Providence Engineering - 2023 Benefits Guide

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VOLUNTARY CANCER INSURANCE CARRIER: Sun Life Cancer Insurance supplements your existing medical insurance in case you are diagnosed with cancer; medical insurance alone may not be enough to cover your expenses. This plan pays a cash benefit during the term of your coverage following a positive diagnosis of certain cancers. WHY PURCHASE CANCER INSURANCE? You and your loved ones can rest a little easier knowing you have protection inplace to help avoid depleting your bank accounts or taking on additional debt to cover day-to-day living expenses. These reimbursements will free up additional monies for: ● Help cover medical plan deductibles, co-pays and other out-of-pocket costs ● Help cover everyday living expenses such as groceries, rent and mortgage payments ● Hire extra help for around the house, such as in-home caregivers ● Pay for travel to treatment facilities away from home as well as family visits Category First Occurrence Pays the amount shown when the insured person is diagnosed for the first time as having internal cancer. This benefit is only payable once per lifetime. Benefit $5,000 Continuous Hospital Confinement (Daily up to 90 days) $400 daily Radiation and Chemotherapy • Injected Cytoxic Medications (weekly) $1,000 • Pump Dispensed Cytotoxic Medications (first prescription & refill) $1,000 • Oral Cytotoxic Medications (per prescription) $500 • Cytotoxic Medications Administered by any other method (weekly) $1,000 • External Radiation Therapy (weekly) $600 • Insertion of Interstitial or Intracavitary administration of radioisotopes or Radium (weekly) $750 • Oral or I.V. Radiation (weekly) $600 Post-hospital Doctor Visits (per visit) $50 Home Health Care (per visit) within 7 days of hospital release and max 30 days per hospital $50 confinement. Max 90 days per benefit year Extended Care Facility (paid daily) Max 90 days per benefit year $200 Hospice (paid per day) Max 100 days lifetime $100 CANCER SEMI-MONTHLY RATES PAYROLL DEDUCTIONS Employee Only $12.48 Employee & Spouse $20.79 Employee & Child(ren) $14.25 Employee & Family $22.56 24
VOLUNTARY CRITICAL ILLNESS INSURANCE CARRIER: Sun Life Critical Illness Insurance supplements your existing medical insurance in case you are diagnosed with a covered condition, like a heart attack or stroke; medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit during the term of your coverage following a covered diagnosis. Critical illness insurance may not cover all types of cancer, but it does cover heart and vascular conditions, cancer-related conditions, and major organ failure. ● Employee Benefit Amount: $5,000 - $30,000 of coverage, in increments of $5,000. ● Employee Benefit Reduction Schedule: 50% at age 70. ● ● ● ● Spouse Benefit Amount: If you elect coverage for yourself, you can choose $2,500 - $15,000 of coverage, in increments of $2,500. NOT TO EXCEED 50% OF THE EMPLOYEE COVERAGE AMOUNT. Spouse Benefit Reduction Schedule: Benefit may be reduced when the employee benefit amount is reduced. Child(ren) Benefit Amount: If you elect coverage for yourself, you can choose $2,500 - $5,000 of coverage. NOT TO EXCEED 50% OF THE EMPLOYEE COVERAGE AMOUNT. Available to Dependent Child(ren) from birth to age 26. Child(ren) Benefit Reduction Schedule: Benefit may be reduced when the employee benefit amount is reduced. COVERED CONDITIONS - The plan pays 100% of the benefit amount unless stated otherwise. *Please refer to the official carrier plan summary for all details, limitations, and exclusions. Core Conditions: Heart Attack, End-Stage Kidney Disease, Occupational HIV/Hepatitis B, C, or D, Major Organ Failure, Stroke, Coronary Artery Bypass Graft, Angioplasty. Other Conditions: Complete Blindness, Complete Loss of Hearing, Loss of Speech, Benign Brain Tumor, Coma, Severe Burns, Advanced ALS/Lou Gehrig’s Disease, Advanced Parkinson’s Disease (Pays 25%), Advanced Alzheimer’s Disease (Pays 25%), Paralysi. Wellness Screening Benefit: Payable to any covered person on your plan one time each year, once you provide proof of an eligible health screening. Employee: $50 Spouse: $50 Child: $50 25
Page 1 and 2: 2023 BENEFITS ENROLLMENT GUIDE
Page 3 and 4: CONTENTS 4-5 Benefits Overview 6-10
Page 5 and 6: BENEFITS OVERVIEW ELIGIBILITY Full-
Page 7 and 8: WHICH MEDICAL INSURANCE PLAN IS RIG
Page 9 and 10: TELEMEDICINE / VIRTUAL VISITS When
Page 11 and 12: HEALTH SAVINGS ACCOUNT CARRIER: Hea
Page 13 and 14: FLEXIBLE SPENDING ACCOUNTS CARRIER:
Page 15 and 16: DENTAL INSURANCE CARRIER: Sun Life
Page 17 and 18: VISION INSURANCE CARRIER: Sun Life
Page 19 and 20: GROUP LIFE INSURANCE CARRIER: Sun L
Page 21 and 22: EMPLOYEE VOLUNTARY LIFE INSURANCE R
Page 23: VOLUNTARY ACCIDENT INSURANCE CARRIE
Page 27 and 28: DEPENDENT VOLUNTARY CRITICAL ILLNES
Page 29 and 30: OPEN ENROLLMENT INSTRUCTIONS During
Page 31 and 32: COMPLIANCE DISCLOSURES PLEASE NOTE:
Page 33 and 34: COMPLIANCE DISCLOSURES PREMIUM ASSI
Page 35 and 36: COMPLIANCE DISCLOSURES HIPAA PRIVAC
Page 37 and 38: COMPLIANCE DISCLOSURES HIPAA PRIVAC
Page 39 and 40: COMPLIANCE DISCLOSURES Model Genera
Page 41 and 42: GLOSSARY Coinsurance: Your share of

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