Employee Benefits• LTDPrepared by4 5
**IMPORTANTBenefits will begin 1st of Month following 60 days of full time employment.Employer Paid Life Short Term Disability Long Term DisabilityRecuro 2 options to enroll:Beaumont - A counselor will be in person on June 18thRemote employees - Sign up for a virtual enrollment meeting and a counselor will call you at your scheduled date/time• Voluntary LifeUHC- Colonial Life- The Standard- The Standard
Plan Type PPO PPO PPO PPOPlan Number P1500i100LX P1500i80LX P3000i100LX P3000i80LXIndividual Deductible (In-/Out-of-Network)1500/3000 1500/3000 3000/6000 3000/6000Family Deductible (In-/Out-of-Network)3000/6000 3000/6000 6000/12000 6000/12000Co-Insurance 100% 80/20 100% 80/20Out-of-Pocket Max (In-/Out-of-Network)4000/8000 4000/8000 5500/11000 7900/15800Doctor Office Visit $25 $25 $25 $25Special Office Visit $75 $75 $75 $75Urgent Care $50 $50 $50 $50Emergency Visit $300+Coins $300+Coins $300+Coins $300+CoinsPharmacy $15/35/75/250 $15/35/75/250 $15/35/75/250 $15/35/75/250PPO Plan Options include In- and Out-of-Network benefitsPlan Type EPO EPO EPO EPOPlan Number E1500i100LX E1500i80LX E3000i100LX E3000i80LXIndividual Deductible (In-/Out-of-Network)1500/NA 1500/NA 3000/NA 3000/NAFamily Deductible (In-/Out-of-Network)3000/NA 3000/NA 6000/NA 6000/NACo-Insurance 100% 80/20 100% 80/20Out-of-Pocket Max (In-/Out-of-Network)4000/NA 4000/NA 5500/NA 7900/NADoctor Office Visit $25 $25 $25 $25Special Office Visit $75 $75 $75 $75Urgent Care $50 $50 $50 $50Emergency Visit $300+Coins $300+Coins $300+Coins $300+CoinsPharmacy $15/35/75/250 $15/35/75/250 $15/35/75/250 $15/35/75/250EPO Plan Options include In-Network benefits onlyBrent Coon Medical Plan Summary - 2024-2025
Plan TypePlan Number P1500i100LX P1500i80LX P3000i100LX P3000i80LXEmployeeEmployee + SpouseEmployee + Child(ren)Employee + FamilyEE Per Pay (26)$166.76$677.80$536.70$1,051.55EE Per Pay (26)$138.50$611.68$481.02$957.73EE Per Pay (26)$118.43$564.71$441.49$891.10EE Per Pay (26)$79.87$474.49$365.52$763.09Plan TypePlan Number E1500i100LX E1500i80LX E3000i100LX E3000i80LXEmployeeEmployee + SpouseEmployee + Child(ren)Employee + FamilyEE Per Pay (26)$149.97$638.52$503.63$995.82EE Per Pay (26)$126.93$584.60$458.23$919.33EE Per Pay (26)$107.84$539.93$420.62$855.94EE Per Pay (26)$70.58$452.75$347.22$732.24PPOEPO2024 - 2025 - Brent Coon Medical Plan Summary(Rates reflect $500 Monthly Employer Contribution)
Applicable to policy form Individual Dental PPO(IDN8000)Dental PPOZip Codes: 755, 756, 757, 758, 759, 763, 767, 768, 769, 777, 779, 780, 781, 782, 783, 784, 785, 788, 790, 791, 792, 793, 794, 795, 796, 797, 798, 799, 885ISSUE AGE INDIVIDUAL INDIVIDUAL ANDSPOUSEINDIVIDUAL ANDCHILDRENINDIVIDUAL ANDFAMILYCOVERAGE LEVELPlan 3 - 100/80/50,$1,500 MAC17-74 $13.63 $25.63 $32.32 $47.78Plan 5 - 100/80/50,$1,500 PPO17-74 $20.25 $38.73 $49.18 $73.02Optional Vision RiderApplicable to policy forms ACCIDENT 1.0-HS and ACCIDENT1.0-NSISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILYPlan Frequency: 12/12/12$120 Material Allowance 0-80 $2.89 $5.71 $6.01 $9.42Note: The Vision is an optional rider on the Dental Plan. Dental Rates vary by Zip Code - Rates shown are Zone 2Dental and Vision plans are fully portable even into retirement
For more information, talk with your benefits counselor.Dental InsurancePlan 5 – $1,500, 100% | 80% | 50%PPO – Choose any dentist IDN8000 – PLAN 5 PPODental insurance from Colonial Life can help preserve your smile with easy-to-use coverage that promotes overall wellness. Benefits can help with a variety of dental costs, from routine cleanings to more advanced procedures. Coverage is available for you, your spouse and dependent children.Plan detailsThe benefit year maximum for this plan is $1,500 per person.Class A, B and C services apply toward the benefit year maximum.This plan has a deductible of $50 per person. Families only pay the deductible for a maximum of three people. Applies only to class B and C services.The co-insurance for this plan is:See reverse for covered procedures and waiting periods.ColonialLife.comCLASS TYPE OF SERVICE INSURANCE PAYSClass A Preventive services 100%Class B Basic services 80%Class C Major services 50%Choose any dentistMembers may choose any dentist but may receive additional savings by choosing an in-network dentist. Members are free to choose a new dentist at any time. Our national dental network oers more than 323,000 access points.1 Out-of-network benefits are paid based on the customary charge for a given area. To locate a participating dentist, access the provider search at ColonialLifeDental.com.
Covered procedures and waiting periodsColonialLife.com1 Internal data (2017). Access points are sites where network dentists see patients. Some dentists may be available at more than one access point.2 Member may have one additional periodontal maintenance in lieu of an additional cleaning. Periodontal maintenance is a major service and subject to a 12-month waiting period.Preventive services (Class A): No waiting period Routine exams and cleanings (twice every 12 months) – One additional cleaning per 12 months if member isin second or third trimester of pregnancy X-rays – Bitewing X-rays (up to four films; once every 12 months) Children’s services (up to age 14) – Fluoride treatment (once every 12 months) – Sealants (once every 36 months) – Space maintainers (up to age 14; once every 24 months) Adjunctive pre-diagnostic oral cancer screening (for age 40+; once every 12 months)Basic services (Class B): No waiting period Full mouth/panoramic X-rays (once every five years) Simple restorative services (fillings) Simple extractions Emergency treatmentMajor services (Class C): 12-month waiting period Oral surgery (extractions and impacted teeth) Anesthesia (subject to review; covered with complex oral surgery) Repair of crown, denture or bridge Periodontics (gum treatments) Endodontics (root canals) Inlays and onlays Crowns Bridges Dentures Endosteal implants (in lieu of an approved three-unit bridge)The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.5-18 | 101840-1Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
For more information, talk with your benefits counselor.Individual Dental PPO InsuranceVision RiderIDN8000 – VISION RIDERDental insurance oers an optional vision rider to help pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.Vision benefitsIN-NETWORKOUT-OF-NETWORKALLOWANCECO-PAYSExam (once per 12 months) $10 Up to $35Materials $25 See belowSTANDARD PLASTIC LENSES (once per 12 months)Single vision Covered by co-pay Up to $25Bifocal Covered by co-pay Up to $40Trifocal Covered by co-pay Up to $50Lenticular $80 allowance Up to $50Progressive $70 allowance Up to $40Polycarbonate lenses (for children to age 19) Covered by co-pay N/AFRAMES1 (once per 12 months)Choose any frame available at provider locations $120 allowance Up to $50CONTACT LENSES2 (once per 12 months) (Includes fit, follow-up and materials) In lieu of eyeglass lenses and frames Elective Up to $120 allowance Up to $100 allowanceMedically necessary Up to $210 allowance Up to $210 allowanceFreedom of choiceYou’ll have access to a national vision network that includes independent optometrists, ophthalmologists and retail stores including Walmart, Sam’s Club Optical, Costco,3 Pearle Vision and Target. You can search for providers at ColonialLifeVision.com.Additional vision benefit advantages Eye exams and materials (frames, lenses) can be purchased from dierent locations and providers. For example, you could have an eye exam with your favorite eye care professional and order contacts online. Check the network for Value Added and Service Plus providers. They can provide special discounts for extra purchases of lenses and coatings, frames, contact lenses and other products.ColonialLife.com
ColonialLife.com4-18 | 101851-21 Eyeglass lenses and frames are paid in lieu of the contact lenses benefit.2 The contact lenses benefit is paid in lieu of eyeglass lenses and frames. Contact lenses consist of three components: materials, exams and fittings. Coverage is for materials and the exam, up to the contact lenses allowance. Fittings may be covered but only up to the amount of any unused contact lenses allowance – aer materials.3 Optometrists at Costco Optical outlets are independent of Costco and may not be in network. To verify that your vision exam will be fully covered aer co-pay, confirm that your doctor is an in-network provider. Special payment and reimbursement terms apply for material purchases at Costco. Additional discounts are not applicable.4 Not a covered benefit. These schedules are subject to change without notice. Added value discounts may not be available in all geographical areas and vary by network. Many providers are not able to oer discounts on “Prestige” frames. Special lens packages that combine numerous lens enhancements at value price points are not covered by these added value programs. Cannot be combined with any other promotions or discounts.5 Some retail chains sell sunglasses in departments outside of their optical shops where discounts do not apply.The policy or its provisions may vary or be unavailable in some states. The policy had exclusions and limitations, which may aect any benefits payable. See the actual policy or your Colonial Life benefits counselor for specific provisions and details of availability.Special discounts on material purchases4Providers identified as Value Added or Service Plus in our online provider directory oer the following additional values for our members on vision material purchases. We encourage you to contact your selected provider prior to visiting their location to confirm their continued participation. Not all providers, such as Walmart, Sam’s Club and Costco Optical,³ choose to participate in these special discounts.Value Added providersDISCOUNTS FOR FIRST PAIR OF GLASSESLens options (add-ons for insured purchases):PURCHASE A SECOND PAIR OF GLASSES AND RECEIVE PREFERRED PRICINGLenses:DISCOUNTS ON FRAMES, CONTACT LENSES AND OTHER PRODUCTSService Plus providersRECEIVE UP TO A 20% DISCOUNT FOR THE FOLLOWING ADD-ONS TO INSURED PURCHASES: UV coating Solid tinting/gradient tinting Standard scratch resistance coating UV coating…$15 Solid tinting/gradient tinting…$15 Standard scratch resistance coating…$15 Standard anti-reflective coating…$45 Premium anti-reflective coating…$70 Ultra anti-reflective coating…20% discount Polarized…$75 Transition…$75 Progressive lenses:– Standard…$110– Premium…$170– Ultra…member receives a 20% discount Standard polycarbonate …$40 High index (single vision)– 1.56-1.60…$60– 1.66+…20% discount High index (multi-focal)– 1.56-1.60…$75– 1.66+…20% discount Single vision plastic lenses…$40 Bifocal plastic lenses…$60 Trifocal lenses…$70 Progressive lenses (standard)…$110 Progressive lenses (premium and ultra)…20% discount Frames – Up to 35% discount Contact Lenses – 5-15% discount, depending on type Other products – 20% discount on non-prescription sunglasses and other ancillary products/solutions Standard anti-reflective coating Premium anti-reflective coating Transition Standard polycarbonateUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
Dental and vision benefits management at your fingertips.With the AlwaysAssist app, we’ve made it simple for you and your family to have 24/7 access to your dental and vision benefits on your mobile device.Features include: Up-to-date dental and vision ID cardsA convenient alternative to your paper card that’s easy to share with familymembers and providers. In-network provider search functionAccess a map-view of providers near you. Then, call and schedule anappointment with your provider directly from your search results. Benefits, plan and claims informationManage and review your benefits and plan information from one location.AlwaysAssist mobile app Sign up todayDownload the AlwaysAssist app: 1. Visit the App Store or Google Play on your Apple or Android device2. Search for “AlwaysAssist”3. Download the appSimply follow the prompts to sign up and you’re all set. AlwaysAssist allows covered family members 18+ who sign up to securely access benefit and claim information anytime, anywhere.Insurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. Dental plans are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC, and administered by Starmount Life Insurance Company. ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 6-19 | 101907-1Scan this code or go directly to ColonialLifeDental.com to download the app.For questions, contact our dental customer service department six days a week at 888-400-9304 or 24/7 at ColonialLife.com.
Activate your membershipRegister: www.247wellvia.comPatient Care Center: 1.888.241.4302Get StartedAccess your WellVia benefit by:Mobile App: Android or ApplePhone: 1.888.241.4302Online: www.247wellvia.comCreate LoginCreate your login credentials by entering your email, name, and date of birth, then creating your username and passwordMedical SurveyComplete a health survey to begin your medical recordRequest a ConsultYou’re now ready to request a consult with a Doctor*Disclaimer: These Services are for non-emergency conditions only. Telehealth does not replace the primary care doctor, services are not considered insurance or a Qualified Health Plan under the Patient Protection and Affordable Care Act. Telehealth doctors do not prescribe DEA controlle d substances (schedule I-IV) and do not guarantee that a prescription will be written. Available nationwide where allowable by law. For updated full disclosures, ple ase contact your Program Administrator.*Registering your account is not required to use thisservice, call 888.241.4302 anytime for 24/7 access.TelehealthTelehealth doctors diagnose acute non-emergent medical conditions and prescribe medications when clinically appropriate. Acne / RashesCold / Flu / CoughEar ProblemsNausea / VomitingInfectionsSore ThroatUTI’sAllergiesConstipationFever / HeadacheRashesSinus ConditionsPink EyeAnd moreVirtual $0 Copay Urgent CareWhat’s Included?01020304Virtual Urgent CareTelehealth:
Basic Life provides a $ 0,000 Life Insurance to all full-time employees working at least 0 hours per week. This benefit is provided at no cost to you through . Please make sure to update your beneficiary information during enrollmentBenefits reduced by 35% at age , and by 50% at age 7 . Supplemental Life Insurance Employees may elect to purchase supplemental life insurance. Coverage is available in $1,000 increments from a minimum of $10,000 up to the lesser of 5 times annual salary or $ 00,000. Coverage is Guarantee Issue up to $ ,000, not to exceed 5 times salary for new hires. Late Entrants and increases in coverage may be subject to medical questionsSpouse Life CoverageEmployees are also given the option to purchase lifeinsurance for their spouse as a spouse term rider in $5,000 increments up to the lesser of 0% of employee benefits or $50,000. Employees must purchasevoluntary life insurance in order to purchase the spouseterm rider coverage for their spouse. The spouse term rider is guarantee issued to a max of $ 5,000 for New Hires. Late entrants are subject to EOI.Dependent Child(ren) Life - up to age Insurance for dependent children may be purchased asa dependent child rider in increments of $1,000 to amaximum of$10,000. Employees must purchasevoluntary life insurance in order to purchase dependent term rider coverage for their child(ren). Child coverageis Guarantee Issue for new hires. Life
Supplemental Benefits All rates are per pay period (26)Group Medical Bridge (GMB7000) Applicable to Policy Forms GMB7000–P & GMB7000-ClWithout Wellbeing Assistance, Outpatient Surgical Procedure: Option 1 - ($500 / $1000 / $1500)HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 2: $100017-49 $6.92 $12.76 $10.80 $16.6450-59 $9.58 $18.90 $13.46 $22.7860-64 $12.88 $26.42 $16.76 $30.3065-99 $16.96 $35.24 $20.84 $39.11HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-49 $11.26 $20.56 $16.99 $26.2950-59 $15.21 $30.07 $20.93 $35.8060-64 $20.77 $42.85 $26.50 $48.5865-99 $28.04 $58.27 $33.77 $63.99Group Accident Applicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident CoveragePreferredISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $6.89 $11.37 $13.18 $17.66Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important NoticeGroup Critical Care with Cancer Applicable to policy forms GCC1.0-P & GCC1.0-ClFull CI Benefit, with Subsequent Diagnosis, Diagnosis of Cancer Benefit, $100 Health Screening BenefitNon-Tobacco RatesISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY$5,000 16-29 $3.90 $6.03 $4.02 $6.1430-39 $4.71 $7.23 $4.82 $7.3440-49 $6.46 $9.86 $6.60 $10.0050-59 $9.28 $14.24 $9.42 $14.3860-74 $13.06 $20.01 $13.20 $20.15$15,000 16-29 $5.56 $8.52 $5.91 $8.8630-39 $7.99 $12.12 $8.33 $12.4640-49 $13.25 $20.01 $13.66 $20.4350-59 $21.69 $33.16 $22.11 $33.5860-74 $33.05 $50.47 $33.46 $50.89*Consult a benefits counselor for Tobacco Rates*We don't plan for the unexpected. Supplemental Benefits through Colonial Life can help offset the out of pocket expenses associated with an illness or injury, such as deductibles, co-payments, time off work, etc. You can choose to cover dependents even if they are not covered on Medical. Most plans are portable if you leave or retire.
Term Life (ITL5000) Applicable to policy form ITL5000l20-Year Term Base PlanNon-Tobacco RatesISSUE AGE $25,000 $49,000 $50,000 $100,000 $150,00025 $4.97 $7.97 $4.87 $7.89 $10.9135 $6.11 $10.20 $5.35 $8.85 $12.3545 $8.41 $14.70 $10.06 $18.27 $26.4855 $18.07 $21.00 $21.39 $40.92 $60.4665 $28.41 $53.90 $54.96 $108.08 $161.19Tobacco RatesISSUE AGE $25,000 $49,000 $50,000 $100,000 $150,00025 $9.33 $16.51 $8.41 $14.97 $21.5235 $10.75 $19.30 $9.52 $17.20 $24.8745 $15.57 $28.74 $20.99 $40.12 $59.2555 $36.39 $48.00 $48.95 $96.04 $143.1365 $47.86 $92.03 $93.87 $185.88 $277.90Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important NoticeWhole Life (IWL5000) lAdult Base Plan Paid-Up at Age 100Non-Tobacco RatesISSUE AGE $10,000 $15,000 $25,000 $49,000 $50,00025 $4.78 $6.48 $9.88 $18.04 $16.6135 $6.26 $8.70 $13.58 $25.30 $23.5245 $8.92 $12.69 $20.23 $38.34 $36.4055 $14.10 $20.45 $33.17 $55.47 $56.5765 $24.97 $29.70 $48.59 $93.91 $95.80Tobacco RatesISSUE AGE $10,000 $15,000 $25,000 $49,000 $50,00025 $7.26 $10.20 $16.09 $30.21 $24.3835 $9.13 $13.01 $20.76 $39.37 $31.9645 $12.51 $18.07 $29.21 $55.92 $49.1355 $21.70 $31.86 $52.18 $77.14 $78.6865 $38.79 $39.79 $65.40 $126.85 $129.42Juvenile Whole Life (IWL5000) lDependent Child Base Plan Paid-Up at Age 70ISSUE AGE $10,000 $20,000 $30,000 $40,000 $50,0001 $2.87 $4.35 $5.83 $7.32 $8.803 $2.90 $4.43 $5.95 $7.47 $9.005 $3.00 $4.63 $6.26 $7.89 $9.517 $3.14 $4.90 $6.65 $8.41 $10.1710 $3.36 $5.34 $7.31 $9.29 $11.2713 $3.63 $5.89 $8.14 $10.39 $12.6515 $3.85 $6.33 $8.80 $11.27 $13.7417 $4.10 $6.82 $9.54 $12.26 $14.98
Contact John Handcock As a New Participants: Call an Enrollment Specialist Toll-Free: 855-543-6765 For participating employees with questions: Call Participant Services Toll-Free: 800-395-1113