Voya Wellness Benefit | Weaver Popcorn

Wellness Benefit Group Name: Weaver Popcorn Company, Inc. Group Number: 700932

What is the Wellness Benefit?

The Wellness Benefit is included with your Accident, Critical Illness, and Hospital Indemnity Insurance coverage. It provides an annual benefit payment if you complete a covered health screening test on or after your coverage effective date, whether or not there is any out-of-pocket cost to you. You only need to complete one health screening test and may only receive a benefit payment once per calendar year, even if you complete multiple tests. You may also receive a benefit payment for your spouse and/or children if they are covered for the Wellness Benefit and complete a health screening test on or after your coverage effective date.

Getting your Wellness Benefit is easy.

1

You, your covered spouse and/or your covered children complete a health screening test.

What types of health screening tests are eligible?

Covered Health screening tests include but are not limited to: • Blood test for triglycerides • Chest x-ray • Well child/preventative exams • Pap smear or thin prep pap test • Mammography age 1 through age 18 • Flexible sigmoidoscopy • Colonoscopy • Biometric screenings • CEA (blood test for colon cancer) • CA 15-3 (breast • Electrocardiogram (EKG) • Bone marrow testing cancer) • Annual Physical Exam – Adults • Serum cholesterol test for HDL & LDL • Stress test on bicycle • CA 125 (ovarian cancer) levels or treadmill • Tests for sexually transmitted • Hemoccult stool analysis • Fasting blood glucose infections (STIs) • Serum Protein Electrophoresis (myeloma) test • Ultrasound screening for • Breast ultrasound, sonogram, MRI • Thermography abdominal aortic aneurysms • Molecular or antigen test (Coronavirus • PSA (prostate cancer) • Hemoglobin A1C (HbA1c) disease (COVID-19)* • Hearing test • Bone density screening • Immunizations • Routine eye exam • Routine dental exam

2

Visit the Voya Claims Center at voya.com/claims or the Employee Benefits Resource Center at https://presents.voya.com/EBRC/FileAClaim/WeaverPopcornCo Group policy name: Weaver Popcorn Company, Inc. Group policy number: 700932

3

Complete the questions regarding the health screening test, electronically sign and submit your Wellness Benefit claim. A confirmation number will be provided for your reference, as well as the option to save the form for your records.

4

Receive a benefit payment for each covered individual for whom an eligible claim was filed.

ReliaStar Life Insurance Company, a member of the Voya® family of companies

How can the Wellness Benefit help?

It’s automatically included.

Every day we learn more and more about the importance of regular health screenings and the increased chances of survival when serious illnesses are detected early. The Wellness Benefit encourages you to get regular health screenings. The benefit payment you receive for your health screening can be used to help pay for the cost of the test or however you like.

The Wellness Benefit is included with your Accident, Critical Illness, and Hospital Indemnity Insurance.

How much is the Wellness Benefit?

Your group’s plan specifies the benefit amount payable for each person who completes a health screening test.

WELLNESS BENEFIT WITH YOUR ACCIDENT INSURANCE:

$50

For yourself & for your covered spouse

$50

For each covered child

WELLNESS BENEFIT WITH YOUR CRITICAL ILLNESS INSURANCE:

$50

For yourself & for your covered spouse

$50

For each covered child

WELLNESS BENEFIT WITH YOUR HOSPITAL INDEMNITY INSURANCE:

$50

For yourself & for your covered spouse

$50

For each covered child

If you have any questions about the claim process, call 1-888-238-4840.

*Includes COVID tests performed at a medical facility, pharmacy or at-home.

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Insurance products are issued by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya ® family of companies. Voya Employee Benefits is a division of ReliaStar Life Insurance Company. Product availability and specific provisions may vary by state or employer’s plan.

For use by: Weaver Popcorn Company, Inc. Group Number: 700932 ©2022 Voya Services Company. All rights reserved. CN2020429_0224 212664-02152022

Claims Checklist & FAQ Wellness Benefit

Ready to file a claim?

Equip yourself with helpful information and documentation before you get started.

Information you’ll need:

Questions you’ll answer:

☐ Employer or Group name ☐ Group number (optional, but speeds up

☐ Date of visit ☐ Type of screening test ☐ Name of medical provider

the process)

☐ Employee name ☐ Employee birthdate ☐ Employee Social Security number ☐ If the claim is for a spouse and/or child,

No documentation or forms are generally needed for this type of claim. Go to the Voya Claims Center and complete the online claim form.

you’ll also need:

☐ Spouse/child’s name ☐ Spouse/child’s birthdate ☐ Spouse/child’s Social Security number What kinds of health screening tests are covered?

The Wellness Benefit provides an annual benefit payment if you complete a health screening test, whether or not there is any out-of-pocket cost to you. You only need to complete one health screening test, and may only receive a benefit payment once per year, even if you complete multiple health screening tests. You may also receive a benefit payment for your spouse and/or children if they are covered for the Wellness Benefit and complete a health screening test. For a complete description of your available benefits, exclusions and limitations, see your certificate of coverage and any riders.

Health screening tests covered by the Wellness Benefit include, but are not limited to: • Immunizations (including COVID vaccines and screening tests) • Routine eye exams • Annual physical exams (adults) • Mammography • Routine dental exams • Biometric screenings • Colonoscopy • Bone density screenings • And more ReliaStar LIfe Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY), members of the Voya® family of companies

Additional FAQs Can I receive more than one Wellness Benefit payment per year?

You are limited to one benefit payment per covered person, per eligible product, per calendar year. A maximum amount payable for all covered children in one calendar year may apply. One health screening can be used to satisfy the requirement for any insurance under which you are also covered by the Wellness Benefit. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders.

Do I need to submit documentation or results related to my screening test?

No, you do not need to submit documentation or results. Go to the Voya Claims Center and complete the online claim form with the required information.

For a complete description of your available benefits, conditions on benefit determination, exclusions and limitations, see your certificate of insurance and any riders.

Get started now The fastest way to submit and monitor the status of your claim is online at voya.com/claims

This is intended to be used for information purposes only and does not indicate eligibility for a benefit. Filing a claim may require any necessary medical records or proof of claim as determined during the review process. This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate(s) of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. Insurance products are issued and underwritten by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Voya Employee Benefits is a division of both companies. Product provisions and availability may vary by state or employer’s plan. ©2023 Voya Services Company. All rights reserved. CN2691361_0225 213330-02152023