Critical Illness Insurance
Major Organ Transplant/Placement on UNOS List, End-Stage Renal Failure Cerebral Palsy, Structural Congenital Defects, Genetic Disorders, Congenital Metabolic Disorders, Type 1 Diabetes Acute Respiratory Distress Syndrome (ARDS)
100%
Organ
25% 100% 100% 50% 25%
Childhood/Developmental *benefits only available to children
Cancer (Invasive)
Cancer
Bone Marrow Transplant
Carcinoma in Situ, Benign Brain Tumor
COVERAGE GUIDELINES 2
MINIMUM $10,000
MAXIMUM $10,000
GUARANTEE ISSUE 3
$10,000 $10,000
For You Elect in $10,000 increments Spouse Elect in $10,000 increments
$10,000
100% of employee’s CI Principal Sum, up to $10,000
25% of employee’s CI Principal Sum, up to $5,000
$3,000
Child(ren) *benefit for each child
ADDITIONAL BENEFITS Policy Benefit Maximum
The maximum payout amount is 300% of the CI Principal Sum amount for each insured person. If the policy benefit maximum is reached for an insured person, the coverage will terminate. Dependents will remain insured if you continue to satisfy the eligibility requirements of the policy. Once benefits have been paid for a Critical Illness, no additional benefits are payable for that same Critical Illness for each insured person. Benefits are still payable for any other Critical Illness in the same benefit category, for each insured person. The reoccurrence benefit is equal to 100% of the Critical Illness principal sum. When insurance ends, you have the right to continue group Critical Illness insurance for yourself and your dependents.
Additional Occurrence Benefit
Reoccurrence Benefit
Portability
CONDITIONS & LIMITATIONS Benefit Waiting Period
There is no benefit waiting period.
SERVICES Hearing Discount Program
The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more. Advocacy services give an employee who has been diagnosed with a medical condition access to skilled clinicians and nurses for personalized, problem- solving assistance in a one-on-one setting. Call 1-866-372-5577 Monday – Friday 7 A.M. to 7 P.M. CST or email careadvocates@gilsbar.com for assistance.
Advocacy
1 Payment of a partial benefit reduces the remaining amount payable in a category . 2 The amount of insurance for your spouse and child(ren) will be rounded to the next higher multiple of $1,000, if not already an even multiple of $1,000. 3 Subject to any reductions, Guarantee Issue is available to new hires. Amounts over the Guarantee Issue will require a health application/evidence of insurability. For late entrants, all amounts will require a health application/evidence of insurability. Amounts over the Guarantee Issue and/or not meeting minimum participation levels will require a health application/evidence of insurability.
12 INFRATECH CORPORATION 2023 BENEFITS GUIDE
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