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MEMORANDUM
 

MEMORANDUM

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    MEMORANDUM MEMORANDUM Document Transcript

    • EMPLOYEE BENEFIT PLAN ENROLLMENT PACKET 2007 This packet includes the following information: Memorandum Comparison of Health Insurance Benefit Options Dental Plan Highlights AFLAC Cancer Insurance Disability Insurance Options Life Insurance Options Long-Term Care Insurance Vision Care Insurance Vision Discounts Tax-Sheltered Annuity Companies Retirement Plans Updating Your Benefit Coverage For additional information, please contact Janet Clack, Employee Benefits Coordinator at (770) 887-2461 extension 202136 or 202141 or e-mail at jclack@forsyth.k12.ga.us. Please check out our Employee Benefits link in the Department section of our web site at forsyth.k12.ga.us.
    • MEMORANDUM TO: New Employees for 2007 School Year FROM: Business Office SUBJECT: Eligibility Coverage You are eligible to enroll yourself and your eligible dependents for State Health Benefit coverage if you are: • A certified public school teacher who works half time or more, but not less than 18 hours a week. • A non-certified service employee of a local school system who is eligible to participate in the Teachers Retirement System. You must also work at least 60% of a standard schedule for your position, but not less than 20 hours a week. • An employee who is eligible to participate in the Public School Employees’ Retirement System. You must also work at least 60% of a standard schedule for your position, but not less than 15 hours a week. To be eligible for all other benefits you must work at least 20 hours per week.
    • Forsyth County Board of Education Employee Benefit Effective Dates Hire Date Benefits Effective Date December 2, 2006 – January 2, 2007 February 1, 2007 January 3, 2007 – February 1, 2007 March 1, 2007 February 2, 2007 – March 1, 2007 April 1, 2007 March 2, 2007 – April 2, 2007 May 1, 2007 April 3, 2007 – May 1, 2007 June 1, 2007 May 2, 2007 – June 1, 2007 July 1, 2007 June 4, 2007 – July 2, 2007 August 1, 2007 July 3, 2007 – August 1, 2007 September 1, 2007 August 2, 2007 – September 4, 2007 October 1, 2007 September 5, 2007 – October 1, 2007 November 1, 2007 October 2, 2007 – November 1, 2007 December 1, 2007 November 2, 2007 – December 3, 2007 January 1, 2008 Your employee benefits begin on the first day of the month following one full calendar month of employment.
    • STATE HEALTH BENEFIT PLAN RATE SHEET JANUARY 2007 – DECEMBER 2007 The Forsyth County Board of Education pays $49.38 for all employees participating in the health insurance program through the State Health Benefit Plan. Any premiums in excess of the $49.38 are listed below and will be deducted from your monthly paycheck. UNITED HEALTHCARE (UHC) PPO MONTHLY PREMIUM PPO Options: www.myuhc.com/groups/gdch Single Family PPO (877) 246-4189 $ 21.76 $167.78 PPO Tobacco Charge $ 61.76 $207.78 PPO Spouse Charge $197.78 PPO Tobacco & Spouse Charge $237.78 PPO CCO $ 65.64 $249.24 PPO CCO Tobacco Charge $105.64 $289.24 PPO CCO Spouse Charge $279.24 PPO CCO Tobacco & Spouse Charge $319.24 Indemnity Option: Indemnity $214.62 $522.32 Indemnity Tobacco Charge $254.62 $562.32 Indemnity Spouse Charge $552.32 Indemnity Tobacco & Spouse Charge $592.32 High Deductible Option (HDHP): (877) 246-4195 High Deductible $ 0.00 $ 96.62 High Deductible Tobacco Charge $ 40.00 $136.62 High Deductible Spouse Charge $126.62 High Deductible Tobacco & Spouse Charge $166.62 High Deductible CCO $ 23.38 $151.38 High Deductible CCO Tobacco Charge $ 63.38 $191.38 High Deductible CCO Spouse Charge $181.38 High Deductible CCO Tobacco & Spouse Charge $221.38 TRICARE Supplement $ 5.00 $ 10.00 www.asitrisuppga.com (800) 638-2610 Ext. 255 If an employee and spouse are both employed with the Forsyth County School System, please ask about our discounted rates for family coverage.
    • HMO COVERAGE OPTIONS MONTHLY PREMIUM HMO Options: Single Family BlueChoice www.bcbsga.com $ 22.42 $126.42 BlueChoice Tobacco Charge (800) 464-1367 $ 62.42 $166.42 BlueChoice Spouse Charge $156.42 BlueChoice Tobacco & Spouse Charge $196.42 BlueChoice CCO $ 78.98 $239.50 BlueChoice CCO Tobacco Charge $118.98 $279.50 BlueChoice CCO Spouse Charge $269.50 BlueChoice CCO Tobacco & Spouse Charge $309.50 CIGNA www.cigna.com $ 22.64 $126.96 CIGNA Tobacco Charge (800)-564-7642 $ 62.64 $166.96 CIGNA Spouse Charge $156.96 CIGNA Tobacco & Spouse Charge $196.96 CIGNA CCO $ 79.36 $240.38 CIGNA CCO Tobacco Charge $119.36 $280.38 CIGNA CCO Spouse Charge $270.38 CIGNA CCO Tobacco & Spouse Charge $310.38 Kaiser Permanente www.kp.org/ga $ 28.20 $140.58 Kaiser Permanente Tobacco Charge (404) 261-2590 $ 68.20 $180.58 Kaiser Permanente Spouse Charge $170.58 Kaiser Permanente Tobacco & Spouse Charge $210.58 Kaiser Permanente CCO $ 89.32 $262.76 Kaiser Permanente CCO Tobacco Charge $129.32 $302.76 Kaiser Permanente CCO Spouse Charge $292.76 Kaiser Permanente CCO Tobacco & Spouse Charge $332.76 United Healthcare www.provider.uhc.com $ 25.92 $135.02 United Healthcare Tobacco Charge (866)527-9599 $ 65.92 $175.02 United Healthcare Spouse Charge $165.02 United Healthcare Tobacco & Spouse Charge $205.02 United Healthcare CCO $ 85.24 $253.62 United Healthcare CCO Tobacco Charge $125.24 $293.62 United Healthcare CCO Spouse Charge $283.62 United Healthcare CCO Tobacco & Spouse Charge $323.62
    • Delta Preferred Option Dental Program Deductibles and Annual Maximum apply from January 1st – December 31st The Board of Education pays $23.58 for each employee participating in the dental insurance program. MONTHLY PREMIUMS Employee Only $ 6.00 Employee & One Dependent $23.00 Employee & Family $51.00 A BOUT D ELTA P REFERRED O PTION The DeltaPreferred Option (DPO) program allows you to: 1♦ Save on out-of-pocket expense when you visit a network dental office 2♦ Visit any dentist of your choice — select a different dentist for each member of your family 3♦ Change dentists at any time 4♦ Go to a dental specialist of your choice 5♦ Receive dental care anywhere in the world ____________________________________________________________________________________________ Under the DPO program, you may visit any licensed dentist you wish. However, the greatest cost savings are achieved by visiting a DPO dentist. DELTA NON-DPO PREFERRED DENTIST (DPO) DENTISTS* Your out-of-pocket expense will probably be less because DPO dentists have You may be responsible for the dentist’s fees, which could be agreed to charge DPO patients reduced fees. higher than those approved by Delta. Claim forms will be completed and submitted for you at no charge. You may have to complete and submit your own claim forms or pay a service fee. You may be charged only the patient share** at the time of treatment, not You may have to pay the entire amount in advance and wait for Delta’s portion. reimbursement. *If you do not choose to visit a DPO dentist, you may benefit by choosing a DeltaPremier dentist over a non-Delta dentist, since DeltaPremier dentists agree not to balance bill. ** “Patient share” is the copayment, any deductible and any amount over the annual maximum. Some services may not be covered; please refer to your Evidence of Coverage. Some examples of services not covered are cosmetic dentistry, experimental procedure and services to correct congenital malformations. D ELTA P REFERRED O PTION I S E ASY T O U SE DeltaPreferred Option is Delta’s preferred provider program. The program provides the maximum benefit when you visit a DPO dentist. DPO dentists are Delta dentists who have agreed to charge DPO patients reduced fees. To use your DPO program, just call the dental office and verify that the dentist is a DPO dentist. For a list of dentists in your area, visit our web site at www.deltadentalins.com and click on dentist directory. Then choose the DeltaPreferred Option (DPO/PPO) dentist’s link. Delta Dental offers you what no other dental plan can — the Delta Difference.® Here’s what makes us unique: 1♦ Delta dentists agree to charge you no more than the amount approved by Delta. ♦ A nationwide network of Delta dentists. ♦ We require professional treatment standards. Delta dentists must meet professional standards for hygiene, radiation safety and other areas of quality care. Sample Claim Payment DPO Dentist Non-Delta Dentist* Dentist Submitted Amount $120.00 $120.00 Delta Approved Amount $75.00 $120.00 Delta Allowed Amount $75.00 $90.00 Delta Payment (80%) $60.00 $72.00 Patient Payment** $15.00 $48.00 *If you do not choose to visit a DPO dentist, you may benefit by choosing a DeltaPremier dentist over a non-Delta dentist, since DeltaPremier dentists agree not to balance bill. **The difference between the Approved Amount and the Delta Payment
    • PRINCIPAL BENEFITS AND COVERED SERVICES* In-Network Out-ofNetwork WHO’S ELIGIBLE Primary enrollee and spouse as well as dependent children to age 23 (Full-time students to age 25). DEDUCTIBLES AND BENEFITS MAXIMUM $50 per person, $150 per family, per calendar year. The maximum benefit paid per calendar year is $1,000 per person. ORTHODONTIC MAXIMUM $1,500 separate lifetime maximum for orthodontics per dependent child until age 23 (Full-time student to age 25). DIAGNOSTIC AND PREVENTIVE BENEFITS* -- oral examinations, cleanings, 100% of DPO fee schedule 100% of UCR (Usual, x-rays, biopsy/tissue examinations of tissue biopsy, fluoride treatment, space (no deductible applies to these services) Customary, and maintainers, specialist consultation Reasonable) (no deductible applies to these services) BASIC BENEFITS* -- simple extractions, fillings, simple restorations, miscellaneous 80% of DPO fee schedule 80% of UCR (Usual, restorations; denture repairs, Customary, and endodontics (root canals); periodontics (gum treatment) Reasonable) MAJOR BENEFITS** 50% of DPO fee schedule 50% of UCR (Usual, -- crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, Customary, and full dentures) Reasonable) 12 Month Waiting Period 12 Month Waiting Period ORTHODONTICS BENEFITS* 50% of DPO fee schedule 50% of UCR (Usual, Dependent Children Only Customary, and Reasonable) 12 Month Waiting Period 12 Month Waiting Period *If you do not choose to visit a DPO dentist, you may benefit by choosing a DeltaPremier dentist over a non-Delta dentist, since DeltaPremier dentists agree not to balance bill. ** “Patient share” is the copayment, any deductible and any amount over the annual maximum. Some services may not be covered; please refer to your Evidence of Coverage. Some examples of services not covered are cosmetic dentistry, experimental procedure and services to correct congenital malformations. SERVICES THAT ARE NOT COVERED Although your program covers many of the most commonly needed services, some services are not covered. If you are unsure whether a particular procedure is covered, or how much of it is paid for by your program, check with Delta before proceeding. The following are not covered by the program: 1♦ Services for injuries or conditions covered under Workers’ Compensation or Employer’s Liability Laws 2♦ Cosmetic surgery or dentistry or services to correct congenital malformation 3♦ Experimental procedures 4♦ Therapeutic drugs, premedication or pain relievers 5♦ Hospital costs or extra charges for hospital treatment 6♦ Anesthesia (except for general anesthesia for oral surgery) 7♦ Extra-oral grafts, implants and implant removal The preceding information is not intended for use as a summary plan description, nor is it designed to serve as an Evidence of Coverage for the program. This program is administered by Delta Dental Insurance Company. If you have specific questions regarding benefit structure, limitations or exclusions, consult the Evidence of Coverage or contact Delta’s Customer Services department. Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809 770-645-8700 or 1-800-616-3631 www.deltadentalins.com
    • VISION DISCOUNTS Each employee and their families are eligible for vision care discounts with two local providers: FREE OPTICAL 770-844-8411 184 Tri-County Plaza Cumming, GA 30040 PEARLE EXPRESS 770-889-2014 546 Lakeland Plaza Cumming, GA 30040 Simply inform the vision care provider that you are a Forsyth County School system employee and/or family member. You may be required to show your school system badge. State Health Benefit Plan Insurance also includes a wide range of vision discounts through Lens Crafters. Discounts vary depending upon the vision care center you select. Please call (800) 377-6436 for more information.
    • Advantage Enhanced Vision Care Monthly Vision Care Rates Forsyth County School System Advantage Enhanced Benefit Frequency & Plan Design EXAMINATION SPECTACLE LENSES FRAME CONTACT LENSES PLAN B Once every 12 months Once every 12 months Once every 24 months Once every 12 months Advantage Enhanced Schedule of Benefits IN-NETWORK OUT-OF-NETWORK Eye Examination Covered in full after the co-pay* Reimbursed up to $40.00 Spectacle Lenses (pair) -Standard Single Vision Covered in full after the co-pay * Reimbursed up to $30.00 -Standard Bifocal Covered in full after the co-pay * Reimbursed up to $50.00 -Standard Trifocal Covered in full after the co-pay * Reimbursed up to $75.00 -Standard Lenticular Covered in full after the co-pay * Reimbursed up to $80.00 Progressive Lenses 20% off the UCR, less $50 plan allowance Reimbursed up to $40.00 Specialty Lenses (pair) 20% off U&C, minus the corresponding standard lens plan payment* Corresponding standard lens reimbursement. Lens Options Preferred Pricing (20% off retail) Reimbursed up to $0.00 Frame $35 wholesale allowance (approx. retail of $75 to $100) Reimbursed up to $45.00 After the co-pay * Contact Lenses (In lieu of frame and spectacle lenses) -Elective $110 allowance* After an Avesis preferred discount Reimbursed up to $110.00 -Medically Necessary Covered in full with no co-pay* Reimbursed up to $250.00 Advantage Enhanced Monthly Rates PLAN B (12,12,24,12) $10/$20 CO-PAY* Employee Only $ 6. 48 Employee & One Dependent $ 1 1. 32 Employee & Family $ 1 6. 82 * $10/ $20 co-pay includes $10 co-pay for the exam and $20 co-pay for materials (spectacle lenses & frame). • Co-pays do not apply for Contacts & out-of-network reimbursement • Employees enrolling in the group voluntary plan must agree to remain enrolled during the designated plan period • Employees who elect not to enroll during the initial plan enrollment period must wait until the next plan enrollment period • Funding may be stand - alone, 100% Voluntary by the Employee. When you need to see an eye care professional, simply visit www.avesis.com or call Avesis Monday through Friday, 7AM to 5PM (MST) at 1-800-828-9341 for a provider in your area. Avesis’ Customer Service Representatives and its web site have the most current listing of Participating Providers. To use your benefit, simply 1) Select a Participating Provider. 2) Call up and identify yourself as an Avesis member. 3) Schedule an appointment. 4) Present your ID Card and pay any co-pays and expenses not covered under the plan. You may also verify eligibility or print additional or replacement ID cards on-line at www.avesis.com.
    • AFLAC CANCER POLICY The Board of Education offers a basic cancer plan through AFLAC. The premiums for cancer coverage are payroll deductible and qualify for pre-tax saving under the Cafeteria Plan. Important Facts: • The cancer policy pays benefits directly to the insured regardless of other coverage with no coordination of benefits; • The specified disease rider will pay extra benefits if hospitalized for any of the specified diseases listed on our insert (meningitis (bacterial), encephalitis, etc.) • The first occurrence benefit rider will add to the first occurrence benefit of $1500 - $500 per year per person until the first diagnosis of an internal cancer. For single parent, employee-spouse and family coverage, the benefit will continue to accrue for those individuals not having been diagnosed with cancer; • Policy is guaranteed renewable for life and portable at the same rate being paid through the school system; • Dependent children may be covered until age 25; • Policy has 30-day waiting period. • Cancer Screening Wellness Benefit- $40 per calendar year per covered person. Fax screening results or billing to Betty Suggs at (770) 503-7756. MONTHLY RATES Individual One-Parent Employee/Spouse Two-Parent Family Family $18.70 $21.70 $30.50 $30.50 Specified Disease Rider l.00 l.50 2.00 2.00 First Occurrence Building 3.00 4.50 6.50 6.50 Benefit ($500/year/person-5 units If you have any questions, please call Betty Suggs, AFLAC Associate At (770) 532-5171 or (800) 559-5171
    • LONG TERM DISABILITY INSURANCE 2007 LONG TERM DISABILITY INSURANCE – Mutual of Omaha Core/Base Plan (no cost to employee): Provides 50% coverage of gross monthly Salary (Benefit is taxable) Buy-Up/Optional Plan (paid by employee): Provides an additional 16.67% coverage for a total of 66.67% (Buy-up portion of benefit is NOT taxable) • Benefits begin after 120 days of continuous disability from accident or illness (sick leave may be used during this time). • Disabilities beginning before the age of 60 have a maximum benefit period to age 65. Disabilities beginning after the age of 60 have a reducing benefit period but a minimum of one year. • Maximum monthly benefit is $7,000. • No medical questions when first eligible. Definition of Disability: Class 1 Employees: Inability to perform each of the duties of your “own occupation” for (Certified) first five years of disability, “any occupation” thereafter. Includes: Active Superintendent & Assts, Central Office Administrators, Principals & Assts, Full-time Teachers, Media Specialists, Psychologists, Social Workers & Counselors Class 2 Employees Inability to perform each of the duties of your “own occupation” for (Non-certified) the first two years of disability, “any occupation” thereafter. Includes: Active Maintenance & Transportation employees, Para pros & Aides, Secretaries, and Food Service Personnel Buy-Up Rates Gross Monthly Salary divided by 100 multiplied by . 28 equals monthly premium. (i.e. $2500.00 divided by 100 = 25 x .28 = $7.00 per month) FORSTYH COUNTY
    • RETIREMENT AND SUPPLEMENTAL RETIREMENT PLANS TEACHER RETIREMENT (TRS) As of this date, employee contribution to Teachers Retirement is 5% of gross salary. Eligibility includes: Active Superintendent & Assts, Central Office Administrators, Principals & Assts., Full-time Teachers, Media Specialists, Psychologists, Social Workers & Counselors, Para pros, Secretaries, Food Service Managers. PUBLIC SCHOOL EMPLOYEES RETIREMENT (PSERS) Employees not eligible for Teachers Retirement must participate in this plan. The contribution rate is $36 per year deducted at the rate of $4 per month for nine months. VALIC SUPPLEMENTAL RETIREMENT PLAN – Bus Drivers, Custodians, Food Service Workers, Maintenance and Warehouse The Board has established a Supplemental Retirement Plan with Variable Annuity Life Insurance Company (VALIC) for employees that participate in the Public School Employees Retirement Plan. The Board will match employee contributions to this plan up to a maximum of 4% of your salary. Employee contributions can be more than the Board maximum. Our representative for VALIC is Mr. Gary Parker, and he can be reached at (678)-576-2673.
    • LIFE INSURANCE OPTIONS II. UNIVERSAL LIFE INSURANCE – Trustmark Insurance Company • Cash value accumulation • Level premium (does not increase with age) • Earns tax-deferred interest at 4.25%, guaranteed minimum 4% • Long-term care rider included • Terminal illness rider included • Waiver of Premium and AD & D options available • Coverage is PORTABLE upon termination of employment (same rate & benefit) Employees Offered: 1. Up to 2 times salary or $100,000, subject to two medical questions when first eligible 2. Up to $250,000 subject to three additional medical questions during Open Enrollment Family Coverage offered: 1. Spouse eligible up to $250,000 with or without employee coverage 2. Children’s term rider available with employee or spouse policy (ages 15 days-18 years) 3. Child or grandchild policy available with or without employee coverage (ages 0-26) Rates are subject to participant’s age, smoker/non-smoker status, and amount of coverage requested. For more information, contact Janet Clack at the Central Office (770-887-2461 ext. 2136).
    • UNUM PROVIDENT LONG TERM CARE INSURANCE Who Needs Long Term Care Insurance? • If you are hoping to set up a financial plan for a worry-free retirement • If you worry about being a burden to your family • If you don’t have family members to take care of you • If you want to remain independent for as long as you are able Who Can Apply? • Employees – Full –time employees • Family Members – Spouses, adult children, siblings, parents (in-law), and grandparents (in-law) ages 18 to 80 may apply with medical underwriting. Levels of Care Long Term Care Facility: A Long Term Care Facility is an institution or distinctly separate part of a hospital that provides skilled, intermediate or custodial care under state licensing and certification laws. Assisted Living Facility: An Assisted Living Facility is licensed by the appropriate agency (if required) to provide ongoing care and services to a minimum of three inpatients in one location. Professional Home Care: Includes visits to your home by a licensed Home Health Care Provider during which skilled nursing care; physical, respiratory, occupational, dietary or speech therapy; adult day care or hospice care; or homemaker services are provided. Options Inflation Protection: Compound Growth Uncapped. Your monthly benefit amount will increase each year by 5% on a compounded basis. Your pool of benefit dollars will also increase by 5% each year on a compounded basis. Elimination Period: Your plan’s Elimination Period of 60 consecutive days is the amount of time you must wait before benefits become payable. This time period needs to be satisfied only once during the life of your plan. What’s the Cost? Your individual cost for insurance will depend on your age, the plan and the options you choose. The younger you are when you purchase the insurance, the lower the cost. Rates will not go up because you grow older. For more information, contact Janet Clack at the Central Office (770-887-2461 ext. 2136)
    • TAX SHELTERED ANNUITY COMPANIES
    • BALES & ECKEL LINCOLN NATIONAL TSA 475 Tribble Gap Road, Suite 101 3625 Cumberland Blvd. SE Suite 900 Cumming, Georgia 30040 Atlanta, Georgia 30339 David Bales/Tim Eckel 770-205-6890 John Koshy (770) 799-7075 1st INVESTORS MERRILL LYNCH 1100 Circle 75 Parkway Suite #260 380 Dahlonega St. Suite 201 Atlanta, Georgia 30339 Cumming, Georgia 30040 Adam Hextell (770) 818-0700 Rick Groff 678-513-7908 EDWARD JONES MET LIFE 911-C Market Place Blvd. Suite 12 9000 Central Park West, Suite 325 Cumming, Georgia 30041 Atlanta, Georgia 30328 Rex E. Abbott (770) 844-1000 Steve Shearod (770) 390 - 5680 FIDELITY INVESTMENT NATIONWIDE TSA P.O. Box 770002 3068 Meadow Mere W. Cincinnati, Ohio 45277-0089 Chamblee, Georgia 30341 Client#61005 Stephen Ebert (800) 868-1023 Loy Day (770) 781-4130 HORACE MANN INSURANCE CO. NORTHERN LIFE INSURANCE CO. P.O. Box 3145 1645 Blue Pond Drive Gainesville, Georgia 30503 Canton, Georgia 30115 Andy Gaddis (678) 316 - 1460 Jerry Bohus (770) 499-0659 HARRIS CONSULTING THE SECURITY BENEFIT GROUP 555 Sun Valley Drive A4 4924 October Way, NW Roswell, Georgia 30076 Acworth, Georgia 30102 Joe Harris (770) 642-2228 ext 3 Jim Downey (770) 975-0244 Michael J. Riscica (404)275-3290 ING 995 Kilmington Court VALIC Alpharetta, Georgia 30004 1100 Ashwood Parkway, Suite 190 Derrick Friedman (770) 754-4081 Atlanta, Georgia 30338 Stephan Bayani Cell (770) 778-9290 Gary Parker (678) 576 - 2673 e-mail rsb6262@aol.com
    • LIFE INSURANCE OPTIONS I. TERM LIFE INSURANCE – The Standard Insurance Co. A $20,000 Term Life/AD&D Insurance policy is provided at no cost to each eligible employee. This coverage includes a Living Benefits Option and the policy may be continued at group rates when you no longer are eligible. Supplemental Term Life: • Includes Accidental Death & Dismemberment • Includes Living Benefits Option • Employees offered a minimum of $10,000 and a maximum of 5 times annual salary not to exceed $500,000 • No medical questions asked when first eligible up to the greater of the Guarantee Issue Amount of $100,000 or 5 times annual salary. • Includes Waiver of Premium • Coverage is PORTABLE or CONVERTIBLE upon termination of employment • Family coverage available 1. Spouse minimum $5,000 to a maximum of $100,000 in increments of $5,000 2. No medical questions on spouse when first eligible up to the Guarantee Issue Amount of $20,000 • Children minimum $2,000 and maximum of $10,000 (employee must also be covered) 1. Unmarried Child from birth to age 21 or to age 25 if a registered student in full time accredited educational institution 2. No medical questions on children when first eligible up to $10,000 • TOBACCO AND NON-TOBACCO RATES AVAILABLE
    • ADDITIONAL TERM LIFE, AD&D, DEPENDENT TERM LIFE PREMIUM RATES 7-1-2003 EMPLOYEE EMPLOYEE TOBACCO NON-TOBACCO Under age 29 = .114 Under age 29 = .074 30 to 34 = .133 30 to 34 = .087 35 to 39 = .153 35 to 39 = .100 40 to 44 = .223 40 to 44 = .148 45 to 49 = .375 45 to 49 = .251 50 to 54 = .638 50 to 54 = .426 55 to 59 = .846 55 to 59 = .587 60 to 64 = 1.065 60 to 64 = .763 65 to 69 = 1.79 65 to 69 = 1.325 70+ = 2.911 70+ = 2.324 SPOUSE SPOUSE TOBACCO NON-TOBACCO Under age 29 = .192 Under age 29 = .125 30 to 34 = .221 30 to 34 = .145 35 to 39 = .257 35 to 39 = .168 40 to 44 = .380 40 to 44 = .253 45 to 49 = .648 45 to 49 = .433 50 to 54 = 1.102 50 to 54 = .699 55 to 59 = 1.421 55 to 59 = .986 60 to 64 = 2.144 60 to 64 = 1.537 65 to 69 = 3.642 65 to 69 = 2.696 Dependent Children $.26 per $2,000 Example of Rate Calculation: of Coverage Age 35 non-tobacco, $50,000 coverage $50,000 divided by 1000 = 50 50 x .100 = $5.00 per month
    • Benefit Updates PLEASE remember to update your various benefit coverage. The benefit choices you make during open enrollment or as a new hire will stay in effect for the duration of the 2007 plan year, unless you experience certain changes in status defined by federal law as qualifying events. Qualifying events include, but are not limited to: • Marriage or divorce; • Birth or adoption of a child or placement for adoption; • Death of a spouse or child, if only dependent enrolled; • Your spouse’s or dependent’s eligibility for or loss of eligibility for other group health coverage; • A change in residence by you, your spouse, or dependents that makes you or a covered dependent ineligible for coverage in your selected option; and • A change in employment status that leads to a loss or gain of eligibility under the plan. • Your dependent child’s full-time student status; If you experience a qualifying event, you may be able to make changes for yourself and your dependents, provided you request those changes within 31 days of the qualifying event. The following changes may be made anytime throughout the fiscal year: 1. Beneficiary updates on Life Insurance and Retirement Plan 2. Direct Deposit 3. Federal and State Withholding Certificate