum of 80 hours per month DENTAL

5 Term Life TERM LIFE Provides an easy way for your client to offer additional coverage and the individual can choose the amount. For other options available, speak with your sales representative. VOLUME 2-25 LIVES TERM LIFE $100,000 Base + Supplemental: $100,000 $100,000 S AT A GLANCE For all coverages, your client must be actively at work on the effective date, or the effective date of coverage will be deferred until the individual returns to work. BASE LIFE FUNDING Employer pays 100%, or Employer and employee share cost SUPPLEMENTAL LIFE pays 100% LIVES $175,000 $175,000 $175, LIVES $200,000 $200,000 $200,000 COVERAGE REQUIREMENTS Purchased with EPIC Base Term Life 100+ LIVES $500,000 $500,000 $500,000 GROUP SIZE 2-9 with other EPIC coverage 10+ on a stand-alone basis 2+ with EPIC Base Term Life GROUP TERM LIFE FLAT SCHEDULED PLAN ANNUAL EARNINGS AMOUNT VOLUME $15,000 per covered employee $10,000 per covered employee Each employee is covered by the same amount of term life insurance. Benefit levels are determined by categories, such as occupation or length of service. Benefit levels are based upon a multiple of the employee s salary Lives: must work a minimum of 30 hours per week 51+ Lives: must work a minimum of 80 hours per month DEPENDENT TERM LIFE This coverage extends your client s benefit package to include coverage for eligible spouses and dependent children. s are able to convert to an individual life insurance policy without health underwriting, if the client applies within 31 days from the date their Dependent Term Life insurance ends. EMPLOYER CHOOSES ONE LEVEL SPOUSE $2,000 $5,000 $7,500 $10,000 $15,000 $25,000 EACH CHILD $1,000 $2,000 $3,000 $4,000 $6,000 $10,000 PARTICIPATION Non-contributory plans: 100% Contributory plans: 2-9 Lives: 100% 10+ Lives: 75% OPTIONS Employer Chooses: Flat benefit Scheduled plan Multiple of earnings Subject to maximum volume amounts ISSUE Based on group size, volume, and participation ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) OPTIONS Employer can add AD&D up to 2 times the Base Life amount Contributory plans: 2-9 Lives: 2 Lives or 50%, whichever is greater 10+ Lives: 5 Lives or 15%, whichever is greater Chooses: $10,000 minimum, and $5,000 increments thereafter Multiple of earnings Subject to maximum volume amounts AD&D is available up to 2 times the Supplemental Life amount FEATURES INCLUDED Waiver of Premium Living Benefit Conversion Initial 1-year rate guarantee Initial 2-year rate guarantee Everyone I contact at EPIC is courteous and I enjoy working with them. METAL FABRICATOR TAX S The cost of group Term Life insurance is a tax-exempt benefit up to $50,000 under IRC Title 26, Section 79. For your clients, the premium they pay is a tax-deductible business expense up to $50,000 for federal income tax purposes, in accordance with IRS Section 264. Your clients can consult with their tax advisor for details regarding state and federal tax laws. TERM LIFE

6 Vision BASIC PLAN This plan allows your client and their employees to visit any licensed vision care provider they choose. It also provides complimentary access to the Affinity Program. The employee must pay for service and then submit the claim. S EPIC PAYS Eye Examination Every 12 months, $40 or $60 Frames Every 24 months, $70 or $100 Spectacle Lenses Single Bifocal Trifocal Single Lenticular Bifocal and Trifocal Lenticular (includes blended) Contact Lenses In lieu of eyeglasses Includes disposable Value Added Feature Complimentary access to the Affinity Program Benefits Eye Examination Every 12 months $60 $90 $100 $130 $150 Every 12 months, $80 or $100 Included WELLNESS PLAN 1 AFFINITY PROGRAM 2 Every 12 months, covered in full 3 Member Cost 15% off 4 provider s Usual & Customary charges Frames 5 $40, plus 10% off 4 cost over $70 Spectacle Lenses (uncoated plastic) 5 Single, bifocal, trifocal, lenticular $35, $55, $65, $110 BRIGHT EYES PLAN VALUE PLAN Benefits Eye Examination Lenses (Spectacle or Contact) Frames: Davis Vision Frame Collection Fashion Designer Premier Non-collection Lens Upgrades All ranges of prescriptions and sizes Plastic or glass Scratch-resistant coating ultraviolet coating Fashion, sun, gradient, or solid tint Polycarbonate Anti-reflective coating (Standard Premium Ultra) Progressive (Standard Premium) 3 Photochromic glass plastic photosensitive High-index 4 Blended (invisible) Intermediate vision Polarized Scratch protection plan Contact Lenses Elective Collection Non-collection BRIGHT EYES PLAN VALUE PLAN In-Network Every 12 months, $0 $10 Copay Every 12 months, $25 Copay Every 12 months $0 copay $0 copay $25 copay $130 allowance, plus 20% discount 1 over allowance Every 24 months $0 copay $20 copay $40 copay $100 allowance, plus 20% discount 1 over allowance Included Included Included Included Included Included Included $12 copay Included $15 copay Included $15 copay $0 2 $30 copay for Adults $0 2 $35 copay for Adults $35 $48 $60 copay $50 $90 copay $20 $65 copay $55 copay $40 $55 $69 copay $65 $105 copay $20 $70 copay $60 copay $20 copay $30 copay $75 copay $20 copay single $40 copay multifocal Includes daily wear, planned replacement, and disposable $130 allowance, plus 15% discount 1 over allowance Not Applicable $100 allowance, plus 15% discount 1 over allowance 5 Lens Options (add lens prices above) 5 Glass Tinting of plastic lenses (solid gradient) Scratch-resistant coating ultraviolet coating Standard anti-reflective coating Polycarbonate Progressive (standard premium) Photochromic glass plastic photosensitive High-index Blended (invisible) Intermediate vision Polarized Contact Lenses (in lieu of eyeglasses) 4 Evaluation Conventional contacts Disposable/planned replacement contacts Value Added Features Laser Vision Discount Network Replacement Contact Lens Program 1 Wellness Plan is not available in Ohio. 2 Affinity Program is not available at Shopko. 3 $30 out-of-network exam benefit in Illinois. $18 $10 $12 $20 $15 $45 $30 $75 $125 $35 $65 $55 $20 $30 $75 15% off provider s Usual & Customary charges 20% off provider s Usual & Customary charges 10% off provider s Usual & Customary charges Up to 25% off provider s Usual & Customary charges or 5% off advertised specials, whichever is lower Mail order program - free membership 4 Members receive Walmart s everyday low price on eye examination, frame, and contact lens purchases. 5 Special lens designs, materials, powers, and frames may require additional cost. Medically Necessary (with prior approval) Laser Vision Correction (in lieu of normal materials benefit for three years following surgery) Value-Added Features Laser Vision Discount Network Low vision benefit Replacement contact lens program (Lens 123! ) 1 Members receive full allowance towards everyday low prices at Walmart and Sam s Club. Additional discounts do not apply. 2 For dependent children, monocular patients, and patients with prescriptions of 6.00 diopters or greater. 3 Does not apply to all forms of progressive lenses. 4 Does not apply to all forms of high-index lenses. 5 Value Plan allowance applies to all contact lenses. Included $250 lifetime benefit per eye OUT-OF-NETWORK REIMBURSEMENT SCHEDULE Eye Examination: up to $30 Frame up to $30 Spectacles Lenses (per pair) up to: Single Vision $25, Bifocal $35, Trifocal $45, Lenticular $60, Contacts: Elective up to $75, Medically Necessary up to $225 Included Not covered Up to 25% off provider s usual & customary charges or 5% off advertised specials, whichever is lower. Included Mail order program - free membership VOLUNTARY VISION PLANS GROUP SIZE 2+ LIVES S Low out-of-pocket costs Multiple levels of coverage, including fully covered exams and eyewear Multi-year rate guarantee Flexibility to choose rates, copay, and plan coverage levels Laser vision correction benefit and discounts No restrictions on eyewear selection No-cost breakage warranty No-cost replacement contact lens program VALUE PLAN Affordable Plan Options Multiple plan design options Exam copays Frame frequency VISION PLUS PLAN paid, or Combination of employer/employee paid VISION

7 Voluntary EPIC S 4-STEP ENROLLMENT PROCESS 1. Present and sell voluntary benefits to your client using our simplified voluntary marketing materials. 2. Employer, Agent and EPIC agree upon a flexible and personalized marketing plan designed to increase enrollment. 3. EPIC facilitates group meetings with your client s employees to encourage enrollment. 4. Your client goes through the online enrollment process seamlessly. VOLUNTARY PRODUCTS AVAILABLE TERM LIFE LONG-TERM DISABILITY SHORT-TERM DISABILITY DENTAL VISION TERM LIFE FUNDING GROUP SIZE VOLUME VOLUME LIVES LIVES LIVES 100+ LIVES PARTICIPATION OPTIONS AD&D OPTIONS AGE REDUCTION S INCLUDED pays 100% 10+ $10,000 per covered EE $100,000 $175,000 $200,000 $500, lives: 30 hrs/wk; 51+ lives: 80 hrs/mo lives: 10 lives min; lives: greater of 10 lives or 25%; 51+ lives: 20% min $10,000 to $500,000 in $5,000 increments up to 5x salary AD&D available equal to the Voluntary Life amount Coverage reduced by 35% at age 65 and by 50% at age 70 Waiver of Premium; Living Benefit 2-years LONG-TERM DISABILITY FUNDING GROUP SIZE PERCENTAGE PARTICIPATION DURATION ELIMINATION PERIOD ISSUE AMOUNTS OPTIONS pays 100% 10+ $10,000 per month 50% or 60% lives: 30 hrs/wk; 25+ lives: 80 hrs/mo lives: the greater of 10 lives or 50%; lives: the greater of 10 lives or 25%; 100+ lives: 25% 2 years, 5 years, or Social Security Normal Retirement Age (SSNRA) 90, 120, 150, 180, 270, or 365 days $10,000 Survivor Benefit; Residual Disability; Maternity 2-years

8 RIDE THE WAVE PROGRAM SHORT-TERM DISABILITY EPIC will waive Voluntary participation requirements when 80% of your eligible employees make a coverage election. PROGRAM DETAILS Applies to all EPIC Voluntary products Term Life Insurance, Rapid Pay Income Replacement (Short-term Disability), Long-term Disability, Dental, Vision. FUNDING pays 100% GROUP SIZE lives: 30 hrs/wk; 51+ lives: 80 hrs/mo WAITING PERIODS Accident: 1, 8, 15, or 30 days; Sickness: 8, 15, 0r 30 days DURATION 13 or 26 weeks PERCENTAGE ISSUE STANDARD S 50 & 60% $2,000 $1,000 Survivor Benefit; Maternity 2 years For groups of more than 25 employees: new and existing. Agent, group, and EPIC must agree to a marketing/enrollment plan that results in 80% election (accept or decline), after participating in designated education method. EPIC will provide marketing tools and a flexible enrollment process, customized for each employer. The program is simple just contact your local EPIC representative to get started on your Voluntary marketing plan. Conditions and limitations may apply. If marketing plan is not met, standard Voluntary participation rules apply. Available in all EPIC marketing states, except IL and TX (awaiting reinsurer approvals). DENTAL FUNDING pays 100% DESIGNS AVAILABLE Preventive, Basic, Major, and Orthodontia CALENDAR-YEAR DEDUCTIBLE OPTIONS $25, $50, $75, and $100 COINSURANCE - PREVENTIVE 80% or 100% COINSURANCE - BASIC 50% or 80% COINSURANCE - MAJOR 50% COINSURANCE - ORTHODONTIA 50% COINSURANCE - ENDODONTICS & PERIODONTICS CALENDAR-YEAR OPTIONS: PREVENTIVE, BASIC, AND MAJOR Covered in Major Group size 10+: $1,000; Group size 26+: $1,500; Group size 100+: $2,000 ORTHODONTIA LIFETIME Group size 10+: $1,000; Group size 26+: $1,500; Group size 100+: $2,000 WAITING PERIODS GROUP SIZE Preventive - 0 Months; Basic - 3 Months; Major - 12 Months; Orthodontia - 24 Months 10 Lives PARTICIPATION Lives: the greater of 10 Lives or 50%; Lives: the greater of 10 Lives or 40%; 51 to 99 Lives, 35%; 100 to 499 Lives, 25%; 500+ Lives: 20% Lives: work 30 hrs/wk; 25+ Lives: work 80 hrs/mo VOLUNTARY