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EMPLOYEE INSURANCE BENEFITS OCTOBER 1, 2011 – SEPTEMBER 30, 2012 Information Packet It will be very beneficial to review the information in this packet prior to  your attendance at one or more of the open enrollment meetings  scheduled for September 7th, 8th, & 9th. Please feel free to invite your spouse to attend as well. We have also scheduled a meeting on September 12th @ 6:30 pm in the  Court Room at Town Hall to better accommodate the attendance of  spouses. Please be sure to bring this information with you to the open  enrollment meeting as it will serve as an effective reference guide.   Since the Town is changing dental insurance providers and offering  three new Aflac ™ products, your attendance is vitally important.

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EMPLOYEE INSURANCE BENEFITS OCTOBER 1, 2011 – SEPTEMBER 30, 2012 The Town of Highland Park retained Randal R. Martell, HIA, MHP, CBC an Brent Weegar, MBA of IPS Advisors, Inc. to conduct a  request for proposal, report , and recommendations for the 2011‐2012 health and welfare benefits renewal.  The Town chose  to enter the insurance renewal market after a review of health insurance claims supported an estimated 18.6% premium  increase. IPS Advisors, Inc. recommended that the Town consider the following strategies concurrent with health and dental insurance  renewal: 1. Further differentiation of the employee and dependent cost sharing between the HSA (“Health Savings Account”) and PPO  (“Preferred Provider Organization”) plans to encourage enrollment in the HSA program. 2. Establishing a sustainable wellness program that includes incentives for preventive care testing. 3. Consider adding worksite insurance including HSA compatible worksite products to supplement out‐of‐pocket expenses. The following pages contain the result of efforts to satisfy items 1 and 3 above. Since the late‐1980’s, the Town has made available HMO (“Health Maintenance Organization”)and PPO/POS plan options.  The  Town funded the employee’s portion of the HMO product, the less expensive of the two plans.  Employees wishing greater  flexibility in health‐care benefits that the PPO/POS plan offered could purchase same through additional premium.  Two years  ago, the Town chose to introduce an HSA plan  (a consumer‐driven health plan which is defined as a high‐deductible health plan  (HDHP)) to accompany a PPO plan.  HSA plans offer specific tax benefits and retention of cost savings that PPO plans do not.   During this two year period, the Town chose to fund the employee’s premium cost on either plan elected.  The Town’s funding  also included funding the $2,500.00 deductible for employees opting for the HSA plan. Effective October 1, 2012, the same two plans will be offered.  What will be different is that the Town will fund the employee’s premium for the HSA plan and contribute $2,500.00 to each employee opting for the HSA plan.  The same dollar amount will be  funded toward employees choosing the PPO plan.  What differs is that an additional employee contribution will be required to  cover the total premium cost of the PPO plan for the employee.  Any and all dependent coverage will remain the obligation of  the employee. Item #3 is addressed with the offering of three Aflac © products.  Information on those products are included in this package. 2


HEALTH INSURANCE PLAN DESIGNS BENEFIT

PPO PLAN In Network

Lifetime benefit Deductible Coinsurance Out‐of‐pocket maximum  (includes deductible)

HSA PLAN

Out of Network

In Network

Unlimited None 100% None

Out of Network Unlimited

$2,000 individual /      $4,000 family 70% $6,000 individual   /$12,000 family

$2,500 individual /      $5,000 family 100% $3,500 individual /      $7,000 family   

$4,500 individual /        $9,000 family 80% $5,500 individual /      $11,000 family

Dr. visit co‐pay

$15

70% after deductible

100% after deductible

80% after deductible

Specialist co‐pay

$25

70% after deductible

100% after deductible

80% after deductible

$15/$25 co‐pay

70% after deductible

100% after deductible

80% after deductible

$250 co‐pay per admission

70% after deductible

100% after deductible

80% after deductible

100%

70% after

100% after

80% after

co‐pay

deductible

deductible

Preventive care services Inpatient hospital services Surgery:  Dr's office Out‐patient hospital Emergency/urgent care:  Hospital ER

$75 co‐pay

$75 co‐pay

100% after ded.

100% after ded.

Urgent care facility

$35 co‐pay

70% after ded.

100% after ded.

80% after ded.

100%

100%

100% after ded.

100% after ded.

Ambulance

Note:  On the HSA Plan, after the $2,500 individual and/or $5,000 family deductible has been met, all medical services are at 100%.  The pharmacy deductible continues for an additional $1,000 individual and/or $2,000 family.

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HEALTH INSURANCE PLAN DESIGNS BENEFIT

PPO PLAN In Network

Mental/Nervous: Out‐patient services Inpatient services Home health care Pharmacy ‐ 30 day supply: Generic/Brand/non‐form. Mail order ‐ 90 day supply: Generic/Brand/non‐form.

HSA PLAN

Out of Network

In Network

Out of Network

$25 co‐pay $250 co‐pay per admission 100%

70% after co‐pay 70% after co‐pay

100% after ded. 100% after ded.

80% after ded. 80% after ded.

70% after co‐pay

$10/$25/$50

$10/$25/$50

$25/$62.50/$100

$25/$62.50/$100

100% after ded. Deductible, then $10/$35/$60 Deductible, then $25/$87.50/$150

80% after ded. Deductible, then $10/$35/$60 Deductible, then $25/$87.50/$150

Note:  On the HSA Plan, after the $2,500 individual and/or $5,000 family deductible has been met, all medical services are at 100%.  The pharmacy deductible continues for an additional $1,000 individual and/or $2,000 family.

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HEALTH INSURANCE PLAN PREMIUMS CURRENT Employee only (Town pays) Town contribution Employee plus one Employee plus family

RENEWAL Employee only (Town pays) Town contribution Employee only (Employee) Employee plus one Employee plus family

PPO PLAN

HSA PLAN

$892.50 ‐ $303.44  $632.10 

$616.36 $2,500.00  $211.04  $434.64 

PPO PLAN

HSA PLAN

$855.52 ‐ $84.12  $395.86  $730.82 

$647.18 $2,500.00  ‐ $214.98  $445.42 

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HEALTH INSURANCE PLAN COMPARISONS CLAIM SCENARIOS Current PPO Option Individual - Low Utilizer

Individual - High Utilizer

PPO PLAN

PPO PLAN

Preventive Office Visit x 1 (100% Coverage)

$0

Outpatient Surgery (100% Coverage)

General Practice Office Visit x 2 ($15 copay)

$30

General Practioner x 2 ($15)

$0

Specialist Office Visit x 2 ($25)

$50

Specialist Office Visit x 6($25)

$150

$30

One Maintenance Drug x 12 ($10)

$120

Three Maintenance Drugs x 12 ($10)

$360

Total Claims Expense

$200

Total Claims Expense

$540

Premium contribution

$0

Premium contribution

$0

Amount Applied to Deductible

No Deductible Responsibility

Amount Applied to Deductible*

No Deductible Responsibility

Plan Pays 100%

Amount Applied to Coinsurance

Plan Pays 100%

Amount Applied to Coinsurance Member Out of Pocket for Copays

$200

* Copays Apply to Prescriptions ($10 / $25 / $50)

Member Out of Pocket (Ded & Copays)

* Copays Apply to Prescriptions ($10 / $25 / $50)

Family - Low Utilizer

Family - High Utilizer

PPO PLAN Preventive Office x 3 (100% Coverage)

$540

PPO PLAN $0

Inpatient Surgery x 1 ($250 Copay)

General Practice Office Visit x 4 ($15 Copay)

$60

General Practioner x 6 ($25 Copay)

Specialist Office Visit x 3 ($25 Copay)

$75

Specialist Office Visit x 6 ($25 Copay)

$250 $90 $150

Two Maintenance Drug x 2 insureds x 12 ($10)

$240

Six Maintenance Drugs x 12 ($10 Generic)

Total Claims Expense

$375

Total Claims Expense

$1,210

Premium contribution

$7,371

Premium contribution

$7,371

Amount Applied to Deductible Amount Applied to Coinsurance Member Out of Pocket for Copays * Copays Apply to Prescriptions ($10 / $25 / $50)

$720

No Deductible Responsibility

Amount Applied to Deductible*

No Deductible Responsibility

Plan Pays 100%

Amount Applied to Coinsurance

Plan Pays 100%

$7,746

Member Out of Pocket for Copays

$8,581

* Copays Apply to Prescriptions ($10 / $25 / $50)

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HEALTH INSURANCE PLAN COMPARISONS CLAIM SCENARIOS Renewing PPO Option  Individual - Low Utilizer

Individual - High Utilizer

PPO PLAN

PPO PLAN

Preventive Office Visit x 1 (100% Coverage)

$0

Outpatient Surgery (100% Coverage)

General Practice Office Visit x 2 ($15 copay)

$30

General Practioner x 2 ($15)

$0

Specialist Office Visit x 2 ($25)

$50

Specialist Office Visit x 6($25)

$150 $360

$30

One Maintenance Drug x 12 ($10)

$120

Three Maintenance Drugs x 12 ($10)

Total Claims Expense

$200

Total Claims Expense

$540

Premium contribution

$1,009

Premium contribution

$1,009

Amount Applied to Deductible

No Deductible Responsibility

Amount Applied to Deductible*

No Deductible Responsibility

Plan Pays 100%

Amount Applied to Coinsurance

Plan Pays 100%

Amount Applied to Coinsurance Member Out of Pocket for Copays

$1,209

* Copays Apply to Prescriptions ($10 / $25 / $50)

Member Out of Pocket (Ded & Copays)

* Copays Apply to Prescriptions ($10 / $25 / $50)

Family - Low Utilizer

Family - High Utilizer

PPO PLAN Preventive Office x 3 (100% Coverage)

$1,549

PPO PLAN $0

Inpatient Surgery x 1 ($250 Copay)

General Practice Office Visit x 4 ($15 Copay)

$60

General Practioner x 6 ($25 Copay)

Specialist Office Visit x 3 ($25 Copay)

$75

Specialist Office Visit x 6 ($25 Copay)

$250 $90 $150

Two Maintenance Drug x 2 insureds x 12 ($10)

$240

Six Maintenance Drugs x 12 ($10 Generic)

Total Claims Expense

$375

Total Claims Expense

$1,210

Premium contribution

$8,770

Premium contribution

$8,770

Amount Applied to Deductible Amount Applied to Coinsurance Member Out of Pocket for Copays * Copays Apply to Prescriptions ($10 / $25 / $50)

$720

No Deductible Responsibility

Amount Applied to Deductible*

No Deductible Responsibility

Plan Pays 100%

Amount Applied to Coinsurance

Plan Pays 100%

$9,145

Member Out of Pocket for Copays

$9,980

* Copays Apply to Prescriptions ($10 / $25 / $50)

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HEALTH INSURANCE PLAN COMPARISONS CLAIM SCENARIOS Current HSA Option Individual - Low Utilizer

Individual - High Utilizer

HSA PLAN

HSA PLAN

Preventive Office Visit x 1 (100% Coverage)

$0

Outpatient Surgery x 1

$4,400

General Practice Office Visit x 2 ($120)

$240

General Practioner x 2 ($120)

Specialist Office Visit x 2 ($170)

$340

Specialist Office Visit x 6($170)

$1,020

One Maintenance Drug x 12 ($30)

$360

Three Maintenance Drugs x 12 ($30)

$1,080

Total Claims Expense

$940

Total Claims Expense

$6,740

Premium contribution

$0

Premium contribution

$0

Amount Applied to Deductible Amount Applied to Coinsurance

$940 Plan Pays 100% Above Deductible

$240

Amount Applied to Deductible Amount Applied to Coinsurance

$2,500 Plan Pays 100% Above Deductible

HSA Account - Employer Contribution

$2,500

HSA Account - Employer Contribution

HSA Account Balance

$1,560

HSA Account Balance

$0

Member Out of Pocket after HSA Account

$0

Member Out of Pocket after HSA Account

$0

$2,500

* Copays Apply to Prescriptions after Deductible is Met ($10 / $25 / $50 up to $1,000 Out of Pocket) Family - Low Utilizer

Family - High Utilizer

HSA PLAN

HSA PLAN

Preventive Office x 3 (100% Coverage)

$0

General Practice Office Visit x 4 ($120)

$480

General Practioner x 6 ($120)

Specialist Office Visit x 3 ($170)

$510

Specialist Office Visit x 6 ($170)

$720

Six Maintenance Drugs x 12 ($30)

Two Maintenance Drug x 12 ($30)

Inpatient Surgery x 1

$18,000 $720 $1,020 $2,160

Total Claims Expense

$1,710

Total Claims Expense

$21,900

Premium contribution

$5,090

Premium contribution

$5,090

Amount Applied to Deductible Amount Applied to Coinsurance HSA Account - Employer Contribution HSA Account Balance Member Out of Pocket after HSA Account

$1,710 Plan Pays 100% Above Deductible $2,500 $790 $5,090

Amount Applied to Deductible Amount Applied to Coinsurance HSA Account - Employer Contribution HSA Account Balance Member Out of Pocket after HSA Account

$5,000 Plan Pays 100% Above Deductible $2,500 $0 $7,590

Note: If member contributes to HSA, the Out of Pocket will be reduced up to an additional $2,500

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HEALTH INSURANCE PLAN COMPARISONS CLAIM SCENARIOS Renewing HSA Option  Individual - Low Utilizer

Individual - High Utilizer

HSA PLAN

HSA PLAN

Preventive Office Visit x 1 (100% Coverage)

$0

Outpatient Surgery x 1

$4,400

General Practice Office Visit x 2 ($120)

$240

General Practioner x 2 ($120)

Specialist Office Visit x 2 ($170)

$340

Specialist Office Visit x 6($170)

$1,020

One Maintenance Drug x 12 ($30)

$360

Three Maintenance Drugs x 12 ($30)

$1,080

Total Claims Expense

$940

Total Claims Expense

$6,740

Premium contribution

$0

Premium contribution

$0

Amount Applied to Deductible Amount Applied to Coinsurance

$940 Plan Pays 100% Above Deductible

$240

Amount Applied to Deductible Amount Applied to Coinsurance

$2,500 Plan Pays 100% Above Deductible

HSA Account - Employer Contribution

$2,500

HSA Account - Employer Contribution

HSA Account Balance

$1,560

HSA Account Balance

$0

Member Out of Pocket after HSA Account

$0

Member Out of Pocket after HSA Account

$0

$2,500

* Copays Apply to Prescriptions after Deductible is Met ($10 / $25 / $50 up to $1,000 Out of Pocket) Family - Low Utilizer

Family - High Utilizer

HSA PLAN

HSA PLAN

Preventive Office x 3 (100% Coverage)

$0

General Practice Office Visit x 4 ($120)

$480

General Practioner x 6 ($120)

Specialist Office Visit x 3 ($170)

$510

Specialist Office Visit x 6 ($170)

$720

Six Maintenance Drugs x 12 ($30)

Two Maintenance Drug x 12 ($30)

Inpatient Surgery x 1

$18,000 $720 $1,020 $2,160

Total Claims Expense

$1,710

Total Claims Expense

$21,900

Premium contribution

$5,345

Premium contribution

$5,345

Amount Applied to Deductible Amount Applied to Coinsurance HSA Account - Employer Contribution HSA Account Balance Member Out of Pocket after HSA Account

$1,710 Plan Pays 100% Above Deductible $2,500 $790 $5,345

Amount Applied to Deductible Amount Applied to Coinsurance HSA Account - Employer Contribution HSA Account Balance Member Out of Pocket after HSA Account

$5,000 Plan Pays 100% Above Deductible $2,500 $0 $7,845

Note: If member contributes to HSA, the Out of Pocket will be reduced up to an additional $2,500

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DENTAL INSURANCE PLAN DESIGNS AETNA PPO PLAN BENEFITS ARE IDENTICAL TO METLIFE/SAFEGUARD SERVICE Type I ‐ Preventive Waiting period Oral exams Bitewing X‐Rays Full mouth X‐Rays Cleanings

METLIFE

AETNA

None 2/year 1 set/year 1 set/3 years 2/year

None 2/year 1 set/year 1 set/3 years 2/year

Type II ‐ Basic Waiting period Co‐pay

None 80%

None 80%

Type III ‐ Major services Waiting period Co‐pay

None 50%

None 50%

Type IV ‐ Orthdontia Waiting period Co‐pay (Adult/child) Lifetime limit

None 50% $1,500.00

None 50% $1,500.00

Annual Deductibles Employee Family

$50.00 $150.00

$50.00 $150.00

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DENTAL INSURANCE PLAN DESIGNS AETNA DHMO PLAN BENEFITS DIFFER SLIGHTLY FROM  METLIFE/SAFEGUARD AS THE FOLLOWING EXAMPLES INDICATE SERVICE

METLIFE

AETNA

D0120 periodic exam

$0.00

$0.00

D0210 intraoral exam with bitewings

$0.00

$0.00

Diagnostic

D0272 bitewings ‐ two films

$0.00

$0.00

D0330 panoramic film

$0.00

$0.00

D1110 prophylaxis‐adult

$0.00

$0.00

D1120 prophylaxis‐child

$0.00

$0.00

D1351 sealant ‐ per tooth

$0.00

$5.00

D2140 amalgam‐1 surface

$10.00

$10.00

D2160 amalgam‐3 surfaces

$18.00

$18.00

D2391 resin‐based composite

$48.00

$35.00

D2792 crown ‐ full metal

$185.00

$255.00

D3310 root canal ‐anterior

$95.00

$0.00

D3330 root canal ‐molar

$175.00

$280.00

D4341 sealing, 4 or more

$50.00

$62.00

D4910 maitenance

$30.00

$45.00

$14.00

$0.00

Preventive

Restorative

Endodontics

Peridontics

Oral surgery D7140 extraction  Orthodontics D8080 adolescent

$1,480.00

$1,945.00

D8090 adult

$1,780.00

$1,945.00

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DENTAL INSURANCE PLAN PREMIUMS CURRENT Employee only (Town pays) Employee only (Employee) Employee plus one Employee plus family

RENEWAL Employee only (Town pays) Employee only (Employee) Employee plus one Employee plus family

DHMO PLAN

PPO PLAN

$12.22 ‐ $10.96 $22.54 

$12.22 $24.48 $58.72 $107.68 

DHMO PLAN

PPO PLAN

12.84 ‐ $11.52 $23.70 

$12.84 $21.24 $53.04 $98.48 

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FLEXIBLE SPENDING ACCOUNTS

There are no changes to the structure of the Flexible Spending Accounts for medical and child care costs. It is an important reminder for employees opting for the HSA plan that IRS regulations prohibit you from having a Flexible Spending Account that can be used for the reimbursement of medical expenses. However, employees on the HSA plan can maintain a Limited Purpose Flexible Spending Account through which out‐of‐pocket dental and vision costs can be reimbursed

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PACKET CONTENTS

•HSA Information and Overview •HSA Questions and Answers •Tax Benefit Examples on HSA Contributions •Aflac ™ Accident Indemnity Advantage (Insurance) Overview •Aflac ™ Hospital (Insurance) Protection Overview •Aflac ™ Premium Schedule for Accident Indemnity and Hospital         Protection Products •Aflac ™ Critical Illness (Insurance) Overview •Aflac ™ Premium Schedule for Critical Illness Product

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Helping you understand your 2011 Medical UHC HDHP with HSA Benefits

Town of Highland Park Š 2008 UnitedHealthcare


UnitedHealthcare Definity Health Savings AccountSM (HSA) Plan

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

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The Definity HSASM Plan Made up of two parts

Medical Plan • Lower monthly premiums • Network and non-network coverage • Annual deductible • Protection from major costs • 100% preventive care • Personal support and tools • Help from 24-hour Health Coaches • No copayments at doctor’s office

Health Savings Account (HSA) •Owned by you • Used for eligible medical and pharmacy bills • Helps pay deductible • Triple tax savings • No “use it or lose it”

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 3


Your Basic medical benefits at a glance Type of coverage

Network benefit

Non-network benefit

$2,500/$5,000 (embedded)

$4,500/$9,000

$3,500/$7,000

$5,500/$11,000

Emergency room services

100% after deductible

100% After deductible

Inpatient hospital stay

100% after deductible

80% After deductible

Deductible Out of Pocket Max

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 4


The Definity HSA Plan And pharmacy coverage

• You will pay actual cost of medications until annual deductible is met • Payments will apply to the annual deductible • After deductible, you will pay $10/$35/$60 for covered medications

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 5


The Definity HSA Plan

Important things you should know:

• You will pay actual cost of care up to your deductible – Includes pharmacy expenses

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 6


The Definity HSA Plan Consumer-driven health plan that gives you: • Ability to open and own a health savings account (HSA) • Ownership of your health care dollars • Freedom to choose your doctor or hospital • Dedicated support to help lower your costs and improve your health (Ex: Treatment Cost Estimator)

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 7


Preventive care coverage

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

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Take advantage of your preventive care coverage • Preventive care is covered at 100% • Regular preventive care helps – Reduce risk of disease – Detect health problems early – Protect you from higher costs down the road – May save your life

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 9


Preventive care services include Adult

Child

Annual routine office visit and exam

Six visits 0-12 months

Tetanus/Diphtheria booster

Three visits 12-24 months

Annual influenza vaccination (flu shot)

Annual visits age 24 months through age 18

Cholesterol screening

Annual Pap smear and pelvic exam, as appropriate by age

Annual mammogram after age 40

Lead-level testing

Annual Pap smear and pelvic exam

Immunizations

Labs, pathology, chest X-ray, and EKG (when performed as preventive care)

Labs, pathology, chest X-ray, and EKG (when performed as preventive care)

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 10


The Definity HSASM Plan How the plan works

*From www.healthcarelane.com Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 11


2

The HSA payment process 1 1 Present ID card to doctor

2 Doctor sends claim to UnitedHealthcare

UnitedHealthcare applies network discount, sends back to doctor

33 Doctor then bills you for payment

44 When you have claim activity, you will receive a Health Statement

After deductible, doctor bills you for your share of coinsurance

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 12


To be eligible to open an HSA… • Must be covered by Town of Highland Park’s Basic Plan (high-deductible health plan) • Cannot be covered by other non-HDHP health insurance (this includes a healthcare FSA other than a limited FSA) *Must deplete your FY2011 FSA Balance • Cannot be enrolled in Medicare, TRICARE or TRICARE for Life • Cannot be claimed as a dependent on someone else’s tax return

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 13


Why open an HSA? • Once you open it, you… • • • • • •

Decide how much you want to deposit Decide when and how to spend it Keep it if you retire, change jobs or insurance plans Use it as a retirement plan for your health Save on taxes in three ways Can change amount as needed provided you don’t exceed max

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 14


Contributing to an HSA • For 2011, you can contribute up to the IRS maximum of: – $ 3,050 (single) – $ 6,150 (family) – Employees responsibility to monitor • Age 55 and older, “catch-up” contributions of $1,000 • Contributions may be made via: – Payroll deduction (and it’s pre-tax) – Direct to OptumHealth Bank by check or myuhc.com – Employees can change their contribution anytime throughout the year

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 15


Triple Tax Savings •

Deposits are not taxed - Employer will take money right from your paycheck, before taxes, and automatically deposit for you.

Payments on eligible medical and pharmacy expenses are free from income tax

Money made from interest or investments* is not taxed *Investments are not FDIC insured, are not guaranteed by the bank and may lose value.

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 16


HSA Qualified Medical Expense • Funds you withdraw from your HSA are tax-free when you pay for • eligible medical expenses (Can use HSA and limited FSA for vision) • • • • • • • •

Examples: Acupuncture Eyeglasses Infertility treatments Laser eye surgery Massage therapy (when recommended by a physician) Smoking cessation programs Prescription drugs • The IRS defines QME as amounts paid for the diagnosis, cure, mitigation treatment or prevention of disease and for treatments affecting any part or function of the body. For a more detailed list, please visit Web site, please visit www.irs.gov

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 17


Open your HSA with OptumHealthSM Bank, Member FDIC • • • •

Yes, they are a real bank and the largest HSA bank in the country Will be linked to your insurance plan to make things easy Focused only on health care and helping you save CALIBRE will deposit $250 on your behalf only with OptumHealth Bank (prorated by employment status and hire date) One Web site, myuhc.com, to easily manage health plan and HSA

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 18


You will receive a UnitedHealthcare HSA Debit Card Easy access to HSA dollars • • • •

Provided by OptumHealth Bank Use at doctor’s office or pharmacy Withdraw cash at ATM Get additional cards for family members (no charge) • Free online bill pay • Checks (optional, $10 for 25) *Access fees may also be charged by ATM owner. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 19


How Can An Individual Use HSA Funds? HSA funds can be used for both qualified and non-qualified expenses • A list of these expenses is available on the IRS Web site, www.irs.gov in IRS Publication 502, “Medical and Dental Expenses,” or can be ordered directly from the IRS at 1-800-TAX-FORM • Funds employees withdraw for qualified expenses are tax-free when used to pay for eligible health care expenses defined by IRS Code Sec.213(d). • If funds are used for non-qualified expenses, the amount withdrawn is subject to both income tax and a 20% penalty unless over the age of 65

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

20 20


HSA Choices Only from OptumHealth BankSM eAccessSM HSA

for active health care spenders

eSaverSM HSA

for those looking to earn competitive interest rates

eInvestorSM HSA

for those who plan to build and grow their HSA balances

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 21


Growing Funds Investments Provides greater potential greater for long-term growth • Funds over threshold amount of $2,000 can be directed into mutual fund(s) in $100 increments • • • •

Choice of 12 pre-selected highly rated mutual funds Auto sweep functionality Separate disclosures required – not FDIC insured Access to investments via Web site or IVR including Morningstar® Quick Take Pages (updated daily) and Lipper Fund Facts • Integrated statements – deposit and investment accounts combined – viewable online Any investments in mutual funds are not FDIC-insured, are not guaranteed by OptumHealth Bank, and may lose value.

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 22


Reporting - Employee Monthly Statements (summary of account activity) •Online statement standard via myuhc.com -(can opt to receive printed monthly statements)

Annual Form 1099SA •Reports distributions (Sent to account holder and IRS) •Sent by January 31 (if no distributions occurred, no form will be issued)

Annual Form 5498SA •Reports contributions (Sent to account holder and IRS) •Sent by May 31

Account holders will be required to file a Form 8889 with their annual tax return

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 23


Integrating Health and Financial Messages Personalized health messaging with HSA-Specific Campaigns ƒ How account works with medical plan ƒ Visiting your doctor with an HSA ƒ Identify ways to use the plan effectively ƒ Save vs. spend? ƒ Event triggered messaging ƒ (ie. “You’re eligible - open an HSA today”) ƒ Illustrate tax savings opportunities ƒ Address planning for future health needs ƒ Tax reporting ƒ forms you’ll receive, what you have to do ƒ Paying bills ƒ online or with your Debit MasterCard Delivered via:

ƒ Myuhc.com ƒ Health statements ƒ Customer care professionals Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 24


Account Holder Newsletters Bimonthly e-mail newsletters to United members with OptumHealth Bank HSAs – Seasonal message – e.g. tax reminders in Q1



Marketing message – how an HSA helps you plan, save and pay for health care



HSA need-to-know– e.g. how to check your balance and pay your bills



Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 25


Access to Accounts via myuhc.com

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 26


Account Balances on myuhc.com

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 27


HSA Summary on myuhc.com

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 28


Account Summary (begin access to account detail)

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 29


Consumer Online HSA Tools: Tax Resource Center

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 30


Quicken Health Expense Tracker for CDH A new way to help members better understand their health care claims and expenses • Intuit is the maker of TurboTax® and Quicken® • New online tool that helps your employees understand exactly what to pay and why

Once a member signs up, the tool: • Automatically downloads, organizes, and tracks their UnitedHealthcare medical, Medco pharmacy claims, and HRA/HSA/FSA account balances • Provides step-by step guidance so members know exactly what to pay and why • Allows easy online payment with any major credit or debit cards, including CDH consumer account cards Available through myuhc.com at no additional cost

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 31


Health Savings Account Benefits you can understand. October 2011

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. © 2008 UnitedHealthcare

© 2010 United HealthCare Services, Inc. UHCEW439246-000


Answers to Your HSA Plan Questions As you think about enrolling in the UnitedHealthcare Health Savings Account (HSA) Plan, keep in mind these great benefits. Your premium cost for this plan is usually lower than traditional copayment plans. One of the biggest benefits is that you will often pay lower plan premiums. A health plan with a high deductible will usually cost less than a low deductible plan.

You have protection from high out-of-pocket costs. The plan gives you financial protection with an out-of-pocket maximum. If you reach the maximum, the plan will pay 100 percent of all eligible expenses for the rest of the plan year.

Your preventive care is covered 100 percent in our network. Health reform and HSAs With the passing of the health reform law, two important changes affecting HSAs became effective January 1, 2011: • You can no longer pay for overthe-counter (OTC) medicines with an HSA unless you have a prescription. HSAs can still be used to pay for insulin and for many OTC supplies. • If you use an HSA to pay for items or services that aren’t qualified medical expenses and you are under age 65, the tax penalty increased from 10 percent to 20 percent of the HSA distribution.

Preventive care services will include routine wellness exams, well-child exams, physicals, mammograms, flu shots and other immunizations. See your plan benefit documents for specific details on preventive care coverage.

You have the option of opening a personal health savings account, or HSA. When you enroll in the HSA Plan, you have the option of opening a personal HSA to save money, income tax-free, to pay for qualified medical expenses which may count toward your deductible and other related health care expenses. You can use the HSA to save for future health expenses, including expenses you may have after you retire. All the money in the HSA is yours to keep and spend on qualified medical expenses, even if you change jobs or health plans. There is no “use it or lose it” rule.

The HSA can save you on taxes. There are tax advantages to an HSA. It is what we call “triple tax savings.” 1. Your deposits are exempt from federal income tax and most state income tax.* 2. Your savings grow tax-free. 3. Money you spend on qualified medical expenses is income tax-free, too.

*There are currently three states that require you to pay state income tax on the HSA: Alabama, California and New Jersey.


AnSWerS TO YOUr HSA PLAn QUeSTIOnS

What is a plan deductible? The plan deductible is a fi xed amount of money that must be paid before your health plan begins to pay for health care expenses. The only exception is preventive care, because the plan will pay 100% for those services when received in network, without requiring you to pay the deductible. As you pay for out-of-pocket medical expenses, these expenses may apply to the deductible. This can include payments using your HSA. If you reach the deductible, the plan will start paying its portion of covered medical expenses. The deductible will start over again in the new plan year.

What is a qualified medical expense? These are medical, dental or vision expenses that the IRS says can be paid for from an HSA without having to pay income taxes. Examples of qualified medical expenses include doctor’s office visits, drug prescriptions, dental treatments and X-rays, along with eyeglasses and vision exams. Even certain health plan premiums qualify, including:

Do I have to use the bank my employer chooses? No, you may open an HSA with the bank of your choice. You own your HSA, and you decide where to open your account.

If I need to pay for a doctor visit or for a prescription, how do I do so using HSA dollars? The HSA Plan does not require you to pay copayments or other costs at the time of service, especially if you are seeing a network doctor or hospital. Instead, the doctor should first submit the claim to UnitedHealthcare. This is to ensure that: • W e can determine if the claim is an eligible expense under your plan. • W e can determine whether the claim was for preventive care, so it can be paid 100 percent. • You receive any discounts for seeing a network doctor.

• COBRA health insurance premiums

example

• Qualifi ed long-term care insurance premiums

When you arrive for a network doctor appointment, be sure to present your health plan ID card so the office staff is aware that you have the HSA Plan. After your visit, the doctor will submit a claim to UnitedHealthcare for the cost of the visit.

• C overage while receiving federal or state unemployment benefits • O ther deductible health plans for those age 65 and older (except a Medicare Supplemental policy) The IRS may modify the list of qualified medical expenses from time to time. For example, recently the IRS added breast pumps and lactation aids to the list of qualified expenses. Visit irs.gov for more information. You should save all receipts for medical expense payments with your tax records. That way, you have proof that you used your HSA only to pay or reimburse yourself for qualified medical expenses.

1

UnitedHealthcare will process the claim at the rate agreed upon by the doctor.

2

If the visit was for preventive care, UnitedHealthcare will pay the claim 100 percent.

What expenses don’t qualify for tax benefits? Examples of expenses that do not qualify include cosmetic surgery, health club memberships, teeth whitening and overthe-counter medicines purchased without a prescription. If you use an HSA to pay for an expense that is not qualified, you will have to pay taxes on the expense and may also have to pay a 20 percent penalty. So, if the expense was $100, you would pay an extra $20, plus taxes.

2

Or

2

If the visit was not preventive care, UnitedHealthcare will notify both the doctor and you of the amount you owe.

3

The doctor will then be responsible for billing you directly.

4

Once you receive the bill, you can pay the bill with cash or credit card.


Once you receive a bill from your doctor or if you are at the pharmacy filling a prescription, you have a few options.

Can I use the HSA for my spouse or dependents if they are not covered under my plan?

• F  irst, most banks will give you a debit card to make paying easy. You can pay the bill with your debit card by filling out the credit/debit card information on the bill. If you are at the pharmacy or a walk-in clinic, you can swipe the card or hand it to the cashier, just like you would with any other debit card.

Yes, you can.

• S  ome banks may also make checks available to you (sometimes at a charge). • Y  ou can pay another way, such as with cash or other credit card. Later, you can choose to reimburse yourself from your HSA. Or, let your dollars grow for the future.

Is there a limit on how much I can contribute (deposit) to my HSA? Yes, there is an annual limit, determined by the IRS. For 2011, the most you can contribute to an HSA is $3,050 if you have individual coverage and $6,150 if you have family coverage. For 2012, the most you can contribute is $3,100 if you have individual coverage and $6,250 if you have family coverage. If you are 55 or older, you can make “catch-up” contributions, too. In 2012, you can deposit an additional $1,000. This helps people who are nearing retirement speed up their savings. If your spouse is also 55 or older, and meets the eligibility requirements for opening an account, he or she may establish a separate HSA and make “catch-up” contributions, too. While there is a limit on how much you can deposit into your HSA each year, there is no limit on how much you can save in your HSA over the long term.

Can other people contribute to my HSA? Yes, anyone can contribute to your HSA. A family member, for example, may choose to give you money that you can deposit into your account. Wherever the money comes from, though, keep in mind there are annual contribution limits set by the IRS. Contributions above the annual limit are subject to income taxes and a penalty.

What happens to my HSA if I leave my current employer or retire? You keep it. You don’t even have to change banks. If you take a job elsewhere or retire but do not have coverage under an HSA-eligible health plan, you can still use your HSA to pay for qualified medical expenses. However, IRS rules will not allow you to deposit money into the HSA and receive tax benefits if you are not currently enrolled in an HSA-eligible health plan.

If I am still carrying health coverage for my 24-year-old, can I use my HSA to help pay for his qualified medical expenses? It depends. An adult child must still be a tax dependent in order for his or her medical expenses to qualify for payment or reimbursement from a parent’s HSA. If the adult child is not a tax dependent but is covered by a parent’s HSA-eligible health plan, he or she may be able to open his or her own HSA. In these circumstances, it is best to consult with a competent tax advisor.

What if my spouse is also covered by an HSAeligible health plan and has an HSA? The law says that in this case, the two of you together can only contribute up to the family limit, either to individual HSAs or to one or the other’s HSA.

If I’m 65 or older and decide to retire, what happens to my HSA? Once you retire, you can continue to receive tax benefits when you use the HSA for qualified medical expenses. If you are 65 years old or older, there is no penalty for withdrawing your money, even if you enroll in Medicare. When your Medicare coverage starts, you can use your HSA to pay your Medicare premiums, deductibles and copayments. After you turn 65 or become entitled to Medicare benefits, you may withdraw money from your HSA for non-medical purposes without penalty. The withdrawal is treated as retirement income and is subject to normal income tax.

I want my dollars to go as far as possible. So how can I find out how much a treatment or procedure is going to cost? After you enroll, you will have tools on myuhc.com, like the Treatment Cost Estimator, to help you make the best decision regarding your care. The Treatment Cost Estimator can help estimate the cost of treatments and other procedures based on your health plan, a specific doctor or hospital, and your ZIP Code. We also encourage you ask your doctor how much a service or procedure might cost. Doctors and hospitals may charge different rates for the same services depending where you go. So your choice can make a big difference.

3


AnswerS TO YOUR HSA PLAN questions Can I have an HSA and a health care flexible spending account, or FSA? No. Federal tax law does not permit you to enroll in a health care FSA. But the law does permit you to enroll in what is called a limited-purpose FSA to pay for qualified dental and vision expenses. See your benefit plan to see if a limited-purpose FSA is available to you. You may also open a dependent care FSA if your employer offers this option. A dependent care FSA can help you save to pay for qualified day care expenses for children under 13 or adult dependents who cannot care for themselves.

OptumHealth Bank is UnitedHealthcare’s health care bank of choice OptumHealth Bank, Member FDIC, is one of the nation’s leading HSA custodians. Only OptumHealth Bank gives you the convenience of managing your HSA dollars through your health plan website – myuhc.com. When you log in to myuhc.com, you can do all of your banking: pay bills, make deposits, reimburse yourself, track spending, start investments and see your tax savings. In addition, you also get the Health Savings Account Debit MasterCard® to make it easy to pay from your account and the Health Savings News, an e-newsletter for health care saving and spending tips. How do I open my HSA with OptumHealth Bank? You can complete a paper application, if available. Or, you can go to myuhc.com and click on Health Savings Account, under the Information Center. Follow the instructions to complete the online application. You’ll need your health plan information, such as your group number, to complete the application. OptumHealth Bank will send you a welcome kit, your HSA Debit MasterCard and PIN.

UnitedHealthcare Insurance Company Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., or their affiliates. Health savings accounts (HSAs) are individual accounts offered by OptumHealth BankSM, Member FDIC, and are subject to eligibility and restrictions, including but not limited to restrictions on distributions for qualified medical expenses set forth in section 213(d) of the Internal Revenue Code. This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change. Please check your health benefit plan materials to determine whether your employer will make supplemental contributions to your HSA. Information for individuals residing in the state of Louisiana or have policies issued in Louisiana: Health care services may be provided to you at a network health care facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of these fees for those non-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles, and non-covered services. Specific information about network and non-network facility-based physicians can be found at myuhc.com or by calling the toll-free Customer Care telephone number that appears on the back of your health plan ID card. myuhc.com® is a registered trademark of UnitedHealth Group Incorporated. MasterCard® is a registered trademark of MasterCard Worldwide. This card is issued by OptumHealth BankSM pursuant to license by MasterCard® International 100-10680 06/11 Consumer

© 2011 United HealthCare Services, Inc. UHCEW533346-000


See Samuel Save. Sam enjoys the tax advantages of the OptumHealth Bank, Member FDIC, health savings account (HSA). Samuel’s HSA contributions are easy to make and tax-deductible. } Samuel plans to contribute to his OptumHealth BankSM HSA on a biweekly basis to reach the IRS maximum allowable amount of $6,250 for family coverage. Individuals can contribute $3,100.

Samuel is married with three children. Samuel chooses family coverage with the UnitedHealthcare HSA Plan. He opens an OptumHealth BankSM, Member FDIC, health savings account (HSA) to help him pay and save for qualified medical expenses today and into the future.

Biweekly amount

Annual totals (26 contributions)

HSA contribution

$260

$6,250

Tax Savings

$86

$2,063

(28% federal, 5% state income taxes)

Any money Samuel withdraws from his HSA to pay for qualified medical expenses is tax-free. } This year, Samuel expects to withdraw $3,000 from his HSA to pay for qualified health care expenses for him and his family.

} Those include a couple of trips to urgent care, prescription costs, visits to see medical specialists and dental care. Samuel saves money on taxes while his account balance grows and grows. }A  fter his $3,000 in expenses are paid, Samuel will have $3,250 left over from his annual $6,250 contribution.

}S  amuel can keep this money and carry it over to the next year. Over time, this can really add up! See Samuel’s balance grow:

With an HSA, Samuel gets triple tax savings: 1. The money he puts into his HSA is exempt from federal income tax. 2. Any interest he earns is tax exempt, and he has the potential to build a health care nest egg for the future. 3. Any money he takes out of his HSA to pay for qualified medical expenses is income-tax free.

In 1 year

In 5 years

In 15 years

$6,250

$31,250

$93,750

- Samuel’s HSA = Money left in Samuel’s HSA

($3,000)

($15,000)

($45,000)

$3,250

$16,250

$48,750

Money Samuel saves on taxes + (28% federal, 5% state)

$2,063

$10,313

$30,938

Samuel’s HSA contribution Qualified expenses paid with

Samuel uses his HSA to save for the future } Every year Samuel will earn tax-free interest on his HSA balance. } Once the balance meets a certain amount, he can begin to invest some of his savings into mutual funds for potentially greater long-term growth.

Investment products are not FDIC insured, are not guaranteed by OptumHealth Bank, and may lose value.


OptumHealth BankSM is UnitedHealthcare’s health care bank of choice. OptumHealth Bank is one of the nation’s leading HSA custodians. Only OptumHealth Bank gives you the convenience of managing your HSA dollars through your health plan website – myuhc.com®.

When you log in to myuhc.com, you can do all of your banking: pay bills, make deposits, reimburse yourself, track spending, start investments and see your tax savings. In addition, you also get the Health Savings Account Debit MasterCard®, to make it easy to pay from your account, and Health Savings News, an e-newsletter for health care saving and spending tips.

UnitedHealthcare Insurance Company Hypothetical example is for illustrative purposes only. All events, persons and results described herein are entirely fictitious and amounts will vary depending on your unique circumstances. Any resemblance to real events or persons, living or dead, is purely coincidental. In 2012, the IRS limits are $3,100 for individual and $6,250 for family coverage. Health savings accounts (HSAs) are individual accounts offered by OptumHealth BankSM, Member FDIC, and are subject to eligibility and restrictions, including but not limited to restrictions on distributions for qualified medical expenses set forth in section 213(d) of the Internal Revenue Code. This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment, and restrictions. Federal and state laws and regulations are subject to change. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., or their affiliates. myuhc.com® is a registered trademark of UnitedHealth Group Incorporated. 161-0154 07/11

© 2011 United HealthCare Services, Inc. FSEDU0325Sv01MA UHCEW535186-000


Plan One

Accident Indemnity Advantage

SM

24-Hour Accident-Only Insurance If you’ve ever been out of work because of an injury, you know there are two things that are increasingly hard to come by:

Peace of mind and cash benefits. Our insurance policies help provide both.

American Family Life Assurance Company of Columbus (Aflac) Form A35175TX

IC(4/09)


Plan One

Accident Indemnity Advantage

SM

24-Hour Accident-Only Insurance Policy A35100TX

The Need

Accidents happen to all kinds of people every day. In 2005, over 30 million people sought medical attention for an injury and almost 3 million of these were hospitalized.* What would the financial impact of an injury mean to your security? Are you prepared for medical debts in addition to everyday household expenditures and lost wages? Out-of-pocket expenses associated with an accident are unexpected and often burdensome; perhaps the accident itself could not have been prevented, but its impact on your finances and your well-being certainly can be reduced.

Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with expenses incurred due to an injury, to help with ongoing living expenses, or to help with any purpose you choose. Aflac Accident Indemnity Advantage is designed to provide you with cash benefits throughout the different stages of care, regardless of the severity of the injury.

The Accident Indemnity Advantage Insurance Policy has: • No deductibles and no copayments. • No lifetime limits. • No network restrictions—you choose your own medical treatment provider. • No coordination of benefits—we pay regardless of any other insurance.

*Injury Facts, 2008 Edition, National Safety Council.


Aflac enables you to take charge and to help provide for an unpredictable future by paying cash benefits for accidental injuries. Your own peace of mind and the assurance that your family will have help financially are powerful reasons to consider Aflac.

Out-of-pocket

When you consider the competitive cost of providing your family with Aflac, it’s truly remarkable that this policy could potentially save you and your loved ones from financial uncertainty during a very stressful time. Knowing that you have prepared for the many financial consequences of an accident is an assurance in itself, yielding strength and confidence for uncertain possibilities.

are unexpected and

Aflac is a market leader with more than 50 years in the insurance industry, and we work hard to help meet your insurance needs.

expenses associated with an accident often burdensome; perhaps the accident itself could not have been prevented, but its impact on your finances and your well-being certainly can be reduced.

The policy to which this sales material pertains is written only in English; the policy prevails if interpretation of this material varies.


Benefit

Wellness

Benefit Amount

Additional Benefit Information

$60 once per policy, per 12-month period, payable after the policy has been in force for 12 months

Payable if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Eligible family members are your Spouse and the Dependent Children of either you or your Spouse. Services covered are annual physical examinations, dental examinations, mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, ultrasounds, prostate-specific antigen tests (PSAs), and blood screenings. This benefit will become available following each anniversary of the policy’s effective date for service received during the following policy year and is payable only once per policy each 12-month period following your policy anniversary date. Service must be under the supervision of or recommended by a physician, received while your policy is in force, and a charge must be incurred.

Aflac will pay the following benefits as applicable if a Covered Person’s Accidental Death, dismemberment, or Injury is caused by a covered accident that occurs on or off the job. Accidental Death, dismemberment, or Injury must be independent of Sickness or the medical or surgical treatment of Sickness, or of any cause other than a covered accident. A covered Accidental Death, dismemberment, or Injury must also occur while coverage is in force and is subject to the limitations and exclusions. Treatment or confinement in a U.S. government hospital does not require a charge for benefits to be payable.

Accident Emergency Treatment

$120 once per 24-hour period and once per covered accident, per Covered Person

Payable when a Covered Person receives treatment for Injuries sustained in a covered accident. This benefit is payable for treatment by a physician or treatment received in a hospital emergency room. Treatment must be received within 72 hours of the accident for benefits to be payable.

X-Ray

$25 once per covered accident, per Covered Person

Payable when a Covered Person requires an X-ray while receiving emergency treatment in a hospital or a hospital emergency room for Injuries sustained in a covered accident. This benefit is not payable for X-rays received in a physician’s office. The X-Ray Benefit is not payable for exams listed in the Major Diagnostic Exams Benefit.

Accident Follow-Up Treatment

$25 for one treatment per day, up to a maximum of six treatments per covered accident, per Covered Person

Payable when a Covered Person receives emergency treatment for Injuries sustained in a covered accident and later requires additional treatment over and above emergency treatment administered in the first 72 hours following the accident. The treatment must begin within 30 days of the covered accident or discharge from the hospital. Treatments must be furnished by a physician in a physician’s office or in a hospital on an outpatient basis. This benefit is payable for acupuncture when furnished by a licensed, certified acupuncturist. The Accident Follow-Up Treatment Benefit is not payable for the same days the Physical Therapy Benefit is paid.

$1,000 once per period of Hospital Confinement or $1,500 once when a Covered Person is admitted directly to an intensive care unit; payable once per calendar year, per Covered Person

Payable when a Covered Person is admitted for a Hospital Confinement of at least 18 hours for treatment of Injuries sustained in a covered accident or if a Covered Person is admitted directly to an intensive care unit of a hospital for treatment of Injuries sustained in a covered accident. Hospital Confinements must start within 30 days of the accident.

Accident Hospital Confinement

$200 per day up to 365 days per covered accident, per Covered Person

Payable when a Covered Person is admitted for a Hospital Confinement of at least 18 hours for treatment of Injuries sustained in a covered accident. Hospital Confinements must start within 30 days of the accident.

Intensive Care Unit Confinement

An additional $400 per day for up to 15 days per covered accident, per Covered Person

Payable for each day a Covered Person receives the Accident Hospital Confinement Benefit, and is confined and charged for a room in an intensive care unit for treatment of Injuries sustained in a covered accident. Hospital Confinements must start within 30 days of the accident.

Initial Accident Hospitalization


Benefit

Accident Specific-Sum Injuries

Major Diagnostic Exams

Benefit Amount

Additional Benefit Information

$25–$10,000 (according to the policy) for: • Dislocations • Burns • Skin grafts • Eye injuries • Lacerations • Fractures • Concussions • Emergency dental work • Coma • Paralysis • Surgical procedures • Miscellaneous surgical procedures

Treatment must be performed on a Covered Person for Injuries sustained in a covered accident. We will pay for no more than two dislocations per covered accident, per Covered Person. Benefits are payable for only the first dislocation of a joint. If a dislocation is reduced with local anesthesia or no anesthesia by a physician, we will pay 25 percent of the amount shown for the closed reduction dislocation. Burns must be treated by a physician within 72 hours after a covered accident. If a Covered Person receives one or more skin grafts for a covered burn, we will pay a total of 50 percent of the burn benefit amount that we paid for the burn involved. Lacerations must be repaired within 72 hours after the accident and repaired under the attendance of a physician. We will pay 25 percent of the benefit amount shown for the closed reduction of chip fractures and other fractures not reduced by open or closed reduction. We will pay for no more than two fractures per covered accident, per Covered Person. Emergency dental work does not include false teeth such as dentures, bridges, veneers, partials, crowns, or implants. We will pay for no more than one emergency dental work benefit per covered accident, per Covered Person. The duration of paralysis must be a minimum of 30 days, and this benefit will be payable once per Covered Person. Coma must last a minimum of seven days. Coma does not include any medically induced coma. Treatment for surgical procedures must be performed within one year of a covered accident. Two or more surgical procedures performed through the same incision will be considered one operation, and benefits will be paid based upon the most expensive procedure. Only one miscellaneous surgery benefit is payable per 24-hour period even though more than one surgical procedure may be performed.

$150 once per calendar year, per Covered Person

Payable when a Covered Person requires one of the following exams for Injuries sustained in a covered accident and a charge is incurred: computerized tomography (CT scan), computerized axial tomography (CAT), magnetic resonance imaging (MRI), or electroencephalography (EEG). These exams must be performed in a hospital or a physician’s office. Exams listed in the Major Diagnostic Exams Benefit are not payable under the X-Ray Benefit.

Epidural Pain Management

$100 paid no more than twice per covered accident, per Covered Person

Payable when a Covered Person is prescribed, receives, and incurs a charge for an epidural administered for pain management in a hospital or a physician’s office for Injuries sustained in a covered accident. This benefit is not payable for an epidural administered during a surgical procedure.

Physical Therapy

$25 per treatment for one treatment per day, up to a maximum of ten treatments per covered accident, per Covered Person

Payable when a Covered Person receives emergency treatment for Injuries sustained in a covered accident and later a physician advises the Covered Person to seek treatment from a licensed physical therapist. Physical therapy must be for Injuries sustained in a covered accident and must start within 30 days of the covered accident or discharge from the hospital. The treatment must take place within six months after the accident. The Physical Therapy Benefit is not payable for the same days that the Accident Follow-Up Treatment Benefit is paid.

Appliances

$100 once per covered accident, per Covered Person

Payable when a Covered Person receives a medical appliance, prescribed by a physician, as an aid in personal locomotion for Injuries sustained in a covered accident. Benefits are payable for the following types of appliances: a wheelchair, a leg brace, a back brace, a walker, and/ or a pair of crutches.

The policy has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. See the policy and outline of coverage for complete details, definitions, limitations, and exclusions.

T

F


Benefit

Benefit Amount

Additional Benefit Information

Prosthesis

$500 once per covered accident, per Covered Person

Payable when a Covered Person requires use of a prosthetic device as a result of Injuries sustained in a covered accident. This benefit is not payable for repair or replacement of prosthetic devices, hearing aids, wigs, or dental aids, to include false teeth.

D

Blood/ Plasma/ Platelets

$100 once per covered accident, per Covered Person

$150 when a Covered Person requires ambulance transportation

Ambulance

$1,000 when a Covered Person requires air ambulance transportation

Payable when a Covered Person receives blood/plasma and/or platelets for the treatment of Injuries sustained in a covered accident. This benefit does not pay for immunoglobulins.

Payable when a Covered Person requires ambulance transportation or air ambulance transportation to a hospital for Injuries sustained in a covered accident. Ambulance transportation must be within 72 hours of the covered accident. A licensed professional ambulance company must provide the ambulance service.

Transportation

$400 per round trip, up to three round trips per calendar year, per Covered Person

Payable per round trip to a hospital when a Covered Person requires Hospital Confinement for medical treatment due to an Injury sustained in a covered accident. This benefit is also payable when a covered Dependent Child requires hospital confinement for medical treatment due to an Injury sustained in a covered accident if commercial travel is necessary and such Dependent Child is accompanied by any immediate family member. This benefit is not payable for transportation to any hospital located within a 50-mile radius from the site of the accident or the residence of the Covered Person. The local attending physician must prescribe the treatment requiring Hospital Confinement, and the treatment must not be available locally. This benefit is not payable for transportation by ambulance or air ambulance to the hospital.

Family Lodging

$100 per night, limited to one motel/hotel room per night, up to 30 days per covered accident

Payable for one motel/hotel room for a member of the immediate family who accompanies a Covered Person who is admitted for a Hospital Confinement for the treatment of Injuries sustained in a covered accident. This benefit is payable only during the same period of time the injured Covered Person is confined to the hospital. The hospital and motel/hotel must be more than 50 miles from the residence of the Covered Person.

AccidentalDeath

Common- Other Hazardous Carrier Accident Activity Accident Accident

Insured $ 100,000 $ 25,000 $ 6,250 Spouse $ 100,000 $ 25,000 $ 6,250 Child $ 15,000 $ 7,500 $ 1,875

We will pay the applicable lump sum benefit indicated for the Accidental Death of a Covered Person. Accidental Death must occur as a result of an Injury sustained in a covered accident and must occur within 90 days of such accident. Note: We do not recommend that you name a minor child as your beneficiary. If you name a minor child as your beneficiary, any benefits due your minor beneficiary will not be payable until a guardian for the financial estate of the minor is appointed by the court or such beneficiary reaches the age of majority as defined by your state. If there is no beneficiary, Aflac will pay any applicable benefit to your estate. Please see the Terms You Need to Know section of the brochure for more details about Common-Carrier Accidents, Other Accidents, and Hazardous Activity Accidents.


Benefit

AccidentalDismemberment

Continuation of Coverage

Additional Benefit Information

Benefit Amount

$500–$25,000

We will pay the applicable lump sum benefit indicated in the policy for dismemberment. Dismemberment must occur as a result of Injuries sustained in a covered accident and must occur within 90 days of the accident. Only the highest single benefit per Covered Person will be paid for dismemberment. Benefits will be paid only once per Covered Person, per covered accident. If death and dismemberment result from the same accident, only the AccidentalDeath Benefit will be paid. Loss of use does not constitute dismemberment, except for eye injuries resulting in permanent loss of vision such that central visual acuity cannot be corrected to better than 20/200.

Waive all monthly premiums for up to two months

We will waive all monthly premiums due for the policy and riders for up to two months if you meet all of the following conditions: (1) Your policy has been in force for at least six months; (2) We have received premiums for at least six consecutive months; (3) Your premiums have been paid through payroll deduction and you leave your employer for any reason; (4) You or your employer notifies us in writing within 30 days of the date your premium payments cease because of your leaving employment; and (5) You re-establish premium payments either through your new employer’s payroll deduction process or direct payment to Aflac. You will again become eligible to receive this benefit after you re-establish your premium payments through payroll deduction for a period of at least six months, and we receive premiums for at least six consecutive months. (Payroll deduction means your premium is remitted to Aflac for you by your employer through a payroll deduction process.)

What Is Not Covered Limitations and Exclusions We will not pay benefits for services rendered by you or a member of the immediate family of a Covered Person. We will not pay benefits for treatment or loss due to Sickness, including (1) any bacterial, viral, or micro-organism infection or infestation, or any condition resulting from insect, arachnid, or other arthropod bites or stings; or (2) an error, mishap, or malpractice during medical, diagnostic, or surgical treatment or procedure for any Sickness. We will not pay benefits whenever coverage provided by the policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void. We will not pay benefits for an Injury, treatment, disability, or loss that is caused by or occurs as a result of a Covered Person’s: • Participating in any activity or event, including the operation of a vehicle, while under the influence of a controlled substance (unless administered by a physician and taken according to the physician’s instructions) or while intoxicated (intoxicated means that condition as defined by the law of the jurisdiction in which the accident occurred); • Using any drug, narcotic, hallucinogen, or chemical substance (unless administered by a physician and taken according to the physician’s instructions) or voluntarily taking any kind of poison or inhaling any kind of gas or fumes; • Participating in any illegal activity that is defined as a felony (felony is as defined by the law of the jurisdiction in which the activity takes place); or being incarcerated in any type penal institution; • Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane; • Having cosmetic surgery or other elective procedures that are not medically necessary; • Having dental treatment except as a result of Injury; • Being exposed to war or any act of war, declared or undeclared; • Actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserve. Hospital does not include any institution or part thereof used as a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for the aged, or care for persons addicted to drugs or alcohol. A physician or a physical therapist does not include you or a member of your immediate family.


Terms You Need to Know Guaranteed-Renewable: The policy is guaranteed-renewable for your lifetime, subject to Aflac’s right to change premiums by class upon any renewal date. Effective Date: the date(s) coverage begins as shown in the Policy Schedule. The Effective Date of the policy is not the date you signed the application for coverage. Covered Person: any person insured under the coverage type you applied for: individual (named insured listed in the Policy Schedule), named insured/Spouse only (named insured and Spouse), one-parent family (named insured and Dependent Children), or two-parent family (named insured, Spouse, and Dependent Children). Spouse is defined as the person to whom you are legally married and who is listed on your application. Newborn children are automatically covered under the terms of the policy from the moment of birth. If coverage is for individual/Spouse only, and you desire uninterrupted coverage, you must notify Aflac in writing within 31 days of the birth of your child, and Aflac will convert the policy to one-parent family or two-parent family coverage and advise you of the additional premium due. Coverage will include any other unmarried Dependent Child, regardless of age, who is incapable of self-sustaining employment by reason of mental retardation or physical handicap and who became so incapacitated while covered hereunder. Dependent Children are your natural children, stepchildren, grandchildren, or legally adopted children who are unmarried, under age 25, and your dependents. A Dependent Child (including persons incapable of self-sustaining employment by reason of mental retardation or physical handicap) must be under age 25 at the time of application to be eligible for coverage. Hospital Confinement: a stay of a Covered Person confined to a bed in a hospital for which a room charge is made. The Hospital Confinement must be on the advice of a physician, medically necessary, and the result of Injuries sustained in a covered accident or for rehabilitative care for Injuries sustained in a covered accident. Treatment or confinement in a U.S. government hospital does not require a charge for benefits to be payable. Sickness: an illness, disease, infection, or any other abnormal physical condition, independent of Injury, occurring on or after the Effective Date of coverage and while coverage is in force. Injury: a bodily injury caused directly by an accident, independent of Sickness, disease, bodily infirmity, or any other cause, occurring on or after the Effective Date of coverage and while coverage is in force. See the Limitations and Exclusions section for Injuries not covered by the policy. Accidental Death: death caused by a covered Injury. Common-Carrier Accident: an accident, occurring on or after the Effective Date of coverage and while coverage is in force, directly involving a common-carrier vehicle in which a Covered Person is a passenger at the time of the accident. A common-carrier vehicle is limited to only an airplane, train, bus, trolley, or boat that is duly licensed by a proper authority to transport persons for a fee, holds itself out as a public conveyance, and is operating on a posted regularly scheduled basis between predetermined points or cities at the time of the accident. A passenger is a person aboard or riding in a common-carrier vehicle other than (1) a pilot, driver, operator, officer, or member of the crew of such vehicle; (2) a person having any duties aboard such vehicle; or (3) a person giving or receiving any kind of training or instruction. A Common-Carrier Accident does not include any Hazardous Activity Accident or any accident directly involving private, on demand, or chartered transportation in which a Covered Person is a passenger at the time of the accident. Hazardous Activity Accident: an accident that occurs on or after the Effective Date of coverage, while coverage is in force, and while a Covered Person is participating in sky diving, scuba diving, hang gliding, motorized vehicle racing, cave exploration, bungee jumping, parachuting, or mountain or rock climbing, or while a Covered Person is a pilot, an officer, or a member of the crew of an aircraft and has any duties aboard an aircraft, or while giving or receiving any kind of training or instruction aboard an aircraft. A Hazardous Activity Accident does not include any Common-Carrier Accidents. Other Accident: an accident occurring on or after the Effective Date of coverage and while coverage is in force that is not classified as either a Common-Carrier Accident or a Hazardous Activity Accident and that is not specifically excluded in the Limitations and Exclusions section. Grace Period: A grace period of 31 days will be granted for the payment of each premium falling due after the first premium. During the grace period, the policy will continue in force. Premiums: Premiums are subject to change. Risk Class: _____ Policy: A35100TX Optional Riders: Off-the-Job Accident Disability Benefit Rider: A35050TX On-the-Job Accident Disability Benefit Rider: A35051TX Benefit Rider: A35052TX Sickness Disability Accident Disability Benefit Rider: A35053TX Spouse Off-the-Job Additional Accidental-Death Benefit Rider: A35054

Annual $_______

Semiannual $_______

Quarterly $_______

Monthly $_______

$_______ $_______ $_______ $_______ $_______

$_______ $_______ $_______ $_______ $_______

$_______ $_______ $_______ $_______ $_______

$_______ $_______ $_______ $_______ $_______

The person to whom the policy is issued is permitted to return the policy to Aflac within 30 days of its delivery and to have the premium paid refunded. American Family Life Assurance Company of Columbus (Aflac) 1932 Wynnton Road • Columbus, GA 31999 • Phone: 706.323.3431 • Toll-free: 1.800.992.3522 • aflac.com 


Plan 1

Hospital Protection Hospital Confinement Indemnity Insurance ‌ what you need, when you need it.

Designed specifically for hospital stays

American Family Life Assurance Company of Columbus (Aflac) Form A46175TX

RC(4/07)


Hospital Protection Policy A46100TX Annual Hospitalization Confinement Benefit Aflac will pay the amount listed below for the first five days of hospitalization when a covered person requires hospital confinement* for a covered sickness or injury, or for rehabilitory care as a result of sickness or injury, and a charge is incurred. Sickness Injury

$400 per day $500 per day

Benefits for the Annual Hospitalization Confinement Benefit are limited to a total benefit payment of five days per calendar year, per policy. Confinements not separated by 30 days or more, or hospitalization that begins prior to the end of one calendar year and continues into the next calendar year, will be considered one confinement. Daily Hospital Confinement Benefit Aflac will pay $100 per day for the period of hospital confinement* when a covered person requires hospital confinement for a covered sickness or injury, or for rehabilitory care as a result of sickness or injury. This benefit is payable in addition to the Annual Hospitalization Confinement Benefit. The maximum benefit period for any one period of hospital confinement is 365 days. No lifetime maximum. *Hospital confinement does not include emergency rooms. Treatment or confinement in a U.S. government hospital does not require a charge for benefits to be payable. Waiver of Premium Benefit Aflac will waive from month to month, for the named insured only, any premium(s) falling due during the named insured’s continued hospital confinement. This benefit will begin after the named insured has received Daily Hospital Confinement Benefits from the policy for 30 consecutive days. When Daily Hospital Confinement Benefits are no longer being paid, premium payments must be resumed. Once premium payments are resumed, any new confinements must again satisfy the 30-day continued confinement for premiums to be waived. If you die and your spouse becomes the new named insured, premiums will start again at the appropriate rate and will be due on the first premium due date after the change. The new named insured will then be eligible for this benefit if the need arises.

Grace Period A grace period of 31 days will be granted for the payment of each premium falling due after the first premium. During the grace period, the policy will continue in force. Premiums Premiums are subject to change. Risk Class: ________ Annual Semiannual Quarterly Monthly Policy A46100TX: $_______ $_______ $_______ $_______ Optional Rider: Initial Hospitalization Benefit A46050:

$_______ $_______

$_______ $_______

The person to whom the policy is issued is permitted to return the policy to Aflac within 30 days of its delivery and to have the premium paid refunded. Guaranteed-Renewable The policy is guaranteed-renewable for your lifetime, subject to Aflac’s right to change premiums by class upon any renewal date. Family Coverage Family coverage includes the insured; spouse; and dependent, unmarried children under age 25. Newborn children are automatically insured from the moment of birth. One-parent family coverage includes the insured and dependent, unmarried children under age 25. A dependent child must be under age 25 at the time of application to be eligible for coverage. Effective Date The effective date is the date shown in the Policy Schedule, not the date the application is signed. Payroll rates may be retained after one month’s premium payment on payroll deduction.


Pre-Existing Conditions A pre-existing condition is an illness, disease, or disorder for which, within the 12-month period before the effective date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a pre-existing condition will not be covered unless it begins more than six months after the effective date of coverage. A sickness is an illness, disease, or disorder, independent of injury, diagnosed or treated more than 30 days after the effective date of coverage and while coverage is in force. Limitations and Exclusions Any illness, disease, or disorder diagnosed by a physician or medically treated during the 12 months prior to the effective date of the policy will not be covered, unless the loss begins more than six months after the effective date of the policy. Benefits are not payable for any illness, disease, or disorder that is diagnosed by a physician or medically treated before coverage has been in force 30 days from the effective date shown in the Policy Schedule, unless the loss begins more than six months after the effective date of the policy. Benefits for a covered sickness for all persons added to the policy (including newborns) are subject to a 30-day waiting period. Aflac will waive the waiting period for newborns added after the policy has been in force for ten full months. The policy does not cover losses caused by or resulting from intentionally self-inflicting bodily injury or attempting suicide; participating in any illegal activity that is classified as a felony (the term felony is as defined by the law of the jurisdiction in which the activity takes place); being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve; having treatment for a mental or nervous disorder without demonstrable organic disease; alcoholism or drug dependency; any loss sustained or contracted due to a covered person’s being intoxicated or under the influence of alcohol, drugs, or any narcotic unless administered on the advice of a physician and taken according to the physician’s instructions (the term intoxicated refers to that condition as defined by the law of the jurisdiction in which the injury or cause of the loss occurred); having cosmetic surgery that is not medically necessary; having elective surgery that is not medically necessary within the first 12 months of the effective date of the policy; pregnancy or childbirth for a covered person, if the pregnancy is a normal pregnancy and the pregnancy began prior to the effective date of the policy (complications of pregnancy will be covered to the same extent as a sickness); routine nursing or well-baby care for a newborn child; being hospitalized before the effective date of coverage; or donating an organ within the first 12 months of the effective date of the policy.

If the period of hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless the later confinement is the result of an entirely unrelated sickness or injury, or the confinements are separated by 30 days or more during which the covered person is not confined in any institution or facility. A physician does not include a member of your immediate family. Hospital does not include any institution or part thereof used as an emergency room; a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a psychiatric unit; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for the aged, or care for persons addicted to drugs or alcohol. Complications of pregnancy do not include premature delivery without incidence, false labor, occasional spotting, prescribed rest during pregnancy, morning sickness, and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy. Cesarean deliveries are not considered complications of pregnancy. The policy to which this sales material pertains is written only in English; the policy prevails if interpretation of this material varies.

This is a brief summary of coverage. Refer to the policy, rider, and outline of coverage for complete details, limitations, and exclusions.


Aflac is ... • A Fortune 500 company (Fortune magazine, April 2006) with nearly $60 billion (company statistics, December 2005), in assets, insuring more than 40 million people worldwide (company statistics, May 2005). • Rated AA in insurer financial strength by Standard & Poor’s (June 2006), Aa2 (Excellent) in insurer financial strength by Moody’s Investors Service (January 2006), A+ (Superior) by A.M. Best (June 2006), and AA in insurer financial strength by Fitch, Inc. (June 2006).* • Named by Fortune magazine to its list of America’s Most Admired Companies for the seventh consecutive year in March 2007. • A premier provider of insurance policies with premiums payroll deducted for more than 370,000 payroll accounts nationally (company statistics, November 2006). • Included by Forbes magazine in its annual list of America’s 400 Best Big Companies for the seventh year in January 2007. • Named by Fortune magazine to its list of the 100 Best Companies to Work For in America for the ninth consecutive year in January 2007. *Ratings refer only to the overall financial status of Aflac and are not recommendations of specific policy provisions, rates, or practices.

1.800.99.AFLAC (1.800.992.3522) En español: 1.800.SI.AFLAC (1.800.742.3522) Visit our Web site at aflac.com. Your local Aflac insurance agent/producer

American Family Life Assurance Company of Columbus (Aflac) · Worldwide Headquarters · 1932 Wynnton Road · Columbus, Georgia 31999 · aflac.com


Rate sheet prepared by Web User on 7/28/2011 12:38:20 PM. Texas Payroll Premium rates are Monthly for industry Class A The rates shown on this insert page are for illustration purposes only; they do not imply coverage. For more information about policy benefits and limitations, please refer to the accompanying product brochure for each insurance policy listed below. ACCIDENT INDEMNITY ADVANTAGE 24-HOUR LEVEL ONE - Series A-35100

18-49

Premium INDIVIDUAL

50-70 18-49

HUSBAND WIFE

50-70 18-49

ONE-PARENT FAMILY

50-70 18-49 50-70

TWO-PARENT FAMILY

$17.68

Total $17.68

$17.68

$17.68

$25.09

$25.09

$25.09

$25.09

$28.60

$28.60

$28.60

$28.60

$37.31

$37.31

$37.31

$37.31

HOSPITAL PROTECTION PLAN ONE - Series A46100

Page 1 of 1


Peace of Mind and Real Cash Benefits

GROUP CRITICAL ILLNESS

CI

G

CAI2875 IC(3/10)


CI

G

GROUP Critical Illness Policy Series CAI2800

You can win the battle against a critical illness, but can you handle the added costs? A group critical illness plan helps p r e p a r e y o u f o r th e added costs of battling a specif i c c r i t i c a l i l l n e s s . The good news is that many people with a critical illness survive these lifethreatening battles. Unfortunately, as the recovery process begins, people become aware of the medical bills that have piled up. Your recovery doesn’t have to be sp o i l e d b y m e d i c a l b i l l s . With this plan, our goal is to help you and your family cope with and recover from the financial stress of surviving a critical illness.

COVERAGE WORKSHEET

Employee Benefit:

$____________________

Spouse Benefit:

$____________________

Child Benefit:

$____________________

Total Weekly Deduction:

$____________________

(25 percent of the primary insured amount)

This worksheet is for illustration purposes only. It is not an implication of coverage.


B E N E F ITS C o v e r e d C r i t ic a l Illn e s s e s 1 :

CANCER (Internal or Invasive) HEART ATTACK (Myocardial Infarction) STROKE (Apoplexy or Cerebral Vascular Accident) MAJOR ORGAN TRANSPLANT

100% 100% 100% 100%

F IRST OC C URENC E B ENE F IT

After the waiting period, a lump sum benefit is payable upon initial diagnosis of a covered critical illness. Employee benefit amounts available from $5,000 to $50,000. Spouse coverage is also available 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 OCC U RRENC E B ENEFIT If an insured collects full benefits for a critical illness under the plan and later has one of the remaining covered critical illnesses, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least six months. $50 He alth Screening Benefit (Employee and Spouse only)

After the waiting period, an insured may receive 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. Payment of this benefit will not reduce the critical illness benefit payable under your certificate. There is no limit to the number of years the insured can receive the health screening benefit; it will be paid as long as the certificate remains in force. This benefit is payable for the covered Employee and Spouse. This benefit is not paid for Dependent Children. C o v e r e d h e a lt h s c r e e n i n g t e s t s i n clu d e :

• Mammography • Colonoscopy • Pap smear • Breast Ultrasound • Chest X-ray • PSA (blood test for prostate cancer) • Stress test on a bicycle or treadmill • Bone Marrow Testing • CA 15-3 (blood test for breast cancer)

RENAL FAILURE (End Stage) CARCINOMA IN SITU2 CORONARY ARTERY BYPASS SURGERY2

100% 25% 25%

RE-OCCU RRENCE BENE F IT 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 occurrence unless the Insured has gone treatment free for 12 months. CHIL D C OVERAGE AT NO ADDITIONA L C OST Each Dependent Child is covered at 25 percent of the primary insured amount at no additional charge.

1.4

OVER

FAC T

MILLION

The number of new cancer cases that were expected to be diagnosed in 20093.

3

Cancer Facts & Figures 2009, American Cancer Society. Society.

• CA 125 (blood test for ovarian cancer) • CEA (blood test for colon cancer) • Flexible sigmoidoscopy • Hemocult stool analysis • Serum protein electrophoresis (blood test for myeloma) • Thermography • Fasting blood glucose test • Blood test for triglycerides • Fasting blood glucose test • Serum cholesterol test to determine level of HDL and LDL

All covered conditions are subject to the definitions found in your certificate. If a benefit is paid for Carcinoma in Situ, the Internal Cancer benefit will be reduced by 25 percent. If a benefit is paid for coronary artery bypass surgery, the heart attack benefit will be reduced by 25 percent.

1 2

What is Not Covered, Limitations and EXCLUSIONS, AND TERMS YOU NEED TO KNOW. If diag n o s i s occur s a f t e r t h e ag e o f 7 0 , h a lf of t he b enefi t i s p a ya bl e .

The plan contains a 30-day waiting period. This means that no benefits are payable for any insured who has been diagnosed before your coverage has been in force 30 days from the effective date. If an insured is first diagnosed during the waiting period, benefits for treatment of that critical illness will apply only to loss starting after 12 months from the Effective Date or the Employee can elect to void the coverage and receive a full refund of premium.

The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description. ex clu sions

Benefits will not be paid for loss due to: • Intentionally self-inflicted injury or action; • Suicide or attempted suicide while sane or insane; • Illegal activities or participation in an illegal occupation;


What is Not Covered, Limitations and EXCLUSIONS, AND TERMS YOU NEED TO KNOW. • War, whether declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence; • Substance abuse; or • Pre-Existing Conditions (except as stated below). No benefits will be paid for loss which occurred prior to the effective date.

produces permanent clinical neurological sequela following an initial diagnosis made after any applicable Waiting Period. We must receive evidence of the permanent neurological damage provided from Computed Axial Tomography (CAT scan) or Magnetic Resonance Imaging (MRI). Stroke does not mean head injury, transient ischemic attack, or chronic cerebrovascular insufficiency.

No benefits will be paid for diagnosis made or treatment received outside of the Cancer (Internal or Invasive) means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of distant United States. tissue. Cancer includes leukemia. Excluded are Cancers that are Non-Invasive, Pre-ex i s t i n g C o n d i t i o n L i m i t a t i o n such as (1) Pre-malignant tumors or polyps; (2) Carcinoma in Situ; (3) Any Pre-Existing Condition means a sickness or physical condition which, within skin cancers except melanomas; (4) Basal cell carcinoma and squamous cell the 12-month period prior to the Effective Date, resulted in the insured receiving carcinoma of the skin; and (5) Melanoma that is diagnosed as Clark’s Level I or medical advice or treatment. II or Breslow less than .77mm. We will not pay benefits for any critical illness starting within 12 months of the Cancer is also defined as a disease which meets the diagnosis criteria of Effective Date which is caused by, contributed to, or resulting from a Premalignancy established by The American Board of Pathology after a study of the Existing Condition. A claim for benefits for loss starting after 12 months from the histocytologic architecture or pattern of the suspect tumor, tissue, or specimen. Effective Date will not be reduced or denied on the grounds that it is caused by a Pre-Existing Condition. A critical illness will no longer be considered pre-existing Carcinoma in Situ means Cancer that is in the natural or normal place, at the end of 12 consecutive months starting and ending after the Effective Date. confined to the site of origin without having invaded neighboring tissue. Renal Failure (Kidney Failure) means the end stage renal failure presenting as The Effective Date of your insurance will be the date shown in your Certificate chronic, irreversible failure of both of your kidneys to function. The Kidney Failure must necessitate regular renal dialysis, hemo-dialysis or peritoneal dialysis (at Schedule. least weekly); or which results in kidney transplantation. Renal failure is covered, Employee means the insured as shown the Certificate Schedule. provided it is not caused by a traumatic event, including surgical traumas. Spouse means an employee's legal wife or husband. Coronary Artery Bypass Surgery means undergoing open heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass Dependent Children means your natural children, step-children, legally grafts, but excluding procedures such as, but not limited to balloon angioplasty, adopted children, or children placed for adoption, who are unmarried, chiefly laser relief, stints or other non-surgical procedures. dependent on you or your Spouse for support, and younger than age 25. TERMS Y OU NEED TO KNO W

However, if any child is incapable of self-sustaining employment due to mental retardation or physical handicap and is dependent on a parent(s) for support, the above age of 25 shall not apply. Proof of such incapacity and dependency must be furnished tot he company within 31 days following such 25th birthday. Treatment means consultation, care or services provided by a physician including diagnostic measures and taking prescribed drugs and medicines. Major Organ Transplant means undergoing surgery as a recipient of a transplant of a human heart, lung, liver, kidney, or pancreas. Myocardial Infarction (Heart Attack) means the death of a portion of the heart muscle (myocardium) resulting from a blockage of one or more coronary arteries. Heart Attack does not include any other disease or injury involving the cardiovascular system. Cardiac arrest not caused by a Myocardial Infarction is not a Heart Attack. The diagnosis must include all of the following criteria: 1. New and serial eletrocardiographic (EKG) findings consistent with Myocardial Infarction; 2. Elevation of cardiac enzymes above generally accepted laboratory levels of normal [in case of creatine physphokinase (CPK), a CPK-MB measurement must be used]; and 3. Confirmatory imaging studies such as thallium scans, MUGA scans, or stress ecocardiograms.

A doctor, physician, or pathologist does not include an insured or a family member. P o r ta bl e C o v e r a g e

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 or the group master policy terminates. termination

Coverage will terminate on the earliest of: (1) The date the master policy is terminated; (2) On the 31st day after the premium due date if the required premium has not been paid; (3) On the date the insured ceases to meet the definition of an Employee as defined in the master policy; or (4) On the date the Employee is no longer a member of the class eligible.

Coverage for an insured Spouse or Dependent Child will terminate the earliest of: (1) The date the master policy is terminated; (2) On the 31st day after the Stroke means apoplexy (due to rupture or acute occlusion of a cerebral artery), premium due date if the required premium has not been paid; (3) The premium or a cerebral vascular accident or incident which is first manifested on or after due date following the date the Spouse or Dependent Child ceases to be a your Effective Date. Stroke does not include transient ischemic attacks and dependent; or (4) The premium due date following the date we receive a written attacks of verterbrobasilar ischemia. We will pay a benefit for Stroke which request to terminate coverage for a Spouse and/or Dependent Children.

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.

Underwritten by:

Continental American Insurance Company 2801 Devine Street | Columbia, South Carolina 29205

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 CAI2800.


NON-TOBACCO Monthly AGES

18-29 30-39 40-49 50-59 60-69

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

$3.60 $5.15 $8.65 $14.22 $21.75

$5.45 $8.55 $15.55 $26.68 $41.75

$7.30 $11.95 $22.45 $39.15 $61.75

$9.15 $15.35 $29.35 $51.62 $81.75

$11.00 $18.75 $36.25 $64.08 $101.75

$12.85 $22.15 $43.15 $76.55 $121.75

$14.70 $25.55 $50.05 $89.02 $141.75

$16.55 $28.95 $56.95 $101.48 $161.75

$18.40 $32.35 $63.85 $113.95 $181.75

$20.25 $35.75 $70.75 $126.42 $201.75

NON-TOBACCO Spouse AGES

$5,000

$7,500

$10,000

$12,500

$15,000

$17,500

$20,000

$22,500

$25,000

18-29 30-39 40-49 50-59 60-69

$3.60 $5.15 $8.65 $14.22 $21.75

$4.53 $6.85 $12.10 $20.45 $31.75

$5.45 $8.55 $15.55 $26.68 $41.75

$6.38 $10.25 $19.00 $32.92 $51.75

$7.30 $11.95 $22.45 $39.15 $61.75

$8.23 $13.65 $25.90 $45.38 $71.75

$9.15 $15.35 $29.35 $51.62 $81.75

$10.08 $17.05 $32.80 $57.85 $91.75

$11.00 $18.75 $36.25 $64.08 $101.75

TOBACCO Premium Monthly AGES

18-29 30-39 40-49 50-59 60-69

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

$4.85 $7.60 $16.25 $26.75 $41.75

$7.95 $13.45 $30.75 $51.75 $81.75

$11.05 $19.30 $45.25 $76.75 $121.75

$14.15 $25.15 $59.75 $101.75 $161.75

$17.25 $31.00 $74.25 $126.75 $201.75

$20.35 $36.85 $88.75 $151.75 $241.75

$23.45 $42.70 $103.25 $176.75 $281.75

$26.55 $48.55 $117.75 $201.75 $321.75

$29.65 $54.40 $132.25 $226.75 $361.75

$32.75 $60.25 $146.75 $251.75 $401.75

TOBACCO Premium - Spouse AGES

$5,000

$7,500

$10,000

$12,500

$15,000

$17,500

$20,000

$22,500

$25,000

18-29 30-39 40-49 50-59 60-69

$4.85 $7.60 $16.25 $26.75 $41.75

$6.40 $10.53 $23.50 $39.25 $61.75

$7.95 $13.45 $30.75 $51.75 $81.75

$9.50 $16.38 $38.00 $64.25 $101.75

$11.05 $19.30 $45.25 $76.75 $121.75

$12.60 $22.23 $52.50 $89.25 $141.75

$14.15 $25.15 $59.75 $101.75 $161.75

$15.70 $28.08 $67.00 $114.25 $181.75

$15.70 $28.08 $67.00 $114.25 $181.75

2012 Insurance Information  

2012 insurance Information