2024 Wolter Benefit Guide

VISION PLAN

LIFE & DISABILITY

Vision Plan Through Delta Dental of WI

Life & AD&D Through Sun Life

DeltaVision, in partnership with EyeMed’s Insight network, is one of the nation’s largest vision care provider networks with more than 26,300 locations nationwide.

Wolter provides benefit eligible employees with group life & accidental death & dismemberment (AD&D) insurance, & pays the cost of this benefit. Employees who want to supplement their group life insurance benefits may purchase additional coverage. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through payroll deductions.

Participating Provider

Non-Participating Provider

Basic Life / AD&D

Disability Insurance Through Sun Life

Services / Material

Frequency

Basic Life Benefit

Flat $50,000 Flat $50,000

Exam

Paid in full

Up to $35 retail value Once every 12 months

Wolter provides benefit eligible employees with voluntary short & long-term disability income benefits. In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income.

AD&D Benefit

Retail allowance of $150, then 20% off balance

Frames

Up to $75 retail value Once every 24 months

Voluntary Life / AD&D

Lenses Single Vision

Employee

Up to $500,000 in $10,000 increments, not to exceed 5X basic annual earnings ▶ Guarantee Issue: $150,000 Up to $250,000 in $5,000 increments, not to exceed 100% of the employee’s amount ▶ Guarantee Issue: $50,000 $2,000 / $4,000 / $6,000 / $8,000 / $10,000 ▶ Guarantee Issue: N/A

Paid in full Paid in full Paid in full

Up to $25 retail value Up to $40 retail value Up to $55 retail value Up to $40 retail value

Bifocal

Voluntary-Short Term Disability Benefits Begin - Accident

Once every 12 months

Trifocals

8th Day 8th Day 12 weeks

Progressive

Members pay $75

Benefits Begin - Illness

Contact Lenses Conventional

Spouse

Benefits Duration

Contact allowance of $150, then 15% off balance

Up to $120 retail value

Percentage of Income Replaced 60% Weekly Maximum Benefit

Once every 12 months

Disposable

$150 allowance

Up to $120 retail value

$750 / week

Medically Necessary

Paid in full

$200

LASIK

15% off retail price or 5% off promotional price

Voluntary-Long Term Disability

Child (to age 26)

DEDUCIBLE: Exam $10 | Materials $10

Elimination Period Benefits Duration

90 Days SSNRA

Reduction Schedule

33% at age 70, 50% at age 75

Own Occupation Period 2 Years Percentage of Income Replaced 60% Maximum Benefit

Tier

Vision Monthly Premiums

Accelerated Life Benefit 12 month life expectancy, 75% to a maximum of $500,000 Waiver of Premium Included

$5,000 / Month

$7.04 $14.08 $14.37 $21.41

Employee Only

Social Security Integration

Full Family 3 Months 24 Months

EMPLOYEE PREMIUMS Your monthly vision payroll deductions before taxes.

Employee + Spouse Employee + Child(ren)

Survivor Benefit

Conversion Portability

Mental/Nervous/Drug/Alcohol

Family

Pre-existing Conditions

12 / 12

LIFE / AD&D / DISABILITY / WOLTER / / 9

8 / / WOLTER / VISION PLAN

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