Voluntary Group Critical Illness Insurance Plan Highlights
This document outlines the key features of the voluntary group critical illness insurance, including coverage details, eligibility criteria, benefit amounts, and contribution requirements for employees and their dependents.
www.reliancematrix.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Plan Highlights The Life is Good Company COVERAGE Voluntary group critical illness insurance provides a fixed, lump- sum benefit upon diagnosis of a critical illness, which can include heart attack, stroke, paralysis and more. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and child care. ELIGIBILITY All Active Full-Time and Part-Time Employees working 30 hours or more per week, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are: Your legal spouse or your domestic partner. Your dependent children from birth to 26 years. A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT Employee: Choose from a benefit of $5,000 to a maximum of $20,000 in $5,000 increments. Spouse: Choose from a benefit of $5,000 to a maximum of $10,000 in $5,000 increments, not to exceed 50% of approved employee amount. Child(ren): 25% of approved employee amount up to a maximum of $5,000. GUARANTEED ISSUE Employee: $20,000 Spouse: $10,000 Child(ren): $5,000 BENEFIT REDUCTION DUE TO AGE Age Original Benefit Reduced to 70 50% CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. RATES See attached Rate Sheet Voluntary Group Critical Illness Insurance
www.reliancematrix.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. FEATURES DIAGNOSIS ADULT BENEFIT Carcinoma In Situ 25% Coma 100% Coronary Disease 25% Heart Attack 100% Life Threatening Cancer 100% Loss of Sight 100% Major Organ Failure 100% Paralysis 100% Ruptured Cerebral, Carotid or Aortic Aneurysm 100% Severe Brain Damage 100% Stroke 100% DIAGNOSIS CHILD BENEFIT Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Downs' Syndrome 100% Muscular Dystrophy 100% Spina Bifida 100% Type 1 Diabetes 100% Lifetime Maximum Benefit – 1000% of Insurance Amount Subsequent Occurrence Benefit – 100% of benefit if diagnosed 0 months or later Recurrence Benefit (Same Illness) – 100% of benefit if diagnosed 6 months or later MSLA Continuation Transfer of Coverage Annual Enrollment Portability Wellness (Health Screening) Benefit – $50
Reliance Standard Voluntary Plans Critical Illness Insurance Premium Table Plan Holder: The Life is Good Company Scheduled Benefit: Each eligible employee may elect for himself and/or his eligible spouse an amount of insurance shown in the table below. Employee/Spouse Premiums: To find you and your spouse's premium - • Determine your age band: o Your age = your age at your last birthday. o Spouse age = your age at your last birthday. o For employees age 70 or older, benefit amounts are reduced according to the age-based reduction chart shown in the Plan Highlights. When selecting an amount of insurance, you must select at pre-age 70 benefit amount. • Select a benefit from: o Select an employee and spouse benefit from the table below. • Employee and spouse rates change as insured moves from one age bracket to the next, based on the age determination rules. Employee Weekly Premiums Benefit Amount Age 18-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70+ $5,000 $0.72 $0.72 $0.92 $0.92 $1.72 $1.72 $3.30 $3.30 $5.82 $5.82 $10.60 $10,000 $1.43 $1.43 $1.85 $1.85 $3.44 $3.44 $6.60 $6.60 $11.63 $11.63 $21.21 $15,000 $2.15 $2.15 $2.77 $2.77 $5.16 $5.16 $9.90 $9.90 $17.45 $17.45 $31.81 $20,000 $2.86 $2.86 $3.69 $3.69 $6.88 $6.88 $13.20 $13.20 $23.26 $23.26 $42.42 Spouse Weekly Premiums Benefit Amount Age 18-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70+ $5,000 $0.72 $0.72 $0.92 $0.92 $1.72 $1.72 $3.30 $3.30 $5.82 $5.82 $10.60 $10,000 $1.43 $1.43 $1.85 $1.85 $3.44 $3.44 $6.60 $6.60 $11.63 $11.63 $21.21 Dependent Child(ren): Your dependent child(ren) is eligible for a benefit amount of 25% of your Critical Illness benefit election, limited to a maximum of $5,000 To calculate Dependent Child(ren) Benefit: Employee Benefit Amount x 25% = Dependent Child(ren) Benefit. No rounding needed. To calculate Weekly Dependent Child(ren) Premium: Dependent Child(ren) Benefit/1000 x 0.06 Please Note: One rate and benefit amount for all eligible children in family, regardless of number. Please read this important information - You may not have coverage as both an employee and as a dependent. - Employee must have coverage in order for spouse and dependent children to be covered. Please note, these rates are approximate and subject to change.
