Voluntary Group Critical Illness

Transcription

1 Voluntary Group Critical Illness Prepared for Edgewood ISD #903 Presented by EBSO July 1, 2015 A+ rated, providing flexible, affordable benefits solutions for over a century.

2 Contents Executive Summary...3 About This...4 Plan Description & Cost Summary...5 Plan Details...8 Limitations About Reliance Standard Situs State: Texas Effective Date: August 1, 2015 Expiration Date: August 30, 2015 Sales Representative Kevin Dreier Broker EBSO Reliance Standard Life Insurance Company Prairie Lakes Drive Suite 280 Eden Prairie, MN Toll Free: (800) Direct: (952) Fax: (952) Page 2

3 Executive Summary On behalf of Reliance Standard Life Insurance Company (Reliance Standard), I would like to thank you for giving us the opportunity to quote the enclosed Voluntary Critical Illness plan for Edgewood ISD #903. We are confident this will uniquely respond to the benefit needs of your client today and in the future. At Reliance Standard, our goal is to provide your client with a benefits plan that will enhance their ability to attract and retain valued employees, and to provide for their security in times of need. Our commitment to you is: A customized insurance plan that meets your client s goals and objectives Quick, efficient handling of all administrative, claims and underwriting matters Cooperative and efficient service for you and your client. The Group Critical Illness Insurance plan enclosed contains many benefits and provisions. I invite you to read through and consider the proposed plan. The highlights are featured on Page 5, Plan Description. As an added benefit, Reliance Standard offers a secure website providing Benefit Managers online access to the benefits related information they need. From our site, policyholders are granted access to our Benefit Manager s Extranet. Here you can obtain state specific forms required for day to day administration/maintenance of the group policies; enroll employees; manage and pay invoices online; and gain access to management reports, including: o o o Premium & Claim History Claim Activity (status) Evidence of Insurability Status and Tracking I look forward to reviewing this with you. Please feel free to contact me with any questions you may have. Sincerely, Kevin Dreier Page 3

4 About this This outlines some of the features and benefits that we offer in our policy, but it is not a policy. The actual group insurance policy will contain additional provisions not fully described in this document. If there are any discrepancies between the and the group insurance policy, the policy will govern. The provisions are explained in basic terms and may be subject to some state restrictions. It is important to remember that the Group Critical Illness Policy provides a limited benefit for certain Critical Illnesses. It is NOT medical insurance or Medicare supplement insurance. Receipt of benefits under the policy may affect eligibility for Medicaid or other government benefits and/or entitlements. We based the premium rate and plan design quotations on the underwriting data you gave us. Final premium rates, rate guarantee and plan provisions may change if: The terms of the change; There is a change in the factors bearing on the risk to be assumed; Any information provided to us in connection with the underwriting of the was incorrect; or There is a change in the law or regulation affecting the insurance coverage. For further details of any of the coverages, including exclusions, any reductions or limitations, and the terms under which the policy may be continued in force or discontinued, contact your sales office. This is valid only if presented by a licensed insurance agent or broker who is appointed with RSL. It is valid until the date shown, unless we replace or withdraw it. Page 4

5 Plan Description & Cost Summary Eligibility Employees: Spouse: Each Active Full-Time Employee working 30 hours or more per week, except any person working on a temporary or seasonal basis. An eligible employee s legal spouse under age 75. (However, on the date of application, the spouse must be under age 70.) Coverage for domestic partners may be available upon request, unless prohibited by state law. Domestic and civil union partner coverage is automatically included on the plan where required by state law. Dependent Children: An eligible employee s child(ren) from 14 days to 26 years, including natural children, legally adopted children, children who are dependent on the eligible employee during the waiting period before adoption, stepchildren, and foster children. Foster children must be in the custody of the eligible employee to be considered a Dependent; and an eligible employee's child(ren) beyond the limiting age who is incapable of self-sustaining employment by reason of intellectual disability or physical handicap and who is chiefly dependent on the eligible employee for support and maintenance; and an eligible employee's unmarried grandchild(ren), from 14 days to 25 years who are financially dependent upon the eligible employee. Employee must be insured under the policy for dependent spouse and/or children to be insured. A person may not have coverage as both an employee and a dependent. Plan Description Employees: Option of $5,000 to $50,000 in increments of $5,000 Guaranteed Issue Amount $15,000 Spouse: Option of $5,000 to $50,000 in increments of $5,000 Guaranteed Issue Amount $15,000 Dependent Children Coverage limited to 25% of employee approved Amount of Insurance to a maximum of $12,500. All dependent child amounts are guaranteed issue. Page 5

6 Plan Description & Cost Summary Included Benefits Basic: 100% of Amount of Insurance Heart Attack, Life Threatening Cancer, Stroke, Major Organ Transplant, Kidney (Renal) Failure Partial: 25% of Amount of Insurance Coronary Artery Bypass, Carcinoma in situ Wellness (Health Screening) Benefit $50 Benefit Waiting Period 30 Days Lifetime Maximum Benefit per Category* 200% of the Amount of Insurance Subsequent Occurrence Benefit (Different Category*) 100% of Basic, Enhanced, or Partial Benefit/6months Recurrence Benefit (Same Category*) 50%of Basic, Enhanced, or Partial Benefit/18months Pre-Ex Limitation 12 month look back period/12 month coverage period Transfer of Coverage Yes Family Medical Leave Included Portability Included *CRITICAL ILLNESSES FALL INTO ONE OF THREE CATEGORIES AS FOLLOWS: Cancer Related: Life Threatening Cancer; Carcinoma in situ Cardiovascular Related: Heart Attack; Stroke; Coronary Artery Bypass Other: Kidney (Renal) Failure; Major Organ Transplant Page 6

7 Plan Description & Cost Summary Rate Schedules Critical Illness Insurance Cost Monthly Rate per Employee, and Spouse if applicable, per $1,000 of Coverage Employee Premium Cost Critical Illness Coverage Monthly Rates Employees age are limited to $5,000 in coverage. Non Smoker $5,000* $10,000 $12,500* $25,000 $50,000 $75,000 $100,000 Ages $0.85 $1.70 $2.13 $4.25 $8.50 $12.75 $ $1.08 $2.15 $2.69 $5.38 $10.75 $16.13 $ $1.41 $2.81 $3.52 $7.03 $14.07 $21.10 $ $2.08 $4.16 $5.20 $10.39 $20.78 $31.17 $ $3.17 $6.33 $7.92 $15.83 $31.66 $47.49 $ $5.22 $10.45 $13.06 $26.12 $52.23 $78.35 $ $8.27 $16.55 $20.69 $41.37 $82.75 $ $ $13.30 $26.61 $33.26 $66.51 $ $ $ $18.89 $37.78 $47.23 $94.46 $ $ $ $26.04 $52.08 $65.10 $ $ $ $ $ $31.90 Smoker $5,000* $10,000 $12,500* $25,000 $50,000 $75,000 $100,000 Ages $1.25 $2.51 $3.13 $6.27 $12.54 $18.81 $ $1.47 $2.93 $3.67 $7.33 $14.66 $21.99 $ $2.28 $4.56 $5.70 $11.39 $22.78 $34.17 $ $3.54 $7.08 $8.85 $17.70 $35.40 $53.10 $ $5.80 $11.60 $14.50 $29.01 $58.01 $87.02 $ $9.46 $18.93 $23.66 $47.32 $94.65 $ $ $15.47 $30.94 $38.68 $77.35 $ $ $ $23.55 $47.11 $58.88 $ $ $ $ $35.50 $71.00 $88.75 $ $ $ $ $47.53 $95.06 $ $ $ $ $ $ $61.26 Page 7

8 Plan Description & Cost Summary Age-banded premium rates are based on the age at last birthday. They will change on the policy anniversary date coinciding with or next following the Insured's last birthday. The Insured Dependent spouse age, for purposes of determining Premium, is equivalent to the Insured's age. Dependent Children Insurance Cost Monthly Rate per $1,000 of Coverage Child Premium Rates $0.29 One rate for all eligible dependent children in family, regardless of number. Keep in mind, only one Wellness Benefit will be paid in a 12 month period for all Dependent Children as a group. Age Reduction For Insureds age 70 and over, the Amount of Insurance is subject to automatic reduction. Upon the Insured s attainment of the specified age below, the Amount of Insurance will be reduced to the applicable percentage. This reduction also applies to Insureds who are age 70 or over on their Individual Effective Date. Age Percentage of available or in force amount at age % The Dependent spouse Amount of Insurance will reduce in the same manner as the Insured's Amount of Insurance upon the Dependent spouse's attainment of the reducing age. The Child Amount of Insurance will continue at the percentage (reflected on the Plan Description) of the Insured's Amount of Insurance prior to any reductions due to age. Participation Requirements and Rate Guarantee Participation Requirements Minimum number of employees approved for coverage: The greater of 10% of eligible employees or 10 insured lives. If the minimum number of employees are not approved for coverage, a policy will not be issued. Rate Guarantee We guarantee the final premium rates for 24 months from the Policy effective date. The Policy is optionally renewable. Page 8

9 Plan Details Critical Illness Benefit A lump sum benefit (per the Plan Description and Included Benefits sections of the Plan Description & Cost Summary of this ) will be payable if the Insured (or any Insured Dependent, if applicable) is Diagnosed by a physician with a Critical Illness. Payment of the benefit is subject to all of the following: (1) the Diagnosis must have been made within the United States or its territories; and (2) the Insured's (and Insured Dependents', if applicable) coverage must be in force under the policy at the time of the Diagnosis of a Critical Illness; and (3) the Diagnosis must be made by a physician after completion of any applicable Benefit Waiting Period; and (4) any exclusions or limitations contained in the policy; and (5) any age reduction as shown in the policy. In the event the "First Diagnosed/First Diagnosis" Exclusion is included (on the Plan Description), the term "Diagnosed or Diagnosis" will be "First Diagnosed or First Diagnosis" wherever it appears throughout this, and no benefit will be paid under the policy unless an Insured's Critical Illness is the First Diagnosis of such Critical Illness. Eligibility Guaranteed Issue Actively-at-Work means a person is actually performing on a full-time basis each and every duty pertaining to his/her job in the place where, and in the manner in which, the job is normally performed. This includes approved time off such as vacation, jury duty and funeral leave, but does not include time off as a result of an injury or sickness. An eligible employee, and eligible spouse if applicable, will automatically be insured for an Amount of Insurance up to the guaranteed issue amount as shown on the Plan Description if application is made within thirty-one (31) days of first becoming eligible. Dependent Children coverage is always guaranteed issue, but the employee must be approved for insurance in order for children to be insured. Wellness (Health Screening) Benefit Available to the employee, and his/her spouse and children if applicable. The Wellness (Health Screening) Benefit pays the amount shown on the Plan Description for one (1) health screening test performed during a twelve (12) month period for the Insured and his/her Insured Dependents, if applicable. One (1) Wellness Benefit will be paid in a twelve (12) month period for all Insured Dependent children as a group. Health screening tests covered under the policy are: Breast ultrasound or mammography Blood test for lipids including LDL, HDL and triglycerides Chest x-ray Colonoscopy Pap smear PSA (blood test for prostate cancer) Stress test on a bicycle or treadmill Fasting blood glucose test Bone marrow testing CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) CEA Flexible sigmoidoscopy Hemoccult stool analysis Serum Protein Electrophoresis (blood test for myeloma) Page 9

10 Plan Details Benefit Waiting Period The period of time shown on the Plan Description after the Insured s, or his/her Insured Dependent s if applicable, Individual Effective Date of coverage that the Insured or his/her Insured Dependents, if applicable, must be covered under the policy before being Diagnosed with a Critical Illness for which benefits may be payable. NO BENEFITS ARE PAYABLE FOR ANY CRITICAL ILLNESS DIAGNOSED BEFORE OR DURING THE BENEFIT WAITING PERIOD. Lifetime Maximum Benefit per Category Subsequent Occurrence Benefit Recurrence Benefit Concurrent Diagnosis of More Than One Critical Illness Diagnosed Or Diagnosis Continuation of Insurance The aggregate maximum we will pay under the policy for all Critical Illnesses within a Category for each person insured. Pays for a Critical Illness Diagnosed in a different Category from a Critical Illness previously diagnosed for which a benefit has been paid under the policy as long as the diagnoses are separated by at least the number of months shown on the Plan Description. Pays a reduced benefit as shown on the Plan Description for a Critical Illness Diagnosed in the same Category as a Critical Illness Diagnosed previously and for which a benefit has been paid under the policy as long as the diagnoses are separated by at least the number of months shown on the Plan Description. If the Insured, or Insured Dependent if applicable, can qualify for benefits for more than one Critical Illness at the same time, we will only pay for one (1) Critical Illness with the highest benefit. The diagnosis by a Physician that must be: (1) made while the Insured s, or the Insured Dependent s if applicable, coverage is in force under the Policy; and (2) made after the Benefit Waiting Period as shown on the Plan Description; and (3) in writing; and (4) if First Diagnosed/First Diagnosis Exclusion is included on the Plan description, the first time in the Insured s, or the Insured Dependent s if applicable, lifetime a Diagnosis of any type of such Critical Illness has been made; and (5) based on objective clinical findings or laboratory tests that are supported by medical records and any other diagnostic requirements defined in the policy. An insured employee may continue his/her coverage (and that of any insured dependents, if applicable) in accordance with the following but not longer than: (1) twelve (12) months, if due to Sickness or Injury; or (2) one (1) month, if due to temporary lay-off or approved leave of absence. Your policy must remain in force for an Insured's coverage to continue. Premium must be paid during the continuation period or coverage will terminate. Page 10

11 Plan Details Family and Medical Leave Act (FMLA) The Family and Medical Leave Act of 1993 mandates that employers with more than 50 workers continue group health coverage during an approved period of family or medical leave, just as if the employee was on the job during that time. FMLA does not require you to continue group critical illness coverage, but we make continuation available as an option. Coverage may continue for the Insured, and Insured Dependents if applicable, until the later of the end of the leave period required by the Family and Medical Leave Act of 1993 as amended, or any similar state law and in accordance with your policies for such leave provided premium continues to be paid. If you choose not to continue coverage while the Insured is on FMLA, coverage will be reinstated when the Insured returns from such leave. A leave of absence taken in accordance with the Family and Medical Leave Act of 1993 will run concurrently with any other applicable continuation of insurance provision in the Policy. Uniformed Services Employment and Reemployment Rights Act (USERRA) We will continue the Insured s coverage and that of his/her Insured Dependents, if applicable, in accordance with USERRA and your policies surrounding USERRA provided the premium continues to be paid. If you choose not to continue the Insured s coverage and that of his/her Insured Dependents, if applicable, we will reinstate coverage when the Insured returns from such leave. Please note that while the Insured is on military services leave, there is no coverage for any loss which occurs while on active duty if such loss is caused by or arises out of such military service, including but not limited to war or act of war, whether declared or undeclared. A leave of absence taken in accordance with USERRA will run concurrently with any other applicable continuation of insurance provision in the Policy. Portability If the Insured s coverage terminates because he/she ceases to be eligible (other than termination of the policy or the Insured s retirement), he/she may port (elect to continue) coverage in effect prior to ceasing to be eligible. Evidence of insurability is not required. Dependent coverage, if applicable, may not be ported independent of the Insured. The Insured must have been covered for twelve (12) months (including time insured under the prior group critical illness policy, if applicable, which was replaced), and portability must be elected with thirty-one (31) days from the date coverage terminates. Provided premium payment is made, ported insurance will terminate on the first of the following to occur: (1) the date the Insured attains age seventy (70); (2) Dependent spouse coverage, if applicable, on the date the spouse attains age seventy-five (75). Premium for this coverage will be based on rates charged for ported coverage and billed directly to the Insured on a quarterly basis. Page 11

12 Limitations Pre-Existing Condition Limitation Benefits are subject to a pre-existing condition limitation. A pre-existing condition is any sickness or injury, whether specifically diagnosed or not, for which an Insured, or Insured Dependent if applicable, received treatment, consultation, care or services, including diagnostic procedures, or for which he/she took prescription drugs or medicines, during the look back period (reflected on the Plan Description) before the individual effective date of coverage (or the effective date of an increase in coverage). Benefits (or an increased benefit) would not be payable due to a pre-existing condition unless the Critical Illness is diagnosed after the coverage period (reflected on the Plan Description) from the Insured, or the Insured Dependent s if applicable, effective date of coverage (or effective date of an increase). A pre-existing condition limitation will not apply to a recurrence of a Critical Illness. Time insured under a prior group critical illness plan maintained by you which was in effect immediately prior to the effective date of this plan will be credited toward satisfaction of the pre-existing condition coverage period. Pre-existing Condition definition may vary by state. Exclusions A Critical Illness benefit will not be paid: (1) If caused by or contributed to by one of the following: (a) an act of war, declared or undeclared; (b) intentionally self-inflicted Injury; (c) the Insured s, or the Insured Dependent s if applicable, commission or attempted commission of a felony; (d) the Insured s, or the Insured Dependent s if applicable, use of alcohol or drugs unless taken as prescribed by a Physician; (e) a Sickness or Injury that occurs while the Insured, or the Insured Dependent if applicable, is confined in a penal or correctional institution; (f) cosmetic or elective surgery that is not medically necessary; (g) committing or attempting to commit suicide while sane or insane; (h) the Insured s, or the Insured Dependent s if applicable, participation in a riot or insurrection; (2) for a Critical Illness Diagnosed outside of the United States unless such Diagnosis is confirmed within the United States. If such Diagnosis is confirmed within the United States, the Critical Illness will be deemed to have occurred on the date Diagnosis was made outside the United States; (3) for a Critical Illness Diagnosed in one Category, that follows a Critical Illness Diagnosed in another Category, for which a benefit has been paid, within a shorter time period than reflected on the Plan Description. (Subsequent Occurrence) (4) for a Critical Illness in the same Category as a Critical Illness Diagnosed, for which a benefit has been paid, if it is Diagnosed within a shorter time period than reflected on the Plan Description. (Recurrence) (5) if the First Diagnosed/First Diagnosis Exclusion is included on the Plan Description, for a Critical Illness which is not the First Diagnosis of such Critical Illness; (6) for a Critical Illness which is Diagnosed before or during the Benefit Waiting Period; or (7) for a Heart Attack that occurs within twenty-four (24) hours of a medical procedure. Exclusions may vary by state. Based on the final plan design, your policy may not contain all of the exclusions described above, but may also reflect additional exlcusions. Page 12

13 Limitations Termination of Individual Insurance Policy Termination Individual coverage will terminate if: premium is not paid as required; the policy terminates; the Insured enters military service, excluding the Reserves or National Guard unless coverage is continued as provided under Military Services Leave of Absence Extension of coverage provision); the Insured ceases to be eligible; or all Critical Illness benefits applicable to the Insured have been paid. You may cancel the policy at any time. We may cancel: if premium is not paid at the end of the grace period; if the number of Insureds (excluding Dependents) is less than ten (10); or on any policy anniversary after coverage has been in force for twelve (12) months (if Optionally Renewable). Additional Information Annual Enrollment Life Event Changes Enrollment Materials/ Certificates/ Plan Administrator's Guide Because insurance needs may change from year to year, employers often hold annual enrollment periods. We will review requests for annual enrollment periods encouraging employees to take advantage of this insurance. Approval of such enrollment periods must be obtained prior to the enrollment period. We recognize that insurance needs may change at a time that does not coincide with an annual enrollment - like the employee's marriage or divorce, or the birth or adoption of the first dependent child to be insured. We call these "life event changes" and allow the employee to apply (or if already insured, to increase or decrease his/her amount of insurance) outside of the formal enrollment period. Requirements include that the election be made within 30 days after life event change, and that the application/increase be for an amount not to exceed your case guaranteed issue amount. We provide you with sufficient quantity of enrollment materials (brochures and applications) for your eligible employees. We will provide you with sufficient quantity of Certificates of Insurance for your insured employees. You will receive a Plan Administrator's Guide that provides important and valuable information regarding your administration of the Voluntary Critical Illness Insurance plan. The foregoing information represents a brief synopsis of benefit features, limitations and exclusions under the Group Critical Illness policy. For more detailed information, please refer to the policy. Group Critical Illness coverage is provided by policy form, LRS-9401, et al through Reliance Standard Life Insurance Company. Page 13

14 About RSL Reliance Standard Life Insurance Company was incorporated in 1907 as Central Life Insurance of Illinois. Reliance Standard is domiciled in Illinois, and maintains its administrative offices in Philadelphia. Reliance Standard is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. Our Commitment to Service Excellence Employee benefits consist of three parts - the coverage itself, implementation and on-going customer service. Reliance Standard has invested heavily in people and systems to make it easy to do business with us. We reduce your administration downtime with easy-to-use online billing and enrollment support, backed by a National Service Organization spanning our entire network of sales and service offices. Our service and sales professionals are committed to assisting you in every step; from designing an affordable, customized benefit plan to assure smooth and effortless implementation, to assisting employees with questions and service requirements. A Strong, Diversified Company As a premier insurance carrier, Reliance Standard consistently earns strong financial ratings: A.M. Best A+ (Superior), upgraded August 2013 Standard & Poor s A+ (Strong), upgraded July 2013 Reliance Standard Life Insurance Company is a member of the Tokio Marine Group. The Tokio Marine Group operates in the property and casualty insurance, reinsurance and life insurance sectors globally. The Group s main operating subsidiary, Tokio Marine & Nichido Fire (TMNF), was founded in 1879 and is the oldest and leading property and casualty insurer in Japan. Comprehensive Benefits and Services In business for over 100 years, Reliance Standard Life Insurance Company (Reliance Standard) is a leading insurance carrier specializing in innovative and flexible employee benefits solutions including disability income and group term life insurance, dental insurance, critical illness and accident insurance. Reliance Standard offers a complete suite of voluntary (employee paid) coverage options and services, as well as fully integrated absence management services. Our products and services are marketed through independent brokers and agents to employers of all sizes. Page 14