Human Resources

Optional Insurances

Delta Dental Logo

Dental


Group Administration
Delta Dental
1130 Sanctuary Parkway, Suite 600
Alpharetta, GA  30009
1-800-521-2651

Claims:
Group Claim Office
P.O. Box 1809
Alpharetta, GA  30023-1809

An optional dental insurance plan is available for those who desire coverage. Dental insurance is at the top of the list of the benefits most requested by employees. Delta Dental is designed to provide a sound dental benefit that meets your needs today and for years to come. Employees who elect the coverage will pay the full premium by payroll deduction, and they may insure a spouse and dependent children from age birth to 19 years of age or less than 23 years of age and a full-time student.

There are no networks and the employee and their insured dependents can choose any dentist. Benefits are structured to include Preventive, Basic, Major, and Orthodontics dental Services. Dental premiums qualify for pre-tax treatment under Section 125 of the Internal Revenue Code. There are two types of dental plans.

Low Plan:

  • Type I Dental Services: Benefits include routine oral examinations, bitewing x-rays, dental cleanings, sealants and fluoride are covered under diagnostic and preventive fluoride – under age 19. Sealants on first permanent molars through age 8 and second permanent molars through age 15 if without cavities or restorations on occlusal. Benefits are payable at 100% of the allowable charges.
  • Type II Dental Services:  Benefits include full mouth/panoramic x-rays, periapical x-rays, restorative amalgams, restorative composites, denture repair, and simple extractions. Benefits are payable at 80% of the allowable charges.

A $50 deductible applies to Type II dental services only. The benefit maximum per person, per policy year is $1,500.

High Plan:

  • Type I Dental Services: Benefits include routine oral examinations, bitewing x-rays, dental cleanings, sealants and fluoride are covered under diagnostic and preventive fluoride – under age 19. Sealants on first permanent molars through age 8 and second permanent molars through age 15 if without cavities or restorations on occlusal. Benefits are payable at 100% of the allowable charges.
  • Type II Dental Services:  Benefits include full mouth/panoramic x-rays, periapical x-rays, restorative amalgams, restorative composites, denture repair, and simple extractions. Benefits are payable at 80% of the allowable charges.
  • Type III Dental Services: Benefits include inlays, onlays, crowns, crown repair, endodontics (nonsurgical), endodontics (surgical), periodontics (nonsurgical), periodontics (surgical), prosthodontics (fixed bridge, removable complete/partial denture), complex extractions, and anesthesia. Benefits are payable at 50% of the allowable charges.
  • Type IV Orthodontic Dental Services: Payable at 50% and the lifetime orthodontia maximum is $1,000. Orthodontics is available only to children under age 19. Benefits include limited, interceptive, and comprehensive orthodontic treatment. There is a 12-month waiting period.

A $50 deductible applies to Type II and Type II dental services only. The benefit maximum per person, per policy year is $1,500.

 

Low Plan Rates

Hi Rates

Employee

$20.14

$34.62

Employee + Spouse

$41.18

$65.80

Employee + Child(ren)

$62.30

$88.70

Employee + Family

$79.10

$119.88

Vision


Over 60% of Americans require some form of vision correction and eyestrain is the #1 office-related health complaint. Vision insurance is offered through Davis Vision.

With Davis, you and your eligible dependents will receive comprehensive, high-quality vision care at affordable monthly rates. If you visit a participating provider and select covered vision-related materials, you will experience no additional cost beyond your co-payment. When you use a network provider, participants and dependents are eligible for the following:


In-Network Benefits

Designer Plus Vision Plan

Frequency – Once Every:

Plan Design

Eye Health Examination inclusive of Dilation (when professional indicated)

12 Months

Spectacle Lenses

12 Months

Frame

24 Months

Contact Lens Evaluation, Fitting & Follow-Up Care

12 Months

Contact Lenses (in lieu of eyeglasses)

12 Months

Copayments
Eye Health Examination

$10

Spectacle Lenses

$20

Contact Lens Evaluation, Fitting & Follow-Up Care

$20

Eyeglass Benefit – Frame

 

Non-Collection Frame Allowance (Retail):

Up to $130
Plus a 20% discount on any overage that may apply

Davis Vision Frame Collection (in lieu of allowance)
Fashion Level

Included

Designer Level

Included

Premier Level

$25 copayment

Eyeglass Benefit – Spectacle Lenses
All ranges of prescriptions and sizes

Included

Choice of glass or plastic lenses

Included

Oversize lenses

Included

Fashion and gradient tinting of plastic lenses

Included

Polycarbonate lenses

$0 or $30

Scratch Protection

Included

Ultraviolet Coating

$12

Standard Anti-Reflective (AR) Coating

$35

Premium AR Coating

$48

Ultra AR Coating

$60

Standard Progressive Lenses

$50

Premium Progressives (Varilux, etc.)

$90

Intermediate-Vision Lenses

$30

Blended-Segment Lenses

$20

High-Index Lenses

$55

Polarized Lenses

$75

Photochromic Glass Lenses

$20

Plastic Photosensitive Lenses

$65

Contact Lens Benefit

 

Non-Collection Contact Lenses: Materials Allowance

Up to $130
Plus a 15% discount on any overage that may apply

–    Evaluation, Fitting & Follow-Up Care Allowance – Standard Lens Types

Included

–    Evaluation, Fitting & Follow-Up Care Allowance – Speciality Lens Types

Up to $60
Plus a 15% discount on any overage that may apply

Collection Contact Lenses (in lieu of Allowance):

–    Materials (up to 4 boxes), Evaluation, Fitting, & Follow-Up Care

Included

Medically Necessary Contact Lenses (with prior approval)
– Materials, Evaluation, Fitting & Follow-Up Care

Included

Out-Of-Network Benefits

 

Eye Examination

Up to $40

Frame

Up to $50

Single Vision Lenses

Up to $40

Bifocal Lenses

Up to $60

Trifocal Lenses

Up to $80

Lenticular Lenses

Up to $60

Elective Contact Lenses

Up to $105

Medically Necessary Contact Lenses

Up to $210

–        At Walmart locations, members will receive the full allowance toward Walmart’s everyday low prices. Additional discounts not applicable.

–        Collection is available at most participating independent provider offices. Collection is subject to change. All contact lenses in Collection are single vision spherical lenses.

–        Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions +/-6.00 diopters or greater

 

One-year eyeglass breakage warranty included


Davis Monthly Rates:

Employee Only $7.37
Employee + 1 Dependent $13.89
Employee + Family $21.66

The Hartford Insurance Company

Hartford Life Insurance


SUPPLEMENTAL LIFE INSURANCE

Employees may select Supplemental Life Insurance provided by The Hartford Life & Accident Insurance Company in even multiples of $5,000, subject to a minimum of $5,000. Guarantee issue up to $50,000. Evidence of Insurability is required over $50,000. After 31 days from the date of eligibility, you will be considered to be a “late enrollee” applicant and will be required to submit an evidence of insurability form to request coverage. Hartford Life must give approval on all “late enrollee” applications before coverage can be provided.

The current cost is:

Age

Cost per $1,000

Age

Cost per $1,000

Under 30

$.067

55 – 59

$.47

30 – 34

.067

60 – 64

.661

35 – 39

.078

65 – 69

1.254

40 – 44

.123

70 – 74

2.666

45 – 49

.213

75 & Up

5.387

50 – 54

.336

Travel Assistance Program

The Travel Assistance Program gives you 24-hour, toll-free access to emergency assistance when you travel 100 miles or more from home for 31 consecutive days or less. The benefits and services are also available for your dependents – whether or not they’re traveling with you. The Travel Assistance Program is provided by Worldwide Assistance Services, Inc. (WA) and provides the following benefits.

Emergency Medical Assistance

  • Medical Referrals
  • Medical Monitoring
  • Medical Evacuation
  • Medical Repatriation
  • Traveling Companion Assistance
  • Dependent Children Assistance
  • Visit by a Family Member of Friend
  • Emergency Medical Payments
  • Return of Mortal Remains
  • Replacement of Medication and Eyeglasses

Emergency Personal Services

  • Urgent Messages
  • Emergency Travel Arrangements
  • Emergency Cash
  • Location Lost/Stolen Luggage/Personal Possessions
  • Legal Assistance/Bail
  • Interpretation/Translation

Please see the brochure to learn more about the services WA provides. All you have to do to take advantage of this program is to sign and return the Travel Assistance Program enrollment sheet to Human Resources.

TA Logo

Universal Life Insurance


Transamerica Life Insurance
P.O. Box 8063
Little Rock, AR 72203-8063
1-888-763-7474
1-800-400-3042


Voluntary Universal Life Insurance, offered through Transamerica, combines life insurance protection with an ability to grow cash value. You have the safety and security of a specified death benefit plus the opportunity to tailor your coverage to your personal situation. Individual or family coverage is available and the policy is guaranteed issued up to $100,000.

To address employee concerns about losing coverage because of a layoff. The layoff waiver protects your life insurance from lapse up to six months if you are involuntarily laid off. You must have been employed on a permanent, full-time basis. The layoff must be due to: a reduction in work force due to economic conditions; a decrease in your employer

5 Year Term Life Insurance
 20 Year Term Life Insurance
IPT Term
Whole Life Insurance
NYLIAC VUL 2000 (Variable Universal Life)

Click on a product below to view additional details about the policy.


New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
www.newyorklife.com


Five (5) Year Term Life Insurance

5 Year Term (5YT) offers affordable, temporary life insurance protection. The initial premiums are guaranteed and remain level for the first five years. In years 6-10 premiums increase and are expected, but are not guaranteed, to remain level. Thereafter, premiums increase annually.

The coverage 5YT provides could help families and business owners safeguard their financial future. The proceeds can be use to help pay mortgages and other debts, fund a child’s college education, and help a family continue its standard of living.

Highlights

  • Pure life insurance protection.
  • A death benefit that is, in most instances, free from federal income tax.
  • Guaranteed renewable coverage through the expiry age.
  • The privilege to convert to a permanent policy that builds cash value.
  • The financial strength of New York Life.

The Uses of 5YT

Temporary Need for Protection – When coverage is needed for a relatively short period of time, 5YT can be ideal. A common use is when a mortgage or student loan is taken.

Limited Funds – In situations where life insurance is essential but dollars are scarce, 5YT could serve as a stop-gp. Young people starting their careers can choose 5YT, then convert to a permanent plan as their finances improve.

Supplemental Insurance – 5YT can be added as a rider to a permanent plan to help boost the death benefit.

Provide Other Coverage – Riders can be added to the policy to insure a spouse and/or children, parents, or business partners, guaranteeing their future insurability.

Product Specifics

Issue Ages: Base Plan: 15 – 75
Rider: 0 – 75
Expiry Age: 90 for all states, except New York
Minimum Face Amount: Base Plan: $100,000
Rider: $10,000
Premium Modes: Several convenient ways to pay premiums: annually, semi-annually, quarterly, monthly, automatic bank draft or NYL-A-Plan method
Premium Guarantee Premiums are guaranteed and level for the first five years
Risk Classes Based on defined underwriting criteria, New York Life offers the following risk classes: select preferred, preferred, non-smoker, select standard, standard, and non-smoker and standard special class 2-13.
Conversion Privilege 5YT policies allow the owner to convert all or part of the policy into permanent, cash value life insurance without furnishing evidence of insurability. In all states, except New York, the conversion period is during the later of 10 years or age 30.

 


Twenty (20) Year Term Life Insurance

20 Year Term (20YT) offers affordable life insurance protection. The initial premiums are guaranteed to remain level for the first ten years. In year eleven, the premiums are expected to remain the same for the next ten years, but this is not guaranteed. At year twenty-one, the premium rates increase annually.

The coverage 20YT could help families and business owners safeguard their financial futures. The death benefit can be used to help pay mortgages and other debts, fund a child’s college education, expand business operations, and help a family continue its standard of living.

Highlights

  • Pure life insurance protection
  • A death benefit that, in most instances, is free from federal income tax.
  • Guaranteed renewable coverage through the expiry age.
  • The privilege to convert to a permanent policy that builds cash value.
  • The financial strength of New York Life.

The Uses of 20YT

Temporary Need for Protection – When coverage is needed for a finite period of time, 20YT can be ideal. A common use is when a mortgage or student loan is taken.

Limited Funds – In situations where life insurance is essential but dollars are scarce, 20YT could serve as a stop-gp. Young people starting their careers can choose 20YT, then convert to a permanent plan as their finances improve.

Product Specifics

Issue Ages: Age 15 – 60
Expiry Age: 90 for all states, except New York
Minimum Face Amount: $100,000
Maximum Face Amount Subject to New York Life limits
Premium Modes: Several convenient ways to pay premiums: annually, semi-annually, quarterly, Check-o-Matic, and NYL-A-Plan method
Risk Classes Based on defined underwriting criteria, New York Life offers the following risk classes: select preferred, preferred, non-smoker, select standard, standard, and non-smoker and standard special class 2-13.
Conversion Privilege 20YT policies allow the owner to convert all or part of the policy into permanent, cash value life insurance without furnishing evidence of insurability.

  • Original Age Conversion – Final conversion date is the fifth policy anniversary
  • Attained Age Conversion – Final conversion date is age 30 or the tenth policy anniversary, whichever is later.

 


Increasing Premium Term (IPT) Insurance

Increasing Premium Term (IPT) offers temporary life insurance protection at an affordable initial premium. IPT is guaranteed renewable through the contract expiry age and includes a conversion privilege that is available until age 70. The coverage it provides could help families and business owners safeguard their financial futures.

Highlights

  • Pure life insurance protection
  • A death benefit that is, in most instances, free from federal income tax.
  • An initial premium that may be considerably lower than a comparable permanent plan.
  • Guaranteed renewable coverage through the contract’s expiry date.
  • The privilege to convert to a permanent policy that builds a cash value.
  • A Conversion Credit that’s applied to the new policy’s first-year premium
  • The financial strength of New York Life.

The Uses of IPT

Temporary Need for Protection – When coverage is needed for a relatively short period of time, 5YT can be ideal. A common use is when a mortgage or student loan is taken.

Limited Funds – In situations where life insurance is essential but dollars are scarce, IPT could serve as a stop-gp. Young people starting their careers can choose IPT, then convert to a permanent plan as their finances improve.

Supplemental Insurance – IPT can be added as a rider to a permanent plan to help boost the death benefit.

Family Coverage – Optional riders such as Spouse and Children’s Insurance and Children’s Insurance can be added to the policy to extend coverage to family members.

Product Specifics

Issue Ages: Base Plan: 15 – 65
Expiry Age: 100 for all states, except New York, New Jersey, Maryland
Minimum Face Amount: Base Plan: $250,000
Rider: $25,000
Premium Modes: Several convenient ways to pay premiums: annually, semi-annually, quarterly, monthly, automatic bank draft or NYL-A-Plan method
Premium Guarantee Premiums are guaranteed and level for the first three years
Risk Classes Based on defined underwriting criteria, New York Life offers the following risk classes: select preferred, preferred, non-smoker, select standard, standard, and non-smoker and standard special class 2-13.
Conversion Privilege IPT policies allow the owner to convert all or part of the policy into permanent, cash value life insurance without furnishing evidence of insurability. This valuable privilege until the insured is age 70.

 


Whole Life Insurance

In addition to paying a death benefit, Whole Life is also a value builder. The cash values that accumulate in the policy can be accessed during your lifetime to fund vital needs such as a child’s education or a new home. Whole Life is a flexible product that can be customized to meet your family’s unique needs. It can provide a foundation upon which you can build your family’s financial future.

Highlights:

  • A guaranteed death benefit, generally free from federal income tax
  • Tax-deferred cash value accumulation
  • Generally, the ability to borrow from cash value on a tax-free basis
  • A level premium that is guaranteed never to increase
  • Permanent coverage that can never be canceled, provided that premiums are paid when due
  • Eligibility to earn dividends as declared by the Company
  • The ability to customize the plan be adding optional riders

The Uses of Whole Life

Traditional Insurance – Provides the financial security that gives families the peace of mind they deserve.

Mortgage Protection – Can help pay off mortgage and other outstanding debts in the event of a premature death.

Retirement Funding – Over the long term, if you no longer need the death benefit protection, accumulated cash value can be accessed through policy loans or surrenders to help supplement a retirement income.

Education Funding – Help pay for children’s and grandchildren’s education through policy loans, or as named beneficiaries.

Pension Maximization – A possible solution to the pension dilemma, whereby a “single-life” pension option is chosen and life insurance proceeds are earmarked to replace the lost pension benefit in the event of a pensioner’s death.

Estate Planning Tool – Whole Life insurance can be an effective way of providing funds for estate expenses, and to help avoid the sale of assets and/or the need to borrow.

Charitable Giving – Bequesting life insurance is an effective way to make a significant donation to your favorite charity.

Product Specifics

Issue Ages: Age 0 – 90
Minimum Death Benefit For Issue Ages:
0 – 17: $10,000
18 – 90: $25,000 (Can go below $25,000 minimum as long as annual premium is at least $480)
Premium Modes: Several convenient ways to pay premiums: annually, semi-annually, quarterly, monthly, automatic bank draft, Check-O-Matic or NYLA-Plan method, or government allotment.
Policy Loans

The maximum loan value on a policy anniversary, on a premium due date or during the grace period, is:

Guaranteed cash value plus dividends values plus Option to Purchase Paid-Up Additions values minus the total of current loans and loan interest.

At all other times, the maximum loans value is the amount that, with interest, will equal the maximum loan value on the next anniversary or on the next premium due date, if earlier.

Loan Interest Rate Whole Life features a variable loan interest rate, which is increased or decreased based on the Monthly Average Corporate Yield shown in Moody’s Corporate Bond Yield Average. The Company sets the loan interest rate at least once each year and may se the rate as often as quarterly.
Risk Classes Based on defined underwriting criteria, New York Life offers the following risk classes: select preferred, preferred, non-smoker, select standard, standard, and non-smoker and standard special class 2-13.

 


NYLIAC VUL 2000 (Variable Universal Life)

Highlights:

  • Flexible life insurance coverage that enables you to tailor your policy with flexible premium payments: You can pay more than your planned premium, less or, sometimes, no premium at all.
  • Ability to increase or decrease coverage (increases subject to underwriting; decreases may be subject to surrender charges), add or delete riders and change options.
  • Tax-deferred accumulation/tax-free transfers among a variety of Investment Divisions.
  • Favorable tax advantages – the death benefit may be excluded from the gross income of the beneficiary’s income for federal income tax purposes.
  • Access to cash surrender value through loans and/or withdrawals.
  • 27 Investment Divisions and a Fixed Account.
  • 3-Year No Lapse Guarantee (minimum premium payment required).
  • Available on a non-qualified basis or within a qualified profit-sharing plan.
  • Quarterly statements provided summarizing important facts about your policy.
  • Convenient access to policy information through a toll free “800” number, available 7 days a week, 24 hours a day.

Insurance Benefit Options

  1. Option 1 – Provides a level life insurance benefit equal to the policy’s face amount.
  2. Option 2 – Provides a variable life insurance benefit that equals the sum of the policy’s face amount and cash value.
  3. Option 3 – Provides a variable life insurance benefit that varies and equals the sum of your policy’s face amount plus the total premiums paid, less any partial withdrawals.

No matter what option you choose, a higher Life Insurance Benefit will apply if necessary to qualify as life insurance under Section 7702 of the Internal Revenue Code.

Fixed Account

Minimum guaranteed interest rate is 3%.

The current interest rate is set by NYLIAC and is subject to change daily. Interest rates will be set in advance and become effective no later than the next day. All amounts (including any applied to or transferred to the Fixed Account) receive the current interest rate. Different rates may apply to loaned and unloaned funds.

Investment Options

The NYLIAC Variable Universal Life 2000 policy offers a variety of investment options. You allocate your premium payments to achieve your financial objectives. You can select up to a maximum of 21 Investment Options, including the Fixed Account at one time.

Transfers

Transfers between Investment Divisions are easy and generally tax-free. There is no limit on the amount of money you can transfer between Investment Divisions. The minimum amount of a transfer from an Investment Division or the Fixed Account is the lesser of $500 or the total value of the Accumulation Unit in the Investment Division from which the transfer is being made. Limits apply to the maximum amount that can be transferred to and/or from the Fixed Account.

Loans

The maximum loan can never exceed 90% of the policy’s cash surrender value (cash value less surrender charges, any additional contract charge in the first Policy Year, unpaid loan principal, and accrued loan interest). Other limits and conditions apply. Loans will reduce the policy’s cash value and death benefit.

Partial Withdrawals

The minimum available for withdrawal is $500, which is deducted from the policy’s cash surrender value (cash value less any surrender charges, any additional contract charge in the first Policy Year, unpaid loan and accrued loan interest). A fee equal to the lessor of $25 or 2% of the amount withdraw will apply. Withdrawals will reduce the policy’s cash value and death benefit.

TA Logo

Cancer Select


Transamerica Life Insurance Company
P.O. Box 8063
Little Rock, AR 72203-8063
1-800-400-3042
1-888-763-7474
Claims Fax: 501-227-1651


CancerSelect is a supplemental health insurance policy, offered through Transamerica, which provides benefits for the direct medical and indirect non-medical costs of cancer treatment. Benefits are paid in addition to any other insurance you may have, including the employer’s medical plan. Benefits are paid directly to you or directly to anyone else you choose. CancerSelect is also available to your spouse and children at the same rates. Coverage is guaranteed renewable for life, and is 100% portable at the same rates.

Medical Benefits include:

In-Hospital Benefits

  • Hospital Confinement: This plan pays $100 per day-for up to 75 days of covered confinement. Beginning with the 76th day of continuous confinement, CancerSelect will pay the usual and customary charges for in-hospital costs in lieu of all other benefits (except surgery and anesthesia, which remain the same).  No lifetime maximum.

For hospital treatment where you are not required to pay for most services (government or charity hospitals) – in lieu of all other benefits – CancerSelect will pay $200 per day for the first 10 days of covered Hospital Confinement and $125 per day thereafter. This plan will also pay $75 per outpatient radiation therapy or chemotherapy. No lifetime maximum.

  • Attending Physician: CancerSelect will pay $45 for first day and $30 each day thereafter. No lifetime maximum.
  • Private Duty Nurse:  CancerSelect will pay $100 per day with no lifetime maximum.

In- or Out-of-Hospital Benefits

  • Drugs and Medicine:  This plan will pay $25 per day or $250 per confinement for in-hospital benefits, whichever is greater with no lifetime maximum. Radiation Therapy:  Pays charges from $5,000 to $25,000 (your choice) each calendar year for radiation therapy treatments with no lifetime maximum.
  • Chemotherapy Drugs: Pays charges from $5,000 to $25,000 (your choice) each calendar year for chemotherapy drugs with no lifetime maximum.
  • Experimental Treatment:  Pays usual and customary charges of up to $4,000 per year for drugs, chemicals, surgery, or therapy approved by FDA, NCI, or ACS. No lifetime maximum.
  • Surgery: Pays up to $3,000 for in-hospital surgery as scheduled in the policy. Pays up to $4,500 for outpatient surgery (including biopsies). No lifetime maximum.
  • Anesthesia: 25% of covered Surgery Benefit with no lifetime maximum. Diagnostic Tests:  Pays up to $300 for in-hospital biopsies and $150 for other tests per Period of Hospital Confinement. For out-of-hospital, this plan will pay up to $300 for further diagnostic tests done within 30 days prior to a Period of Hospital Confinement (in lieu of in-hospital diagnostic tests). No lifetime maximum.
  • Reconstructive Surgery:  Charges (as scheduled in the policy) of up to $750 for reconstructive surgery within two years of cancer removal. Lifetime maximum for skin cancer is $500; other cancers have no lifetime maximum.

Outpatient Benefits

  • Physician: Pays $60 for one visit by your physician, other than the surgeon, on the day of outpatient surgery. No lifetime maximum.
  • Drugs, Medicines, Lab:  Pays $250 for drugs and tests related to outpatient surgery that are received within 30 days of outpatient surgery. No lifetime maximum.
  • 2nd and 3rd Surgical Benefits:  Pays $150 each. No lifetime maximum.
  • Skin Cancer:  Pays $200 per removal, $400 per calendar year, for clinical diagnosis. Pathological diagnosis not required. With pathological diagnosis, all applicable benefits in policy schedule will be paid with no lifetime maximum with a pathological diagnosis.
  • Transportation:  When non-local hospital confinement (more than 50 miles from your residence) is required, the plan will pay (1) actual round-trip charges by common carrier, or private vehicle allowance of $.35 per mile (up to 700 miles) and (2) actual round-trip charges by common carrier for you or your spouse to accompany a child who is a covered person and requires non-local hospital confinement. Payable once per Period of Hospital Confinement. No lifetime maximum.
  • Family Member Lodging and Transportation:  When non-local hospital confinement is required, the plan will pay (1) charges no to exceed $40 per day at a motel, hotel, etc. for an adult member of your immediate family. The maximum benefit is $2,400 per Period of Hospital Confinement. And (2) actual round-trip charges by common carrier for same adult. No lifetime maximum.
  • Cancer Screening Wellness:  Pays $100 per calendar year for tests performed to determine whether cancer exists in a Covered Person. Diagnosis of cancer is not required for benefits to be payable. The benefit is not payable for any person during the first 30 days from the effective date of coverage. This benefit is limited to one payment per calendar year per covered person.

This is a partial benefit list. For additional benefits, riders, and more information regarding the above benefits, please see the CancerSelect brochure.

CancerSelect Rates:

Rates for New Enrollees effective March 1, 2007

$5,000 EACH for Radiation, Chemo, and Blood & Plasma, $200 daily hospital benefit, $100 Cancer Screening Benefit

Age 18 – 59

Age 60 – 64

Age 65 – 69

Age 70 – 74

Age 75 – 79

Age 80 -85

Individual

$19.70

$19.70

$49.65

$53.80

$57.20

$60.80

Single Parent Family

$23.80

$23.80

$53.75

$57.90

$61.30

$64.90

Two-Parent Family

$26.75

$26.75

$63.95

$70.70

$76.75

$82.95

Family

$29.35

$29.35

$66.55

$73.30

$79.35

$89.05

$10,000 EACH for Radiation, Chemo, and Blood & Plasma, $200 daily hospital benefit, $100 Cancer Screening Benefit

Age 18 – 59

Individual

$22.80

Single Parent Family

$27.50

Two-Parent Family

$30.65

Family

$33.85

$15,000 EACH for Radiation, Chemo, and Blood & Plasma, $200 daily hospital benefit, $100 Cancer Screening Benefit

Age 18 -59

Individual

$25.90

Single Parent Family

$31.20

Two-Parent Family

$34.55

Family

$38.35

You may add up to two additional $5,000 increments (for a total of $15,000 each) for Radiation, Chemotherapy, and Blood. Listed below is the monthly cost for each $5,000 increase

Age 60 – 64

Age 65 -69

Age 70 – 74

Age 75 – 79

Age 80 – 85

Individual

$3.10

$7.50

$7.50

$7.20

$6.40

Single-Parent Family

$3.70

$8.10

$8.10

$7.80

$7.00

Two-Parent Family

$3.90

$9.40

$9.80

$9.60

$9.00

Family

$4.50

$10.00

$10.40

$10.20

$9.60

MetLife

Accidental Death and Dismemberment


Metropolitan Life Insurance Company
New York, NY
www.metlife.com


A group accidental death and dismemberment insurance plan which offers high level protection at a low premium is available to employees who desire to pay the full premium to supplement other coverage. You can select a Principal Amount based on your individual needs. The amount will be based on your annual salary or a flat dollar amount. The highest amount available is 10 times your basic annual earnings or $500,000, whichever is less. Employees may also cover their spouses and children for a percentage of the face amount of the coverage selected. Coverage is provided regardless of health history and provides broad 24-hour protection, year round. Voluntary Accidental Death and Dismemberment is offered through Metlife

Voluntary Accidental Death and Dismemberment covers:

For The Loss Of

The Amount Payable Is

Life Principal Amount
Two or more members Principal Amount
One member 50% of Principal Amount
Thumb and index finger on same hand 25% of Principal Amount
Hearing in both ears 50% of Principal Amount
Speech 50% of Principal Amount
Hearing in both ears and speech Principal Amount
Covered losses also include:

The Amount Payable Is

Quadriplegia Principal Amount
Paraplegia 50% of Principal Amount
Hemiplegia 50% of Principal Amount

In addition to choosing coverage for yourself, VAD&D offers you the opportunity to choose coverage for your family. Spouses and dependent children can receive VAD&D, including the Seat Belt, Exposure and Hospitalization Benefits.

Family Benefits include:

  • If you are married with children, your spouse may be covered for 40% of your Principal Amount and each child for 10% of your Principal Amount.
  • If you are married without children, your spouse may be covered for 50% of your Principal Amount.
  • If you do not have a spouse, your children may each be covered for 15% of your Principal Amount.
  • If you and your spouse were to die in the same accident, your spouse’s death benefit would be increased to 100% of your Principal Amount.

Special Benefits:

  • Seat Belt Benefit: Payable if you or a covered dependent should die from injuries sustained in an accident while driving or riding in a private passenger car and wearing a properly fastened seat belt. The benefit amount is an additional 10% of your Principal Amount, but not less than $1,000 or more than $25,000.
  • Hospitalization Benefit: Provides the patient with a monthly income to help defray hospitalization costs resulting from an accident. It is equal to 1% of your Principal Amount to a maximum of $2,500 per month, with a maximum during of 12 months.
  • Child Care Center Benefit: Provides funds for each eligible dependent child, 12 years or younger, to attend a licensed child care facility for up to four consecutive years as long as the child is enrolled in a child care center at the time of your accidental death. The yearly benefit for each eligible child is equal to 3% of your Principal Amount or the actual amount of child care costs incurred, whichever is less, and cannot exceed $5,000 per year, per child. If none of your dependents qualifies, an additional benefit of $1,000 will be paid to your beneficiary.
  • Child Education Benefit: Provides tuition funds for each eligible dependent child to attend college or another accredited institution for up to four years as long as the child is enrolled in the institution at the time of, or within one year following your accidental death. The yearly benefit for each eligible child is equal to 2% of your Principal Amount or the actual amount of tuition costs incurred, whichever is less. The benefit maximum is $5,000 per child. If none of your dependent children qualifies, an additional benefit of $1,000 will be paid to your beneficiary.
  • Spouse Education Benefit: Provides tuition funds if your spouse is enrolled in an accredited school at the time of your accidental death. The benefit is payable for up to one year and is equal to the actual cost of tuition or $5,000, whichever is less.
  • Common Disaster Benefit: Provides funds if you and yours spouse die within one year of sustaining bodily injuries in the same accident or separate accidents occurring within the same 24 hour period. The spouse’s benefit amount will be increased to equal that of the employee’s schedule of benefits.

 VAD&D Monthly Rates:

Per Thousand

Individual $.02
Family $.03

TA Logo

Accident Select II


Transamerica Life Insurance Company
P.O. Box 8063
Little Rock, AR 72203-8063
1-800-400-3042
1-888-763-7474
Claims Fax: 501-227-1651


Accident Select II provides insureds with several benefits to assist with injuries associated with certain accidents. This product is offered through Transamerica.

Schedule of Benefits:

  • Accident Specific Sum Injuries Benefit: Pays for dislocations, burns, ruptured discs and torn knee cartilage, eye injuries, lacerations, internal injuries, fractures, and blood and plasma.A. Dislocation (Dislocations which are reduced under general anesthesia)
1. Hip

Open Reduction
Closed Reduction

$4,000
$1,330
2. Knee or Shoulder

Open Reduction
Closed Reduction

$1,330
$530
3. Collar Bone

Open Reduction
Closed Reduction

$2,130
$400
4. Ankle or Foot (excluding toes

Open Reduction
Closed Reduction

$1,330
$400
5. Lower Jaw

Open Reduction
Closed Reduction

1,330
$665
6. Wrist or Elbow

Open Reduction
Closed Reduction

$1,065
$530
7. Toe or Finger

Open Reduction
Closed Reduction

$265
$130
  1. Tendons and Ligaments:Must be torn, ruptured, or severed and must be treated by a physician within 72 hours after the Covered Accident and repaired through surgery within six months after the Covered Accident. If a covered person receives a fracture and/or a dislocation and also tears, ruptures, or severs a tendon/ligament in a Covered Accident, the Insurer will pay only one benefit. The Insurer will pay the largest of this benefit, the Fractures Benefit or the Dislocation Benefit.
Repair of one $665
Repair of all if more than one $1,330
1. Second-degree burns of a least 25%, but not more than 35% of body surface $530
2. Second-degree burns of more than 35% of body surface $1,330
3. Third-degree burns covering 6 through 9 square inches of body surface $1,065
4. Third-degree burns covering 10 through 25 square of inches of body surface $2,665
5. Third-degree burns covering more than 25 square inches of body surface $5,330
  1. Ruptured Disc or Torn Knee Cartilage: Must be treated by a physician within 72 hours after the accident and repaired through surgery within one year after the Covered Accident.
  2. Eye Surgery
With Surgical Repair $265
  • Accident Follow-up Treatment Benefit: Pays for additional treatment of injuries sustained in a Covered Accident over and above emergency treatment administered within 72 hours following the accident. This benefit is payable for up to a maximum of three treatments per Covered Person per Covered Accident. Such treatment must begin within 30 days of the Covered Accident or discharged from the hospital or extended care facility, and be within the six-month period following the Covered Accident or discharge. Pays $25 per visit.
  • Accident Emergency Treatment Benefit: Pays for emergency treatment for a Covered Accident, we will pay the amount shown in the Policy Schedule for treatment received. This benefit is payable for treatment by a physician, x-rays, or treatment received in a hospital emergency room. Treatment must be received within 72 hours of such accident. This benefit is payable once per Covered Accident.
Insured and Spouse $150
Children $105
  • Initial Hospitalization for Injury Benefit:  When a Covered Person is confined for 24 hours or more for a covered accidental bodily injury, the Insurer will pay the benefit amount shown in the Policy Schedule. This benefit is payable only once per Hospital Confinement and only once for each Covered Person per calendar year. Benefit amount is $1,500.
  • Accident Hospital Income Benefit: Pays for hospital confinement for treatment of a Covered Accident, the Insurer will pay the daily amount shown in the Policy Schedule for each day of such confinement. Such confinement must start within 30 days of the accident. The Insurer will pay this benefit for up to 365 days per Covered accident.  Benefit amount is $200 per day.
  • Ambulance Benefit: Pays for ambulance transportation to a hospital or emergency room. Ambulance transportation must be within 72 hours of the accident. Pays four times the Ambulance Benefit for transportation provided by an air ambulance. The hospital or emergency room must be within 100 miles of the site of the accident or residence of the Covered Person. Benefit is limited to one trip per Covered Accident per Covered Person.
    Ground Ambulance $150
    Air Ambulance

    $600

  • Physical Therapy Benefit: Pays if a physician advises a Covered Person to seek treatment from a physical therapist. Physical therapy must be for injuries sustained in a Covered Accident and must start within 30 days of such accident or discharged from the hospital. Pays for one treatment per day up to six treatments per Covered Accident. The six treatments must take place within six months after the accident. Benefit amount is $75 per day.
  • Transportation Benefit: Pays for transportation to a hospital for special treatment and confinement for injuries sustained in a Covered Accident. This benefit is payable for the trip to the hospital. The local attending physician must prescribe the treatment, and the treatment must not be available locally. This benefit is not payable for transportation to any hospital located within a 100-mile radius of the site of the accident or residence of the Covered Person. This benefit is payable for up to three trips per calendar year per Covered Person. Benefit amount is $300.
  • Family Lodging Benefit: Pays for one motel or hotel room for a member (or members) of the immediate family to accompany the Covered Person for hospital confinement for the treatment of injuries. This benefit is payable only during the same period of time the injured Covered Person is confined to the hospital. Benefit is not payable for the trip to the hospital. The hospital and the motel or hotel must be more than 100 miles from the residence of the Covered Person. The local attending physician must prescribe the treatment. This benefit is payable for up to 30 days per Covered Accident. Benefit amount is $100 per day.
  • Wellness Benefit: After 12 months of paid premium for this benefit, the Insurer will pay for an Insured to undergo routine examinations or other preventive testing. Benefits include and are payable for: annual physical exams, mammograms, pap smears, immunizations, flexible sigmoidoscopy, Prostatic Specific Antigen, and blood screenings. This benefit is payable only once per 12-month period. Benefit amount is $60.
  • Accidental Death Benefit:  Death must occur as a result of a Covered Accident and must occur within 90 days of a Covered Accident.

Insured

Spouse

Child

Common-Carrier Accidents

$70,000

$35,000

$7,000

Motorized-Vehicle or Pedestrian Accidents

$50,000

$25,000

$5,000

Other Accidents

$30,000

$15,000

$3,000

  • Accidental Dismemberment: Pays a percentage of the Accidental Death Benefit selected.
Both arms and both legs 100%
Two arms or two legs 50%
Two eyes, hands, or feet 50%
One eye, hand, foot, arm, or leg 20%
One or more fingers and/or one or more toes 5%

OPTIONAL DISABILITY BENEFITS:

  • Off-the-job Accident Disability Benefit:  This Rider only applies to the Insured employee (not a spouse or child), as shown in the Policy Schedule. A 1,000 monthly benefit is available.
    • 1. Full-time employee through age 69: If an Insured is totally disabled within 90 days of a covered off-the-job accident, pays the benefit selected beginning with the very first day of disability; will pay benefits for up to 12 months.
    • 2. Not Employed Full-time through age 69: If an Insured is unable to perform two or more Activities of Daily Living (ADLs) as certified by a physician, and direct personal assistance is required to perform such ADLs, within 90 days of a covered accident, benefits are payable for up to 12 months.
    • 3. Age 70 or above: If, as a result of a covered off-the-job accident, a covered person is hospital-confined, the Insurer will pay one-thirtieth of the benefit shown in the Policy Schedule times three for each day of confinement. Benefits are payable up to 12 months.

Accident Select II Monthly Rates:

Employee Only $22.49
Employee and Children $35.09
Employee and Spouse $33.64
Employee and Family $46.24

Southern Administrators and Benefit Consultants

Mailing Address:
P.O. Box 2449

Madison, MS 39130-2449

Physical Address:
567 Highway 51, Suite A
Ridgeland, MS 39157

Phone (601) 856-9933
Fax (601) 856-8088
http://www.sabcflex.com/ 

Cafeteria Plan

Cafeteria Plans are Flexible Benefit Plans that enable employees to choose from a menu of fringe benefits as defined in Section 125 of the Internal Revenue Code. There are two primary types of Cafeteria Plans.
In a Premium Only Plan, known as POP, the employee pays the premium for group insurance plans such as life, dental, vision, health, cancer, accidental death and dismemberment, and others with pre-tax dollars.
In a Full Flex Plan, in addition to paying group insurance premiums with pre-tax dollars, the employee participants in one or both types of Flexible Spending Accounts: an Unreimbursed Medical Expenses account, in which a portion of the employee’s pre-tax income is set aside to pay for deductibles and other out-of-pocket medical expenses or a Dependent Care Reimbursement account, in which a portion of the employee’s pre-tax income is set aside to pay for childcare or other dependent care expenses.
By paying premiums with pre-tax dollars, employees can reduce their taxable income by the cost of eligible benefits chosen. The savings can be used to select additional benefits from the Cafeteria Plan menu. Participation in one or both Flexible Spending Accounts can yield additional tax savings. Since the Plan reduces reportable taxable income, the enrolled employee may incur a reduced Social Security benefit at the time of retirement. The extent of the reduction depends on both the length of time under the Pre-tax Benefit Plan and the total amount of tax reductions.
Changes to the Cafeteria plan cannot be made unless major changes in family status occur such as marriage, divorce, death of a spouse or dependent, birth or adoption of a child, termination of employment of employees’ spouse, switching from part-time to full-time employment status or from full-time to part-time status of employees’ spouse or employee or employee’s spouse taking an unpaid leave of absence. Changes are not automatic and should be made within 60 days of a qualifying event. You must contact Human Resources and complete the necessary forms within 60 days of the change.
Flex Plans: 
  • Careflex: Dependent care expenses are covered if the dependent is age 12 or under, or physically or mentally incapable of self-care. An incapacitated dependent, who is age 13 or older must regularly spend at least eight hours a day in the employee’s household to qualify. These expenses must be incurred to allow an employee and spouse to work unless the spouse is a full-time student or incapable of self-care. Eligible expenses include the costs for in-house or on-site care centers (caring for six (6) or more individuals) or at-home services provided by third parties who meet applicable state and federal law standards. Preschool costs for a child may also qualify for reimbursement. The maximum allowable expense per year is $5,000 for a married couple. Dependent care expenses reimbursed cannot be applied toward the federal income tax credit for dependent care. During the Plan year (September through August) flexible spending account participants may not change the amount of their monthly deduction unless major changes in a family status occur.
  • Unreimbursed Medical Expenses: This plan allows for non-reimbursed medical expenses up the amount of $5,000 to be paid with before tax dollars. You may choose to defer a certain dollar amount per month and then, as eligible expenses are incurred, file for reimbursement by providing receipts for covered expenses. During the plan year, participants cannot change their election unless major changes in a family status occur. Should you have medical expenses in excess of available funds in the medical reimbursement account, you cannot claim against the dependent care account. Funds in the accounts must remain separate.

claim form and supporting documentation, such as explanations of benefits, receipts, etc. must be submitted directly to Southern Administrators and Benefit Consultants. The fax number is 601-856-8088 or claims may be mailed directly to the following address: Southern Administrators and Benefit Consultants; P.O. Box 2449, Madison, MS 39130-2449. Claims must be submitted by 3:00 p.m. each day in in order to receive reimbursement the next day.

Southern Administrators and Benefit Consultants Claim Form for Unreimbursed Medical and Daycare Expenses

EXAMPLES OF ELIGIBLE REIMBURSEMENT ACCOUNT EXPENSES
  • Ambulance Hire
  • Artificial limbs and breasts (only if reconstructive)
  • Braille books and magazines
  • Contact lens solution
  • Crutches
  • Drugs (legal, prescription only or insulin)
  • Elastic hose (medically prescribed)
  • Eye glasses/contacts
  • Fees for:
    1. Acupuncture 11. Clinic

    21. Dentist

    2. Chiropractor 12. Gynecologist 22. Hospital
    3. Examination 13. Nurse 23. Obstetrician
    4. Laboratory 14. Optometrist 24. Oral Surgery
    5. Ophthalmologist 15. Osteopath 25. Pediatrician
    6. Orthodontics 16. Physiotherapist 26. Podiatrist
    7. Physician 17. Psychoanalyst 27. Psychologist
    8. Sanitarium 18. Surgeon 28. Surgery
    9. Therapy 19. X-ray
    10. Anesthetist 20. Chiropodist
  • Hearing devices
  • Insurance co-payments and deductibles
  • Needles, syringes and other diabetic-related supplies
  • Nursing care
  • Oxygen equipment
  • Rental of medical or healing equipment
  • Seeing-eye dog and hearing-assisting cat
  • Support or corrective devices
  • Telephone for deaf
  • Medically prescribed therapy treatments
EXAMPLES OF INELIGIBLE REIMBURSEMENT EXPENSES
  • Retin-A
  • Smoking cessation program
  • Weight loss program
  • Elective cosmetic surgery
  • Medical insurance premiums
  • Health club dues
  • Rogaine
  • Maternity clothing
  • Non-prescription drugs
  • Exercise programs and health spa membership
  • Diaper service
  • Swimming lessons
  • Household help

This page is maintained by Lisa Giger. Send questions and comments regarding this site to lgiger@deltastate.edu