2025 E MPLOYEE BENEFITS GUIDE
WELCOME TO YOUR BENEFIT ENROLLMENT GUIDE 2025 PLAN YEAR
Please note: This benefit guide contains the basic information about your benefits program. It does not cover every detail; but it does provide a general description of each benefit plan. Every effort has been made to ensure that the information is accurate. However, this guide is not an insurance policy. If there is any question as to coverage, benefit eligibility, or interpretation, the insurance contract and the Certificate of Coverage you receive from the insurance carrier will govern the administration of your benefits. If you would like additional or specific information, please contact the Human Resources Department. Spring Harbor is proud to offer you a comprehensive benefits package for the upcoming plan year. This enrollment guide will assist you in determining the coverage levels that will provide you and your family with the protection that gives you peace of mind. This guide explains each type of coverage, and provides examples to help you determine your benefit and payroll deduction amounts. We encourage you to take the time to review the enrollment guide prior to enrollment. Keep in mind that you have until Friday, June 20 th to select your benefits. The benefits you select during this enrollment will be effective July 1 st , 2025 and will continue through June 30 th 2026.
ADDITIONAL INFORMATION
WHO IS AN ELIGIBLE DEPENDENT? You can enroll the following dependents in our group benefit plans: • Your legal spouse • Your natural, adopted, or stepchildren living with you, or any other children whom you have legal guardianship, up to age 26 • Unmarried children of any age if disabled and claimed as a dependent on your federal income taxes ELIGIBILITY: As a Spring Harbor employee, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package beginning the 1st of the month following 30 days of full-time employment.
WHEN YOU CAN ENROLL IN BENEFITS:
• During your initial new hire eligibility period • During the annual Open Enrollment period for a July 1st effective date
If you fail to enroll within the time frame given for the new hire eligibility or annual enrollment window, you will not be able to elect benefits again until the next Open Enrollment period, and you will not have coverage, unless you experience a qualified life event. Please make your elections on time, or you may experience a delay in using your benefits.
QUALIFYING LIFE EVENTS are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage. Qualifying Life events include: • Marriage, divorce, or legal separation • Death of spouse or other dependent • Birth or adoption of a child • You or your spouse experience a work event that effects your benefits • A dependent’s eligibility status changes due to age, student status, marital status, or employment • Relocation into or outside of your plan’s service area You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.
HOW TO ENROLL
Step 1: Creating your Employee Navigator Account
Welcome Email:
• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice
• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [spring22] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:
Step 2: Complete HR Tasks
• Once your account is set up, you will be taken to your employee homepage.
• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.
• The first few tasks require you to put in demographic information and e-sign for online acknowledgment.
T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”
Step 3: Benefit Elections
• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.
4 | Spring Harbor 2025 Benefits Guide
Step 4: Forms
• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.
Step 5: Review & Confirm Elections
• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.
T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED! Step 6: HR Tasks (if applicable) • To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!
5 Spring Harbor 2025 Benefits Guide |
NETWORK:
MEDICAL COVERAGE
Insurance Carrier:
Angle Health Medical Insurance: Cigna PPO Network
Medical Plan:
Base Plan
Buy-Up Plan
HDHP w/ HSA
In-Network: Primary Care Visits
$25 Copay
$25 Copay
Deductible; then 0% Coinsurance
Specialist Care Visits
$75 Copay
$75 Copay
Deductible; then 0% Coinsurance
Urgent Care
$85 Copay
$85 Copay
Deductible; then 0% Coinsurance
Emergency Room Care
Deductible; then $300 Copay
Deductible; then $300 Copay Deductible; then 0% Coinsurance
Preventative Visit Copay
$0
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
$25 Copay
$25 Copay
Deductible; then 0% Coinsurance
Advanced Imaging
Deductible; then 0% Coinsurance Deductible; then 0% Coinsurance Deductible; then 0% Coinsurance
Plan Coinsurance
100%
80%
100%
Employee Deductible
$7,000
$5,000
$7,000
Family Deductible
$14,000
$10,000
$14,000
Employee Out-of-Pocket Max
$9,000 (includes deductible)
$7,000 (includes deductible)
$7,000 (includes deductible)
Family Out-of-Pocket Max
$18,000 (includes deductible)
$14,000 (includes deductible)
$14,000 (includes deductible)
Inpatient Hospital
Deductible; then 0% Coinsurance Deductible; then 20% Coinsurance Deductible; then 0% Coinsurance
Outpatient Hospital or Facility Deductible; then 0% Coinsurance Deductible; then 20% Coinsurance Deductible; then 0% Coinsurance Out-of-Network Plan Coinsurance 50% 50% 50% Employee Deductible $14,000 $10,000 $14,000 Family Deductible $28,000 $20,000 $28,000 Employee Out-of-Pocket Max $18,000 $14,000 $14,000 Family Out-of-Pocket Max $36,000 $28,000 $28,000 Prescription Drugs 30-day supply Tier 1 - Generic $20 $20 Deductible; then 0% Coinsurance Tier 2 - Preferred $60 $60 Deductible; then 0% Coinsurance Tier 3 - Non-Preferred $85 $85 Deductible; then 0% Coinsurance Tier 4 - Specialty Deductible; then 20% Coinsurance Deductible; then 20% Coinsurance Deductible; then 0% Coinsurance Employee Bi-Weekly Deduction Employee Only $87.92 $110.81 $60.41 Employee + Spouse $383.12 $444.00 $409.02 Employee + Child(ren) $330.80 $368.04 $379.54 Family $620.92 $656.11 $594.19
6 | Spring Harbor 2025 Benefits Guide
Hello!
The Angle Experience
Re-imagining The Health Insurance Experience Meet your new health plan! At Angle, we’re building a modern health insurance company to bring quality, tech-enabled health plans to our members. Healthcare is complex, but we’re here to make it easy, affordable, and convenient. This guide provides information about your medical plan benefits and services offered through Angle Health. Born out of frustration from the personal healthcare experiences of our team, we founded Angle Health to bring a truly technology-enabled solution to health insurance. One where members don't have to spend hours navigating the complex maze of health systems and aren’t left to "figure out" their health insurance in order to access the right care.
The App Our fully digital platform delivers a personalized member experience that centers around ease of use, personalization, and better access to care.
Our Vision Bring transparency, simplicity, and humanity to healthcare so that people can live their best lives.
7 Spring Harbor 2025 Benefits Guide |
The Angle Care Team Angle Health does the heavy lifting so you don’t have to. Members have access to resources and real-time chat with Angle Health’s care team; a dedicated cadre of healthcare professionals to guide members through the entire care journey. Our care team helps you navigate the complex health care system with convenient and friendly human support so you don’t have to.
Member Services • Personalized service with a focus on making wellness easy. • Expert counseling in navigating the ins and outs of our convoluted health system. • Single touchpoint solutions with an actual human on the other end. • 1:1 support available via chat, email, & phone • Dedicated team members available to field questions and connect you with experts to provide clinical guidance through your wellness journey.
8 | Spring Harbor 2025 Benefits Guide
Make The Most Of Your PPO Plan. PPO is a type of health plan that contracts with medical providers such as hospitals and doctors to create a network of participating providers.
Defining a Network – Who are my providers?
Providers in our network include doctors, hospitals, pharmacies- anywhere you receive care. When it comes to defining physicians there are two types you should be familiar with: • Primary Care Physician (PCP): Your general doctor for basic needs • Specialist Care Physician (SCP): Your doctor who specializes in certain types of care (knees, eyes, etc.) Providers who have contracted with the plan are “in-network” and providers who have not contracted with the plan are “out-of- network.” You are not required to choose a Primary Care Physician. You have a complete choice of providers within your network.
Referrals to specialty providers are not required
Increased flexibility
• Angle’s PPO does not require the use of in- network providers, however, visiting an out- of-network provider generally will result in additional cost sharing for you. • Providers who are in-network can be used with generally lower cost sharing for you. • PPO networks allow you to have the most flexibility in accessing any providers as you see fit. You typically have access to many more doctors than an HMO (Health Maintenance Organization).
Finding or Changing your Provider
Not sure if your provider is in network? Check out the provider search tool: anglehealth.com/network-directories. As always, we encourage you to reach out to our Care Team if you are looking for a new provider or have any questions.
9 Spring Harbor 2025 Benefits Guide |
Accessing Care: Know Where To Go With so many options for health care services, it can be confusing to understand where you should go for care when you need it. There’s big differences between a visit to the emergency room and your primary care provider.
Routine Medical Care
Emergency Care
Urgent Care
Need immediate help? call 9-1-1 if you have an emergency or life- threatening situation. In an emergency, you should get care from the closest hospital that can help you.
Preventive Services Chronic Condition
Minor Illnesses & injuries that are not emergencies, but should be treated within 24 hours.
Management Vaccinations Overall Health Improvement
Behavioral Health
Virtual Visits through DoD
Local Urgent Care
In-Office Prim. Care
• General Inqiries • Health Education and Wellness • Chronic Condition Management
Check network status through the Angle App or by calling the Care Team
Angle Care Team
10 | Spring Harbor 2025 Benefits Guide
The Angle Health Mobile App With the Angle Health App, members have access to resources and real-time chat with Angle's care team in addition to many self-serve features right at your fingertips. Care Navigation Your dedicated member care team is always just a chat away. Members can conveniently access our friendly (human) support team through the app or web browser. Healthcare iscomplicated: whether you’re managing a complex condition, or just want some extra help navigating the system, ourteam is here to guide you through your care journey. Find Providers And Facilities Searching for doctors and facilities is easy From the home screen in your app or browser, simply click on "facilities" to see the map view of in-network facilities near your location. Click on the upper right filter to search for specific facilities. Virtual Care Angle is proud to partner with virtual healthcare provider, Doctor on Demand, to provide convenient and accessible healthcare options to our members. Doctor on Demand allows you to schedule an appointment with a provider in minutes directly from the app or member portal. See page 13 to learn more about Doctor on Demand services. *Most health plans offer $0 cost share for visits. Access Your Plan Information Forgot your physical ID card at home? Don't sweat it. You can access your digital ID card via the mobile app and share with your provider's office.Use our app for common health plan ques- tions, like deductible spend, insurance ID cards, how the plan pays for specific benefits, and much more!
App Store
Google Play
Spring Harbor 2025 Benefits Guide |
11
Preventive Care All health plans cover preventive care at 100%— that means no copay,coinsurance, or deductible.
Preventive care, lab work, examinations and counseling
Keeping Healthcare Costs Low 1. Stay Up to Date on your Preventive Care Check your Plan Documents to confirm what preventive care services are recommended and covered for you and your family 2. Get Care in the Right Place: Scheduling your appointments with a provider who in your plan’s network to reduce costs. 3. Regular Primary Care: Seeing a primary care provider regularly to stay ahead of health problems can help you be healthier and save on healthcare costs.
Annual physical exams Complete Blood Count (CBC), and screenings for colon, lung, prostate, and other cancers. Screenings are preventive for diabetes, cholesterol, glaucoma, hearing loss, chlamydia, Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV), hepatitis viruses B and C.
Procedures Preventive care procedures such as
mammograms, Pap tests, bone density/DEXA scans, and counseling for weight loss, smoking cessation, alcohol misuse, and more.
More Tools for Good Health
Recommended adult and child immunizations
1. Angle Health Member Portal : Log into your account at www.anglehealth.com/providers to search for a primary care provider. 2. Angle Health Care Team: Your dedicated member care team is always just a chat away to ease the burden of care coordination. 3. Doctor On Demand by Included Health offers Urgent Care visits and Behavioral Health visits using the convenience of telemedicine. You can schedule your telemedicine appointment with an urgent care provider or therapist seven (7) days a week, 24 hours a day.
Adult immunizations are covered from a tetanus shot to your annual flu shot. And your children’s annual wellchild exams and immunizations are also covered as preventive care.
Contraception and Breastfeeding Supplies & Support
Most contraceptives for women are covered by your pharmacy benefits as a preventive service. This may include generic oral medication, the patch, Intrauterine Devices (IUDs) and injections. *For services to be covered as preventive, your doctor must bill your claim with preventive codes. If your provider finds a condition that needs further testing or treatment, you’ll need to pay regular copays, coinsurance, or deductibles
12 | Spring Harbor 2025 Benefits Guide
Doctor On Demand
Angle and Doctor On Demand Angle is proud to support our members with convenient and accessible healthcare options. Access board certified physicians, psychiatrists, psychologists, and psychotherapists, anytime and anywhere with Doctor On Demand’s (DOD) Total Virtual Care. As an Angle Health plan member, you can access your favorite DOD provider right from your smartphone, tablet, or computer - directly from the Angle app or portal.
Doctor On Demand Services Available to Angle Members
Everyday and Urgent Care
Behavioral Health
• 24/7 behavioral health care - on demand or by appointment. • Psychiatry visits including medication management. • Therapy visits: psychologist or master level therapist.
• 24/7 medical care - on demand or by appointment. • New and refill prescription orders. • Lab test orders, results interpretation, consultation and escalation. • COVID-19 screening, assessment and testing referral.
What Doctor On Demand Practitioners Treat
Everyday and Urgent Care
Behavioral Health
• Anxiety and Depression • Stress • Postpartum Depression • Trauma and loss • Post Traumatic Stress Disorder • Behavioral Therapy • Social Anxiety • Insomnia
• Cold & Flu • Sinus infections • Bronchitis and Pneumonia • Urinary Tract Infections • Vomiting and Diarrhea • Conjunctivitis • Vaginal and Yeast Infections • Cellulitis and Skin Conditions • Women’s Health • Men’s Health • Labs & Screenings
• Allergies • Asthma • High Cholesterol • High Blood Pressure • Weight Management How Do I Access Doctor On Demand? Angle and Doctor On Demand have partnered to create a single sign on experience. • Sign on directly through the Angle website or app to access Doctor on Demand. • Seamless login process using the same email and password. Telemedicine services from designated providers are covered in full; all others are covered at their respective Office Visit levels. * After 1/1/2023, telemedicine must be $0.00 after deductible for HSA-eligible plans.
Spring Harbor 2025 Benefits Guide |
13
The Angle Experience
QUESTIONS? WE’RE HERE FOR YOU
Download the Angle App to chat with our Care Team, or reach out by phone Mondays – Fridays, 8am – 6pm (MST) Phone: +1 (855) 937-1855
App Store
Google Play
Please refer to your Angle Health Onboarding Email for your log-in credentials. If you have any questions please don’t hesitate to reach out to a member of our Care Team.
Thank You!
14 | Spring Harbor 2025 Benefits Guide
HEALTH SAVINGS ACCOUNT (HSA)
When you enroll in a High Deductible Health Plan (HDHP), you are eligible to open a Health Savings Account (HSA) through Health Equity. This account lets you put pre-tax money aside for qualified health care expenses. Because your contributions are deducted pre-tax, you can save up to an estimated 25% on out-of- pocket costs. To participate in an HSA, you must meet the following requirements: • Be enrolled in a qualified HDHP • Not be covered by any other non-HSA qualified health plan • Not be enrolled in Medicare • Not eligible to be claimed as a dependent on someone else’s taxes • Not enrolled in a standard Health care FSA while actively contributing to your HSA
2025 IRS Calendar Year Contribution Limit
The Internal Revenue Service (IRS) sets the annual contribution levels for HSAs. It is your responsibility to monitor the amounts deposited not to exceed the maximum limit, keeping in mind that any funds contributed by Spring Harbor also count towards the maximum amount.
2025 $4,300 $8,550 $1,000
If you cover just yourself on the plan:
If you cover yourself and a spouse or dependents:
Age 55+ Catch-Up:
HOW DOES IT WORK? You determine the amount you wish to be deducted from each paycheck. The funds are automatically deposited into your account. Unused funds carry over from year to year and can build over time. HSAs are portable; if you leave Spring Harbor you can take the account and all the funds in it. WHAT CAN YOU USE YOUR HSA FUNDS ON? Use your HSA funds to pay for health care items such as copays, prescriptions, home care, medical supplies and equipment, and other out-of-pocket expenses your insurance may not cover. You may also use these funds for dental and vision expenses, counseling, chiropractic care, physical therapy, certain OTC medications, and more. Visit irs.gov/forms-pubs/about-publication-502 to see a complete list of IRS- qualified expenses.
Spring Harbor 2025 Benefits Guide |
15
HEALTH REIMBURSEMENT ARRANGEMENT
The Health Reimbursement Arrangement (HRA) is a plan owned and funded by Spring Harbor that you can use to pay for eligible health care expenses for you and your family.
Spring Harbor Health Reimbursement Arrangement (HRA) Illustration
Employee Only Illustration
Plan Arrangement
Base
Buy-Up
Employee pays first
$3,500 $2,500
Spring Harbor pays next to equal plan deductible
$3,500 $2,500
Coinsurance now pays at 100% (except for copays of any type)
$7,000 $5,000
Employee is liable for this amount in copays to equal out-of-pocket max $2,000 $2,000
Employee out-of-pocket maximum equals
$5,500 $4,500
Employee + Dependent(s) Illustration
Plan Arrangement
Base
Buy-Up
Employee pays first
$7,000 $5,000
Spring Harbor pays next to equal plan deductible
$7,000 $5,000
Coinsurance now pays at 100% (except for copays of any type)
$14,000 $10,000
Employee is liable for this amount in copays to equal out-of-pocket max $4,000 $4,000
Employee out-of-pocket maximum equals
$11,000 $9,000
16 | Spring Harbor 2025 Benefits Guide
FLEXIBLE SPENDING ACCOUNT (FSA) With an FSA, you elect to have your annual contribution deducted from your paycheck each pay period in equal installments throughout the policy year. The amount of your pay that goes into an FSA will not count as taxable income, so you will have immediate tax savings. FSA dollars can be used during the plan year to pay for qualified expenses and services for yourself and any immediate dependents in your family.
2025 IRS Contribution Limit
Medical FSA - $3,300* Carry over $660 of unused funds Dependent Care FSA - $5,000 • Married Filing Separately - $2,500 • Single or Married Filing Jointly - $5,000
Obtain a complete list of eligible and ineligible expenses for FSAs by accessing www.irs.gov. Under “Search Forms and Publications,” enter “502” for the health care plan and “503” for the dependent care plan.
Accounts Offered Health Care FSA - medical, dental, vision and pharmacy expenses Dependent Care FSA - care for your child, disabled spouse, or other dependent who is physically or mentally incapable of self-care. Medical expenses for your dependent are not eligible for reimbursement under the Dependent Care FSA. Is an FSA right for you? An FSA is a great way to pay for expenses with pre-tax dollars. A Health Care FSA could save you money if you or your dependents: • Have out-of-pocket expenses like copays, coinsurance, or deductibles for health, prescription, dental or vision plans • Have a health condition that requires the purchase of prescription medications on an ongoing basis • Wear glasses or contact lenses or are planning LASIK surgery • Need orthodontia care, such as braces, or have dental expenses not covered by your insurance
Spring Harbor 2025 Benefits Guide |
17
DENTAL BENEFITS
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower.
Keeping your teeth and gums clean and healthy will prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.
Your dental plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Dental Insurance
PPO Dental Plan You pay:
Plan Type:
Calendar Year Deductible
$50 Individual / $150 Family
Calendar Year Maximum
$1,500
Preventive Services
100%
Basic Services
80%
Major Services
50%
Orthodontia (dependent children only)
$1,500
Out-of-Network Reimbursement
90th Usual & Customary
Employee Bi-Weekly Deduction
Employee Only
$14.35
Employee + Spouse
$27.49
Employee + Child(ren)
$33.98
Family
$50.76
18 | Spring Harbor 2025 Benefits Guide
VISION BENEFITS
You can help protect your eyesight by visiting an eye doctor regularly. Taking care of your eyes today can lead to a better quality of life later.
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.
Your vision plan is through MetLife and offers “in and out-of-network” benefits.
Insurance Carrier:
MetLife Vision Insurance
In-Network You pay:
Out-of-Network You are reimbursed:
Eye Exam every 12 months
$10 Copay
Up to $45
Lenses every 12 months • Single Vision
$25 Copay $25 Copay $25 Copay $25 Copay
Up to $30 Up to $50 Up to $65 Up to $100
• Bifocal • Trifocal • Lenticular
$130 Allowance; then 20% off balance **
Frames every 24 months
Up to $70
Up to $105 Medically Necessary: Up to $210
Contacts every 12 months
$130 Allowance
Employee Bi-Weekly Deduction
Employee Only
$2.78 $5.57 $4.71 $7.77
Employee + Spouse
Employee + Child(ren)
Family
*Contacts benefit is in lieu of eyeglass frames and lens benefit. ** $70 Allowance at Costco, Walmart and Sam’s Club.
Spring Harbor 2025 Benefits Guide |
19
BASIC LIFE AND AD&D INSURANCE COVERAGE
Spring Harbor provides all Full Time employees with Basic Life and Accidental Death & Dismemberment at no cost to you.
MetLife Basic Life w/AD&D Insurance
Eligibility Requirement Life Insurance Benefit
All Full Time Employees
1.5x Annual Earnings to a max of $150,000
Guarantee Issue
Yes
Accidental Death & Dismemberment Benefit (AD&D)
Same as Basic Life Amount
VOLUNTARY TERM LIFE INSURANCE COVERAGE
As a supplemental benefit, Spring Harbor allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through MetLife. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.
MetLife Voluntary Life w/AD&D Insurance
Eligibility Requirement
All Full Time Employees
Employee Benefit Amounts Employee
5x Annual Earnings to $500k in increments of $10k 50% of Employee to $100k in increments of $5k
Spouse
Child(ren)
Flat $10k
Guarantee Issue Employee
$150k
Spouse
$25k $10k
Child(ren)
20 | Spring Harbor 2025 Benefits Guide
DISABILITY INSURANCE
The goal of Spring Harbor’s Disability Insurance Plan is to provide you with income replacement should you be unable to work due to a non-work-related illness or injury. The company provides employees with the option to purchase voluntary Short-Term Disability income benefits. Long-Term Disability is provided to you by the company. Both the Short-Term and Long-Term Disability coverages are offered through MetLife. Rates will be automatically calculated and shown in Employee Navigator during the enrollment process.
MetLife Short-Term Disability Insurance
Plan Type:
Voluntary
Eligibility Requirement Benefit Percentage Maximum Weekly Benefit Guaranteed Issue Amount Accident Elimination Period Sickness Elimination Period
All Active Employees 60% of Weekly Earnings
$1,000 $1,000 0 Days 7 Days
3 Month Pre-Existing / 12 Month Waiting Period
Pre-Existing Condition Limitation
Benefit Duration
26 Weeks
MetLife Long-Term Disability Insurance
Plan Type:
Employer Paid
Eligibility Requirement Benefit Percentage Maximum Monthly Benefit Guaranteed Issue Amount
All Active Employees
60%
$5,000 $5,000
Elimination Period
180 Days 2 Years Included 24 Months 24 Months
Own Occupation Coverage Partial Disability Benefit Mental & Nervous Limitation Drug & Alcohol Limitation Pre-Existing Condition Limitation
3 Month Pre-Existing / 12 Month Waiting Period
SSNRA
Benefit Duration
Spring Harbor 2025 Benefits Guide |
21
AFLAC CRITICAL ILLNESS
For more than 60 years, Aflac has been dedicated to helping provide individuals and families peace of mind and financial security when they’ve needed it most. The Aflac Group Critical Illness plan is just another innovative way to help make sure you’re well protected.
Here’s why the Aflac Group Critical Illness plan may be right for you.
But it doesn’t stop there. Having group critical illness insurance from Aflac means that you may have added financial resources to help with medical costs or ongoing living expenses.
The Aflac Group Critical Illness plan benefits include: • Critical Illness Benefit payable for: – Cancer – Heart Attack (Myocardial Infarction) – Stroke – Kidney Failure (End-Stage Renal Failure) – Major Organ Transplant – Bone Marrow Transplant (Stem Cell Transplant) – Sudden Cardiac Arrest – Coronary Artery Bypass Surgery – Non-Invasive Cancer – Skin Cancer • Health Screening Benefit
Features: • Benefits are paid directly to you, unless otherwise assigned. • Coverage is available for you, your spouse, and dependent children. • Coverage may be continued (with certain stipulations). That means you can take it with you if you change jobs or retire.
How it works
Aflac Group Critical Illness pays an Initial Diagnosis Benefit of $10,000
A physician determines that you have suffered a heart attack.
Aflac Group Critical Illness coverage is selected.
You experience chest pains and numbness in the left arm.
You visit the emergency room.
Amount payable based on $10,000 Initial Diagnosis Benefit.
For more information, ask your insurance agent/producer, call 1.800.433.3036, or visit aflacgroupinsurance.com.
22 | Spring Harbor 2025 Benefits Guide
Benefits Overview
AFLAC CRITICAL ILLNESS
COVERED CRITICAL ILLNESSES:
CANCER (Internal or Invasive)
100%
HEART ATTACK (Myocardial Infarction)
100%
STROKE (Ischemic or Hemorrhagic)
100%
KIDNEY FAILURE (End-Stage Renal Failure)
100%
BONE MARROW TRANSPLANT (Stem Cell Transplant)
100%
SUDDEN CARDIAC ARREST
100%
MAJOR ORGAN TRANSPLANT (25% of this benefit is payable for insureds placed on a transplant list for a major organ transplant)
100%
NON-INVASIVE CANCER
25%
CORONARY ARTERY BYPASS SURGERY
25%
INITIAL DIAGNOSIS We will pay a lump sum benefit upon initial diagnosis of a covered critical illness when such diagnoses is caused by or solely attributed to an underlying disease. Cancer diagnoses are subject to the cancer diagnosis limitation. Benefits will be based on the face amount in effect on the critical illness date of diagnosis. ADDITIONAL DIAGNOSIS We will pay benefits for each different critical illness after the first when the two dates of diagnoses are separated by at least 6 consecutive months. Cancer diagnoses are subject to the cancer diagnosis limitation. REOCCURRENCE We will pay benefits for the same critical illness after the first when the two dates of diagnoses are separated by at least 6 consecutive months. Cancer diagnoses are subject to the cancer diagnosis limitation.
CHILD COVERAGE AT NO ADDITIONAL COST Each dependent child is covered at 50 percent of the primary insured’s benefit amount at no additional charge. Children-only coverage is not available.
SKIN CANCER BENEFIT We will pay $250 for the diagnosis of skin cancer. We will pay this benefit once per calendar year.
The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions. SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the primary insured’s death, the surviving spouse may elect to continue coverage. Coverage would continue at the existing spouse face amount and would also include any dependent child coverage in force at the time. WAIVER OF PREMIUM If you become totally disabled due to a covered critical illness prior to age 65, after 90 continuous days of total disability, we will waive premiums for you and any of your covered dependents. As long as you remain totally disabled, premiums will be waived up to 24 months, subject to the terms of the plan. HEALTH SCREENING BENEFIT (Employee and Spouse only) We will pay $50 for health screening tests performed while an insured’s coverage is in force. We will pay this benefit once per calendar year. This benefit is only payable for health screening tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations. This benefit is payable for the covered employee and spouse. This benefit is not paid for dependent children.
Spring Harbor 2025 Benefits Guide |
23
AFLAC ACCIDENT
GROUP ACCIDENT INSURANCE INITIAL ACCIDENT TREATMENT BENEFIT – MID LT
BENEFIT AMOUNT
INITIAL TREATMENT (once per accident, within 7 days after the accident, not payable for telemedicine services) Payable when an insured receives initial treatment for a covered accidental injury. This benefit is payable for initial treatment received under the care of a doctor when an insured visits the following: Hospital emergency room with X-Ray / without X-Ray $175/$125 Urgent care facility with X-Ray / without X-Ray $175/$125 Doctor’s office or facility (other than a hospital emergency room or urgent care) with X-Ray / without X-Ray $100/$75
$300 Ground $900 Air
AMBULANCE (within 90 days after the accident) Payable when an insured receives transportation by a professional ambulance service due to a covered accidental injury.
MAJOR DIAGNOSTIC TESTING (once per accident, within 6 months after the accident) Payable when an insured requires one of the following exams: Computerized Tomography (CT/CAT scan), Magnetic Resonance Imaging (MRI), or Electroencephalography (EEG) due to a covered accidental injury. These exams must be performed in a hospital, a doctor’s office, a medical diagnostic imaging center or an ambulatory surgical center.
$150
BLOOD/PLASMA/PLATELETS (3 times per accident, within 6 months after the accident) Payable for each day that an insured receives blood, plasma or platelets due to a covered accidental injury.
$200
PAIN MANAGEMENT (once per accident, within 6 months after the accident) Payable when an insured, due to a covered accidental injury, is prescribed and receives a nerve ablation and/or block, or an epidural injection administered into the spine. This benefit is only payable for pain management techniques (as shown above) that are administered in a hospital or doctor’s office. This benefit is not payable for an epidural administered during a surgical procedure.
$75
CONCUSSION (once per accident, within 6 months after the accident) Payable when an insured is diagnosed by a doctor with a concussion due to a covered accident. $350
COMA (once per accident) Payable when an insured is in a coma lasting 30 days or more as the result of a covered accident. For the purposes of this benefit, Coma means a profound state of unconsciousness caused by a covered accident.
$5,000
24 | Spring Harbor 2025 Benefits Guide FRACTURES (once per accident, within 90 days after the accident) Payable when an insured fractures a bone because of a covered accident and is treated by a doctor. If the fracture requires open reduction, 200% of the benefit is payable for that bone. For multiple fractures (more than one fracture in one accident), we will pay a maximum of 200% of the benefit amount for the bone fractured that has the highest dollar amount. For a chip fracture (a piece of bone that is completely broken off near a joint), we will pay 25% of the amount for the affected bone. This benefit is not payable for Up to $2,500 based on a schedule EMERGENCY DENTAL WORK (once per accident, within 6 months after the accident) Payable when an insured’s natural teeth are injured as a result of a covered accident. $30 Extraction $120 Repair with a crown EYE INJURIES Payable for eye injuries if, because of a covered accident, a doctor removes a foreign body from the eye, with or without anesthesia. $175 BURNS (once per accident, within 6 months after the accident) Payable when an insured is burned in a covered accident and is treated by a doctor. We will pay according to the percentage of body surface burned. First degree burns are not covered. Second Degree Less than 10% $50 At least 10% but less than 25% $100 At least 25% but less than 35% $250 35% or more $500 Third Degree Less than 10% $500 At least 10% but less than 25% $2,500 At least 25% but less than 35% $5,000 35% or more $10,000 AG70075ITM-LT R1 Underwritten by Continental American Insurance Company (CAIC) A proud member of the Aflac family of insurers
IV (1/20)
$500
35% or more
Third Degree
$500
Less than 10%
$2,500
At least 10% but less than 25% At least 25% but less than 35%
AFLAC ACCIDENT $5,000
$10,000
35% or more
FRACTURES (once per accident, within 90 days after the accident) Payable when an insured fractures a bone because of a covered accident and is treated by a doctor. If the fracture requires open reduction, 200% of the benefit is payable for that bone. For multiple fractures (more than one fracture in one accident), we will pay a maximum of 200% of the benefit amount for the bone fractured that has the highest dollar amount. For a chip fracture (a piece of bone that is completely broken off near a joint), we will pay 25% of the amount for the affected bone. This benefit is not payable for stress fractures. Up to $2,500 based on a schedule
DISLOCATIONS (once per accident, within 90 days after the accident) Payable when an insured dislocates a joint because of a covered accident and is treated by a doctor. If the dislocation requires open reduction, 200% of the benefit for that joint is payable. We will pay benefits only for the first dislocation of a joint. We will not pay for recurring dislocations of the same joint. If the insured dislocated a joint before the effective date of his certificate and then dislocates the same joint again, it will not be covered by the plan. For multiple dislocations (more than one dislocated joint in one accident), we will pay a maximum of 200% of the benefit amount for the joint dislocated that has the highest dollar amount. For a partial dislocation (joint is not completely separated, including subluxation), we will pay 25% of the amount for the affected joint.
Up to $2,000 based on a schedule
LACERATIONS (once per accident, within 7 days after the accident) Payable when an insured receives a laceration in a covered accident and the laceration is repaired by a doctor. For multiple lacerations, we will pay a maximum of 200% of the benefit for the largest single laceration requiring stitches. Lacerations requiring stitches (including liquid skin adhesive): Over 15 centimeters $300 5-15 centimeters $150 Under 5 centimeters $75 Lacerations not requiring stitches $37.50
OUTPATIENT SURGERY AND ANESTHESIA (per day / performed in hospital or ambulatory surgical center, within one year after the accident) Payable for each day that, due to a covered accidental injury, an insured has an outpatient surgical procedure performed by a doctor in a hospital or ambulatory surgical center. Surgical procedure does not include laceration repair. If an outpatient surgical procedure is covered under another benefit in the plan, we will pay the higher benefit amount.
$300
FACILITIES FEE FOR OUTPATIENT SURGERY (surgery performed in hospital or ambulatory surgical center, within one year after the accident) Payable once per each eligible Outpatient Surgery and Anesthesia Benefit (in a hospital or ambulatory surgical center). $75 OUTPATIENT SURGERY AND ANESTHESIA (per day / performed in a doctor’s office, urgent care facility, or emergency room; maximum of two procedures per accident, within one year of the accident)
Payable for each day that, due to a covered accidental injury, an insured has an outpatient surgical procedure performed by a doctor in a doctor’s office, urgent care facility or emergency room. Surgical procedure does not include laceration repair. If an outpatient surgical procedure is covered under another benefit in this plan, we will pay the higher benefit amount.
$35
INPATIENT SURGERY AND ANESTHESIA (per day / within one year after the accident) Payable for each day that, due to a covered accidental injury, an insured has an inpatient surgical procedure performed by a doctor. The surgery must be performed while the insured is confined to a hospital as an inpatient. If an inpatient surgical procedure is covered under another benefit in the plan, we will pay the higher benefit amount.
$750
$350 Plane $150 Any ground transportation
TRANSPORTATION (greater than 100 miles from the insured’s residence, 3 times per accident, within 6 months after the accident) Payable for transportation if, because of a covered accident, an insured is injured and requires doctor-recommended hospital treatment or diagnostic study that is not available in the insured’s resident city.
Spring Harbor 2025 Benefits Guide | Surgical Procedures may include, but are not limited to, surgical repair of: ruptured disc, tendons/ligaments, hernia, rotator cuff, torn knee cartilage, skin grafts, joint replacement, internal injuries requiring open abdominal or thoracic surgery, exploratory surgery (with or without repair), etc., unless otherwise noted due to an accidental injury. SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
25
EXCLUSIONS Plan exclusions apply to all riders unless otherwise noted. We will not pay benefits for accidental injury, disability or death
condition resulting from insect, arachnid or other arthropod bites or stings. In North Carolina: any viral or microorganism infestation or
AFLAC HOSPITAL
AFLAC GROUP HOSPITAL INDEMNITY HI G Policy Series C80000
The plan that can help with expenses and protect your savings.
Does your major medical insurance cover all of your bills?
Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even with major medical insurance, your plan may only pay a portion of your entire stay. That’s how the Aflac Group Hospital Indemnity plan can help. It provides financial assistance to enhance your current coverage. It may help avoid dipping into savings or having to borrow to address out-of-pocket-expenses major medical insurance was never intended to cover. Like transportation and meals for family members, help with child care, or time away from work, for instance.
The Aflac Group Hospital Indemnity plan benefits include the following:
• Hospital Confinement Benefit • Hospital Admission Benefit • Hospital Intensive Care Benefit • Intermediate Intensive Care Step-Down Unit • Successor Insured Benefit
How it works
The Aflac Group Hospital Indemnity plan is selected. The Aflac Group Hospital Indemnity plan pays $1,300 Amount payable was generated based on benefit amounts for: Hospital Admission ($1,000), and Hospital Confinement ($150 per day). The insured has a high fever and goes to the emergency room. The physician admits the insured into the hospital. The insured is released after two days.
The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.
26 | Spring Harbor 2025 Benefits Guide
AFLAC HOSPITAL
G
Benefits Overview
BENEFIT AMOUNT
HOSPITAL ADMISSION BENEFIT per confinement (once per covered sickness or accident per calendar year for each insured) Payable when an insured is admitted to a hospital and confined as an inpatient because of a covered accidental injury or covered sickness. We will not pay benefits for confinement to an observation unit, or for emergency room treatment or outpatient treatment. We will not pay benefits for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is confined as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth). HOSPITAL CONFINEMENT per day (maximum of 31 days per confinement for each covered sickness or accident for each insured) Payable for each day that an insured is confined to a hospital as an inpatient as the result of a covered accidental injury or covered sickness. If we pay benefits for confinement and the insured becomes confined again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness. HOSPITAL INTENSIVE CARE BENEFIT per day (maximum of 10 days per confinement for each covered sickness or accident for each insured) Payable for each day when an insured is confined in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in a Hospital's Intensive Care Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit. INTERMEDIATE INTENSIVE CARE STEP-DOWN UNIT per day (maximum of 10 days per confinement for each covered sickness or accident for each insured) Payable for each day when an insured is confined in an Intermediate Intensive Care Step-Down Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in an Intermediate Intensive Care Step-Down Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intermediate Intensive Care Step-Down Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
$1,000
$150
$150
$75
SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time. In order to receive benefits for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of the covered accident (in Washington, twelve months).
military, armed forces, or an auxiliary unit thereto. (We will return the prorated premium for any period not covered by the certificate when the insured is in such service.) War does not include acts of terrorism. • Suicide – committing or attempting to commit suicide, while sane or insane. − In Missouri, Montana, and Vermont: committing or attempting to commit suicide, while sane. − In Minnesota: this exclusion does not apply. • Self-Inflicted Injuries – injuring or attempting to injure oneself intentionally. − In Missouri: injuring or attempting to injure oneself intentionally which is obviously not an attempted suicide. − In Vermont: injuring or attempting to injure oneself intentionally, while sane.
LIMITATIONS AND EXCLUSIONS EXCLUSIONS We will not pay for loss due to:
• War – voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, or voluntarily participating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any country or international authority. (We will return the prorated premium for any period not covered by the certificate when the insured is in such service.) War also includes voluntary participation (In North Carolina, active participation) in an insurrection, riot, civil commotion or civil state of belligerence. War does not include acts of terrorism (except in Illinois). − In Connecticut: a riot is not excluded. − In Oklahoma: War, or any act of war, declared or undeclared, when serving in the
Spring Harbor 2025 Benefits Guide |
27
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40www.springharborseniorliving.org
Made with FlippingBook - professional solution for displaying marketing and sales documents online