NBS Mobile App

Mobile app features

Sample Expenses

Medical Expenses

•Acupuncture

•Addiction programs

•Adoption (medical expenses for baby birth)

•Alternative healer fees

•Ambulance

•Body scans

•Breast pumps

•Care for mentally handicapped

•Chiropractor

•Copayments

•Crutches

•Diabetes (insulin, glucose monitor)

•Eye patches

Dental Expenses

•

•Dentures

•Fertility treatment

•First aid (e.g., bandages, gauze)

•Hearing aids & batteries

•Hypnosis (for treatment of illness)

•Incontinence products (e.g., Depends, Serene)

•Joint support bandages and hosiery

•Lab fees

•Menstrual Products*

•Monitoring device (blood pressure, cholesterol)

•Non-prescription medicines or drugs (vitamins/supplements without a prescription are not eligible)*

•Physical exams

•Pregnancy tests

•Prescription medicines or drugs

•Psychiatrist/psychologist (for mental illness)

•Physical therapy

•Speech therapy

•Vaccinations

•

•Weight loss program fees (if prescribed by physician)

•Wheelchair

Vision Expenses

•Braille - books & magazines

•Eyeglasses

*After January 1, 2020

•Copayments

•Deductible

•Dental work

•Orthodontia expenses

•

•Bridges, crown, etc.

•Contact lenses

•Contact lens solutions

•Eye exams

Items that generally do not qualify for reimbursement

•Personal hygiene (e.g., deodorant, soap, body powder, sanitary products. Does not include menstrual products)

•Addiction products**

•Cosmetic surgery**

•Cosmetics (e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil)

•Counseling (e.g., marriage/family)

•Dental care - routine (e.g., toothpaste, rinses, teeth whitening/bleaching)**

•Exercise equipment**

•Haircare (e.g., hair color, shampoo, conditioner, brushes, hair loss products)

•

•Homeopathic supplement or herbs**

•Household or domestic help

•Laser hair removal

•Massage therapy**

•Laser surgery

•

•Guide dog and upkeep/ other animal aid

•Nutritional and dietary supplements (e.g., bars, milkshakes, power drinks, Pedialyte)**

•Skin care (e.g., moisturizing lotion, lip balm)

•Sleep aids (e.g., snoring strips)**

•Vitamins**

•Weight reduction aids (e.g., Slimfast, appetite suppressant)**

**Portions of these expenses may be eligible for reimbursement if they are recommended by a licensed medical

Critical Illness Insurance

canpaymoneydirectlytoyouwhenyou’rediagnosedwithcertainseriousillnesses.

How does it work?

If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.

Why is this coverage so valuable?

•Themoneycanhelpyoupayout-of-pocketmedical expenses,likeco-paysanddeductibles.

•Youcanusethiscoveragemorethanonce. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit pays 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.

What’s covered?

• Heart attack

• Stroke

• Major organ failure

Critical illnesses

• Coronary artery disease

Major(50%): Coronary artery bypass graft or valve replacement

• End-stage kidney failure

Minor(10%): Balloon angioplasty or stent placement

Cancer conditions

• Invasive cancer — all breast cancer is considered invasive

• Non-invasive cancer (25%)

• Skin cancer — $500

Progressive diseasesSupplemental conditions

• Amyotrophic Lateral Sclerosis (ALS)

• Dementia, including Alzheimer’s disease

• Multiple Sclerosis (MS)

• Parkinson’s disease

• Functional loss

• Loss of sight, hearing or speech

• Benign brain tumor

• Coma

• Permanent Paralysis

• Occupational HIV, Hepatitis B, C or D

• Infectious Diseases (25%)

Why should I buy coverage now?

•It’smoreaffordablewhenyoubuyitthroughyour employerandthepremiumsareconveniently deductedfromyourpaycheck.

•Coverageisportable.Youmaytakethecoveragewith youifyouleavethecompanyorretire.You’llbebilled athome.

Be Well Benefit

Every year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as:

• Annual exams by a physician include sports physicals, wellchild visits, dental and vision exams

• Screenings for cancer, including pap smear, colonoscopy

• Cardiovascular function screenings

Who can get coverage?

• Screenings for cholesterol and diabetes

• Imaging studies, including chest X-ray, mammography

• Immunizations including HPV, MMR, tetanus, influenza

You: Choose $10,000, $20,000 or $30,000 of coverage with no medical questions if you apply during this enrollment.

Your spouse: Spouses can only get 100% of the employee coverage amount as long as you have purchased coverage for yourself.

Your children: Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.

Active employment: You are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 18.75 hours each week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 0 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date.

If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/media/9486. Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations.

Critical Illness Insurance benefit and cost

Monthly

Well benefit: $50 EmployeeSpouse under25$3.86$3.86 25-29$4.76$4.76 30-34$5.96$5.96 35-39$7.96$7.96 40-44$10.46$10.46 45-49$13.56$13.56 50-54$16.96$16.96 55-59$22.66$22.66 60-64$31.46$31.46 65-69$45.26$45.26 70-74$70.36$70.36 75-79$103.76$103.76 80-84$151.36$151.36 85+$243.76$243.76 Monthly costs Age Employee coverage: $20,000 Spouse coverage: $20,000

Be Well

Your paycheck deduction will include the cost of coverage and the Be Well Benefit. Actual billed amounts may vary.

Pre-existing conditions

We will not pay benefits for a claim when the Covered Loss occurs in the first 12 months following an Insured’s Coverage Effective Date and the Covered Loss is caused by, contributed to by or occurs as the result of any of the following:

• a Pre-existing Condition; or

• complications arising from treatment or surgery for, or medications taken for, a Preexisting Condition.

An Insured has a Pre-existing Condition if, within the 12 months just prior to their Coverage Effective Date, they have an injury or sickness, whether diagnosed or not, for which:

• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;

• drugs or medications were taken, or prescribed to be taken during that period; or

• symptoms existed.

The Pre-existing Condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage Effective Date refers to the date any initial coverage or increases in coverage become effective.

Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.

Continuity of coverage

We will provide coverage for an Insured if the Insured was covered by a similar prior policy on the day before the Policy Effective Date. Coverage is subject to payment of premium and all other terms of the certificate. If an employee is on a temporary Layoff or Leave of Absence on the Policy Effective Date of this certificate, we will consider your temporary Layoff or Leave of Absence to have started on that date and coverage will continue for the period provided temporary Layoff or Leave of Absence under Continuation of your Coverage During Extended Absences in the certificate. If you have not returned to Active Employment before any Insured’s Date of Diagnosis, any benefits payable will be limited to what would have been paid by the prior carrier.

If the Employer replaces a critical illness policy with this Policy, or the employee becomes insured due to a merger, acquisition or affiliation, and the prior carrier’s pre-existing condition requirement has been satisfied, the Pre-existing Condition requirement under this coverage will not apply. However, if the Unum certificate provides a higher level of coverage at the time it becomes effective, its Pre-existing Condition requirement will apply to any increase in coverage. If the prior carrier’s pre-existing condition requirement has not been satisfied, periods of coverage applicable to the prior carrier’s Pre-existing Condition will count towards satisfying the Pre-existing Condition requirement under this coverage.

Date of diagnosis must be after the coverage effective date.

Exclusions and limitations

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: committing or attempting to commit a felony; being engaged in an illegal occupation or activity; injuring oneself intentionally or attempting or committing suicide, whether sane or not; active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or injury for self-defense; participating in war or any act of war, whether declared or undeclared; combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; being intoxicated; and a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the Coverage Effective Date.

End of employee coverage

If you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the: date this policy is canceled by Unum or your employer; date you are no longer in an eligible group; date your eligible group is no longer covered; date of your death; last day of the period any required premium contributions are made; or last day you are in active employment.

However, as long as premium is paid as required, coverage will continue in accordance with the Continuation of your Coverage during Absences provision or if you elect to continue coverage for you, your Spouse, and Children under Portability of Critical Illness Insurance. Unum will provide coverage for a payable claim that occurs while you are covered under this certificate.

THIS INSURANCE PROVIDES LIMITED BENEFITS

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 or the Certificate Form GCIC16-1 or contact your Unum representative.

Underwritten by: Unum Insurance Company, Portland, Maine

DID YOU KNOW?

Million People 25

are sent to the emergency room through ground or air ambulance every year * .

Insurance companies may not may not cover all air and ground ambulance expenses which can result in max in-network out-of-pocket** costs of:

$8,700 Individual $17,400 Family

Ground ambulance out-of-network transportation costs may be even costs may be even higher than in-network than in-network since the No Surprises Act does not apply to ground ambulance at this time.

Emergent Plus Membership Benefits

A MASA MTS Membership provides the ultimate peace of mind at an a ordablerateforemergencygroundand air transportation assistance expenses within the continental United States, Alaska, Hawaii, and while traveling in Canada, regardless of whether the provider is in or out of your group healthcare bene tsnetwork.Afterthe group health plan pays its portion, MASA works with providers to make certain our Members have no out-ofpocket expenses~ for emergency ambulance transportation assistance and other related services.

Emergency Air Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Emergency Ground Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Hospital to Hospital Ambulance Coverage1

MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or xed-wingaircraft.

Repatriation to Hospital Near Home Coverage1

MASA MTS provides services and covers out-of-pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation.

Contact Your Representative, to learn more:

The information provided in this product information sheet is for informational purposes only. The bene ts listed and the descriptions thereof do not represent the full terms and conditions applicable for usage and may only be o ered in some memberships. Premiums and bene ts vary depending on the bene ts selected. Commercial air and Worldwide coverage are not available in all territories. For a complete list of bene ts, premiums, and full terms, conditions, and restrictions, please refer to the applicable member services agreement for your territory. MASA MTS products and services are not available in AK, NY, WA, ND, and NJ. MASA MTS utilizes third-party transportation service providers for all transportation services. MASA Global, MASA MTS and MASA TRS are registered service marks of MASA Holdings, Inc., a Delaware corporation. Void where prohibited by law.

~If a member has a high deductible health plan that is compatible with a health savings account, bene ts will become available under the MASA membership for expenses incurred for medical care (as de ned under Internal Revenue Code (“IRC”) section 213 (d)) once a member satis es the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.

COVERAGE TERRITORIES:

1. All coverage provided by this membership is limited to the continental United States, Alaska, Hawaii, and Canada, and must originate and conclude therein.

SOURCES:

*ACEP NOW 2014

** Patient Protection and A ordable Care Act; HHS Notice of Bene t and Payment Parameters for 2022 and Pharmacy Bene t Manager Standards. May 5, 2021.