2024 E MPLOYEE BENEFITS GUIDE
CLASS 3
WELCOME TO YOUR BENEFIT ENROLLMENT GUIDE 2024 PLAN YEAR
Yates LLC 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 the benefits you select during this enrollment will be effective June 1 st , 2024 and will continue through May 31 st , 2025.
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.
ADDITIONAL INFORMATION
ELIGIBILITY: As a Yates LLC 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.
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
WHEN YOU CAN ENROLL IN BENEFITS:
• During your initial new hire eligibility period • During the annual Open Enrollment period for a June 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 [yates] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • 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.
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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!
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MEDICAL AND PHARMACY COVERAGE
Yates LLC offers the following plans through Meritain Health.
Insurance Carrier:
Meritain Health Medical Insurance
Basic Plan You pay:
Standard Plan You pay:
HSA Plan You pay:
In-Network:
Deductible (first dollar cost for covered in-network services) Individual / Family $1,000 / $3,000
$2,000 / $6,000
$5,000 / $10,000
Coinsurance (after you reach your deductible) Plan Pays 70%
80%
100%
Out-of-Pocket Maximum (includes deductibles, copays, prescription costs, and coinsurance) Individual / Family $5,500 / $12,700 $5,000 / $12,700
$5,000 / $10,000
Plan Features Preventive Care
100% deductible waived
100% deductible waived
100% deductible waived
Primary Care Visits
$25 Copay, then 100% deductible waived
$20 Copay, then 100% deductible waived
100% after deductible
Specialist Visits
$50 Copay, then 100% deductible waived
$40 Copay, then 100% deductible waived
100% after deductible
Urgent Care
$50 Copay, then 100% deductible waived
$50 Copay, then 100% deductible waived
100% after deductible
Emergency Room
$200 Copay, then 100% deductible waived
$200 Copay, then 100% deductible waived
100% after deductible
Diagnostic Testing & Blood Work
70% after deductible
80% after deductible
100% after deductible
Bloodwork - Quest Diagnostics
100% deductible waived
100% deductible waived
100% after deductible
Imaging
70% after deductible
80% after deductible
100% after deductible
Inpatient Hospital
70% after deductible
80% after deductible
100% after deductible
Outpatient Surgery
70% after deductible
80% after deductible
100% after deductible
Inpatient/Outpatient Physician Fees
70% after deductible
100% deductible waived
100% after deductible
Prescription Benefits 30-day supply Tier 1 - Generic
$7 Copay
$7 Copay
100% after deductible
Tier 2 - Formulary
$40 Copay
$40 Copay
100% after deductible
Tier 3 - Non-Formulary
$70 Copay
$70 Copay
100% after deductible
Tier 4 - Specialty
Contact ShaRx @ 314-451-3555, Option 1 or sharx@sharxplan.com
Mail Order 90-day supply
2x Copay
100% after deductible
Semi-Monthly Deduction (per paycheck cost for coverage) Employee Only $38.50
$74.25
$27.50
$123.75
$151.25
$96.25
Employee + Spouse
$96.25
$126.50
$77.00
Employee + Child(ren)
$165.00
$211.75
$123.75
Family
*HSA PLAN - YATES WILL MATCH $1,000 FOR INDIVIDUAL / $2,000 FOR FAMILY TO SAVINGS ACCOUNT*
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HEALTHCARE BLUEBOOK
Healthcare Bluebook™ CareConnect Get paid to save on care!
Use Healthcare Bluebook to shop for medical care and earn rewards With Healthcare Bluebook, you’ll save hundreds to thousands of dollars on medical procedures by choosing Fair Price™ (green) facilities for your care. Plus, you’ll get paid to save. Every time you shop for eligible procedures in Healthcare Bluebook and use a Fair Price (green) facility for your care, you’ll earn a reward. It’s easy!
Gear up and be empowered { On your PC, laptop and tablet: meritain.com { On your mobile phone: Download the app. Mobile code: MERITAIN
Go green to get green 1. Shop for your procedure using Healthcare Bluebook 2. Use a Fair Price (green) facility of your choice 3. Earn up to a $1,500 reward on eligible procedures No forms or extra steps required. It’s automatic! Dependents also eligible for rewards. Please allow 60-90 days for processing. Use Healthcare Bluebook to shop for care Use the Healthcare Bluebook website, mobile app, or phone support to shop for a Fair Price (green) facility for your procedure. Then schedule your appointment. Always check network status before scheduling. Up to a $1,500 Reward per procedure!
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HEALTHCARE BLUEBOOK
List of common reward procedures
Go Green to Get Green: Engagement Rewards with CareConnect
Incentive Categories
Outpatient procedures X-rays/Bone density scan
$25 $35 $35 $75
Mammogram (screening or diagnostic) Ultrasound (obstetric and non-obstetric) Echocardiogram (TEE, TTE or TTE with doppler)
Most CTs and MRIs
$100 $125 $150 $150 $150 $150
Sleep study
Breast biopsy (with ultrasound guidance)
Cataract surgery
Colonoscopy or Upper GI endoscopy
Heart perfusion imaging
Carpal tunnel surgery or Repair finger tendon Ear tube placement or Complex ear drum repair
$250* $350* $350* $350* $350* $350* $350* $500*
Hysteroscopy
Lithotripsy
Nasal passage widening surgery or Nasal septum repair
OP surgery (elbow, hip, knee, shoulder) Tonsillectomy or removal of adenoids
Cholecystectomy (laparoscopic) Inpatient Procedures Benign breast tumor removal
$300 to $500* $500 to $750* $700 to $1,000*
Hysterectomy
Total joint replacement (hip or knee)
Spinal fusion
$1,000 to $1,500 *CareConnect concierge support is available for these procedures.
To get started, just call 1.800.875.9717 today! Download the app:
www.meritain.com | © 2021–2022 Meritain Health, Inc.
8 | Yates LLC 2024 Benefits Guide
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
High Plan You pay:
Low Plan You Pay:
Plan Type:
Calendar Year Deductible
$50 Individual / $150 Family
$50 Individual / $150 Family
Calendar Year Maximum
$5,000
$1,000
Preventive Services
100%
100%
Basic Services
80%
80%
Major Services
50%
50%
Endo/Perio
50%
50%
Out-of-Network Reimbursement
90th Usual & Customary
Maximum Allowable Charge
Semi-Monthly Deduction
Employee Only
$26.92
$12.06
Employee + One
$55.38
$27.51
Employee + Two or more
$65.37
$52.61
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VISION BENEFITS
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.
You can feel more confident with dental insurance that encourages routine cleanings and checkups. Dental insurance helps protect your teeth for a lifetime.
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
$45 allowance
Lenses every 12 months • Single Vision
$10 Copay $10 Copay $10 Copay
$30 allowance $50 allowance $65 allowance
• Bifocal • Trifocal
Frames every 24 months
$130 Allowance + 20% off balance
Up to $70
Contacts every 12 months
$100 Allowance + 20% off balance
Up to $105
Semi-Monthly Deduction
Employee Only
$4.48
Employee + One
$8.43
Employee + Two or more
$12.00
*Contacts benefit is in lieu of eyeglass frames and lens benefit.
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BASIC LIFE AND AD&D INSURANCE COVERAGE
Yates LLC 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 All Full Time Employees Life Insurance Benefit $25,000 Guarantee Issue Accidental Death & Dismemberment Benefit (AD&D) Same as Basic Life Amount
Spouse - $5,000 Child - $2,000
Dependent Life
VOLUNTARY TERM LIFE INSURANCE COVERAGE
As a supplemental benefit, Yates LLC 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.
Voluntary Life w/AD&D Insurance
Eligibility Requirement
All Full Time Employees
Employee Benefit Amounts Employee
minimum of $10,000 / up to $500,000 in increments of $10,000 minimum of $5,000 / up to $100,000 in increments of $5,000
Spouse
Child(ren)
minimum of $5,000 / up to $10,000
Guarantee Issue Employee
$200,000 $50,000
Spouse
Child(ren)
$5,000
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DISABILITY INSURANCE
The goal of Yates LLC’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 Short-Term Disability income benefits at no cost to employees. Long-Term Disability is voluntary. Both the Short-Term and Long-Term Disability coverages are offered through MetLife.
MetLife Short-Term Disability Insurance
Plan Type:
Employer Paid
Eligibility Requirement
Class 3 - All Eligible Employees
Benefit Percentage
60%
Waiting Period - Accident Waiting Period - Sickness Maximum Weekly Benefit Pre-Existing Condition
7 Days 7 Days $2,000 3 / 12
Benefit Duration
12 Weeks
MetLife Long-Term Disability Insurance
Plan Type:
Voluntary
Eligibility Requirement
Class 3 - All Eligible Employees
Waiting Period
90 Days
Benefit Percentage
60%
Maximum Monthly Benefit
$10,000 SSNRA 2 Years 3 / 12
Benefit Duration
Own Occupation Definition
Pre-Existing Condition
*Maximum Monthly Benefit varies by classification.
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FLEXIBLE SPENDING ACCOUNT (FSA)
Yates LLC – Time to get more money in your paycheck What is a Flexible Spending Account (FSA)? It is a plan which allows you to set aside funds, on a pre-tax basis, to pay for eligible expenses you incur during the plan year for medical, dental, pharmacy and/or vision services related to you or your dependents. There are two accounts – Medical Flexible Spending and Dependent Care Flexible Spending . How do I get this tax savings? You determine the amount you want to allocate for participation in either, or both, accounts and complete the enrollment form during your Open Enrolment period. The amount you elect to set aside is not taxed, you end up with more money in your pocket. The amount you allocate is divided evenly over the course of the year and deducted from your payroll, reducing your applicable tax each pay period. Who can I “cover” with my allocation? Expenses for you and your dependents are reimbursable under this plan if they are deemed eligible by the IRS guidelines.
Medical Flexible Spending Account • Budget and save for qualified known medical expenses for you and your family for the upcoming plan year, June 1, 2024 to May 31, 2025. • Your entire election amount is available the first day of the plan year. Maximum election amount is $3,200 . • Yates LLC plan has the grace period/carry over. This means you can still incur expenses and spend down your 2023 balance through August 31, 2024/carry over up to $640 into the next plan year.
Dependent Care Flexible Spending Account • Set aside money pre-tax to pay for day care/child care expenses for the upcoming plan year, June 1, 2024 to May 31, 2025. • Expenses for children under the age of 13 who are tax dependents and disabled spouse or disabled dependents of any age can be reimbursed. • Maximum election amount is $5,000 ($2,500 if married filing single). • This is a pay as you go account, funds are not paid in advance of your deposits. • Examples of Eligible Expenses: Child care for infant child Before and after school care Pre-School Summer day camp Dependent Care FSA Tax Savings Example:
• Examples of Eligible Expenses 1 : Prescription Medication Copays & Deductibles Chiropractic Care
Vision Care Dental Treatments Orthodontia Diabetic Supplies Physical Therapy
Medical FSA Tax Saving Example:
Without an FSA
With an FSA
Gross taxable wage Federal, FICA & State Tax Dependent care cost Amount left to spend
Gross taxable wage Dependent care election Federal, FICA & State Tax Amount left to spend
$500
$500
Savings
Charges
$113 $101 $108
$500 $450 $480 $220 $100
Deductible
-113.25
-96.15
Co-pays
Take home pay $386.75 Taxable wage
$403.85
Prescriptions
-96.15
-91.47
$49 $22 $16
Contacts/Vision services
Dental
$290.60
$312.36
$75
Over-the-counter items+
FSA Tax Savings per week
$21.78
Total
$1,795
$409
Annual Savings
$1,132.56
800-444-1922 ext. 1 • www.basiconline.com
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AFLAC ACCIDENT
AC
GROUP ACCIDENT
Benefits available for spouse and/or dependent children. Benefits for both inpatient and outpatient treatment of covered accidents. Guaranteed Issue - No underwriting required to qualify for coverage.
PLAN FEATURES 24-Hour or Non-occupational Coverage. No limit on the number of claims. Supplements and pays regardless of any other insurance programs.
PLAN BENEFITS
Accidental Death and Dismemberment Accidental Common Carrier Death (Plane,Train, Boat or Ship) $100,000 Accidental Death $50,000 Double Dismemberment $25,000 Single Dismemberment $6,250 Loss of One or More Fingers or Toes $1,250 Partial Amputation of Fingers or Toes (Including at least $100 onejoint)
Major Injuries Fractures* (open reduction) Hip/Thigh
$6,750 $6,075 $5,400 $5,062 $4,050 $3,375 $3,375 $2,700 $2,700 $2,362 $2,362 $2,025 $1,350
Vertebrae (except processes)
Pelvis
Skull (depressed)
Leg
Forearm/Hand/Wrist Foot/Ankle/Knee cap
Hospital Benefits Paralysis Hospital Admission
Shoulder blade/Collar bone
$10,000 $1,000
Lower Jaw (Mandible)
Skull (Simple)
$400 $200 $125
Hospital Intensive Care (per day) Hospital Confinement (per day)
Upper Arm/Upper Jaw Facial bones (except teeth) Vertebral Processes Coccyx/Rib/Finger/Toe Dislocations* (open reduction) Hip
Medical Fees
$540
Specific Injuries Burns
$100–$10,000
$5,400 $3,900 $3,000 $2,400 $2,100 $1,800 $1,500 $1,200
$25–$400 $100–$400 $400–$600 $100–$400 $50–$250
Lacerations
Knee (not knee cap)
Ruptured Disc
Shoulder
Tendons/Ligaments Torn Knee Cartilage
Foot/Ankle
Hand
Eye Injuries
Lower Jaw
$10,000
Coma
Wrist
$200
Concussion
Elbow
$50–$150
Emergency Dental Work
$480
Finger/Toe
Additional Benefits Internal Injuries
Catastrophic Accident Rider $100,000 We will provide this benefit due to an accidental injury that re- sults in the loss and irrecoverable use of sight (in both eyes), hear- ing (in both ears), speech, arms or legs. Benefit reduces by 50% at age 65. Benefit payable after 365 day elimination period. $250 We will pay this benefit if the insured is admitted to a hospital and confined as a resident bed patient due to a covered sickness. We will pay this benefit once for each covered sickness. $100 We will provide this benefit beginning on the first day of hospi- tal confinement, per day, for up to 30 days, per hospital confine- ment. Sickness Rider Hospital Admission Hospital Confinement
$1,000
$500 $500
Air Ambulance
Prosthesis
$150–$300
Transportation
$250 $100 $100 $100 $100
Exploratory Surgery
Ambulance Blood/Plasma
Appliances
Family Lodging Benefit
$60 $25 $25
Wellness Benefit
Accident Follow-up Treatment
Physical Therapy
*Closed reduction pays a benefit 150% less than open reduction.
CAI7780
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AFLAC CRITICAL ILLNESS
GROUP CRITICAL ILLNESS CI
Covered Specific Critical Illnesses: CANCER (Internal/Invasive) ....................................................100% HEART ATTACK (Myocardial Infarction) ............................100% STROKE (Apoplexy or Cerebral Vascular Accident) ......100% MAJOR ORGAN TRANSPLANT ..............................................100% RENAL FAILURE (End Stage)....................................................100% CARCINOMA IN SITU ....................................................................25% CORONARY ARTERY BYPASS SURGERY ................................25% NOTE: If a benefit is paid for carcinoma in situ, the internal cancer benefit will be reduced by 25%. If a benefit is paid for coronary artery bypass surgery, the heart attack benefit will be re- duced by 25%. All covered conditions are subject to the definitions found in your certificate.
PLAN BENEFITS First Occurrence Benefit After the waiting period, a Lump Sum Benefit is payable upon initial diagnosis of a covered illness. Employee benefit amounts available from $5,000 to $50,000. Spouse coverage is also avail- able in benefit amounts up to $25,000. If you are deemed ineligible due to a previous medical condition you still retain the ability to purchase spouse coverage. Additional Occurrence Benefit If an insured collects full benefits for a criti- cal illness under the plan and later has one of the remaining covered ill- nesses, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least 6 months.
Re-Occurrence Benefit If an insured collects full benefits for a covered condition and is later diagnosed with the same condition, we will pay the full benefit again.The two dates of diagnosis must be separated by at least 12 months or for Cancer, 12 months treatment free. Cancer that has spread (metastasized) even though there is a new tumor, will not be considered an additional oc- currence unless the Insured has gone treatment free for 12 months.
25% Child Coverage at no Additional Cost Each dependent child is covered at 25 percent of the primary insured amount at no additional charge.
$50 Health Screening Benefit (employee and spouse) After the Waiting Period, pays a maximum of $50 for any one covered health screening test per calendar year.We will pay this benefit regardless of the results of the test. Covered health screening tests include (but are not limited to): mammography, colonoscopy, pap smear, breast ultrasound, chest x-ray, PSA (blood test for prostate can- cer), stress test on a bicycle or treadmill, and bone marrow testing. FEATURES Guaranteed Issue $10,000 employee/$5,000 spouse based on 20% participation and 50 applications • $5,000 employee based on 10% participation and 25 applications.
Same Day Coverage Coverage will be effective the date the employee signs the application pending underwriting approval.
Portability Employees can keep coverage at same rates and benefits if they leave their job, with certain stipulations.
Cancer Option May be sold with or without cancer benefit.
Premium Options May be sold on tobacco/non-tobacco structure or uni-tobacco structure.
HEART RIDER
PARALYSIS ................................................................................................100% SEVERE BURNS ........................................................................................100% COMA ........................................................................................................100% LOSS OF SPEECH ....................................................................................100% LOSS OF SIGHT ........................................................................................100% LOSS OFHEARING ..................................................................................100% ADDITIONAL BENEFIT RIDER
SPECIFIED SURGERIES OF THE HEART ........................................100% CORONARY ARTERY BYPASS SURGERY, MITRAL VALVE REPLACE- MENT/REPAIR, AORTIC VALVE REPLACEMENT/REPAIR, SURGICAL TREATMENT OF ABDOMINAL, AORTIC ANEURYSM INVASIVE HEART PROCEDURES AND TECHNIQUES ....................10% ANGIO CLOST BUSTING, BALLOON ANGIOPLASTY, LASER ANGIO- PLASTY, ATHERECTOMY, STENT IMPLANTATION, CARDIAC CATHETERI- ZATION, AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR, PACEMAKERS
CAI2880
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AFLAC HOSPITAL
HI2
G
group Hospital indemnity
Supplemental Hospital Indemnity Policy Series CA8500-MP This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.
PLAN BENEFITS
PLAN 2
$200
Hospital confinement per day (up to 180 days per confinement) This benefit is paid when a Covered Person is confined to a hospital as a resident bed patient because of a Covered Sickness or as the result of Injuries received in a Covered Accident. To receive this benefit for Injuries received in a Covered Accident, the Covered Person must be confined to a hospital within six months of the date of the Covered Accident. Hospital admission per admission The benefit is paid when a Covered Person is admitted to a hospital and confined as a resident bed patient because of Injuries received in a Covered Accident or because of a Covered Sickness. In order to receive this benefit for Injuries received in a Covered Accident, the Covered Person must be admitted to a hospital within six months of the date of the Covered Accident. Hospital intensive care per day This benefit is paid when a Covered Person is confined in a hospital intensive care unit because of a Covered Sickness or due to an Injury received from a Covered Accident. To receive this benefit for Injuries received in a Covered Accident, the Covered Person must be admitted to a hospital intensive care unit within six months of the date of the Covered Accident. surgical benefit up to the amount shown If an insured has surgery performed by a physician due to an Injury received in a Covered Accident or because of a Covered Sickness, we will pay the appropriate surgical benefit amount shown in the Schedule of Opera- tions. The surgical benefit paid will never exceed the maximum surgical benefit designated in the plan. The surgery can be performed in a hospital (on an inpatient or outpatient basis), in an ambulatory surgical center, or in a Physician’s office. anestHesia benefit up to the amount shown When an insured receives benefits for a surgical procedure covered under the Surgical Benefit, we will pay the appropriate benefit amount shown in the Schedule of Operations for anesthesia administered by a Physi- cian. However, the anesthesia benefit paid will not exceed 25 percent of the amount paid under the Surgical Benefit. Hospital emergency room/pHysician benefit (medical fees) maximum per visit If an insured is injured in a Covered Accident or has treatment as the result of a Covered Sickness, we will pay the following benefit: physician (per visit) – $50 laboratory fees (per visit) – $25 X-ray (per visit) – $50
$300
$200
$2,000
$500
$50
injections/medications (per visit) – $25 maximum $250/insured per calendar year maximum $1,000/family per calendar year maximum $50/per visit
$25
Well baby care benefit per visit We will pay the Well Baby Care Benefit amount associated with each benefit plan option when an insured baby receives well baby care (four visits per calendar year per insured baby). For this plan, a baby is a Dependent Child 12 months of age or younger. This benefit is payable only if coverage is issued with the Dependent Children Rider. out-of-Hospital prescription drug benefit five-prescription maximum per year We will pay an indemnity benefit, based on the plan definitions, for each prescription filled for a Covered Person. Prescription drugs must meet three criteria: (1) be ordered by a Doctor; (2) be dispensed by a li- censed pharmacist; and (3) be medically necessary for the care and treatment of the patient. This benefit is subject to the Out-of-Hospital Prescription Drug Benefit Maximum.
$10
CAI85802 4/11
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AFLAC HOSPITAL
WHAT IS NoT CovErEd, LImITATIoNS ANd EXCLUSIoNS, ANd TErmS YoU NEEd To KNoW
eXclusions We will not pay benefits for loss caused by Pre-Existing Conditions. We will not pay benefits for loss contributed to, caused by, or resulting from: • War – participating in war or any act of war, declared or not, or participating in the armed forces of or contracting with any country or international authority. We will return the prorated premium for any period not covered by this certificate when you are in such service. • Suicide – committing or attempting to commit suicide, while sane or insane. • Self-Inflicted Injuries – injuring or attempting to injure yourself intentionally. • Traveling – traveling more than 40 miles outside the territorial limits of the United States, Canada, Mexico, Puerto Rico, the Bahamas, Virgin Islands, Bermuda, and Jamaica, except under the Accidental Common Carrier Death Benefit. • Racing – Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test. • Aviation – operating, learning to operate, serving as a crew member on, or jumping or falling from any aircraft, including those which are not motor-driven. • Intoxication – being legally intoxicated, or being under the influence of any narcotic, unless such is taken under the direction of a Physician. • Illegal Acts – participating or attempting to participate in an illegal activity, or working at an illegal job. • Sports – participating in any organized sport: professional or semiprofessional. • Custodial Care. This is care meant simply to help people who cannot take care of themselves. • Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications. • Services performed by a relative. • Services related to sex change, sterilization, in vitro fertilization, or reversal of a vasectomy or tubal ligation. • A service or a supply furnished by or on behalf of any government agency unless payment of the charge is required in the absence of insurance. • Elective abortion. • Treatment, services, or supplies received outside the United States and its possessions or Canada. • Dental services or treatment. • Cosmetic surgery, except when due to medically necessary reconstructive plastic surgery. • Mental or emotional disorders without demonstrable organic disease. • Alcoholism, drug addiction, or chemical dependency. • Injury or sickness covered by workers’ compensation. • Routine physical exams and rest cures. pre-eXisting condition limitation pre-existing condition means within the 12-month period prior to the Effective Date of the certificate those conditions for which medical advice or treatment was received or recommended. We will not pay benefits for any loss or injury which is caused by, contributed to by, or resulting from a Pre- Existing Condition for 12 months after the Effective Date of the certificate, or for 12 months from the date medical care, treatment, or supplies were received for the Pre-Existing Condition, whichever is less. A claim for benefits for loss starting after 12 months from
a convalescent home; a rest home or a home for the aged; a place for alcoholics or drug addicts; or a mental institution. a hospital intensive care unit is not any of the following step-down units: a progressive care unit; a sub-acute intensive care unit; an intermediate care unit; a private monitored room; a surgical recovery room; an observation unit; or any facility not meeting the definition of a hospital intensive care unit as defined in the certificate. effective date – The date as shown in the Certificate Schedule if you are on that date actively at work for the policyholder. If not, the certificate will become effective on the next date you are actively at work as an eligible employee. The certificate will remain in effect for the period for which the premium has been paid. The certificate may be continued for further periods as stated in the plan. The certificate is issued in consideration of the payment in advance of the required premium and of your statements and representations in the application. A copy of your application will be attached and made a part of the certificate. The certificate, on its Effective Date, automatically replaces any certificate or certificates previously issued to you under the plan. individual termination – Your insurance will terminate on the earliest of the date the plan is terminated; on the 31st day after the premium due date if the required premium has not been paid; on the date you cease to meet the definition of an employee as defined in the plan; on the premium due date which falls on or first follows your 70th birthday; or on the date you are no longer a member of an eligible class. Termination of any Covered Person’s insurance under the certificate shall be without prejudice to his or her rights as regarding any claim arising prior thereto. portable coverage – When coverage would otherwise terminate because the employee ends employment with the employer, coverage may be continued. The employee will continue the coverage that is in force on the date employment ends, including dependent coverage then in effect. The employee will be allowed to continue the coverage until the earlier of the date the employee fails to pay the required premium or the date the group master policy is terminated. Coverage may not be continued if the employee fails to pay any required premium, the insured attains age 70, or the group master policy terminates.
the Effective Date of a certificate, as applicable, will not be reduced or denied on the grounds that it is caused by a Pre- Existing Condition. Pregnancy is a “Pre-Existing Condition” if conception was before the effective date of a certificate. Treatment means consultation, care, or services provided by a Physician, including diagnostic measures and taking prescribed drugs and medicines. If a certificate is issued as a replacement for a certificate previously issued under the Plan, then the Pre-Existing Condition limitation provision of the new certificate applies only to any increase in benefits over the prior certificate. Any remaining period of Pre-Existing Condition limitation of the prior certificate would continue to apply to the prior level of benefits. terms you need to KnoW you and your – Refer to an employee as defined in the Plan. spouse – Means your legal Spouse who is between that ages of 18 and 64. dependent children – Means your natural children, stepchildren, foster children, legally adopted children, or children placed for adoption, who are under age 26. Your natural children born after the Effective Date will be covered from the moment of live birth. No notice or additional premium is required. Coverage on Dependent Children will terminate on the child’s 26th birthday. However, if any child is incapable of self- sustaining employment due to mental retardation or physical handicap and is dependent on his parent(s) for support, the above age of 26 shall not apply. Proof of such incapacity and dependency must be furnished to the company within 31 days following such 26th birthday. covered person – If the certificate is issued as: Individual coverage, the Covered Person means you; Employee/Spouse coverage, Covered Person means you and your legal Spouse; Single Parent Family coverage, Covered Person means you and your covered Dependent Children, as defined in the applicable rider, that have been accepted for coverage; Family coverage, Covered Person means you and your Spouse and covered Dependent Children, as defined in the applicable rider, that have been accepted for coverage. injury or injuries – An accidental bodily Injury or Injuries caused solely by or as the result of a Covered Accident. covered accident – An accident, which occurs on or after a Covered Person’s Effective Date, while the certificate is in force, and which is not specifically excluded. sickness – An illness, infection, disease, or any other abnormal condition, which is not caused solely by or the result of an Injury. covered sickness – An illness, infection, disease, or any other abnormal physical condition which is not caused solely by or the result of any Injury which occurs while the certificate is in force; and was not treated or for which a Covered Person did not receive advice within 12 months before the Effective Date of his/her coverage; and is not excluded by name or specific description in the certificate. doctor or physician – A person, other than you or a member of your immediate family, who is licensed by the state to practice a healing art; performs services which are allowed by his or her license; and performs services for which benefits are provided by the certificate. a hospital is not a nursing home; an extended care facility;
We’ve got you under our wing. ® aflacgroupinsurance.com 1.800.433.3036 the certificate to which this sales material pertains is written only in english; the certificate prevails if interpretation of this material varies.
this brochure is a brief description of coverage and is not a contract. read your certificate carefully for exact terms and conditions. this brochure is subject to the terms, conditions, and limitations of policy form series ca8500-mp. Underwritten by: Continental American Insurance Company 2801 Devine Street | Columbia, South Carolina 29205
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METLAW
AFFORDABLE & CONVENIENT LEGAL REPRESENTATION, FOR LESS THAN A CUP OF COFFEE A DAY
Finding an affordable lawyer to represent you when you have trouble with identity theft, buying or selling your home, or even preparing your will can be a challenge. MetLaw is a Smart. Simple. Affordable. ® solution to all of your legal needs.
With MetLaw, you, your spouse and dependents can receive fully covered legal services for a wide range of personal legal matters. Because no matter how old you are, you have legal needs. Here are some common legal issues for each generation:
GENERATION:
COMMON FINANCIAL LEGAL ISSUES:
COMMON PERSONAL LEGAL ISSUES:
Millennials (18 - 34)
Traffic Tickets, Purchase of a Home or Condo, Landlord Negotiations
Credit Card Debt, Debt Collection Defense
Gen X (35 - 50)
Foreclosure, Refinancing, Estate Planning
Adoption, School Hearing, Will Preparation, Trusts
Baby Boomers (51 - 69)
Powers of Attorney, Living Wills, Medicare questions
Tax Audits, Property Sale, Identity Theft
Traditionalists (70+)
Property Sale, Nursing Home/Assisted Living Agreements, Leases, Deeds
Powers of Attorney, Wills, Living Wills, Medicare/ Medicaid questions, Prescription Plan questions
See reverse side for all available coverages.
USING THE PLAN IS EASY. Simply give us a call or log into our members’ site to view your plan coverage and find attorneys. As long as you use a Network Attorney for a covered matter there are: No deductibles or co-payments - No waiting periods or claim forms - No limits on usage
For more information visit our website: info.legalplans.com and enter access code: LegalCM or call: 800.821.6400 Monday - Friday: 8:00 am - 8:00 pm (EST/EDT)
Where available, you may also visit us at www.metlife.com/mybenefits
© 2018 MetLife Services and Solutions, LLC.
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METLAW
CONSUMER PROTECTION MATTERS • Disputes over Consumer Goods and Services • Small Claims Assistance
IMMIGRATION ASSISTANCE • Advice and Consultation • Preparation of Affidavits and Powers of Attorney • Review of Immigration Documents JUVENILE MATTERS • Juvenile Court Defense, including Criminal Matters • Parental Responsibility Matters TRAFFIC OFFENSES • Defense of Traffic Tickets (excludes DUI) • Driving Privilege Restoration (Includes License Suspension due to DUI) PERSONAL PROPERTY PROTECTION • Assistance for disputes over goods and services • Consultations and Document Review for Personal Property Issues
DEFENSE OF CIVIL LAWSUITS • Administrative Hearings • Civil Litigation Defense • Incompetency Defense • Pet Liabilities • School Hearings
DOCUMENT PREPARATION & REVIEW • Affidavits; Deeds; Demand Letters • Mortgages • Promissory Notes • Review of Any Personal Legal Documents
ELDER LAW MATTERS • Consultations and Document Review for issues related to your parents including Medicare, Medicaid, Prescription Plans, Nursing Home Agreements, Leases, Notes, Deeds, Wills and Powers of Attorney as these affect the Participant
REAL ESTATE MATTERS • Boundary or Title Disputes • Eviction and Tenant Problems (Primary Residence - Tenant Only) • Home Equity Loans (Primary, Secondary or Vacation Home) • Property Tax Assessment • Sale, Purchase or Refinancing (Primary, Secondary or Vacation Home) • Security Deposit Assistance (For Tenant) • Zoning Applications
ESTATE PLANNING DOCUMENTS • Codicils • Healthcare Proxies • Living Wills • Powers of Attorney (Healthcare, Financial, Childcare) • Simple and Complex Wills • Trusts (Revocable and Irrevocable) FAMILY LAW • Adoption and Legitimization • Guardianship or Conservatorship • Name Change • Prenuptial Agreement • Protection from Domestic Violence
HERE’S HOW TO ENROLL: • Select MetLaw during your benefit enrollment period. • Your cost for the Plan will be automatically deducted from your paychecks. • Once you enroll, you must remain in the Plan for the entire Plan year.
1 These benefits provides the Participant with access to LifeStages Identity Management Services and FraudScout Triple Bureau Credit Monitoring Services provided by CyberScout, LLC. CyberScout is not a corporate affiliate of Hyatt Legal Plans.
FINANCIAL MATTERS • Debt Collection Defense • Foreclosure Defense • Negotiations with Creditors • Personal Bankruptcy • Tax Audit Representation • Tax Collection Defense IDENTITY THEFT MATTERS • Identity Theft Defense
Exclusions: Please see your plan description for complete details. No service (including consultations) will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the employer, MetLife ® and affiliates, and plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or dependents, in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm matters, business or investment matters, matters involving property held for investment or rental, or issues when the participant is the landlord; 6) patent, trademark and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Group Legal Plans are provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan Property and Casualty Company and Affiliates, Warwick, Rhode Island. L1217501056[exp0219][All States][DC,PR] ML3wCreditMonitoringRM
• LifeStages - Identity Management Services 1 • FraudScout - Triple Bureau Credit Monitoring 1
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Employee Assistance Program EMPLOYEE ASSISTANCE PROGRAM
Professional support and guidance for everyday life
Life doesn’t always go as planned. And while you can’t always avoid the twists and turns, you can get help to keep moving forward. We can help you and your family, those living at home, get professional support and guidance to make life a little easier. Our Employee Assistance Program (EAP) is available to you in addition to the benefits provided with your MetLife insurance coverage. This program provides you with easy-to-use services to help with the everyday challenges of life — at no additional cost to you.
Expert advice for work, life, and your well-being The program’s experienced counselors provided through LifeWorks — one of the nation’s premier providers of Employee Assistance Program services — can talk to you about anything going on in your life, including: • Family: Going through a divorce, caring for an elderly family member, returning to work after having a baby • Work: Job relocation, building relationships with co-workers and managers, navigating through reorganization • Money: Budgeting, financial guidance, retirement planning, buying or selling a home, tax issues • Legal Services: Issues relating to civil, personal and family law, financial matters, real estate and estate planning • Identity Theft Recovery: ID theft prevention tips and help from a financial counselor if you are victimized • Health: Coping with anxiety or depression, getting the proper amount of sleep, how to kick a bad habit like smoking • Everyday Life: Moving and adjusting to a new community, grieving over the loss of a loved one, military family matters, training a new pet Convenient and confidential help when you want it, how you want it Your program includes up to 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar year. You can call 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365. When you call, just select “Employee Assistance Program” when prompted. You’ll immediately be connected to a counselor. If you’re simply looking for information, the program offers easy to use educational tools and resources, online and through a mobile app. There is a chat feature so you can talk with a consultant to guide you to the information you are looking for or help you schedule an appointment with a counselor. Log on to metlifeeap.lifeworks.com, user name: metlifeeap and password: eap
Help is always at your fingertips. Our mobile app makes it easy for you to access and personalize educational content important to you. Search “LifeWorks” on iTunes App Store or Google Play. Log in with the user name: metlifeeap and password: eap
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EMPLOYEE ASSISTANCE PROGRAM
Answers to important questions
When you need some support, we’re here to help.
Are Employee Assistance Program services confidential? Yes. Any personal information provided to LifeWorks stays completely confidential.* How do I get help? Getting professional help is just a phone call away. Simply call 1-888-319-7819 to speak with a counselor or to schedule a phone or video conference appointment. These services are available 24 hours a day, 7 days a week. When is the right time to call? That’s up to you. Counselors are here whenever you need them —whether you simply need to talk or want guidance on something you are going through. Is my Employee Assistance Program included with my MetLife coverage? Yes. There is no cost to you because your employer pays for the services provided within our program. While we offer a broad range of services, there may be some assistance that’s not included. You can still work with counselors for these services by arranging to pay for them directly. Does the program have any limitations? While we offer a broad range of services, we may not cover all services you may need. Your Employee Assistance Program does not provide: • Inpatient or outpatient treatment for any medically treated illness • Prescription drugs • Treatment or services for intellectual disability or autism • Counseling services beyond the number of sessions covered or requiring longer term intervention • Services by counselors who are not LifeWorks providers • Counseling required by law or a court, or paid for by Workers’ Compensation
Phone 1-888-319-7819
Web metlifeeap.lifeworks.com user name: metlifeeap and password: eap
Mobile App user name: metlifeeap and password: eap
*MetLife and LifeWorks abide by federal and state regulations regarding duty to warn of harm to self or others. In these instances, the consultant may have a duty to intervene and report a situation to the appropriate authority.
Some restrictions may apply to all of the above-mentioned services. Please contact your employer or MetLife for details.
Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 OPT1 L1217501239[exp0119][All States][DC,GU,MP,PR,VI] © 2017 METLIFE, INC.
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